The URL can be used to link to this page

Home My WebLink About670 17TH ST - Building Permits� � PflQIECTAOUflESS: 6'IU W i'7TH ST OWNEH'S NPME: FIRS AN,ERICAN TRUST CO noosess: pACIFIC MESA PROPERTIES 6%0 W 17TH ST C-9 CM CA 92627 ' RflCMIENGINEEB: • nooxess: flEG.NO.: UNIT: uxiT: PEPMITTEE: ((EII'CERS GEN CONTRACI'ING f 714 ) 251-0181 noosess: 2698 WHITE RD 100 IRVINE CA 92714 LILENSED CONTBACTOB UECU1flATI0N: I here0y atfirm Iha� I am licensed unAer pmvisions ol C�aO�er 8(commencing with Sec�ion 7000) ol Division 3 0l Ihe Business and Pmlessions CoOe, an� my license is in lull fo¢e ana eaec� ciTr uc.: 0. 4? 6 fl sure uc.: 5 g q g 3� cuss: g Dale'. Signature: _ �Y_4ti�� WOPKENS' MP ISATIONOEUAMTION: Iher¢�yallirm��at �aveacenifi ol onsentroself-insureoracetlilicateolWorkers' Campensa�ion In rance. or a certifieA copy �hereol (Seclion 3800. Lab. C). voucrxo.:1200708-91 E%P.URTE: O%I 1/92 coMrnxr: 5TATE .� CerlitieE coOY is Aereby lumis�etl. � C¢niliea copy is IileO wilh �he cily Builtling Divi ' n. �a�e: 7�/ FpPlicani: E%FMPTIO FAO WOPRENS' fAMPENSATION �ECUIIATION: R�is section nee0 nol be com0� the permit is lor o� huMrM (5100) or less�. I cenily Inai in Ihe petlarmance o� �he work for which Ihis Dermi� is issued, I s�all noi em any person in any manner so as to hecome suUle�� o Ihe Workers' ComDensa�ian Laws o� Califomia. Oale' Signa�ure: NOTICE: II, after making lhis tleclaralion, you shoNU become sublect ta the Workers Compensation O�o�isions of ihe Labor Cotle. you must lonnwitn comply vnih such provisions or iNs permit shall 6e OeemeO revoketl. CONSTBULTION IEN�ING AGENCY: I herehy allirm Ihal lhere is a conslmction lenaing agency for Ihe pedormance ol ihe woA Por w�ich I�is permit is issued (Section 3097, Civ. C�. LENDEfl: FODPESS: OWNEfl BUILOEN OECLAHRTION: I her¢Ey aflirm Iha� I am es¢mpl Imm �he CqnVaCi0r5' State License Law lor the following reason (Secibn 7031.5 Bu9neS5 an0 Pmfessional Cotle: Any city o� tounly wllictl requires a permi� �o Cans�Nci, alier. improve. Aemolis�, or a0air any slmciure. D��or to ns issuance. aim requires ��e aOUlicanl lor such permit lo �ile a siAned 5talement that he/sAe is licensed pursuanl lo Ihe pwvisians of ihe Contrac�ars' S�ate License law �Chapter 9(commencing wit� Sectian 7000) ol 0ivision 3 0l t�e 9usineu and Pra�e55ion5 CoOe) or Iha� he/She is eKempt ��erelmm and Ihe basis for �he allegetl exemp�ion. Any nolaiion a� SeClion 7031.5 �y any applicanl for a Oe�mit subjects t�e apPlicant to a civil penaliy of not more t�an live hundred dollars (E500�. I, as owner of ihe pmpeny or my employees wilh waqes as iheir sole comDensation, will tlo ihe work, anU ihe ❑ s�mcmre is not inten0etl or oiferetl for sale �Seclion 7044, Business antl Pwlessional COJe: The Contractors' State License Law Go¢5 n0t aDPly �o an owner ot a pmperiy who �uiltls or improves Ihereon, antl who tloes such work himSelVhersel� or Ihmuqh � �is or �er awn emDloyees. pmvitleC ihat suc� improvemenis are not intentletl ar afleretl for ule. If, however the �uiltling or im0�ovemenl i5 soltl wi��in one year o� compleiion. �he owner vnll �ave Ihe bur0en ol O�ovinp he/s�e tlid noi 6uiltl ar imOrove lor Ihe purpose ol sale). � I, as awner of the pmperiy. am excluSiveN contraclinp vnt� IicensM contracmrs to wnstmct tAe D�olect (Section 7044, Business ❑ and Pmle55i0n5 fAtle: T�e CAnlrati0r5' State Lkerrse Law aoes not appy to an owner ol proDef�/ wna e��ms o� imo�es me�eon an0 wh0 tOmrat�s �Or SUch pmjed5 vniA a tanlfat�Or�s) GRnse Oursuan� to the ConlraclOR' $IdIP LICCOSC L2W�. I drtl dWdfE I�al proof of I�eir Warker's Compensation insunnce shoWO 6e pmvitle0 to me. � I am exemp� unEer Section: 8. d P. C. br Ihis reason: Oate: Owoec I tlo nereby cenily ihal I am aware ol anU uneerstane ine reduiremenls af Calilomia Health and Salely CoUe Sections 25505, 25533, antl 2553A andlha� loranyluture building occu0an�will/will not (circie one) neetl�o comply with saitl 5�aie cotles an0i�e requiremenis�or a permil lo� consimc�ion or moOAicalion �mm Ihe Air Oualily ManaAemen� Disiricl. Pesitlenlial cons�mction applicaiions are exempt tmm ihese o�ovisions. oate: Applicanl'. Ihereby terliiy I�al I �ave rea0ihi5 apPlltaiion antl S�ate ortlinMCeS and slaie IawS relaling �o �uildinq constmqiW . pmDeny br ins tlion r0oses Oaie: � Signaiure: Onver's Lit nse a Socal S¢cun�y .: I agree to tomply wil� all ciiy antl coun�y lhiS city Io enler upon Ihe above-mentioneG I6at�a6 W�ile—BuilUing: Green—CaEe EnlorremmC Canary—ApplicanC Pink—qevenue; GoldenroC—Assessar �� CITY OF COSTA MESA — SIGN PERMET �� PERM NO: SB 057:�01 PERMIT NO; s'B 057301 PLAN CHECK NO: 01692-42 S GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: STR SIG PURPOSE; OTH JOB DESCRIPTION : 8 MANSARD ROOF MOUNTED SIGNS SQ FT: CLAIM VALUE: 3,200,00 CALC—VALUE: 3,200.00 GROUP OCC: B-2 / COMMENTS: 8 SIGNS iE if if� ih �lE �lE �1FiEiFie if if dE i( iE iE 3F iE if iE iE if iE iE ii �f �lE ie-M�� iE if �lf iE�7F iEjF if �If �If i(� �IE i(� 3(1f �lf iF �X--)f df iC �lE df �4 if �M �)E iE �k jF �1F �lf�d'c �lE �if �7F�lE �if 1E �%jf iF #F�IFiE jE i(� �7f iF S I G N S N F U R M A T I O N DISTRICT; 2 TY.PE: WALI� (8) ILLUMINA7'ION: NON CA'TEGORY: NEW DIMENSIONS: lOFT 04IN X 2FT 04IN AREA: 197.00SOFT LETTER HT: 1R" STREET FRUNTAGE i; i42,00 STREET 1: $UZliDING FRON1' STREET FRONTAGE 2: 0.00 STRE£T 2: PARCEL: 04242821 ZONE: MP LOCATION > FRONT: X REAR: BUSINESS NAME: MESA PACIFZC PROPERTIES > LEFT: iC RIGHT: X O T H 6 R T O T' A L S G R O U N D S I G N THIS AC'PIVITY . 192.00SQFT OVERALL HEIGH'P: OFT OIN THIS SITE : 192.00SQFT GROUND CLEARANCE: OFT OIN ITEM5 OF INFO : 1 PLANTER AREA; O.00S�FT ITEMS FOR ACTIVITY: 1 BLDG SET BACK: 20F'I' COPY VERBIAGE : BLANK tCHANGE OF COPY PERMITS WILL BE PULLED LA7'ER) PLANNING NOTES: ik fF i!� ii� 1E iF iE if 1f 14 jF ik if iF �E �i- iE iE it iF 1E �lF iF �E �f %�!F it ii� �R # it if �lh if iFif 1f ff * if iE iElE if 3(-it if if iE �F if iE 1FiE�%� iE 3F iE 34 i(� il� �f 3F ii� iE iE #P iF 3E ib iF �7't I(- 4 iE iF it% D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APFROVED BY ; � � DATE; �71/'� HUILDING APPROVED HY :�LC C' DATE: _,�7��j3_ APPLICA'CION ISSUED BY;�� F L„_ aw.,.. DATE: � ii�fiE�1F3E1fiFiflEiff(-jE1k3EibjEii��7t�iFiEiflE x+c-+exicn�xx�c.:xarrxa.tete7FiFIFIfiE�N�iFiEiFiEfEiF�e � c e r � F ��EiF LEGALI'I,ATION:N F EFEF FS U M M A R Y STRUCTURAL SEGMENT:Y BLDG PN,T PLUMBING ELECTRIC MECHANIC SIGN SMIP/RES GRADZNG PERMIT 63,00 192,00 SMIP/N67—RES PLAN 40.95 ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID D[7E TOTALS----> 255.67 0.00 40.95 296.62 296,62 ,00 REVENUE DIVTSION TOTALS--> COLLECTED• 296.62 OVER/SHORT: 00 BLDG PMT YLUMBING ELECTRZC MECHANZC SIGN SMIP/TOT GRADING FLAN—CHECK 63.00 192.00 .67 90.45 i! i(� 7F iE IFif iF iE iFif iE !E iE iF �c i4 ii iF iE iF if if iE ff iF if iE iE iE 1F if' If !f� 1! iE 1P 3P iP if if if iF iF ie 1f if if 3f 1f �1F if if iE 1E iF ik if iE 3F i(� iE if 3'r iF iF # ie Ik if 3F 3F i! 3i i6 ai� iF N� li�ih I N D I V Z D U A L F E E B R E A I( D O W N TYPE QTY D E 5 C R I P T I O N UNIT COST NO EES WERE SELECTED rOR'�THTt� PERMIT � EXPIRED �@tC �I a�)t�CtiOfiS ��'--�-�( �3_ $�g �� TOTAL COST 1 "� ' . . g • U',•+�'�:!'•I!'_:r']'] ..'" �r',• _ C"!,� '. L;_. ...,, �i�' tL � CONSTRUCTION ANDPLANNING . � � POOL 'A � APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1. Temporary Electrical Servic�rPole �� 52. Pool & Equipment Location .� 2. Soil Pipe•Undrgrnd. -. _ 53..Steel Reinforcement �-'" 3. Eiectricat Conduit Utiiity-Ur�6rgmd. 54. Forms - � 4. Electrical Condu�t•Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement ' S6. 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., 7est ,. 9. Water Pipe�Undrgrnd. � 6Q. Backwash Lines, P-Trap, O Undrgrnd. . 70. Structurel Floor System 61. APPROVAL TO DECK � 11. Property Sewer �ine & House Connection ' 62. Backwash & ReceptorFinal - 12. Sewe� Cap `. -� 63. Heater & Vent-Finai 13. Roof Drains � � -. 64. Plumbi�g SYstem - Final 14. Rough Plumbing 65. Electrical-Final ' .. 15. flough Electrical-Conduit 66. Solar System-Final 16. Rough Elettric Wiring � 67. Fencing & Access ApProval � 17. Fough Wiring Sign 68. APPROVED FOfl PLAS7ERING 18. Rough Electrical�T Bar Ceiling 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditionin9 FIRE DEPT. REQUIREMENT 20. Rough Factory �ireplace APPROVALS Permit # 21. DuCts, in StructUre .70. Underground Hydro 22. Ducts, Ventilating 77. Product Piping OGas ❑Oil 23. Gas Pipe�Rough & Test 72, Underground Flush 24. Roof Framing � 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing �4, Overhead Hydro 26. T-Bar Ceiling (Structurall & 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 Nailin9 � HEALTH DEPT. REQUIREMENT `" 31. Plaster Brown Coat � 79. FINAL INSPECTION � 32. Elecirical Power Meter-Final ; 80. FOOD CERTIFICATE ISSUED �� 33. Final Eleci�ic NotGs: ' �� 34. Pinal Heating & Air Conditioning ; � 35. Final Gas Pipe-Test ' 36. Hood or Canopy 37. Final Factorv Fireplace . 38. Final Plumbing � 39. Water Service�Final � ` 40. Gas Service-Final � 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuat�on 46. Handicap Regulations 47. FINAL STRUC7URE & BUI�DING 48. FiNALPLANNING , _ 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ; ' � 51. CERTIFICATEOFOCCUPANCY No. Date � � � � ,\ PflOJECT ROUflE55: (7 % OWNEN'S NRME: MARS aooness: 6 7 0 �, C,M. AflCMIENGINEEfl: RUOflESS: W ].'iTH ST LL DUFFIELD 17TH ST #C9 645-6811 sec.xo.: uNiT: � 6 UNIT: PEXMITTEE: MARSHALL DUFFIELD ( 714 ) 645-6811 F�ONE55: 6%O W 17Tk ST C4 C.M. CA 92626 LICENSED CONTBACTOB OECLABBTION: I �ereby alfirm �hal l am IicenseG un0¢r pmvisions ol ChaO�er 9(commencing wilh Section 7000� o� Dirsion 3 0l I�e Business antl Pm�euions CaOe. and my license i5 in �ullforce and eflect. CITY LIC.: STpTE LIL.: CLRSS: Da�e: Signature: WOPREBS' COMPENSATION OECLAPATION: I �ereGy aifirm Ihat I �ave a cerlificale oi con5eni Io sell-insure or a certilica�e ot Workers' ComDensation Insurance. ar a rertifieA copY ��ereot (Section 3800. LaO. C�. 70LICY NO.: E%P. DRTE: COMPANY: 7 Ceniliea copy is here0y IumisheC. ❑ Ce�iliea copy is filetl vnt� the cdy Builtling Division. Oa�e'. Applican�: E%EMPTION FBOM WONKEflS' LOMPENSl�TIOX OECLAMTION: QMs sttlian neeA ipt Oe mmpkteA ii the perml is lor one hu�reA �5100) ar less�. I c¢rtity ttu� in ihe pedormance af I�e work �or whic� tNs per '''S5ue0, I shall nOt emptoy any perwn in any manne� so as �o become subjecl lo ��e Workers' Compensalion Laws oi Cali�or �. i Oa�e: � �� Signatu e' NOTIC : 11. a er making t�is EecWration. yau stroulE bewme suble« �o tAe Wo iers Compensation provisions of [he La6or Code. yau musl fohhwitA Comply wilh suc� pmnsions or �his permii s�atl 6e tleemeG revoked. CONSTNUCTION LENDING RGENCY: I �ereUy affirm ihat Nere is a wnstmction IenAing a0ency for the peAormance of the work for which Ihis permit is issuetl 1Section 3W7. Civ. CI. LENDEP: • aooeess: CITY OF COSTA MESA — BUZLDING PERMIT PERMIT NO; E 058194 PLAN CHECK NO: N CONSTRUCTION TYPE: PERMIT TYPE: ELE JOB DESCRIPTION : ELECTRICAL METER CLAIM VALUE: CALC—VALUE: YGKM NV; r; V725 9 (GU 1 : N SUl•'Y; N FU�POSE: OTH SQ FT; GROiJP OCC: B-2 / COMMENTS; NO OTFiER WORK PERMITTED ��e-x***rx�t�r�r*�r�e�xa�x*��*�*x��r�t��*�-�+��e*�+r�r�c�x��**�x�c*��t*�*x��x�*x****��**�**��+� Z O N I N G R E� U Z R E M E N T S sEraacxs ------------ MAIN HUILDING ---------- --------- ACCESSORY B[JILDZNG --------- F'RNT; FT IN REAR: FT IN FRNT: FT IN REAR; FT ZN LEFT: FT IN RGHT: FT TN LEFT: F'1' IN AGHT; FT IN PARKING RE(� • PROV: PARCEL; 00000000 ZNE; REF NO; PI.ANNING N(STES> 1 iE il�k iF i(-iF iE iF 3t iE i(� �FdF iE ii iE iE if iE iE iF iF k iFlf 3h if ik #f �)f if 3E �lf �1F 1E if if 3f jc �E 1E af �)f iE iF *#• if �f� �If� it it IF if IF iF iF ie ii 1E ih Ik iE iE 1F ii* ii 1F�E �E iF �clE IE if iF 1E �F iF D E V E L O P M E N T S F: R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : DATE: 1 APPLICATSON ISSUED BY: S�-� DATE• � ifikifiEiFiF�liEiElfiFiFiFaFiE1EiF3fifjfiFifiFiFiFiF�iFiFiF3FiFTFiFiF3F�FiF3F7e'k 3F3FiF7FiF'iCiF'3F3ric3F3r3FiriFlFif�fiEiE1E-1EiFiE iEiF iE iE af if iE iE k ik ff iF iE iF iE if iElF �E iE if if if iF iE iE iE If 1E 1E ik iE k iE if 1E if if� � if ik iF-)f #k �f iF �7(-1EiE iE i6 # jE iE if i(� iE i4 if if if iE if iE iE ii• if i4 k iF iF iF �F �1E iF iF af iF �F if iE LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:N OWNEN BUILUEP OECLABpTION: I hereby atlirm tAat I am e.empt irom t�e Coniractars' State License Law �or tne fouowina reason BLDG PMT PLUMB ING ELECTRIC MECHAN IC r IRE Sr1IP /RES GRAD ING �Seclion 7031.5 Business ana Pmfessional CoGe: Any ci�y ol counry wluc� reQuires a permit to wnsimc6 alter, impmve, UemolisR or P ERM I T 18 5 0 repair any stmcWre. D�ior to its issuance, aim repuires the a00�icam Ior sucn permit to file a signeJ starement Ihat he/she is Iicense0 S� 0 3 SM I P/NON—RES pursuam to �he Dmvisions ol ��e ConVac�ors' Sla[e License �aw (CluOter 9(commentinq wilA Seclion 7000) o� Division 3 0l ��e Business p j.AN antl Pmfessions Coae� or t�al �e/she a erempt t�erelmm ana i�e basis br the alleAetl exemption. Any viola�ion of Section 7Q31.5 by I$$UE FEE � 15 . 0 0 � ' any aDPlicanl lor a Dermit suDlects I�e aOPlicanllo a civil penalry of noI moa I�an INe hunEred tlollars (5500�. ,;,t l as owner 01 Ihe pmp¢rty ar my employees witn wapes as meir mie comvensation, win ao �na work, antl me BUILDING—DIV—> PERMIT ISS�.IE PLAN—CHECR TOTAL P%iID DUfi L'1 simclure is not inlen0e4 or ollereA for sale (Section 7614.8usiness anE Pmfessional CoUe: The Cqnlractors' State �icense �aw TOTALS----> 18 . S 0 1 S, 0 0 �. 00 3 3. 5 0 3 3, S 0 , 0 � Goes no� appry to an owner of a Ompetly who EuilGs ar imD�a•es t�ereon, anU wlia Ooes suc� work �imseli/hersell or t�mup� , his or he� own em0loyees, D�ovitleU Iha� such impmvemems are not intentle0 or olleretl br sale. Ii, however Ihe buildinB or RfiV£NU$ D I VISIOI�I TOTALS--> COLLECTED • 3 3, SO OVER /SHORT � UU impmvemenl ls sold vnihm One year al cample�ion, Ihe ownei vnll �ave I�e hurden ot pwvinq �e/5he di0 no� huilA or imOmve BLDG FMT PLUMB ING ELECTR IC MECHANIC FIRE SMIi� /TOT GRAD INi�i PI.AN—CHECK �or I�e purpoS¢ ol sale). I, as owner ol Ihe pmpeny. am eMclusively comractinq with license� contracmrs to consimct Ne D�olect (Section 7044, Business 3 3, S 0 ❑ anE Pmlessions CaOe: T�e Comractors State Licenu Law Eces no� aDON �o an owner ot propeM who OuilJs ar imomvu Ihereon antl who conirac�s lor such pmjects wilh a conVactoqs)license pursuanl to IM1e Conlraclo�s' S�ate �icense Law),I am aware t�at Dmol ol t�eir Worker's Compensation insuranu stwNU be 0«4� �o me. � I am exemD� untler Sectim: B. d P. C. for Inis reas n: Date: �6 9 � Ownec I tlo hereby cendy iha am aware ol anU unAerS�antl lh¢ reQuiremen6 0� CalilOmia Heal(h and $a�eiy o0e Sec�ions 25505. 25533, an0 2553A and ��al I or any INure Euilaing occupani wi11Wn11 no� (circle ane� neeG Io wmpty wi1115did siate cotles and �he repuiremenis for a permil lar consimclion or modilica�ion imm Ihe Nir OuaLty Management �isVicl. flesiaential consimc�ian applicaiions are exempl Irom mese Drovisions. �al¢: Applitanl: I hereby certily Ihatt �ave reaU�Ais appiica�ion ane Slaie lhali�e a0ove infoimationis corretl.lagreeio comply with all ciry an0 couniy or0inanresands�atelawSrelalingtoOuitJingconstructionandhereb tror¢erepreSenlativesolth6tiryloenieruponlheahove�menlione0 pmOe�Y �orinspec�ion Dur0ose5. _ �ate: SignaWre' oriver'sLicense rsocia�securiiya: 164bC6 WM1ile—Builtlina: Green—CoOe Enbrcement: Canarv—/aolicanq Pink—Fevenue: Goltlenrotl—Assessor It aF it ik iF iF iFlE if iE If iE if 1f iF iE ae 1E ie 1E iElf iE iPlb iE 3E iE if # if iE ik iE iE iF iF iF iF iF if N� )f !E 1E 1E k�lE iE #!f iE �lF iE fE iF iF iE iF iF �t 1Fik %�t iF iF iF iE �E iF iE if )f if K� )f if iE 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 M. ELE 1 S�tVICES BELOW 600 V 6 HELOW 201 AMP 18,50 18.50 E,5 � � � FEi1}1D OF FEES , ��r �rtg .7...✓�CttU(1S i ,08iE . �� ; 01 �D•Sa«�_ �. _--- OC e' � � ,. i l i_.. i w� � _ t'.tlTE=�O?; 1� i� � Ii;; .5�.^- CCFVS= RUCTION AND PLANNING .. POO SPA ` ` APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole � 52. Poo� & Equipment Location . 2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Uti�ity-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrqrnd. 55. Electrical Bonding 5. Steel Reintorcement 56. Rough Plumbing & Pressure Tesi 6. Electricat UFER Gr�d. 57. APPftOVAI TO COVER•GUNITE 7. Footings 58. Electrical Conduit•Undrgrnd. 6. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe•Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd. 10. Structurel 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 Orains 64. Plumbing System � Final 14. Rough Plumbing 65. Electrical-Fina� ' 15. Rough ElectricabConduft 66. Sofar System•Finaf 16. Rough Elearic Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign . 68. APPROVED FOF PLASTERING 18. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Hsating & Air Conditioning FIRE DEPT. REQUIREMENT 20.� Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 77. Product Piping �Gas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Rooi Framing 73. Undergrnd.StorageTank OGas OOiI 25. Roof Sheathing 74. Overhead Hydro 26. T�Bar Cei��ng (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. FO00 CERTIFICATE ISSUED • 33. Final EleCiric Notes: 34. Final Heating & Air Conditioning ,� 35. Final Gas P�Pe�Test 36. Hood or Canopy � � � 37. Final FaMory Fireplace 38. Final Plum6ing 39. Water Service�Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation SYstem . 45. Sound Attenuation 46. Handicap Regu�ations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Dace Pfl0.1ECTRODNE55: (j-JO W 17TH $T OWNEH'SNRME: MARSHALL DUFFIELD nooeess: SAME 645-6811 ppCH1ENCINEEN: nooxess: flEG.NO.: uxiT: uxiT: PEPMITTEE: MARSHAI.L DUFFIELD ( 714 ) 645-6811 aooaess: 670 W 17TH ST C4 C.M. CA 92627 LICENSED LONTBRCTOfl UECLANATION: I hereby aliirm Ihat I am licensed untler provi5ion5 0l ChaD�e� 9(commencing wii� Section 7000� ol Division 3 0l Ihe Business and Pmiessions Cotle, anA my license is in lull force and e��eci. CITY LIC.: STRTE LIC.: LU55: Date: Signawre: WONREBS' COMPENSpTION OECLARpTION: I here6y affirm thal I �ave a cenificale of consent to selFinsure or a certilicate of Workers' Compensation Insurance, or a cenifie0 coOY ��ereof (Seciion 38W, LaE. C�. POLICY NO.: E%P. ORTE: Ceriilied copy is hereby fumishea. ❑ Cetlified copy is IileU wiN tAe ciry BuildinA Division. Oate: PD�licam: EXEMP110NFqOMWONI(EflS'LOMPENSRTIONOECUMTION: RhissectpnnttEirolUecompleteOi�IhepermilisloronehmMreO(E700)orless�. I cenily ��at in Ihe petlormance of Ihe work tor which ��is permi� is issued, I shall no� em0loy any person in any manner so a5 [0 6ecome sublect �o the Workers' CamOensation Laws ol Califomia. Date: S�gnaiure: NOTICE: Ii. atter makinp t�is tleclaration, you s�oultl Decome su6lect la I�e Workers Compensation Dmvisions o1 the Lahor CoOe. you mus� foh�wiih comply wilh such provisions or Ihis Oermil s�all be AeemeO revokeU. CONSTfl�LTION LEN�INC AGENCY: I hereby aflirm Ihal ��ere is a consimction lentling agenty for �he performance oi t�e work �or w�ich Inis permit is issue0 (Seclion 3097. Civ. C�. LENOEP: nooRess: OWNEfl BWLUEB OECIAMTION: I �ere0y aflirm itwl I am exempl �mm Ihe ConVac�ors State License Law for Ihe lollowing reason (Set�ion 7031.5 Busine55 and Prate55ional Code: Fny tiry o� muniy whith rtqUir¢5 a p¢rmii �o canSlmti, ali¢r, impmve, Oemolish, or repair any slmclure. prior �o i1s issuance. also requires I�e aDDlicant for such permii �o file a siAned Statement �Iiat he/she is Iicense0 pursuant to ��e pmvisions ol t�e Cantracmrs' State License law (Chapter 9(commencing vnt� Sectian 7000) ol Division 3 0l tAe Business antl Pmiessions CoOe) ar �hat he/she is e�empt t�erelmm ana ihe basis lor the alleged exemption. Any violation ui Section 7031.5 Cy any apolicanifar a permit su�jetls Ine aoDliwnito a civJ Denalty ol not mOre than frve hunCreO tlollars (3:A01. I, as owner ol tne pmperty or my employees wit0 wages as their sole comoensation, will Ao ihe work, an0 ihe ❑ strucWre is not intentleE or ollere0 far ule (Section 70ad, Business anG Pmiessional Catle: T�e Caniractors' State License Law � Aoes not apply to an owner of a pmpeny who Ouiltls or impmves ihereon, antl who Aoes suc� wark �imsel//hersell or ihmuAh �i5 Or �¢r own employee5. provia¢A Nal SUt� impwvemenis are n01 int¢nGetl or aflere0 br sale. II, how¢ver lhe EuildinA or improvemenl ¢ 5oM vn�hin one year oi com0�etlon. f�e awner will �ave t�e Ourtlen oi O�ovin8 he/she Eitl nol Oui10 or improve IOr Ih¢ purpo5e ol sale�. I, as owner of the omperty. am evclusively caniracting witA licensed contractors to conslNct �he project (5ection 704a, Business � anG Pmfessions CoOe: t�e Coniraclors' Staie License Law Aoes nol appry m an owner ai D�operry who Gmlds or improves Nerean aM who coniracts la� sucn Omjects wit� a wntractor(s) license pursuant to tne Contracmrs' SWte License law�. I am aware Inat prooi of IAeir Worker's ComOensation insurance shoula be pmvi0etl Io me. � I am eKempl unAer Sec�ion: B. 8 P. C. lOr Ihis rea5on: Oa�e'� ��/��/ Owner: I Oo hereby certfly ihat I m aware ol ana un0ers�an0 the requiremems of Calilomia Healih and Saf Coee Sections 25505, 25533, antl 2553E an0 �hat I or any INure buil0ing occupant will/will nol (circle one� nee0lo comply wiih said sia�e co0es anA Ihe reQuirements tor a p¢rmit lor conslmc�ion o� mo0ifkaiion Imm ��e Ai� Oualily Management Usinc�. Nevdential conslrucli0n aDDliWtions are eaempi Imm inese O�odsions. Date: ADPlicam: I nereLy certify Inat I luve reaa tnis ap0�iwtion an0 s�ate I�at Ihe above iniormation is correcl. I apree to compty witn all ciry aM counry wOmances an0 slate Wws reWiing Io UutlOing cros�mtlion an0 he uthonze representatives ol IAis ciry Io emer upon ��e a�ove�mentiane0 � pmDeny lar inspeclion purposes. / � Dale'. �J ` SignaWre: — ^ oriver's license or Socia� Security x: 1641-a6 While—BUAEmg: Green—Code EnlorcomenC Canary—ApplicenC Pink—Revenue; Goltlonrotl—Assessor CITY OF COSTA MESA - SIGN FERMIT PERM NO; S STtif� � PERMIT NO: SB 057011 PLAN CHECK NO: 01909-92 S �C�1%'['�SUi�N CONSTRUCTION TYPE: PERMIT TYPE; STR SIG PURPOSE: OTH JOB DESCRIPTION : 32SF NONLUMINATED GROUND SIGN SQ FT; CLAIM VALUE: 1,500.00 CALC-VALUE: 1,500,00 GROUP OCC: B-2 / COMMENTS: "17Tfi ST SELFSTORAGE" *#*-�x�xx***�****+��***�*��*�*****�*�*��r*�+��*�***��*�*��+��*�c**x�**�ce***+��**�**�r S I G N I N F O R M A T I O N DISTRICT: 1 TYPE: GROUND ILLUMINATION: NON CATEGORY: NEW DIMENSIONS; SFT OOIN X 4FT OOIN AREA: 32.00SQFT LETTER HT: 28 STREET FRONTAGE 1: 602.00 STREET 1: 47 17TH ST STREET FRONTAGE 2; 0.00 STREET 2: PARCEL; 42428123 LONE: MG LOCP.TZON > FRONT; X REAR: BUSINESS NAME; 17TH ST SELF-STORAGE > LEFT: RIGHT; O T H E R T O T A L S G R O U N D S I G N T'HIS ACTIVITY . 32.00SQFT OVERALL HEIGH'T: 4FT OIN THIS SITE . 32.00SQFT GROUND CLEARANCE: OFT OIN ITEMS OF INFO : 1 PLANTER AREA: 90.00S[,�FT ITEMS FOR ACTIVITY: i BLDG SET BACR: 20FT COPY VERHIAGE : 25 HR - 17TH STREET SELF-STURAGE WITH ADDRESS PLANNING NOTES; iF iE iE 1E iE±k iE if a! aE iElE if if if iF iF iF iF iE �f if 3F itlP if iE aF �f iE iE iPiE if iE if 3F if iE it iE jE aE �E 3E �E �F iF IE iF�E 3F iP 3EiE if if if aE iP �k �f *�f 3F �E 1E IF iE �lf af �k iE 3FiE �f iE 1F �E D E V E L O P M E N T S E R V Z C E S R E Q U I R E M E N T 5 ZONING APPROVED BY �J P,�i� DATE; � � �1�� BUILDING APPROVED BY : DATE; APPLICATION ISSUED BY• �� DATE; �I l� ., il1E�1EiElFif�itffi4llilaFiE�1EiE1FfFlfifikiElE3EieiE�FiFTfic�iFiFiFiFiF3FiFiF�iF 7FifiFiFiFiF7F�F�F�IE�IE�If1EiElE�1FiFlEif r ifff LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;Y HLDG PMT PLUMBING ELECTRIC MECAANIC SIGN SMIP/RES GRADING PERMIT 35,00 32,00 YLAN 22,75 .50 ISSUE FEE BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE TOTAL5----> 67,50 0,00 22,75 90.25 90.25 ,00 REVENUE DIVISION TOTALS--> COLLECTED; 90.25 OVER/SHORT; .00 BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/TOT GRADING PLAN-CHECR 35,00 32.Q0 ,50 22.75 k if �F If iE iE �F iE iF iE iE iE iE fE if iF if iE IE �F 1E 1F �E iF �f iF if iE iE if if iE iE iE iE iE iE iE �F iE iF �f if if IE �F iF 3E iF iE �! iF if �F 3E�f iF iE iE iF iE aF �E if iF iE fF if ±(� �E if if 3F iE iF iE iF �E iE 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 NO FEE� WERE SELECTED FOR THIS �ERMIT E X P I R E D ol 001l2935-aJ11't9,i5 ': :_�', 1 18te lnspection5 DATE: U4llbi92 Tii'r: ;;:�. t�ate �'� SiB � ,k J, CON�TION AND PLANNING � - P��'PA APPROVALS Permit # Date Inspector p�ppROVALS Permit # Date Inspector 1. Temporary Electriwl Service or Pole 52. Pool & Equipment Location ' 2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Cond�it-Undrgrnd. 55. Electrical Bonding 5. Steei Reinforcement � 56. Rough Plumbing & Pressure Test 6. Electrical UFER Gmd. - 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit�Undrgrnd. 8. Foandation - , 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 Dreins � 64. Plumbing System � Final . 14. Rough Plumbing 65. E�ectricabFinal � 75. Rough Electrical-Conduit 66. Solar SYstem-Final 76. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVEO FOR PLASTERING 18. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAI ' 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure -70. Underground Hydro 22. Ducts, Ventilating 77. Product Piping � Gas ❑ Oil 23. Gas Pipe�Rough & Test ' - 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling ($Iructural) & 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 37. Plaster Brown Coat 79. FINAL INSPECTION ' 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED , 33. Final Electric Notes: '' � i 34. Final Heating & Air Conditioning � ' �, c 35. Final Ga: Pipe-Test � ��. 36. Hood or Canopy � . 37. Final Factory Fireplace • 38. Final Plumbing ' � � � 39. Water Service-Final - i 40. Gas Service-Final ' 47. Solar pomesticFinal - 42. Backflow Preventer 43. Backflow Irrigation � 44. Landscape Irripation System 45. Sound Attenuation � 46. Handicap Regulations � 47. FINAL STRUCTURE & BUILDING 48. FINALPLANNING • -. 49. Electric Release to Edison 50. Gas Release to Southem Califomia Gas Co � , 51. CERTIFICATE OF OCCUPANCY No. Dace Applieant ta till in all,spaees except l�ose wit�in heavy eartlor Iinas anC sign all appropriate CS7V g;�TA nnESn CONSTRUCTION PE7j�� MIT ' Prqj�t Address �� /, ' l 7 �� / • � �,.,�� ,.Applicant's Mailing Address � �/�'� Owner's Name � �FFi s «y % an��a�''YS^6,�/ 67e��'' �� Addreu Arch/Eng. License No. Address r � �� Contractor's Nameb/� � yf" - Phone�s''�`�ZS Address(mailinglZ�`fyZ�'hv �j'�'(�• City License No. LICENSED CONTRACTOR DECLARATION ' , 1 h¢reby atfirm that 1 am licensetl untler proviSiOoz Of Charte� 9(tommencing with section �000) of DIvi5lon 3 ot the Busine=5 antl Professions Cotle, anC my Iicense is in fy orce anG eife<L . LJcenso Class lic e No.•377�� Datq/(�� J�-�T Signature WORKERS'.COMPENSATION DECLARATION , hereby affirm tbat 1 have a certlticate ot consent to self-Insure or a certifiwte i Workers' Compensatio surance, or a certiflap �opy there (SecE n �800, Lab. O.'A � � � Y � Policy No: �� Company—�:�� Cerlitietl mpy i5 hereby tu�nishetl. Ce�rtl� Y!$ ��e_tl with the city Builtlin vision. Date fit; /aP011cant �� EXEMPTION FROM WORKERS' COMPENSATIpN OECLARATION (This section neetl no[ be completetl if tne perml[ is for one M1untl�etl ($100) or less). I<¢rtify that in the perPormante Of Ihe work t0� which Ihis pe�m�t iz izsuetl I shdll nOt emplOy any persOn in any manne� so as to becoma subject t0 t�¢ Workers' CompensaHon �aws ot Calitornia. � pate. Si9nature 'NOTICE: If, after making this tleclaration, you shoultl become subject to the WOrkelS' Comp¢n5ation provi5ion5 of the .Ldb01 Cotla, you mu5t fofthwith comply wltn sucn provisions or this permlt snall be tleemetl revoketl. CONSTRUCTION LEN�ING AGENCV ' � I nereGy aifirm thal tnere is a construction lentling agency for tne performance of Ihe work (or which �t�is permit is issu@tl (Section 309]. Civ. C.) Lenaer's Name . LentleYs Adtl�es2 OWNERBUILDER OECLARATIOfJ 1 I hareby aitirm that I am exempt tmm the Contractor•s License Law tor the ._u.......... .e��.... icu�n..n ]nat 5 Ruciness antl P.ninc<inna� rntle: Anv citv or a pe�mit to construct, altQr iTprove, tlemolish o� its issuance. alm requires ({�e aoolitant for zucn p a 1¢I¢fYOrtl and-tne bdS15 b� If1E dll¢g¢a exemp400.'Hny vioianon o� �eciron �031.5 by any applicant for a permit subjects [he applicant to a civil �enalry of not more than five huntlretl tlollars (§500). -� I, as owner o( the property�or my employees�wlth wages aYfhelr sole CompensatiOn, will do Ne wo�k, dnU ihe SlructWe Is not intentletl o��oHeretl for wle (Section ]044, Business antl Profe551nnal CoAe: �The Contractor's LlcenSe Law tloes not•apply to an owner of a property who builtls or imorovez thorcon, antl who tloes suctt work hlmself/he�s¢It Or tnrou9h nis or he� own employees, Droviaetl that such Improvements are'not Intentletl or otteretl for sale. It, however, Ine builtling or Imp�ovement IS soltl within ane year of com- Dletlon, tne owner will �ave the burtlen ot proving Ite/she tlltl not builtl or im- �Ove lor the purpose ot Shcej. LI I, as owner of the property, am excluzively contractin9 with licensea con- tractors (o construct the Oroje<t (Section 7044, �usiness antl Professions Cotle: The ConVactor's License Law tloes not apply to an owner of property who builtls or improves thereon, antl who contracts for such projects with a con- [�aclo�(s} licenze pur5uanl to the Contracfor'S L�ICense Law). I am aware thal prooi ot their Worker's Compensation insuranee shoWtl be provitletl to me. ❑ I am exemp[ untle� Section B. & 7. C. fo� thi5 /eason Date ' Owner _ I hereby certify that I have reatl this intormation is corre<L I a9ree to compl antl state laws relating to builtlmg cons sentatives oi thiz It � to ent� upon Insoectlan our /i Signature -u-�CF4 •�'� Drivers' License or 55 4f 'tale that�the abova tl county ortlinances eby authorize �ep�e- ionetl property for oat�0 � 9� � a 3 U . ___ ._ TYPE OFCONSTRUCTION NEW A�D � ALTERATION REPAIR ' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Ap �!, DESCRIPTION OF WORK/USE OF BLDG. S Main Buildin9: E TVPE OF PERMITp� GRADING FOUNDATION STRUCTURAL T Ffont O TENANT �1 ELECTRICAL ❑ PLUMBING ❑ MECHANICAL . A Rear ❑ �OTHER ` . - � PROJECT DESCRIPTION 5a.F7. ° occuPANcv � C Righ[ K Left CONSTRUCTIONTVPE VALUATION$ $ ZONE GRADING,CU. VOS. ACRES Ping. R2f. # Remarks: . � � Plannin9 Notes: Sink Preventer I rrigation Drinking Fountains Floor Orains Floor Sinks Gas Service Interceptors Kitchen Sink Lavatories � P—Trap . Roof Dreins • � Reinspac[ion Fee Showers Service Sink -- Sewe/Cap Sewer Connection Solar Collecrors Solar Piping Solar Tank Swimming Pool w Urinal �IIlICiS Water CI052i Water'Heater ' Water Service • Auto-Wash - WundryTrays � $15 � Issue Fee , , MECHANICAL � - Duct-,UnderGround Duct-Sttuctural � Duct - Ventilating Exhaust System ❑ Multiple ❑ FirepbFact.Blt.ICBO� � Heating System & Ducting' � ❑ 0�100,000 BTU O t 00,000 6Ti Reinspection Fee I $15 I CMF 0865-46, rev. 30/84 White - BUIltlinq; Canary - qpplicant; Plnk - Accounting; Goltlenrotl - Assessor Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTU ❑ 100,000 BT System Repair/Alteration ' Fire Dampers � � ' Registers � . laue Fee $ 3 FEES $ 3 Automatic Washer, Construction PoleSub. Cooking Unit � Dishwasher Dryers ❑Gas ❑Elec� Fan F.A.U. Fixtures � — Device Boxes Outlets Switches Garbage Dispoul Generator �65 KW C Fee 3137 10/29/85 Zone Accessory Building: Parking Req./Provided . ELECTRICAL � . Traostormer.❑'15-SOKW — ❑ 50+KW Meter ❑up to 100 amps Meter �over100amps � Sub Panel Motors�0.lHP�iX-8 � Inc.Solar �9-15 HP 076-15+ � - Microwave - ^ Pole Light Range ' ; $tanding Sections 5 KW 7rash Compacmr $15 15sue Fee . ' DEVELOPMENT SERVICES REQUIREMENTS: Zoning APProved By �' Building Approved By � ISoOC TL � FEES 1 $ 3 2 O N I N G R E Q M T S � SUMMARY OF PEES � , , BUILDING PERMIT $ gM�p � $ ' � P�AN CHECK � $, pERMIT � j � � � PLUMBING . $ � ISSUANCE $, PLAN CHECK 25% $� ENERGY P.C. $' ELECTRICAL $ � GRADING $ PLANCHECK 50% $ � � MICROFILM' $ —/�'y(�/}) MECHANICAL� $ � TOTAL FEE $. "�' � `� PLAN CHECK 25% $ ' _ . . , �OIVSTRUCTION AND PLANNING POC SPA l�4PROVALS Permit # Date Inspector AppROVALS Pe�mit # Date Inspector • . Temporary Electrical Service or Pole ��' � 52. Pool & Equipment Location � . Soil Pipe-Undrgmd. - 53. Steel Reinforcement ' 3. Electrical Conduii Gtility-Undrgrnd. 54. Forms '� 4.� lectrical 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. Founiiation � � � 59. Gas Pipe, O Undrgrnd., Test r 9� Water Pipe-Undrgrrid. , " 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor Sysiem /' 61. APPROVAL TO DECK 11�. Property Sewer Line�& House Connection � 62. Backwash & Receptor-Final _ � 12. Sewer Cap � . � 63. Heater & Vent-Final r, 13. Roof:Dreins ,� � � 64. Plumbing System - Final 14. Rough Plumbing;, ' 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final _ 16.��Rough Elec[ric Wiring 67. Fencing & Access Approval . 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL - . 19.� Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT, 20. Rough Factory Fireplace APPROVAIS Permit# � 2L�Duct.s, in Structure � 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. G`as Pipe-Rough &'Test 72. Underground Flush� �� 24. Roof Framing , 73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical , 27. Frame and Flashirig � 76. Dry Standpipe . 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation , . 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT I31. Plaster Brown Coat 79. FINAL INSPECTION � 32. Electrical Power Meter-Final 80. FOOD CERTIF�CATE ISSUED 33. �Final Electric Notes: 34. Final Heating & Air Conditioning , � � t.. / 35. Final Gas Pipe-Tesi, � 36. Hood or Canopy , .37. Final Factory Fireplace � 38. Final Plumbing ' ' � 39. Water Service-Final � 40. Ga's Service-Final . • \ 41. Solar pomestic-Final ' � �1 42. Backflow Preventer 1 43. Backflow Irrigation i ' 44. .landscape Irrigation System � 45. Sound Attenwtion . � 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 No. � Date _ � � � City of Coz[a Mesa Development Services Department Building Safety DiviSiOn P.O.Box 7200 Cosca Meu, California CERTIFICATE OF OCCUPANCY No. OO��S�� The Building located at A7ft G1nah 17hh Shr .t. SuitP. C3 has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Grou ccupancy. Use of Building ne;..; c�...-�.,e Legal Descripti ISee reverse side for Metes and Bounds) Building Permit No A il4<l5 Electrical Permit No. E 21476 Plumbing Permit No. Mechanical Permit No ISSUED T0: ' onrifir M�ca PromrF.itas G70 el. 17th Street� Ste. C2 rnara rtoaa, Cd 496�7 Number of apartments and/or guest rooms Building Official William T. Horrard Date Anri.l 9, 1 GR� �'his Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 3015-46 rev. 1/83 White � Owner, Canary - NumeriCal File; Pink - 61dg. Permit File Applleant lo fill in all tpaces except those wit�in �eavy borEer Ilnes an0 51gn all aporopriata Aeclantions. ciTY oF COSTA MESn CONSTRUCTION PERMIT I p,o;(�,�a�e,s .__-569r5�fr;-598-W• 17th Street C q J pppliwnt'sMailingAddreu 690 W. 17tYi Street . ' ow�e�•sr�ame MdrShdll Duffleld pho�e545-6811 Addreu 690 W. 17th Street,.Costa Mesa CA 92627 � Arch/Eng. Bd112U2�0�ftlel'SOI1.IIlC.LicenseNo.C-i19�1 ' Address 301 N. Rampart St.,-Suite F Oranqe, CA Conuaclor'sNama KY'dUSC� Construction Pho„e536-1429 Addreu (mailing) /� 1 P � Hunti n ton Bch � CiryLicenseNo. Il� Ci� 92G46 LICENSED CONTRACTOR DECLARATION I hereby aHi�m [nat I'am licentttl untler provi5iOn50f Charte� 9(commencing witn saction �000) o� Division 3 ot the Business antl Protessions Cotle, antl my ncense is in tuu rorce and eitect. ?7 7��y License CI ss LI<�e lso No.- Dale �� 5'g t � �!/��"'� � WORKERS'COMPENSATION DECLARATION ' h¢reby aflirm [hat I nave a ce�UllCalO Ot COnSCnt lo self-Insu� o� a Certi/Itdt! t WOtken' Compensation Inimanca, or d tertlfletl copy emof,(SOCtion Pol��icY No. �� /ComPany �� Certifietl copy is hereby furnisM1etl. . f • Certifl tl copy is til&twith the ci[y Builtll vlsion./y Date�l�i /-.�j APPlicant �C�e�FG ��-t�� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This zec[ion ne¢tl na[ be COmpletetl i( the permit is br One huntlretl (5100) or Icss). I certity that In tne perbrmance of the work tor whlch tnis perm�t is Issuatl I s�all not employ any person In any manne.iso as to bacome subjett [o t{�e WOrkers' ComOensalion LawS of CalHornia. Date Si9nature 'NOTICE: II, aller making thii tlCCla�ation, you Shou10 becomo subjact to tne Workerz' Comp¢n5ation Provisions ot Ih¢ Labor Cotlo, you must forthwlth comply wilh such O�oviSions or thii petmi� shall be tle¢motl rovokoE. CONSTRUCTION LENDING AGENCV I hereby aftirm that tnere is a consiruction lentling agency tor lhe performance ot the work for which this permit Is issuetl (SectiOn 3097 dv. CJ Lentler's Name �entler's AtltlresS OWNER BUILDER OECLARATION ' - I hereby affirm chat I am exempt irom the ContractarY Licenze L.aw for the foliowin9 reason (Socifon �031.5 Buslnozs antl Profassional Cotle: Any city or county whlth roquires a permit to consVucc, allor, Improve, tlemolish or ropair any sVucturc, prbr to Its issuancn, also reqWros tha applltant for such permit [o liie a zignetl slatement thal ho/she is Ilcansetl Ourivant to tne provlsians of tne Contractor's Llcenu Law (Chapter 9(tommencing wiln Sn<tlon 7000) ot Oivision 3 of [he Business antl Professions Cotlo) or lhat ha/she Is enempt ierefrom antl tne basis for the allegetl exemption. Any violatlon of Section 031.5 by any �applicant 10r a permit SUDjectS the dpplicant to d Civll Q�e0dl[y ot not more Ihan five huntlreE t1011an �E500). � � u 1, ai Owner of tlte prope�ly or my emplOy¢¢s wllh wage5 as their Sole compensation, will tlo the work, aud tne structure is not IntenGetl or offeretl tor sale (Section 7044, Buziness antl.Protesslonal Cotle:'The Contrattor'S Litenie Law tlOes not apply to an owner of a p�oparty wlt0 builtls or improvos thereon, an0 who tloes such work nimsell/herself or tnrough his or nor own em0�oyees, 0/o�itletl tnat SUGh ImprovOments arn not Intentletl o/ oHoretl fOr salG. Ii, nowever, lhe builtling or ITProvement IS Soltl wl[hin nno ycar of cOm- plotlon, tho ownor will �ava Iho burtlan ol provin9 hC/The Oltl not bulltl o� Im- �1fOve fOr tllo purposo ot sal¢). LI I, as owner of the property, am oxcluslvely contracting wRh Iiconsotl <on- VactoR l0 con5[ruct the pfofect (Sectlon 7044, Busineis antl PrOte551ons COtlO: The Con[ractor's License Law doe5 not apply t0 an owne� of prOperty who ' builtls or improves lhereon, antl who contracts tor such pro)ects with a<on- [ractor(st Ottnse pursvant to the Contractor's Litense Law). I am awaro that proot O� thelr Wo�keYs Compensatlon insurance Shoultl ba Orovltletl t0 me. ❑ I am ezempt untler Secfion , B. & P. C. �or this reason i Date Owner I hereby certity tnat I have reaa tnis applicatlon and stata that tho above - Iniormatlon'Is wrrect. I agree to comply with all clty antl counly orainances antl 5late laws relatin9 to builtling construcNon, antl horeby authorize reprn• Sentdtives of lhls city t0 n[Or upon th0 above-mentlOnetl proparty 10r inspectlon purpo Si9nature Dato ��_ Drivers' License or 55 � TYPE OF CONSTRUCTION L�I NEW U ADD � LJ ALTERATION IJ REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q.p, # . Z � DESCRIPTIONOFWORK/USEOF�BLDG. ��»-St(1PiigP � S Main Building: TYPEOFPERMITp-� GRADING FOUNDATION� STRUCTVRAL T FrOnt � ❑ TENANT �J ELECTRICAL PLUMBING ❑ MECHANICAL A Reer I ❑ �OTHER' � - PRWECTDESCRIPTION so.Fr. �2 9D0 ocCuaarvcY B-Z C Right CONSTRUCTIONTVGEV-N S�]1'IOIC�2Y'PCl/ALUATIONS'��/�;'�zcv�.�v�' $ Left � ZONE GRADING CU. YOS. A�Fb�� p��y, Ref. # Remarks: Ri�ilrlinn ('-9 '.�!/� Zi-�n�i-7� SZSA . . 'PlanningNoies: Sink Preventer IrrigatiOn Drinking Fountains Flaor Drains Floor Sinks GasService Outlets Intefceptor5 Kiichen Sink � - � La'vatories P-Trap Root Drains Reinspection Fee � $15 Boiler Duct- Under Ground DuCt - $truGtufel Duct = Yentilating . Exhaust System ❑ Multiple ❑ Firepl/FacL Blt. ICBO # Fleating System & Ducting 00.100;000 BTU � 100,000 BTI Reinspection Fee ' � � $75 CMF 0865-46, rev. 10/84 White - Bulltling; Canary - Appliwnh Pink - Accounting; Goltlenrotl - Aisessor 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 ❑ EES Refrigeration System ' ❑aioo,000sru ❑iao,000 System Repair/Alteration ' Fire Dampers Regizters Issue Fee � 0 $ 3 Automatic Washer Conslruc[ion Pole Sub. Cookin9 Unit Dishwasher , - Dryers ❑Gas ❑Elec Fan .. . F.A.U. Fixtures Device Boxes Outleti Switches Garbage Disposal Generator 065 KW [ fee ' � . 3469 II/01/85 � . zone Accessory Building: � � Parking Req./Provided , �...JTS � ELECTR AL Transformer ❑ 15-50 KW O SO+ICW , 'i Meter ❑up to 100 amps - Meter ❑over 100amps Sub Panel Momr500.1 HP�1'X-8 Inc.Solar �9�15 HP,�16-15+ Microwave Pole Li9ht Range aAla4E Tl. �� Z ' • O N i N G R E T S / FEES '� ; Standing Sections 5-15 KW Trash Compactor' $15 Issue Fee S 3 SERVICES RE�UIR 2oning APProved BY_ Building Approved By � APPliption laUed By_ ' S VR6r,,FEES C BUILDING PERMIT $ ' V" SMIP $ �_ ��+ �ANCHECK $� PERMIT • PLUMBING ' $ �SSUANCE $ PLAN CHECK 25% $ ' ENERGV P.C. $� ELECTFICAL $ � GRADING � $: PLAN CHECK� 50% $ MICROFI LM $�� MECHANICAL� , $� TOTALFEE' $ � PLAN CHECK 25% $ �"� CON.STRUCTION AND PLANNING POO SPA � APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 1. jemporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnq, . 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 �• �eot��s �Ll9 � '� (� g� 58. Electrical Conduit-Undrgrnd. � 8. Foundation -�- ��_ � �/g/jj 59. Gas Pipe, � Undrgmd., Test . ''9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Propeity 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 - i 6. Rough Electric Wiring , 67. Fencing & Access Approval � i 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18.-Rough Elec[rical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19�. Rough Heating & Air Conditioning FIRE OEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro -22. Ducts, Ventilating 77, Product Piping O Gas ❑ Oil ': - 23.. Gas Pipe-Rough & 7est 72. Underground Flush - � . 24. Roof Praming �-2-a[� 73. Undergrnd.Storege.Tank OGas ❑Oil � 25. Roof Sheathing - _ 3_�� 74. Overhead Hydro 26. T-Bar Ceiling (Structuraq & Monocoat 75. Dry Chemical . 27. Frame and' Flashing � 76. Dry Standpipe 28.•,Lathing & Siding � � 77. FIXED SYSTEM FINAL 29.•Insulation � 78. FIREPREV.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 . ; , I� G aS 37. Final Factory Fireplace'-. � ��_ 3 �38.. Final Plumbing � � ' , li 2O �Aw� �cS 39. WaterService-Final - . _ �" 40. Gas Service-Final _ - � ' � � � 41. Solar pomestic-Final � 42. Backflow Preventer { � 43. Backfiow Irrigation . : - - � � 44. ,Landscape Irrigatipn System � � � � � � 45. Sound Attenuation , � "' ' � 46. Handicap Regulations -� 47. FINAL STRUCTURE & BUILDING 6� ' � 48. Specia� Requirements Completed 49. Electrie Release to Edison � . _. �� + 50. Gas Release to Southern�California Gas Co ' 51. CEflTIFICATE OF OCCUPANCY � ' ' � No. Date �� ` ACPlicant lo fill in all spaees eacept tnosa witnin heavy borCer Iines antl si9n all approD��ate aeclarationz. CI7Y oP COS7A ME ON T,RUC O PERM T , Project �ddress � � APdlicant's Mailing dress Owner's Name Phone Address Arch/Eng. _ License No. Address Convacror'i Name hone Address (mailing) ��! �� Ciry Licen�u Mn LICENSED CONTRACTOR DECLARATION � � I hereby affi�m that I am Iicensetl untle� provi5ion5 of Chdrter 9(commencing �wi[h section 7000) ot DivlSion 3 oi the Business antl Prot¢SSions Cotlo, antl my Iicense is M tull Porce a eHe ' ��/�� J � License � ce e No...1S.Cl�I , I ^ Date� — Si9nature �� WORKE 5' OMPENSATION DECLARAT1 N � \ ' hereby aftirm that 1 have a ce�tlticate of con5ent to selt-insu�e o� a cerUflcat¢- f Workers' Com ensation I urance, or a certif c py [hereof (Settion�. � l800, Lab. CJ �;� �'�% � Policy No. C� Company • � rtifietl cop is hereby fu�nlih¢tl. Cer[ifi "' tl with the city Bu' ' � jf(�d._ _../ Date Applicant � �( n�rlit.t/ EXEMPTI N 0.0M WORKERS' COMPENSA ON DECLARATION (This section neetl not be completetl it the permit is for one huntlretl ($300) or less). I certily that In the p¢rformance o( the wo�k for which this perT�t is issuetl, I shall not employ any person in any manner so as to become subject lo lhe Workers' Comp¢nsation LawS of Cali/ornia. Date Si9nature 'NOTICE: It, after making this tleclaration, You shoultl become subject to the Worke�s' COmpensation provi5iOn5 ot Ihe Labor COtle, y0u must forthwilh comply wilh such p�Ovislons or thi5 permit shall b¢ tleemetl rBVOketl. CONST0.UCTION lENO1NG AGENCV - � ' 1 hereby atfirm that there is a con5truction lentling'agency for the performance of the work fOr wM1ich �thi5 permi[ is. hsuetl (Section 3097 Civ. C.) Lentler's Name Lender'S Atltlr¢ss � OWNER BUILOER bECLARATION ' � I hereby atflrm that 1 am exempt from the Contractor'S License Law fOr tha followin9 reason (Section �031.5 Business anA Professional Cotle: Any citY-or county which requires a Dermil to construct, alter, improve, tlemolish or repalr any sVucture, prlor to Its Issuance, also requlres the applicant tor such'permit to file a Si9netl 5[atement that ne/she i5 licensetl pursuant to the provi5ion5 of the Contractor's License Law (Chapter 9(commencing with Sectlon 7000) ot Division 3 of fhe BuSin¢55 antl Profesvons Cotle) ot that he/She is ezampt herefrom antl the basis for the allegetl exemption. Any violatlon ot Sectlon '031.5 by any applicant for a permit subjects th¢ applicant to a civll �enalty o( nol more than Bve huntlretl tlollars (5500). i, as owner ot the property or my employees with wages as;their sole compBnsation, will tlo the wo�k', antl the Structu�e is not intentletl or of(e�etl fOI Sd�B ($2CI10�1 iOAG� BUSII1255. dOE� P(0f25510lIdl Cotle: The Contractor's licen5¢ l.aw tl0¢s not,dpplY to an owner ot a Drop¢rty wito builtl5 or imptoves thereon, antl wM10 tlo¢s such woik himselt/h¢rself o� through hiz o� her own ¢mployee5, provltletl Ihat SUCh Improv¢ment5 are not intentletl or offered for sale: If, hOwevGr, [he bulltling or Improvement is soltl within one Year Of COm-, pletlon, the owner wlll nave tha bur0en ot proving.he/she tlla not builtl or Im- orove �or the Ourpose of sale). � � � o( The Con[ractor'S License Law a� builtlz or improves thereon, antl Itacior(s1 Iicense pursuant ro th¢ proof ol tneir Worker'S Compen ❑ I am exempt untler Sectlon— Date Owner _ I he�eby certify Ibat I hav¢ reatl thi5 intorTation IS CO/rect. I a9r¢e to comp 519�ature / lY Driver5' Litense or CMF 0865-46, rev. 30/84 :tor'i License Law�. I am aware that nsurance shoultl be provitletl to ma. B. & P. C. for this reason pplication antl state Ihat the above with all city antl county Ortlinances 'uclion,antl hereby authoNze repre- th¢ above-mentionetl prqpe�y Jps � TYPE OF CONSTRUCTION LJ NEW LJ ADD L'J ALTERATION LJ REPAIR ' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER � /�,p, �(! DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi E TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL _ - T Front ❑ TENANT ❑ ELEGTRICAL ❑ PlVM81NG ❑ MECHANICAL A Reaf� • ❑ ATHER- ' PROJECT DESCRIPTION 54. FT. � oCCUPANCv . C Right � K Left CONSTRUCTIONTVPE VALUATION$ $ ' 20NE GRADING CV. VDS.' ACRES' Ping. Ref. #. Remarks: 0 �— � _ • � �Plannin9N0tes: Sink • <flow Preventer <flow Irrigation ttubs ' ifiers ivrasher iking Fountains x Drains • Showers . _ ' Service Sink � Sewer Cap� - Sewer Connection Solar Collecmrs Solar Pipin9 Solar Tank Swimming Pool w/Spa Gas Service Outlets Interceptors KitchenSink� � ' Lavatoriei � . ' P—Trap . Roof Drains� � Rainspection Fae � � $75 Dutt-UnderGround Dutt = Structural Duct - Ventilating . Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating Sy'stem & Ducting O ai oo,000 sru O i oo,000 sr� �"�'�"`-- I I Reinspec[ion Fee I� S75 White - Builtlin9: Canary - APplicant; Plnk - A<counting; Goltlenrotl - Assessor Wdt¢r CIDut ' Water Heater,' � - � Water Service � <Auio-Wash - � Laundry Trays � _. . Isue Fea. . , $•3 Hood o� Typel ❑ ' CanOpy Type I I ❑ Refrigeration SVstem ❑0.100,000 BTU ❑ 100,000 2 System Repair/Alteration Fire Dampers Registers ' laue Fee � $ 3 0 Auromatic Washer Construction Pole Sub. Coaking Unit Dishwasher Dryers �Gas ❑Electric \ J774 II/U4/tllZone -C�05� T�. - Accessor,y Building: Z O N ' N G R Parking Req./Provided = � . E � ' M 1 � S ELECTRICAL ' Transformer ❑ 15-50 K6 ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Fan F.A.U. Fixtures Device Boxes Outlets Switches /7 Garbage Disposal Generator DO-5 KW 05�15 KW Sub Panel Motors041 HP�1X-8 Inc.Solar �9-15 HP �1E15+ Microwave � ' ' Pole Light Range ; Standing Sections Trash Compactor� � FEES I Reinspection Fee I$15 I ' Issue Fee � I $ 3 I DEVELOPMENTSERVICESREDUIREMENTS: � � 2oning Approved By Data 8uilding Approved By Date�' Applintion Iszued By � Date "'� 4' , SUMMARV OF FEES . � BUILDING PERMIT $� SM�P $ PLAN CHECK $ PERMIT PLUMBING ' $ � ISSUANCE $ PLAN CHECK . 25% $ � ENERGV P.C. $ • ELECTRICAL $ �O GRADING ' $ PLAN CHECK 50% $ � MICROFILM $, �1� � MECHANICAL ' $ TOTALFEE $ d�+`-�� PLAN CHECK 25% $ , ' � COI�ISTRUCTION AND PLANNING POC SPA APPROVALS Permit# Date Inspector qpPROVALS Permit# Date Inspector 1. :emporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgmd. ' � 53. Steel Reinforcement � 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undfgrnd. 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-Undrgcnd. "' 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structurel Floor System 61. APPROVAL TO DECK 1�1. 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 3 � �„ 67. Fencing & Access Approval 17. •Rough Wiring Sign 68. APPROVED FOR PLASTERING � 18. ,Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19: fRough Heating�& Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro � 22. Ducts, Ventilating 71. Product Piping OGas OOiI 23. Gas Pipe-Rough & Test � ' 72. Underground Flush 24. Roof Framing � 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structura�) & 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 ' �3 � � 1(�1 Notes: " 34. Final Heating & Air Conditioning � ' 35. Final Gas Pipe•Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final � 40. Gas Service-Final � 41. Solar pomestic-Final ' 42. Backflow Preventer � 43. Backflow Irrigation � 44. .Landscape Irrigation System 45. Sound Attenuation � ' 46. Handicap Regulations � _ - 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed � 49. Electrie Release to Edisa� •_ 50. Gas Release to Southern California Gas Co � 57. CERTIFICATE OF OCCUPANCY . ' No. Date \� Applicant to fill In all spaees exceo� enose w(inin �eavY �oraer Itnes ana sign all aDProo�iala tleclaralions. CI7v oF cOSTn nnESn CONSTRUCTQIO�N PERMIT' Project�.ddressb�0`�:.`�TWST. GR�71�' C.'3 'ApplicanYs Mailing Address �� - `-sr..Acnj RD. Ln �ilaHap Owner's Name �hone Address ArchlEng. � w License No. Address �< (<`%�• Ro�+ea�j S� Cihn.,c6�CA Contracror's NamCY�V_V�.oCs Fns � �=f1141phoneSQL-222 1 Addresslmailing) �Sl W. l..n.+AM� Qe 6\ cR_nn �Of,Z� City License No. �Q� LICENSED CONTRACTOR DECLARATION I nereby affirm inat I am iicansatl untler provisians of Charter 9(commencing wi[h secllon 7000) oi Divizlon 3 ot tha Butinesz antl Professions Cotle; and � my Iicense is in full to e ana efeect. � 25qq3L License Class ' ` cense o. Date �2-'b"i�s Si9nature Z WORKERS' COMVENSATION OECLA ATION I hereby affirm tnat I have a rertlticate of consent to selfansure or a certificate� of Wotker5' Compensa[ion InSurance, or a cerUfi¢tl cOpy [hereot ($ectlon 3800, Lab. C) ` PolicY No�`Z.•16Z•02�IO19OISComPanY�\(DEM1�`( n�OTUw�- [] Certifletl copy is hereDy turnishetl. �0 Cer[�if�ietl� c�opy i5 tiletl witM1 [ne cit uiltlin Dlvisio Date_1L_��F�_APPlicantY��e � ��^� �i1j�e�' EXEMPTION FftOM WORKER$' COMPENSATION DECLARATION . "(This section neeC no[ be complalGtl it the p<rmit is for One hunGretl (§I00) o� less). I certity lhat In the pe�formance Ot tha work fOr whlch this permR Is issuetl, I snall not employ any person in any manner zo as to becoma subj¢ct to the Workers' CompensaHon Laws of CalitOmia. Da[e Si9nature `NOTICE: 1/, atter makin9 this tleUaratlon, you shoultl be<ome subject to lhe Wo�ker5' COmpansatlon prOvisions ot tne Labor CoOe, you must'for[hwith comply wilh such provisions or lhis Oermit snall be tleemetl rnvoketl. CONSTRVCTION'LENDING AGENCV ' I hereby atfl�m that there�ls a constru<lion lentling agen[y for tha perfo�manca of , tha work for which lhis putmiL Is Issuetl (Sec[iOn 3097 Civ. CJ LAntler'S Name , lontler's Atltlress OWNER BUILDEH �ECLARATION I hereby.alfl�m that I am oxempt irOm lhe Cont�actor'S\LICOnse Law fOr the following reason (Sactlon ]031.5 Buslness antl Profe55ionsl Cotle: Any tlty'or county which �aquiros a�0¢rrplt to conStruct, altur, Im0/ov0, Gemollsh or repai� any structuro, prior to Its Issuanca, also roqWres tne applicent tor suth permit to fiio a signod s[alumanl that he/she I5 Iicansetl pursuant ta the provisions of ' the Contraclor's Ucense Ww (Chaptar 9(mmmencin9 witb So<Non 7000) of ' Division 3 of tho Businoss and Prolezsions Cotle) or tnat ne/5he Is exempt ihereirom and the ba51s for the allegetl exemptlon. Any vlolalion of Soctlon 7031.5 by any applicant tor a Permlt� SUG�ects the applicanl to a clvll �enalty o! not more tnan Irve huntlretl tlollars (5500�. 1, as owner ot tha prOpOrty or my am0�0ye05 with wag05 as their solo compenSatiOn, will tlo tha work, dntl tne SlruCture is not IntenCotl Or oiferetl �, tor Sale ($eclion 7044, BuSiness antl Professional CotlN The ConVactor's i License Law tloes not apply to an owner of a prop¢r[y who bulltls or improves thereon, antl who tloas such work Nmsell/herselt or through hiz or har own employ ae5, prOviUetl lnal SUCM1 ImprovOmentt aro nol In[entl¢tl o� ott¢retl t0� zale. If, howover, the OUIltling or ITD�ovemont is toltl withln oi�e year ol cOm- pletlon, tM1u ownnr wlll have [hB Ewtlen 01 provin9 hC/S�e tlitl n0[ builtl or im- prove for tne purpose of sala). ❑ 1, as owne� Oi [he D/operty, am exclusiv¢ly conVacting with IIC¢nse0 con- trattors to COmlruct lhe prOject (Section 7044, Busineit antl ProfeSsions Cotle: The Contractor's �icense l.aw doe5 mt apply lo an owne� ol p�operry who builtls,or improva5 lhOruon, arltl who Contracl5 lor TUch prOjeCtS witn a con- tractor(51 Ilconse pu�suant to lhe Cont�actor'S Licanse Lnw). I am aware that proof o( lhair WOrker't COmpensalion InsU/anca Should be p�ovltletl to me. ❑ I am exemo� untler Settion B. & P. C. tor this reason Date �� Owner 1 h¢reby certify that I have r¢atl tnis applicatlon antl state that the above information is co�rect. I agree [O comO�Y w�[h all tlty antl counry Ortlinan<¢5 antl state laws relat to builtling COPsiruction, artl hereDy authori:e repre-, sentatives of thi it to en[cr uxen [he ab0%-mentionetl property for Si9nature DriverY L oace 1Z-�O •85 TVPE OF CONSTRUCTION IZ)I NEW U ADD LJ ALTERATION Ll REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTMER A p.�6 DESCRIPTION OF WORK/USE OF BLDG. � ^«�� eTy �F ��0 O�c.(l �E MainB� TVPE OF PERMIT GRAOING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Reef �'�OTHER �F�nG SQrt�.��l�.nS. PROJECT DESCRIPTION 5c1. FT. oCCUPANcv C Ri9ht CONSTRVCTIONTVPE VAWATIONS�OOO.00 g L¢ft ZONE GRADING CU. VDS. ACRES Ping. Ref. # Remarks: Planning No Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers ' Dishv.asher Drinking Fountains Floor �rains � Floor Sinks - 3as Service �UlIEtS Interceprors . � Ki�chen Sink - . Lavarories ' - ' P—Trep Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct-Structural � Duct � Ventilating Exhaus[ System ❑ Multiple Firepl/Fact.8lt. ICBO # ' Heating System & Ducting ❑ ai ao,000 eTu O i oo,000 Reinspaction Fee I S75 CMF OB65-46, rev. ]0/84 White - Builtlin9: Canary - Applicant: Pink - Accounting; Goltlenrotl - Assessor Showers Service Sink Sewer Cap ' Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Warer Closet . Water Heater Water Service Auto�Wash laue Fee Hood or Type I ❑ Canopy Type I I ❑ Re(rigeration System �aioo,000eTu Oaoo.000 System Repair/Alteration Fire Dampers Registers .. laue Fae� FEES 5 3 5 3 Automatic Washer - Construction Pole Sub.' Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator �0-5 KW ❑ 0797 3/12/�36 2one Actessory Buildin9: Parking Req./Provided ELECTRICAL Transformer ❑ 15�50 KW ❑ SO+ KW � Meter ❑up l0 100 amps Meter �over 100 amps Sub Panel Motors�0.7 HP�IYh-8 Int.Solar �9-15 HP �16-15+ Microwave - Pole Light Range ; Standing Sections 5-75 KW Trash Compactor ' � Reinspectian Fee �$75 I � Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By �� I:.".n�. :T!. FEES $ 3 SUMMARV OF FEES C^ BUILDING PERMI7 $ �2•S� SMIP S �� PLAN CHECK 5 4o•E'3 PERMIT PLUMBING $ ISSUANCE S PLAN CHECK 25% $ ENERGV P.C. 5 ELECTRICAL 5 GRADING S PLANCHECK 50% § MICROFILM 5 MECHANICAL 3 TOTALFEE s \03.�3 PLAN CHECK 25% $ ��_ �� 2 O N 1 N G R E U M T S COAIS7RUCTION AND PLANNING POOL & SPA - AP.{'ROVALS. Permit # DatE' Inspector p�ppROVALS Permit # Date Inspector 1. �-emporary Electrical Service or Pole , 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � , 53. Steel Reinforcement ' 3'.'..Electrical Cdndui[ Utility-Undrgrnd. 54. Forms ' ' _. 4. Electrical Con�uit:Undrgrnd. � 55. Electrical Bonding � 5. $teel ReinfQrcemenc ,� � - 56. Rough Plumbing & Pressure Test � - 6�: Electrical UFE'R;Grrid. . - 57. .APPROVAL TO COVER-GUNITE �'I � 7.�Footings ,. .,, � • � � 58. Electrical Conduit-Undrgmd. ,', 8. Poundation �• r� .: F'� c 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 :i 13. Roof Drains �. - � 64. Plumbing System - Final � _, ,� 14. Rough Plumbing �� • :, 65. Electrical-Final ' 15. Rough Electrical-Contluit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 78. 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�Structuie . 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil -23. Gas Pipe�Rough & Test 72. Underground Flush 24. Roof Framing ' 73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof Sheathing •� 74. Overhead Hydro 26. T-Bar CeNing (S[ruc[ural) & Monocoat 75. Dry Chemical 27. Frame antl Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL - c 29. Insulation 78. FIflE 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 41. Solar pomestic-Final 42. Backflow Preventer �• '� 43. Backflow Irrigation -� ' 44. .Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations . 47. FINAL STRUCTURE & BUILDING ' 48. Special Requirements Completed 49. Electric Release to Edison ,, ! � . � i. 50. Gas Release to Southern California Gas Co p 51. CERT,IFICATE OF OCCUPANCY /' ,,�: No. Date - � ' � j City of Costa Meu Development Services Department 8uilding Salety Division P. O. Box 1200 Costa Mesa, CalifOrnia CERTIFICATE OF OCCUPANCY No. �O�b3O The Building located at 670 'haat 17'tq� chrnot. c�iif.� r�9 has been inspec[ed and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group �.19 Occupancy. U52ofBuilding Mini Ch�rann Legal Description d��Ri_(�Z (See reverse side for Metes and Bounds) Building Permit No A 7971�1d Electrical Permit No. F �le7S Plumbing Permit No. Mechanical Permit No. Number of apartments and/or guest rooms �iC3 PCeV. Permit Ab. F 23012 iSSUED T0: BuildingOfficial William T. Howard Pacific M1ic�aa Prnmrhioa / : j oi0 t:. 17th Strc�t, Sto.C2 bY -��'- -� ��-9 .�.JJtr'� �?911i C�d �iiFiii Date Aoril 9. 1986 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CnnF 1015-a6 rev. 1/83 White -Owner; Canary - Numerical File; Pink - Bldg. Permic File _I , � Applicant to till In all spaces exce0< <hosa wit�in �eavy Eo�Ee Iinas antl sign all appropriate Geelarations. Cll�r.OF COSTA MESA CONSTRUCTION PERMIT - PFoje �,�,�,� 66z. '='--�;--��o-:�. i7th StreetC-«�fldC� ApplicanYsMailingAddress G90 W. :�7ih Stre^t � � owner•srvame Mdrshdll DUffield Phone F�4�-6811 �Address ��ii( �7th Street CocTa Mes�� CA 42627 a.�nie�9.6anzuelo/Rierson IfIC. LicenseNo. C"�7901 'Address'�� N. Rau7part 5�:. Su�itc F Oran�, CA Contractor'sNama Kriiiea f.nnctriiction vno�e ��F-1499 Addreu ( mai I i ng) C i -City License No. 3 - f A e�[i46 LICENSED CONTRACTOR DECLARATION I hereby aftirm [hat I am licensetl untler provisions of Charter 9(commencinq .with 5ection ]000) of DlviSion 3 0( the Bu5ine55 antl Protes5ions Cotle, antl my license is in tuli torce a ettect. ' � 77��y LICCIISE CId55 C2OSC NO. Date �� WORKERS' GOMPENSATION OECLARATION � � hereby aifirm tnat I nave a certificate ot consent to s¢If-inzure or a certiflcate >��-L,i Workers' Compensation I surance, or.a certifietl ,Eopy t ere f(Sec lon ��'3800, Lab. G !� � :: \ Policy No. ��d � ��ompany � � ' n'�{ Certifietl copy is hereby fumishetl. !' }J.Certifietl copy'; fi tl with the city Buil ivisio ' Date �%-/� Applicant�� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION . �(This section neetl nat be completetl if the�permit is for one huntlretl'(5100) or less). � I certify that in the performance of ttte wo�k'tor whiCh this perm�t I5 issuetl, I� shall mt employ any person In any manner so as to become subject to the Workers' Compensation Laws ot Calitornia. � Date Si9nature ' ' ' 'NOTICE: I(, after making Nis tleclaration, you shoultl become subject to the Workers' Compensation provisions ot the Labor Cotle, you must forthwith comply wilh such provisions or fhii permit shall be tleemetl revOketl. CONSTRUCTION �ENDING AGENCV ` � - I hereby aftirm that there i5 a ConstructiOn lentling agency fo� the pertormance ot tM1e wo�k tor which this pe�mit is issuetl (Section 309] Civ. C.) , Lentler's Name � lentler's Aatlress � OWNER BUILDER•OECLARATION. I nereby atfirm that I am exempt from che Contractor's License Law tor the followin9 reason (Section ]031.5 Business antl Professional Cotle: Any clty or county which requires a permit to construct, alteq improve, tlemolish or repair any structure, prior to its issuance, also requires the applicant tor such permit to tile a signetl ztatement Ihdt he/she iz licensetl pur5uant to the prOvisions o( � the Contractor's License Law.(Chapter 9(commencing with Section 7000) of Division 3 0( [ne Busin¢55 antl Professions Cotl¢) o� that he/She is exempt heref�om antl the basis fo� Ihe allegetl exemption. Any viOla[ion bf �Sec[ion . '031.5 by any applicant fOr a permit subjects the applicant [o �a civll enalty of not more than five nuntlr¢tl tlollars (5500). I� I, as owner of the property or my employees with wages as Meir sole ' compensation, wi11 tlo the work, antl the structure is noi Intentletl or ofteretl for sale (Section J044, Business antl Protessional Gotle: The GonGactor'S License Law tloes not apply to an owner ot a property wno builtls or improves thereon, ana who tloes such work himself/herselt or throu9h his or ner own employees, provltle0 that SUCh improvements a�e not intentletl or offeretl f0/ sdle. If, however, th¢ builtling or imp�ovement is Soltl within one yea� of com- pletioq the owner will have the tiuraen ot provin9�he/s�e tlitl not builtl or im- prova for the purpose of sale). • ❑ 1, ai owne�bf the property, am ezclu5ively contracting with licensetl con- tractois td consvuct the Oroject (Section 7044, Business antl Professionz Cotle: The Contracto�'S License Law tloe5 not ap01y to an own�r of prOPerty who builtls o� improves thereon, antl who contract5 fo� such projettz wifh a con- tractor(s1 li<ense pursuant to the Contractor's �Icense Law). I am aware that O�oot o{ their Worker's Compen5ation insuranGe shoultl be p�ovitletl to ma. ❑ I am exempt unaer Section B. & P. C. for this reason �I Date Owner - I hereby certify tnal� 1 have reatl tliis'application and state thaf the above ' information iz correct. I agree to compry with all ciry antl county ortlinances� antl s[ate laws relating to builtling cons[ruction, antl hereby autboAze repre- sentativez of this city to/ enter upon the above-mentioneC property for insPection purpose /y � '� I Signzture �C� -t � � .�ate��_� � Drivers' Licenu or 55 � � CMF 0865-46, rev. 30/B4 TYPE OF CONSTRUCTION �J NEW LJ ADD LJ ALTERATION LJ REPAIR ' 0 CONVERSION ❑�DEMOLISH ❑ OTHER ' , q,p, # -- a� " DESCRIPTION OF WORK/USE OF BLDG. I�11'li —STOY'r3{J, c - S Main Buildi ' E� TYPE OF PERMIT � GRADING FOUNDATION STRUCTURAL ' T F�ont ❑ TENANT F� ELECTRICAI ❑ PLVMBING ❑ MECHANICAL �A Rear a ❑ OTHER PROJECTDESCRIPTION S�.FT.�%-�nn OCCUPANCV R—i C Fight K CONSTRUCTIONTVPFV_.N S�7%'1� flIC�?V'P�jVALUATION$-7Q4L-'�+T� $ Left Zi ZONE GRADINGCV.VDS. AGf�sl,'�� T^— Ping. Ref. # Remarks: p„q �� h�� r_� . pG, •#��f �� Q�j�"'C 'Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishv.asher Dririking Founcains Floor Drains Floor Sinks Gas Service Kitchen Sink' � Lavamries P—Trap ' Roof Drains ' Reinspeetion Fee $15 Boiler Duct - Under Ground Duct - Structurel Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting �� 6100,000 BTU � 100,000 8T 0 r Reinspection fee � . $15 White - Builtlin9; Canary - ApPpcant Plnk - AccounUn9: Goltlenrotl - AS5e5sor $hOWCfS . Service Sink ' ' , Sewer Cap � Sewer Connection :�Solar Collectors' ' ' Solar Piping � ;'Solar Tank ` � .Swimming Pool w/Spa Urinal Water�Closet Water Heater Water Service Auto-Wash . Laundry Trays tl Isue Fee IANICAL Hood or Typel ❑ Canopy Typell � Refrigeration System ❑0-t00,000BTU ❑100,000 System Repair/Altere[ion F ire Dampers Registers ' 0 Issue Fee ' � S 3 FEES S 3 Automatic Washer Consttuction PoleSub. Cooking Unit DiShwasher Dryers ❑Gas ❑Elec[i Fan F.A.U. Fixtures uuuecs � Switches •' � - Gar6age Dispo'ul Generator. �0-5 KW � � 4 ' ,. . � _ , 3468 II/01/85 Accessory Building: 'J<�'9�4. ��. 2 O N I N G R E Q M T � ELECTRICAL -Transformer'� 15-50 KW � 50+KW F , Meter �up to 100 amps Meter ❑over 100amps Sub Panel . ' Motors�0.lHP�lY,-8 - Inc.Solar �9-75 HP'�16-15+ Microwave ., ' . � Pole L'iaht � / / Range Sign . . ,, � ! Standina Sections 5 KW � �"� Trash Compactor ' �ssue Fee DEVELOPMENT SERVICES R Zanin9 APProved By�� Building Approved By _1C Aooliptio'rn Issued Bv c • I E3 _Date �� ' � � _„�S ARV� EES , = ,I� �BUILDING PERMIT ��'15 SMIP � $ ' �LAN CHECK - � q• PERMIT PLUMBING � $ ' ISSUANCE �� $ PLAN CHECK�. 25% $�•� ' ENERGY P.,Cy. $ �' � GRADING'•) $ ' ELECTRICAL. $ PL'ANCHECK 50% $ ' MICROFILM. $ �[� ' MECHANICAL � � $ ' TOTAL FEE , $ 1-IJ—L�_ PLAN CHECK � 25% $ ' � ICONSTRUCTION AND PLANNING POO �PA '� Date Inspector Date ins ector � APPROVALS Permit# APPROVALS Permit# P �� 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location . 2. Soil Pipe-Undrgrnd. ', 53. Steel Reinforcement 3. ElectricaiConduit 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. �oatirn�s- �'•� '�,,' �� ` 58. Electrical Conduit-Undrgrnd. 8. Foundation� ��,.g[� /.'� /O g� 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 � a 62. Backwash & ReceptorFinal � � 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 .. r "17. Rough Wiring Sign 6S. APPROVED FOR PLASTERING 18. � Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19.�Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20.-Rough Factory Fireplace . APPROVALS Permit # 21. Ducts,.in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil �- 23. �Gas Pipe-Rough & Test 72. Underground Flush � - • , 24. Roof Framing , /-,7 p.yj(� � 73. Undergrnd. Storage Tank O Gas ❑ Oil 25: Roof Sheathing J-a/-g(o @u 74. Overhead Hydro � ' � �' 26: �T-Bar Ceiling (Structurall-&�Monocoat 75. Dry Chemical ' � / + 27.: Frame and Flashing a 76. Dry Standpipe � 28. Lathing & Siding � 77. FIXED SYSTEM FINAL ' 29.-,Insulation � � ' 78. FIRE PREV. F�NAL ` 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; =" g�],D F�R $PF��Aj, ]�EQIJ]REMEj�7'$ 35. Final Gas Pipe-Test ' � ��,�� 36. HoodorCanopy , -' - /' / sa(!C� l2L�w �U %/N l�6O� 1..' 37. Final Factory�Fireplace ;' � � . 7/ 3� � !O8'a � ✓ � � 38. Final P,lumbing • - - ll d$ j� ��G� R�V �(i/ ,� 39. WaterService-Final� " _ . ` �f//�� v/,j�UO�0i5/ � � /�� p �i«. r 40. Gas Service-Final - � � - _ - �/�K � � �aQ � �fvrs . q� u. ..F 41. Solar pomestio-Final-'I. " i ('Q � e ry�e�U/S/Oi0 4� 42. Backflow Preventer � �, ' � ' v 's��W e� O " ��P �/ � Q �i��/✓ 43. Backflow Irrigation �oKo (Af ��7 �� 6 5, S�� o[�,� 44. ,Landscape Ir�igation System . � .�g1� � cIL� GC.• e�t- t_ A 45. Sound Attenuation �T� .,� 46. Handicap Regulations ' r �� -�-��p � 47. FINAL STRUCTURE & BUILDING � �/ g�p O U S R� �� 48. Special Requirements Com.pleted �' $ � � _ 49. Electri�c Release to Edison . ' -� � 50. Gas�Release to Southern California Gas Co _ ." �- , 51. CERTIFICATE OF OCCUPANCY � , � � No Date � � Applicant to flll in all s0aces excepl those within heavy borEer lines anE sign all CITY OF COSTA ME A ON T U�J�ID Y MI In PERMIT NO. ., TRACT NO. LOT NO. � �:'' c� � �'Y�ioject Address Applicant's Mailing A r ss Ov¢ner's Name �e Address � Arch/En9. License No. Address /� Contractor's Nam �.,,'^ Phone 'Address (mailing) ! �la��v�� City License No. r� � LICENSED CONTRACTOR OECLARATION � �1 hereby affirm that I�am licensed untler provisions of Charter 9(commencing with section 7000) ot Division 3 of the Business antl Professions Cotle, antl �'my license is in full fo e an �fect. � �Q�J ucense CJ a C/ �'c Se No.�S/�d�/�_i i Date�/� � Si9nature WORKE 5' OMPENSATION DEC�N ' � � � hereby afiiim that I have a certificate of consent to seli-inzure or a certlficate � f Worke�s' Com ensation Ins rance, o� a ce�titie o0 (� tne� f(Sec "on_ � .B00, Lab. C. ' \ Policy No. Company ' �' � ❑ qertifietl co is hereby urnishetl. , IjJ�Certifie o with the city wl �� iJ n � Date Applicant - %rt/ EXEMPTI ROM WOHKERS' COMPE�ON DECLARATION (Thissection neetl not be mmpletetl if the permit i51ar one huntlred ($300) or less). • I certity that in tne pertormance of tne work for whlch thi5 permk is issuetl, 1, 5ha11 nol employ any persOn in any manner so a5 to becOme subject to the� Workers' Compensation Laws of Calitomia. � Date ' Signature ' ' ' � 'NOTICE: If, after making this tle<laration, you shoultl become�subject to the Workers'.Compen5ation provisions ot the Labo� Cotle,.you mu5t.tor[hwitn comply with such p�ovlsions or thi5 permit Shall bE tleemetl �evoketl. CONSTRVCTION'LENDING AGENCV - ' . I hereby affirm tha{'there is a mns(ruction Ientlin9 a9ency for tne performance of the work fo� which this � permit is issuetl (Section. 309] Civ. C.), Lentler's Name Lentler's Htltlress OWNEfi BUILOER DECLARATION � - ' � I hereby affirm that I am exemp[ from the ConVacror's License Law �Tor the '- following reason (Section ]031.5 Business antl Professional Cotle:�Any <ity or county which �requires a permit lo construct, alter, improve, tlemolish or repair any Structu�e, prior to Its issuance, also require5 the applicant torSucM1�pe�mit to file a signetl statement that he/she i5 licenzetl putsuant to the provi5ions�ot the Contractor's LiGense-law (Chapter 9(commenUng with $ectibn ]000) ot Division ;3 of ihe Business and ProfessionsCotle) or that he/she'is exempt , herefrom antl-the basis tor the allegetl exemption. Any violation ot Sectioro 031.5 by any applicanL (or a• permit zubjects ihe applicant to a civil � p¢nalty of nof more [han five huntl�etl tlolla�s ($500�. - ,. � � I, as owner ot the property or my employeeswith wages as their sole Compen5ation, will tlo tbe work, and the structure is not intentletl or ofterEtl for sale (Sec[ion ]044, Business antl Profezzional,Cotle: The Contractor's' License law tloes not apply to an owner oi a property who builtls ar improves thereon, antl who tloes such work himself/herselt or through his or her own employees, provitletl that sucn improvements are not intentletl or offeretl for ' sdl¢. If, hOweve�, tne builtlin9 or improvement is soltl within one yea� of com- � pletion, the owner will have the burtlen of proving he/she tlitl not builtl or im- prove for the purpose ot sale). ' . ❑ I, as owne� of the OrOperty, am exclusively cont�acting with IicenSetl Con- Vactors to construct Ihe project (Section 7044, Business antl Protessions Cotle: ' The ContractoYs LicenSe Law tlOes not ap0ly.to an owner ot property who builtls �or improves thereon, antl who contracts tor such projects with'a con- tractor(sf license pursuant to the Con[ractor's License L.aw). I am aware that proot o( tneir Worker's Compensation insurance shoultl be provitletl to.me. ❑ I am exempt untler Se<tlon B. & P. C. for this reason Oate Owner I hereby certify'that I have read this application antl state thaf the above information is correcL I a9ree to compty w�th all clty antl county ortlinances antl state laws �elating to Ouiltling con5bucti , antl hereby authorae r pre- sentatives of this city o t upon the bove-mentionetl pro rt f� inspectlan pur os Signdture Da[e Drivers' License or 5 TYPE OF CONSTRUCTION LJ NEW LI ADD LJ ALTERATION ❑ CONVERSION �❑ DEMOLISH ❑'OTFiER _ ' DESCRIPTION OF WORK/USE OF 6LDG. tleclarations, REPAIR TVPEOFPERMIT ' GRADING 'O FOUNDATION ❑ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER . �PROJECT DESCRIPTION�SQ.FT. � � oCCVaArvCv— ' CONSTRUCTION TVPE VALVATION $ � ZONE GRADINGCU.VDS. ACRES— Remarks: ,�//('G^G (f�.[� Bar Sink � � ' ' Backflow Preventer • Backflow Irrigation ' ' • Bathtubs � Clarifiers � Dishwasher' ' � Drinking Fountains Floor Drains ' � � Floor Sinks � - , Gas SerJice Outlets . Interceptors Kitchen Sink' ' Lavatories � � � P—Trap ' ' Roof Drains ' � - Reinspection'Fee . $15 Duct - Under Ground Duct-Structural � Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heatin9 System & Ducting' ❑aioo,aooeTu Oioo,000 I Reinspection Fee � $15 CMF 0865-46, rev. 10/84 White - Builtling; Ganary - Appli<ant; Pink - Accounting; Goltlenrotl - Assessor Showers Service Sink � Sewer Cap�� Sewer�Connection Solar Collectors � Solar Piping Solar Tank, Swimming Pool w/Spa Urinal �� - - Water Closet . ' Water'Heater �. Water�Service � A.P. #" S Main Building: E� T Front ARear C Right ' g Left Ping. Ref. # Planning Notes: � FEES ' E ' - � Automatic Washer � - � - ' - l•' ConstructionPoleSub.� i� • Cooking Unit ' Dishwasher � � � ' Dryers ❑Gas ❑Electric � Fan F.A.U. -' - Fixwres - ' - + Device eoxes � . - � Outlets ' � �, ... � . c..:...�.... / i h frays ,t ' r' � Issue Fee 'Hood or Type I ❑ �Canopy Type I I ❑ � Refrigeration System �6100,OOOBTU ❑100,OOOBTU System Repair/Alteration ' FireDampers ' � Registers . i laue Fee t.� Garbage Dispolal Generator DO-5 KW 05-15iKW 9557 II/04/E35 ' Accessory Building: . i . Parking Req./Providec � ;ipo°0 TL Zone Trenstormer ❑ 75-50 KW �� , � ❑SO+KW Meter ❑up to 100 amps Meter ❑overi00amps Sub Panel Motors �0-1. HP � 1 X- 8 IncSolar �9-15 HP �16-75+ � Pole Light ' Range Sign Standing Sections - Trash Compacmr' $ 3 Reinspection,Fee $15 Issue Fee FEES �DEVELOPMENTSERVICESREQUIREMENTS: � - Zoning Approved By Building Approved By Appliption laued Bv � $ 3 2 O N ' N G R E Q M T �' S -FEES $ 3 � SUMMARV OF FEES � . BUILDING PEflMIT $ , SMIP $ PLANCHECK: $ � 'PERMIT , PLUMBING � $ ISSUANCE $, PLAN CHECK 25% $ ENERGY P.C. $ ; � ELECTRICAL $ �a • GRADING $' PLANCHECK� 50% $ ��Iy:�V MICROFILM. $ MECHANICAL $ ' TOTALFEE $ 3.0.9� � PIAN CHECK 25% $ � �ONSTFtUCTION AND PLANNING POO ;PA �' APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector ' 1. Terreporary Electrical Service or Pole 52. Pool & Equipment Location - 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement „3. Elec[riral.Conduit Utility-Undrgmclt - ' 54. FormS , 4. Elect[ical Conduit-Undrgrnd. 55. Electrical Bonding ' � 5. Steel Reinforcement "i - - 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. " � 6p. Backwash Lines, P-Trap, O Undrgrnd. � 10. Structural Floor System . - � 61. APPROVAL TO DECK � 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap � 63. Heater & Vent-Final 13. "Roof Drains 64. Plumbing System - Final 14. Rough Plumbing, 65. Electrical-Final . 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 3�� pUj 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 O Gas ❑ Oil 23. Gas Pipe-Rough & Test i 72. Underground Flush � 24. Roof Framing �' 73. Undergrnd.StorageTank OGas ❑Oil � - 25. Roof Sheathing f . 74. Overhead Hydro � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe , 28. tathing & 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 ' ' a � (�! Notes: � 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace . 38. Final Plumbing - 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer � . 43. Backflow Irrigation 44. �Landscape Irrigation System 45. Sound Attenuation� � 46. Handicap Regulations ' 47. FINALSTRUCTURE&BUILDING 46. Special Requirements Completed � 49. Electrie Release to Edison � . ' • 50. Gas Release to Southern California Gas Co , 51. CERTIFICATE OF OCCUPANCY ' No. � Date Applicant to 1111 in all spaces except lhosa wi��in heavy Dortler Ilnas antl sign all aOPropritta Eecla�atlons. ' Ci7v oF cOSTa MESa CONSTRUCTIQN PERMIT . Project Address �70 W. �1�~ ST , FS�o'� G2 Applicant'sMailingAddress �45��•�-unoGt�t�o.leyw4a� Qwner's Name Phone Address Arch/Eng.� VGI.o ��rt oN • LitenseNo. - •Address O N w � nK Contractor'sNamaAOVaNt6 �" PhoneS2b•223) Addresslmailingl_�451 W. Lc..eEv�.r �lio `• yse�n,CA City License No. O 1.(..OSO �R063 � LICENSED CONTRACTOR DEGLARATION I he�eby al/i�m that I am licensatl untle� prOvi5ion5 ot Chdrter 9(COTmCncing with settion 7000) of �ivision 3 Of lhe Busine55 antl ProteSsionS Cotla, antl my license is in f Wl.tor<¢ antl eifect. -ucense Class '�L- cense 2Sg Date��0•i{S Signature WORKERS'COMPENSATION DECLAf� TION I hereby afiirm tnat I have a cerUtiwte ot consent to selNnsure or a certlfiwte of Workers' Compensation Insurance, or a certifietl.,<oDY lhereof (Section 3800, Lab. C.) � 015 aoucv NoW�-Q-' �62'OZ'(OW� Company �..�oanT7 �vTun�.. ❑ Certifietl copy is hereby turnizh¢tl. �j� Certifletl cop`[ is tlletl with the city B iltling Division. Oate \Z-l0'YlC APPIiGdn[ ��eNL6 ��nG rG��n.._ E%EMPTION FROM WORNERS' COMPENSATION DECLAFATION (This saclion neeG not be completetl It the permit is (or one huntlretl (y100) or IeSs). � I certify that In th¢ performance ot the wo�k fo� wNch Iltis p¢rm�t i5 issuetl 1 zhall no[ em0�oy any person in any manner so as to become subject [o t�e Workers' Compensatlon Laws Of CalitOmid. , . Date Si9nalure 'NOTICE: If, afte� mdking this GCClaratiOn, you zhOultl become Subj¢Cl (O lh0 Workers' Compensation provisions of the Labor Coae, you must torthwith. comply with sucn provisions or this permit shall be tleemetl revoketl. �CONSTRUCTION LENpING AGENCV� '..�� 1 nereby afiirm that tnere is a conscruttlon'lentling agency for tha oerformance \of the work far whiCh Ihis pormit is i55uetl (SCction 309] Civ. C.) Lentler's 'Name - \ Lentler's Atltlress � \ OWNER BUILDER OECLARATION \I hereDy aliirm that 1 am exempt irom the ConVattor's License L.aw tor the tollowin9 reason (Section 7031.5 Business antl Professional Code: Any Nty "or munly whi<h r¢quires a pe�mit to ConS[ruct, alte�, Improve, tlemoli5h OrrOpalr any StruGturo, pNo� to It5 ISSuanCO, also requl�es th¢ applitdnt tor such pe�mi[ ' to tiie a si9notl stalement that he/zhe is licensetl pwsuant to the provisions of t�e Contractor's License Law (Cnapler 9,(commencing wlth SecHon �000) ot Dlvlsion 3 of IhC BUsin¢55 antl Prote55ion5'.CotlO) O/ tltat he/she is axempt lhereirom antl the ba5is tOr the allCgetl ¢z¢mption. Any vlolalion oi �SocNOn 7031.5 by any applican[ br d pormit subject5 lht dpplitant lo a dvll ��enalty of not more than (ive huntlretl tlollars (E500j. I, as owner of Ihe prope�ty Or my nmployees with wages as IbOir sola - Comp¢nsatio0, will tlo Ine work, dntl the il�uctura ii nol inlentletl o� ofteretl ior sale (Section 7044, Business� antl Protesslonal Cotle: The Contrac[or'S License Law tloe5 nOt apO�Y to an Owner af a properfy wlt0 builtls or improvei thcroon, antl who Cces suclt wo�k himselt/herseli or thrOugh his o� her own employ ees, provitletl that Such ImD/oveman[s are not Inlentlt� or Ofleretl for sHle. If, howevar, th¢ Duilding o� Improvement i5 SOItl within ona yea� oi com- pl¢tion, lhe Owner will nave tha buraan ot proving ho/sho tlitl not builtl or Im- prOve tor tho pu�pose oi Sa10). � ❑ I, as owne� of Ihe property, am aztluslvely contraCting with licensetl con- Vacto�s to ConSlruct th¢ project ISCCIIOO %044� B11510C'S5 dOC P10�255I0lIS COCB: The Contractor's LlcenSe Law doo5 nOl apply Io an ownet of pro0erty who builtls or improves thereon, antl wno contracts for such pro7ects with a con- tractor(S) liGante pursuant to the Conbactot's Llcense Law). 1 am awa�e Ihat prooi o( t�el� WOrker's Compensatfon in5uranCO ThOultl be prOvitletl IO m¢. ❑ I am exempl untler Sectlon B. & P. C. for this reason Date �'Dwner 1 hereby certify that I have reatl this application antl state thab the above iniormatlon Is mrrecL I agree to comply witn a1l tlty antl county ortlinances antl State laws rel ' g to builtlin9 construciion antl he�eby au[ho�ize repre- seniatives ol t ci y to enter pon tne ve-mentlonetl property for inspec[ion uro oses. Signature ` Date,2"�O'RS TVPE OF CONSTRUCTION I� NEW LI AOD LJ ALTERATION LJ REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. 2NSCQl.I.Oj'�Orf OF �VTC] F\�tf S TVPEOFPERMIT GRADING FOUNDATION STRVCTURAL ❑ TENANT ❑ ELECTRICAI ❑ PLUMBING ❑ MECHANICAL � �OTHER F\RG ��rt.�.�r �n L PROJECT DESCRIPTION SQ. FT. OCCUPANCV - CONSTRVCTIONTVPE VALVATIONS �OOO.O� 20NE GRADINGCU.VDS. ACRES Remarki: Preventer Irrigation Clarifiers Dishwasher, � Drinking Fountains Floor Drains ' FloorSinks - - - Gas Service Outlets I ntercepmrs Kitchen Sink Lavntories P—Trap Roof Drains Reinspection Fae � S15 Boiler Duct - Under Ground Duct - Structural Duct � Ventilating Exhaust System ❑ Muliiple Firepl/Fact &L ICBO # Heating System & Ducting ❑ 0�100,000 BTU � 100,000 Reins cti F Driverf Ucense 55 � � I Pa on ee CMF 0865-46, rev. 30/84 White � Bullding; Canary - Appllcant; Pink - Accountin9: Goltlenrotl - Assessor S15 PLUMBING $IIOW2I5 Service Sink - Sewer Cap Sewer Connection � Solar Collectors Solar Pipin9 Solar Tank Swimming Popl w/Spa Urinal � Water�ClOset Water Heater Water Service ' Auto-Wesh Laundry Trays Isue Fee Hoodar Typel ❑ Canopy Typell ❑ Refrigeration Sys[em ❑o-ioo,000eru ❑iao,000aT System Repair/Alteration Fire Dampers � Registers � Issue Fee A.P. M+ S Main Buildi E T Front B Rear A C Right K Left S Ping. Ref. # P18nning Notes: � Automatic Washer Construction Pole Sub. Cooking Uni[ Dishwasher Drvers ❑Gas ❑Elec 0798 3/12/3G Zone Parkin9 Feq./Provided ELECTRICAL Transtormer � 15-50 KW - ❑ 50+KW Fan F.A.U. Fixtures Device Boxes � Outlets Switches Garbage Dispoul Generator �0.5 KW �5-75 KW Meter ❑up to 700amps Mecer ❑over 100 amps Sub Panel Mo[ors �61 HP � 1 X- 8 Inc. Solar 09-15 HP 01615+ Microwave Pole Light Sign ; Standing Sections Trash Compactor S 3 Rainspection Fae $15 Issue Fee FEES � �DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By Buildine APProvad By _ Application luued By 5 3 IC:;or.� iL Z O N I N G R E Q M T S FEES $ 3 SUMMARV OF FEES �/� BUILDINGPERMIT $ �n2.S0 SMIP $ •s+ PLAN CHECK s 40.�3 pERMIT PLUMBING 5 �SSUANCE 3 PLAN CHECK 25% 3 ENERGY P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM $ �MECHANICAL $ . TOTALFEE $ �� PLAN CHECK 25% $ /�j�' ' CONSTRUCTION ANDPLANNING POOL .3PA � APPROVALS; Permit# Date Inspector qppROVAIS Permit# Date Inspector 1. Temporary Electrical Service or Pole • 52. Pool & Equipment Location 2. Soil Pipe-Uqdrgrnd. . ' � 53. Steel Reinforcement 3. �Electrical Conduit Uxility-Undrgrnd. � 54. Forms ; � 4' �Electrical Conduit,�Undrgrnd. 55. Electrical Bonding . 5. 5teel Reinfo�cement�� '- 56. Rough Plumbing & Pressure Test , 6: �El:ectrical UFFR Grnd. • 57. APPROVAL TO COVER-GUNITE , � 7: ;Footings ' �, . �. !� 58: Ele�trical Conduit-Undrgrncl. 8. foundatiori '� � • 59. Gai Pipe, O Undrgrnd., Test ' ' 9...,Water Pipe-Undrgbnii; �� , 60. Backwash Lines, P-Trap, O Undrgrnd. � 10.;,Structural Floqr System , 67. APPROVAL TO DECK 11. Pro:perty Sewer, Line•& House Co'nnection • .. 62. Backwash & Receptor-Final i � 12.•Sewer Cap � r ' ' � � . 63. Heater & Vent-Final 13. Rd.pf Drains ��.; i, '�.' � 64. PlumbingSystem-Final �� 74. Rough Plumbing .� ', : ' 65. Electrical-Final �� 15. Rough Electrical-Conduit 66. Solar System-Final , i6. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign. ' 68. APPROVED FOR PLASTERING 19. Rough Electrical-T Bar Ceiling � � 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT 20. Rough Factory�Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil - 23. G�s Pipe:Stough �$� Test 72. Underground Flush 24. Roof Framing •� � .73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing ! ' 74. Overhead Hydro 26. T-Bar Ceiling (StrLctural) & Monocoat . 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL �L 29. Insulatio� 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat : 79. FINAL INSPECTION 32. Electrical Power Metei-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 Ser�vice-Final 41. Solar pomestic-Final ,. 42. Backflow Preventer , 43. Backflow Irrigation , � ' 44. .Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations - %'• 47. FINALSTRUCTURE&BUILDING �j� 48. Special Requirements Completed 49. Electric Release to Edison "' ., 50. Gas Release to Southern California Gas Co '�' �' 51. CERTIFICATEOF.00CUPANCY � ' �'� No. � Date � " AOP�icant to fili in all sDaces axeepl tnosa witnin heavy Eoraer Iines antl sign ail aooroo��ata tleclaratlons. CiTY oF COS7o, M Sn CONSTRUCTIO PERMIT' � Project Address � �� (� � �� ST� � /aprylicanYs Mailin Address �j� L(�� 7 ST . t�' Owner'sName .�{� L a� ho/n/g�� S.��.�d� Adqreu �� , • ^ ��• � ' �Q-S�� Arch/En� �6 � _Licenu No. � Adqress � _�1✓1 _ e_� �F �� Ba�j Contiactor'sName�� Phone S'3G•�}jf Adqren fmailingl ^'s � p 3 City License No. —.3 �d 3 ��' 7o3'G LICENSED CONTRFCTOR DECLHRATION � I hQ�eby a//i�m lhdl I am licansea Untler provlslon5 O! Charter 9(�pmmancing with 5ection 7000) of Divlsion 3 of tno 6usiness antl Professlons Cotla, a my license K fn full torce itacl. ' �� y./� Lic¢nse Q s � Date�Z` 99�ature , WORK RS' OMPENSATION U LARAT nereby affirm that I have a certi/icate ol mnsent to selbinsure or a certlliwte �� Warkers' Compensation 1 surance, oi a certified-copY thareot;(Section 3800, �ab.�� ry�� / ' � PoqCy No. •�d /�� Comoany_ ertiffeA copy is hereby IurnisheE. � Certitie opy f d with Ihe city� nie � a e APPlica�t EXEMP ION OM WORKERS'�CO ENSA DE LARATI � (This sectiOn ne¢tl not be COm0lete� if the perm i5 ior onC huntlr¢ §100) Or less). I c4rtily that In the pe�formance of the wo�k fo� whlch thl5 pe�m�t is izsuetl I sha�l no[ emplOY any persOn in any mannCr so a5 to become Subjecl t0 t{�e Workers' Compensatlon Laws oi California. Date $ignature � 'NOTICE: Ii, aRer making this tleclaraUon, you zhoultl become subjecl to the Worke�s' Compon5alion OrOvI51on5 Of the Ltbo� Cotle, y0u mu5t �ortbwith co�hply wi�h suc� provl5ions Or tltib pOrmil s�ali b0 tleemeG revOkCtl. CONSTRUCTION LENDING AGENCV ' � I hpreby aftirm that tnero Is a conztructipn lentling agency for tha periormanco , Of the work for wnich th15 Oermit is ISSUCtl .($ection 3097 Civ. C.) I_eqaer's Name . �enEer's ACtlress OWNER BUILDER OECLA0.ATION ' I 4¢reby dfllrT that I am oxempt irom the ConVactOr's Lic¢n5e Law tar the /opowing rea50n (Section 7031.5 Bu5ine55 antl ProfCsslonal Cotl¢: AnY UtY or county wnlch requires a pormit to construct, alter, improve, tlamolish or repair dny stru[tur0, prlOr to 1�5 I55udnce, DI50Iequbes the appllcant lor Such parmi[ IO 1i1¢ a Signed SlatemGnt thdt'he/she Is IICCn50tl pursuant to the prOvlsioni ot Ihp Gontracior'i U�ense Ldw (Chapte� 9(commencing wilh $eC[ion ]000j of OiWsion 3 ot tne Businass antl Professions Cotle) or that ha/she is ezempl 'nptefrom anE thG Da5i5 f0/ lhe allegetl exemption. Any vlolation of SectiOn ]031.5 by any applicant fOr a permil Subject5-tlte appllCant to d Clvil � �¢nalty ot not more thdn tiv¢ huntlretl tlollars ($500). � �� as owner ot the O/OpertY or n1y empinyees with wages as Ihei� SOIe compensatlon, will tlo the work, antl fhe structure is not intentletl or of/eretl toY wIC (Se�4on 7044, Bu5ine55 anG Profe55iOndl Cotle: The Contractor's License,Ldw tloes mt aoDly to an owner ot a oroperty who Duiltls or imoroves the�eon, antl wM10 tloe5 Such work himsolf/M1erself or [n�ou9h hiz o� her own emo�oyees, proviGea thal such Improvaments are not intentled'or oHeretl for sale. Ii, howaver, tne bullqin9 or imorovament is soltl wit�ln one year ol com- o�eilon, tho owne� wUl have tne burtlen ol p.oving he/sho tlitl mt buila or Im- �Ove tof [hC pulpo5e 01 zale). , , 1, as owner ot tbe proper[y, am exclusivoly contraclinq with IicenseC con- trdctorstd construct the project (Sectlon ]044, Businuss antl Pro/essions Cotla: Thu ConVactorY Licenso.Ww dOes n0[ appry lo an owne� OI pmperty who bUiltls or Imp�ove5 Ihe�oon, antl who coMracts for such pr0)etls wlth a COn- lr8clor(s IlcGnsn pur5uant�to lhc Conbactor'S UcCnse Law) I am aware tbat P�oOf o� thair WOrker's COmpanSation Insuranta ShOWC be prOvlaGtl to me. ❑ 1 am eaempt untler SecUon . B. & P. C. lor this reason D'ote Owner _, I tiereby <ertity that I navo reatl this �ntormatlon IS tortec[. I agree to comp aotl State laws relali to builtlin sentatives oi tnis oi inspec[ion D Slynature Drivers' Li nse o n TYPE OFCONSTRUCTION, LINEW LJ ADD U ALTERATION IJ.REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OT R DESCRIPTION OF�W�qF�iK1MbE-AF�6- ��%G��DUA7I7 F!1?�"��.K 1.,1 1 --s TVPEOFPERMIT IJ GRA�ING �FOUNDATION STRUCTURAL ❑ TENHNT ❑ ELECTRICAL ❑ PLUMBING ❑ MECMANICAL ❑ OTHER PROJECT DESCRIVTION 5a. FT. oCCVPn�N�Cv_�� j�J'� CONSTRUCTION TVP� ' VALUATION $� ZONE GRADING GU. VDS. ACRES marks: � Bar Sink r Beckflow Preventer � � � Backflowlrrigation ' Bathtubs Clarifiers � ' Dishwasher Drinking Fountains � ' Floor Dreins . ' � Floor Sinks ' � GasScrvice Outlets Interceprors Kitchen Sink � Lavatories P—Trap Roof Drains Reinspection.Fae $15 Boiler Dutt - Under Ground Duct - $tructural - Duct � Ventilating Exhuust SYstem � Multiple Firepl/Fact. Blt. ICBO �`- Heating System & Ducting , ' ❑o-ioo,000eru�ioo,000 ' � Showers Service Sink Sewer Cap � Sewer Connection Solar Collectors Solar Pipin9� Solar Tank � Swimming Pool w/Spa Urinal Warer Closet � - • Water Heater � • 6Vater Service Auto�Wesh . Laundry Treys ; � Issue Fee Hood or Typel ❑ Canopy Type II ❑ A.P. •/k S Main Buildi E T Front B Rear A � Right K Left S Ping. Ref. # Planning Notes: � Automatic Washer ' Construction Pole Sub. CAoking Unit � Dishwasher ' Dryers �Gas ❑Eleci Fan F,q,U. . Re(rigeration Sys[em � ❑aioo,000sru ❑ioo,000 ❑ System Repair/Alteretion Fire Dampers Registers , , 5 3 FEES Reinspection Fee I S15 I I Issue Fee, I $ 3 CMF 0065-46, rev, 10/84 White - Builtling; Canary - Applicani: Pink - Account7n9: Golqenrotl - Assessor " 96G4 2/<".Q/36 � Zone Actessory Building: Parking Req./Provided ELECTRICAL � , Transformer ❑ 75�50 KW ❑ 50+KW Meter ❑up ro 100 amps � Meter �over 100 am�s 0 Device Boxes OuUecs Switches Garbage Dispoul Generator �0-5 KW 05�15 KW Fee Sub Panel Motors �61 HP � 1'h - 8 Inc.Solar �9-15 HP 016-75+ Microwave Pale Liglit ; Standing Sections TraSh Compactor laue Fee ;DEVELOPMEN7 SERVICES REQUIREMEN7S: Zoninq Approved By Buildirtg APProvetl BV � �� :�o�.� I�. FEES $ 3 Z O N I N G R E Q M T, S SU�jry��q,R� �p/� FEES BUILDING PERMIT S � "" SMIP $ • �� PLANCHECK 5 �yDJ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% § ENERGV P.C. $ , ELECTRICAL $ GRADING $ PLANCHECK .50% $ '- MICROFILM $ MECHANICAL $ � TOTALFEE $��,3�iE3 PLAN CHECK 25% $ � . , . - CONSTRUCTION AND PLANNING � ' P�L�� 1 SPA APPROVALS Permit # � Date`� Inspecior qppROVALS Permit # Date Inspector 1. Temporar�y�Electrical $ervice or Pole� i 52. Pool & Equipment Location r 2. Soil Pipe"Undrgrnd. . ..�. �' 53. Sreel Reinforcement " 3.'Electiical,Cpnduit�,Utility-Undrgrnd.� " 54. Forms '• � � 4.,Elect icahCond'uit-Undrgmd. �� % 55. Electrical Bonding , 5.` Steel�Reinfo`rcement �� 56. Rough Plumbing & Pressure Test , 6.lElectrical, I�FER%Grnii:, �'- 57. APPROVAL TO COVER-GUNITE � 7.�Footings' '! �� •) �,� !r � � ! 58. Electrical Conduit-Undrgrnd. � f ,: , 8. Foundationj �� i' � f 59. Gas Pipe, O Undrgrnd., Test �,' �• ; 9,Water Pipe-Unilrgrnd.^. �`��r , 60. Backwash Lines, P-Trap, O Undrgrnd. � ii 10. Structura� Floor System �! ,'' �' 61. APPROVAL TO DECK 11.'Property Sewer Line�& House Connection ' � i , , ,` (� 62. Backwash & Receptor-Final 12. Sewer,Cap ' ' . •' ? ' •� 63. Heater & Vent-Final � �' ,r' � � ' �� /�t 13: Roof Draihs�'.' ` � • `� ��, �'J •% 64. Plumbing System - Final %- 14. Rougti�PlumbirL`q}� ��' � 'I 65. Electrical-Final % .15. Rough' Electric�l-Conduit 66. Solar System-Final ' 1'6. 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 ��S/�� 22. Ducts, Ventilating 71. Product Piping OGas OOiI 23. Gas Pipe-Rough & Test 72. Underground Flush L�^� ! . � C 24. Roof Fiaming 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. FIRE PREV. FINAL � 1,� 30. Drywall Nailing �'� HEALTH DEPT. REQUIREMENT � � 31. Plaster Brown Coat ;i 79. FINAL INSPECTION n i 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heatin9 & Air Conditioning � � -� � 35. Final Gas Pipe-Test 36. Hood or Canopy � 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final � 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation ' 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING ' 4S. Special Requirements Completed 49. Electric Release to Edison � • 50. Gas Release to Southern California Gas Co � � � 51. CERTIFICATE OF OCCUPANCY . No. Date , Ci�y of Costa Mesa Developmen� Services Department Builtling Safety Division P. O. eox 1200 Cosia Mesa, California CERTIFICATE OF OCCUPANCY No. 00��4�3 The Building locatetl at 67f1 4.''�ar 17th SYroAt. Cnitw Ca has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group c� Occupancy. Use of Building .M.Ini Crnrano Legal Description e�d_�RiJl1 (See reveru side for Metes and Bounds) Building Permit No391A4A.AP927d2 Electrical Permit No.E?.1<177.F.23b02 plumbing Permit No.R21477,F,29602 Mechanical Permit No. h� ZZ%� Number of apartments and/or guest rooms ISSUED T0: Pacific Mesa Prppsrties u%0 W. 17th StCeSt� Ste. C2 �osta M.asa. CA 92627 Building Official William T. Howard � --^ by 1�. ..� i l .� . Date Aotil 9, 1986 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 1015-46 rev. 1/83 White - Owner, Canary - Numerical File; Pink - Bltl9. Permic File � � � Applicant to fill in all spaees excapt those within heavy boraar Ilnas anE sl9n all prapriate Geelaratlons. CITY' COSTA MESA CONSTRUCTION PERMIT �Pro�e��s �� N. 17th $t�^i:et � y ApplicanYsMailingAddren �y0 �•J. 17th Street OwneriName Marshall Duffield Pho�e645-6811 Address �9�..�: �17th Streei:, COSt� ��eSd C� yzb2% A,�niE„9.E3anzue'lo/Rierson Int: ��e��eNo. �-11901 Address 3n1 N. ftam��art St. Suite F Urange, �i� - Contractor'sNamP'<rause Construction Pno�e�36-1429 Addreulmailing) �� 1 fl ori Bcl City License No. C�1 92646 �ICENSED CONTRACTOR DECLARATION � ` 1 he�eby aifirm Ihat I am Iicensetl untler provi5iOn5 oi Cha�te� 9(commencin9 with section �000) of DlviSion 3 ot tne Buslness antl Professions Cptle, antl my license Is in /ull force a tl at(ect. Litense elass �� No � 7 7�/S/ Da[eT � �—�� Si9nature ��"� WORKERS' COMPENSATION DECl/1RATION ' hereby atiirm tnat 1 have a cerNflcata ot content to self-Insure or certilicate �f Workers' Compensation nsurance, or.a certifi copy t e f(SeFtion �� 3800, Lab. GQ� ��.�� 1�.' Company-� � � PolicY No.�� p�. I�Ceriifietl copy is nereby furnishetl. � Certifietl copy is flletl with the <ity Bu' `ngbiv' lon. Date //-/i,�� ADPIi<ant / EXEMPTION FROM WORKERS' COMPENSATION D CLARATION (This section neetl not be completetl 11 the Oerm�t is for one hundre0 ($300) or less). � ' I certify that in tne pertormance of the work for which this permit is Issuetl, 1 shall not employ any perzon In any manner so az to become subject to the Workers' Compen5atlon LawS of Cdlifomia. �� ate Signature � 'NOTICE: I(, after making thistleclaratlon, You shoultl betome subject to the Workers' Compensation provisions ot tne Labor Cotle, you mus[ Porthwith comply with such O�oNsions or lhii permil shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV I hereby affirm tnat lhero is a constructlon lentling agency for the pertormance� of the work tor whith this permll is ISsuetl (Sectlon 3097 Civ. Q) Lentler's Name � LenOer's Atlaress OWNER BUII�EN UECLARATION ' I hereby af8rm that I am exompt irom the Conlractor's License law for the tollowin9 reason (5ectlon 7031.5 Buslnass antl Professional Cotle: Any cl[y or munty whlth requires a permlt lo conSVucl, alter improve, tlemoll5h Or repalr any sl�uClWu, P�lor [O Its I550ante, alio reqWr¢5I{�e apP��ant (Or such parml[ to tl�e a si9notl sta[emenl that ho/she I5 Iicensetl pursuant to the provisions of the Contractor'z LicanSe Law (Chapter 9(commoncin9 with SecUon 7000) of DlviSion 3 0l thC Bu5in055 antl ProfC55ions COtle) Or [hat be/she I5 exempt Inerefrom antl tna bazis lor the atlogetl exomption. Any vialation ot Section 7031.5 by any appllWnt lor a Po�mlt sub�ecls the ap011canl to a civil �enalty oi not mo�e than Ilve huntl�atl t1011a�s (5500). I, as ownor o1 ihe p�OpCrty Or my ampl0y0l5 with wa9es ai thei� sola compensation, will tla tha work, anC [ho s[ructure Is not Inlentletl or otteretl br sale (Se<tion ]044, Buiinass antl Prole55ional Cotle: The Contractor's Licenu Law tloes not apply lo an owner of a property wno builtls or ImOroves theroon, antl wno tloe5 sucb work himsalt/her5elt or through his or her own ¢mO�oyCes, O�ovitl¢tl thal Suth ImprOvemant5 dr0 not intentloa or oflered for sale. If, howevar, tna bulltling or improvoment is soltl witnin one year of com- pletion, tho ownar will navC th¢ burdOn ot prOving he/Sh0 tlIG not builtl o� IT- �rom for tna putDose of sale). I, as owner o1 Ine prOperty, am axCluSively con[tacting with IlcenSG� con• I�aclO/5 t0 const�ucl the p�ojGtl ($¢CtiOn 70A4, Buslne55 dntl PrOlessiOns Cotle: Tho COn�tattor's Llcanio Law dOes not dppiy t0 an owne�.o1 prOPe�ty wh0 bulltls or Imoroves theraon, ana who contracts tor such projects with a con- tractor(51 IlcenSa puRuant to tno ConVactor's Litense Ldw). I am aware that proof of [heir Wo�ket'S CompansatlOn Inzutanco ihoultl be prOvldetl to ma. ❑ I am axempt unaer Sectlon B. & P. C. tor tnis reason Date Signatura K /-�i Drivers' LI__..,,. _ _ . Owner hava reatl this apo��catlon antl state lhat the above agrea to <omply with all dty antl coun[y ortlinances o bulltling conStruction, antl b¢reby authorize repr¢- t0/ �¢nter upon th0 abOva-mentioneC /proPerlY fl LGLqj�/ Date"� TYPE OF CONSTRUCTION IGl NEW U ADO U ALTERATION LJ REPAIR ❑CONVERSION ❑OEMOLISH ❑OTH�,Rni-.;tora e AP# � DESCRIPTIONOFWORK/USEOFBLDG. y S Main Building: E TVPE OF PERMIT GRADIrvG FOUNDA710N STRVCTURAL T front ❑ TENANT�� ELECTRICAL � PLVMBING � MECHANICAL A Rear � ❑ OTHER � PR0.IECT DESCRIPTION SO. F7. 14.�S�O � OCCUPaNCYg-2 C RigM � K � CONSTRUCTIONTVVE�I_f�_S+j�j.alC-]..e��/ALUATIONS�p�- S Lefl � ZONE GRADING CU:YDS. ��353�� Ping. REf. #�� Remar�: EZU1 � dl (19 C'4 ' lj ��'f � RC� Planning Notes:_ �� Sink Pieventer Irrigation Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors ' Kitchen Sink Lavatories Roof Drains Reinspection Fee � $15 Duct � Under Ground Duct - Strucwral Duct - Ventilating Exhaust System ❑ MultiplB ❑ Firepl/Fact. Blt. IC80 # . Heating System & Ducting ❑0.100.000 BTU 0100.00OBT Reinspection Fee � $75 CMF 0865-46. �ev. 30/84 Whita - Bulltling: Canary - Appllcant; Pink - Accountin9; Goltlenrotl - Assessor Servite$ink � Sewer Czp�, ; ' Sewer Connection. �-" Solar Collectors • ' Solar Piping, �l Solar Tank�� Swimming Pool w/Spe Urinal . Waler Closet Water Heater Water Service Auto-Wesh Laundry Trays • laue Fae Hootl or Typel ❑ Canopy Type I I ❑ Re(rigeration SV�em 04100,OpOBTU 0100,000 Syztem Repair/Alteration Fire Dampers Registers laue Fee FEES S 3 FEES $ 3 Automatic Washer Construction PoleSub. Cooking Unit D ishwasher Dryers ❑Gas ❑Electric Fan F.A,U. Fixtures Device Boxei 0 3�10 I./Ii;/��: � : % � �a�a G Accessory Building: Z O N I N G R 7arking Req./Provided E ',' ,.;��.� ' _ M i S ELECTRICAL / � Transformer ❑.15-50KW ; 050+KW . Meter ❑upto.100amps, ' Meter ❑over100amps . Sub Panel ' Motors �0.1 HP O 1 X- 8 Inc. Solar �9�15�HP.�76-15+ Microwave �% Pole Ligh[ ; o........ _ . • Switches .�, Garbage Disposal Generator �0.5�KW �5�15 KW 7 i I� • /' . Reinspection Fee , '$15 DEVEIOPMENT SEHVICES REQUIR � Zoning Approved By'� Building APProved BY —1.4 Sign � i� Tiash laue Fae FEES 5 3 � SUM ARV OF FEES ' BUILDING PERMIT $ :g S� U SMIP $ «.�15 �j BLAN CHECK $ � Z PERMIT , PLUMBING ', ; $ ' ISSUANCE $ . PLAN CHECK 25% .$ ENERGY P.C. $ ELECTRICAL � $ � GRADING $ PLAN CHECK 50% ,$ ' ' MICROFILM $ MECHANICA'L � $ � � TOTALFEE $ /0 p�. ,4'1 . PLAN CHECK , 25%- �$ r� : $ONSTRUCTION AND PLANNING APPROVALS Permit# ` 1. jTemporary Electrica� Service or Pole 2� Soil Pipe-Undrgrnd. 3. ElectriCa Conduit Utility-Undrgrnd. 4. Electrical Conduit-Undrgrnd. 5. Steel Reinforcement (�(/� y.l�! 6. Electrical UFER Grnd. i �: �;*�- �.gl� •� 8. Foundation� s� Y� 9. Water Pipe-Undrgrnd. 10. Structural Floor System 11. Property Sewer Line & House Connection 12. Sewer Cap 13. �Roof Drains 14. tRough Plumbing 15. Rough Electrical-Conduit I1 16. Rough Electric Wiring I17. Rough Wiring Sign 18. Rough Electrical-T Bar Ceiling 19. Rough Heating & Air Conditioning 20. �Rough Factory Fireplace 21. Ducts,in Structure 22.-Ducts, Ventilating 23. Gas Pipe-Rough & Test 24. Roof Framing � g� � 25. Roof Sheathing �7 '� �(� 26rT-Bar Ceiling (Structura�) & Monocoat �. 27. Frameand Flashing '� 28. Lathing & Siding , 29. Insulation 1 ,30. Drywall Nailing II 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 Faaoiy Fireplace •. � � 38. Final Plumbing' . . � 39. Water Service-Final - : 40. Gas Service-Final � 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation �� 44. Landscape Irrigation System' 45. Sound Attenuation 46. Handicap Regulations � 47. FINAL STRUCTURE & BUILDING ��. 48. Special Requirements Completed 49. Electric Release to Edison I 50:'Gas Release to Southern California Gas Co Date Date 0 . z-ati -2-8G POC. _ .. SPA Inspecior qppROVALS Permit# 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical Bonding �% 56. Rough Plumbing & Pressure Test �� 57. APPROVALTOCOVER�GUNITE 58. Electriral Conduit-Undrgrnd. � 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, O Undrgrnd. 61. APPROVAL TO DECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System - Final 65. Electrical-Final 66. Solar System-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit# 70. Underground Hydro 71. Product Piping �Gas ❑Oil 72. Underground Flush - 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical ' 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: ' �OLD FOR SP '«,'�"'.' e �f Date � Inspector I Aop��cant to fill in all spaees except those within neavy Doraer lines ana sign all apProoriate Ceclarations. cI7Y OF COSTn /MESA CO�N�S)TRUCTION PERMIT Proiect AdAress �y7� C.!/ �� Ar.�ficant'sMail�i�nyy/A,d,dJresrs �y6 c��7� sr� Owner's fJam/e �/t/^y�/l��,�•�+��Phone�j Address �,/�{!� � �� 6:I s%�� Address �L/ �/SC/f�� 1�1d'.I'FGY'i ��'/7�[� v�C/S'd Convactor'sNnme!�rv�� C'9�xSp � Phon � g Address (mailingll✓S�S(�✓�!dx �+ r City License No. � 3 `.a-9� LICENSED CONTRACTOR DECLARATION I M1ereby alfirm [ha[ I am licensetl untler provislons of Charter 9(commencing with section ]000) of �Divlsion 3 of Ihe Busin¢ss antl Protezsions Cotle, ana my license is in full torce antl ct. ��r� �_ i./ License C ss �a No. - X� V Date � Signa[ure WOR ERS' OM ENSATION CLARA, � hereby affirm that 1 have a certi(icatu of E'onsent to selbins re or a certificate ,f Workers' Compensation In�ance, or a certlfietl copy tnereof (SecHon 3800, Lab. C.1 p q G� 7�ompany �Z 'v Policy o. L � /6 ` rtifl¢tl <Opy iz h¢reby (umisM1etl. CertHie y's i with the city B' ing D' . / ' �ale_ APPIi EXEM ION OM WORKERS� N D LARAT (Thi55eClion neetl not be completetl if the pe it i5 for One huntlr ($100) or � IessJ. 1 certify Iha[ in tM1e perto�mance of the wOrk tor whiGh Ihis p¢rm�t i5 issue�, 1• shall nOl employ any DCrSon in any manner so az to become subject to�the , workers' Compensation Laws of Calitomia. , Date � Signature ' ' 'NOTICE: If, S�ter making this tlecla�alion, you shoultl bewme Subject to�the Workers' COmpensatlon provi5ion5'Ot the Labov COtlC, you must fortM1with comply wlth such proviSions or [M1Is ,pe�mit shall be tleemetl rOvoketl. CONSTRVCTION LENDING AGENCY ' � I heteby atfirm Iha5yp� re is a cons[�ucllon lentling a9en�y-t�r lhe pe to�mance o� the work f6r 1" b i e� t�� i �&tl '( 9c' h Civ. CJ LenOer•s Name Lentler's ACtlress _ � OWNER BUILDER UECLARFTION � � I hereby atiirm that I am ezempt trom the Cantractor's L ense Law for tna following reason (Section 7�31.5 Business antl Protesslonal Cotle: Any city ar county which requir¢5 a permit to con5truct, alter, improve, tlemolish or repair any siructure, prior to�lts izsuance, also reQuires the apo�icant tor such permil to tile a Slgnetl ztatement thathe/she i5 licensetl pursudn[ to (he Orovi5ion5 of �he ConVaclor's Litenze Law (Chapler 9(commencing witM1 Section �000) of �ivision 3 of the Business antl Protessions Cotle) or that ne/she iz exempt �erefrom' and tne basis for the alleged exemptlon. Any violation of Section /031.5 by any applicant for a pormil subjects the applicant to a civil �enatty of not more [han �ive nuntlretl tlollars (E500). 1, as owner of the ProOe�ty or my employ¢¢z with wa9es d5 th¢I� sole mrtfpensation, will tlo Ih¢ wo�k, antl Ihe SVuc[u�0 Is nOt Intentled or otferetl for wle (Section 7046, Busine5z antl Protessional Cotle: The Gontractor's LicenSe�Law tloes not apply to an owner of a property who builtls or improves thereon, antl wno tloes such work nlmself/herself or through his or her own employees, provitletl tnat such improvements are not Intendetl or ofieretl for sale. It, nowever, [M1e bullding or•imProvement is solG witM1in one year of com- pletlon, Ihe owner wlll M1ave the burtlen of proving he/she tlitl not builtl or im- prova for the purpose of sale). ❑ I, as owner ot the o�operty, am ezciusively contracting witn Ilcensetl con- lrattOrs lo <ons[�ucl lhe project (Section ]044, Busine55 dntl Professions Cotle: The Contractor's Llcense Law aoes not apply to an owner oi properlY who builas or improves Ihereon, antl who conVacts for zuch pmjects with a con- tracto�(51 license pursuant to tne Contrac[or's License Law). 1 am aware that proof o/ thei� Worker'S Compensatlon insuranCe shoultl be p�ovltletl to me. ❑'1 am axempt uritler Section B. & P. C. (or [bis reason Date Owner I hereby certity tnat 1 have reatl thiz application ana state that tne abov¢ inbrmation is to�r ct. I agree to comply wi[h all City antl county orCinanGes antl state laws yQ2ting to byytling constructian, antl hereby authorize reDre- sentativez o( �s Uty�p�etrter upon the above-mentionetl property for ��:�Z `7/-�2 I N� ,uessF I%�oeo�.so7 ��.I C TVPE OF CONSTRUCTION ' NEW AOD ALTERATION LJ REaAiR ❑ CONVERSION ❑ DEMOLISH ❑ OT E O SCRIPTION OF WOR /USE OF BLOG. �� -�d � L �'f�,4,u4'E- eE �.r-�c�vs -> Aaoi7: o cE , rtc� TVPEOFPERMIT ❑ GRA�ING FOUNDATION STRUCTURAL • ❑ TENANT LECTRICAL ❑ PLUMBING ❑ MECHANICAL �.OTHER �P /// � S (j�_�� PROJECT DESCRIPTION 5 FT. � � oCCUaarvcv ' CONSTRUCTIONTVP� � ALUATION§ %QOOv� ZONE GRADINGCU.VDS. ACRES Remarkz: f.�./� ji� C1 �.(� �r�ri� �� /� T �. c-• l{j�� ! �' F Sink � kflow Preventer � kflow Irrigation �rinking Fountains loor Drains � loor Sinks � � idi�$2fVICQ . �UiICtS nterceptors ' ' - :itchen Sink ' �.avamries� ; —Trep ' ioof Drains Reinspection Fee � $15 Boiler Duct- Under Ground Duct - SVuctural Duct - Ventilating Exhaust SyStem � Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑0.100,000 BTU �100,000 Reinspeaion Fee CMF 0865-46, rev. 30/84 White - Builtling�Canary - Applicant; Pink - Accountlng; Goltlenrotl - Assessor S15 Sewer Cap Sewer Connection Solar Collectors � Solar Piping Solar Tank . Swimming Pool w/S� Water Closet Water Hearer Water Service • � �Auto-Wash . Laundry Trays A.P. qW 'Z S Main Building: E D T Front � AReara, � C Right � K Left S Ping. Ref. # �R Planning Notes: m FEES �W I 07 (�O(1(J ' E Automatic Washer � ConstructionPoleSub. Cooking Unit DISf1W85f1Cf ' Dryers ❑Gas-��Electric Fan .'1,'.� ' F.A.U. � DEV ICC BO%CS Outlets � ' 2 Q Switches - ' Garbage Dispoul . . Generator �65 KW lauo Fee ' - $ 3 ' IANICAL FEES Hood or, Type I ❑ CanOpy Type I I ❑ Refrigeration System Oo-ioo,000sru ❑ioo,aooaTu System Repair/Alteration � Fire Dampers Registers Issue Fee � � $ 3 Fea 9312 2/13/(in Accessory Buildin9:. Parking Req./Provided 1G�Of�- T4. Zane MG Z O . N I - N G R � • E Q M T S FEES , Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100�amps � �Merer pover 100 amps, Su6 Panel Motors �0-1 HP � 1 X- 8 Inc. Solar �9-15 HP �16-15+ Microwave � � Pole Light , Range . ! Standing Section 5-15 KW Trash Compactor $15 �Issue Fee . DEVELOPMENT SERVICES REQUIR Zoning Approved By .' � Buildine APP�oved By $ 3 2.i36� � SU MARV OF FEES BUILDING.PERMIT $ 2� O SMIP • $ O.SO PLAN CHECK $ � PERMIT PLUMBING $ �00 ISSUANCE $ PLAN CHECK 25%; S� �' SO ENERGV P.C. � 5 ELECTRICAL 5 GRADING $ PLANCHECK 50°6 $ ' MICROFILM $ ' MECHANICAL �$ TOTAL FEE $ D . I�L PLAN CHECK 25% $ '� CQNS7RUCTION AND PLANNING POC . SPA �' App�{pVALS Permit# � Date Inspector qppROVALS Permit# Date Inspector 1.. �emporary, E,iecirical $ecvice or Pole ��, 52. Pool. & Equlpment Location 2. Soil Pip �� ndrgrnd. � ' 53. Steel Reinforcement . i. 3. �Electrical�Cdnd°uiY�Uiility-Undrgrnd.:' �'`r� 54. Fo�ms 4.-�Electrica(:Cbnduii-Undrgrnd. �� 55. Electrical Bonding � �. . 5. Steel Reinforce}nent; ;' 4'f f , f. 56. Rough Plumbing & Pressure Test ' r 6.-Electrical,UFER.Grnd.' � �'., .'' 57. APRROVALTOCOVER-GUNITE .�_-�,� 7. Footings,- -� ' _ � `- : ; � :.� 58. Electrical Conduit-Undrgrnd. � .` �. ,: 8.�Foundation�' )�. �:,i �a'�'� � 59. Gas�Pipe, O Undrgrnd., Test � 9.�,Water Pipe-Undrgmd�-. , �� 60. Backwasli Lines, P-Trap, O Undrgrnd. 10.�Struct�aS:Floor System �� y '�,- :,� !� 61. APP.ROVAL TO DECK 11., Property'$ewe�,..Line.& House Connection ��- 62. Backwash & Receptor-Final , 12. Sew�r CaP �.,-, �,1 % {.' �' ".. ,�: 63. Heater & Vent-Final 13 %-Roof Drains .� . . ,.� i • !' � � � 64. Plumbing System - Final _ � � 14:'`Rough'Plumbing � {� � � /! ' 65. Eleat'rical-Final ' � ,i 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 20r Rough Factory:Fireplace ,(;C APPROVALS Permit# 21.'Ducts, in Structure . �� 70. Underground Hydro 22. Ducts, Ventilating, � �' ' 71. Product Piping � Gas ❑ Oil � 23..Gas'Pipe;Rough &��Test � ; - , 72. Underground Flush 24. Roof Framing �' _ ., 73. Undergrnd. Storage Tank 0 Gas ❑ Oil 25. Roof 5heathing .. �� 74. Overhead Hydro 26.- T-Bar'Geiling (Structural) &�Monocoat 75. Dry Chemical 27. FrameandFlashing �i' �� 76. DryStandpipe . 28. Lathing'& Siding' 77. FIXED SYSTEM FINAL 29; Insulation 78. FIRE PREV. FINAL 30.'Drywall,Nailing � - ��.i HEALTH DEPT. REQUIREMENT 31. Plaster,�8rown Coat,.� i? 79. FINAL INSPECTION � 32. Electri�:al Power Mete� �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 i v j3� � 39. Water 5ervice-Final � � 40. Gas Service-Final � � � 41. Solar pomestic-Final . 42. Backflow Preventer . � ' . . � : i�W 43. Backflow Irrigatlon - ' 44. Landscape Irriqation System � � 45. Sound Attenuation . 46. Handic8p Regulations 47. FINA� STRUCTURE & BUILDING � y)�� ;��,,� • 48. Special Requirements Completed � �� 49. Electric Release to Edison ' , 50. Gas Release to Southern California Gas Co � 51. CERTIFICATE OF OCCUPANCY " IVo. Date � � ADG��canl to flll in all fpaces excep� t�ose wil�in heavy noraer Iines ana sign all aporooriate aeelantions. CI7v� F COSTa MESA CO(�STy1UCTION PERMIT/f....Gc_.�' j�Froject Address �7O � �1 J7� �/N� S!O/tA�C� �cc 'Applicant's Mailing Addre 5 /'¢i�Z 2. � ��, Owner's Name �� !7� !�- � Phone Address � 7� � �! S �b �g/�'«f�i Arch/Eng. License No. Address Contracwr's Nam -- 0 NC hone Y AddreulmailinglCgi�L Q�c[�, i.e�� ii/Q /Ia� City License No. � Z $9 7 LICENSED CONTRACTOR DECLARA710N � I hereby affirm Ihat I am Iicensetl unaer provisions of Cnarter 9(commencing with section 7000) -of Divlsion 3 of the Business antl Professlons Cotle, antl my Iicense iz in full brce antl eHect. LicenSeClass ' L)'�ens o�-�8�7� Date�LQi'��519 l ' ��(�' _�--In' WORKERS'COMVENSATION OECLA ATION �� I.hereby affirm that I have a certlflcato o� consent to selttinsure or a certlflcate oi Workers' Compensation Insurante, or a certifietl copy tnereof (Section 3800, Lab. C.) G ��tN �"AS ��' Policy No. kLS ' OU Y/ 8 Company _—T_ �CertitieC copy is hereby fumis�etl. Certifietl'copy i1 fl etl with the city�ding Div�'Sy'° DateKOV 4- 23� qpplicant -�b(• �—' � 4- EXEMPTION FROM WORKERS' COMP NSFTION DECLARATION (Tnis section neetl not be completetl i/ tlte permit is for one huntlretl (5100) or less). . I cerlify tha[ in the parformance of the work fOi which this pe�m�l i5 issuetl, I sM1au not employ any person In any manner so as to becoma suoject to tha Workers' Comoe�saHon Laws ot Calitornia. . �ate Si9nature - -' ' 'NOTICE: 11, afler making this tleclaratiqp, you shoWtl oecome subject to tho Workers' Compensation provisions o/ the Labor Coae, you must forthwith' comply wiih such provislons o� thig pe�mit shall be tleem¢tl �evoketl. CONSTPUCTION LENDING AGENCV • I nereby atflrm thal there Is a constructlon Ientling agenty tor the performance of Iho wark tor wniCh Ihls permit IS ISsuetl (Section 3097 Civ. C.) Lentler'i Name � LenEer's Adtlress - -- - OWNER BUILDEN UECLARATION I hereby alflrm that I am axompt trorr� the Contractor'S Ucense Law for the tollowin9 raason (Sectlon ]033.5 Buiiqoss antl Professional� Cotle: Any city or �n 7031.5 by any ap0��ant tor d P¢lTILSUO�eCtS [no, appncanc m a avu �enalty o/ not more than tiv0 hund�etl qpila�i (5500). � ' I, ns ownor of llia P�oparty or my emplOy¢85 witn wag¢5 as thair sole companSaUon, will tlo tne work, antl the slructure is nol Intentletl or ofteretl /or salo (Saclion 7044, Busine5s anC Prolessional Cotle: The Contractor's License Law tloes not apply to an ownar ot a property who builEs or Improves thareon, antl who tloes su<n work nimselt/nerselt or throu9h his or her own employees, provltlod that such Im0�ov4menl5 are.not intendetl or offeretl for sale. If, however, tha bulltllnB ar Improvament Is soltl within one year of com- pletiOn, IM1e ownor wlll hdve lho bu�tleM1 Of Orovin9 h¢/she tlid not bulltl or Im- �rove forthn purpoio oisale�. . LJ I, as ownar oi the'oroDerty, am exUusively contracting wltn Iicensea con- tractors to conitruct Iha prOject (Seclion 7044, Business antl ProfeSsions COde: The Contrac[or'S Licensa Law does not apply to an owner of proparty who bulltls or Improves tneraon, antl who tontracts for such projects with a con- [ractor(s) Ocense pursuant�to tho�Con[tactor's Li<anse Law). I am aware that proof o( lnalr Worker's Compensatloq InSurance Shoultl be provitled to me. ❑ I am exempt untler Section B. & P. C. for thls reason� �ate Owner I hereby certity that'I have reatl this application antl state that the aDove- intormation is correct. I agree to comply wlth all city antl county ortlinances antl state laws ralating to Euiltling construction, antl hereby authorize rapre- sentatives of t city to nt upon tha aDova-mentionetl Oroperty for Inspectlon ur s • /� � Signature i��+�u 4 Date�.lOV q B.� . �� , _ �-- Drivers' L- or 55 e TYPE OF CONSTRUCTION I�l NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTfiER q,p,.h6 DESCRIPTION OF WORK/USE OF BLDG. 1 1Zr�.tTf]l L� Nl� �-- / S Main Buildi E TVPE OF PERMIT GRADINGOI FOVNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICFL l�J PLUMBING ❑ MECHANICAI B Fear . ❑ �OTHER A' PROJEC7 DESCRIPTION 5Q. FT. ' oCCUPANCY C Right K Lett CONSTRUCTION TVPE VALUATION $ $ ZONE GRADING CV. YDS. ' ACRES Ping. R¢f, i� Remarks: � �. , � Plannin9 Notes: low Preventer low Irriqation ihc Drinking Fountains � Floor Drains Floor Sinks Gas Service Outlecs Interceptors ' Kitchen Sink Lavatories . , . Roof Dreins Reinspaction Fee Service Sink Sewer Cap' . Sewer Connection � Solar Collecmrs Solar Piping Solar Tank � Swimming Pool w/Spa - Urinal - Water Closet � Water Heacer Water Service Auto-Wash $15 Duct�UnderGround Duc�-Structurel � Duct - Ventilnting Exheust System ❑ Multiple Firepl/Fact Blt. ICBO •1k Heating System & Ducting, ❑0.100,000 BTU 0100,000 0 Reinspection Fee � $15 CMF 0865-46, rev. 30/84 Whit¢ - Builtling; Canary - Appliwnq Pink - Accounting; Goltlenrotl - ASseSSOr FEES reys laue Fea S 3 FEES Hood or Typel ❑ , Canopy Typell ❑ Refrigeration System � ❑0.100,OOOBTU ❑100,000 System Repair/Alteration ' Fire Damperz . Registers Iswe Fee 5 3 Automatic Washer � COnstruction Pole Sub.� Cooking Unit � ' Dishwasher ' Dryers ❑Gas .�Elect Fan �i F.A.U. � � Fixtures Device Boxes Outlets Garbage Disposal Generator �0.5 KW Fee 3527 II/04/85 Aaeuory Building: . .3=00 �l 2one 2 O N 1 N . G R Q ' • M , T . S ELECTRICAL � Transformer ❑ 15-50 KW ❑ 50 + KW Meter �up to 100 amps Meter �over100amps Sub Panel � Motors O0.1 HP � 1 h- 8 Int.Solar �9�75 HP �16�15+ ' Microwave Pole Light ' Range ; Standing Sections 5 KW Trash Compactor S75 laue Fae DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By � Buildjng Approved By � Applitation laued By � FEES $ 3 - ' � SUMMARV OF FEES � � BUILDING PERMIT $ ' SMIP $ PLAN CHECK $ PERMIT PLUMBING $ � ISSUANCE $ . PLAN CHECK 25% 5 ENERG� P.C. $ � ELECTRICA� $ GRADING $ 'PLANCHECK 50% $ MICROFILM $ MECHANICAL 5 TOTALFEE $ 33- PLAN CHECK 25% $ 'iICSNSTRUCTION AND PLANNING POO SPA , APPROVALS Permit # Date Inspector pppROVALS Permit # Date Inspector � 1.•Temporary Electrical Service or Pole � 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � ,�� (�'y�i 53. Steel Reinforcement , 3., Electrical ConduirUtility-Undrgrnd. '� 54. Forms � 4. Electrical ConduibUndrgrnd. ' � 55. Electrical Bonding .r 5. Steel Reinforcement-, " 56. Rough Plumbing & Pressure Test i ' 6• Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE . � 7: Footing's� � ' � 58. Electriwl Conduit-Undrgrnd. � 8. Foundation .� � � 59. Gas Pipe, � Undrgrnd., Test ' 9'�Water_Pipe-Undrgrnd: ' �L�, �' L� 60. Backwash Lines, P-Trap, O Undrgrnd. ' 10. Structural Floor System � ,� 61. APPROVAL TO DECK 11.'Property Sewer Line & House Cbnnection 62. Backwash & Receptor-Final 12. �Sewer Cap � - ' „ 63. Heater & Vent-Final • � 13. �Roof Drains � �,� ' 64. Plumbing System - Pinal r 74. Rough Plumbing' �. . j/f� Q� 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 Struc[ure 70. Underground Hydro 22. Oucts, Ventilating ,/• 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test � 72: Underground Flush 24. Roof Framing , 73. Undergrnd.StorageTank �Gas ❑Oii 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:3'G-�C �/ � 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-Test /f� �,� ' � ' 36. Hood or Canopy � � � �- 37. Final Factory Fireplace 38. Final Plumbing / � 39. Water Service-Final 40. Gas Service-Final ' 41. Solar pomestic-Final ' 42. Backflow Preventer ' - 43. Backflow Irrigation • 44. .Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations � 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison � . , 50. Gas Release to Southern California Gas Co � �� ' 51. CERTIFICATE OF OCCUPANCY - No Date ' AOp��ant to fill In all spacef except lhose wlt�in �GavY �orticr Ilne3 antl slgn all ap0/eDriate tleclarations. CITY OF COSTA SA�% CONSTRUCTION PERMIT �� PERMIT NO. L. TRACT NO. , LO7 NO. UNIT NO. Project �dress ��✓ ' �• �� S � � � � AppYcant's Mailiiig A ress � � / Owner's tdame F/��–(J Phon Atldress Arch/Eng. License No. Address ,.y/ G ( S� Contracror's Name � ��/// � �� Phnno/1 J� O Address (mailing) z� City License Nb. �� LICENSED CONTRACTOR DECLAqAT10N � I hereby altirT that I am IiCeniotl unqxpro IslOns o( ChdrtOr 9(commencin9 witb section 7b00) ot Division 3 f t�e Bus ess antl Pryfesstons'Cotle, an my license i in =ipj�ana etiect � � Licen58 GI ss «l �i No. Date Signature _ WORK RS' QMPENSATION DECLARATIO � ' I hereby altirm Nai I have a certifiwle ol conse to se �nsure or a certHicale of Workers' Cbmpensation Insu�ance, or a certi <opY Ihereof (Se<tlon 3800, Lab. C.) Policy No. Company 8 Certitiea copy is h¢reby tumizhetl. . Certifietl copy is Flletl witn the city Builtlin9 Division. Date i\oGli<ant E%EMPTION RROM WORKERS' COMPENSATION DECLARATION (ThiSsection ne¢tl not be comPletetl i1 ihe permit is tor one n�ntlretl (5700� or less). I certify Ih t iq Ihe perlormance of th¢ rk fo iGh this perm�l ii ISSuea 1' shall not e ploy y pOrsOn In any m e� 5 a5 beiDrna Subjett to t{�e WOfk p lyWS O( Cdli� I. ' Da[e Si9natur¢ �NOTIC : If, a er making [hI5 tlOEla�ation, you Oultl ecoTa Sub�ect to lh0 Worklrs' Comb¢nution provl5ions o} the Labor e, y0u must torthwith' comply with such v�ovisions. or this pormlt shall be aeematl revoketl. CONSTRUCTION LENOING AGENCV I hereby alflrm inat there Is a construUlon Ientling a9oncy lor tne porformance � Of lM1e work tpr wnicn tni5 permit is IsSuetl (Section 3097 Giv. C.) �,entler's Namp LenEer's Atlaress OWNER BUILpEN DECLARATION � I hereby atfi�h� lhat I am ezempl IrOm th¢ ConlraGtO�'s LICenSo I..aw IOr tna tollowin9 reasbn (Setiion 7031.5 Businezs antl Professional Cotle: Any clty or county whlch requires a permit to conztruct, alter, improvo, tlemolish or repair • any structure, prior to Ils issuance, also requires the applicant for such permil [o lile a Si9netl Statemenl Ihat ha/ShQ ii IicenSftl pufsuant to the provf5ions of the Conlractor5 LiCense Law (Chapt¢r 9(cortimencing with $¢cUon 7000) of Division 3 of tho BuSiness anC Grofaizions Cotl¢) o� thdt he/sh¢ is exempl .herCfrom antl Ihe ba5is !or [�e allegetl exemp[ion. Any vbldtiOn o( SBCtion 7031.5 by aqy appliwn[ ror a Permi[ subjects tne' appliCanl lo a civil . �enalry of noc more tnan five buntlred tlollars (5500J. _ LJ 1, as owner of the property or my'employees wi[n wagas as their sole <ompensation, will tlo the work, antl the structura iz not Intentletl or ofteretl fOI SdIC ($2CtlOn 7044� BOSiO¢SS dptl PlOfe55iOndl Cotle: ThG COOLfdCtO!'S LicenSe law does mt apply to an owne� ot a prop¢rty who Duiltls or ITpmvei Nereon, ana Wno tloCs such work tlimsel�/he�591f Or InrOuqh his or he� own employce5, proviC¢0 Nal such improvements ar0 not IntentlBtl o� Otteretl t0� Shce. It howeVer, tne builtlin9 or improvemen[ Is Soltl wilhin one yea� 01 com- � O�etion, the OWner will nave the burtlen 01 O�oving ne/sh¢ tlltl not builtl or im- p�ove tor th¢ purpOse oliale). ❑ I, as owner oi the properiy, am exclusNely contracting with Ilcensetl con- [ractors to canzlrud Ihe project (Section 7044, BuSinesi antl ProfessiOns Cotle: 7he GonVactOr's Ucen56 Law tloes noLappry to an owner otfproPerty who builas or Improves thereon, antl who contracts /or such projetls with a con- Vattor�sf Iicenze pursuant�to ine Con[rac[or'S License Law). I am aware lhat proot o( theiy Worker'i Compensaqon InSuranca zhoultl be provitlatl to me. ❑ I am exemp( under Section B. 6 P. C. lor thls reason Date . Owner ' havc re�aE�lhis appllCatlon and Ttate tha[ [he abovo agree to comply with all clty ana county ortlinances o builtlin9 �onztruction, antl hereby autnorize repre- ,llenter upOn the above-menliop¢4 pro erly Or n�� Date � �� L� TYPE OF CONSTRUCTION L"J NEW LJ ADD LJ ALTERATION LJ HEPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPE OF PERMIT LI GRADING LJ FOUNDHTION/LJ STRUCTVRAL ❑ TENANT ❑ EIECTRICAL ❑ PLUMBING I(� MECHANICAL ❑ OTHER PROJECT DESCRIPTION Sq. F7. oCCUnnNCv_ CONSTRVCTIONTVPE 'VALUATION$ 20NE GRADINGCU.VDS. ACRES_ Remarks: Sink Preventer Irri9ation Drinking Fountains Floor �rains Floor Sinks " Gas Service Kiichen Sink Lavatories P—Trap Roof Drains ShOwefS Service Sink Sewer Cap Sewer Connection $olar Collectors ' $alar Pipin9 - Solar Tank � � Swimming Pool w/Spa Urinel ' � • WeI¢f CIOSQI Water Heater � � Water Service Auto-Wesh � FEES Reinspection Fee I 515 I I laue Fee I E 3 Haod or Typel ❑ Under Ground � �^opy Type II ❑ Duct - Ventilating - � Exhnust System Multiple ❑ Firepl/fact. Blt. IC80 dk �He ng System & Ducting aioo,000eTu��oo,000sr Drivers' Licen'se or $ � �� >�� r�e CMF 0865-46, rev, 10/84 White - Builtling: Canary - Appllcan�; p�nk - Accountin9; Goltlenrotl - Atsessor 575 i�e%f igeration System CJO-100,OOOBTU ❑100,000 SVstem Repair/Alteretion Fire Dampers Registers A.P. # S Main Buildi E T Front B Rear A C Ri9ht S � Lefi Ping. Ref. dh Planning Notes: 9531 2/18/�6 2on¢ Accessary Building: Parking Req./Provided. ELECTRICAL _ �— Automatic Washer � Construction Pole Sub. � Cookin9 Unit � Dishwasher_ _ Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures' " � - - � Device Boxes � Outlecs Switches Garbage Dispoul Generator 00.5 KW �5�15 KW ❑ 15-50 KW ❑ 50+KW Meter [Jup to 100 amps Mecer ❑over 100amp5 Sub Panel Morors �0.1 HP � 1 h- B Inc.Solar �9-15 HP �16-15� Microwave � - Pole Light , Sign Standing Section: Trash Compactor � Reinspection Fee �$15 � �� Issue Fce DEVELOPMENTSEqVICESRE�UIREMENTS: 2onin8 Approved By Buildinp App.ovad By Aaolimtion laued Bv —'A Issue Fee � � $ 3 �. �'- ?40_5 TL Z O N I N G R E Q M r S FEES S 3 ' SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ �ISSUANCE $ PLAN CHECK 25% 5 ENERGY P.C. $ ELECTRICAL $ GRADING S PLAN CHE�CK 50% $ MICROFILM $ � � MECHANICAL 5 �.a . TOTAL FEE $ ��s` PLAN CHECK 25% $ • CQNSTRUCTION AND PLANNING POO. _ SPA �,APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 1°�I'emp6�ary Electrical Service or Pole 52. Pool & Equipment Location 2. SoiPPipe-Undrgmd. 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. Electricai UFER Grnd. � 57. APPROVAL TO COVER-GUNITE 7. Footings • 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System _ 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap � 63. Heater & Vent-Final 13. Roof Dreins 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. F?ough 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 /y/�, h��-/ FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Venti�ating 71. Product Piping � Gas ❑ Oil � 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ Oil �" 25. Roof Sheathing � 74. Overhead Hydro 26. T-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 37. Plaster Brown Coat . 79. FINAL INSPECTION 32. Electrical Power Me[er-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: �/ L Q�f � Q 34. Final Heating & Air Conditioning ,U�? � � /j/ 35. Final Gas Pipe-Test � 36. Hood or Canopy � 37. Final Factory Fireplace , � 38. Final Plumbing � 39. Water Service-Final 40. Gas Service-Final � 41. Solar pomestic-Final . 42. Backflow Preventer 43. Backflow Irrigation � , 44. Landscape Irrigaiion 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 No. Date � u AOp��canl f0 fill in all spaces exce0� �hose wit�in haavY �ortle� Iinos anE si9n all aoDroo��ate aeclarations. CIT�YjUF COSTA MESA CONS RU � ION E T � Project�Address "Appliwnt'sMailingAd ess � Owner's Name Phone Adtlreu Arch/Eng. License No. Addreu Cantractor's Nam G Phone Addreu (mciling) City License No. LICENSED CONTRACTOR DECLARAT�ON I n0r¢Dy alflrm Ihat I am IIC¢nsetl untle� p�ovi510n5 01 Charler 9(comm¢nCing . wit� saclion ]000) of Divislon 3 0l th¢ Buslness antl Professions Cotle, antl�� my IlcenSC Is in fuli fOrce a eH¢ . , � LJcenze Class � i se No. � " Date� Si9nature , '� — WORKERS C MPENSATION DECLARq ON .� � i 1 M1ereby aHi�m that I hava a certilica[e ol �onient to self-Insu�e o� a CCrtiflcate � ot workers' Co�/m/yyyeee, nsatio Insurance, or, a certifie op thereof (Sectiori 3800, Lab. C�� Policy No. Company � rtifietl copy is nereby furnishetl. Certifie wlth [he city i ' zi . , Date Applicanl EXEMPT N ROM WORKERS' COMPpNSA ION DECLARATION (Thi; sec[ion neatl no[ be mmpletetl If th0 permit is to� one huntlretl ($100) or less). 1 certily that in t�e perlormance o( [ho work for which thiz perm�t is issuetl, I' shall not em0loy any person in any mdnner so a5 to become subject t0 Iha, Workers' Compensatlon Laws Of California. Oate $I9nature ' � 'NOTICE: If, atter making this tleclaraUon, you shoultl become subject ro the Workers' CompensallOn provlslon5 OI Ih¢ labor Cotle, you mus[ tor[hwilh com0ly with SUCh provl51on5 or fltis p¢�mlt Shall b¢ tleemetl revok¢tl. CONSTRVCTION IENDING AGENCY 1 noreby alllrm lhat there it a consV uction Ientling a9ency for tne pertormance _ o/ Ihe work tor which Ihls Oermit i5 ISsuetl (Section 3097 Civ. C.) l.entler'S Name Lenaer's AtlUress ' OWNER BUIIDEN DECLARATION I horeby dltirm lhdt I am ¢xOmpl Irom (n0 Contractor's LlcenS¢ law tor th! /ollowing roason (Saction �031.5 Buflnqss antl Professlonal Cotl¢: Any city or. - county wnich requires a permit to const�uct, alter, Impmve, aemolish or repair any ziructure, prlor to its issuance, also raquires the app�icant tor s�c� permit to file a Signed Sla[ement Ihdl he/sh¢ I5 IlcenSetl pu�suant to Ihe provi5io05 of �� the Contractor'S LlcenSe law (Chdpter 9(�ommencing with Section ]000) of Divlsion 3 ot the Busine55 antl Pr01e551on5 CoOej o� thdt-he/zhe i5 ¢xempt �he�eirom antl Ihe ba575 to� the ailegetl exemption. Any.violation of $ec[ion '031.5 by any applican[ tor a permit subjects Ihe applicant to a Uvil �enalty o( not more tban five nuntlretl tlollars (E500). I, as Owner oi the proper[y o� my ¢mPloyees with wa9es a5,[h¢It sole compensation, will tlo the work, antl Ihe structure is not intentlea or ofteree for wie (Soction ]044, Buzlness an❑ Pro(e55ional � Cotle: The Contractor's Litense Law tloe5 not appty lo an owner ot a proper[y w�o bulltlz or improves lhereon, antl who tloes such w0/k hlmb¢If/heRell or through his or her own emo�oye¢s, provltletl tna[ such �mprove�nents are not Intentletl or otteretl tor, sale. If, hOwav¢r, tne bullUing or improyement is soltl within one yGar ot com- pleHon, tne owner will navo lhe burtlen of proving he/sne tlitl not builtl or Im- p�ovB forthe purpOse ot Sale). - ❑ 1, as ow'net o1 Ihe O�Oparty, dm a%clu5lvaly cont�aCting wllh II<ensetl Con- tractors to construct the project ISectbq 7044, Businezs anU Profezsions Cotle: The' Contractor'S Licente Law does not apply to an owner of property who Duiltls or imDroves lhereon, an0 wno contracts /or such pro�ects wlth a con- tractor(s1 Ocensa pursuant�to tho�Contrac[or's Liconze L.aw). I am aware tnat prOot o( Inelr Worker'S CompenSallon InSuranCa shoultl be provitletl [o me. ❑ I dm Oxempl untler SOCUOn B. 6 P. C. lor thi5 r¢ason Date � Owner _ I haretiy certiy tha[ I have reatl this inlo�mdtiOn is conect. I ag�eo to Compl antl s[ate laws ralaUng to bulltling cons senta[ives ot thlz cltyjo epter upon inspectlon p rp $ignatu�e Drivers' Llcenu or�'! IF 0865-46, rev. 10/84 above antl TVP� OFCONSTRUCTION LJ NEW U ADD LIALTERATION LIREPAIR �_ � CONVERSION ❑ DEMOLISH ❑ OTHER q,p.# . �ESCFIPTION OF WORK/USE OF BLDG. 5 Main Buildii E T�YPEOFPERMIT GRADING FOVNOATION STRUCTURAL T Fronl d TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Reef d OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCV C Right K Left CONSTRUCTION TVPE VALUATION S $ 20NE GRADING CV. VDS. ACRES ping, Re(, dp Ramarks: � � �, R � Planning NoteS: Sink oammos Clarifiers , � Dishwasher - Drinking Fountains Floor Drains Floor Sinks Ci85 $ANICC �Utl2t5 Interceptors Kfmhen Sink Lavatories . P—Trap Roof Drains � � Reinspection Fea� � Under Ground $15 Duct - Ventilating Exhaust System ❑ Multiple Firepl/FecL BIL ICBO # Heating Syscem & Ducting ❑0.100,000 BTU 0100,000 Reinspeetion Fee � $75 White - Bulltling; Canary - ApGlicant; Pink - Accounting: Goldenrotl - Asse55or Showers Service Sink � Sewer Cap� � Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Wetef pOse[ . Wacer Heater � Warer Service . Isue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System , 00.100,OOOBTU ❑100,000 System Repair/Alteration � Fire Dempers Registers laue Fee Automatic Washer - � Consvuction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec�� Fan F.A.U. ' � $ 3 S 3 3555 II/04/85 Zone Atceuory Building: I Parking Req.�Provided ELECTRICAL . Trans(ormer ❑ 15�50 KW ❑ 50+KW Device Boxes Outlets Switches Garbage Disposal Generator �65 KW �5-15 KW Meter LJup to 700 amps Meter over 100 amps Sub Panel ��— Motors OO-i HP 11(� 'F. � 8` Int.Solar 09�15 HP 016�15+ Microwave ' ' Pole Light � Range Standing Sections Trash Compacror 60,0? TI_ _ Z O N I N G R E Q M T . $ .FEES , �- . Rai�spection.Fee $15 Issue Fee $ 3 ��, �DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By Date - Building Approved By Date r •Applicetion lauod By Dat� ! � SUMMARV OF FEES � �i - BUILDING PERMIT $ � SMIP $ , � PLAN CHECK $ PERMIT — PLUMBING $ I$SUANCE $ PLAN CHECK 25% $ ENERGV P.C: $� � ELECTRICAL $ GRADING $ .' ` ' PLANCHECK 50% $ •�0 MICHOFILM $ MECHANICAL $ TOTAL FEE $ � ' Od PLANCHECK' 25% $ . �CONSTRUCTION AND PLANNING POO, SPA : APPROVA4S Permit # Date Inspector AppROVALS Permit # Date Inspector . ` 7. �Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � 53. Steel Reiaforcement 3. Electricai Conduit Utility-Undrgrnd. ` 54. Forms 4. Electrical Conduit-Undrgrnd. � 55. Elec[rical Bonding � 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Eiectrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE 7. Footings • 58. Electrical Conduit-Undrgrnd. 8. Foundation � �� 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe�Undrgrnd. • 60. Backwash Lines, P-Trap, O Undrgrnd. 10. -Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap , 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing . � 65. Electrical-Final 15. Rough Electrical_Conduit �� tl,.�y I�� 66. Solar System-Final 16 Roug Electric Wiring z�N 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18.'RoughElectrical-TBarCeiling 3a� 69. POOUSPASYSTEM$FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas QOiI 23. Gas Pipe-Rough & Test 72. Underground Flush � 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceilin9 (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & 5iding 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 Ppwer Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: �� S O 34. Final Hea[ing & Air Conditioning ! l'Npi�C> � E 6 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace / 38. Final Plumbing -� � � � 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer , 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Atte�uatio� 46. Handicap Regulations � 47. FINALSTaUC"fURE & BUILDING 48. Special Requirements Completed l 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date AOP�icant ta flll in all soaces exeept ihosa witnin naavY eoreer Ilnas ana sl9n all aooroDriata tleclaratians. CITY OF COSTA�MESA CONSTRUCTION PERMIT � PERMIT NO. _ TRACT NO. ' LOT NO. UNIT NU. Frojeci Address � 7O � �7�s!_ C� � Applicant'sMailingAddress � Owner's Name p��/�v�F, �« F�• �on Addreu �/� �'��ST ArchlEng. License No. Adtlress c ConvactOr's Nam �/ � P� nY %� Addreulm'1' I �.IT��/�t/.Q✓QyOQ [�'� IT � Ciry License No. -��Q Q.� �.4�9 LICENSEO CONTRACTOR DECLARATION I hereby a/tirm that I am Ilcensetl unUer provi5ion5 of Charte� 9(commenctng witn section ]000) of Dlvizian 3 ot the Buslness antl Protesslons Cotle, antl my license is in lull (or tl etfecL �� Llcense ss o. /�T Date Sl9natur WO KERS' COMP NSATION DE I here�y aHi�m thal I have a certilicato o nsent to sel/-inzure or a<ertHiwte of WOrkers' CompenSdtiOn I Surant8, or d CertltieE copy thercof (SeCUOn 3800, Lab. C. � � ' � Policy No. � � Compdny ertifietl copy is hereby turnishetl. � Certifi c I tl witb t�e dty Di bi . Da APPlicant EXE ION F OM WORKERS' CO TIO l TION (ThiS SGction need nal be complet¢tl it lhe per I[ ' On¢ tlratl ( 0) or less). 1 cerlify tha[ in tbe Oe�fotmanca of lho wOrk tOr whlth th15 pe�m�t I5 ISSUBtl, I. shdll nOl employ any pCI50n Ip dny manner SO a5 f0 OlComO suDjott to tlle Workers' CompenSaUon Laws ot Califomia. Date Si9nahre 'NOTICE: 1(, a(tcr making tnis tleclaraHon, you shoultl become sublacl to the Worker5' COmpensatlon provision5 ot tne LabOr Cotle, you mu5t forthwith wmpty with such provisions or � tnls permit shall be Oeemetl revokod. CONSTRUCTION IENDING AGENCV � - 1 hereby aHirm that there is a mnstructlon lentling agency tor lhe pertormance of [he work (or wnicn tnis permit is issuetl (Section' 3097 Civ. C.) Lentler's Name Lentler's AtltlrMs OWNER BUILDEN OECIARATION � I hereDy atiirm that I am exemo� irom tho Contractor's License Law for tha following red50n (SeCtiOn 7031.5 Buiiness antl Protesslonal Cotle: Any Clty Or ' counly whlch �equires a permit t0 cOnsVuc[, allEr, imprOVB, Oemolish O� repalr any structuro, prior to I[s issuance, also requires the apo�icant (or su<h permft t0 tile a signetl stalemtnt that ne/ihe IS licensetl pul5uanl tOlhB prOvisloni ot the Coneractor's L�cense Law (Chapler 9(commoncing wlth Sactlon 7000) ol Dlvision 3 Ot Ine Business antl P�ofe55ion5 Cotle) or [hat he/She is exempl herefrom antl the basis for the allegatl exemption. Any vlolatlon of Section /031.5 by any applicant for a permi[ subjects the aOP�tcan[ [o a clvil �enalty of not more than tive huntlretl tlollars (E500�. I, as owner of the property or mY emPloy¢es wit� wage5 a5 thGi� sole compensalion, will tl0 the work, antl Ne structura is not intentleC o� o(feratl tor wle (Section 7044, Business antl Professional Cotle: The Contractor's Litense Law tloes not apply lo an owner Of a p�ope�ty who Ouiltlt O� ImO�oveS Ihereon, ana who tloes such work himsell/narsel/ or tnrou9h his or her own emplOyces, provitlotl that such Improvemen[5 ar8 nOl IntontlOtl of ottCrCd 10I SaIG. II, ttownver, thC Dulltling Or Improvement Is soltl wit�ln one year of com- pletlon, the Ownfr will havC the burtlen ol proving he/Sh0 tlitl nOl bulltl or Im- prove 1or the pur0ose of zale). ❑ I, as owner of the pro0erty, am exclusively contracting with Ilcensetl con- tra[tofs tU construG[ tM1e projeCl (SectiOn 7044, Busine55 antl ProfM51on5 COtlB: The Con[ractor's Licensc l.aw tloes not apply to an owner ot Oroperty.w�o builtls or Improves tnereon, anU who contracts ior suth proje<[s with a con- Vactor(sl liwnse pursuanc�to the ConVac[or'{ License Law). I am aware tnat proof o� lhei� Wotke�'S Compensation InsurdnC! shoultl be p�ovitletl to m¢. ❑ I am exempt unticr Sectlon B. & P. C. tor this r¢ason ' Date Owner I hereby certity that I hava reatl tM1is appllcaUon antl state that Ihe abovo inbrmatlon is correcL 1 agruo to comply�yith all clty antl county ortlinan<os in5pec[lon rpos Slqnature Orivers' License or ; h TYPE OF CONSTRUCTION LJ NEW U ADD LJ ALTERATION Ll REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER p� p# DESCRIPTION OF WORK/USE OF BLDG. � S Main Buildi E TVPE OF PERMIT GRADING FOVNDATION STRVGTURAL T FrOnt �TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Reer OTMER E�.GLfGT wOQ�G L[J/�fi a' PROJECT DESCRIPTION 5�. F7. OCCUVANCv C Right K Lefi CONSTRUCTIONTVVF VALUATION$ S 20NE GRADING CU. VDS. ACRES Ping. R2f. � Remarks: - � PId00104 NOtez: Bar Sink Back(low Preventer Backflow Irrigation 8athtu6s Clarifiers Dishwasher � Drinking Fpuntnins Floor Drains Floor Sinks 3asService Outlets ' Interceptors - - Ki[chen Sinli ' Lavatories . P—Trap Roof Drains - ' Reinspection Fae $15 Boiler Duct � Under Ground Duct-Structurel � �uct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/FacL Blt. ICBO # Heating System & Ducting � ❑0�100,000 BTU O100,0008Ti Reinspeetion Fea � 515 CMF OB65-46, rev. 30/84 White - Builtling; Canary - AP�Iican4 Pink - Accauntin9: Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Sotar Collectors Solar Piping Soler Tank Swimming Pool w/Spa Urinal Water Closet � � Water Heater Water Service Auto-Wash laue Fee Hoodor Typel ❑ CenOpy Type II ❑ Refrigeration System 00�100,OOOBTU ❑100,000 System Repair/Alteration Fire Damperz Registers 0 luue Fee FEES $ 3 $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A,U. Fiz[ures Davice Boxes Outlets Swimhes Garbage Disposal Generator �0-5 KW �615 ut9, aisaisr Zone Req./Provided ELECTRICAL Transformer ❑ 15�50 KW ❑ 50+KW Meter �up eo 100 amps Meter �over100amps Sub Panel Motors �0.1 HP O1'r5 - 8 Ina Solar �9-15 HP �16�15* Microwave Pole Light Sign ; Standing Sections Trash Compactor � FEES 2 O N 1 N G R E Q M T S � Rainspection Fee � 815 � � luue Fee � S 3' DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approvad By � Date Building Approved 9� � ��' Date� Appliwtion Issued 8y Date ' � .SUMMARV OF FEES BUILDING PERMIT $ � SMIP � $ PLAN CHECK $ PERMIT , PLUMBING $ � ISSUANCE S PLAN CHECK 25% 3 ' ENERGV P.C. $ ELEC7RICAL $ � GRADING S PLAN CHECK 50% $ MICROFILM 5' MECHANICAL . $ TOTAL FEE ' $ � PLAN CHECK 25% $ � � r;. �� - CONSTRUCTION ANDPLANNING POO� _SPA Date�'� Inspector Date Inspector � �APPROVALS Permit # APPROVALS Permit # • 1. Temporar,y Electrical Service or Pole ,' 52. Pool & Equipment Location 2. Soil Pi,pe-Lndrgrnd. • 53. Steel Reinforcement . 3..flectrical�ConduitrUtility-Undrgmd:," ', 54. Forms �, �. � 4.,Electrioal�ConduiYUndrgind. :�! '� 55. Electrical Bonding � � i r �� 5. SteGl.Fjeinforcement �. ' i 56. Rough Plumbing & Pressure Test �.� 6.,�ElectricaPUFERGrnd:'� � 57. APPROVALTOCOVER-GUNITE , � , 7. Foo[irigS �� ,� . � 58. Electrical Conduit-Undrgrnd. .- c- 8.;�,Foundation •�� '' 59. Gas Pipe, O Undrgrnd., Test ` 9. ;Water.Gipe-Undrgrnd: � ';�� 60. Backwash Lines, P-Trap, O Undrgrnd. � 5 10. St�uctifral Floor System . ✓ 61. APPROVAL TO DECK 11 t,Property Sewer Line-& House Conriection � , 1� . 62. Backwash & Receptor-Final '� , 12. Sewer Cap ' :�;- � f 63. Heater & Vent-Final • � l 13. Roof�Drains � ' � . � '� �� ' . . ;� 64. Plumbing System - Final . 14. Rough�Plumbing � �;; ' • 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilati�g 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough &. Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas �Oil 25. Roof Sheathing :; 74. Overhead Hydro 26. T-Bar Ceiling (Structurat) & Monocoat 75. Dry Chemical r 27. Frame and Flashirig _ 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. Finai Gas Pipe-Test 36. Hood or Canopy 37. Final Fanory Fireplace - 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer � 43. Backflow Irrigation 44. Landscape Irrigation System ' 45. Sound Attenuation � 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison � � 50. Gas Release to Southern California,Gas Co 51. CERTIFICATE OF OCCUPANCY N0. Date i � � � �\ AOD��ant ta fill in all SDaees except those wititin �eavY �ortler Iinei anC ilgn al� appropriate aeclarations. a'rv oF COSTA MEsa CONSTRUCTIOQN PERMIT Pro'pfctAddress 6�0\�. ��TW SC. 4��1. L''4. �Applicant'sMailingAddress �45\ V.1. Lev�9EnT QZn Le �1nec��a Owner's Name Phone Address � Ar �ch/Eng. LUG� License No. Address 3a\ N R n o T� (ih wrc C� A Contracmr's Name �Ov �—�—a F�ei Pf+ac� (i141phone S26'2Zz� �Addresslmailing) �451 �l]• L�'.fSEwr �g, e N��+-. �10b'3\ City License No. A �[_� SO LICENSED CONTRHCTOR DECLARATION I hereby a�firm that I am Iicensetl untler provislons o( Charter 9(commencing 'with section 7000) of DiviSion 3 ot the Bu51ne55 antl Protes51on5 Cotle, antl my Iicense is in tull torce antl eftect. , • ��_ „, Date F�""�-rs� Si9nature - WORKERS'. COMVENSATION DECLARATION I hereby affirm that I have a certificate of consent to self-insure or a cerHficate ot Workers' Compensation Insurance, or a certifietl copy tnereot (Sectlon� 3800, Lab. C.) � � ' � � aor�v rvoWc2•162•02�1O14•O15�om6anv` 1�^S�'`�••Z�n�:. ' Certitietl copy is hereby furnishea. � � Certifietl co y is tiletl wittt the city�uiltling Dlvislon. . � Date \2-\O-�i5 APPIiCant�i��i(.Ci.�ti Q—�^-r�Zio� EXEMPTION FROM WORKERS' COMPENSATION DECLA0.ATION (Thissecfion neetl not b¢ completetl if ihe permit is (o� one huntl�etl ($300) or lesz). ' I certify that ln the performance of tne wo�k tor which thls pe�m�t is issuetl, I shall not employ any� person in any manner zo as to become subject to the Workers' Compensation Laws o( California. _ ' . Date �� Signature � �NOTICE: If, after making tnis tleUaratlon, you shoultl become subject to the' Workets' Compensalion pravisiOns ot the Labor COtle, y0u muz[ tortbwlth comply with such p�ovisions o� thi5 permlt shall be .tleemetl revoketl. CONSTRVCTION LENOING AGENCV ' � • I hereby aitirm that there is a consVuttion lenaing agency for the pertormance ' of the work to� which th"5 p �t ' � sue�l5eetion 309� Civ. CJi Lentler's Name Lentler'S Atltlress OWNER BUILDEH OECIARATION ' - I h¢reby.afHrT Ihal I am exempt trom the Conlraclor's Licenzo l.aw (or the � following reason (Section 7031.5 Busine55 antl Professional Cotle; Any clry or counry whlcn requires a permit �to construct, alter, improve, tlemolish or,repair any ztructure, prlor to Rs issuance, also reqWres the applicanl for such permit to (iie a signetl siatement that he/she is Iicensetl pursuant lo Ihe orovisions o1 the Contractor's License Law (Chapler 9(Commencin9 with Sectlon ]000) of ' �ivision 3 of the Business antl Protessionz_Cotle) or Ihat he/she is ezempt therefrom antl Ihe basls tor [he allegetl exemptlon. Any violation ot $ecHon ' 7031.5 by any applicanl tor a permit sublects [ne applicant to a civil �enally of no[ more than f(ve huntlretl tlollars (E500). I, as owne� of the p�operty o� my om0loyee5 with wages a5 [hoi� sole compensa[ion, will tlo the work, antl the sVutture I5 not Intentletl or otteretl for sale (Saction ]044, Business antl Professional Cotle: The Contractor'S License Law aoes noc apply to an owner of a property wno builtls or improves thc�eon, antl who tloes such wo�k himself/h¢rself or throu9h his o� her own employees, provitletl t�at such fmprovem¢nts are not intentle0 or offeretl fo� sale. It, howeveq the bulltlin9 or Improvemenl is Soltl wi[hin one year oYcom- pletlon, the owner will bave [he burtlen ot proving he/she tlitl not builtl or im- prove forthe purpose oisale). ❑ I, az owner of lhe prope�ry, am exclusively Contracting wlth licensetl cOn- tra<to�stu construct [he proj¢tt ISettion ]044, Business antl ProfesSions Cotle: The Contractor's License Law doe5,n0[ aOPly to an owner of property who bulltls or improves thereon, antl who contracts lor zuch projects wleh a con- � traCtor(s) IicenSe pursuant fo the Contracto�'S License Law). I am aware Ihat ! prooi o� lheir Wo�ker'S Compen5ation insurante shoultl be prOvitletl to me. �I ❑ I am exempt untler Sect'on � — a- & P. C. for this reason Date -�� owner I h¢reby certify that I have reatl tnis application antl state cnat the above information is correct. I agree to comply wrth all city antl munty ortlinances antl state laws relat� to builtling cqnstruction, and hereby authorize repre- SCII[3LIVC5 Of Ih15 I LO COIE( y}Spn [he above/Fnentione0 PfoPerty tor Signature Orivers' LicenSe 5`. CMF 0865�46, rev. 30/84 oate \'t-'�o'R S TVPE OF CONSTRUCTION Ize� NEW U ADD LJ ALTERATION U REPAIR ❑ CONVERSION ❑ DEMOLISH O OTHEF p� p.�6 DESCRIPTION OF WORK/USE OF BIDG. �L�; � OF S Main Building: E TYPEOFPERMIT� GRADING FOUNDATION STRVCTVRAL , T Front ❑p TENANT ❑� +ELECTRICAL O PLVMBING ❑ MECHANICAL A Reaf L�I�OTHER F\ttE. ��n��..�G�.�iI�S PROJECT DESCRIPTION 5Q. FT. � OCCUPANCv ' C Right K CONSTRVCTIONTVPE VALUATION$ � 000.0� g Left 20NE GRADING CU. VDS. ACRES p�ng. Re(. # Remarks: � Planning Notes: , � , - Sink Preventer Irrigation , Dishwasher Drinking Fountains Floor�Drains Floor Sinks -- Gas Service Interceptors Kitchen Sink LaJarories . , P—Trap Roof Drains �ReinspeMion Fee Duct- UnderGround Duct - Structurel Duct - Ventilating Exhaust Syscem ❑ �Multi Firepl/Fact.6lt. ICBO # Heating System & Ducting ❑0.100,000 BTU 0100,( Reinspection Fee Whit¢ - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Asse55or $15 $15 Showers Service Sink Sewer, Cap Solar Collecmrs. � Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal — Water Closet , ' " Water Service Auro�Wesh Issue Fea $ 3 Aummatic Washer " Canstruction Pole,Sub, Cooking Unit Dishwasher Oryers ❑Gas ❑Elec Fan F.A.U. Fixtures . ', - Device Boxes � Outlets Switches Garbage Disposal Generator �0-5 KW C 0745 3/12/86 I t:�.,, _ Zona ELECTRICAL � '� Transformer � 15-50 KW� ❑ 50+KW 5KW Meter ❑up to 100 amp5 Meter �ovei 100amps Sub Panel Motors �0.1 HP �7'/:-8 Ina Solar �9-15 HP 016-15+ Microwave - Pole Light ` Range Sign � Standing Sections Tresh Compactor Reinspaction Fee $15 Issue IANICAL FEES Hoodor T DEVEIOPMENTSERVICESREQUIREMENTS: yp01 ❑ Canopy Type I I ❑ 2oning Approved By Building Approved ey Refrigeration System ❑aioo,000sTu ❑ioo,000eTu ' System Repair/AlterStion Fire Dampers -� Fegisters • � laue Fee I $ 3 2 O N I N G R E Q M T S FEES $ 3 ' SUMMARV OF FEES BUILDINGPERMIT $ L�A•SO SMIP $ •'� PLAN CHECK s- 44.53 pERMIT ' PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. S ELECTRICAL $ GRADING S PLANCHECK 50% $ MICROFILM 5 MECHANICAL $ TOTALFEE S ��3,Sq__ PLAN CHECK 25% $ ' / CONSTRUCT.ION AND PLANNING POOL a SPA �PROVALS, Permit# Date Inspector AppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location 2. Soil Pipe-Und�grnd. , • 53. Steel Reinforcement ' 3:}Electrical Cbnduit;UTility-Undrgmd�. . 54. Forms 4. Electrical C,onduitFUodrgmd. � �' � 55. Electrical Bonding �'� 5. �Steel Reinfo�cemen�, `� . 56. Rough Plumbing & Pressure Test � '- .� 6;.'Electrical UFER,Grrid.� 57. APPROVAL TO COVER-GUNITE -� '�� 7. Footings �� . �� '�: 58. Electrical Conduit-Undrgrnd. ��..: r 8: Foundation • .. � � 59. Gas Pipe, O Undrgrnd., Test � -' � 9. Waier Pipe-Uridrgrnd�. : 60. Backwash Lines, P-Trap, � Undrgmd. . �� 10.;Structural Floor System . 61. APPROVAL TO DECK 11, i'roperty Sewer� Line�& House Connection � ' 62. Backwash & Receptor-Final 12. Sewer Cap �,��• : .'- ' � 63. Heater & Vent-Final . 13. Roof Drains �� 64. Plumbing SYstem - Final . p 14. Rough Plumbing ��• �• ,.-./ . 65. Electrical-Final ' " � 15. AoGgh Electrical-Conduit _� • 66. Solar SYstem-Final 1r6. Rough Electric Wiring 67. Fencing & Access Approval 17.' Rough Wiring Sign 68. APPROVED FOR PLASTERING 78.'Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL 19. �Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20:.�Rough Factory,Rireplace APPROVALS Permit# 21. Ducts, in Structuie 70. Underground Hydro 22. Ducts, Ventilatiny , 71. Product Piping OGas ❑Oil 23. Gas Pipe-,Rough & Test 72. Underground Flush 24. Roof Framing . 73. Undergrnd. Storage Tank O Gas OOiI 25. Roof Sheathing . 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL `J/1 29. Insulation 78. FIRE PREV. FINAL - 30. Drywall Nailing '+; HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat . 79. FINAL INSPECTION - 32. Electriral Power Mete'r,-final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace - � 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer � '.' 43. Backflow Irrigation � ' �' 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations � � . 47. FINAL STRUCTURE & BUILDING ' 48. Special Requirements Completed , 49. Electric Release to Edison . 50. Gas Release to Southern California Gas Co . '�� 51. CERTIFICATE OF OCCUPANCY ', No Date Ciry of Costa Mesa Development Services Departmeni Building Safety Divisian P. O. Box 1200 Costa Meu, Calitomia CERTIFICATE OF OCCUPANCY No. �j�„�,�b The Building located at fi7A tda_h 17Th StCc??t. Suito Cl has been inspected and tound to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group R� Occupancy. Use of Building Min� Storaao Legal Description 49A-281-03 (See reveru side for Metes and eauntlsl Building Permi[ No p ��dA'3 Electrical Permit No. E 214%�i Plumbing Permit No._ Mechanical Permit No. Number of apartments and/or guest rooms Eice Prov. Permit Iw. F 23013 ISSUED T0: Pacific Masa Promrties 670 W. 17th Streat. Ste. C1 Costa I1eea. CA 92627 Building Official by �•�, � . . �L.. . Date Aori19, 1986 This Certificate of Occupancy SHALL BE posted in a co�spicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 1015-46 rev. l/83 White -Owner, Canary - Numerical File; Pink - Bldg. Permit File t-� �� l� r� �sT � Applicant to fill in all spaees exeept tnose witnin heavy oo.eep lines anE sign all apPropriate tleclarations. G7YOFCOS7AMESa CONSTRUCTIONPERMIT � .�Projec�'A�.�: `"�. � . . llth Stree+.. l' / Applicant'sMailingAddreu h9n ��- 1%��fl Street. Ow�ersrvame MarsYiall Duf�ield Pno�e545-6811 'naa�eu '}�n W. 17th Street. Costa Mesa. CA S262 nrcnie�9. �a��ualn/Riarcnn I�CLicenseNo.�-j Q�� Address '�11� i� 2amnar�_'Suite F Orange CA Contractor'sNam ��fd115E Const:•uction rno�e 535-1429 Address (mailingl 21542 Surve Ci Ci rcl e Hun'ci n ton BC City License No. � • ' CA 92646 LICENSED CONTRACTOR OECLARHTION I bereby af(irm tha[ I am Iicensetl untlGr provisions of ChdrtO/ 9(commencin9 witn section ]000) of Division 3 ot the•Business antl ProfeSslons CoOe, antl my Ilcense is in fuu force astl ettect. :�, p,, y LlcenseClass ��7 � �' ¢nse o. �� 7a� Date��-� 59 I �� I WORKERS'COMPENSATION DECLARATION 'i 1 hereby aHirm that I have a certificate ot mnsent to selt-Insure r a tertiflcate. �,. of Workers' Compensation- yIn�surancS, or .a cerU cop t reof (a$ectlon � �400. Lab. Cy�QZpSy.y,/ComPanY �" "-' " licy No. d-I J6 drt �Certifietl mpy is hereby furnishetl. �� Ceriifi tl c py (" etl wi[h tne city Builtli visio e �� APPlicant� ��u/ � EXEMPTION FROM WORKERS' COMPENSATION DEGLARATION (Thissection neetl not be complete0 it the permit is for one huntlretl (5300) or Iess). � I ceriity that in the periormance of tne'work for wnlch thls oerm�t iz issuetl, I shall not employ any petson In any manne� so a5 to beCom¢ Subject to the Wo�ker5' ComOensation LawS ot CalifOmia. � . . Date Si9nature �NOTICE: It, af[er making thiz tl¢claration, you shOultl become subj¢Ct t0 Ih¢ Workers' Compensation provisions of the Labor. Cotle, you must fortnwitn comOb �+�ih such p�ovisions or Ihis petmit Shall b¢ tleemetl revok¢tl. CONSTRUCTION LENDING AGENCV • • � I hereby atflrm that there is a consiruction lentling agency tor tho pertormance • of the work for .which this permit is i55uetl ($ectlon 309]' Civ. C.) Lentler's Name � _ _ . Lentler'S Atltlress ' OWNER BUILDER DECLARATION ' I hereby atfirm that I am exempt irom [he GonVactor's�License Law for the tollowing reason (Section �031.5 Business antl Professional Cotle: Any city or county which requires a pe�mlt fo cons(ruc[, alteq improvo, tlemoli5h�o� �epair ' any structure, prior to its issuance, also requires the appllcant (or such permit to tile a signetl Statement [M1at ne/She Is licensetl pu�suant to the p�ovi5ions oi the Contractor's License Law (CnaOter 9(commencin9 with SecUon 7000) of Division 3 ot tM1e Bu5ine55 antl ProfesSions Cotle) or tha[ he/she is ezempt the�efrom antl the basis tor the,allegetl exemption. Any vlolatlon ot $ectlOn �031.5 by any �applicant for a permit subjects the appli<ant to a civll nalty of not more than five huntlretl tlollars ($500). - ' • � I, as owner of the property or my employee5 with wages as thei� Solo Wmpensation, will tlo tne work, antl the structure is not Intentletl or offeretl for zale (Section 7044, Business antl Professional Cotle: The Contractor's LicenSe law tloes not apply t0 an Owne� of a p�ope�ty who builAs o� imp�ove5 thereon, antl who Coes Such work hlm5elf/he�self or thrOugh hls or he� own employ ees, provitletl [hat such Improv¢ments are n0[ IntenCetl or oHeretl to� sale. If, howeve�, the builtling or improvement is soltl wlthin one year of com- pletlon, lhe owner will have the burtlen oT proving he/sho tlIU not build or im- prova for the pu�pose�o� sale). ❑ I, as owner of the property, am exclusivety contracting with Ilcensetl con- tractors t6 construct the project (Sectlon �044, Business antl Profeszions Cotle: The Con[ractor`s License law tloes mt appry ro an owner ot pro0erty wbo builBs or improves thereon, antl who conVacts for such projects with a'con- Iractor(51 fltense DurSuant'to the Contractor'S LiCense Law). I am aware Ihat proof of tM1eir Worker's Compen5ation insurance shoultl be provltletl to me. ❑ I am exempt untler Section ` B. & P. C. for this reason Dale Owner 'I nereby certity chat 1 �ave reatl fhis application antl state Nat tne xbove information is correct. I a9ree lo comply with all tity and county ortlinances antl state laws relating to builtling constructlon, antl hereby authorize repre- senta[ives of this city to n[er u on the above-mentioneA pro0erry (or inzpec[ian purpases. /�� Signature �'�-� Da�a� TYPE OF CONSTRUCTION KM NEW LI AOD LI ALTERATION LI REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER� DESCRIPTIONOFWORK/USEOFBLDG. NIIN) STORAGE TVPE OF PERMITp-� U GRADirvG VJ FOUrvOA7iON y� STRUCTURa� ❑ TENANT LLJ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PRWECTDESCRIPTION SQ. FT. iZ.EOO oCCUanNCV� CONSTRUCTIONTYPE V-N SPRINKLEP,E�y„�unT�on,s�'O��¢��q ZONE GRADINGCV.VDS. At��ttnx— Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtuhs Clarifiers - Dishwasher Drinking Fountains Floor Drains Floor Sinks GasService ^. Outlets � Interceptors � Kitchen Sink � La'vatories , P-Trap Roof Drains . ' Reinspection Fee� � $15 Boiler Duct-UnderGround Duct - Structural Duct - Ventilating ExhaustSystem ❑ Mul[iple FirepUFact Blt. ICBO # Heating System & Ducting ❑0100,000 BTU 0100,000 a Reinspaction Fee � Orivers' License or SS � � � CMF 0865-46, rev. 10/84 White - Builtling; Canary • Applicant; Plnk - Accountln9: Golaenrotl - Assassor. $15 Showers Service Sink , - Sewer Cap � ' Sewer Connection Sola� Collectors Solar Piping .' Solar Tank � � 'Swimming Pool w/Spa Urinal � Water Cbset � WaterHeater, Water Service Auto�Wash ' i Issue Fee� Hood or Typel ❑ Canopy Type 11 ❑ - Refrigeration System ' , � ❑aioo,000eru ❑ioo,000eTu System Repair/Alteretion Fire Dampers � Registers - laue Fee FEES $ 3 m 5 3 A.P. # L S Main Bu E T Front 6 Rear A C Right K l.eft s , Plnq. Ref. # Automatic Washer �- Construction PoleSub. Caoking Unit Dishwasher , Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures Device Boxes � - � w��e�s Switches � - Garbage Dispoul Genereror_�0.5 KW f � 3472 II/01/BS Accessory Building: ( I (7 d„ Parking Req./Provided ' - � , ) l o �'� T;. zo�a IM �� ELECTRICAI Transformer ❑�15-50KW ❑ 50,+KW ' Meter ❑up to 700 amps Meter ❑over100amps Sub Panel Motors � 0.1 HP � 1'h - 6 Inc.Solar 09-15 HP �1675+ Microwave Pale Light ! Standing Sections 5 KW Trash Compactor � Fee . �$15 � � luue Fee DEVELOPMENT SERVICES REQUIR i . 2oning APProved By 6uilding /lpproved By � FEES $ 3 Z O N i N G R E Q M T S " � � SUM tl/�R�( /F�EES � " �BUILDING PERMIT $ ]/ v SMIP � $ �% � �D PLAN CHECK�� $ ----�J�'PSSUANCE $� d✓ � PLUMBING $. � PLAN CHECK 25% $ � ENEFGV P.C. $, ELECTRICAL $ " � GRADING $ PLAN CHECK� 50% $' '� MICROPILM $ �� MECHANICAC $ TOTALFEE $, �1��.CL � i PLA'N CHECK 25% $ � ' "�CONSTRUCTION AND PLANNING POOL 8 , � APPROVALS � Permit # �ate Inspector qpPROVALS Permit # Date Inspector 7.,Tem orary 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 Reintorcement 56. Rough Plumbing & Pressure Test 6� Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. af�etings S' �� 58. Electrical Conduit-Undrgmd. 8. Foundation � � • ol.�Ip/g�� 59. Gas Pipe, O Undrgrnd., Test a. 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. _ 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final .12. Sewer Cap ., , � 63. Heater & Vent-Final . � I' 13. Roof Drains 64. Plumbing System - Final 1 � 14.'RoughPlumbing . 65. Electrical-Final 'I� - 15. Rough Electrical-Conduit 66. Solar System-Final I 16: Rough Electric Wiring 67. Fencing & Access Approval _ 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING . - 78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL � 19. 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 O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush� 24. Roof Framing � (�1G -S�c �cy, 73. Undergmd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing %-�/�� 74. Overhead Hydro � 26, T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 127. Frame and Flashing � ,a �/ U� 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. Electrical Power Meter-Final • 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: � 34. Final Heating & Air Conditioning � � � � � � 35. Final Gas Pipe-Test �1 ��s Oo i � <" k� / . , 36. Hood or Canopy '_ ,p� � l�.g LS(c eo/ . Y , P . - ,<nii �f%/N so�v � 37. Final Factor Fire lace p �Q�� 38. Final Plumbing . � I �{ ' }7A �L T 39. Water Service-Final . �. - I '425 z9 33 3� 5 2 40. Gas Service-Final _ .. � � _ a I 41. Solar pomestic-Final � ' '�'� � - -u' �- �� `g- Z � 42. Backflow Preventer ' , �� zO '� , �.� �� 43. Back4low Irrigation � ' . � 1 �F+- � 34� b - � � � 14-1 `J 44. ,landscape Irrigation System ��- I� %/�� aTN s /1/u c� 1� I�rf�'C/ 45: Sound Attenuation Z Zp r � �� ..� � 46. Handicap Regulations � Z�I a "Q�q,�y� .qg 47. FINALSTRUCTURE & BUILDING 6 _/� 48. Special Requirements Completed 5 $6 . 49. Electrie Release to Edison� � � � '., 50. Gas Release to Southern California Gas Co � � 51. CERTIfiICATE OF OCCUPANCY , • ' � No Date Aoolicant to flll in all soacas axceot lhosa within neavr Gortler Iines antl sign all aooroP/iate tleclarations. .-�Il'J OF COSTA ME ONSTRUCTLO.� RMIT � PERM� NO.� TRACT NO. LOT NO. Uyi� N. 3556 I I/OG/s�j . �roJec��+ddress � � �-- �+050 AppliCan�'S Mailing A dfe55 / TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISN ❑ OTHER q,p, # 2one Owner's Name Phona DESCFIPTION OF WORK/USE OF BLDG. .. Address S Main Building: � Accessory Building: E Z Arch/Eng. Licens¢ No. TYPE OF PEFiMIT GRADIrvG FOVNDA710N STRUGTURAI. T Front- ' p Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Reaf N ❑ OTHER Contractor's Nam Phone � PROJECT DESCRIPTION SQ. FT. oCcurnrvcv C Right � ' N Address (mailing) - K Left G � CONSTRUGTION TVPE VALVATION S $ . • R -City LiCensE No. 20NE GRADING CV. VDS. ACRES IICENSED CONTRACTOR DEC ARATION Plny. R2f. � Pd�king R¢q./P�OvidEd E O �I hereby atflrm that I am lic¢nsetl untler provlslons oi Charter 9(commencing Remarks: � Planning Notes: , � -. with section 7000) ol Division 3 of the Businezs antl Professions Cotle, antl - � . M .my Iicense is in t II t ce tte<t. �� . . - T -License C � � e Se No. S � oate Si9�ature PLUMBING FEES , WORKERS' OMPENSATIONDEC ON BarSink ' ShoW2r5 � ' 1 hereby aHirm that I have a certificate ot conzenf ro seH-insure or a certificate ELECTRICAL FEES ' of Workers' Co oensation Inzurance, or a certif tl o tl eof (Sec on gackflowPreventer - ' ServiceSink ' - - - - - 3800, �ab. �� Automatic Washer Transformer ❑ 15-50 KW - � colicyNo. Company � � �.'Backflowlrrigation SewerCap �� ConstructionPoleSub. �50+KW �❑ Gfrtifietl co y 5 he�eby furni5h¢tl. ��Certifie pae'with the city uil i ' � Bathtubs � Sewer Connection �- Cpoking Unit Meter ❑up to 100 amps Date Applicant ' � EXEMPTI N ROM WORKERS' COMP A ON DECLFRATION ' Cldti(iC�S Solar Cotlectors '! Dishwasher Meter ❑OVE� 100dmpi (This section neea not �e completetl if che oer it is for one huntlretl (5100) or - � - , less). � Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify �ha[ in tne Oetfo�mance of the work tor whiGh [his p¢�m�t Is Issuetl, I . shall not employ any perzon In' any manner zo as to become subject to the . Drinking Fountains Solar Tank - Fan ' � workers' Compenzatlon Laws ot Caiitornia. , Momrs D0�1 HP �1Ya-8 f�are Siqnature Floor Drains I Swimming Pool w/Spa F.A,U. � Inc.Salar �9-15 HP �16�15+ 'NOTICE: If, a(ter making this tleclaratlon, you shaultl become sub7ect to the . Wofkel5' Compen5dlion provisions ot the LdbOr COtl¢, y0u Tusl loflhwl[h FI00f $i0k5 Ufin81 FixtUf¢5 - MiGfOwdv¢ ' com0ly with Suth ptovlsions o� thi5 p¢rmil ihall be tleemetl revOk¢tl. , CONSTRUCTION LENDING AGENCY - . Co25 $¢lviC¢ �utlBti Wet¢f CIOS¢t D2vic2 BOx¢S P012 Li ht � ' 1 her¢by affl�m thdt there is a conStruCtiOn IenUing agency to� tne performant¢ ' _ 9 of the work fOr whith this pC/mlt Is Issuatl (5¢CtiOn 3097 Civ. CJ Interceptors . � Ware� Heater � � Outlets � Lentler•s Name Range Lenaer's Aatlress � Kitchen Sink . Waier Service � Switches ' g�9� � � �, OWNER BUILDER OECLARATION ' � I hereby affirm that I am exampt trom tho Contractar•5 Licenso I..aw lor t�e LavalOries , Auto-Weih ' Garba e Dis o521 , followln9 reason (Seclion �031.5 Business antl Profeisional Catle: Any city or 9 P ; Standing Sections county whicn requires a permil to construct, alter, Imorove, tlemolish or raDair P—Trap • � � leundry Trays Generator 00.5 KW OS-75 KW any's(ructure, pdor to its issuance, also reqWres tna appli<ant lor such Oormit - Traih CompactOr lo file a signeU stalement [hdt ne/sh0 IS Iicensetl pur5udnt t0 tlte p�OviSiOns of . ROO( Df8105 ` Ihe Contractor's License Law (Chapter 9(commen<ing witn SatUon 7000) ot �. Dlvision 3 01 the Bu5in855 antl Prot¢SSIonS Cotle) Or Ihat ne/sha IS Oxnmpt � thcretrom antl the Dasis lor the alle9etl exemOt�on. Any violation ot Section �- _ -. 7031.5 by any applicant for a permi[ SUCjects tna applicant to a civil � �¢nalty of not more [han fivC huntlretl t1011ars �$500). •_ . i _ � U I, ds owner o� th¢ propelty Or Ty employaGi with wage5 ds tllelf SolO ReInSpBC[i011 FBB $15 ISUB F88 $ 3 compensalion, will tlo tho work, antl the structure is not Intentletl or offerotl Rainspaetion Fee 515 ISSue Fee $ 3 (or wle (Sectlon 7004, euslness antl Protesslonal Cotlo: The Contractor's � MECHANICAL � FEES LlCense taw tloes not apply t0 an Owner o/ a properry who builtls or improves . thereon, antl who tloes such work nimsell/nerseit or throuqn nis or nor own Boiler ' Hood or Type I ❑ � � DEVELOPMENT SERVICES RE�UIREMENTS: emo�oY ees, orovitlea tnat sucn Improvamen[s ara not intonaea or oHeretl for , Zonin A roved B � sale. It, howaver, tne building or Improvemen[ is soltl within one year of com• - Canopy Type II ❑ 9 PP Y Date pletion, the owner wlll nave tha burtlen ol proving he/she tlitl not bullU or Im- Ducl - Unde� G�ound Buildinp APProvad By � Date �ove for Iho purpose oi Shcn). • �y-��- I, as owner ol the o�operty, am oxclusively contracUng with Iicensotl con- Duct • Structural Refrigeration System Appliotion Issuad By� Date 1��l �� [ractors to construct [ha project (Sec[ion 7044, Business antl Protessions Cotle: The Contractor's Licansa lsw does ,not apply ro an owner of Droperty who Duct � Ventilating ❑0.100,000 BTU ❑100,000 BTU builas or improves [hereoo, antl wno contracts for zucn projects with a mm � - - - . SUMMARV OF FEES tractor(s1 Iicense pursuanl ro the Contratlor's License Law). I am awara that Ezhaust SyStem � Multiple ❑ System Repair/Alteration - BUILDING PERMIT $ � SMIP $ proof o/ tneir Worker'z Compensation Insuranco shoWtl be orovitletl to me. PLAN CHECK' ' $ � PERMIT ' ❑ I am exempt untler Sectlon ' , B. 6 P. C. for tnis reason Firepl/FatL BIL ICBO iW Fire Dempers � PLUMBING $ ISSUANCE $. Date Ownar Heatin9 System & Ducting Registers . pLqN CHECK 25% S ' ENERGV P.C. $� I hereb certiry that 1 hava reatl tnis a plication antl state tnal tne abova ❑U700,000 BTU �100,000BT . ' §� i Intormafion Is corra<t. I agree to comply wltn all clly antl county ortlinances ELECTPICAL GRADING $ antl state laws relating to Guilain9 constru tion, antl n¢reby authorize repre- , , PLAN CHECK 50°,G $ S� MICfiOFILM $ ' sentatives o1 this ci y e er upon e abovamenHoneE pr e y f � , . inspection purp MECHANICAL $ ' ' I S Signature Date TOTALFEE' $, Y �rivers' License 5� Reinspeetion Fae $15 Issue Fee $ 3 � PLAN CHECK 25% $ • CMY Utlbo-4b, rev. lv/ov nvn�Ie - Hwm�ng; canary - nyy��wnr, rmR - P.ccoununy: bmaenroa - Nssassor �� GONSTRUCTION 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. Steef 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. Backwa5h 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 i 6. Rough Electric Wiring ,�� g� 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 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.StorageTank OGas ❑Oil 25. Roof Sheathing ' 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing - 76. Dry Standpipe 28. Wthing & Siding , 77. FIXED SYSTEM FINAL 29. Insulation � 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power MeterFinal 80. FOOD CERTIFICATE ISSUED 33. Final Electric L� 3 �0 Notes: 34. Final Heating & Air Contlitioning � � 35. Final Gas Pipe-Test 36. Hood or Canopy � , 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final - 40. Gas Service-Final . 41. Solar pomestic-Final 42. Backflow Preventer � . 43. Backflow Irrigation ' 44. .Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations � 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern �lifornia Gas Co � 51. CERTIFICATE OF OCCUPANCY No. Date � Anolicant to /ill in all soaees exceot thosa witnin heavy Eortler Ilnes antl si9n all approD/Iale tleelarations. CITV OF COSTA MESA CONSTRUCTIOIy,.,PERMIT PERMIT NO. - - TRACT NO. LOT NO. U� rvo. 0796 � 3% 12/8G ,y��i._ 'j''_ .ProlectAddrMs Co�O�V�L. l�(TH SZ. �'J�o�1C'� 1,_-- � _ . . -� Applicant'SMailingAddress I45i W.�.:�M��f1.� Ki�,`O{70o�. TYPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR . ❑ GONVERSION ❑ DEMOLISH ❑ OTHER q.p_ � - Zone , Owner's Name Phone ' DESCRIPTION OF WORKIUSE OF BLDG. Address L p y C � S Main Building: Accessory Building: ' Arth/Eng. � V E Licen52 No. TYPE OF PERMIT GRADING FOurvDATION STRUCTURAL T Front ' p Addre55 �� w. QAN�'en,Z Sr. On�.,.ct LA ' ❑ TENANT ❑ El_ECTRICAL ❑ PLVMBING ❑ MECHANICAL B Rear - N Contracror'sNam�V��-6 ��G�—Pnon��4�yZ�'u3l �'orHEa F�26 �p(L�.a�C�EnS A � PROJECT DESCRIPTION 5c1. FT. oCCUPArvCv C Right N Addresslmailing) �4SI N,LQNiEI�t'��Q_�,q�AM► LQ - - , O�%OSO CONSTRUCTION TVPE VALUATION SC�.000• O O � S Left .City License No. ZONE GRADING CU. VOS. ACRES ' R LICENSEU CONTRACTOR DECLARATION Ping. R¢f. # Parking R¢q./PrOvided E Q I hereby allirm lhat I am IiGonsOtl untler provl5ion5 01 Charle� 9(commencin9 Remarks:� Planning Notes: - M with section ]000) of Divlsion 3 0l the Business antl Protesslons Cotle, antl , my Ilcenze is In lull force antl eftect. ' ' T �icense ciass - L �cepic �0.,�2 `�`� ' . s Date� =��' - 5'9 t e�f� � -A-��y/ /� <L�, PLUMBING FEES WORKERS' COMPENSATION DECLA ATION / �� . ' , I hereby afBrm that I have a certificate ( consent to seH-insure or a tertitiwte Bar Sink Showers ELECTRICAL FEES • ot Workers' Compensatian Insurance, or a certiBetl_topy thereoi (Section BackflowPrevencer �- ServiceSink - ^ 3ao0, Lab. C.) pt5 ` Automatic Washer Transformer ❑ 15�50 KW �\ Policy Nol.+C21G2-OZROl�1' Company`-�3E�Rj 4�vSuuL. Backflowlrrigation SewerCap ConstructionPoleSub., � 50+KW � � Certitietl copy is nereby furNshetl. ^ Cgrt�ifietl copy Is 1lletl with the cit Bulltling Dlvislon. J 62thtubs S¢w¢� COnn¢CtiOn COOkipg Unit Merer ❑up t0 100 amp5 \oatP�l2•10•9S _qPPlicant �w.+ r �y � n.��r_.rT.o � � . ; EXEMPTION FROM wORKERS' COMPENSATION DECLARATION Clarifief5 Solar COIIecLofS Dishwasher � Meter ❑ove! 100 amp5 \ (This section neetl not be completCtl If lhe permit i5 tor One huntlretl (5100) or' \less). . Dishwasher Solar Piping Dryers ❑Gas ❑Electric , Sub Panel 1<ertlty lbat in [he pe�lo�mance Ot Ihe wo�k fo� whiGh this perm�t Is issuetl, I shall not employ any person in any manner so as to become subject to the Drinking fountains Solar Tank Fan \Workers' Comoenution Laws of California., --- � Motors �0-1 HP �1'h � 8 Date "'�^ S�9�ature Floor Drains Swimming Pool w/Spe p,q,U,; 'NOTICE: It, atte� making Ihls tleclaration, you �shoultl becom¢ Subject to tne , , IOC.S018� 09�15 HP 016�15+ Workers' CompCnSatlon provlSiOnS oi the Labor COtle, y0u Tusl forthwilh FI00! SinkS - U�in01 � � - Fixtures � - - - - com0ly with SucM1 provi5ions or lhis pormit Shall be tloemetl revOketl.• MiCrowev¢ ' CONSTRUCTION LENDING AGENCV ' Co25$¢NiC¢ Outlets' WaferCloset ' DeviceBoxes . I hareby alfirm thal there is a construction Ientling agency for the performanco � POIe Light ot tho work for whic� tnis pormit Is Issuetl (Sectlon 3097 Civ. GJ Interceptors � Water Heater Outlets• Ran e Lentler4 Name . 9 Lentler's AOtlrass Kitchen Sink' Water Service Swicches Sign OWNER BUILDEH DECLARATION ' � �� . • I hofeby af(irm [ha[ I am oxempt irOm [ho Conlydctof'S LICen50 ldw tOI Ihe LdvdtOli25 ' AuLO�W85h ' ' (�idlb3 2 Di5 0581 � following reason (Section 7031.5. Buslness antl Professlonal Cotle: Any clty or 9 P ; Standing SCction5 county which requires a permit m construct, alror, improve, Oemolish or reDair P-Trap Leundry Trays Generator 00.5 KW �5-15 KW any 5[�uclure; ptlot lo Iti issuance, also reqW�eS [he applicant for sucb Oermil ' T�eSh COrtlpdCtO� '[O file a signetl italem¢nt lhat he/She Is IicenSetl pulsuant (O [he ploviSiOns O/ - ROOi OfBipS ' � ' the Contractor's License Law (Chapter 9(tommencin9 wi[n'SectionJ000) ot ' �ivision 3 of the Businass antl Pro(essions Cotle) or tha[ he/she is exempt - . IheretrOm anC [he ba5i5 fOr the allegetl exemplion. Any violation ot $eclion ' ]031.5 by'any ap0��ant tor a permit subje<ts the applitant to a civil penalty o( not more than five huntlretl tlollars (E500). , ' S 3 ❑ 1, as owner oi the property or my employees with wagas as their sole ReinspBCtion Fee S15 IStue Fee compensation, will tlo the work, antl tho structure Is not intentletl or otferetl Rainspectian Fee S75 ISSUB FBe $ 3 (or sale-(Section �044, eusinezs antl Professional Cotle: Tne Contractor's MECHANICAL � FEES � Licenie tdw tloes not apply to an owne� of u p/operty who builtls oi improves thereon, antl who tloes such work hlmselt/herseu or througn nIs or her own � DEVELOPMENT SERVICES REQUIREMENTS: employCes, provitled tM1at such Improvem¢nts a�e not intentle0 0� ofleretl for BOiI¢� HOOd O� TypE 1 ❑ sale. if, howeveq the bulltlin9 or imvrovoment Is som wltnin one year oi com- Canopy Type I I ❑ Zoning Approved By Date pletion, th¢ Owner will have th¢ burtlen Oi proving ha/she tlI0 nOt bW IU o� im- DUCL - UOd2� G�OUnd Buildi�g Approv@d By prove tor t�o purpOze ot sale). DetB ❑ I, as owner o1 the property, am exclusively contractin9 with Iicensetl con- Duct � Structural Refrigeration System , • Appliedtion Issued 8y Dat tra<tors to construct tho project (SMIIon ]044, BUSinOSs antl ROtessions Cotle: � Tne Conlractor•s License Law does not apply to an owner ot oroperty wno Duct : Ventilating ❑0.100,000 BTU ❑100,000 BTU �� SUMMARV OF FEES buHtlsror improve5 tb¢reon, antl who Cont�acl5 lor sucn pro�eCls wi[h a con- tractor(sl Iicense pursuant to tne Contractor's License Law). I am aware that Exhaust System ❑ Muliiple � System Repair/Alteration � BUILDING PERMIT $ S�.S� SMip $ . SO prooi o( tnair Worker's Compensation insurance thoultl be provitletl m me. PLAN CHECK §� PERMIT ❑ I am exempt untlor 5ettion e. & P. C. for this reazon Firepl/Fac�. Blt. ICBO # Fire Dempers • pLUM81NG $ � ISSUANCE $ oate Owner Heating System & Ducting Registers i � p�qN CHECK 25% S ENERGV P.C. $ i hereby� certly that i have reae this apo��atlon antl state that me above �❑0-100,0006TU 0100,0008 . ELECTRICAL § GRADING 3 Information Is correct. I agree to comply wlth all tlty antl county orainances � ana state laws relaUn to bulltling onstructlon, antl hereby authorize repre- f � P�AN CHECK 50% § MICROFI LM $ Senlative5 Ot this y to enter on the abo -menlbnetl property for � . inspection purpo s. . MECHANICAL � S 70TAL FEE $ �3.�3 Signature � Oate �2 �"� Reinspection Fee S75 Issua Fee �; - § 3 PLAN CHECK 25% j Orivers' Lit¢nse 5 � CMF 0865-46, /ev. 30/84 White - Builtling: Canary - Applitanq Pink - A<counLn9: Volaenrotl - A5ses5or l �' � ,COVSTRUCTION AND PLANNING POOL tL SPA ,QP'ROVALS Permit # DatA Inspector qppROVALS Permit # Date Inspector 1. lemporary Electrical Service or Pole �� 52. Pool & Equipment Location - � 2. Soil Pipe-U,ndrgrnd. �� •. � 53. Steel Reinforcement ' � 3. Electrical Conduit Ufility-Undrgrnd. • ' 54. Forms ' 4�'Electrical Conduit;Und�grnd. . 55. Electrical Bonding � -. i� 5� 5teel Reinforcement; '• 56. Rough Plumbing & Pressure Test •6. .ElActrical UFER•Grrid. . 57. APPROVAL TO COVER-GUNITE ' � � � i. J 7r-Footings � • � � ,' - 58. Electrical Conduit-Undrgmd. . 8. Foundation .' � . ' 59. Gas Pipe, O Undrgmd., Test ;' 9: Water Pipe-Undrgrnd. �,; _. � 60. Backwash Lines, P-Trap, O Undrgmd. � � ".� i 10: ;Stnuctural Floor System .. ' 67. APPROVAL TO DECK 11,'�Pro'perty Sewer, Line._& House Connection � � ' 62. Backwash & Receptor-Final 12.;SeoOer 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 i 6. Rough Electric Wiring . 67. Fencing & Access Approval 17. Rough lyiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory•Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Fiough & Test � 72. Underground Flush 24. Roof Fraining . 73. Undergrnd. Storage Tank O Gas OOiI 25. Roof Sheathing"' 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. �athing & Siding 77. FIXED SYSTEM FINAL Jr2L 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIR MENT • 31. Plaster Brown Coat .� 79. FINAL INSPECTION 32. Electrical Power MetOr-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-Finai - � 40. Gas Service-Final 41. Solar Oomestic-Final 42. Backflow Preventer � � :. 43. Backflow Irrigation �� ' • 44. .Landsrape Irrigation System , 45. Sound Attenuation � 46. Handicap Regutations � . 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 � {• ' T ` ' pA plicant �O fill i� 211 SpdtCS CxCep� LIIOSO Wlttli0 11ldvy Oo�tle� Iines anU Sign all approD��ale UeclaratlOni. F COS�A INESA� CONSTRUCTIO P� SN�,�T .� r Address (f'] ?0 CJ� pplicant'sMailing,ddress ��r/� + � �.� ��,�,��•� p ��7 11..�, �� Phone�L'1Z.�1 Owner's Name Atldress UR ��•� . �.-�.ir��\�.�r Arch/Eng. License No. Address ,�,�� /( Contractor's Name �% hone �J.?J�i! ,21y \ � Addrenlmai�ingla .�^� LCIIt�YY1iCv �}'V�Ci� �.: � City Licenu No_ t '�� LICENSED CONTRACTOR DECLARATION 1 tfereby aftirm that I am Ilcensetl untler provislons of CM1arter 9(commencin9 with section ]000) of Dlvlsion 3 01 the Business antl Professions Cotle, antl my li<ense is in tull forc antl effect. �� Licen e Class ` _L ns N �ate - �' S�1..� Signature WORKERS'COMPENSATION OEC ATIO ' here�y affirm Ihat I have a certlficate of consent lo self-insure or a certiflcate t Worke�s' Compensation Insu�ance,.o� a.ce�tlfietlL c�opy thereof (Section �BOO,Lab.0.�p��.G'x� ComPanY ?FG'PC. `'i�.°l.11/i Policy No. �Certifietl copy is nereby (urMshetl. - Cer[ifieCc py i(i tl with the cityg uiltlin9 Divisio ��, Date � 1 e� " �� APPlicant..fy�� ,%�" . EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This seclion neetl not be completetl If the permit i5 (or one huntlretl�(E100) or less) • • '. 1 Certity [hat .in th¢ pe�fo�mance of lbe wo�k for which this pe�m�t is iSsuetl, I shall not employ any OerSon in any mannBr So'az fo b¢com¢ SubjeCt t0 th¢ Workers' Compensation Laws ot California. �� . Date Signature �NOTICE: If, after makin9 this tleclaration, you shoultl become sub�ect to the Workers' Compensation provislons ot the Labor Cotle, you mus[ forthwith comply with suc� O�ovi5ion5 or thi5 p¢rmit Shall be tleemetl revoketl. CONSTRUCTION IENDING FGENCV I M1e�eby affirm that there i5 a mnstructlon lentling agency for the perfOrmdn<C of tbe wark for which this permit is issuetl (Section 3097 tiv. CJ Lnntler's Name ' Lontler's Adtlress - OWNER BUILDEH DECLAFATION � I hereby afBrm that I am exempt from the Contractor'z License Law for the following reason (Sectlon 7031.5 Business antl Pwfessional Cotle: Any city or county whith �equires a pe�mit to ConStruct, alter, improve, tlemolish o� �apair anv zbucture. orior to its issuance. also reqWres the appllcant for such permit ' enalty of not more tr � I, as owne� ot th comoensation, wili Ao lor sale (Section ]0� License Law tloes not theroon, antl who tlo� employees, provitled t sale. If, howeve�, Ihe D�e[ion, the ownet wl prove torthe purpose ❑ I, as owner oi the Iractor5 to construct tl The Contractor's Lia builtls or �imDroves th tracmr(z1 license purs proof of lh¢ir Wa�ke ❑ I am exempt unaer Date SBOIdtIV85 Ot t115 I Inspection pur ses Signature Orivers' Licen or 55 is tor [he allegetl exempfion. Any Wolatian ot Section an[ tor a p¢rmit SUDjec[s the appllcant t0 d civil in iive nuntlretl tlollars (5500). pro0erty o� my employ¢e5 with wages as tnei� Sole the work, antl th¢ structure is not intentletl or offeretl l, Business antl Professional Cotlei Tne Contractor't .pply to an owner o! a property who bwltls or Impmves : such work himself/hersali or through his or her own m[ zuch improvem¢nts a�¢ not intentled or oH¢retl 10� uiltling Or Imp�ovement is soltl within one year of com- hav¢ the burtlen of proving ne/she ditl nOt bulltl o� Im- f sale). . oroperty, am exclusively contra<ting with licensetl con- e project (Section 7044, Business and Profe55ions Cotle: • �se law tloes no[ apply to an owne� of Oroperty who � ♦eon, antl who contracts for such projects with a con- ant [o tha Contractor'i �icense Law). I am aware tnat 'S CompenSatiOn in5urance shoultl be prOvitled to me. iection B. & P. C. fOr this reason owner have reatl this apP�icatlon antl state that the above agree to comply with all city antl county ortlinances o builtlin9 �onstructlon, antl hereby authorize repre- tO��Cntec UPon the above-mentionea vroperty tor TYPE OF CONSTRUCTI . LJ NEw LJ aoo LJ ALTERATION ❑ CONVERSION EMOLISH ❑ OT DESCRIPTIONOF ORK/USEOFBLDG.�� -_-f._„��_.� TVPE OF PERMIT LJ GRADING LI FOUNDATION LJ STRVCTUI ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 5[i. FT, oCCUPANCv CON STRUCTION TVPE VALUATION $ � ZONE GRADINGGU.VDS. ACRES_ Remarks: Sink Preventer Irrigation ikin9 Fountains �r Drains >r Sinks Service Outlets Kitchen Sink Lavatories P-Trap Roof Drains Reinspeetion Fee Boiler Duct- Under GrounA Duct - Structural � Duct - Ventilating Exhaust System � Multiple Firepl/Fact Blt. ICBO # Heating System & Ducting �0.100,000 BTU �100,000 Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Witer Closet Water Heaier - Water Service n�co-we:n 5 I I laue Fee " MECHANICAL Hood or Typel ❑ Canopy Typell ❑ - Refrigeration System ❑o-�oo,000eru ❑ioo,000eTu ] System Repair/Alteration Fire Dampers Registers Reinspectian Fee � $75 � � laue Fee 0865-46, rev. 30/84 White - Bulltling: Canary - qpplicant; Plnk - Atmunting; GOICenrotl - Asse55or REPAIR FEES A.P. # S Main Buildi E T Front B Reer A C Right K Left S Ping. Ref. � Planning Notes: Automatic Washer Construction Pole Sub. Cookin9 Unit D ishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes OuNets Switch¢s Garbage Disposal Generator �0�5 KW C 4979 6/I7/85 Zone Accessory Building: Perking Req./Provided ELECTRICAL Transformer ❑ 15-50KW- ❑ 50+KW Meter ❑up to 100 amps Meter �over100amps Sub Panel Motors�0.1 HP�1h-8 Inc.Solar 09-15 HP �i6-15+ Microwave Pole Li9ht Sign ; Standing Sections 15 KW Trash Compacmr $ 3 I �- Reinspection Fee $15 FEES DEVELOPMENT SERVICES REQI Zaning APProved By Building Approved By Appliration luued BV $ 3 Issue Fee EMENTS: Iuo�O TL FEES S3 2 O N I N G R E � M T $ SUMMARV OF EES BUILDING PERMIT $ �� SMIP $ / -S � PLAN CHECK $ PERMIT � , PLUMBING $ � ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ �� J' MECHANICAL $ _ TOTAL FEE $ � PLAN CHECK 25% $ 7STRUCTION AND PLANNING � ?ROVALS Permit#�_ �1. Temporary Electrical Serviceor Pole• - '2. Soil Pipe=Undrgrnd. - � � i 3. ElectriEal Conduit�Utility-Undrgmd. , 4..Electrical Conduit�Undrgrnd. � ' '. 5. Steel F{einforcement i , � ' - ' � 6.`..�Electri�cal UFER Grnd. i ' � -, � i r 1 7^ Faotings , �� i;'� . 1 ' �1 &.-"Fo�ndation . `� '9..•Water Pipe-Undrgrhd. 10.��tructural Floor System � „ � 1.L- Property Sewer Line & House Connection . 12.�Sewer Cap , i I 13. Roof Drains i � 14. Rough;Plumbing � I� 15. Rough Electrical-Conduit � � I � 16. , ough Electric Wiring � �17. , ough Wiring Sign - � � = �18. Rough Electrical-T Bar Ceiling IM 19. Rough Heating & Air Conditioning � 20. Rough Factory Fireplace � � 21. Ducts,in Structure � 22. Ducts, Ventilating 23. Gas Pipe-Rough & Test 24. -Roof Framing , • 25. Roof Sheathing ; i _26. T-Bar Ceiling (Structural) & Monocoat � -27. Frame and Flashing , ' � 28. �Lathing & Siding � ' 29. Insulation ' i 30. �Drywall Nailing . � 31. Plaster Brown Coat 32. Electrical�PowerMeter-Final � � 33. Final Elec'tric 34. Final Heafing & Air Conditioning 35. Final Gas'Pipe-Test . . ,,. 36. Hood or CanopY 37. Final Factory Fireplace 38. Final Plumbing . 39. Water Service-Final � I40. Gas Service-Final 41. Solar pomestic-Final ) 42. Backflow Preventer' I43. Backflow Irrigation 44. ,Landscape Irrigation System J 45. Sound Attenuation 46. Handicap Regulations . 47. FINALSTRUCTURE & BUILDING 48. Special Requirements Completed ' 49. Electric Release to Edison •� 50: Gas Release to Southern California Gas Co 1 No. . ...... . .. ..,. .. _ ... ,. Date �- Date 'I � 0 0 "� 0 Y � !G$ti �� POO� „5PA � � Inspector ,AppROVALS Permit# � � . 52. Pool & Equipment Location �53. Steel Reinforcement - 54. Forms � _ ,. � _ � - � �55. Electrical'Bonding � . � � 56. Rough Plumbing & Pressure Test � 57. APPROVAL TO COVER-GUNITE 58. Electrical Conduit-Undrgrnd. : 59.� Gas Pipe, � Undrgrnd.. Test . . 60. Backwash Lines, P-Trap, �' Undrgrnd. � 61. APPROVAL TO DECK 62. Backwash & Receptor-Final . �° 63. Heater & Vent-Final ' - � 64. Plumbing System - Final ± 65. Electrical-Final � 66. Solar System-Final ' - 67. Fencirig & Access Approval �' 68. APPROVED FOR PLASTERING � 69. POOL/SPASYSTEMSFINAL � FIRE DEPT. REQUIREMENT, APPROVALS Permit# 70. Underground Hydro _ 71. Product Piping O Gas ❑ Oil 72. Underground Flush 73.� Unde�grnd.StorageTank O�Gas ❑Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe ' 77. FIXED SYSTEM FINAL - 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT ' 79. FINAL INSPECTION � 80. FOOD CERTIFICATE ISSUED Notes: ; 0 0 N � r ' � - .. ... .., . Date I Inspector I --- i : I � 0 1 : � � / ADPiicant to fill in all spaces exeepl t�osa within heavY �o�Aer lines dnG si9n all aDPropriate tleelarations, 'CfTY OF coSTA MESA CONSTRUG TION PERMIT . PrOjec[Address �70 ✓ l�T/f �$T �.?C��, Applicant's Mailingpddress ��1/'� �n�� . � � u - Owner'sName �%P�-�� il�.{�.C'�/ Phone a`��—t�z Adtlress �� y� cf �%CL�`�r ArchlEng. License No. Adtlress Contractor'sName • ho'ne'� �' �� Adtlresslmailin9f � �'�' � �� -� n Ciry �License No. � LICENSED CONTRACTOR DECLHRATION I hereby affirm tha[ I am licensetl untler provisions of Charter 9(commen<ing w��h sectlon 7000) 01 �ivislon 3 of the Business antl Professions Cotle, antl my �icense is in full rce ntl elfecL � i!,\�y -�/, rj Lic¢ns¢ Class' C¢ns 4t J -� 0 Date ' I � .' S.g ( ,�y • WORKERS' COMVENSATION D CLARATION � hereby atiirm tnat I have a certificate ot mnsent to zelbinsure or a certificate f Workers' Compensatlon Insurance, or a certifietl coOY thereo7 (SacUon :eoo, �c. c.� �IL�� -��% �y� i'� �inL� Pol�cy No. Company � %f(a. � • ❑.Certifietl cOpy is hereby 1u�ni5hetl. ' • �Certifletl co y is fjjetl with the city Bull Ing Dlvlsiea. oa�e i n- I ��-sCG Applicant �n�'�.f� I Y,Y�Ca ��F� - EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section neetl not be complete0 if (he permit is for one huntlretl ($300) or less�. ' I c¢rtify that in the perfo�mdnce of �he wo�k fo� Which [ni5 p¢rm�t is ISSu¢tl I Shdll not employ any pa�SOn In any manne� So as to become subj¢<t [O t�e Workers' Compensa[ion Laws of California. .. + . Date Signature 'NqTICE: 1f, aite� making tnis tlecla�ation, y0u shoultl become Subject to th0 Warkers' COTpensd[ion Orovi5ion5 ot (he 12bor COtle, you must forthwith COTOb '�'�lh sucb p�ovisions or this pe�mit shall be tlCematl revoketl. CONSTRUCTION LENOING AGENCV ' 1 hereby affirm that there is a constructlon lentlin9 agency tor the pertormance ot the work tor which this permit i5 I55uetl (Section 3097 Civ. C.) Lentler'z Name Lentler's Atltlress OWNER BUILDER �BCLARATION I hereby afflrm that I aT exempt trom the Contractor'S License law fOr lh¢ � following reason (Section 7031.5 Business antl Protessional Cotle: Any cily or Icounty wni<h requirez a permit to construct, aller, improve, tlemolisn or rapalr any structure, prior to ils issuance, also reqWres [he applican[ (or such permit , to /ile a Si9netl 5[atement tha[ he/she is IicenSetl pursuaM to the provisiOnS ot �, the ContractoYs License Law (Chapter 9(commencing with Section 7000) of � Division 3 of tne Business antl Professions Cotle) or that he/she is exempt therefrom antl the basis fOr the allegetl exemption. Any violation of SecHon 7031.5 by any applicant for a permit subjects the applicant to a civil .�@-1ndlty of not mo�e than tive hunC�etl dollars ($500). �-1 1, a5 owner of the p�opMty o��my�emp10ye05 wlth wages as thair sole cqmpensation, will tlo the work, antl Ihe structure is not intentletl or ofteretl for sale (Seclion 7044, Business antl Professional Cotle: The Conlractor'S Li�ense law tloes not avP�Y to an owner ot a property who builtls or Improves LOe�eon, antl who tloes SucO work himselt/Mersolt or througM1 his o� her own employees, provitletl that such Imorovements are not Intenaetl or oifaretl for sale. 1f, however, lhe bulltlin9 or imOrovement Is soltl wi[nin one year of com- P�etlon, ttte owner will have the burtlen of proving h¢/She tl(0 not bufltl Or Im- P�ov! �orthe purpose of sale). � ❑ I, a5'own¢r Of the p�Operty, am ezclusively Cont�ac[ing with licensetl Con- tractors to construc[ tne project f5ection �044, Business antl Profezsions Coee: Tho Contractor's License Law does not apPly to an owner of property who bWltls or improves tnereon, antl wno conVacts for such projects with a mn- bacior(s) li[ense pur5uani �to the Conbactor's Ucanse Law). 1 am aware Iha[ PYoof o( thei� WOrker's Compensation in5uranCO shoultl be provitletl to me. ❑ I amexempt untler Section B. & P. C. (or [hls reason Date I hereby certity [hat 1 Intormatmn �s correct. I antl s[ate lawz relatin9 ' senta[ives of Nis City ��ipectlon pu�0ose . Signature Orivers' Litense SS 9y Owner ,ve reatl th15 applitatlon and s[ate that t�e above ree to comply with all c(ty antl county ortlfnan<es builtling c n5truction, antl he�eby authorize �ep�e- ter u n the abOve-mentionetl prope�ty f0/� Date � �' �� .'��_ TYPEOFCONSTRUCTI�ON� IJ NEW U ADD IJ ALTERATION LJ REPAIR ❑ CONVERSION L7`OEMOLISH ❑ Oy(p,�� R DESCRIPTION OF WORK/USE OF BLDG„��'! g�firr-,�-�— TVPE OF PERMIT L7 GRADING LJ FOUNOATION LJ STRUGTU ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MEGHANIGAL ❑ OTHER PROJECT DESCRIPTION 5(i. FT. oCCUaANCY CON STRUCTION TVPE VALUATION $ _' ZONE GRADINGCU.VDS. ACRES_ Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clariliers Dishwasher Drinking Fountains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink lavatories P=Trap Roof Drains Reinspec[ion�Fee $75 7uct- UnderGround ' Duct - SlrucNral Duct - Ventilating . - Exhaust5ysiem ❑ MWtiple Firepl/Fact. Blt. ICBO # Heatin9 System & Ductin9 ❑0.100,000 BTU �100,000 Peinzpettion Fee � $15 CMF 0865-46, re�. 10/Ba White - Bulltling; Canary - qpppwnt; Pink - Accounting: Goltlenrotl - Assessor Servite Sink � Sewer Cap Sewer Connection Solar Coifecrors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Clout Water Heater Water Service Auto-Wash Laundry Treys Issue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑6100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee F $ 3 FEES $ 3 A.P. # 5 Main Builtling: E T Front ' B Rear A C Aight K g Left Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit � Dishwash¢r Dryers ❑Gas ❑Elee Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Dispoul Generator �0.5 KW C Fee _ \. 4980 6/17/85 IooED 2one Accessory 8uilding: Z O N I N G R Parking Req,/Pro�jd¢�1 - E U M 7 S ELECTRICA4 , Transformer ❑ 15�50 KW � ❑ 50+ KW Meter ❑up to 100 amps Merer ❑over 100 amps 5KW $15 Sub Panel Motors061 HP�1'f,-8 Inc. Solar �9-75 HP �16-75+ Microwave Pole Light Range Sign ; Standing Sections Trash Compactor laue Fea DEVELOPMENT SERVICES REQUIREMENTS: ZoninB APProvad By 8uilding Approved By � , FEES $ 3 SUM ARV F FEES � �-- BUILDING PERMIT $ SMIP � $ � PLAN CHECK $ � PERMIT PLUMBING ^y ISSUANCE 3 PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM $ --�( MECHANICAL $ TOTAI�FEE $ �.��_(.L PLAN CHECK 25%� $ � CONSTRUCTION AND PLANNING APPROVALS Permit # "I 1. Tempo�ary Electrical Service or Pole 2. Soil Pipe-Undrgrnd. - 3. Electrical Conduit �tility-Undrgrnd. "4. ElectriGal Conduit-Undrgrnd. � _ � � 5.'Steel Reinforcement I � ". - .� . .: ...-i 6'�'Eledtrical UFER Grnd. ;,- . -7. Footings � � ? -� . 8"Foundation ,-=1 9.�Water Pipe-Undrgrnd. �; 10. $tructural Floor Syste�m i�=? . 11.-PropertY Sewer Line & House Connection 12.•Sewer CaP ' I 13. Roof Drains ' � 14. Rough Plumbing . 15' Rough Electrical-Conduit - ' i6. RoughElectricWiring 17. Rough Wiring Sign _ 18. Rough Electrical-T Bar Ceiling 19. Rough Heating & Air Conditioning 20. Rough Factory Fireplace 21. DuCts, in Structure 22. Ducts, Ventilating 23. Gas Pipe-Rough & Test 24. Roof Framing 25. Roof Sheathing � � 26. T-Bar CBiling (Structural) & Monocoat 27. Frame and Flashing � 28. Lathing & Siding 29. Insulation � 30. Drywall Nalling 31. Plaster 6rown Coat � 32. Electric&I Power Meter-Final � 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test - 36. Hood or Canopy , 37. Final Fa�tory Fireplace 38. Final Plumbing 39. Water Service-Final � 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preyenter , 43. Backflow Irrigation • 44. .Landscape Irriqation SYstem 45. Sound Attenuation 46. HandicaP'Regulations 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed , .. 49. Electric Release to Edison ' 50. Gas Relsase to Southern California Gas�Co 51. CERTIFICATE OF OCCUPANCY No. ' Date 1 ' Date � _ _ POOI � �PA Inspector . APPROVALS Permit # 52. Pool & Equlpment Location 53. Steel'Reinforcement � 54. Forms _ 55. Electrical8onding -' � 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER-GUNITE • 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test � � 60. Backwash Lines, P-Trap, O Undrgrnd. 61. APPROVA� TO DECK ' - 62. Backwash & Receptor-Final . 63. Heater & Vent-Final ' - 64. Plumbing System - Final' � ' 65. Electrical-Final ' 66. Solar SYstem-Final � 67. Fencing & Access Approval, � - 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hydro 71. Product Piping O Gas O Oil 72. Underground Flush 73. Undergrnd. Storage Tank � Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: Date .Inspector t- � - �; , � � � CiTVbF'COSTA MESA CONST Project Address _ � � • Applicant's MailingAddreu AOp��ant to fill in all spaces exeept those within heavy Eortler Ilnes anC sign all aDVroD��ate Ceclarations. ION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIf NO. �LL <�- -� � s,Q � y� G �- 3 � Address u� V�'L�!/� Arch/Eng. —License No. Address ��1 Contrector'sNam '` - Ph1one�"�CL=�k Address (ma'I' g) �� ')�/Yn �a J l�� - City License No_ �n� �a'! LICENSED CONTHACTOR DECLARATION I nereby ailirm that I am Iicensea untler provizions o1 Charter 9(commencing with 5ection ]000) Of Division 3 01 the Business antl Prot¢SSiOnz Cotle, antl my license is in tull for e an ltect. c- � License CIaSs, � L' ns N� ��% �` e� Datc �D� I � ' CS Signahre WORKEftS' COMPENSATION D RATION 1 hereby afflrm tnat I have a certificate of consent to self-inzure or a certiticate t Workers' CompenSation Inmrance, o� a certitietl mpy thereo( (S¢Clion ,800, Lab. C.) '\ �' .{�� POIICY No. �I LI.0 � �N ComPanY `l�f� ' `-' �'n �Certifiatl copy is hereby furni5h¢0. �'� Cer itietl copy ois (iled with the city Bµiltling Divisi�5 (% Oate ��-��-�"p� AOGlicant �7�>�✓1 1'�%�� `�b. E%EMPTION FROM WORKERS' COMPENSATION DECLARATION (This sectlon neetl not be mmpleteU if tne permit is for one huntlree ($300) or less) ' • I Certify that in the P¢r(ormdnce of Ine wo�k for whith this plrm�t Iz issuetl, I sitall not emplOy any pe�son In any manner zo as t0 Decome subject t0 IhG Workars' Compensatlon Laws of Calitomia. '� ) . Date Si9nature 'NOTICE: 1f, atter making this tleclaration, you shoultl become subject to lhe Work¢rs' GompensatiOn provisions ot the LabOr COtle, you mus[ forthwith cOmply wilh Such p�ovl5ion5 or lhis permlt shall be tle¢m¢tl revoke�. CONSTRUCTION LENDING AGENCV I nereby afflrm that there Is a ton5truction Ientling agenty tOr thG performance of the work far whith thiz permit is issuBtl (Sectlon 3097 Civ. CJ Lqnaer's Name Lonticr's AtlCress __ OWNER BUILOER OECLARATION " I hereby a1fl�m t�at I am exempl trom the COntracto�'S Llc¢nTe l.aw /or the tollowing rea5on (SecHon 7031.5 Business antl Protesslonal Code: Any city or <ountY which requires a permil to construc[, aller, improve, tlemolisn or repair any structure, prlor to ib issuance, alw requires the apolicant for such permit [o file a signatl Slat¢menl t0at he/she IS licensetl pursuant to the proviSiOns of the Convacto.'s Licenso Law (Chapter 9(commencing witn SacUon 7000) of DivlSion 3 01 the Buziness antl Professions Cotle) or [hat ne/she is exompt themfrom antl the Dasli tor t�e allegetl exemptlon. Any vlolatlon oi SecUon 7031.5 by any applitant tor a permlt subjects the appli<ant to d clvll .�¢nalty of nol more than tiva huntl�e0 tlOilars (5500). IJ I, as owner oi the oro0arty or my employees with wagas as tneir solo compenzaHon, will tlo the work, antl the structure is not Intantletl or oi/erea for sale (5¢ction 7044, Business antl Protessional Cotle: The Contractor'S Licenze Law tloes not app1Y to an owner ot a property wt�o builtls or improves thoreon, antl wha Coes sucn work himself/herselt or tnrough hls or her own employ ees, provitletl that such imorovements are not Intentletl or oHeretl ior 581e. It, however, the builtling or ImProvement Is soitl within one year o/ com- plOtiOn,.lho owner will M1ave [he bu�tl¢n of p�ovin9 he/sh¢ ditl nOt builtl Or Im- prova forthe Ourpose otsalo). �❑ I, a5 Owne� ol the property, am exclusively contratting wilh 1{ceOSatl coT i tractors to conztruct the Oroject (Section 7044, Business antl Profe55ions Co�e: Tne Contractor's License law does not apply lo an owner o� property wh0 bulltls or Improves thereon, antl who conVacts tor such projects wltn a con- tracfor(sl Ilcens¢ pursuant to tbe Con[racfor's License Law). I am aware that prOof o( tnei� Worker'S Com0en5ation insurance shoul0 be provitletl to ma. ❑ I am exempt untler Section , B. & P. C. lor this reason Dale — I hereby certi �IIfOITdl�Of1 �5 antl-state laws sentatives of InSpactlan pu . Si9na[ure Driverz' Lice _ Owner that I have reai 'rect. 1 a9ree to iatina to builtlin or 55 � I thiz applicatlon antl state-that the above comply with all city antl county ortllnancas y construcHon, antl �ereby authorize repre- AupOn th¢ above-mentionea P�operty 1or / Dal¢ � � �" � TYPE OF CONSTRUC`TI^ON LJ NEW LJ ADD ALTERATION U R ❑ CONVERSION�1' EMOLISM ❑ OTHER �/I�— DESCRIPTION OF WO K/USE OF BLDG. �� f�� TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION Sq. F7. OCCuaANCv_ CONSTRUCTIONTVPE VALUATION$ �)O.� ZONE GRADING CV. VDS. ACRES_ Remarkz: Bar Sink Backtlow Preventer � Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gai ServiCe Ouilet5 Kimhen Sink Lavatories P-Trap Roof Orains Roinspaction Fee � 515 eoiier Duct-UnderGround Duct - Stru[tural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. IC80 # Heating Sysrem & Ducting ❑0.100,000 BTU 0100,00087 Reinspection Fee � $1b CMF 0865-46, rev. 30/84 White - Builtling; Canary - ApPlicant; Pink - Accounting; Goltlenrotl - Asze55or $howers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto�Wesh laue Fee I g 3 A.P. qIe S Main Buildi E T Front B Rear A C Right K Left S Ping. Ref. # Planning Notes: Aummatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers OGas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Dispoul Generator �0.5 KW �5�15 4981 6/17/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ SO+KW Meter LJup to 100amps Meter �over100amps $ub Panel Motors �47 HP O1'/h - 8 Inc.Solar �9-15 HP �i6-15+ Microwave Pole Light Range Sign Standing Sections Trash Campactor Reinspection Fee $15 Issuo Fee IANICAL FEES Hoodor Typel O DEVELOPMENTSERVICESREQUIREMENTS: Canopy Type II ❑ Zo�ing Appraved 8y BuildinB APProved By Refrigeration System ❑6100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Isue Fee � $ 3 — 150:0 Tl Z O N I N G R E U M T S FEES $ 3 SU RX OF EES BUILDING7ERMIT $ `� SMIP $ r S O PLAN CHECK $ PERMIT PLUMBING $ S iD �J ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ �.c� MECHANICAL $ TOTAL FEE $ /. S � , // PLAN CHECK 25% $ � . I j•.CONSTRUCTION ANDPLANNING- .. POOL..dPA . - - �'�, APPROVALS Permit# - Date Inspector p�ppROVALS Permit# Date Inspector ' ! • 1. Temporary Electrical Service or Pole . 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � , � � 53. Steel Reinforcement . � '3. Electrical�Conduit Utility-Undrgrnd.� ' 54. Forms � 4�'Electrical.Conduit'Undrgind. 55. Electrical6onding 5:'Steel Reinforcement � - 56. Rough Plumbing & Pressure Test - : � 16. ;Electrical UFER Grnd. -^-'i � 57. APPROVAL TO COVER-GUNITE 7 Footings . ' � - - - � 58. Electrical Conduit-Undrgrnd. i � 8.. �oundation _ � � 59. Gas Pipe, O Undrgrnd., Test � 9!�Water Pipe-Undrgrnd., `:� � 60. Backwash Lines, P-Trap, O Undrgrnd. ' 10. Structural Floor System ; 61. APPROVAL TO DECK . I1.: Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap . ., G�� 9� �' 63. Heater & Vent-Final i 13. Roof Drains 64. Plumbing System - Final 114. Rough Plumbing 65. Electrical-Final . � -757 Rough-ElectricakConduit 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 O Gas �❑ Oil � 23. Gas Pipe-Rough & Test � . � 72. Underground Flush 24. Roof Framing 73. Undergrnd.,StorageTank �Gas ❑Oil � � � 25. Roof Sheathing - 74. Overhead Hydro i 26. T-Bar Ceiling (Structurall & Monocoat 75. Dry Chemical - 27. Frame and Flashing 76. Dry Standpipe ' i 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. ElectYical Power MeterFinal - 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 1 38. Final Plumbing 1 ' 39. Water Service-Final . 40. Gas Service-Final � 41. Solar pomestic-Final . ' 42. Backflow Preventer ' ' • 43. Backflow Irrigation - ' � � ' 44. .Landscape Irrigation System ' � . ' 45. Sound Attenuation � , � � 1 46. Handicap Regulations . ' 1 47. FINALSTRUCTURE&BUILDING . � � 48. Special Requirements Completed , . . � 49. Electric Release to Edison • - � ' 50. Gas Release to Southern California Gas Co ' � � I\ 51. CERTIFICATE OF OCCUPANCY i No. Date � � . i- 1' � Applicant to fill in all s0aces except ihose within heavy Dortler lines an0 sign all app�opriata tleelarationz. c�7Y o� Cosrq MESA CONSTRUCTION�PERIyIlT � I Project Address .5� L Applicant's Mailin Address - L-�,� , � Owner's Name' ��'P-� ✓le�-1� �A.1 a �_Phone �2_7�L�� Address � �5/..A'Y. J1.�sY�lC��b� ' Arch/Eng. License No. Address Contractor's Nam Phone �"��_U? Address (m 'I' g) �� ' �n��A. � �... i � - City License No. ��i��a� LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed untler provisions of Charter 9(commencing with section ]OOQ) of DlviSion 3 ot Ihe Bu5ine55 antl Prof¢s5ions Cotle, antl my license is in full f ce a effect. License qass ens� II��]�GI S� Date � � Si9nature ^ WORKERS' COMpENSATION D LARATION I hereby attirm th8t I have a certificate of consent to self-insure or a certificate �f WorkersL Compensation Insurance, or a certifietl� copy thereof (Section � 3800, Lab. C.) �n ' �(�' !�j.,� /�' � Policy No. ��/u � Company�`��'�1�� Certifietl copy Is hereby furnishetl. - a� Certifietl mpy�5 £letl with the city B yil�tlin�.� D��ivisio� �,-� �{�1 (�� Date � 0-1_,_LI_�4C� Applicant �v�r_J..1'�6.:�YY A l:f�_ EXEMPTION FROM WORKERS' COMPENSATION DEGLARATION (This section neetl not be com0�etetl if tne permif is for one nuntlretl ($100) or IE55�. - ��'t. I certify that in the p¢rfo�mance of Ihe wo�k for which tnis Oe�m�t�i5 issuetl, I shall not employ any person in any manner so as to become subject to the Workers' Compenkation Laws of Calitornia. � t+ .• . Da[e Signatme 'NOTICE: If, after making this tleclaration, you shoultl bemme subject to the Workers' Compensation provisions ot the Labor Cotle, you mu5t (orthwitM1 comply with SUCh provi5ion5 or this permit shall be tle¢metl revoketl. CONSTRUCTION LENDING 'AGENCV ' I hereby aHirm'th8t there is a wnsVuction Ientling agency for tne performance of tne work tar whlch [his permit is i55uetl (Section 309] Civ. CJ Lentler's Name' Lentler's AtlOresi . OWNER BUILpQR dECLARATION i nerebv aftirm tnat i am exempt from the Contractor'S License Law for the any strutture, pr�Or to to file a si9netl statem� the Contractor's Licem DiviSion 3 of th¢ Bu! therefrom an0 tq¢ ba� �031.5 by any appli / ¢Odlty of not mbfe [h � I, as owner ry} [hi Compensation, will do for sale (Sectio� ]04 License Law tlo25 not thereon, ana'wno tloE ¢mployees, p�ovitletl t sale. It, however, the I pl¢tion.�the own¢r wil �rove foYttte purppse � I, as owner oi the tractorsto construct tl The Contractor'3 Lice builtls or imp�oves th tractor(Si-license pur5i proof of their Vyorke� ❑ I am exempt Untler Date Siqnahre � Drivers' Lic nse pr 55' �7031.5 Business antl Professianal Cotle: Any city or iermit to construct, alter, improve, tlemolish or repair iszuance, also requires the applicant tor sucn permit that he/she I5 IIC¢nsetl pur5udnt to the p�ovi5ions ot �w (Chapter 9.(commencing with Section ]000) ot 55 antl P�o(eS5ion5 Cotle) o� that he/she is exempt for the alle9etl ex¢mp[ion. Any violation of Section t for a permit subjects the applicant to a civil five huntlretl tlollars (SSo�). rope�ty or my�employees with wages a5 thei� sole a work, antl tna structure is not intentled or offeretl Bu5ine55 antl Pro(e55ional Cotle: The Contfdctof'S dy to an owner ot d p�operty who builtls ov improves uch work himself/he�self o� through his or h¢r own such improvements are noc intentleG or offeretl for Itling or improvement is soltl within one year oF mm- 3ve the burtlen Ot Provin9 he/she tlitl not builtl o� im- ale). �oerty, am exclusiveiy contracting with licensetl con- iroject (Section 7044, Bu5ine55 antl Prote55ions Cotle: Law tloes not appty to an ownet ot p�operty who on, antl who contracts for such projects with a con- t to the Contractor's License Law). I am aware that Compensation insurance shoultl be provitletl to me. :tion B. & P. C. for this reason Owner� have reatl this aoPlication antl ztate that the above agree to compty with all city antl county ordinances oJJyaayyy�Itling onstruction; and hereby authorize repre- t� �ter'�on th¢ above-men[ionetl Property (or /� t .i�n � 11 i�SF TVPE OF CONSTRUCTION LJ NEW u aDo yJc�n��a�a�� ' ❑ CONVERSION DEMOLISH ❑ OTHER J� 1 DESCRIPTION OF W RK/USE OF BLDG. TYPE OF PERMIT GRAOING FOUNDATION STi2UCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING Q MECHAfY1CAL ❑ -OTHER PRQIECT DESCRIPTION 5a. FT. oCCUPANCv_ CON STRUCTION TYPE VALUATION $ _�� ZONE � GRADING GU. VDS. ACRES_ Remarks: 8ar Sink Backflow Preventer ' ' Backflow Irrigation eathtubs ciw.ific.< � Drinking Fountains ' Floor Drains Floor Sinks 3as Service Outlets Interceptors - Kitchen Sink P—Trap Roof Orains Reinspeaion Fee $15 Boiler Duc[ - Under Ground Duct - Structurel Duct- Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ 6100,000 BTU O 100,000 BTI Reinspeccion Fea $15 CMF 0865-46, rev. lb/86 White - Builtling; Canary - qppllcant; Pink - Accountlng; Goltlenrotl - Asse55or Showers Service Sink � ' ' Sewer Cap Sewer Connection Solar Collectors Solar Piping' Solar Tank Swimming Pool w/Spa Urinal Wacer Closet Wacer Heater Water Service A uto-W ash laue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration Sys[em �0-100,000 B7U 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee R FEES $ 3 $ 3 A.P. # S Main Building: E T Fron[ B Rear A C Right g Left Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher � Dryers ❑Gas ❑Elec Fan F.q,U. Fixtures Device Boxes OULIQIS 4982 6/t7/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Garbage Disposai Generator �0-5 KW �5�15 KW Meter LJup to 700 amps Meter ❑over100amps' Sub Panel Motors � 0-1 HP � i%- 8 fna Solar'09-75 HP 016-75+ � Microwave � Pole Light Range Sign ', Standing Sections Trash Compactor � Reinspection Fee �$15 � � Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Appioved By APPliption Issued BY � /� 19.:Q Tl FEES $ 3 2 O N 1 N G R E Q M T S SUMMARY�)F EES BUILDINGPERMIT $ �� SMIP g ,.S l) PLAN CHECK $ PERMIT � PLUMBWG $ � �ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. �$ ELECTRICAL $ � GRADING $ PLANCHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE $ �'S PLAN CHECK 25% $ J�CONSTRUCTION AND PLANNING _ � ' POOL n SPA � Date Inspector - - ` Date Inspector 'r; APPROVALS Permit# APPROVALS :Permi[# 1. Temporary Electrical Service or Pole, T . • 52. Pool & Eguipment Location . _ _ � 2. Soil Pipe-Undrgrnd. i:. - 53. Steel Reinforcement � 3. Electrical Conduit Utility-Undrgmd. � 54. Forms - � "' . 4.:'�lectrical Conduit-Undrgrnd. _ -E � . ' . •55. Electrical Bonding � ��'"� � 5.'.Steel Reinforcement � . - . 56.. Rough Plumbing,& Pressure Test �. - � � � i 6. �Electrical UFER G�nd. """ 57. APPROVALTO COVER-GUNITE :�.�`� ; .� 7..-Footings � ,. - '--� 58. Electrical Conduit-Undrgrnd. ;, '8:•Fiou�dation ' � ,.,.� �59.GasPipe,�Undrgrnd.,Test . •, �� 9�.Water Pipe-Undrgrnd. ',.; . �60r Backwash Lines, P-Trap, O.Undrgrnd.- � .�� 7�0. Structural Floor System _... 61. APPROVAL TO DECK , . 11;o,Property Sewer Line & House�Connection . 62. Backwash & ReceptorFinal � � 12. Sewer Cap . � � � 63: Heater & Vent-Final � ,� � 13. Roof Drains � � 64.� Plumbing System - Final � � . � 14. Rough-Plumbing 65. Electrical-Fina�' � , 15. Roug15 Electrical,-Conduit - ' - 66. Solar System-Final ' '- - _ 16. Rough Electric Wiring, . �' 67. Fencing & Access Approval • �- � 17. Rough Wiring Sign 68. APPROVED FOR PLASiERfNG � , - 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 0 Gas ❑ Oil - 23. Gas Pipe-Rough & 7est . � � � 72. Underground Flush � � 24. Roof Framing . 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro � �� -26. T=6ar Ceiling (Structural) & Monocoat 75. Dry.Chemical . � � 27. Fram'e 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. Electiical Power Meter-Final . 80. FOOD CERTIFICATE ISSUED � � 33. Final Electric � ' Notes: ' • • , 34. Final�Heating & Air Conditioning - 35. Final Gas Pipe-Test ' - _ � - 36. Hood or Canopy , � � � � , � 37. Final Factory Fireplace � - . • ' � _ � 38. Final Plumbing � ' � � 39. Water Service-Final ' � 40. Gas Service-Final ' � � 41. Solar pomesticFinal � . _., � � 42. Backflow Preventer. , � . � � � ' 43. Backflow Irrigation - � ". � � . � ' 44. �Landscape Irrigation System � _ ' � � 45. Sound Attenuation� ' � • � . - 46. Handirap Regulations - " ' ' 47. FINALSTRUCT.URE&BUILDING � • ' . 48. Special Requirements Completed � � � � � - � r 49. Electrie Release to Edison , , . - - - � � • � 50. Gas Release to Southem California Gas Co � , � � i 51. CERTIFICATE OF OCCUPANCY _ _, i i No. � Date ' , ' � . ' I \ AOG��anl to 1i11 in all spaces exce0� tnose within heavy CorEe� Ilnas antl sign all apo�opriala Eeclarations. Ci7Y oF COSTA MESA CONS7RUCTION PE MIT 'Project Address � �0 W � 7� #� ApplicanYs Maili Add o�'�' `_o al �� r in i�c�, � Li� Owner'sName ��' �'�-�'`�� Phone��'�y� Address f��s�.�i- �..1�1%C-i��!'� Arch/Eng. License No. Address 1 /�� Contractor's NamP - nr1 !�n�, I„L�—Phone N xIn�3USf Addreulmailing) a3�'O l,U��1�7�Y1lQ. . l�:}',�. City License No. �� u�) LICENSED CONTRACTOR DECLFRqTION � I hereby aiflrm fhat I am licensetl untl§r provislons ot Charter 9(commenclnq with section 7000) of Dlvision 3 of the BuSiness antl Profession5 Cotle, antl my license Is in full force antl eitect. ,,,}��/// O,�� (' Lice e CI s�� "�-�LIJ(+1se � d Date��"' 1 ci^ r —q ll� WORKERS' COMPENSATION DECLRRATION r 1 hereDy aifirm that I have a certificate ot consent to self-insure or a certificata o} Workers' CompensatiOn Inzurance, or d cer[IfIeU copy theteof (SeGtlOn 3800, Lab. CJ��T � �y COmpany_15,�.�11 �- �� Policy No, t! n�y Certifi¢tl copy i5 hmeby tumish¢tl. LW Cer)Hietl cOPy is filetl wlth the city Bu``il ��i-ng Divl 'on. /� � Date �,(�� /�.POlicant �y y� �/� l�!� • EXEMPTION FROM WORKERS' COMPENSAT O�O�ECLARATION (This 5ectiOn neetl no[ be compl<t¢tl ii the Oermit i5 tor one huntlretl (5300) or less). � I certity Ihat in th¢ Pe�to�manCe 01 th@ �yo�k tor which th{s pe�m�t�i5 isSuetl I s�all not employ any per5on in any rryann¢r so as to become subjeGt [o t{�e Worke�s' Com0an5ation Laws of Cali(ornia. . Dafe Si9nature 'NOTICE: 11, aiter making lnis tleclaration, you shoultl Decome subject to the Workers' Compensation provisions ot the Labor Cotle, you must (or[bwltn <omply wi[h such prOv�sions o� thi5 permit sltall be tleem¢tl �evoketl. CONSTRUCTION LENDING AGENCV 1 hereby aHirm that there is a construcqon lentlin9 a9ency for Ihe per(ormance Of the �work tor whlcM1 thi5 permi{ is`issuetl (SecHon 3097 CIv. CJ Lentler's Name Lantler's Adtlress OWNERBUILDEN bECLARATION I hereby atflrm that I am exempt from the Contractor's License Law for tbe '�1.� Oy any appucam m alty of not more than five'� 1, a5 owner oi the prop �Oensatlon, will tl0 the wo sale (Section 7044, Busi :nse �Iaw tloes not appry t reOn, antl who tloes such oloy<es, provitletl that Su[ �_ 11, nowaver, th¢ builtling :ion, tne owner will have t ve tor the purposa o1 sale). I_ as owne! ol the Dfopert bw105 O! imOroves mereun� tratto!(sI 11cen5G pu6uant to� proot of their Worker's Co � I am exempt untler Section a �.ssional Cotle: Any city or nprove, tlemolish or repalr applicant for such permlt 'Suant to the provisions ot ig with Sectlon 7000) oi or that h¢/She is exemp[ Any viOlation o( Sectlon the appllcant t0 a clvil erty or myemployees with wa9es as their sole rk, antl the sVucture is nof inten0etl or offeretl ness anq Professional Cotle: The Conlractor's o an owner of a property who �ulltls or improves wo�k biry�self/her5¢It or through hi5 0� �er Own h imprOvements are not intentle0 0� ott<retl fo� or Imp�ovement i5 Soltl withln ona yea� o( cOm- he burtlan o( provinq he/she tlitl not builtl or Im- y, am exclusively contractin9 with Iicensetl ton- ct (Sectibn 7044. BUSine55 anA ProfG55ion5 COtle: N does not apply to an own¢r ot property who entl who mntracts tor such orojacts with a Con- the Contracto�'s License Law). I dm aware tbat mPensation insurance Shoultl be provi�etl to me. . B. & P. C. for [bis reason Oate Owner 1 hereby certity that I nave reai information Is correct. I a9ree to antl state laws relatln9 to builtl�r sentatives of ihis )ity y6�entEr, Signature—p Drivers' licerl! CMF 0865-46, r¢v. or55� ��tate that tne above tl county ortllnances eby authorize repre- ionetl (prop0rty fco�(r Date lO��t-i-Ol ) - / �% '�) TVPE OF CONSTRUCTIpf�/� NEW ADD LTERATION R P R ❑ CONVERSION � DEMOLISH ❑ OTHER q,p, �6 DESCRIPTION OF WORK/USE OF BLOG. S Main Building: E TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A REaf ❑ OTHER PRpJECT DESCRIPTION S�. FT. oCCUVANCv C Right K �eft CONSTRUCTIONTVPE VAWATION$ � $ Remarks: Bar Sink Backflow Preventer Backflow Irri9ation Bathtubs Clarifiers GHAOING CU. V�S. ACRES Ping. Ref. �i-` Planning Notes: Jrinking Fountains Floor Drains Floor Sinks �as Service Outlets Intercepmrs. Kitchen Sink Lavamries ' - '-Trap Roof Dreins Reinspection Fee $15 Boiler , Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Mul[iple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑0.100,000 BTU �100,0008T Rainspection Fee � $15 Whit¢ - Builtling; Canary - Appllcant; Pink - Accounting; Goltlenrotl - Assezsor Service Sink Sewer Cap Sewer Connection Solar Collectore Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater ' Water Service Auto-Wash Laundry Trays Issue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ' �aioo,000eru ❑ioo,aoosT SVstem Repair/Alteration � Fire Dampers Registers Issue Fee FEES 4983 6/17/BS 2one Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construction PoleSub. ❑ 50+KW COoking Unit Dishwasher Dryers �Gas ❑Electric Fan F.q,U. Fixtures Device Boxes Outlets Switches Garbage Dispoul Generator DO-5 KW 05-15 KW Meter ❑up to 100 amps Meter ❑aver 100 amps Sub Panel • Motors �0�7 HP 01'h - 8 Inc.Solar �9-15 HP �16-15+ Microwave Pole Light Range • Sign ; Standing Sections Trash Compactor � 3 I � Reinspection Fee $15 Issue Fee FEES �DEVEIOPMENTSERVICESRE�UIREMENTS: Zoning APProved BY . Building Approved By Appliqtion IaUad BV $ 3 15,cp TL 2 O N I N G R E Q M T S FEES $ 3 SUMMAR OF EES BUILDING PERMIT $ �� SMIP $ 'S� PLAN CHECK $ PERMIT PLUMBING $ S�� ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ' ELECTRICAL $ GRADING $ PLAN CHECK 50°,6 $ MICROFILM $ � MECHANICAL $ � TOTAL FEE $ �� PLAN CHECK Z5% $ -+ r . � 'CONSTRUCTION AND PLANNING , � POOL n SPA . _ � ' APPROVALS Permit#__ - Date Inspector ' AppROVALS Permit# -� Date Inspector � �, � 7. Temporary Electrical Service or Pole , ' 52. Pool & Equipment Location . �2. Soil Pipe-Undrgrnd. � �, , i. 53. Steel Reinforcement ' � " , ., � �.., '3. Elecirical Conduit Utility-Undrgrnd. . . 54. Forms ._ ' 4.'�Electrical Conduit-Undrgmd. , 55. Electrical Bonding . �-� � `✓. /�Steel Reinforcement � . � 56. Rough Plumbing & Pressure Test _?; � • =6�-,Electrical UFER Grnd. �. 57. APPROVAL TO COVER-GUNITE W� ��7µFootings • � , ' i 5S. Electrical Conduit-Undrgrnd. ,_ � � 8�.Foundation � 59. Gas Pipe, � Undrgrnd., Test � � I 9::Water Pi e-Undr rnd. �' � � P 9 C.�, . 60. Backwash Lines, P-Trap, � Undrgrnd. 10.FStructural Floor System �- r j� 61. APPROVAL TO DECK i J�'Property Sewer Line & House Connection 62. Backwash & ReceptorFinal . 12. Sewer Cap � - 9�L p3 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. REQl11REMENT 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. Undergmd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing ' 74. Overhead Hydro ' 26. T-Bar Ceiling (Struc[ural) & 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 I � , HEALTH DEPT. REQUIREMENT �31. Plaster Brown Coat ' i 79. FINAL INSPECTION � � � : 32. ElecVical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: ' , 34. Final Heating & Air Conditioning � ' � 35. Final Gas Pipe-Test . _ - 36. Hood or Canopy 37. Final Factory Fireplace _ 38. Final Plumbing � ' 39. Water Service-Final 40. Gas Service-Final � - � 41. Solar pomestic-Final ' 42. Backflow Preventer � • � , , 43. Backflow Irrigation � ' ' � � 44. .Landscape Irrigation System • � 45. Sound Attenuation . ' � . " 46. Handicap Regulations� ' ` • 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed � ' � 49. Elec[ric Release to Edison � , � .50. Gas Release to Southern California Gas Co � ' 51. CERTIFICATE OF OCCUPANCY. . . . . ' � �No. Date ' � . � \ ) - Applicant to /ill in all spaces axcept inose wit�in �eavy portlar Iines an0 sign all approprlate tleclarations. �Y OF coS7A nn�70 C�O�NSTR7 T)ON,�RMIT �� . Project Address � ��' `�� n Applicant's Mailing Address ( \ ,�- c n, Owner's nlame ��e— �.�.�._� Phone �� — � Address o��'J�'{- Z �lay�e� �� Arch/Eng. License No. Address /��, �S Contractor's Nam � _Phone �rJ. � Addresslma'I'nnl r�/y. � .Q� I��F'1�Q. � � -�g . CityLicenzeNo_ (��k�� LICENSED CONTRACTOR UECLARATION ' 1 ne�eby affi�m that I am licensetl un0e� p�ovision5 0/ Cna�te� 9(commencing with section 7000) of DiviSion 3 of the Business antl PrOfes5iOn5 CoOe, antl my license is tn tu 1(orce antl eifect. � !' �'�. License class ' en rv . ��l�x � � Date �O-i�-1�-�'� Si9nature � WORKERS' COMPENSATION DE LARATION I hereby aitirm tnat 1 have a certificate o� consent to seH-Insure or a certi�lcate it Workers' Compensation Insurance, or d certlfietl copy Mereof (Section 1800, Lab. C.), •v PoIicY No. �'��'l �! "�� ComoanY ��, �'�•n/� �Certifietl coOY is he�eby furni5hetl, t Certlfie0 copy IS filetl with the city BuilQ Ing _DlviSion.�—} { n Date —�Q._i.�G—Auoiicant .,,J�nn ��'z'�I 7 � EXEMPTION FRdNrdvORKERS' COMPENSATION DECLARATION (Tnis section neetl not be completetl if the permi[ is tor one huntlretl (E100) or less). i .' I certify Mat in the p¢rformance of the work (Or which tnis pe�mk.ivl55uetl, I snall not employ any person in any manner so as to become subject to.the Workers' Comp¢nsation LawS ot Calitomia. . Oate $i9nalure ��'� 'NOTICE: If, after making this tleclaratlon, you shoula Decome sutiject to the Wo�ke�s' Gompensation pmvisions of the Ldbo� Co�e. Yau mu5t torthwith comply witn such provisions or this permlt-shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV 1 hereby affl�m that the�e is a conitructlon lentling agenty tor th¢ Perto�mance of the work fo� which thi5 Pe�mlt is issuetl (Section 309] Civ. CJ l.entler•s Name LanOer's Atltlress OWNER BUILDER DECLARATION . ' I hereby atfirm that I am exempt from the Contractor'z �icense Law for the tollowin9 reason (Section 7031.5 BuSiness antl Professional Cotle: Any city or county which �epuires a pe�mit to const�uCt, alteq improve, tlemolish or repal� any stluctufe, prio! to its iSSuance, a150 r<qulles Ihe dpplicant (or Such pelmit to file a signea statement that he/she Is licensetl pursuant to lhe provisions of the ContraGtor's Licenz¢ Law (Chapter 9(commencing with Sectlon ]000) of .Division 3 of the BuSiness antl Professions Cotle) or that he/she is exempt -<Iherefrom anA the basis for th¢ allegetl exBmption. Any violation of Section _="-7031.5 by any ap0��can[ for a permit subjecl5 tlte applican[ to a Civil _'-=�enalty of not more than five huntlretl tlollar5 (E500�. �J I, as owner of the prooerty or myemployees wich wa9es as their sole compensation, will ao tne work, antl the structure is not inlentletl or ofteretl tor sale (Section 7044, Business anC Professional Cotle: The Contractar's Li<ense Law tloes not apPly to an owne� ot a properfy who bui105 0� ImprOves thereon, anC who aoes zucn work himzeli/herself or tnrou9h nis or her own employees, provitled Ndt Such Improvemen[5 are not inte0tle0 a� olfere� fo� 581e. If, noweve�, the builtling or ImO�Ovement i5 soltl within on0 yea� of com- pletion, the owner will have the burtlen of proving.�e/she tlitl not builtl or im- �rove tor the purpose ot sale). I, as own¢/ ot the property, am extlusively contracting with licensetl Con- t�actors to const�ucf the projett ($ection ]044, Buslness antl PrOfessions COtle: The COnt�actor'S LicenSe Law does not apply to an owne� of properry who builtls or improves thereon, ana who contracts tor such projects wlth a con- t�actor(5 license Du�suant t0 the ConVactor's LiCenSe Law). 1 am awara lhat proot o� tneir Worker'S Compensatlon insutance shOultl be provitlatl to me. ❑ I am exempt untler Sectlon B. & P. C. for this reason Date Owner I herebvi certifY [hat I hav< reai antl Signature _pdy,71,N Driver5' Lice?��se or 55 at the above ty Ortlinances :�orize rapre- property for TYPE OF CONSTRUCTIQN LJ rvEW LJ aDo LTEaaTlorv L R ❑ CONVERSION��V DEMOLISH ❑ OTHE13 � q,p,.�6 DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi E TYPEOFPERMIT GRADING FOUNDATION STftUC7URAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Reef ❑ OTHER PROJECT DESCRIPTION 5ci. Fr. OCCUPANCv�J� C Right CONSTRUCTIONTVPE VA�UATION$ S VU g Left 20NE GRADING CU.YDS. ACRES p�ng. R¢f. # pemarks: Planning Notes: Sink Preventer Irrigation Drinking Fountains Floor Orains FloorSinks � GasService Outlets Interceptors Kitchen Sink Lavatories P—Trep Roof Drains " � Reinspection Fee Under Ground $15 Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. BIt. ICBO # Heacing System & Ducting ❑a100,000 BTU 0700,000 Reinspection Fea � S15 CMF 0065-46, rev. 30/84 White - Builtling; Canary - Appliwnt; Pink - Accounting; GOIEenrotl - Assaisor Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash I�sue Fee � $ 3 Auromatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers �Gas ❑Elecvic Fan F.A.U. Fiztures Device Boxes Outlets Switches Garbage Disposal Generaror �0.5 KW 05�� 498� 6%17/85 Zone Accessory Building: Parking Req,/Provided ELECTRICAL Transformer ❑ 75-50 KW ❑ 50+ KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors�67 HP01'h-8 Inc.Solar �9-15 HP �16-15+ Microwave Pole �i9ht Range ; Standing Sections Trash Compacror Reinspectian Fee $15 Issue Fee IANICAL FEES Hoodor Typel ❑ DEVELOPMENTSERVICESREQUIREMENTS: Canopy Type II ❑ ZaninB APProvad By 8uilding Approved By Refrigeration Sys[em �a�oo,000sru ❑100,OOOBTU System Repair/Alteration Fire Dampers Registers laue fee I 5 3 IosEO TL Z O N I N G R E Q M T $ 0 FEES $ 3 SUMMARV O EES � BUILDING PERMIT $ �/6�0 SMIP $ i PLAN CHECK $ PERMIT PLUMBING $ ._,�� UANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ �� PLAN CHECK 25% $ � l .. �: -. . ... �CON�TRUCTION AND PLANNING' . � - � , - POOI�W SPA -� . . APPROVALS Permit#� � Date � Inspector AppROVALS Permit# � Date . Inspector i�l. Te'mporary Electrical Service or Pole ' ' -� 52. Pool & Equipment tocation _ � , 2. Soil Pipe-Undrgrnd. � � � � 53. Steel Reinforcement - � ' � �� ..3; Elecvi'cal Conduit Utility-Undrgrnd. . , �54. Forms . - - - . ' '` J' , . . : 4.,•Electrical Conduit-Undrgrnd. - ' 55. Electrical Bonding - ' � � �- i� 5. Steel Reinforcement ' ., 56. Rough Plumbing & Piessure Test �`.�; ' � ��'6`�Electrical UFER Grnd. "�j �,' . - 57: �APPROVALTO COVER-GUNITE � � ' .' 7.�Footings . �' '� � 58. Electrical Conduit-Undrgmd. - „ 8:jFoundation ' .,=� - . 59. Gas Pipe, � Undrgrnd., Test , - 9. UVater Pipe-Undrgrnd. • � � 60. Backwash Lines,-P-Trap, � Undrgrnd. -� . �� ., �D'•: Structural Floor SYstem ; ,-�� ' � :61. APPROVAL TO DECK - • � 11. Property Sewer Line & House Connection 62�. Backwash & Receptor-Final _ � i, 12. Sewer Cap �- � 63. Heater & Vent-Final : ' -. 13. Roof Drains . _ 64. Plumbing System�- Final ' � � 14. Rough Plumbing . 65. Electrical-Final � - 15. -Rougk ElectricahConduit ,- - 66. Solar System-Pinal -' 16. Rough Electric Wiring , 67. Fencing & Access Approval , � - - _ 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING • 18. �Rough Electrical-T�Bar Ceiling , I � 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 OGas ❑Oil', 25. Roof Sheathing - 74. Overhead Fiydro � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical • . � 27. F�ame 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 MeferFinal , 80. FOOD CERTIFICATE ISSUED 33. Final Electric ' Notes: ' 34. Final Heating & Ai� Conditioning � , . 35. Final Gas Pipe-Test , � _ 36. Hood or Canopy � � 37. Final Factory Fireplace • . " 38. Final Plumbing � � � � 39. Water Service-Final � � . ' 40. Gas Service-Final ' . 41. Solar.DomesticFinal � _ ' , ' . � 42. Backflow Preventer • • 43. Backflow hrigation ' . � � ' . ' , � 44. ,Landsrape Irrigation System � � ' � 45. Sound Attenuation � . - �_ 46. Handicap Regulations � , � � � 47. FINAL STRUCTURE & BUILDING , ' 48. Speciai Requirements Completed , • - 49. Electrie Release to Edison � - � - - - � - •- -�- � ' ' 50. Gas Release to Southern California Gas'Co , � � 57. CERTIFICATE OF OCCUPANCY _ . _ � _ • , N0. - Date � � � ' � ADC��ant to fill in all spaces except tnosa within neavY Dortler Iines ane sign all avo�avriate tleclarotions. Cn'V G�'COSTA ME� CONSTRUCTaI/9 ,N P RMIT Project Address �� l �� 7� /� ��""`� � � � � ApplicanYs Mailin Address �C ".ds'�i �C-aQ R-) > y_�. ��- Owner's Namte� �'�✓�� J�/,��c� � Phone � �� yTi Address l7��1"ia 5�..�XI�""'{�� Arch/Eng. License No. Address Contracmr's Nam % P(h�one ��Si� A�dress Ima I'nal �?�!°Sd /1„ 1 ) f�j(1 T t aJ . City License No, �� I LICENSED CONTRACTOR DECLARATION I hereby affirm tha[ I am licensetl untler provisions ot Charter 9(commencing with section 7000) of Divlsion 3' ot the Business antl Protessions Cotle, antl my Iicense is in t II force antl eftec : � ' Ucanse Ciass - � � - L' ,nse � Date �/��'�u_.�_�r Signahre WORKERS' COMPENSATION DE ARATION I hereby atiirm that I have a certlficate of consent to self-Insure or a certificate it Workers' Compnnsa(ion Insurance, or a certifiatl copy thereof (Sectlon i800, Lab. C.�I`1 (( � Poli<y No. `�"��!- •J� COmpany `��'��j2� Certifiea mpy is hereDy turnlshetl. - Cer{ifl¢tl copy IS BI¢tl with the city B�iltl1ng411Divisipt. � :�r� Da[e!/�-�u�- AOPlicant K.) ��•• EXEMPTION FROM WORKERS' COMPENSATION OECLARATION (This sectlon neeC not be Completetl If the Oermit is for One huntlr¢tl (5300) o� less). .•,� I cetUfy that in the per/ormdnce of the wo�k for which Ihis perT�t.is Issuetl, I shall nof employ any person in any.�anner so as fo become sutiject to the Workers' Compensation Laws of Calif mia. ;�� . Date ' Si9na[ure 'NOTICE: If, after making this tleclara on, you shoultl become subject to the Workers' Compensation provisions of the Labo� Cotle, y0u muzt forthwitn comply wlth such p�ovisions o� thi5 permit shall be deemetl revoketl. CONSTRVCTION LENDING AGENCV 1 hereby aifirm ehat tnere is a construction lentling agency for Ihe periormance of the work for whiCh this permit is issuetl (Section 309] Civ. C.) Lenaer'z Name �entler's AtlOress _ OWNER BUIIOEH �ECIARATION ' I nereby afflrm that 1 am exempt trom the ContractorY Licenze I..aw for the followin9 reason (Section �031.5 Business antl Pro(essional Gotle: Any city or counry wbi<h requires a permit to conztrucq alter, improve, tlemolish or repalr any structure, prior ta Its Issuance, also requires the applicant for such permlt IO flle d Si9netl Statement thdt'ne/she I5 IitenSeG pursuant to the provi5ions ot the Contractor's License Law (Chapter 9(commencinq with Section ]000) of Division 3 of [he Business antl Professions Cotle) or that he/she is exem0� lherefrom ana the basis tor'the alleged exemption. Any violation of Section 7031.5 by any applicant tor a' permit zubjects (he applicant to a civil �¢nalty of not more than five huntlretl tlollars (E500). . I_I 1, as owner of tne property or my employeez with wages as their sole comDCnsaUon, will tlo the work, anC the structure is not intenaetl or otteretl lor sale (Section 7044, Business antl Professional Cotle: The Gonlractor'S LicenS¢ ldw tlo¢s not apply [o an owner of a proOerty who builtls or improves thereOn, antl wlto tloes sucn work himself/he�selt or throu9h his or h<r own ¢mployees, provltletl thal such imp�ov¢ments are nOt intenaetl or offeretl for I sale. It, however, tbe builtling o� imProvement is Soltl within one yea� o( mm- , pletlon, lhe owner will have the burtlen of provin9 he/she tlitl not builtl or'im- �rova tor the purpose oi sale). ' I, a5 own¢r of [he property, am exclusively contracting with IicenS¢tl con- tractors to construct the projec[ (Section 7044, Business antl Protessions Cotle: The Contractor's License Law does not apply to an owner of property who , builtlsror improves [hereon, antl who contracts for such projeds witn a con- t�actor(sl ilcense pu�suant�to �be Contracto�'s License Law). I dm awar< Inat proof o( tneir Worker's Compensatlon in5u�anre Shoultl be provitletl to me. ❑ I am exempt under Section B. & P. C. tor this reason Date Owner . I hereby certity that I have reatl Infnrmatinn I5 m�rect. I aa�ee [O ( t tne the above �rtlinances rize repre- �perty tor TVPE OF CONSTRUCTION LI NEW L� ADD LTERATION Ll RE ❑ CONVERSION DEMOLISH ❑ OTHER ,p.# DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi E TVPEOFPERMIT GRADING FOVNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Reaf ❑ OTHER A C Right PROJECT DESCRIPTION SQ.FT. oCCUaANG K CONSTRUCTIONTVPE VALUATION$ g Left ZONE GRADING CU. VDS. ACRES Ping. Ref. # qemarks: Planning Notes: Sink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Service OuUets Interceprors Kitchen Sink Lavatories Roof Drains Reinspection Fee � $15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact Blt. ICBO # Heating System & Ducting ❑aioo,000 sTu Oioo,oao ISiqna[ure � Date lo -�-� u�+ �river5' Licen or 55 � Reinspection Fea $15 CMF 0865-46, �ev. 30/84 White - Builtling; Cand/y - Appllcan[: Pink - Accounting; Goltlenrotl - A558550/ Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto�Wash Issue Fee Hood or Typel O Canopy Typell � Refrigeration System Oo�ioo,000eTu ❑ioa,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES $ 3 $ 3 Automatic Washer Construction Pole Su Cooking Unit Dishwasher Dryers ❑Gas ❑EI� Fan F.A.U. Fixtures Device Boxes Outlets Switches Gar6age Disposal Generator �0.5 KW 4985 6/17/B5 15oE0 TL Zone Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+ KW Meter ❑up m 100 amps Meter ❑over100amps Sub Panel Motors �0-1 HP O1 %- 8 Inc.Solar �9-75 HP 016-75+ Microwave Pole Light Range I I; Standing'Sectians 15 KW Trash Compactor � Reinspeaion Fea �$15 � � luue Fee DEVELOPMENT SERVICES RE�UIREMENTS: Zoning Approved By Building Approved By Application laued By il� Z O N I N G R E Q M T S FEES �— $ 3 SUMMARV �O{F FEES ,�� BUILDING PERMIT $ �(L SMIP $ �[,L PLAN CHECK $ PERMIT PLUMBING $ .S , �� ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE $ /S,S(� PLAN CHECK 25% $ � I '� CONSTRUCTION AND PLANNING : POOL a 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-Undrgm�d. ` • � 54. Forms • _ , . � -' ,,,. �;:Electrical Conduit-Undrgcnd. '� � 55. Electrical Bonding . - - , 5. �Steel Reinforcement i_ . - 56. Rough Plumbing & Pressure Test ��ij ' -6;: Electrical UFER Grnd. � ---+�= 57. �APPROVALTO COVER-GUNITE -- , , 7. Footings � ��•*;' � , .58. Electrical Conduit-Undrgrnd, i � � •"8t' Foundation • ' ; 59. Gas Pipe, O Undrgrnd., Test �- 9:`Water Pipe-Undrgmd. `�r� � 60. Backwash Lines, P-Trap, O.Undrgrnd. 10.'Structural Floor System '�=� � ' 61. APPROVAL TO DECK 1.+. 11.'Property Sewer Line & House Connection � 62. Backwash & Receptor-Final 12. Sewer Cap -(I � 63. Heater & Vent-Final , 73. Roof Drains i � 64. Plumbing System - Final � 14. Rough Plumbing 65. Electrical-Final 15. �Rough Electrical-Conduit - 66. Solar SYstem-Final � � 16. Rough Electric Wiring 67. Fencing & Access Approval '� • 17. Rough Wiring Sign ' 68. APPROVED FOR PLASTERING � 18. �Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT � 20. ,Rough Factory Fireplace APPROVALS � Permit # ' 21.�Ducts, in Structure 70. Underground Hydro � 22. Ducts, Ventilating 71. Product Piping OGas OOiI - 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. Fr,arrie and Flashing � 76. Dry Standpipe 28. Lafhing & Siding , � 77. FIXED SYSTEM FINAL 29. Insulation ' 78. FIRE PREV. FINA� 30. Dry�all Nailing . , ' � HEALTH DEPT. REQUIREMENT 31._Plaster Brown Coat' 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED l I 33. Final Electric Notes: 34. Final Heating & Air Conditioning � . 35. Final Gas Pipe-Test � - � 36. Hood or Canopy 37. Final Factory Fireplace " 38. Final Plumbing , 39. Water Service-Final � 40. Gas Service-Final , 41. Solar pomestic-Final 42. Backflow Preventer • - ' . � , 43. Backflow Irrigation ' ' 44. .Landscape Irripation System • 45. Sound Attenuation . � 46. Handicap Regulations � ' • 47. FINALSTRUCTURE&BUILDING ' � � 48. Special Requirements Completed 49. Electric Release to Edison . - - - - • -- � � 50. Gas Release to Southern California Gas Co � � 51. CERTIFICATE OF OCCUPANCY ' No. Date � � � AVP��cant to fill in all spaees except those wHnin heavY Cortler Iines ana sign all approD��ate Eeclantions. �ITY OF coSTA nn SA ' CO JSTRUCTION PERMIT � . Project Address "�'7 Applicant's Mailing Address Owner's Name '� � Phone • �L��' Address ��'1 Z � I r-�U U i� - Arch/Eng. � _ � License No. Address Convacror's Nam ' � • Phone � Addreulma�'��I �,��.Ci" �•�.1 I�VIILv �=_� Ciry License No. �%�1 ,�-1 LICENSED CONTRACTOR DECLARATION ' ' I he�eby aftirm tha[�I am licensetl untlar provlsionsof Char[er 9(commanting with section 7000) of Dlvision 3 of the BuSiness antl Professions Cotle, anU � my license is in �ull rce antl etfect ,. ��3�� y License Class i ens , Date �� - 519 t � WORKERS' COMPENSATION D WRATION , I hereDy aftirm that I nave a cerUilcate of consent to sel(-insuPa or a certltiWte '� i( Workets' CompensdtiOn Insu�ance, Or d CertNleO cOpY the�eof (5<Ction 1800, Lab. C.) (, ^- . PolicY No. �LI{� �` L' GompanY ��cl� F�x."u,.r �Certifietl mpy is bereby tumishetl. , ��r�� Certjfietl copy Iz filetl with the city Builtliqg piv(i,s'lon.� 1� N rrt, Date I�-11_ r=�—APPlicant �r�ri i.r�� . EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This sectfon neetl not be completetl if the permit is far one huntlretl (5300) or less): . . "�. I certify that In tbe performance of th0 wo�k fo� wnlch tN5 pe�mR�iS i55ued 1, shall-not employ any pe�son In any manne� so a5 to becOme SuGject [o t�e , Workers', Compensation Laws ot California. . ,�.�, � �afe Signatur¢ ' ' ' 'NOTICE: If, aiter making tnis Eeclaration, you shoultl become subject to tha � Workers' Compensation -p�ovl5ions o( [he Ldbo� Cotle, you mu5t fortbwlth comply with such O�ovl5ion5 or lhis Oe�mit Shall b¢,0¢emetl �evok¢tl. CONSTRUCTION LENDING AGENCV �" � , 1 bereby af9rm that [here i5 a Conslruction lentling d9ency for�tne performdnte of the work tor wM1i<h this permit is Iszuetl (Section 309� Clv. C.) Lentler's Name� . � Lentler's�Atltlress , I OWNER BUILDEN DECLARATION� - ' ' I hereby atfbm that I am exempt from the ConVaetor's License Law for the (ollowing reason. (Seclion ]031.5 Butlness antl Professional Cotle: Any tlty or munty whicM1 �equires a pe�mit'to cOnStruc[, alte�, improve, Demolish Or repalr any structure, prbr to'its issuance, also requires the applicant for zuch permlt to file a si9nea statement that he/sne Is licenzetl pursuant to the o/ovlsions ot lhe Contraclor'S License Law (Chapter 9(commencin9 with SectiOn 7000) of Division 3 of the Business ana Protessions Cotle) or that ne/she is exemp[ therefrom antl the basis for the alle9e0 exemption. Any vlolatlon of Sectlon 7031.5 by any applican[ for a Permit subjects tne appli<ant, to a civil �endlty of not more than five huntlretl tlollars ($500). � LJ I, as owner of the property or my'employees with wa9es as thelr sole i compensation, will tlo the work, antl the sVucture Is not Intentletl or otteretl for sale (Section 7044, Business antl Protessional Cotle: The Contractor'S License I�w tloes not apply to an owner ot a proper[y who builGs or improves thereon, antl wtto tloes such work hlmself/he�self or thrOu9h hls or.her own employees, provitlea that such Irriprovements are mt Intentled or otferetl (or sale. If, however, tne builtlin9 or improvement Is soltl wilhin one year of com- pletion, the owner wilLhave the burden of provin9 he/she tlitl not bulltl or Im- prova for tM1u purpose of sal¢). � � ❑ I, as�owner of Ihe proOertY, am exclusively contracting witn IlcenS¢tl con- tractors to con5truct the project (Section 7044, Busine55 dntl Profe55ion5 Cotle: The Contractor's License Law does not apply.[o an owner of property who builtls or improves thereon, antl who <ontracts tor su<h projects wlth a con- tractor(s licenze purzuanl to the Contractor's Licanse Law). 1 am aware that proof o� Ihel� Wo�ker'S Coinpensatlon insu�ance shoultl be piovitletl to me. ❑ I'am exempt untlet $ection 8. & P. G�or this reason � Date Owner I hereby certity that I have rea� information is mrtect. 1 a9ree lo antl state laws relatln9 �o builtlir senfatives ot hl5 ity to [er ins0ection pu� ose Signature Drivers' Licen or 55 � thira oper[y i -11J- TVPE OF CONSTRUCTIO � LJ NEW lJ AD� LJ A ERATION lJ F ❑ CONVERSION _�DEMOLISH ❑ OTHER ��,��-'�-�F,G ,DESCRIPTIONOFWORK/USEOFBLOG. � _ . TVPEOFPERMIT GRADING ❑FOUNOATION STRUCTURAL ❑ TENANT ❑ ELECTRICAI. ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTIOM 5a. FT.� oCCUaArvC CON STRUCTION TVPE VALUATION $ � ZONE � GRADING CU. VDS. ACRES_ Remarks: � Bar Sink Backflow Preventer Backflow Irrigation �rinking Fountains � Floor Drains � � Floor Sinks 3as Service QUU2t5 Interceprors - Kitchen Sinli � Lavatories. - � � P-Trap . Roof Drains ` - - Reinspection Fea $15 Boiler Ducr- Under Ground i �UCt - $Lfl1CtUI81 Duct-Ventilating .. _ Exhaust System ❑ Multiple ❑ Firepl/FacL Blt. IC80 # Heating System & Ducting ❑ 4100,000 BTU � 100,000 BT n Reinspection Fee � � $15 CMF 0865-46, rev. 30/84 White - Builtling; Canary - Appllcant: Pink - A<counting; Goltlenrotl - Assessor EES $IIOWCfS � - � Service Sink ' Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank � Swimming Pool w/Spa Urinal -. . . � - - Warer Closet' . � Water Heater ' $ 3 Issue Fee 1ANICAL FEE Hood or Type I ' ❑ � ' � Canopy Type I I, ❑ � � Refrigeration System � ❑0-100,000 BTU ❑100,000 BTU System Repair/Alteration - fireDampers � Registers , �� Isue Fee ' ' � $ 3 A.P. # S Main Buildi E T Front B Rear A C Right K Left S Ping. Ref. # Planning Notes: 4986 6/17/85 Zarie Actessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishvrasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes � Outlets Switches Garhage Disposal , Generator �65 KW 05-15 KW I5.�0 2 O N I N G R E Q M T r S FEES Transformer ❑ 15-50 KW -' - � SO+ KW Meter ❑up to 100 amps Meter �over100amps Sub Panel Motors OO-1 HP O' Inc.Solar 09-15 HP Microwave Pole Light Range ; Standing Sec[iOns Trash Compactor Fee I$15 I I luue Fee Yh-6 �1615+ � DEVELOPMENT SERVICES REQUIREMENTS: 2aning Approvad By � Date BuildinB APP�a`/ed By Date � � SUMMAq,Y Ofi FEES BUILDING PERMIT $� i�J G� SMIP PLAN CHECK $ � PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGV P.C. ELECTRICAL § � GRADING PLAN CHECK 50°6 $ MICROFILM MECHANICAL �$ � TOTA�FEE PLAN CHECK 25% $ $ 3 $ � �` CONSTRUCTION AND PLANNING ' '� APPROVALS Permit # - Date Inspector ��1. Temporary Electrical Service or Pole . .' � � `�2. Soil Pipe-Undrgmd. . ' ' , 3�,Elecvical,Conduit,Utility-Undrgrnd.i � 4�€Iectrical,Conduit=Uridrgrnd. .� 5. Steel Reinforcement ' i `fi`lElectrical UFER Grnd. "'-�j"� , 7:"Footings i .-�`i � , : ,'Si�Foundation , ' _.,^ � 9.�Water Pipe-Undrgrnd. '-> if��StructuralFloorSystem ' . 11. Property Sewer Line & House Connection 12. Sewer Cap ,57� � i i 13. Roof Dreins 14. Rough Plumbing � � 15: Rough Electrical-Conduit � - -•16. ;Rough Eleciric Wiring . - 17. Rough Wiririg Sign � 18. Rough Electrical-T Bar Ceiling 19. Rough Heating & Air Conditioning 20. Rough Factory Fireplace - 21. D'ucts; in Structure � 22. Ducts, Ventilating , � 23. Gas Pipe-Rough & Test � 24. �Roof Framing 25. Roof Sheathing � 26.'T-Bar Ceiling (StructureQ & Monocoat - 27. Frame and Flashing 28. Lathing & Siding . 29. Insulation - � -30. Drywall Nailing . � 31. Plas[er 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 Faaory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final ' 41. Solar pomestic-Final - 42. Backflow Preventer 43. Backflow Irrigation . 44. �Landscape Irrigation System � • 45. Sound Attenuation � 46. Handicap Regulations � 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY . No, Date 0 POOL �. dPA APPROVALS Permit # Date 52. Pool & Equipment Location � 53. Steel�Reinforcement . 54. Forms .- . 55. Electrical Bonding . 56. Rough Plumbing & Pressure Test' 57. APPROVALTOCOVER-GUNITE 58. Electrical Cqnduit-Undrgrnd. � _ 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, O Undrgrnd. 61. APPROVAL TO DECK 62'. Backwash 8i Recepior-Final . � 63. Heater & Vent-Final � 64. Plumbing System - Final 65. Electrical-Final � 66. Solar System-Final " 67. Fencing & Access A�pproval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit# 70. Underground Hydro 71. Product Piping �Gas ❑Oil � 72. Underground Flush � 73. Undergrnd. Storage Tank 0 Gas ❑ Oil 74. Overhead Hydro � 75. Dry Chemical 76. Dry Standpipe � 77. FIXED SYSTEM FINA� � 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION � 80. FOOD CERTIFICATE ISSUED . Notes: Inspector _._�, ' ��I --� .�-'-�- � � - � ' . �: a � � Appllcant'to fill in all spaces exceDt ihosa within �eavy Oortler Ilnas antl zi9n all a00�opriate tleclaralions. CITYOFCOSTAMES CO�N�SfTRUCTIf�NYtHMII�� Project Address _ �'�/ � � � �Applicant�sMailin/g Address �'��V�-�� C� Owner's Name � `�l��- �-t.��c^'p- �Phone ��% Address � L I ��'I � �r,l_YVCU I>r Arch/Eng. , Licenu No. - Address `� Contractor's Nam /�� • Phone ��n.' .3.�" �� < AddresslmA'I'n�l c7��i� L�CjY-.�-�� 1�1110. L• fJ. City License No. �_� q GF-1 � ' ' LICENSEO CONTRACTOR DECLARATION I hGr¢by affirm that I am lic¢nsetl untlGr provislons of Charter 9(commencing � � with section 7000) of Divislon 3 ot the Business ana Professlons Cotle, antl • my Ilcense is in full f ice ana efiect. �.� ' n� � L'icense Class i ns -� Date�'�� '�_ Signature ' WORKERS'COMPENSATION DEC RAT,ION - � 1 hereby affirm that I have a certificate ot consent to self-insure or a certi(icate rf Workers' Compensation Insurance, or a certifietl coOY tbereof (Section l800, Lab. ) fi �I ' POIiCY No. �� i � ComPanY-3�.Jii� . •�'�'�� ❑ Certifietl mpy is hereby fumishetl. � �� . I l/Q Certitietl1copy is (iletl with the city Buil yDivisiqa�� 1 /� Date CO-yj��%�. APPlicant ��f�� 1n � r�(t ��:L� EXEMPTION FROM WORKERS' COMPENSATION OECLARATION (Thi55¢ction neetl not be completetl if the permit is for one huntlretl (5100) or - less): • !d I I c¢rtitylthat in the pertormance of [he wo�k to� wnlch this pe�m�t Is issuetl, I shall not employ any person in any manner so'as to become sub7ect to the ' Worliers' Compensation Laws of California. , Date ' ' ' Si9natura - • 'NOTICE: H, atter making tnis tleUaration, you zhoula become subject to the ' Workers' Compensation provi5ions of the lmbor Cotle, you must fort�with wmply with such provislOns o� this permit shall be tleem¢tl revok¢tl. ; CONSTRUCTION LENDING AGENCV � I hereby affirm that tbe�e is a con5truction lentlinq agency fOr [he Perto�mance of the 'work for �which thi5 permit is issuetl (Section .309] Civ. CJ l.entler's Name OWNE0. BUILDER DECLARATION ' � I hereby aHirm�that I am exemp[ irom [he ContraCtor'S License Law for the following reason (Sectlon ]031.5 Businezs antl Professional Cotle: Any city or county wnicn requir¢z a permit to con5t�utt, alt¢q Imp�ove, tlGmOlish or re0air any Structu�e, priOr [o Its issuance, al5o reqWres the appli<ant tor such permit �to tile a signetl statement tha[ h¢/She I5 Iicensetl pur5udnt to [he prov�5ions of the ContraC[or's LiCenSe Law (Cnapter 9(comm¢ndng with $eCUon 7000) of •Division 3 of the Business antl Professions Cotle) or tnat he/5he is ozempt !herefrom antl tne ba51z for tne allegetl exemption. Any viotation ot Section 7031.5 by any�applicant for a permlT subjects the applicant to a civil enalty ot not more than five huntlretl tlollars (E500). • LJ I, as owner of [ho O�operty Oi my emPloyees with wagos as their sole com0¢nsa[Ion, will tlo the work, antl Ihe ztruclure Is not int¢nOetl or ott¢rBtl � tor sale (Section ;7044, Business antl Protessional Cotle: Tha Contractor's LicenSe Ldw tloes nOt apply t0 an own¢r Of a p�opG�ly who builAs o� imprOv¢5 thereon, antl who tloes su<h work nimzelf/herselt or through hls or her own • emoloyees, provitletl that such improvements are not intenaetl or offeretl for sale. If, however, tne builtlin9 or improvemen[ I5 soltl within one year of com- Oletlon, the owner will have'�the burtlen of proving he/Sh¢ tlitl not builtl o� Im- � p�Ove fOr Ihe purpose o1 sale). ❑ I, as owner of the pro0erty, am exclusively tontracting witlt IicenSetl Con- trattorsto construct the project f5ection ]044, Businezs antl Professions Code: The Contractor's License Law does not apply to dn owner of property who builtls or improves therean„antl who contracts tor such projects with a com � tractor(51 license pursuant to tne Contracror's Licanse Law). I am aware that proof of Iheir Worker's Compensatlon inSUrance shoultl be P�ovitlee [o me. ❑ I am exempt untler Section 8. 8 P. C. tor ihis reason ', Date Owner _ I hereby certify tM1at I have reatl [his information is correct. I a9ree to comp antl state laws relating to buil0ing co sentAHves ot his t' y fo ter p insoectlon pur ases. Signature Drivers' Lice e or SS � � tate that the above tl�county or0inances � eby authorize repre- iOne�l P�operty�i (or Date lD��t-i-L� TVPE OF CONSTRUCT� L1 rvEw U qoo � ❑ CONVERSION DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. _ RATI ON TVPE OP PEFMIT GRADING FOUNDATION LIrSTRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL O OTHER 'PROJECT DESCRIPTION S�.FT. OCCUPArvcv CONSTRVCTION TVPE �VALUATION § �� ' ZONE � • GRADINGCU.VDS. ACf3E5— Remarks: � � „ ' Ba�Sink ; . Backflow Preventer � Backflow Irrigation . ' Bathtubs � � � Clarifiers � . Dishwasher ' ' Drinking Fountains Floor Orains' � i , FloOr Sinks, -" ' � ' CidS $CfVICO , ,�U[ICSS Interceptors� Kitchen Sink " Lavatories� P-Trap Roof Drains � Reinspection=Fee � $15 Boiler Duct , Under Gr< Duct - Structural Duct - Ventilatin Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑0.100,000 BTU 0100,000 I � � Reinspaction Fee ,I $15 CMF 0865-66, rev. 10/04 White - Builtling: Canary - Applicant; Pink - Accountin9� Goltlenrotl - Assessor Showers ServiceSink - Sewer Cap Sewer Connection Solar Collectors Solar Piping i Solar Tank � Swimming Pool w/Spa Urinal . " Water Closet • Warer Heater Water Service Auto-Wesh Laundry Trays � laue Fee FEES � � $ 3 A.P. ql� S Main Building: E T Front A Fear _ C Right g Left Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit � Dishwasher - Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures Device Boxes OuUets Switches Gar6age Disposal � Generator �0.5 KW C 0 4987 6/17/85� Zone Accessory Building: Parking Req./Provided � ELECTRICAL � � � Transformer ❑ 15-50 KW ' � SO+KW Meter ❑up to 100 amps ' Meter �over100amps. Sub Panel Motors �0�1 HP � 1 Yh - 8 � �Inc.Solar�9-15HP�16-15+ Microwave � � . Pole Light � Range ; Standing Sections � � 5 KW Trash Compactor Reinspection Fee $75 luue Fee IANICAL FEES DEVELOPMENT SER VICES REQUIREMENTS: Hood or Type I ❑� Zaning Approved By CanOpy Typell ❑ _ Building Approved By ' Refrigeration System oaioo,000eTu ❑ioo,000 System Repair/Alteretion Fire Dampers � ' Registers u � Issue Fae � $ 3 0 0 �rJo�O Z O N I N G R E � M � , T S FEES $ 3 SUM ARV O FEES \ BUILDING PERMIT $ �� SMIP $ �(� PLAN CHECK $ /y PERMIT ' PLUMBING g _E_6t.. ��UANCE $ PLAN CHECK 25h $- ENERGV P.C. $ ELECTRICAL ! $ � GRADING $ PLAN CHECK 50%�$ MICROFILM S �y' MECHANICAL $ ' TOTALPEE $ �S��L � PLAN CHECK .25% $ •. � CONSTRUCTION AND PLANNING ' _ .. POOL ,. SPA _ � APPROVALS Permit # Date Inspector AppROVALS Permit # • Date Inspector � ;.1. Temporary Electrical Service or Pole� 52. Pool & Equipment Location � .2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement - "�' Y' •i '3. Electri�al Conduit Utility-Undrgrnd.� , 54. Forms ^; ' 4 filectrical Conduit-Undrgmd. � ' � 55. Electrical Bonding - ' T� 5. Steel Reiriforcemeht • 56. Rough Plumbing & Pressure Test "" �� ,, , 6'�Electrical'UFER Grnd. ; '�; 57. APPROVALTO COVER-GUNITE `'� � �' . 7.,.Footings j� �"' � i 58. Electrical Conduit-Undrgrnd. � 8: �Found�atidn , _.� 59. Gas Pipe, O Undrgrnd., Test � 9`�Water Pipe-Undrgrnd. �- 60. Backwash Lines, P-Trap, � Undrgrnd. . 10. Structural Floor System �' , � i 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 - 'f 6. � Rough Elecvic 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 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 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. RE�UIqEMENT , . 3]. Plaster Brown Coat ,, 79. FINAL INSPECTION 32. Electrical Power MeterFinal ' 80. FOOD CERTIFICATE ISSUED . 33. Final�Electric � � Notes: 34. Final Heating & Air Condi[ioning . 35. Final Gas Pipe-Test 36. Hood or Canopy ' � 37. Final Factory Fireplace � ' � 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Fina� 41. Solar pomestic-Final � ' ' 42. Backflow Preventer � � 43. Backflow Irrigation . . . 44. ,Landscape Irrigation System � � � 45. Sound Attenuation • . . 46. Handicap Regulations " � , � 47. FINALSTRUCTURE&BUILDING , � , 48. Special Requirements Completed � � • 49. Electric Release to Edison • � ' 50. Gas Release to Southern California Gas Co . ' � 51. CERTIFICATE OF OCCUPANCY . ; _ No. Date �. ._ . ._ ADp�icant to flll in all sDaces except�those witnin �eavy Eortler lines antl.si9n all aoo�oDriala Eeclarations. CITY,OF COSTA MES C��O)N� STRUC�T-/IO ERMIT ��1 �MIT NO. � TRACT NO. LOT NO. UNIT,�N( Project Address �Q ^`^�' /� ^� 7�'^ �� s pI�� /� � Applicant's Mailing Address ` zy��J ��.� 1 rniA, �� 1�_ TYPE OF CONSTRUCT�- rvEW Aoo LTERATIOrv'. ' - ❑ CONVERSION f ��^EMOLISH ❑ OTHER Owner's�Name - ��» ,� �5 � Phone 5-c �� w ,DESCRIPTION OF WORK/USE OF BLDG. Address '^?��VG��✓ ' � ' Arch/Eng.� � LicenseNo. � TYPBOFPERMIT GRaoING-, FOUNDATIorv STaUCTVRa� Address � ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICA� � Contractol's Nam � • PhOne � �� - � 'OTHER �' ' ' Adtlress (m� i'�gl c'�� Cl. l ✓l1�Cl. y�. � g- PROJECT DESCRIPTION Sq. FT. ' OCCUPANC��V_�� r`M1��1 . CONSTRUCTIONTVPE - VALUATION$__SJ�tl, City License No_� �/v ZONE � GRADING CU. VOS. ACRES LICENSED CONTRHCTOR DECLARATION ' I hereby a(fi�m tM1at I am licensetl untle� provi5ion5 ohCharter 9(commencing Remarks �� - . ' , WIIh 52Ci10l1 7�0�) Oi DIV�S�OfI 3 Oi LI12 BUSIf1ES5 dlld Prof¢SsionS Cotle, antl my Iicense is in tull for � antl' 5ffec[. . _ �/� �/ ... ' , LJC¢n5¢ CId55 � °� _ Z• � en o. � �'��(,\�/� Date ' � Signature � . " PWMBING � ' I WORKERS' GOMPENSATION DE ARATION � ' Bd� SiOk � $hOW¢�5 • � I he�eby�affirm [hat I �ave a certiFlcate of consent to self-insure o� a certificate �f Workers' Compensation Insurance, or a certifietl copy thereof, (Section gackflow Preventer � Service Sink J800, Lab. C.)'I � (�/ S�I.��P. 'N�A.Yl Policy No. "� �� -;,� Company Li � Backflow Irrigation � Sewer Cap� �Certifietl copy is hereby furnished. �,' , .. CerS�fietl copy i5 tile[l wlth the city Builtling iNsion �-11�` �� B2thtu65 � � Sewer Connection Da[e_oQ��`� AOPlicant � -��•�� N � . � _ , . EXEMPTION F.ROM WORKERS'�COMiENSATION DECLARATION Clafifiel5 Solar C011ectof5 (Thissection neetl not be completetl if the permit is tor one huntlred,($100) or , less). Dishwasher • � ' Solar Pipin9 • I certity that ,in the pertormance bf the work for whlch thls oermi{ Is�.lssuetl, I ., Shall, not employ any person in any manner so as to become subj�<t to the t Drinking Fountains Solar Tank ' ' Workers' Comp¢nsation Laws oi California.. - . . Date � Signature ' ' • ' Roor Dreins ' Swimming Pool w/Spa, 'NOTICE: If, atter making this tleclaration, you shoultl become subject to the ' ' ' Wo�kers'. Compensation provi5ion5'ot�the Labo� Cotle; you muSY(orthwith FloorSinks'•- '- ' Urinal , � � comply witn' such �provisions,or this .permit shall be tleemetl revoketl. CONSTRUCTION' LENDING�'AGENCV � ' : � .� � • . �' ... i�. GaSSCrvice � +OUtIC[5 Wdt¢� CIOSCt� ' � I hereby aftirm thai there is a const�uction lentling agency�tar the pe�fo�mance � � � of tbe work �for which [his permit is issuetl (Sec[ion �309] Civ. CJ Interceptots� �Wate� Heate� - Lentler's Name - Lentler's Aatlresi � Kitchen Sink� . ' Water Service � � OWNER BULL�ER OECLARATION ' � - . I hereby affirm that 1 am exempt trom the ConGactor's License Law for the 'Lavatories.'. � Auto-Wash . following reason (Section �031.5 Busine5s antl orotessional Cotle: Any city or ' . county which �equires a permit to con5iruct, alte�, Improve, tl¢molish o� r¢pair P-T�2p, ✓ ' L2ufldry T�2y5 ' ' any structure, prior to its issuance, also requires�ihe applicant for such permit b. �:ic a au...nn ctafamanf lnat hw/che Ic lice.nzetl oursuant to the orovisions ot � ' • . . Division 3 oT tne Business ana Nroresswns coae7 or max ne�sne,is exempe tnerefrom antl the basis to� the alle9etl exemption. Any violation ot Section 703L5 by any ap0licant for a permit subjects-roe�applicant to:a civil ' enalty of not more lhan five huntlretl tlollare ($500). � 1, as owne� of Ihe p�operty o� my-employe¢S�with wages as their sole mmpen5ation, will tlo the work, antl the structure is not intentletl or offeretl for zale (Section 7044, Business and Pwfessional Cotle: Tne Contrac[or's LicenSe Law tloes not apply to an owner of a propmty wM10 builtls or improves � thereon, antl who tloes such work himselt/herself or through his or her own ' employees, prOvitletl iM1at such Imp�ovements are not intentletl o� otteretl fo� Sale. It, howeve�, the builtling or improvement is soltl within one yea� of com- pletion, the owner wIII�M1ave�the bu�den of p�oving he/she tlid not builtl or,irn- ' prove,for the purpose ot sale). ❑ 1, as owner of the property, am exclusively contracting with licensetl con- tractorstb construct the oroject (Section 7044, Business antl Professions Cotle: The Contractor's License ldw does not apply to an'owne� of property wno builtls or improves thereon, antl who contracts for zuch projects with a con- "trattor(51 license pursuant to the Contractor's License L.aw). I am aware that proot of their WorkeYs Compensation insurance shoultl be piovitletl to me. ❑ I am exempt untler Section B. & P. C. for this reason i t ' Date Owner I hereby certify tltat I have�reatl thi5�application andstate that the above- informatlon is conecL I agree to comp ly with all city andcounty ortlinances antl state IawS reldtin) to builtling co/�SVUGtion, antl Ite�eby authorize r¢pre- sentatives af, tHis cipj to (Apter �yp0� the above-mentionetl property tor 'toof Drains - � -� . Reiuspeition Fee - $15 . Issue Fee . , - - � ' �� MECHANICAL 3oiler Duct� Under Ground' Duct-Strucmral � Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting , ❑aioo,000 sTu �ioo,000 I $i9na[ure �OC7`Y�"'� Date lS' �-� uv � Drivers' Licens or 55 � ' Reinspection Fee + $75 L CMF 0865-46, rev. 10/84 Whi[e - Builtlin9; Canary - Applicant; Plnk - Accounting; Goltlenrotl - Asxssor Hoodor Typel ❑ - � Canopy Type 11� ❑ . Retrigeration System , ' ❑4100,000 BTU ❑100,000 BT System Repair/Alteration � Fire Dampers Registers ' � � A.P. # S Main Buildi E T Front B Rear , A C Right K Left S Pln9. Ref. # Planning Notes: 0 Auromatic Washer ' Construction Pole Sub. Cooking Unit � Dishwasher _ Dryers ❑Gas' DElectric Fan � F.A.U. ' ' Device Boxes , � O utleti � Switches - Garbage Disposai Generator O0.5 KW O5� J FEES � Fee $ 3 4988 fi/17/95 Zone ' Parking Req./Provided - ELECTRICAL ' � � � :Trensformer � 15-50 KW , ❑ 50+KW .Meter ❑upto100amps . ,�Meter.�over_100amps. '. _ Motors �67 HP �1'/:- B Inc.Solar�09-15 HP �16-75+ Microwave � ' Pole' Light � � Range , Sign � ; Standing Sections 5 KW Trash Compactor � Reinspection Fee �I $15 � � luue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By � Building Approved By �� Aonlication Issued Bv � � /%� SUMN]pRV�OF�FEES � ' BUILDING�PEftMIT $ L� r' �� SMIP � $ � PLAN CHECK $ PERMIT ' � PLUMBWG $ � '�SSUANCE $ ' PLAN CHECK 25% $ ENERGY P.C. �$ � ELECTRICAL $ ' GRADING $ � PLAN CHECK �50% $ MICROFILM � $ ' � ; MECHANICAL $ TOTALFEE $ / �� PLAN CHECK ZS% $ ' , . � CONSTRUCTION AND PLANNING �'� .APPROVALS Permit# , 1. Temporary Electrical Service or Pole �• i 2. Soil Pipe-Undrgrnd. 3. Elearical Conduit Utility-Undrgrnd. � 4��lectrical Conduit-Undrgrnd. ;5. Steal R'einforcement , , � 6• Electrical UFER Grnd. _._:� - : 7.-footings � i B:�Foundation_ , i ,_,�� :9. ,,Water Pipe-Undrgmd. r 10rStructural Floor System • -_ 11. Property Sewer Line & House Connection 12. Sewer �CaP i � 13. Roof Drains 14. Rough�Plumbing �� 15. Rougfi-Electrical-Conduit 16. Rough.Electric Wiring � 17: Rough Wiring Sign 18. Rough Electrical-T Bar Ceiling 19. {?ough Heating & Air Conditioning 20. Rough Factory Fireplace 21. Ducts, in Structure 22. Ducts, Ventilating - 23. Gas Pipe-Rough & Test 24. Roof Framing� . 25. Roof Sheathing 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing 28. Lathing & Siding ' 29. Insulation � �.30. Drywall Nailing ' 31 . Flaster 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 Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Pre'venter � � 't 43. Backflow Irrigation 44. ,Landscape Irrigation System 45. Sound Attenuation . 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed 49. Electric Release to Edison � ' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OE OCCUPANCY �^�No. Date , POO L ,,, �PA Date� Inspector qppROVALS - Permit # 52: Pool & Equipment Location . b3. Steel Reinforcement � 54. Forms 55. Electrical6onding 56. Rough Plumbing & Pressure Test � 57. APPROVALTOCOVER-GUNITE 58. Electrical Conduit-Undrgrnd. _�- 59. Gas Pipe, O Undrgrnd., Test .� 60. Backwash Lines, P-Trap, O Undrgrnd. � � 61. APPROVAL TO DECK � ' � 62. Backwash & Receptor-Final � �� ' � 63. Heater & Vent-Final 64'. Plumbing System �- Final . � 65. Electrical-Final ' - 66. Solar System-Final - - 67. Fencing & Access Approval " 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT � APPROVALS Permit # 0 � 70. Underground Hydro 71. Produc[ Piping O Gas ❑ Oil 72. Underground Flush - 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro . 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: 0 Date �Inspector 0 � AOPlicant to flll in aIl soaces eacept thosa within neavY DorCer lines antl sign all aoD�op�iate tleclarations. ITY OF COSTA ME�2�ON$TRU�T10N�PEf;IyjlT � j ct Address �iJ /�� /,u' ��` I pplicanYs Mailin/9� Address �� L-C.�� rl� 1 Cl Ownpr's Name .'S��J'�G ��y��(�+ Phorie � �� Address ��J�-�1- „�%I�G�{�ii - Arch/Eng. . License No.� Address ��7 �_ �� Contracror's Nam Phone �7,8'�� Addr¢ss (ma ��a� � � i%�i 1 0.. � i. . R_ City License Na _�L�� --� � LICQNSED CONTRACTOR DECLARATION I bereby afti�m [hat 1 am licensetl untle� proviSiOns o� Charter 9(commenCing with section 7000) ot Division 3 of the Business antl Profeszions Coae, antl my Iicense is In full torce antl effecL n f' Gcend ciass G' ns� rv. ' ��%��/'"� �' Date Signa[ure WORKERS' COMPENSATION DE ARATION �� ' I hereby aftiim that 1 nave a certificate o� ronse�t to self-insure or a certificate �f Workers' Gompensation-Insurance, or a certifietl copY t�ereof (5¢ttion J800, Lab. C.) '\ � / �'(�,(�,� =' Policy No. ��` _ �`/ ComPanY �� G Certifietl copy I5 hereby turnishetl. � Cer ifietl co y is filetl with the tity Buil i Dlvlsl `1' ��/ , Date�'�G� APPlicdnt ,��r �� ,' � � nig s¢cuon neea noi oe compie[ea rt tne permit is ror one nunarea (S�uu7 or less), • • - . I cer�jiy that in the oertormance o1 the work for wNch this perm�bls izsuetl, I shall not emplOy any person In dny mannef 50 ds lo become SubjOct to If1e Workers' Compensation LawS ot Califomla. , . Date Signatdro 'NOTi�E: Ii, after making this tletlaration, you shoultl become subject to [he Workers' compensatlon provisions ot the Labor Cotle, you must fortnwkb compty �yi(h suc� , provisions .Or tbis Oe�mit Shall be tleemetl �ewketl...• CONSTRUCTION LENDING.AGENCV. � • I hereby aifirm that there is a construction lentlin9 agency tor Ihe performante . of tne work for which this permit is issuetl. (Section , 309] Civ. C.) : Lentler's Name OWNER BUILDER OECLARATION - ' - 1 hereby atilrm that 1 am exempt }rom tne Cont�ac[or'S. License Law for the folipwing reason (Section ]031.5 Business ana Professiooal Cdtle: qny Nty or Couhty whlch r0quires a pe�mit to construct, alter, Improve, tlemolish Or �epair' any structure, prlor to its issuante, also requirez the applicant for sucn parmit =lo tile a sign¢tl stat¢ment that h¢/She is licenzetl pu�5uant to th¢ P/ovl5lons ot � the �ontractor's License Law (Chapter 9(commencing with Section ]000),oi ' Division 3 0� lh¢ Businezs antl P�o1e55ions COtle) o� that he/she Is axempt Ihe�etrom antl lhC ba5is for the allegetl exemptiOn, Any violdtion 01 $ection 7W3:5 Dy any applicant fo� d permlf subjects ihe applicant to d civil �enylty of not mor¢ tnan tive nuntlretl tlonars ($500). - LJ i, as owner ot the property or my--employeas with wages as tneir sole compensation, will Oo the work, antl the structure Is not intentletl or offeretl ' for sale. (Section 7044, Business antl Pmfessional Cotle: The Contractor's Licxnu Law aoes not apply to an owner oi a property wno builas or improves thereon, antl who does such wO�k himselt/hetselt or [hrougn nls or ber own employee5, provltl¢tl [hat suGh IrtiprOvements ar0 not Intentletl br OHeretl for sale, �f, howevlr, tne builtling or ImprOvement I5 Soltl wifhin On¢ yea� ot <om- pletioq tne owner will,have the burtlen of provin9 be/she Oitl not builtl or"im- � proye for the Ourpose of sale). ' ❑ I, as owne� 01 the property, am exclusivery coptraCting with Ilcen58tl cOm traCtorsto const�uct [he O�oject (5ection 7044, Business antl ProteS5lons Cotle: The Contractor'i Llcense.Law tloes not apPIY to an owner of property wbo bulltls or improves thereon, antl wM10 coniracts tor such projects with a con- traCto�(s) Ilcensu pursuan[ to Ine Contractor'S License Law). I am aware [hat proof ot thelr Worker's Gompensatlon insuranca shoula be provitletl to me. ❑ I am exempt untler Section B. & P. C, tor this reason Date Owner _ I hereby certlfy that I have reatl tbis a iMormation is correcL I agree to comply antl state IawS telaling to buil g const Senjatives of this_Uty�to e er uppn 99nature f state that the above antl county ortlinances �ereby authoNze repre- �.ntionetl O�operiy fpr � �ate � � �� s 1�;�..,. �� ........ ,..,. ..._. ..,.�� i�. c.� TVVEOFCZINSTRUCT[�I NEW ADD LTEFATION � ❑ CONVERSION �� DEMOLISH ❑ OTHER A p # DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi E TVPE OF PERMIT GRADING FOUNDATION STRUCTV RAL 7 Ftont • ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL - 8 qear ❑ �OTHER' ' � A PROJECT DESCRIPTION SQ. FT. ' - oCCUaArvC C Right K Left CONSTRUCTIONTVPE ' VALUATION$ $ ZONE �_ GRADINGCU.YDS. ACRES P�ng.Ref.# Remarks: � Planning Notes: Sink � cflow Preventer � cflow Irrigation � itubs ifiers iwasher ' iking Fountains . x Drains, v Sinks ' Service Outlets' Kit�hen Sink Lavatories -" . P-Tr�� • Reinspection Fee �� ` $1S Boiler Duct - Under GroUnd ' DuCt - $LNCtufdl Duct - Ventilating � - -. Exhaust System � Multiple ❑ Firepl/Fact.�Blt. ICBO # Heating System & Ducting ❑4100,000 BTU 0700,OOOBT� �ri�ers' �,License o 55 � I I Reinspection Fea I $15 CMF 0865-46, rev. 30/84 White - Builtlin9: Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor Service Sink � Sewer Cap $ewer Connection Solar Collectors Solar Piping Solar Tank . Pool w/Spa Urinal _ �Water Closet Wacer Heater Water Service - Auto-Wash Laundry Treys laue Fee u FEES � $ 3 Automatic Washer Construction Pole Sub. Cooking Unit � Disbwashei � Dryers ❑Gas ❑Electric Fan F.A.U. Fiz[ures � � Device Boxes • � Outlets Switches Garbage Disposal , Generator 00�5 KW C L989 6/17/95 Zone Accessory Building: � Parkin9 Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+ KW Meter ❑up to 100 amps Meter �over t00amps' Sub Panel Motors 00�1 HP O 1 N, - B Inc.Solar 09-15 HP �i6 Pole Li9ht � Range Sign ; Standing�Sections � ' Trash Compactor '� Reinspection Fee $15 Issue Fee IANICAL ' FEES Hoador Typel ❑ � DEVELOPMENTSERVICESRE�UIREMENTS: CanoPY TYPe I I ❑ Zoning APProved By Building Approved By — q Refrigerotion System ❑aioo,000aTu ❑ioo,000er System Repair/Alteration Fire Dampers Registers Issue Fee ,� $ 3 n t5a`�7 FEES $ 3 Z O N 1 N G R E Q M T S SUMMA V��( FEES BUILDING PERMIT $ /� . V SMIP • ' $ �� PLAN CHECK $ PERMIT PLUMBING $� S � O(I ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING �$ PLANCHECK 50% $ MICROFILM 5 MECHANICAL $ � TO7AL FEE � $ �� PIAN CHECK �5%� $ � � , � �STRUCTION AND PLANNING . POOL.. oPA ., PROVALS Peimit # - Date Inspector •APPROVALS Permit # Date Inspector i . 1. Temporary Electrical�Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement � �. 3. Electrical Conduit Utility-Undrgm�l.' 54. Forms �' " • 4. Electrical Conduit-Undrg�nd. . 55. Electricai Bonding : , 5: Steel Reinforcement -- � 56. Rough Plumbing & Pressure Test �%,.� i 6.'',Electrical UFER Grnd. � _._r • 57. APPROVAL TO COVER-GUNITE - 7. Footings '� i „ ' , 58. Electrical Conduit-Undrgrnd. , 8�•Foundation .: _� � 59. Gas Pipe, O Undrgrnd., Test . 9.'.Water Pipe-Undrgrnd, -; � 60. Backwash Lines, P-Trap, O Undrgrnd. 10. �S'tructural Floor System .•-`< '�' �� 61. APPROVAL TO DECK � 11-"`Property Sewer Line & House Connection , j 62. Backwash & Receptor-Final � 12• Sewer Cap ' 9� 63. Heater & Vent-Final I ' � 13. Roof Drains � 64. Plumbing System - Final � 14. Rough�Plumbing 65. Electrical-Final �. - 15. Rough Electrical=Conduit � - �' 66. Solar System•Final � . 'i 6. Rough Electric Wiring � 67. Fencing & Access Approval 17. �Rough Wiring Sign � 68. APPROVED FOR PLASTERING � 18. Rough Electrical-T Bar Ceiling � - 69. POOI/SPA SYSTEMS FINAI ' 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT - 20. Rough Factory Fireplace ' APPROVALS Permit # 21.,Ducts, in Structure ' � 70. Underground Hydro � 22. Duas, Ventilating 71. Product Piping OGas �❑Oil 23. Gas Pipe-Rough & Test - � 72. Underground Flush 24. Roof Framing ' . 73. Undergrnd.STorageTank �Gas ❑Oil 25. Roof Sheathing � 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat .� " 75. Dry Chemical 27. Fram� and Flashing . 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 7S. FIRE-PREV�. FINAL 30. Drywall Nailing � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ` � � 79. FINAL INSPECTION ' 32. Electiical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final�Electric ' Notes: 34. Final Heating & Air Conditioning , 35. Final Gas Pipe-Test ' 36. Hood or Canopy � ' � 37. Final Factory Fireplace , - . 38. Final Plumbing . � 39. Water Service-Final - 40. Gas Service-Final � 41. Solar pomesticFinal � . . . � � 42. Backflow Preventer � � 43. Backflow Irrigation . ' 44. ,Landscape Irrigation SYstem , . � ' 45. Sound Attenuation ' � - 46. Handicap Regulatioris . 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed , , � 49. Electric Release to Edison ' � - � � � � 50. Gas Release to Southem Califomia Gas'Co � � . ' 51. CERTIFICATE OF OCCUPANCY � � ' - � � - No. Date � ' � � i - Applleant to fill in all sDaces exce0t �hose within heavY Oortler Ilnes ana sign all aDVroDriate aeclarations. ciTv`oF coSTA M/�$A C,�O.]N STRU TIO ERMIT "� Project Address [�j�� ✓'�'' �� , /�� y�� (�p Applicant's Mailing Address � tYs_.— -� �_L._;�'�tj •._ � �� Owner'sName � L /, Phone�-��2 Address � ��'� a � �. �✓ VG`�L.! Arch/Eng. Licenu No. Address ��d CoMracror's Nam �._Phone �-.10 Addresslmailingl ��0� ��1� �rn��- � L'`�• r�� u�� City License No. � LICENSED CONTRACTOft DECLARATION � I ner¢by affitT tM1at'I am Ilcensetl untle� provi5iOn50f Charte� 9(commencing witn section ]000) ot Division 3 of the Business antl Pro/essions Cotle, antl my Ilcense is in f W forcga tl effect. ^ rA � License Class —�' �ic e N . �� -� Date �n'- 1�-/��G Signature - " WORKERS' COMPENSATION DEC RATION ' I hereby aftirm that I have a certiflcate of mnsent to selt-insure or a cerfificate �f Workers' Compensation Insurance, or a certlCfietl copy trheieo,f (�SeJ<tion seoo. �ao. c.I L�.L�U" FS�'I Companv J�� T1-�-�1 Policy No. n{� Certifietl copy is hereby (urnishetl. � ,i DateJeDl� �L�PY t�W APPI cantY BuUllrl4D�i5iQR�� n� • 1�JY\ L �r EXEMPTION FROM WORKERS• COMPENSATION OECLARATION (This section neetl not be completetl Vf the permit is tor one huntlreC,lb100) or iece� n , rtlfy that in the performance oi Me work for�wnich this perm�tis issuetl I shall not employ any person in any manne� so a5 t0 become SUGject to t{�e workers' Comoensation. Laws of Calitornia. ',y . Date ' Signa[ure ' 'NOTICE: If, atter making this tleUaration, you shoultl become subje<t to the Workers'�Compensation provl5ions of the Labor Cotle, you must forthwith comply with, such provisions , or this permit shall be tleemetl revoketl. CONSTRUCTION LENOING AGENCV� ' '' � I hereby affirm that roere is a�consVuction lentlin9 agency for tne periormance of the wark •(ar, which tbi5 permif is issuetl-(Section 309J Civ. C.) LentlerY� Name- Lentler's Atltlress , OWNER BUILDER �ECLARATION - I hereby aftirm that I am exempt irom tne Contractor's Licenze Caw tor the followin9 reason (Section �031.5 Business antl Profesilonal Cotle: Any city or county which requires a permit to conztruct, alter, improve, tlemolish or repalr any structure, prior to its Issuance, also requires the applicant (or such permit to file a signetl statement thd[ he/she i5 lic¢nSeU,pu�suahl to [he p�ovi5ion5 Of the Confractor's LJcenSe Law (Chap[er 9(commenUn9 with Section ]000) of Division 3 of the BuSin¢55 antl Profe55ion5 Cotle) or that he/she i5 exeTpt -;�;therefrom antl the basis for the allegetl exem0��on. Any violation ot Section :"7031.5 by any applicant for a permit subjects-[he applicant to a tivil - enalty of not more than five huntlretl tlollarz (E500). • � 1, as owne� of the propeity�or �ny emplOye¢s wltlt wagez as thei� sole compenzation, wi11 tlo ehe work, antl the structure Is not intenaetl or oHeretl for sale (Section 7044, Business antl Protessional Cotle: The Contractor'S License Law Coes not appiy lo an owner ot a property who bulltls or improves thereon, antl who tloes such work himseif/nerselt or throu9h his or her own empl0yee5� prOvitletl that Such'imprOv¢men[s ar8 nOt Intentletl Of Otfeletl for ul¢. It, however, lhe builtling or improvement is soltl within one year ot com- pletlon, the owner will have the burtlen oi praving he/zhe tlia not builtl or Im- , p�ova f0/ tlte purpose ot sale). ' ❑ I, as owner of the property, am exclusively contractln9 with licensetl con- tracto�s [O const�uct [he Oroject (Section ]044, Bu5ine55 antl Pro(e55ions CoOe: The ConVactor•s Licenze Law tloes not apply to an owner of Property who builas or imoroves thereon, antl who contracts for zuch projects with a con- tra<tor(s1 license pursuanl to the Contractor's License Law). I am aware that proot of their Worker's Compensation insurance shoultl be provitletl to me. ❑ I am exempt untler Section B. & P. C. �or ehls reason Da[e I heieby certity fhat information is correct antl state Iaws relatin sentatives oi is t inspectlon pur e Signature Drivers' License or 55 Owner have reatl -this application antl state [tiat the above agree [o comO�Y w��h all clty antl county o�tlinances ,� wltling const�u<tion, antl h¢reby authorize r¢pre- �n[ on the abov¢-T¢ntiOnetl O�opfl�ty fo� Date ( 0 1 �1 'fl_S � �� TVPE OF CONSTRUCTI.Ofj� LJ NEW LJ ADD ALTERATION R � R ❑ CONVERSION � DEMOLISH ❑ OTHER p� p. �6 DESCFIPTION OF WORK/USE OF BLDG. S Main Bu E TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Ffant ❑ TENANT ❑ ELECTRICAk ❑ PWMBING ❑ MECHANICAL B Reer ❑ �OTHER � %� PROJECT DESCRIPTION St2. FT. oCCVPANCV C Right K Left ,CONSTRUCTIONTYPE VALUATIONS�� $ ZONE � GRADING CU. VDS. ACRES p�ng. Ref.'ik Remarks: ' Planning No Backflow Preventer Backflow Irriqation rinking FOuntains loor Drains . loor Sinks as Service Kitchen Sink Lavatories P-Trap Roof Orains Reinspection Fee � $15 Boiler , � Duct - Under Ground Duct - Structural Duc[ - Ventilaiing Ezhaust System ❑ Multiple ❑ Firepl/Fact. BIL ICBO # Heating SyStem & Ducting ' ❑6100,000 BTU �100,OOOBT Reinspection Fee � $15 CMF 0865-46, �ev. 30/84 White - Builtling; Canary - Applicant; Pink - Accoun[In9; Goltlenrotl - Assessor $hOW¢f5 Service Sink Sewer Cap . Sewer Connection $olar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal WdICf CIOSQL Water Heater Water Service Auto�Wash Issue Fee A FEES $ 3 Automatic Washer Construction Pole Si Cooking Unit Dishwasher_ Dryers �Gas ❑EI Fan F.A.U. Fiztures Device Boxes Outlets Switches Garbage Disposal Generator 065 KW e 499� 6/17/85 Zane Parking Req ELECTRICAL � � Transformer ❑ 15-50 KW 050+KW ' � •Meter ❑up to t00ampi , Meter ❑over100amps Sub Panel Motors �0.1 HP � t Y, -�8 Inc.Solar �9-15 HP �16-75+ Microwave Pole Light ' Range I I; Standing Sections 5 KW I Trash Compactor Reinspection Fea $15 Iwue Fee IANICAL ' FEES Hoodor Typel ❑ DEVELOPMENTSERVICESREQUIREMENTS: Canopy Type I I ❑ 2oning Approved By . _ Buildine APProved BY n. Re(rigeration Sys[em ' Oai oo,000 ar u. O i oo,000 sru System Repair/Alteration Fire Dampers Registers 0 Issue Fea � $ 3 t6,50 Z O N I N G R E Q M T S FEES $ 3 SUnQMARV FEES BUILDING PERMIT $ U SMIP g�_.L�� PLAN CHECK $ PERMIT PLUMBING ' $ �i/Q � ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING �, $ PLANCHECK 50% $ � MICROFILM 5 �//�`� �C� /� MECHANICAL $ TOTALFEE $ L�1_L_!L PLAN CHECK 25% $ � � • CONSTRUCTION AND PLANNING :{ . POOL n SPA .•_APPROVALS Perm�t# � Date ' Inspector qppROVALS Permit# Date Inspector � 1. Semporary Electrical Service or Pole, � 52. Poof & Equipment Location 2. Soil Pipe-Undrg�nd. � � � 53. Steel Reinforcement -" ,,�t�' 3.�Electrical Conduit Utility-Undrgrnd.� � � . 54. Forms -� , , . � 4;,�lectrical Conduit-Undrgr�d. . � 55. Electrical Boriding � =''1 S.,�teel F�ein'torcemeAt , � - � 56. Rough Plumbing & Pressure Test __ 6:�Electrical UFER Grnd. � . 57. APPROVAL TO COVER-GUNITE �. �-' •7.,Footings , � � - I 58. Electrical Conduit-Undrgrnd., , B: =�oundation ; � 59. Gas Pipe; O Undrgrnd., Test � 1� 9,,,Water Pipe-Undrgrnd. ''�f . , 60. Backwash Lines, P-Trap, O Undrgrnd. i � 10.''Structural Floor System .��' ,. ,' � 61. APPROVAL TO DECK � , 1.1. Pro�ierty Sewer Line & House Connection ' 62. Backwash & ReceptorFinal � 12. Sewer Cap �� 7£° 63. Heater & Vent-final i � / i ' 13: Roaf Drains � 64. Plumbing System - Final ' 14. Rough Plumbing � 65. Electrical-Final � 15. Rough Electrical-Conduit - 66. Solar System-Final ' •� i6..Rough Electric Wiring 67. Fencing & Access Approval - 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING . 18. Rough Electrical-T Bar Ceiling 69. POOL(SPASYSTEMS FINAL . 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit #_T 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 • J7. FIXED SYSTEM FINAL 29. Insulation ' 78. FIRE PREV. FINAL 30. Drywa�l 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. Finaf Heating & Air Conditioning • 35. Final Gas Pipe-Test � 36. Hood or Canopy � � . 37. Final Factory Fireplace -- . 38. Final Plumbing � . � - 39. Water Service-Final � 40. Gas Service-Final . 41. Solar pomestic-Final , ' i 42. Backflow Preventer, . � � � •t , � 43. Backflow Irrigation, , ' . ' ' � 44. ,Landscape Irrigation System � . 45. Sound Attenuation � 46. Handicap Regulations � � ' .. 47. FINAL STRUCTURE & BUILDING , � • 48. Special Requirements Completed ' � � 49. Electrie Releaseto Edison . - � -- -�^ . 50. Gas Release to Southern California Gas Co � � . 51.'CERTIFICATE OF OCCUPANCY � . . . � , , ' No, Date �. � ' ' � , _ Applitant to /III In all spaees exceD< <hose wlt�in �eavy Cortler Iinas anE si9n all apProO/�ate tleclaraliont. CIrY pF COSTA M• CO��N/ST UC ION MIT Project Address � w �� I� Applicant's Mailing Addreu ��" ��' Owner's Na e�^P1riC. KL-X A ASt� Plione �gur-- �—�• Address � iS� � �-�'VG\ 1(��' Arch/Eng. License No. Address Contractor's Name�1 ^ • Phoneu�� —� Addresslma��;1 a� p`-�tl fYIIC�� L• � . City License No: �� p�' � LICENSEO CONTAACTOR OECLARATION � I M1ereby afflrm that i am Ilt¢nzetl untle� provizions of CM1arter 9(commencing wit� s¢ction ]000) of Division 3 ot tha Business antl Professlons Cotle, and my I��¢nse is in tull rc ntl effect. O UCBfI CId55 C nT! DatC ��%—.«•� � 519 t 1ti WORKERS' COMPENSATION DEC RATION � � I hereby affirm that I have a cerHticate ol consent to self-in5ure or a certiflwte �f Workers' Comp�en]sation Insurance, or a cert�itiej�d.,copy tnereof (Sec[`lon 3800. Lab. CJ' 1_I� ^'/l�'' ComPany (Ji/A�� %/�! PoIICy No. � � Cer[ifletl cOPY IS f I¢tlbwithrthehtltY Bu Itli DivISI ] /�7� Dat@ �O'��C—_ Applitdnt �� M� ` �%. EXQMPTION FROM WORKERS' COMPEtY5AT10N OECLARATION (This seclion ne¢tl nOt be completetl Ii the pe�mi[ i5 f0/ One huntlratl ($300) or less). � • I cer�i}y that in the porformance of the work (or which tnis perm�Pis issuetl I shaq not employ any person in any manner zo as to become subject to t�e WOrkers' CompenSation Laws ot Calitornia. ,�� Date Sigrtature 'NOYICE: Ii, af[er making [his tleclaration, you shoultl become SUCject to lhe Wo�kerz' Comp¢�Salion prOWsions ot [h¢ LabOr COtl¢, You mu5t forthwith compty �vi(h SUCh prOvislons or [his permi[ . s�all be . tlGemetl revOketl. CONSTRUGTION LENDING AGENCV 1 hereby afflrT [ndt IhCr! Is a con5truction I<�Uin9 agenty 10r Ne per(ormance ot [ne wo�k (or wnicn IhiS pe�mit is Issuetl (SectiOn 3097 Civ. CJ Lnntler's Name Londer's Atltlress OWNER BUILOEH �ECLARATION ' ' 1 h0reby aHlrm that I am nxert�pt irom [he Contractor'z Ucente Law for Ihe follo�ying reason (Saction 7033.5 BuSinnss and Professlonal Cotle: Any city or co�ntv wnich rea Wres a oermit to construcq alter, improv4 Aemolish or repai iherelrom antl t�e basiz for Ihe allege0 ezemption. Any violation of Section 7031.5 by any applicanl for a permlt subjects tho appllcant �[o .a civll ;pe�alty ot not morc tnan tive huntlrea tlollars (E500). LJ I, as ownar ot tha property or my amployoas wRh wagas as iheir zole Cornpensatlon, will tl0 the work, antl the SlrUcture IS nOt Intentletl or 0lttratl for sale (Sectian 7044, Business antl Profassional Cotlo: Tha Contractor's License Law tloCs nol appty [O an owne� o! d prop<rty wfio bu71G5 0� improve5 lhe�¢On, antl wlto tloes such wo�k him5elt/he�5¢It Or In�0u9h nis or he� own empioy ees, provitlntl that such improvemonts are not intentletl or offeretl for SalO. It, howeve�, tha Duiltlin9 e/ ImproveTent IS So1E wlttlln One year Of com- ple�ion, tlta owner wlll have tpe burCon ol Proving he/sne tlltl nol bwltl or IT- ��Ova to� thC PurpOso oi sale). 1, as owne� o( tM1e property, am ozclu5ivoly contraCting wilh IlcenS<tl con- Va[tor5 to construct [h¢ Pfoj¢ct ($BcHon ]044, BuSiness a0tl P�ofe55ions COtlO: T�o Conlractor'S License Law tloez mt apply [o an owner o( �Property wM10 bulltls or Improves tneraon, antl who contracts for such orojects with a<on- trartor�s Ocense pursuant to tne Contractor's License L.aw�. I am awaro that p/Oof o� thei� Workcr'S CompenSation InsU�ance ShOultl be provitletl t0 me. ❑ I am exempt �ntler Sectlon B. & P. 0.�or Ihis reason Da�e Owner I hg�¢by certity •that �I have reaa this application antl stalo [nat tne abov¢ inf�rmatlon ii correct. I agree to comply with all city antl county ortlinances anq state law ting t builtlin9 �onstructlon, antl her@by authorize reo�e- sen� llve ot tM1ls cit enter upon the above-mentionetl Property tor in5b ctl p o5 _1 ,�{/ G� 5 ' - Oate jQJ.�� D ers' License or 55 � � ��—� �� -� TVPE OF CONSTRUCT� LI NEW L-J ADD LTERATION LI R� ❑ CONVERS�ON DEMOLISH ❑ OTHER Ap .�y DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TVPE OF PERMIT GRADING FOUNDATION STRVCTURAL T FrOnt ❑ TENANT ❑ EIECTRICAL ❑ PLUMBING ❑ MECHANICAL B Reef ❑ OTHER A PROJECT DESCRIPTION Sp. FT. oCCvvnNCv C Right K CONSTRVCTIONTVPE VALUATION$ g Left ZONE - GRA�ING CU.YUS. ACRES p�ng. Ref. # Remarks: � • Planning Notes: Sink Preventer Drinking Fountains ' Floor Draint Floor Sinks ' Gas Service Outlets Intercepmr5 Kitchen Sink � Lavatories � Roof'Drains '� Reinspection Fae $15 Boiler Duct - Under Ground DuCt - $IfuCtuf21 �uct - Ventilating ' Exhaust System ❑ Multiple ❑ Firepl/FacL Blt. ICBO # Heating System & Ducting ❑ ai oo,000 sTu � i oo,000 sTi 1 � Fea � $15 CMF OB65-46, rev. 30/84 Wnite - Builtling: Canary - APPliwnt; Pink - Atcounting; Goltlenrotl -�Assessor Showers Service Sink Sewer Cap Sewer Connettion Solar Collecmrs Solar Piping Solar Tank � Swimming Pool wlSpa Urinal Water Closet � Water Heater Water Service Auto-Wash I�sue Fee Hoodar Typol, Canopy Type I I Refrigeration System OO-t00,000BTU ❑100,Q00 System Repair/Alteration Fire Dampers Registers , laue Fee rr= $ 3 $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gns ❑Elecvic Fan F.q,U. Fixtures Device Boxes Outlets 4991 6��io5� Zona Acceuory Building: Parking Req.JProvided ELECTRICAL ' - �Trensformer ❑ 15-50 KW - � ❑ 50+KW Meter ❑up to 700 amps � Mecer ❑over100amps Sub Panel Motors �0.1 HP O1 h- 8 'Inc.Solar 09�15 HP �16-75+ Pole Light Range Garbage Disposal ; Standing Sections Generator �0.5 KW �5-15 KW Trash Compactor � qeinspection Fee �$15 � � Issue Fee DEVELOPMENTSERVICESREQUIREMENTS:. Zoning Approved By Building Approved By � Appliration Isued BY i� � //6'/ ' 150;0 FEES $ 3 Z O N I N G R E Q M T S SUM ARV OJ,j FEES BUILDING PERMIT $ CJ SMIP $ , sa PLAN CHECK $ PERMIT PLUMBING $ � ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ � GRADING 5 PLAN CHECK 50% $ . MICROFILM S � �` ��/j— MECHANICAL $ � , TOTALFEE �$ � PLAN CHECK z5% $ , � CONSTRUCTION AND PLANNING � _ - POOL e SPA . �APPROVALS Permit# . � Date f Inspector qppROVALS Permit# Date� Inspectoi e 1. Temporary Electrical Service or Pole � • 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement �,,;� �3�Electrical�Cond'uit Utility-Undrgmd! ' S4. Forms � ' ;"� 4.'Electrical•Conduit-Undrgrnd. ' 55. Etectrical Bonding � • - 5. Steel Reinforcement • 56. Rough Plumbing & Pressure Test '' � ' 6: �Electrical UFER Grnd. �:r� 57. APPROVALTO�COVER-GUNITE , 7:' Footir�gs , - � �,,;. .� 58. Electrical Conduit-Undrgrnd. � �� 8'� Foundation � � �' ' 59. Gas Pipe, O Undrgrnd., Test �� i � ..� 9. Water Pipe-Undrgrnd. � � 60. Backwash Lines, P-Trap, O Undrgrnd. � ' T41:5tructuralFloorSystem `� � I 61. APPROVALTODECK 11.� Property Sewer Line & House Connection I 62. Backwash & Receptor-Final 12. Sewer;Cap � ' � f �� 63. Heater & Vent-Final 13:� Roof brains ; 64. Plumbing System - Final , , 14: Rough Plumbing 65. Electrical-Final 15� Rough Electricaf-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 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. F`ame and Flashing � 76. Dry Standpipe 28. �Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation ' 78. FIRE PREV. FINAL 30. Drywal� Nailing j HEALTH DEPT. REQUIREMENT �.31. Plaster Brown Coat' 79. FINAL INSPECTION 32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: . 34. Final Heating & Air Conditioning ' 35. Final Gas Pipe-Test � • 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final - 40. Gas Service-Final � 41. Solar pomestic-Final . � � 42. Backflow Preventer . . � �� 43. Backflow Irrigation � 44. ,Landscape Irrigation System � 45. Sound Attenuation 46. Handicap Regulations � 47. FINAL STRUCTURE & BUILDING . 48. Special Requirements Completed 49. Electric Release to Edison • '' 50. Gas Release to Southern California Gas Co � ' 51�. CERTIFICATE OF OCCUPANCY � . ' � . No. Date � , _ r � Aoo��ant to /III In a11 spaces excepl thosa within neavy Ooraer Ilnes an0 sign all aoVroprlate tlaclaratlons. 61TV OP COSTA MES 7�C�ONST � iJCT.I O�ERMIT � l%� Project Address � �G� 7'� � �" �( Applicant'sMailin Address �� a-/ � ��1 r��/ �� -�1 Owner's Name �� C. 1 �� Phone � � Addreu � � � a cY.l�i�eu n%^ ArchlEnB� — —License No. Address r,� Contrattor's Nam �1 ^�, � Phone �3�_�a � Addresslmai'�nl ex/c��'�l+'-��Q WL�\ 1'Yl IG�v � i..• �. City License No. J, 6 LI /j �' 1 LICENSED CONTFACTOR DECIARATION 1 �ereby�aHirm tha[ I am Ilcensetl untler provisions of Charter 9(commenNng with section 7000) 01 Dlvlsion 3 oi the Buziness antl Protessions Cotle, antl my Iicense is In tull torce a effect. � License Class en lao._ls2 ��Sf� � Date �n' � � C S'9 t � � WORKERS'COMPENSATION D LARATION 1 h¢reby atBrm [hat I have a CGr[Hicate of consent lo self-in5ure Or a Cnrtiflwte of Workers' Compensation Insurance, or a, certifietl copy thereof (Section 3800, Lab. C.) �`'h� p' ` Company �1�A, ` ��✓�(� PolicY No. NV O�•7 ,� C¢rlltietl copy is hereby furni5hetl. , y Ce/tifi¢ c9PY}�jj{Cd �+'�th [he city B`il i DlviSio� If (/�•^ Oate ln'��'1 ��511— AP�licant � n �^ w•. EXEMPTION FROM WORKERS' COMPENSATION OECLARATION (ThiS seGtion naetl not be completetl it the parmit is for one huntlr¢tl (E300) or � Iess). . ' -'•d I certity [hat in th< Oe�la�mance ot thG work fo� whic� Ihis pe�m�l b ISiuetl I snall not employ any parson in any manner so as to betome suDJect to the Workers' COmpensatian Lawz of Calitornia. , , . Date Si9nature 'NOTICE: It, al[cr making this tleclaration, you shoultl become subject to tho Wo�kcri' CompCnSalion Proviiions of Ihe Labor Cotle, you must brtbwit� compry wlth such p�OWSiOns o� [his pe�mit Shdll b0 deemetl �avok¢tl. CONSTRUCTION LENDING AGENCV- 1 be�eby aifirm thal IhBro is a mnSVuctiOn lentling aqency for tne pertormanGo of tne work lor which this permit is Issuea (Section 3097 Clv. CJ Londet's Name _ � Lentlor's Atltlress � OWNER BUILDEN �ECLARATION � I hereby aiflrm that I am ozemPt lrom tM1e Gon[raclor•s License Law for Iha (ollowin9 reason (Section 7031�.5 Business antl Professlonal Cotle: Any cl[y or county whicn requiras a permit to construct. alter, improve, Cemolish or reoair any stru<turo, prlor ta Its Issuance; also requires the applicant tor sucn �ermit t0 tlle a slgnotl stalement thal he/she is Iic¢nsotl pursuant to tha provi510ns 01 tha Contractor's Licroso Law (Chapter 9(<ommentlng with Sec[lon ]000) ot Dlvision 3 ot the BuSiness antl Professionz Gotle) or thal he/she I5 uxampt therafwm dntl tha Ea5i5 for th¢ allegetl ¢xemptiOn. Any violation o1 $ectlon 7031.5 by any applicant lor a permlt Subjec[5 [ne applitdnt lo a CIvII �enalty of not moro l�an Ilve huntlretl tlollars (550�). I, as owncr oi lne pro0erty or my emPloyees with wa9as as thoir sole ' Compeniation, will Co thC wofk, antl the 5[futtuf¢ IS not int¢ntl¢tl Of o/ieletl for salo (Secllon 7044, BuSinesS antl Prof¢SSional Cotle: Thn ContraGtOr'S License Law Oocs not apply to an owner ot a properry who bulltls or improves tneroon, ana wno tlaes such work Nmself/nerseli or through his or her own employ0es, vroviaoa tnat sucn' improvements are noc Intentlatl or ollerea tor sale. 11, howovar, the bulltling or ImprOvement IS Toltl within ona year of cOm- platlOn, lhu owne� wlll have Iha bur0en Of proving he/she tlltl nOt builtl ot Im- �rove lor lba purposo o� sale). I, as ownC/ of tha property, am eztlusively contrattin9 wlth Ilcensetl COn- traclors lc wnslruc[ the projec( (Sectbn �044, Business antl Professlont Cotle: Tne Contractor's Licenzc Law doas nOl apply to an owner ot propc�ty who builas or imo�oves thereon, antl who contraccs tor sucn projects with a con- tractor�s Ilcenso pursuan[ to the Contractor'S Litensa Law�. I am awara that prOol o� lheir Worka�'s Compensa[ion insurance s�oultl be provltl80 [o me. ❑ I am exempt unEer Section B. & P. C. tor tnii reason Date Owner _ I hereby certity 'that 1 have read this information is correct. I aqree to comp antl state laws relaling to wltlinq c n 5entatives of this clly nt Oi inspection pu pos . Slqnature Drivers' LicenSe or 55 $ s,G � J5�?3 ..._. .--� -- - �.... , ... TVPE OF CONSTRUC O NEW ADD A TERATION R ❑ CONVERSION DEMOLISH ❑ OTHER A,p..�6 DESCRIPTIONOF ORK/USEOFBLDG. � S Main Building: TYPE OF PERMIT GRADtNG FouNDATION S7RVCTURAL T Front ❑`� TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear LJ OTHER A PRQIECT DESCRIPTION 5�. FT. OCCUaANCv C Right CONSTRUCTIONTVPE VALUATIONS C�}D� g Le(t i ZONE GRA�ING CU. VDS. ACRES p�ng. Ref.'Jk Remarks: . ; , . � , Planning Notes: ��ta[e that the above tl COUfIIY OldllldllCUS eby autnorize repre- ionea propertyef.or�r � t Date 0`��—,l\ ' Bar Sink Backflow Preventer Backflow Irri9ation Bathtu6s Clarifiers � . Dishwasher � Drinking Fountains Floor Drains Floor Sinks � GasService � Ouuecs� Interceptors� Kitchen Sink ' - Lavarories � � P-Trap Rooi Drains ' Reinspeetion Fee $15 Boiler Duct� Under Ground Duct - Struc W ral Duct - Ventilaiing ExhauSt System � Multiple Firepl/Fact. Blt. ICBO # Healing System & Ductin9 ❑6100,000 BTU 0100,000 Reinspeetion Fee � I $15 CMF 0865-46, rev. 30/84 Whit¢ - Builtlin9; Canary - APPliwnt; Pink - AccoUnting; GoltlenrOtl - Assessor ShoWerS Service Sink Sewer Cap Sewer Connection Salar Collec[ors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Weter Closet Water Hearer Water Service Auto-Wash Isue Fee Hoodor Typel ❑ Canopy Type I I ❑ RefrigeretiOn System ❑0.100,OOOBTU ❑100,000 System Repair/Alteration � Fire Dampers Registers ' ' ' Issue Fee FEES 0 Automatit Washer Construction PoleSub. Cooking Unit Dishwasher Dryers �Gas ❑Elec Fan F.A.U. Fixwres " . Device Boxes Outlets 4942 6/I7/85 2one Accessory Building: Parking Req./Provided ELECTRICAL Transformer -� 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter �over 100 amps Garbege Disposal Generator �0�5 KW �5-15 KW �7e�� T� Z O N I N G R E � M T s FEES Sub Panel ' ' Motors�61 HP�1X-8 Inc.Solar �9-15 HP 016-15+ Microwave ' Pole,Light Range Si9n Standing Sections � Trash Compactor g 3 I �- Reinspoetion Fea $15 Iszue Fee FEES DEVELOPMENT SERVICES RE�UIREMENTS: Zaning Approved By Building APvroved By �, � APDliotion Issuad BV � � � /�` $ 3 3 3 SUMMARV FEES BUILDWG PERMIT $��/i, C7 SMIP g i S- � PLAN CHECK � $ �QEFMIT PLUMBING $ �"V"��UANCE • $ PLAN CNECK 25% $ ' ENERGV P.C. $ ELECTRICAL $ i GRADING $ PLANCHECK 50% $ MICROFILM , § � MECHANICAL � $ TOTALFEE � $ /S,S PLAN CHECK �Z5% $ ' � • 1 , CONSTRUCTION AND PLANNING � APPROVALS - Permit # �V 1. .Temporariy Electrical Service or Pole 2. Soil Pipe-Undrgrnd. . � 3. Electrical Condui['Utility-Undrgrnp. � 4. Electrical Conduit-Undrgrnd. � r 5.'Steel Reinforcement 6:,��lectrical UFER Grnd. �,•" 7.. Footings ''� ; 8.� Foundation ' � ,:.� : � 9.•WaterPipe-Undrgrnd. S 10� Structural Floor System •I � 11 . Property Sewer Line & House Connection 12. Sewer Cap � 13:: Roof Drains 74. Rough Plumbing � 15� Rough Electrical-Conduit 16. Rough Electric Wiring 17. 'Rough Wiring Sign � 18. Rough Electrical-T Bar Ceiling 79. Rough Heating & Air Conditioning 20. Rough Factory Fireplace 21 � Ducts, in Struaure 22. Ducts, Ventilating , 23. Gas Pipe-Rough & Test 24. �Roof Framing 25. Roof Sheathing � 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing 28. Lathing & Siding 29. Insulation 30. Drywall Nailing ' 31. Plaster Brown Coat 32. Electrical Power Meter-Final 33. Final Electric 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final � 41. Solar pomesticFinal � � 42. Backflow Preven'ter " 43. Backflow Irrigation 44. ,Landscape Irrigation System 45. Sound Attenua[ion 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATEOFOCCUPANCY o. - ' _. _ Date Date � 0 POOL a SPA Inipector qpPROVALS Permit# Date � 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms , 55. Electrical Bonding 56. Rough Plumbing & Pressure Test � . 57. APPROVAL TO COVER-GUNITE , 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, � Undrgrnd., Test 60. Backwash Lines, P-Trap, O Undrgrnd. 61. APPROVALTODECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System - Final � 65. Electrical-Final 66. Solar System-Final � 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit #_� 70. Underground Hydro � 71. Product Piping �Gas ❑Oil 72. Underground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro . 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL � 78. PIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: Inspector .: AOplicanl lo fill in all spaces ex[e0t f�osC within heavy borAe� Iines antl si9n all appropriate Eectarations. C�Tv,oF COSTA M OCO.N$TR11C11pN PF,ifiMlT � iS � ProjeCt Address w ��' '�C�� Appli�ant's Mailingi Add ess ��x-� � rj� ��J �A..�Qi Owner�s Name Y� �` ��L' �Phone � ^��"�� Address .� � SLi � ..yl.L1�U�.V�'� " Arch/Eng. � License No. Add�ess , Contrgcmr's Nam hone� 3� �� Addresslmailing) � t �• Ciry �icense No. �� p �1 LICENSED CONTRACTOR DECLARATION . 1 1 hereby aflirm t�at I am ficen5¢tl�untler provisions oi Charter 9(commenCfng with ;¢Ction ]000) of Dlvision 3 01 the Bu51ne55 antl Prof¢SSiOnz Cotle, antl my license is in (ull'i ce ❑ fiect. /� LJcen Class � Li�e N � -� Date_ �'� =,SI 51g t e . WORKERS' COMPENSATION DEC ARATION � ' � ' I nereby affirm tbat I have a certiticate oi consentro selt-insure or a certiticate of Wbrke�s' Compansallon Insu�ance, or d certifietl copy [hereot (SeCtiOn � 3800, Lab. C.) )1 /\ C,�J� Policy No. N �"I v �� Company � "u { � �f �l i �Certifletl copy is hereby furnishetl. ' , - � Cer ifletl o y I}.�p,� wlth the City Byiltlinh9 DIviSEqn.�f� Date ��'Y� AppllCdnt "[ L{�1�+� �� EXEMPTION FROM WORKEf25' COMPENSATION DECLARATION (This section neetl not be completed if the'permit Is for,one huntlretl (E300) or ' less) � � 1 cert�fy,that in thf peAormance of tM1e work for which this perm�Cis'issuetl I shall' not employ any person in any manner so as to become subject to t{�e Worke�s"Compensdtlon Laws ot CalifOmia. � ?;� . Date Si9nature • ' '- 'NOTIpE: It, aiter making t�is tleciaration, you snoultl become subject to the Workers' Compensatton provisions ot lhe Labor Cotle, you must for[nwi[h _ com0ly wlth Suct1 prOvizions o� this De�mit Shall be .tleemetl �evoketl. CON$T0.VCTION LENDING AC>ENCV' ' ' - � 1 nereby aifirm tnat th¢ro is a conziruction lentlin9 agency for Ihe performan<e of the work for which this permit is Issuetl (Section 3097 Civ. C.) Lentlpr's rvame Lentler's ACtlress � � OWNER BUIIOER �EGILARATIOIV I hereby aHirm that I am•ezempt from the ConVacror's Litense Law tor the foilo�yinq reason (Section 7031.5 Businezs antl Professional Cotle: Any citY or coun[y whith reqUires a Oermit [o const�utt, al[eq improve, tlemolish m repai� any struclure, prior to ils iszuance, also requires the aoPlicant for such permil to file a si9netl statement tnat he/sne is licens¢tl pursuant to tne provisions of [he Contractor'S LiCCnse Law (ChaO�er 9(coTmencin9 wlth $ection'7000) Of Division 3 ot the Buziness antl Professionz Cotle) or that ne/she is ezampt tM1era(�pm a�e tne basii (or Ihe all¢getl ¢xemption. AnY violation ot SecHon 7031.5 by any applican[ for a permit subjects the aOP��cant to a dvil genalty ot not more than five huntlred tlollars (y500). . LJ I, as owner of tho proporty or my employees with wage5 as their sole compensatlon, will tlo the work, antl the structure is not intentleC or offered for sale (Section 7044, Business anE Protezsional Cotle: The Contractor's' Liceryy¢ �w tloes not apply to an owner ot a properry who puiltls or improves tner�on, antl wno tloes such work himself/herself or throu9h his or her own employees, provitletl that such Improvements are not intentle0 or otteretl for sale. If, however, the bulldin9 or improvement Is 5oltl witnin one year of com- pletiOn, the owner will have the burtlen of proving he/she tlitl not builtl or im- prove tor the pu�po5o of sale). � ❑ �, as own¢� ot Ihe property, am exclu5ively cont�actinq with licensetl Con- t�acto�s t0 construc[ Ihe prolect ($ec[ion 7044, Business antl Protessions COtle: � The Conlractor's License Law does not apply to an ownGt of property wh0 builtls or Imoroves thereon, antl who conVacts for such projects with a con- tracfor(s Ilce�se pursuav[ to [he ContractorY UcenSe Law). I am aware that proqf o� their Wo�ker'S CompBnsatiOn Insurance shoultl be ptovitletl to me. ❑ I am exempt untler Section B. & P. C. for this reason Date 1 be�¢by certlfy that I informatlon iz corr¢cL I Signature Orivers' �i nse or 55 � CMF OB65-46, rev. 30/04 Owner this appliWtion antl state tnat tne abova � �mp1Y wrth all tlty antl county ortlinances cqn struction, antl bereby authorize repre- iUDn the above-mentionetl property for !/ �p� � Date �u^�J ��-� -� � �. � � TVPE OF CONSTRUCT� LJ NEW U ADD ALTEftATION RE//p ❑ CONVERSION DEMOLISH ❑ OTHER - /��-�� /% • � �/- �OESCRIPTION OF WORK/USE OF BLDG. � TVPEOFPERMIT GRADING FOUNDATION STRVGTVRAL ❑,TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAI ' ❑ OTHER PROJECT DESCRIP710N SQ.FT. oCCVPArvCv_ CON STRVCTION TVPE VALVATION $ � ZONE GRA�INGCU.YDS. � ACRES Remarks: � - Bar Sink Backflow�Preventer_ BackflOw Irrigetion eathtu6s Clarifiers ; � Dishvrdsher Drinking Fountains Floor Drains FloocSinks ' ' Gas Service � Interceptors � Kitchen Sink' Lavatories P-Trap Roof Drains JIBING Showers Service Sink Sewer Cap Sewer Connection Solar Colleciors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal i w2t2� C1052L Water Heater � Water Service . Auto-Wash Laundry Trays; ES A.P. �k S Main Buildi E T Front B Rear A C Right e Left Ping. Ref. #� Plannfng Notes: Automatic Washer Construction PoleSub. Cooking Unit Dishwasher � Fan F.A.U, � Fiztures Device Boxes Outle[5 Switches � Garbage Dispoul Generetor �0.5 KW �5-15 Reinspection Fee - $15 laue Fee $ 3 Boiler � Ducc-UndecGround Duct - Structural Duct - Ventilating ExhaustSystem ❑ Multiple�� Firepl/Facc Blt, ICBO �p Heating System & Ducting ❑P7 00,000 BTU � 100,000 8Tl FieinspectionFea S75' White - Builtling; Candry - APO��anp Pink - AccoUnting; Goltlenrotl - A55855or 4993 6117/95 Zone Parking Req./Provided ELECTRICAL . Transformer ❑ 15�50 KW ❑ SO+KW Meter ❑up to 100 amps Meter pover 700amps ' ' �Sub Panel • Motors �0-7 HP �1 X� 8 ' Inc.Solar �9�15 HP 016-15+ Microwave Pole Light Range ; Standing Sections Tresh Compacmr Reinzpaetion Fee I$15 Issue Fee IANICAL - FEES Hood or Type I ❑ ' DEVELOPMENT SERVICES REQUIREMENTS: Canopy Type I I ❑ Zoning Approved By Building APProved 6Y — ' r,. Refrigeration System • ❑aioo,000eTu ❑ioo,000eTu System Repair/Alteretion . Fire Dampers • � Registers Issue Fea ' � � S 3 - � 5oti0 TL Z O N I N G R E Q M T S FEES $ 3 SUMM RV F EES �, �d BUILDING PERMIT $ � � r SMIP , $ PLAN CHECK $ PERMIT � PLUMBING $ � i � ISSUANCE � $ PLANCHECK 25% $ ENERGV�P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ � MECHANICAL $ TOTAL FEE $ /� � PLAN CHECK ZS% $ � =i '/CONSTRUCTION AND PLANNING = -� � . POOL a SPA �`APPROVALS Permit# � � Date � Inspector ', ,4PpROVALS 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 � -- .' �"� . 4r''Electrical ConduitrUndrgrnd. .. - 55. Electrical Bonding � «�� - 5. Steel Reinforcement ' ' � - � 56: Rough Plumbing & Pressure Test � . , _ 57. APPROVAL TO COVER-GUNITE ' � � &i Electrical UFER Grnd. � �..,"�" _ .7:� Footings , ' 58. Electrical Conduit-Undrgrnd. . - ' 6` Foundation � 59. Gas Pipe, O Undrgrnd., Test i �9.' Water Pipe-Undrgynd. `�,r ; � 60. Backwash Lines, P-Trap, O Undrgrnd. � �10; Structural Floor System �J 61. APPROVAL TO DECK �71: Property Sewer Line�& House Conhection 62. Backwash & Receptor-Final 12. Sewer Cap �, � f', t 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. Rougli.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. Storage'Tank O Gas ❑ Oil . 25. Roof $heathing , - 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.�PIas�er 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 oi Canopy � _ 37. Final Factor,y Fireplace - 38. Final Plumbing • . 39. Water Service-Final - 40. Gas Service-Final � 41. Solar pomestic-Final . � 42. Backflow Preventer . 43. Backflow Irrigation ' . � � - -' , , .� 44. ,Landscape Irrigation System � - 45. Sound Attenuation ' , ' � 46. Handicap Regulations . � . ' � 47. FINAL STRUCTURE & BUILDING , ' � 48. Special Requirements Completed ' � . � 49. Electrie Release to Edison � � � i � 50. Gas Release to Southern California Gas Co • ' � � 51. CERTIFICATE OF OCCUPANCY . ' - , , No. � Date � . . - . . . . . _ .. . . �, - AOPlicant to fill in all soaces axceDt lhose w(tnin heavY boraer Ilnes ana sign all approo��ate tleclarations. CITY OF COSTA MESiy�oONS'TR ��IQDI P6RMIT ' f� I Project Address � �'�J ��' �L�/` �� Applicant's Mailing ddrei 1 YYiI �O-r�� L��, �I� _ Owner's Name ' �enL �� Phone.lL7.e_—Z� Address � ( �'�� -L�'UGi� 0 r Aich/Eng. License No. Address � ��'�'�,'�t Contractor's Nam ^� � • Phone'�.7��`�' Address (ma'i'nnl c+��/[��0f, l iL� 1 YYl I�G-� i L< e-, City Licenu No. W1 a�"� LICENSED CONTRACTOR DECLNFATION 1 hereby affi�m lhdt I am Iltensetl untle� O�ovi5lOn5 of Cha�te� 9(commencinq with section 7000) of Dlvision 3 of the Business antl Professions Cotle, antl my Iicense is in fu So�t¢,a tl e(tect. � Licans�j C_las� • �� i n e n ._ ' Date �I.L 5'g t � � WORKERS' COMPENSATION DEC RATION ' I hereby affirm tM1at 1 have a certiflcate of con5ent to self-fnsure or a certificate ot Workers' Compensation Insurance„ or a.certl(ietl covY thereof (SecUon 3800, Lab. CJ ' i�� rj� 'GL.. � rr'�� . Polity No. "7 4 Company �« Tr�. �Certlfled capy is hereby �urNshetl. . '� . Cer ifietl � y is le ith the'city Buildin Division.{'�- !�• Date �n—��APPlicdnt y�(7.�1� `��"�h` EXEMVTION FROM WORKERS' COMPENSATION DECLARATION ,. (This section neetl not be completetl It tlie permit is for one hunared ($300) or less). ' ¢�i! I certify that in the performance ot the work fOr which this permR Is issued, I shail not employ any person In any manner so as to become subject to the Workers' Componsation' Laws of Callfomla. � � . Date � $I9nature "S . �NOTICE: It, after makinq this tleclaration, you ShoWtl beGOme subject to the Workers' Compen5ation provi5ions of the Labor Cotle, you must (orthwith comply with such provisions or Ihis permit shall be�tleemetl revoketl. CONSTRUCTION LENDING AGENCV I hereby aftirm that there is a conztruction Ientling agency tor the performance o( Ihe work for which this Oermil is issu¢tl (Sectlon 3097 Civ. C.) l.entler's Name � � Lentler's AGtlre55 , _ _ OWNER BUILDER OECLARATION � I hereby affirm Ihat I am Ozemp[ from tbe Contractor'S License Law for the following reason (Section 7031.5 Business antl Professional Cotle: AnY city or county which requires a permit to conStruGt, alt¢�, imp�ove, tlemollsh oi �epair' any structure, prior to its issuance, also requires the applicant for such permit -to fi�e a signetl stalement that he/she is Iicensetl pursuant to the provisions ot ..e r....�.��,... i��., i aw rcnantwr 9 lcnmmencina with Settion 7000) of therefrom antl lhe Dasis tor [he allegetl exemptlon. Any violatlon o( Section �031.5 by any applican[ for a permit 5ubject5 the applicanl to a civil eendlty of not more than five huntlrGtl tlollars (5500). - L� I, as owner ot the property or my employees with wa9es as their sole mmoe��t�on, will tlo the work, antl the structure ts not Intentletl or ofteretl tor Sale (Section ]044, Buziness and Protessional Cotle: The Contractor's License Law tloe5 no[ apply to dn owner Of a property wh0 builtls or improves tbereon, an0 who tloes such work Nmself/herselt or throu9h his or her own employee5, provitletl lhat such improvement5 a�a not intentletl o� offeretl tot sale. If, however, Ihe builtlin9 or ImOrOvement IS Soltl wi[hln one year of com- pletiOn, the owner will have Ine burtlen ot prOvin9 he/she tlitl not builtl or im- p�ove for [he purpose o1 sale). ❑ I, a5 owne� ai the pro0erty, am exclusively cont�acting with Iicensetl con- tractors to construct the project (Sectlon ]034, Business antl Professions Cotle: The Contractor's License law does no[ apply [o an own¢r of property who builtls or improves thereon; antl who contracls (or such projects with a mn- tractor(sj licenie pursuant to the Contractor's License Law). I am aware that proOt o( their Wo�ker's Comp¢nSallon inSUrance shoultl b¢ prOW�etl to me. ❑ I am exempl unaer Section B. & P. C. for [his reason Date Owner 1 hereby ceriify that 1 have read Inis applicatlon antl state that the above information is correcL I agree to comply with all tlty antl county ortlinances antl itate laws rela[inq [ iltlin9 on5truction, antl hereby authorize re0re- sentatives of thl city, o nt on tna above-mentionetl proper[y tor inspection pu po s. ' _ � ; � TYPE OF CONSTRUCTI LI NEW LJ ADD LTEaAT10N ❑ CONVERSION DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPE-OF PERMIT LJ GRADING IJ FOUNpAT10N LJ STRUCTURAL '❑ TENANT ❑ ELECTRICAL ❑ PLUM6ING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ.FT. OCCVPANC CON STRUCTION TVPE VALUATION $ �� ZONE GRADING CU. VDS. ACRES— 0.emarks: , � Bar Sink � � Backflow Preventer Backflow Irrigation Bathtubs Clarifiers � Drinking Fountains � Floor Drains . ' FloorSinks � Gas Service � OuUets Interceptors KitchenSink •�� " • Lavatories . P—Trap Roof Drains • Reinspaction Fee' $15 Boiler Duct-UnderGround Duct - Structural Duct - Ventilating Exhaust System � Mul[iple FirepVFact. Blt. ICBO # Heating System & Ducting ❑0.700,000 BTU 0100,000 lSignature � Date � ' Drivers' Lice se or'S5 � �.� �� I I Reinspection Fee CMF 0865-46, rev. ]0/84 WM1ife - Builtlin9: Canary - APPllcant; Pink - Accounting; GOICenrotl - Asse55or FEES Showers Service Sink Sewer Cap Sewer Connection � Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal - Water Closet WaterService � - Auto-Wash - LaundryTrays- � - Isue Fee $ 3 IANICAL FEE Hood or Typel ❑ Canopy Typell ❑ , Refrigeration System ❑0�100,OOOBTU ❑100,0008T ❑ System Repair/Alteration � Fire Dampers Registers � H r $15 � � ' Issue Fee � $ 3 A.P. # S Main Buildi E T Front B Rear A C Right K Left 5 Ping. Ref. # Planning Notes: Automatic Washer construcUon Pole Su6. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures ' Oevice Boxes Outlets Switches Garbage Dispoul Generator �65 KW C Fee 4994 6/17/p5 Accessory Building: Parking Req./Provided 15oE0 TL Zone � ELECTRICAL - Transformer -❑ 15-50 KW ❑ 50+KW Meter ❑up [0 100 amps Meter ❑over100amps Sub Panel Motors�0.1 HPO1'F�-8 Inc.Solar 09-15 HP 016-15+ � Microwave Pole Light Range ; Standing Sec[ions 5 KW Trash Compactor $15 Issue Fee DEVELOPMENT SER VICES REQUIREMENTS: 2aning Approved By Date Building Approved By /� Date FEES i $ 3 2 0 N I N G R E Q M T S SUMMARx OF EES BUILDING PERMIT '$ 10,�1 � SMIP $ ,. S(� PLAN CHECK $ PERMIT PLUMBING $ �Q 'ISSUANCE $ PLAN CHECK �25% $ ENERGV P.C. $ � ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM t S � � MECHANICAL � $ SOTAL FEE � $ � PIAN CHECK Z5% $ ' , � CONSTRUCTION AND PLANNING `I . POOL a SPA � . ; ��APPROVALS Permit# � � Date � Inspector AppROVALS Permit# � Date Inspector i �t. Tempora �y Electrical Service or Pole 52. Pool & Equipment Location ' :2. Soil Pipe�Undrgmd. ' ' _ ' 53. Steel Reinforcement _�� -., 3. Electrical'Conduit�Utility-Undrgrnd.� , . . 54. Forms ., � � - . �,. 4�.;Electrical Conduit,Undrgrnd. , . 55.� Electrical Bonding ""`'I . i 56. Rough Plumbing & Pressure Test "' �' • S..Steel Reinforcement ' � .� , i 6:� Electrical UFER Grnd. �- 57. APPROVAL TO COVER-GUNITE . _...;L• .. 7. �Footings �' � � - 58. Electrical Conduit-Undrgmd. � 8.. Foundati0n • , . �59. Gas Pipe, � Undrgmd., Test 9:vWater Pipe-Undrgrnd. � _ . 60. Backwash Lines, P-Trap, O Undrgrnd. . 10. Structural Floor System .F i� 61. APPROVAL TO DECK �: �. . 1.L.'-Property Sewer Line & House Co"nnection i 62. Backwash & Receptor-Final 12. Sewer Cap � ' � � � ��(7(.r 63. Heater & Vent-Final . 13. Roof Drains � ' 64. Plumbing System - Final - i 14. Ro�gh Plumbing 65. Electrical-Final � 15- Rough-Electricai-Conduit � , 66. Solar System-Final "" 76. 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 i - 20� ,Rough Factory Fireplace APPROVALS Permit # ' 21� Ducts,in Structure , � 70. Underground Hydro � � 22-Ducts, Ventilating . 71, Product Piping OGas ❑Oil ` - 23'.-Gas Pipe-Rough & Test • 72. Underground Flush � f 24•.; Roof Framing- 73. Undeigrnd. Storage Tank O Gas ❑ Oil i 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 . I HEALTH DEPT. REQUIREMENT �31. Plast�r Brown Coat � 79. FINAL INSPECTION 32. Elecerical Power Meter-Final 80. FOOD CERTIFICATE ISSUED �. 33. Final Electric � • Notes: 34. Final Heating & Air Conditioning � � 35. Final Gas Pipe-Test ' - � - , 36. Hood or Canopy � � � - � - 37. Final Factory Fireplace � . � . 38. Final Plumbing , - 39. Water Service-Final � 40. Gas Service-Final , 41. Solar pomestic-Final , � . 42. Backflow�Preventer � . � 43. Backflow Irrigation - . � � 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 Southern California Gas Co � ' � ' � � . i 51. CERTIFICATE OF OCCUPANCY - � . � � � No. Date - - . , � ADVlicant to Iill in all spaces exeept those within �eavY DorEer Iines anE sign all aDPropriata tlecla�ations. CITY OF COSTA ME A CONST � CTION P MIT �� PEAMII' NO. _ i TRACT NO. LOT NO. L1NIT NO Project Address W �'V� � 1 P.Pplicant's Mailing Address 1� , '�� Owner's Name ��e�� L fa%-L«+ Phone �� Adqress �' �`-� � ��-�� ✓ Arch/Eng. _Lfcense No. Adqress /-.� Coqtrector's Nam L„(,i—Pho/ne N$� �Y� Adqresslma'I'ng��,�L��% 1. 1 �✓�'�i��Jv) "�• City License No. �Y7% SiaZ L � LICENSED CONTRACTOR DECLFRATION I hQreby aftirm that 1 am IicenSetl untler provisions oi Charter 9(�ommencln9 with section 7000) of Division 3 of the Business antl Professions Cotle, antl my Iicense is in lull tor tl eftect 1(� � LicNn]e Class -� ens N� w� �� Datetn��`� � 5�9� t e �� WORKERS'COMVENSATION D LARATION . I h0reby affirm that I have a d¢r[iticale Ot consent t0 self-Insure Or a certiticat0 bf Worke�s' COmpenSd[ion Insurance, O[ a certiti¢tl cOPY thare0f ($ection 38aoY �b. �.� LfCL.�'b o Y Polic No. � Com an �� •�� Q Certifietl c�o,Ppy is �neryeby furnishee. Dateert 0ie /�-/ Y�{\ WAPPI cantY B tl' 9� isiqr4 J,A /'� � �J/1� � C]— EXEMPTION FROM WORKERS' COMPENSHTION OECLARATION (Tnis section neoa nat be completetl If th¢ permit is for one huntlretl (5100) or lessj. , ,�--. I cBrtify tM1at in tne perforrtlance Of [he wOrk to� whi�h Ihis pe�m�t9s Issuetl, I ShaIP no[ emPlOy any pe�son in any Tanne� so ds t0 become SUbject l0 the `rouYkers'. Compansation Lawz of Califomia. . � Date Signature 'NOTICE: It, a(tC/ making lhis tletlaratlon, y0u shoultl bCGome sUbj¢Ct to llte Workers' Compnnsation provisions ot the Labor Cotle, you must forthwilh coriiply .with suCh p�ovlsiOnS o� thi5 pe�mit Shall be tle¢me0 revoke0. CONSTRUCTION LENDING AGENCY, ' � I hgreby aiflrm that there is a construction Ientlin9 a9ency /or the periormance Ot th¢ work IOt whlth [his p¢rTil i5 i5sued (SeGtlOn. 309Z Civ. C.) LPntler's Namo Lantler's Atltlress OWNER BUILDEH DECLARATION ' 1 herCby aHirm [hat I am ¢xompt trom th0 ConVactor'S Licens¢ Ldw lor Ihe � following reason (Section 7031.5 Builness antl Protesitonal Cotle: Any city or mun�v wnich .eauires a oermlt to <onstrucl. alter, imorove. tlemolish or rapalr . islon 3 oi tno tlusinoss ana rro�essions cova� or ma� ne�sna is oxumyi rotrom anC tne baih for the ailo9ed exemption. Any violatlon o1 SecHon I3.5 by any applicant for a permit suDjects the apPlicant lo a civil alty ot not more tban tive huntlratl tlollars (5500). - I, as owner of tho Proparty or my emPloyees with wa9es ai [hoir soln npensa[ion, will tlo [he work, anC t�e ilrutturo is not intentletl or oNerotl 5ale (Sectlon 7044, Business antl P�ofessional Cotle: The Contractor'S ense Law tloes no[ apo�Y to an owner ot a Droperty who builtls or improves reon, antl wno tloes sucn work nimsel!/herzetl or througn hiz or her own ployees, provltlatl that such imProvemen[s are not IntenOetl Or ott¢reU for : If, however, tne builtling or improvement is sold within one yoar of com- cloq tbe owner wlll have tha burtlen ol proving ho/sho tlitl not bulltl or Im- ve forthc purposo of sale). 1, as owner of the property, am exclusively tontracting witn Iicensetl <on- ]tors t0 conSVuc[ the OrOject (5¢clion 7044, Busi0o55 antl Plofe55lon5 Cotle: • Con[ra<tOr'S LicenS¢ Law doa5 nOt dpP1Y [O an ownei o1 O�Ope�iy wh0 bs a/ ImprOves lhereon, antl wno ConVaCts fo� SUGh pro�etts wlth a con- :tor(s1 ❑cense pursuan[ f0 the ConbaCtor's Llcanie Lnw). I dm awara that �ot of their Worker's Compansation insurance shoula be pravlaetl to mo. I am ex¢mpt untler Section B. S P. C. tor lnis �0a50❑ oate I her¢by c¢rtify tbat IMormation iz correct antl state laws relatin sCMaliv¢s of Ihis CII ��EpGttion p pos SlgnaWre Orivers' License or 55 owner have reatl tnis aoP��ation antl state that tna abova aqree to comply wltn all ci[y antl coun[y ortllnances o Oviltlin9 �onstruction, antl h¢reby authorize ra0re• - en er upon the above-manlioneA property for Date �n-lu-KC' �_ �� TYPE OF CONSTRUCT�- LJ NEW L1 ADD ALTEf2ATION LJ gEpqIR ❑ CONVERSION DEMOLISN ❑ OTHER /ww /r ,/�CJ�.�.O � A P ,M, DESCRIPTION OF WORK/USE OF BLDG. , � S Main Building: E TVPE OF PERMIT GFADING FOVNDATIOf-N� STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING LJ MECHANICAL 8 Reer ❑ OTHER A PROJECT DESCRIPTION 5�. F7. oCCUPANCv C Right CONSTi2UCT10NTVPE ' VALUATION$�� g Left . ZONE GRADING CU. VDS. ACRES p�ng. Ref. # Remarks: " Planning Notes: � . PLUMBING , FEES Backflow Preventer Backflow Irrigation Bathtubs Clerifiers � Disbtiasher ' ' Drinking Fountains � � FlOor Drains Floor Sinks Gas Service ( Interceplors Kitchen Sink � Lavatories P-Trap Roof Drains Reinspection Fae ler ' :t - Under Ground $15 Exhaust System � Multiple ❑ Firepl/Fact. Blt, ICBO # Heating System & Ducting ❑0�100,000 BTU O 100,000 BT � RBinspection Fee � $15 CMF 0865-46, rev. 30/84 White - Bulltling; Canary - Appliwnt; Pink - AccounUng; Goltlenrotl - Asse55or Showers Service Sink Sewer Cap Sewer Connection Solar Collectors $olar Piping Solar Tank Swimming Pool wl5pa Urinal W BSCf, CI052I . Water Heater Water Service Auto-Wash laue Fee Hood ar Type I ❑ Canopy Typell ❑ Refrigeracion System Oaioo,000eru Oioo,000 Syzrem Repair/Alteratian Fire Dampers Registers � Iswe Fee Auromatic Washer - Construction Pole Su6. Cooking Unit , Dishwasher t Dryers [IGas ❑Elect�i� Fan F,A.U. Fixtures Device Boxes ! Outlets 4995 6/I7/B5 Zane Accessory Buitding: Parking Req./Provided ELECTRICAL � Transformer ❑� 15�50 KW ❑50+KW Meter ❑up to 700 amps ' Meter ❑over 100 amps Sub Panel Motors �0.1 HP � 1 Y, - 8 Inc. Solar �9-75 HP 01615+ Microwave Pole Light • Range Garbage Dispoul I I; Standing Sections Generator �0-5 KW 05-15 KW I Trash Compactor S 3 Reinspection Fee 515 laue Fne FEES DEVELOPMEN7SERVICES RE�UIREMENTS: Zoning Approved By BuildinB ApProved BY Aooliratian Issued Bv _ _.I � /,� $ 3 BUILDING PERMIT $ / /l. V V PLAN CHECK $ PLUMBING $ � . PLAN CHECK 25% $ ELECTRICAL $ � , PLAN CHECK 50% $ MECHANICAL $ - PLAN CNECK 25% $ � 15>� TL z O N I N G R E � M T S FEES S 3 SMIP $ .�h PERMIT �ISSUANCE � $ ENERGV P.C. $ GRADING $ MICROFILM S TOTAL FEE $ ��_ �, '• CONSTRUCTION AND PLANNING �� POOL a SPA % APPROVALS Permit# Date Inspector qpPROVALS Permit# Date Inspector i 1. Temporar�y Electrical Service or Pole� _ 52: Pool & Equipment Location � 2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement ,� 3., Electrical Conduit Utility-Undrgrnil.' I � I 54. Forms , 4.�Electrical Condui[-Undrgrnd. 55. Elec[ricaf Bonding i � 5.� Steel Reinforcement ' �' 56. Rough Plumbing & Pressure Test � 6-'Electrical UFER Grnd. • -�� ` 57. APPROVAL TO COVER�GUNITE i 7.^Footings • ; � � � '_ 58. Electrical Conduit-Undrgrnd. 8; �Foundation � � 59. Gas Pipe, O Undrgrnd., Test �.9"' Wafer Pi e-Undr rnd. � � � P 9 .. 60. Backwash Lines, P-Trap, � Undrgrnd. 10:' Structural Floor System �r� �� 61. APPROVAL TO DECK 1.1. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap y'/ �' � 63. Heater & Vent-Final - � i 13. Roof Drains 64. Plumbing System - Final � 14. Rough Plumbin9 � 65. Electrical-Final ' ' 15. �Rough Electrical-Conduit - 66. Solar System-Fina� 16. Rough Elec[ric 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' 77. 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 � 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Dry�all Nailing ., HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat � ' 79. FINAL INSPECTION 32. ETectrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED , 33. Final Electric Notes: 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-Test ' - 36. Hood or Canopy � 37. Final Factory Fireplace - " 38. Final Plumbing � 39. Water Service-Final � ' 40. Gas Service-Final 41. Solar pomesticFinal � � 42. Backflow Preventer . . 43. Backflow Irrigaiion . . 44. ,Landscape Irrigation System 45. Sound Attenuation ' 46. Handirap 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 � � a� Gf ADD��ant lo till in al1 spaces except thosa within neavY eortler Iines ane ti9n al1 aooropriate Oeclarations. Cl.r-YOF coSTA nnEs CO�TRUCTION P MIT # Project Address Applican�'s Maili/ng Address � t � . Owner's Name `� � n� � � �� Phone's?J � � f �� Address ��u7' C. YV�� ' ArchlEng. License No. � Address � �� Contractor's Nam �_"iO.�Ll(�_��Phone Addreu (mailing) p ��1 �J.SZ1��7 .�- •�- City License No_ _ LICENSED CONTRACTOR DECLARATION I hereby. affirm tM1at I am licensetl untler provislo�s of Charter 9(commencing with sectlon 7000) of Divislon 3 of the Business antl Professions Cotle, antl my Iicense is in full r�e aqqetfect. /O� �� / LJcens Class �� 'ce e o. � oace f�—ILd— Sie t �� ' . WORKERS' COMPENSATION CLARATION - I hereby affirm thal I have a certificate of consen( fo self-insure or a cerUficate �'ot Workers' Compensation Insurance, or a certifietl copY [hereof (Sectlon 3800, Lab. C.) !\ }1-�} / �� 1-,:I ,,� POI1cY No. ��'��/ -�� ComPanY „M1'' v T'�✓ I/ CerUfiea copy is hereby turnishetl. Dateerti9etl 5o.py is t, {jp�,wl�to0hcantY Bu�C'ng Yl islo� . 1�• ��. 1 I i_I Xl Yl l XYa EXEMPTION F.ROM WORKERS' COMPENSATION DECLARATION (This section neatl not be completetl if the pe�mil i5 /or One huntlretl (5300) or less) I ce�tily that in Ine performance ot tne work tor �yhiGh this pe�m�t is ISSuatl 1 shall no[ employ any person In any manner so as to become sub(act to t�e ' Workers' Comoensation Laws ot Califomia. . p� . Date Signature 'NOTICE: 1f, after making this tleclaratlon, you shuultl become sub�ect to the ' Workers' COmPensation provl5ion5 ot lhe Labor Cotle, you musl forthwith comO�Y �'�'i�h su<h proNsions or this p¢rmit shall be tleem¢tl revoketl. CONSTHUCTION LENDING AGENCV- ' I . . I hereby a111�m �hdt [he�e is a conStruC[Ion lentling agency tor the pe�lo�mance , o/ tho �work fOr which th15 Permit is issuetl (Section 309]� Civ. C.) tEntler's Name �entler'z AGtlress . OWNER BUILDER �ECLARATION � I bereby affirm that I am exempt from the Coqtractor's Llcense Law for tbe followin9 reason ($ection ]031.5 Business antl'Professlonal Cotle: Any clty or county whicb requires a permit to construct, alter,�improve, tlemolish or repalr any struchre, priOr to it5 is5uance, also reqUireg tha applican[ for SUCh pe�mlt to tile a signetl sta[ement tha['he/sh¢ is licensep pursuant to th¢ provlsion5 of [he Contractor's Liccnse Law (Chapter 9(commencing with Sectlon 7000) of Division 3 of the Business antl Professions Cotle) or that he/sne Is exemp[ therefrom an0 the basis (or the allegetl exemption. Any violation of Section 7031.5 by any applican[ 1or a permit 5ubject5 tlte �ap011cant to a civil �enalty ot not mare than five huntlred tlollars (5500). " I, as owner of the property or my'employees with wages as their sole compensation, will tlo the work, and the structure is not Intantletl or oiferetl for sale (Section 7044, Business ana Protessional Cotle: The Contractor's Litense Law UoeS not apply to an ownEr ot a prryper[y who builtls o� Imp�Ov¢5 � [hereon, antl who tloes Such work.himself/herself o� through his o�'her Own employees, OroviCeE that such ImOrovements are not intentlotl or oftcreU br sale. If, however, lhe oulltling or improvement is soltl witnin one year ot com- pletion, Ihe owner will have tha burtlen ot provin9 he/she tlitl not builtl or Im- prom tor tne purpose of sale). ❑ I, as owner of the pro0erty, am exUusively contractlng with Ilcensetl ton- Vattol5 t0 tonsttuct the project (Section 7044, gu5ine55 antl Pro�es5ion5 COtle: S�e COnVaGIOr'S LicenSe Law tloes not apply to an owner ot prope�ty who builtls or Improves thereon, antl who contracts for such projects with a con- tractor(i llcense pursuan[ to tne Contractor's License Law). I am aware that pwot o� [heir Worker's Compensation insurance shoultl be provltletl to me. ❑ I am exemo� untler Section B. & P. C. tor this reason � �.,, �], ,.�... ..... _... ..... " `I £� TVPE OF CONSTRUCTIQtd NEW ADD ALTERATION EPAIR � ❑ CONVERSION � DEMOLISH ❑ OTHER p�,p.� DESCFIPTION OF WORK/USE OF BLDG. S Main Buildi TVPE OF PERMIT GRADING FOUNDATION STIiUCTV RAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL . A Reaf ❑ �OTHER • C Right PROJECT �ESCRIPTION 54. FT. oCCVPArv v K CONSTRUCTIONTVPE VALUATION$�� g Left 20NE � GRADING CU. VDS. ACRES ping. Ref. # Remarks: - - ' . � Planning Notes: Bar Sink Prevente( Irrigation Clarifiers Dishwasher . Drinking Fountains ' Floor Drains Floor Sinks Gas Service "Outlets <itchen Sink - Lava[ories �—Trap Roof. Drains , Reinspec[ion Fee ' $15 Boiler Duct - Under Ground Duct - SVuctural Duct - Ventilating . . Exhaust System ❑ Mul[iple � Firepl/Fact. Blt. IC80 # Date Owner H2ating System & Ducting • 1 hereby certify that I have read this application ana state that Ihe above ❑0.700,000 BTU �100,OOOBT iniormation is wrrect. I agree to comply with all city antl county ortlinancus antl state laws relatin9 [o bulltlin9 onsfructlon, antl hereby au[Itorize re0re- sentatives of is Ity to nter u on the aqove-mentionetl property for InSpectian pu� se (�. � 1 � 1_ � � Slqnature Date W •-�1 Oriver5' Licen o or'S5 � Reinspection Fee 7F 0865-46, rev. 30/84 White - Builtling; Canary - APplicant Pink - Accountlng; Goltlenrotl - AsseSsor $15 Showers Service Sink ' Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal ' Water Closet" � ' Water Heater Water Service Auto-Wesh LaundryTreys - Issue Fee Hood or TyNel ❑ Canopy Type I I ❑ Refrigeration SVstem ❑aioo,000sTu ❑ioo,000 System Repair/Alteration Fire Dampers Registers u $ 3 Issue Fee � � $ 3 Auromatic Washer Construction Pole Sub. Cooking Unit Dishwasher Oryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes , , Outlets Switches Garbage Dispoul Generemr OPS KW 05-15 4996 6/17/85 . 15,;.0 Zone AcceSsory Buildin9: Z O . N I N G R Parking Req./Provided E Q M �. T 1 S ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 700 amps Meter ❑over 100 amps Sub Panel ' � Motors�41 HP�1X�8 Inc.Solar �9-15 HP �16-15+ Microwave � Pole Light Range ! Standing Sections Trash Compactor Fee �$15 � � luue Fee DEVELOPMENTSERVICESREQUIREMENTS: 2oning Approved By Building Approved By —�— Aoolifation Issued Bv � � �� FEES $ 3 SUMMARV FFEES BUILDING PERMIT $ �� SMIP ' $ '� S—� PLAN CHECK $ PERMIT PLUMBING $ S�O D� ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ � ELECTRICAL � $ GRADING $ PLANCHECK 50% $ MICROFILM $ � MECHANICAL $ TOTAL FEE $ s�� PLAN CHECK 25% $ � , 't CONSTRUCTIO.N AND PLANNING .-. POOL a� SPA - >'APPROVAL5 Permit# _ ' Date Inspector .App'ROVALS Permit# Date Inspector, ,;�1. Temporary Electrical Service or Pole, , 52. Pool & Equipment Location 1�2. Soil Pi e-Undr rnd. � - �^-�� P 9 53. Steel Reinforcement . 3. Electrical Conduit Utility-Undrgmd. , '� - 54. Forms '" 4.'�lectrical Conduit-Undrgrnd. � . . � 55. Electrical Bonding '' .. o 5: Steel Reinforcement � � � 56. Rough Plumbing & Pressure Test „� . . 6: �Electrical UFER G nd. J 57. APPROVAL TO COVER-GUNITE ..---- � � 7.,Eootings � � ` Z - �• � 58. Electrical Conduit-Undrgrnd. � S.� Foundation ��, �,�: � 59. Gas Pipe, O Undrgrnd., Test 9 VJater Pipe-Undrgrnd.� ; . 60. Backwash Lines, P-Trap, O Undrgrnd. 10 rStructural Floor System �l� � 61. APPROVAL TO DECK ' 1 T:'�Property Sewer Line & House Connection 62. Backwash & Receptor-Final - 12. Sewer Cap �� t 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 22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil , 23. Gas Pipe-Rough & Test , . . 72, Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing � - 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe � 28. Lathing & Siding 77. FIXED SYSTEM F�NAL 29. Insuletion �' 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 ' - 41. Solar pomesticFinal � . � . 42. Backflow Preventer � _ � 43. Backflow Irrigation , . . � � 44. .Landscape Irrigation System , � 45. Sound Attenuation � - - , 46. Handicap Regulations � � 47. FINALSTRUCTURE&BUILDING � 48. Special Requirements Completed � . ' - �• 49. Electric Release to Edison ", - 50. Gas Release to Southern California Gas Co , � . � ,51. CERTIFICATEOF'OCCUPANCY • • . _._ , . � � � No. � � Date � - � . A � \ � �, � ADP��ant to lill in all spaces exeeot thoze within neavy�Goraer lines ana sign all aoarooriata aeclarations. CiTY OF coSTA MEs,a CONSTRUCTION PERMIT Project Address �7 �� i�� ST Applicant's Mailing Address �451 �w..�, i�AnnQC'Yl.T L� itA{ift/1- Owner's Name P-.��.1��-� -�7��y.��5� Phone Address �.P!� V��1 u S'� Arch/En9. _ License No. Addreu r Contractor's NamP bn� + 1 � Qi� ' Phone Su�'-Z�� Address (mailing) �4S � '� • �-n"�`��'�� f� ��-%1 CiryLicenseNo. � -0��'J'O � � � LICENSED CONTRACTOR DECLARATION � 1 hereby affirm lhaYl am licensetl unticr provisions ot Chartor 9(mmmenNng with section ]000) of Division 3 of the Business antl Pro�essions Cotle, antl my Iicense is in lu11 torce antl etfect. L�.. (� , LIC2052 CId55 � LICCOSC NO Z�`l��V I Da[e A " - �� Signature W00.KER5' COMPENSATION DECLARATION hereDy�aitirm that 1 nave a certificate o( consen � o setl-Ins ve or a ce iilcate f Warkers' Compensation InSurance, Or d Certlfi¢tl COpy.thereot q5ectlon 3800, Lab. G.) p q�2-iL�liOT.�%�l }nii�,lP 1.14�c.. Policy No.i Go pany �er[ifieG coOY i5 h¢reby fumishetl. � er[if{eOtl=apy i�'ilptl with the city Bui inq Division. i� Date ! S l0 APPIiGdnt EXEMPTION FROM WORKERS' GOMPENSATION DECLARATION (This section neetl not be mmpletetl if [he perml[ Is for one tiuntlretl (E100) or � 1es57. ' I certi(y tha[ in tM1e OertormanGe of Ih¢ work fOr which thii p¢rm�l i5I55uetl, I s0all not employ dny per5on in any manne� so as [O become subject to the Workers• ComOensation Laws of California. � Dale —� Si9nature — NOTICE: It, after making this tleclaration, you shoultl becoma subject to tha Wafkefs' COmpenSdtion provi5ion5 01 thG LdbOr Cotle, y0u mu5t forthwith comply with such p�ovisions o� tM1is pe�mit shall D¢ aeemetl revoketl. CONSTRUCTION LENOING AGENCY I hereby aHirm that there Is a constructlon lentling agency for tne perlormance- of the work for which tbis permil is issuetl (Settion ,3097 Civ. C.J, , LPnEer's Name - L� Lentler'z Adtlress '� � OWNER BUILDER DECLARATION�- I hereby affirm that I am ezemP[ from the Contractor's License Law for the tollowing reason (Sectiom 7031.5 Business antl� Pmfessional Cotle: Any city or county which r¢q Wres a pe�mit to ConStruct, alte�, Improve, tlemOlish Or re0ai� any structure, prior to its issuance,-also requlres�the applicant for sucn permit � o file a sign¢tl statement that -0e/she I5 IicenS¢tl pur5uant to the provi5ion5 of .the Contractor's�License Law (Chapt¢r 9(commencing with SectiOn 7000) of �vision 3 of the Buslness antl Profeisions CotlC) or tnal he/she i5 exempt erefrom �antl the basi5 for the alle9e� exemption. Any viOldtiOn of Section J31.5 by any applican[ for a permit subjeCtS the apPlicant to a civil ,�nalty of not more than five huntlretl tlollars (§500).. . LJ I, as owner ot the oroperty or my employees with wa9es as their sole compensation, will tlo the work, antl the sVucture is not intentletl or offeretl for sale (Section ]044, Business antl Professional Cotle: The Contractor's License Law tloes not apply lo an owner of a property who bulltls or improves thereon, antl who tloes such work hlmself/herself or tnrough his or her own ¢mployees, p�ovitletl that such Improvements are not inte0tle� o� offe�etl for sale. If, how¢ver, the bulltling cr improvement is soltl wlthin one year of com- � pl¢[ion, the owner will have the burtlen Ot p�oving he/sne ditl nOt builtl or Im- �rove for the purpose of sale). I, as own¢r of the property, am exclu5ively cantraCting witn IlcenSetl Con- , [�actors to conrt�uct tbe p�oject (Seclion 7044, BuSinesS antl Prote551ons Cotle: The COntractor'S LitenSe Ldw tloes nOt apply to an owner ot O�operty who builtls or improves tnereon, antl wno contracts for such projects with a con- tractor(5} license pursuant�to the Contractor's Licanse �aw). I am aware tM1at proof of their Worker'S Compensation insurance ihoultl b¢ provitletl to me. ❑ 1 am exemp[ untler Section B. & P. C. tor this reason � Date Ownen I hereby certify chat I nave�reatl-this aOP�ication antl state that�the�above Iniormation is correct. 1 agree to comply with all tity antl'county ortlinances antl state laws relatin to builtling onstruction, antl hereby authorize repre- senta[ives of this to enter on Na ove-mentionea pro0erty tor inspection purpoy s. � . Signature li Date u TVPE OFCONSTRUCTION LI NEW L1 ADD �i' ALTERATION Ll REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER qp # DESCFIPTIONOFWORK/USEOFBLDG:' A �� ^jPQ�Al��fLS �•-�y'��5 —N '— -'r'��1.�� - 5 MainBuilding: TVPE OF PERMIT GRADING LJ FOUNDATION LJ STRUCTURAL � T Front � ❑ TENANT ❑ ELECTRICAL '❑ PLVMBING ❑ MECHANICAL B Rear �OTHER �((ls 'S�(1�LNILI.t.�iL..S %� PROJECTDESCRIPTION Sc�.F7. OCCUPANCV C Right - K Left CONSTRUCTIONTYPE �VALUATION$� $ ZONE GRADING CU. VDS. . ACRE ping. Ref. # Remarks: . _ � ' ' , , � . , Planning Notes: , Sink Preventer' � � Irrigation Drinking Pountains Floor Drains . Floor Sinks Gas Service " Outlets Intercepmrs - Kitchen Sink Lavatories • P-Trap Roof Drains Rainspection Fee $75 BOiI¢r Duc[ - Under Ground � Duct - Structural Duct - Ventilating � Exhaust System ❑ Multiple ❑ Firepl/Fact. BIt. ICBO # Heating System & Ducting ' ❑0�100,000 BTU O 100,000 BTI orivers' Licenu 55 � I I Reinspection Fee CMF 0865-46, rev. 4/84 White - Builtling: Canary - Appliwnt; Pink - Accounting: Goltlenrotl - Assessor $15 PLUMBING Showers 'Service,Sink Sewer Cap Sewer Connection � Solai Collectore Solar Pipin9 � Solar Tank Swimming Pool w/Spa Urinal Water Clout - :Water Heater . laue Fee IANICAL Hood or Type I ❑ • Canopy Typell ❑ FEES Automatic Washer � � Construction Pole Sub. Cooking Unit Dishwasher ' ' Dryers ❑Gas ❑Electric Fan' F.A'.U. Fixmres Device Boxes Outlets Swi[ches Garhage Disposal Generator 00.5 KW �5-75 KW $ 3 FEES � Refrigeration System ' ❑0-100,000 BTU ❑�100,000 BTU System Repair/Alteratibn , !, i , laue Fee'��„ i $ 3 • 6854 6%05/86 69.00 �L 2one Accessory Building: Parking Req./Provided i IICAL Transformer � 15-50�KW � 50+KW Meter ❑up to 100 amps Meter ❑over100amps Sub Panel Motors �0.1 HP � 1 Yh - 8 Inc.Solar �9-15 HP �16-15+ Microwave - Pole Li9ht Range Standing Sections Trash Compactor Fee �$15 � � Issue Fee DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By Building Approved By � �T FEES $ 3 Z O N I N G R E O M T �. BUILDING PERMIT $ SUNyNqgV pFl`ESMIP $ ' J v � PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ E�ECTRICAL $ � GRADING � $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE $ � PLAN CHECK 25% $ � CONSTRUCTION AND PLANNING � APPROVALS Permit# L�Temporary Electrical Service or Pole � 2. Soil Pipe;Undrgrnd.�� . 3.. Electrical Conduit Utility-Undrgrnd. R.� Electrical'Conduit-Undrgrnd. . 5. Steel Reinforcement :� � i �6. Electrical UFER Grnd., _ � 7. Footings` ' ' � -$. Foundation � . ,! 9. Water Pipe-Undrgrnd. � ; I.' 10. Structural Floor System � 11. PropertY Sewer Line & House Connection .� 72. Sewer Cap . �� 73. Roof Drains � . y� � - 14. Rough Plumbing � " � 15. Rough Electrical-Conduit � � � I16. Rough Electric Wiring , �� ... 17. Rough Wiring Sign � 18. Rough Electrical-T Bar Ceiling , � 19!�Rough Heating�& Air Conditioning 20. Rough Factory Fireplace . ! 21. Ducts, in Structure � 22. Ducts, Ventilating . ,.% / 23. Gas Pipe-Rough & Tesi � � 24. Roof Framing L 25.�Roof Sheething . 26. T-Bar Ceiling (Structural) & Monocoat 27, Frameand Flashing � 28, Lathing & Siding 29. Insulation � � 30. Drywall Nailing � 31, Plaster Brown Coat , - 32. Electrical Power Meter-Final 33. Final Electric � 34. Finaf Heating & Air Conditioning � 35. Final Gas Pipe-Test ' 36. Hood or Canopy � 37. Final Factory Fireplace ' 38. Final Plumbing � � � 39. Water Service-Final ' 40. Gas Service-Final � 41, Solar pomestic-Final , ' 42. Backflow Preventer � i p43.�Backflow Irrigation ��44��Landscape Irrigation SYstem ' ,�, 45 �Sound Attenuation I�j46.� andicap Regulations . �47iiFINALSTRUCTURE & BUILDiNG , 48. Special Requirements Completed i 4g. Electrie Release to Edison . �50.0 as Release to Southern California Gas Co r Date / ' i•. 0 51.�EERTIFICATE OF OCCUPANCY I , o._ Date � POC SPA Inspector qppROVALS Permit # 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms , ' _ 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVAL 70 COVER�GUNITE 58. Electrical Conduit-Undrgrnd. � 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, � Undrgrnd. 61. �APPROVAL' TO DECK. 62. Backwash & Receptor-Final - 63. Heater & Vent-Final 64. Plumbing System - Final 65. Electrical-Final � , 66. Solar System-Final 67. Fencing & Access Approval - � 68. APPROVED FOR PLASTER�NG 69. POOL/SPASYSTEMSFINAL � FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hydro 71. Product Piping O Gas ❑ Oil 72. Underground Flush 73.� Undergrnd. Storage Tank 0 Gas' O Oil 74. Overhead Hydro � 75. Dry Chemical . 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL ,HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION � 80. FOOD CERTIFICATE ISSUED Notes: 0 Date Inspector . r : / � '1 ,� � �� ; Aop�ieant to till in all soaees exceo< those witnin�heavr boraer Ilms antl s(gn ali apvropriate tleclantions. CITV OF COSTA MESA CONSTRUCTION PERMIT . Project Address •� ApplicanYs Mailing Address 0 n � 1� Owner's Name '/�/�R�H.(1��.f�()�Fr� Phone (��(-,.�// � Address � yr% W/� %'� sT (� z%A'� iN '�" i��a % � �Arch/Eng. C:/TY :�� s LicenseNo. Address � ' � Contractor'sName�Q%G1/L{��rS,, �Qr�iNN O PhoneT�4��yQ3 Address (mailing) o %�/ �-�T'� =�r1 N�/ ��fT' ��t: City License No. �3 %� 33 �LICENSED CONTRACTOR DECLARATION I hereby af(irm lhat I am IicenseG undar provisions ot Charter 9(commencing with section 7000) of Division 3 ot the Business antl Professions Cotle, antl 1 my license is in full forc antl eifect. ��.�v ` License Class� �ICenS o. �y� v�� ate � Si9nature _ . � )RK RS'C MPENSATION DECLARATION �.ereby affir}em that I have a cerUllcata ot tonsent to selhinsure or a certlfica[e of Workerz' Compensation �Msurance, or a terti(i�¢7tl ,c(o,,pY ereof (SecHon 3800. Lab. �%% �J /I �l "X. �J � �P licy No. Et� Company � � Certifietl copy is hereby furnishetl. � ' ' Certif'$tl opy Is filetl with the city B iltling Divjslan Date-''-./��.�f� APPlitant a��T'-�.+� � = ;�/�/ EXEMPTIbN OM WORKERS' COMPENSATION DECLARATION �� (Thi55ection neetl not be mmpletetl If �hg permit is for one huntlretl (E300) or ., Icss). ' ' I certity that in tne periormance oi tho work for which this perm�t is issuetl, I sha11 mt employ any person In•.any manner so as [o become subject to the � workers' Compensatlon Laws o(:Calitomia. , . Date 519nature 'NOTICE: If, atter making thi5 tleclaratlon, you shoultl become subject to the � Workers' Compensation provislons o/ tne Labor Cotle, You �*,ust tormwitn- - comply'with such proWsions o� lhi5 p¢rml[ ihall bC tleemetl revoketl. CONSTRUCTION LENDING AGENCV � ' � I hereby aHirm that theie is a construction lentling agency fot the periormance of [he work for which thiz permit is issuetl (Section 309] Civ. CJ Lentler's Name . LQOdCYS Addf255 OWNER BUIL�EH �ECLARATION - � ' I hereby affirm that I am exompt fiom the Contractor's License Law tor the following reason (SecHon ]031.5 Business antl Professional Cotle: Any city or county which requires a permlc to construct, alter, improve, tlemolish or repair any sVucture, priOr to Its isSudnce, also �equires ltte applicant for suclt permit b tile a signetl slatement that he/Sh¢ IS licenzetl pur5uant to tne provi5ions ot � ie Contractor's License Law (Chapler 9(commencing witn Section 7000) of � Iivision 3 ot tn¢ BuSinesS antl PrOt¢i5ion5 COtl¢) O� that he/shG is exempt therefrom antl.lhG basis (or thC allegetl exeenptlon. Any violation of $ection 7031.5 by any applicant fo� a permit subjects the applicanl to a civil '�enalty of not more than five nuntlretl tlollars ($500�. - , LJ I, as owner of the properly or my empioyeez with wages az their sole compensa[ion, will tlo the work, antl the s(ructure is not in[entletl or offeretl fo/ sale ($ection 7044, Bu5ine55 antl 7roteszional Cotle: The Contractor'S Li<ense Law tloes not apply to an ownar ot a proparty who builCs or improves thereon�, ana who aoes such�work himself/herself or throu9h his or. her own employees, provitletl tha[ sucb improvements are not in(entletl or offeretl for sdle. It, however, the bulltling or Improvement is soltl within one year oi com- pletion, the owner will hav2 tbe burtlen of pwving ne/she tliG not builtl o� im- prove for tne purpose of sale). � � ❑ I, as owner Of the property, am e%clusively coniractinq with IicenSetl mn- t�acfors,to construc[ Ihe project ($ecUon 7044, BuSinesS antl ProfessiOns Code: The ConVactor's License Law does not appty to an owner of�O�operty who • builtls or improves the�eon, an0 who cont�acti for such project5 wltn a con- w S tractor(s} licen5e pursuant�[o Ihe�ConVactor'S license Law). I am aware Ihat proof oi their Worker's Compensatlon insurance shoultl be provitletl to me. � �] I am exempt unaer Section B. 8 P. C. fm this reason Date Owner ' I hereby certify that 1 have reatl this appliwtion antl state that the'above inbrmation is correcL 1 agree to comply with all dty antl county ortlinances antl state laws relatin9'to builtling consiruction, antl hereby authorize repre- 5¢ntatives ot this ciry t0 ente� upon th¢ abovG-mentionetl property (o� insoection purpo,�es. ' �. ' Si9nature %/ ./ � Da[e ....e.. .� ..e.,.a ,,. « � _ TVPE OF CONSTRUCTION �I`-V NEW LJ ADD LJ ALTERATION Ll REPAIR ❑ CONVERSION ❑ DEMOLISH � OTHER q•p• # �1 � DESCRIPTION OF WORK/USE OF BLDG. d' - � S MleiwBvild'e TVPE OF PERMIT � GRA�ING FOUNDATION . STRUCTURAL T F.[put. _❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL g ��, � � �OTHER� �� C/Ufi'/Li � � �I-[l�� A lY � � PROJECT DESCRIPTION 5(,. FT. � OCCUPANCv�— K CONSTRUCTIONTVPE VAWATION$ �OC%'�� $ �� ZONE GRADING CU. VDS. ACRES p��y, Ref. # 0.emarks: �. a� L�/f Planning Notes: Sink Preventer I rrigation Drinking Fountains Floor Drains Floor Sinks' Gas Service Interceptors Kitchen Sink ' Lavamries P-Trap Roof Drai Outlets $hOwQfS Service Sink Sewer Cap Sewer Connectic Solar Collectors Solar Piping , Swim ng Pool w/Spa inal � � Water Closet Water Heater ' � - Water Service - . Auto-Wash - � Laundry Treys �Fee � � ' $15 Boiler ' Duct- UnderGround Duct - Structural Duct-Ventilating �� Exhaust System ❑ Multiple Firepl/Fact BIL ICBO # Heating System &g cting ❑ o-� oo,000 eyd O i oo,oao Reinspection Fee I S15 GMF 0865-46, rev. 10/84 Wbite - Builtling: Canary - Appliwni; Pink - Accounting; Goltlenrotl - Assessor luue Fee Hoodor Typel ❑ Canopy Typeli0 9efriger � n System i � OO,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Fiegisters • Issue Fee FEES $ 3 FEES $ 3 I Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher - Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures • ' ' Garbage Dispoul Generator 00. CW �5-15 KI w/ � fleinspection Fee $15 DEVELOPMENTSERVICE EQ� ZoninB APP�o�ed By Building'Approvad By� APpliWti00 ISSuBd BV � ' 0063 2/27/86 " 51a5� TL Zone � G/ 'y Building: . Z O � N I N G R Req./Provided � � E� Q M ' T S ELECTRICAL Transformer ❑ 15-50 KW ❑ SO+KW Meter ❑up ro 100'amps Mecer ❑over 100 amps Sub Panel Motors00- P�1'h-8 Inc.So 9-15 NP �16�15+ Pole Light Range • Sign ; Standing Sections Trash Compactor luue Fee FEES $ SUMry�MA V OF FEES � ,� .BUILDING PERMIT $ �� $MIP. $ � �PLANCHECK $ �PERMIT ' ,PLUMBING � $ �SSUANCE $ PLAN CHECK 25% $ ' ENERGV.P.C. $ ELECTRICAL � ' $ ' GRADING $ , PLANCHECK 50% $ MICROFILM $ /J�� MECHANICAL $ TOTAL FEE $ ��Z PLAN CHECK 25% $ . �-_. . -. . . � . ,--. CONSTRUCTION AND PLANNING P� & 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 . � 8` / 56. Rough Plumbing & Pressure Test , 6� Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE , 7. Footings-�-`�%P s1.. �7 `'�'G 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 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 FINA� 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace , APPROVALS Permit #� 21. Ducts, in Structure 70. Underground Hydro � 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush ' 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing - 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing � 76. Dry Standpipe 28. Lathing & Siding - 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL � 30. Drywall Nailing , HEALTH DEPT. REQUIREMENT 37. Plaster Brown Coat ' ' 79. 'FINAL INSPECTION - 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final EleGtric " Notes: 34. Final Heating & Air Conditioning 3_� gG d /N � i-tL 35. Final Gas Pipe-Test 36. Hood or Canopy � ' � 37. Final Factory Fireplace 38. Final Plumbing . 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final. � ' i � 42. Backflow Preventer� � � 43. Backflow Irrigation ' 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING �)�� 48. Special Raquirements Completed � - 49. Electric Release to Edison -- � � 50. Gas Release to Southern California Gas Co � � 51. CERTIFICATE OF OCCUPANCY � . . , I No. Date AOP�icant to fill in all soaces except those within neavy Cortler lines ana sign all avoroDriate tleclaralions. CI7Y oF COSTA MESA CONSTRUCTION PERMIT ProjectAddress �%� �• ��%iii ��f�L Applicant'sMailingAddreu ��'Z ��.ItiwZ �2. � 7AIZ1xU � n/E Owner's Name ��,.l�¢D ��Y� � Phone � 5b-a32'7 Address ��a w. �� UN(T Z Arch/Eng. License No. Address Contractor'sNamrl�2A�11'� �'�U��t�( r�t� hone��y-7061 Addresslmailing) ��.S4yo "r'lVAL-��1aZ 'DR•�C�kPL'G�.I.F.�lT City LicenseNo. � (�p � LICENSED CONTRACTOR DECLARAYION 1 hereby aHi�m that I am licensetl unde� p�ovlslon5 of Charte� 9(comm¢ncing with sectlon 7000) of Division 3 of the Business and Pr01e55ions Cotle, and my Iicense is in full force antl eftect. License Ciass LrM IT,Ev S��uM��icense NJ�'i:i(d4 C'�e� oate ��+`�� Si9�ature 2� �- 4N<=2tJ WORKERS' COMPENSATION DECIARATI� � hereby atfirm tnat 1 have a certiticate o� consent to snit-Insure or a certificate :�;orker5' Compensation InSurance, e� a certltietl cOpy Ihereof (SeciiOn c0; Lab. C.��q�( ✓ Policy No. I Company yniE ��9 eCertilietl copy is hereoy furnishetl. Certifietl copy �is .failetl with the city Builtling Division. Date �_��—tcza— AOPlicant %�Ql� > /� / EXEMPTION FROM WORKERS' COMPENSAT�N DECLARATION (This section neetl not be completetl if [1le parmlt is (or one huntlretl ($300) or Iess). I cerUty that In Ihe perlormance ot the �yo�k �o� whiCh (his perm�t is Issuetl, I shall no[ employ any pe�son in any manner so as to become subject to the Workets' Compensatlon LawS of Cali(omia. Dale Signatuie NOTICE: If, aiter making this tleclaration, you snoultl become subject to the Workers' Comp¢nsation provisions ot the t2bo� Cotla, you must for[hwi[h comply with such provisions or this pe�mit shall be tleemetl revoked. CONSTRUCTION LENDING AGENCy I M1e�eby afflrm IM1at ther¢ iz a const�uctipn lentlin9 agency (or the performance of the work for whicM1 this permit is Issuetl (Section 3097 Civ. CJ Lentler's Name Lentler's Atlaress OWNER BUILDEN DECLARATION I hereby afflrm thal I am exempt from the ConlydGtO/'s LlcenSe Law lor the following reason (Section 7031.5 Business antl Professlonal Cotle: Any city or county w�Icn requi�es a permit to conSFruc[, alte�, improve, demolish o� �epair any siructure, prlor to its issuance, aiso requlres the applicant for sucn permit t0 (Ile a Si9ned SWlCment tha[ he/zhe ig Iicensed pu�suan[ [o Ihe provisions of - the Con[ractor'S License Law (ChaDter 9(commencin9 with Sec[lon 7000) of DivlSion 3 of [he Business ana ProtelbiOnS Cotle) or Ihat be/ihe i3 exempt •e/rom antl the basiz for the allegeq exemption. Any violation of Section 1.5 by any applicant for a Perrt�it subjects the applicant to a civil ' .alty ot not more than five huntlretl qollars (E500j. U I, a5 owner o1 the O�op¢rty o� my emPloyee5 with wage5 as their Sole comp¢nsa[io0 will tlo th¢ wo�k, antl t4e St�uCturo Is not int¢ntletl o� offeretl for sale (SecFion 7044, Bu5ine55 antl PrOfessional Cotle: The Contractor'S License Law does not appiy to an owner of a property who builas or improves thereon, antl who tloes such work himseli/herself or through hls or her own employees, provitletl tnat such improvements are not intentled or offereC tor Salo. If, nowevev, the bulltling or impro�ement is soltl wlthin one yea� of rom- pletion, lhe owner will nave the bu�tle� Of Proving he/She tlltl not builtl o� Im- prova to� t�e purpose ot Sale). ❑ 1, ds owner of the D�oPerty, am exClusivety conttactlng with Ilc¢n5etl con- Iractors lo conzVuct the project (Section ]044, Buslness antl Prote55ions Cotle: The Con[ractor's License Law tloes npt apply ro an owner of pro0erty who builtls or improves tnereon, antl who conVacts for such projects with a mn- �Itractor(sl �icenSe pursuan[ [o the �ContractOr'S license Law). I am awa�e that proof of their Wotker's Compen5ation insu�ance ShOu10 De provltletl.to me. ❑ 1 am ¢xtm0� untler Section 8. & P. C. t0/ lhls reason Date Owner _ I herebvi cer[IH tha[ I bave reatl [his Signature ��'/Q.GbL Drivers' License or 55 � [hat tne above F 3 2 � 2 I -:�. - �.w.� Z TYPE OF CONSTRUCTION_: _,; "� NEW ADD ALTERATION REPA1 R ❑ CONVERSION ❑ DEMOLISFI ❑ OTHER q,p, �h DE RIPTION OF WORK/USE:OF BLDG. S Main Buildi E TYPE OF PERMI GRADI OUNDATION STRUCTURAL T Front ❑^ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Redr U OTHER ' r1 � �' PROJECT DESCRIPTION Sc]. FT. oCCUPANCv C Right CONSTRUCTIONTYPE � VALUATION$ �Q��e^� $ Left ZONE ' GRA�ING CU.YDS. ACRE$ Ping. Ref. # Remarks: �l_ o y_� � 1� Qfi PlanningNotes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Kitchen Sink Lavatories P—Trep Roof Drains Reinspaction Fee $15 Duct- Under Ground Duct - Sbuctural Duct � Ventilating Exhaust System ❑ Multiple Firepl/Fact.8lt. ICBO # Heating System & Ducting ❑a100,000 BTU 0100,000 Reinspection Fee � $15 Showers Service Sink Sewer Cap Sewer Connection Solar Collecrors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Hearer Water Service� Auto�Wash laue Fae Hoodor Typel � Canopy Typell ❑ Refrigeretion Syslem �aioo,000eru ❑ioo,000 System Repair/Atteration Fire Dampers Registers � Pink - Acmunting; Goltlenrotl - Azsessor ' laue Fee fEES 47.89 2/OB/88 ' Zone Parking ELEC7RICAL Automatic Washer - Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over100amps Dry¢rs ❑Gas ❑Elec[ric Sub Panel Fan Motors�0-1 HP�1X-8 F,q,U. Inc.Solar Og-15 HP �16-15+ F ix W res Microwave Device Baxes Pole Light Outlets Switches Garba9e Disposal Generatar 00.5 KW 05-75 KW 2 O N I N G R E Q M T S Standing Sections Trash Compacror $ 3 Reinspection Fee $15 luue Fee FEES DEVELOPMENT SERVICES RE�UIREMENTS: Zoning Approved By _ �� Building Approved By ApplicatiOn IssuBd BV $ 3 SUMMARV OF FEES BUILDING PERMIT S �S'� SMIP PLAN CHECK $ PERMIT PLUMBING S ISSUANCE PtAN CHECK 25% S ENERGV P.C. ELECTRICAL S � GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTALFEE PLAN CHECK 25% $ � FEES $ 3 5 ' -� T� CONSTFUCTION AND PLANNING . . POOL & SPA APPROVALS �Permit# Date Inspector pppROVALS Permit# Date Inspector i. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcemen[ 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-Und�rgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final� � 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & AccesS Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ' I 18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL '' �'' 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' � �'' � 20. Rough Factory Fireplace APPROVALS Permit # `' � l �' 21. Ducts, in Structure 70. Underground Hydro . 22. Ducts, Ventilating 77. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush �',� 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil ��"• 25. Roof Sheathing 74. Overhead Hydro � ' � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � -� � r 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. REnUIREMENT '� 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. WaterService-Final - ..' ' � •� � �� . 40. Gas Service-Final �� .. � . � ' 41: Solar pomesticFinal �• � � � � � 42. Backflow Prevenier � - -�� . '43.,Backflowlrrigation - " ' • . �r 44. Landscape Irrigation System � ' . � � � 45. Sound Attenuation ' `: � � � . rr 46: Handicap Regulations ._ ., . + � 47.� FINAL STRUCTURE & BUILDING �� _ �• 48. Special Requirements Completed ' • . 49: Electric Release to Edison � � 50. Gas Release to Southern California Gas Co 57. CERTIFICATE OF OCCUPANCY +� No. Date � � �— � ADP��ant to fill in all spaces�except tnosa wlthin �eavy Dortle� linei antl si9n all appro0��ate Geclarations. CirY oF COSTA M�SA CONSTR CTION PERMIT �ect�Address �O'ID W - (�� G�. - '`�plicant's Mailin9 Addrpyt Owner's Name �U e. r�a- � cn��,.S3G�/S'.�9 Addreu ��0 !�� C—� C-�• Arch/Eng. Licenu No. ' Addrea �-./� Convactor's Nama � �� Phone�y�'q,.t�!��`��y� Addrenlmailingl �� S. ��w� ��""'� City License No. 3�O-� �-' IICENSED CONTRACTOR OECLARATION I�hereby atflrm [hat I am licensetl untler provisions of Cbarter 9,(commenUng with section ]000) ot -Divislon 3 of tne Business antl Professions Code, antl my II<ense is in t n force antl eHect. � 3yy�Va Licenspe Cla�ss � ce No. Date1�� 99naturG , W00.KER5' COM7ENSATION DECLARATION ! hereby aitirin Inat 1 have a certi(icate'of consent to selbinsure or a tertifl<ate � •`"�''��. Workers' Compensatlon Insurance; or a certifietl copy t�ereof (SeCtion �``° �'y`ao. �c. �16 - 86 Gh�i H51 S'fAiL �t/1't� 1 �Policy No. y Comoany ertifietl copy is nereby /urnishetl. Certi i o Is tiletl wilh the tlty 8' ' � � Oa[ Applican� � EX MPTION FqOM WORKERS' C NSATI ECLARATION (This seclion neetl not b¢ completetl it the p¢rmit i5 for One huntlretl (E100) or less). I certiry lhat in the performance ot tne work for,which Ihls perm�t Is issuetl 1 sball nof employ any person in any manner so as to become subje<t to t�e Workers' Companzation Lawi of CdlifOrnia. ' Dace Slgnature 'NOTICE: Il,after making this tleclaratlon, you shoultl bewme sublec[ to-the Workers' Compensation provizions of tne Labor Cotle, you must forthwlth tomply wilh such p/ovislons o� thi5 p¢rmlt zhall be tleemetl �evOketl. CONSTRUCTION LENDING'AGENCV ' ^ • 1 hereby affltm that thCie I5 a con5tructiOn lentling agency tor the p¢Ao�mance ot \the work 1or which lhi5 Permit is issuetl (Section' 3097 Clv. C.) � Lentl2Ys�-MEmc ' lentleYs AaEress - ' OWNE0. BUILDER bECLARATIOfJ � ' I hereby affirm [hat 1 am oxempt from the Contractor4 Cicense�Law for the � foilowing rcason (SecNon 7031.5 Business antl Professional Cotle: Any ci[y or . county which requires a permit to construct, alter, improve, tlemolish or repalr .�r., .�.��eu.a nnnr tn�its issuance. also reauires tho aoa�icant for such permit pvision 3 ot tne Bus�ness ana rroressions i.oae� or mai nn�ane � nv �v� ,',F.��:�refrom an0 tbe basiz for. the allegetl exemption. Any violation of Section �?-A1.5 by any ap01i<ant for a permib subjects'the applicanl to�a civil y;':lalty o( not more Ihan five huntlretl tlollars ($500�. � L� I, as owner ot tne pro0erty or my employees with wages as their sole mmpensatlon, will tlo thc work, antl tbe sVucture is no[ inten0ed or olleretl for sale ($ettion 7044, Busine55 anG PrOfessional COtle: The ContraGtO/'S License law Ooes not aoPty to an owner of a property wno builas or improves thereon, antl who tloes sucn work.himself/herself or tbroug� his or� har own employees, Orovitletl that such imOrovements are not intentletl or offereU for sale. If, howev¢r, [he builtlin9 or improvement is soltl within one year ol com- pleliOn, the Owne� will hdve the bu�tlen ot pwving heJshe tlitl not bulltl or Im- prove tor the purposa ot sale). � ❑ I, as owner oi She property, am exclusively contracting with Ilcensetl con- tracto/sto const�Uct lhe project ISection ]094, Business antl ProfeS51an5 Cotle: Th¢ Contracror's License .law does nol appty to an owner. oLproperty who builtls or improves thereon, antl who rontracts tor sucn projects with a con- tractor(sl licenso pursuant�to the�ConVactor's License Law). I am aware tnat o�oor of their Worker's Compensalion insurance shoultl be provlEetl to me. ❑ I'am exempt untler Se<tion , B. & P. C. for thls reason Datc ' Owne� I hereby certity thaY I have reatl this application antl state tha[ the above information is correct. 1 a9ree to comply with all city antl county ortlinances antl state laws relatin to b iltli onSVuction, antl hereby authorize repre- 'entatives of t}l� c lo e � en the above-mentionetl prop� ertY tor ryepeCpfQtth@rlym2s, �j �i D�_ Si9 t�kL91=-,�d � � � CMF 0865-46, rev. 30/80 White - Builtlin9: Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor $15 ShOWCfi Service Sink Sewer Cap Sewer Connection Salar Pipin9 Swimming Pool w/Spa Urinal • WdtCf C1052L ' Water Heafer � ' ' Water Service �. � � Auto�Wash � .� , . � Issue Fea Hood or Typel' ❑ Canopy Typell ❑ Refrigeration System . ❑aioo,000eru ❑ioo,000eru System Repair/Altera[ion Fire Dampers � � Registers Issue Fee $ 3 Auromatic Washer Construction Pole Sub. Cooking Unit � Dishwasher - � - Dryers ❑Ga5 ��Electr Fan `� F.A,U. Fixtures Device Boxes � 4��a 4��5�� : /^. �,^ � Accessory 8uilding: ELECTRICAL Switches Garbage Disposal Generator �0.5 KW �5-15 KW Reinspection fee � S75 F E ES �� DEVELOPMENTSERVICESREQI ZoninB APProved By Building Approved 8y $ 3 Zone ransformer ❑ 15-50 KW � 50+ KW leier ❑up to 100 amps lerer ❑over 100 amps - Suh Panel Motors �0.1 HP � 1 h- 8 Inc. Solar �9-15 HP 076-15+ Microwave � Pole Li9ht � Range Standing�Sections Trash Compactor Issue Fee FEES S 3 2 O N I N G R E Q M T S SUMMARY OF FEES BUILDING PERMIT � $ � SMIP � $ - PLAN CHECK $ � PERMIT PlUM61NG - - $ ,�(� ISSUANCE . $ � ' PLAN CHECK 25%� $ ENERGV P.C. $ ELECTRICAL $ � GRADING $ � � PLANCHECK 50% $ MICROFILM S - � ,�� MECHANICAL $ TOTALFEE $ _SLL� PLAN CHECK �Z5%� $ , - APPROVALS Permit# 1• Temporary Electrical Service or Pole 2. Soil Pipe-Undrgrnd. 3. Electrical Conduit�Utility-Undrgrnd. 4. Electrical.Conduit-Undrgrnd. 5. Steel Rei�nforcement , 6. Electrical UFER��Grnd. ' 7. .Footings � � 8. Foundation � .. 9: Water Pipe-Undrgrnd.• '�� . tO.�Structural Floor System 11. Property Sewer Line & House Connection 12. Sewer Cap , . 13. Roof Drains � 74. RougFi Plumbing''' • � 15. Rough Electrical-Conduit 16. Rough Electric Wiring �17. Rough Wiring Sign 18. Rough Electrical-T Bar Ceiling 19. Rough Heating & Air Conditioning 20. Rough Factory Fireplace 21.� Ducts, in Structure 22. Ducts, Ventilating � 23. Gas Pipe-Rough & Test 24. Roof Framing 25. Roof Sheathing 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing 28. Lathing & Siding 29. Insulation 30. Drywall Nailing 37. 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 Faaory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation � 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed 49. �Electric Release to Edison �50. Gas Release to Southern California Gas Co ... CERTIFICATE OF OCCUPANCY , Date Date Inspector qppROVALS v Permit # 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical Bonding � 56. Rough Plumbing & Pressure Test 57. APPROVALTOCOVER-GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, � Undrgrnd., Test 60. Backwash Lines, P-Trap, O Undrgrnd. 61. APPROVAL TO DECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System - Final 65. Electrical-Final 66. Solar SYstem-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hydro 71. ProductPipingOGas ❑Oil 72. Underground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: Date� �Inspeitor r n .NDRFSSOFBUM1qW: [j7U W 17TH S'C OYMER9WYEIFRlOYM: pACIFIC MESA PROPERTIES �%% 670 W 17TH STC-4 COSTA MESA :A 92627 �vv�. Wuw�o �oo�s: i�wcxrtEttax�+ax¢n: 1XCX.OR EN�.'4 AOOIIEA: r� ' r-� (714)645-6811 uc rioa cor�m�croas xaa: CONfii/�CTOR4 YNlR10 �5y IlC NO_ ur�r: G 8 urrt: UM: IJCQlSED COMHRCTOq9 DECIAR�TION: I Artly ellim uider pnYy d pxjuy thm I em Iwiuetl wMr pwiMwu d Cheqs 9 (mmmacn0 Nh Sciim 1000) d Di+bun � M tlr ��ed Pmlaum� CaM. cd mY 4m�r u in tu0 bru vd allaa. cm uc. no.: uc. cuss: uc. No.: ov.: cam.aa: OWNEN BUILUEP DECIANATION: I lwsby elfum undx W�dY d psjry �hel I em uanq hwn �M WmMm licem� lew la tlw tWbx*q roafan (Setlian ]W 15 Bu�ir� end RAab�v CoM: MV M' a mvqY �1� npimm e Oe�! lo mMW. eGs.'vnVwe. Gamofeh. a rapei mry abucUna: q'w b b eweroe. No �eVwa� �M eppirmn la weh pemN lo fils a apneE qaienieN tlet he a ehe o i�.ee w� �o me nw�,. a a. cor.�. uo.�.e i... Icnw. e tm�.�«m,a .nn s.a� moo> a a.e� a a ib Buainew W FrMew'ue COEeI a �IW Ir a dr e mamp �Aera6om end IM bsu la iM Wped aiemqion. My videtion d Swion )W t.5 b� e�ry epplre�tl 1« e panN n6pC� O+eppfre�s lo a dvi yauCy d nd man then R.�a hnNed EWu� �SSOOp. ❑ t�o�.amewwanr«mv«�v�a��•,•n.�.o.+..m.:.d.�o�.�.aaom.w�..�wm..m�.sM.��.wee a oRared br seb (Smbn lou. Bw'vm eM Pnlaaabna f:ade: TMCaamfon Liom�e law dom roi eVWYto en owner d pwMY W�YJ b11�0IX �11pWM I�l0IW11. Yld'MD dOOo �11f31 Md{'. �IYIIMOIX �WOO� IX I�1fPI�1 �1G Of h!f OW11 M11�0)M. D��' d ��1d t11Ch imGA+emams ra nd'utleMM o aRsed la ub. tl. Mwever. Na dnUmO a inP��am u md rrilhm aroY� W mm0�ion. Me y oxmer-0inlder wi0 hm �M WMm d pwinp M a pw GE nd bidd a"vnpvn la IM prpo�e d robl. L'] t., o.n.. a m. o�w«n..m•�dMN mumro wn b.wn.d wweaa. m aimun m. woia (seaon rou. ewm...nd Pmlmriuu COEa: TM Cauream Lianr lew Jw nol WON b a� a s d papMY wM Wild� a iry'ww tMnw� xtl Wn coweNa I« wM p9a» wM e mueev(q 4aued Wnuem to Ne mreaw� lioema law � I em ue iq Mr Sac�ion: B. 8 P.C.. b tlu n � Dem: Owiwr. �� eo n�w o fM Nel I mn �w�r� d rd �vkw�IW iM npmmw d CtlircNe Nrlh coe. swo�. usos. nw..oe �acc ...� rn.� �.,..m, e�e�.. i..v:n ommw W/ rA ia lucle orl irM m oumN ' uid tlm� ooAr uM tM naulnm�nb be �bn w axemp Imm 1Mu Deb: �Vq�: WOHNEN'S COMVEN9�TON OEC4N�TION: I MrWy df uMar pruAy d prjury ar d iM Idbwiiq detivmion�: ❑ �n.r..�e,.umeua.n.ea,arst.am..u�o..o;mw.a.�ak.+•emp+e�w�...w�r«ha.dbna]ooa�n.l.ec. coa. i« ine oM�• d me .� ia.�n w. c.�+ e m�.e. ❑ � nw..�e we m.im.n..o�w+• am�w�on inwruae. n�.a�hea M s.abn a�ao a mme �em. cod.. ror ms o�«menm d m. work la wt�idi ihi� 0�� b u�ueE. My wnken' mmV�xtbn "vuuruic� wris eM VdkY number ms: c.�..: vw�y ra,mn.c �(1h( .x�ion msd na w ewnderoe � trw a�� u kr aa hWMrad adWs R�ool a l�a.) [� 1 cMN � In tM palamenca d IM wak far whfch thb prmi u"rmu�E. I 1 I nd amplay ury prwn In ury men�wr �o m io Exana wbjeq �o tM xwFxJ wnqaeuubn lew a Celdamie. uM . ihm J I Nwul man. w4ea m �M waMen' compemeibn �wde'au d Sedian �)00 d IM lebor COM. I YWI IOM � oomp�y wiN tho N�ions. � o�e: roa� w.m��a:c.u�ro..o .on�...•�o�ro�no�eo+.�.ar•M t.,wn.n.�n �n�+Pl%vrocMMnIYM�Itl�s�nE nnr nn.. w b«�. nuw�.e rno�nm aaan (f� W oaoA m.w�don ro m• co.� or iwn a�.�.. ., ao.�w.e ro. m S�cHon J105 0l tln LMor cotl�, /mw�u4 uM �rtaimy'� fw. CONSTIIUC110N LENDINO AOENCY: I ta�by effvm uMr pauW M pM�Y �M1d �M1w+ b e miC�fbn M�diiq epsicy lor Ns perlormarae d IM xqk In wliirli ihe pami h ewMC (�� . CM. CI. lENOEP'9 NW E: LENOEfl'9 �DORE99: I cenM �� I heva ned Nu eppGcetian ud mte �I� the aEws udanxtion e ronw.l epn� to canply xi�h M ayend mu�ny admerce� eM etete lexe nleliq b Witivp mmvutlion W hxebY a�¢a npewniairvw d tAia erym mlr upan IM eErn.meMiw�eE pmparry lor inspedion Wrpwee. SUSA�I WHITE D P�/MifiC/`�— Dtle: `�� o� gqnpuie y er/ApeealMD anUCorcerfa �5151d6.WP) WAue-BwYiqBSeMY�4Rm�-Fb:GnW-AVP�a:Pink�wnm:OOldmvoE-M�em CITY OF COSTA MESA - SIGN PERMII' PERMTT NO: SB 081633 PLAN CHECK NO: 00614-97 S CONSTRUCTION TYPE: PERMIT TYPE: STR SIG JOB DESCRIPTION : NEW NON-ILLUM WALL SIGN PERM NO: SB OII163 GOVT: N SUPP: N SQ FT: PURPOSE; OTH CLAIM VALUE: 300.00 CALC-VALUE: 300,00 CROUP OCC: B / COMMENTS: THE "CATALINA FISH KITCHEN AND SEAFOOD DELI"/ PAINTED WALL SIGN iF iE IF-If iE if 1E �F 1E'lF'IE IE IE �E 7E IE 1E �E iE 1E If 1t 1f 1F i416 fk iF if 1E If fF It iE 1! 1F iF if 1F fE fE if ik fF iE 1k 1t Ik 1F 1E IE 1E IE 1E IE IE if iE 1k 1! fhlF 3E IE 1E 9E 1E'1E it * IF iF iF iE iE iF If # 1E S I G N I N F O R M A T I O N DISTRICT: 1 TYPE: WALL ILLUMINATION: NON CATEGORY: NEW DIMENSIGNS: :iFT UUIN X SFT UUIN AREA: iS.00SOFT LETTER HT: 12 STREET FRONTAGE 1: 282,00 STREET 1; W 17TH ST STREET FRONTAGE 2: 0.00 STREET 2: PARCEL: 42428123 ZONE: MG LOCATION > FRONT: X REAR: BUSINESS NAME: CATALINA FISA KITCHEN > LEFT: RIGHT: O T H E R T O T A L S G R O U N D S I G N THIS ACTIVITY . 15.00SQFT OVERALL HEIGAT: OFT OIN TFIZS SITE . 1.00SQFT GROUND CLEARANCE: OFT OIN ITEMS OF INFO 1 PLANTER AREA: O.00SQFT ITEMS FOR ACTIVITY: 1 BLDG SET BACK: 71FT COPY VERHIAGE : CATALINA FZSH KITCHEN AND SEAFOOD DELI PLANNING NOTES: iE iE if iE jf if if iF iF �E 9E iE iE fE if iE iE iE iE iE ik iF iE iE if �F ik if 1E iF iF iF iF if ik it ik iF iE dE iF it it If iE it it iE iE iE iE IF IE if k iF iE iE if 1E if iE iF iE iE iF iF iE fE iE iF iF iE iE iF iE it iE IE 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 ZONZNG APPROVED BY : �,��CtJB DATE: �-��Y�7v BUILDING APPROVED BY : �) '�/� DATE: .� %� APPLICATION ISSUED BY: /'S[��L � ftitftiEiEi6x�itx�iEiE�-iEi[-itft�tit�+EiEiE�t3F3Fii'iFiF��ii�iF i �FiS iF 7��F fTFifTF7Fi iFitiEitiEDiAe�iTh*it�E 7x-iE LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMHING ELECTRIC MECHANIC SIGN SMIP/RES GRADING PERMIT 21.00 PLAN 13.65 ISSUE FEE BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTALS----> 21.50 0.00 13.65 REVENUE DIVISION TOTALS--> COLLECTED: BLDG PMT PLUMBING ELECTRIC MECHANIC 21 .00 ,_ �t*+r+t***�*��jt*x itie*it*x it****ie*ie**ieitiE��* I N D Z V I D U A L TYPE QTY D E S C R I P T I O N SMIP/NON-RES .SO TOTAL PAID DUE 35.15 35.15 .00 �5 OVER/SHORT: 00 ��P/TOT GRADING PLAN-CHECR � .50 13.65 x �*+�+�+�***x ��+�*****+r*****x-* E A K D O W N UNIT COST TOTAL COST NO FEES WERE SELECTED FOR THIS PERMIT 82-14-1997/10:88 NM/f35.15 RCPTN:81-B802078 PEkMIT:081633 � '�' POO L _ SPA CONSTRUCTION AND PLANNINC / � � APPRQVALS Permit # � J Date Inspector qppROVALS Permiti# Date Inspector t. Temporary Electrical Service or Pole �.� 62. Pool & Equipment Location - � 2. Soil Pipe•Undrgmd. . 53. Steel Reinforcement 3. Electrical Conduit UtilityUndrgrnd. 54. Forms . ' �� 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding � � 5. Steel fleinforcement 56. Rough Plumbinq & Pressure Test 6. Electrical UFER Grnd. 57, APPROVALTO COVER•GUNITE 7. Footings 58. Electrical Conduit�Undrgrnd. - 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P•Trap, O U�drgrnd. 10. Structural Ploor Svstem / . 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-Fi�al 15. Rough Electrical-Conduit . 66. Solar6ystem-Final . 76. Rough Electric Wiring 67. Fencing & Access ApProval . 17. Rough Wiring Sign � . 6S, qPPROVED FOR PLASTERING 18. Rough Electrical-T Bar Cei�ing 69. POOUSPA SYSTEMS FINAL - 79. Rough Heating & Air Conditio�ing FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace ., APPROVALS Permit # 21. Ducts, in Structure . 70. Underground Hydro 22. Ducts, Ventilating 71. Product P�ping OGas ❑Oil 23. Gas Pipe�Rough & Test • 72, Underground Flush ' 24. Roof Framing _73. Undergrnd.Storage Tank'0 Gas ❑ 0(1 25. Roof Sheathing . � 74.' Overhead HYdio 26. T�Bar Ceiling (Structureil & Monocoat . 75. Dry Chemical 27. Frame and Flashing � . 76. Dry Standpipe � 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. PIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. RE�UIREMENT 37. Plaster Brown Coat ' 79. FINAI. INSPECTION 32. Electrical Power Meter�Final " 80..FOOD CERTIFICATE ISSUED 33. Final Electric � � Notes: 34. Finai Heating & Air Conditioning " 35. fina� Gas Pipe•Test � _ 36. Hood or Canopy •� - 37. Final Factory Fireplace , � 38. Final Plumbing , - . 39. Water Service-Final , v 40. Gas Service-Final � 41. Solar pomesticFinai 42. Backflow Preventer � , 43. Batkflow Irrigation 44. �andscape Irrigation System - � 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING . ' 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern Calitornia Gas Cv 51. CERTIFICATE OF OCCUPANCY No Dace \f . � A MESA CO ApplicanQ'sMailin A dress �Z,��%W�� % Orvner's Na/me // Address (p7l%� �� C'as /% Arch/Eng. License Address Contracto�'� Na,.,n �2.4i�LS s�� Address Im� �'�� City License No. LICENSED CONTRACTOR OECLARATION I hereby a/firm that I am licensetl untler provi5ion5 ot with sectlon ]000) of Dlvislon 3 ot lhe Busine55 antl my Iicense is In full fyya�antl eifect. A �� f1NORKEpS' COMOENSATION DEi;LI //iereby at(irm that I have a certificate �i Worke�s' Compenzation Insurance �� 3800, Lab. C��,� / PoIICY No%� �� C ertlfietl c py is bereby (umis \ Cert fietl opy' fil with ih clty Da Applic EXEM O ROM WORKERS'CO AOO�itanl ta fill in a11 spaces except those wit�in heavy bo�Cer tines anG sign all apPropriate tleclaralions. PERMIT E P MIT NO. TRACT NO. LOT NO. UNIT NO. � i �� a � f'�, TYPEOFCONSTRUCTION NEW. ADD ALTERATION REPAIR � � ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' �� DESCRIPTION OF WORK/USE OF BLDG. �� +�A=^G TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHEii � PROJECT DESCRIPTION� Sq.F7. � oCCUP'A/NCy_ CONSTRUCTION TYPE VALUATION yy��`� ZONE• GRADING CV. VDS. ACRES— (commencing Remarks�.� � �ns Cotle,;ntl _ . �_ . :Yfft [O SEIf-IOSIIf¢ OI d CCI(ItlCdtf certlfletl copy thereof (Section � � %ill'��.I% r (Tnis section neee nat be rompleteG H[he p6rKiit iSfor one huntlretl ('$100) or \less). �I certily Ihat in Ihe performance ot the wOrk fOr which this perm�t iSlssuetl, I Shall not emplOy any pe�son in any mdnne�' so as to become subject t0 th¢ Workers' Compensation Laws oi Callfomia. ' I 1 Date $ignaturC �NOTICE: It, a1[e� making this 4ecla�ation,�you Shoultl b¢come zubjectlto�tha . Workers' ComOensation�provisions of the Labor Cotle, you must Porthwith comply with such provisions or this permlt snall be tleemetl revoketl. CONSTRVCTION LENDING AGENCV ' 1 hereby affirm that there is a constructlon lentling agency tor the pertormance o� tho work for whiGh thls pe�mil, is issuetl (Section 3097 Civ. C.) Lentler's Name . Lentler's AOtlress � ' OWNER BUILDER UECLARATION I her'eby afflrm thaC 4am exempt trom tha Contractor's License Law for the �..un�..�no reazon �5¢ction ]031.5 BuSiness antl Professional Cotle: Any Gty'or ile a slgn6a statement mai ne/sne is ucensea pursuam m mn y�ovuiwn v� Con(ractor's License Law (Chapter 9(commencin9 with SecUon 7000) ot ision 3 of the Business anB Professions Cotle) orthat-he/she'is exampt 'ef�om dnd the basis (or the allegetl exemptiOn. Any viOlation ot $action �1.5� by any applicant (or a permit subjects the applicant to a civil alty o( not more than five huntlretl tlollars (E500). . . I, as own¢� of the prope�ty o/ my employees with wage5 as thel� Sole ipensation, will tlolne work, antl lhe structure is not intentleA or oHeretl 5ale (Section.7044,'Business an0 Professional Cotle: The Contractor's inso; Law does.not'apply to an owner o( a prop¢rty who builds or improves �eon, antl who tloes such work hlm5elf/h¢rs¢If o� th�ougn hI5 or he� own oloyces, provitletl that such improvemenls are no[ intentled or offeretl /o� . It, �oweve�, lhe bui10in9 or ImprOvement is Soltl wlthin one yea� of cOm- '.ion; the owner wlll have Iha burtlen of proving he/she ditl not builtl o� Im- ve for the purpose oi sale). .. ' 1, as own¢r ot the proOertY� am e%cluslvely cont�actin9 wi[h Ilcen50C COn- :tors to construct the project (Sectlon 7044, BuSiness antl P�ofe55ions Cotle: i Contractor's Licanse Law does nol apply to an owner ot property who Itls or improves thereon; ana who conlracez for such projects witn a con- :tor(s) 'llcense'oursuant to the Contractor's License Law). 1 am awara that oi a( thlir, Wo�ker'S CompensatiOn InSurance'shoultl be prOvltletl to me. I am exempt untler Sectlon B. & P. C. ror this reason e Owner ereby certity'tnat I have reatl thi p Iication anG state that the above mmation Is correct ' to m ly Ith a11 clty antl county ortlinances slat¢ la to Dw on uction, ana hereby authorize repre-_ '.atives [K to en n[he abOveynentionetl O�opp�tyj or ieCtio purp /� . . i // /G/. Prevencer ' ' - ' Irrigation Dishwdsher_, . Drinking Fountains Floor Drains Floor Sinks i GasService Outlet Intereeptors ' Kitchen Sink _. . LdVdtOfIES P—Trap Roof Drains Reinspection Fee � $15 Boiler _ � Duct- Under Ground Duct-Struttural ' Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # � Heating System & Ducting � � ❑ ai oo,oao eru O i oo,000 �ni9namr � _ _ Drivers' License or 5 Reinipee[ion Fee �$15 CMF 0865-46, rev. SO/ WM1ite - Builtling; Canary - Appllcant; Plnk - Accounting; Goltlenrotl - Assessor Showers Service Sink � - Sewer CaP . . Sewer Connection ' Solar Collectors .. - Solar Piping - Solar Tank $wimming Pool w/Spa Urinal ,Water Closet � : Water Heater •-Water Service � Auto-Wash laue Fee Hootlor Typel ❑ � Canopy , Type I I ❑ Feirigeration Sys[em ' ❑aioo,000eru ❑iao,000 System Repair�Alreration Fire DamOers � Registers Issue Fee -FEES A.P. # _ _ S Main Building: : � E ' - T Front 8 Rear � A C Ai9ht � g Left � PIn9. Ref. � � . ' ! . i tomatic�Washer'� � - •' ' nstructinnPnlwR��h .. � Cooking Unit` ' Dishwasher . - Dryers'�Gas �Eleciri� Fan ! � F.A.U. - - � � Fixtures i Device Bozes i ' � Outlets � � i : � - Switches - ' --- � - ' Garba9e Disposal Generaror �0.5 KW'OS- $ 3 $ 3 6986; 6/06%86 46.T0 TL �o...^. ' .' ' _' .'_ .. .,., ; . _ � Zone Accessory Building: � Parking Req./Provided � 1 -; Transformer ��0 15-50 KW �� i ' � `�'50+KW - ,. � Meter' ❑up to 100 amps Meter� �over100amps Sub Panel -� ' � - Motors �0.1 HP � 1 X;, 8 Inc �Solar �9-15 HP 016-15+ _ Z O N I N G R � � E Q M T S � " FEES � � Microwave, � 1 ' ' � Pole Light � ' i Range � i ' Sign . .' _ _" , j � Standing Sections i � 75 KW Trash�Compactor � � , Reinspection Fee 515 Issue Fee � � .$ 3 DEVELOPMENTSERVICESREQUIREMENTS: � , � - = 2oning Approved By - �ata � � Building Approved By Date� APPlifatian Issued BY � � � � Datq (/// ."� i adlQ'O SUMM RV O. FEES , � BUILDING PERMIT $ -� SMIP . • $� � PLANCHECK/g�0$, PERMIT. - . :� PLUMBING � '. $ ' �SSUANCE ' $ _ �' PLAN CHECK 25% $ ENERGV P.C. $ ^_ ELECTRICAL � � $ ' -GRADING _ $-' �� , PLAN�CHECK 50%� $ � ', MICROFILM $ � = MECHANICAL $ J _TOTAL FEE � $ PLAN CHECK 25% $ � - � � n, %J; � • CONSTRUCTION AND PLANNING POOL & SPA o APPROVALS Permit# Date Inspector, qppROVALS Permit# Date InspectorL c 1. Temporary Electrical�Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement . 3. Electrical Conduit Utility�Undrgrnd. 54. Forms � r 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' � I 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ° 6. Electrical UFER Gmd. 57. APPROVAL TO COVER-GUNITE � - .i 7. Footings ��_ � 30 �/ 58. Electrical Conduit-Undrgrnd. �' 8. Foundation � 59. Gas Pipe, O Undrgrnd., Test ' � 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, O Undrgrnd. 10. Structural Floor System 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 & Accest 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 Fzctory Fireplace � APPROVALS Permit # _ - 21. Ducts, in Structure 70. Underground Hydro ' ' t� 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush � 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil y .i 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: "`�� l 34. Final Heating & Air Conditioni�g I; 35. Final Gas Pipe-Test. � ' , ' 36. Hood or Canopy �'; (. � ��! :� . . '.� 37.; Final Faaory Fireplace �' �' • � „ ;/� • � � ' . �• 38; Final Plurobing . ' r' ` ,', . � ` � I; '� ' , ' � , 39: Water Service-Final ' " y.�� . � r�. ,�40. Gas Service-Final " , � ' ` . , ' j � .�. „ �. 41. Solar pomesticFinal / � , � � ' ; �i , • I � , �42. BackflowPreventer ' ' �'I ' f - � ( /� � 43. ,Backflow Irrigation � . , ' ` � ' � � � ' � �' . 44..Landscape Irrigation System �.` : ' J � �,.. �� ' . . � . , '45. Sound Attenuation p� ,:�'. r�. , ' " � 4fj. Handicap Regulations ' --, � . , � � ' 47. FIN'ALSTRUCTURE&BUILDING i• al t�� .; - ' . �' �" . �� 48� Special Requirements Completed ,, �� - " ' ' ' ' 49. .Electric Release to Edison " ' � , - ' I . 50. Gas Release to Southern California Gas Co ' . �� O 51. CERTIFICATE OF OCCUPANCY ' , . � ;; No. Date ` � .. � i � �' � ._. PR0.IELTROONESS: ('�O W 17TH ST OWNEfl'SNAME: �.'IRST AMERICAN TRUST noosess: GEORGE RUSSEL,L 1120 W, LA VITA AV STE100 QRANGE CA 92668 714 66`1-3939 FflCHIENGINEEH: NEG.N�.: PDUflESS: UNIT: PEPMITTFE: fORDAN ROOF COMPANY ( 71 4) 897-6I05 AODXESS: 9ZO N. TOWVER 5T. SANTA ANA CA 92703 LICENSED CONTPACTOq OECUIPATION: 1 �eieEy alllrm l�at I am licens¢0 unC¢r D�ovisions ol ChaD�e� 9(commencing wilA Sec�ion 7000� at Oivision 9 0l ��e Business anG ProlesSions Catle. antl my li nse is in tulllorce and eHeq. ci,ruc.:03`'916 sTnTeuc.:406783 ' —39 � Dale: ��20 d SignaWre: _ WOPREPS'COMPENSRii0N0EQAM7I0N: I�ereOyallumthall. ve emlicaleolconsentto5e14insureorarenilicateofWorkers' Gompensdtion Insurance, or a cenilie0 copy iherroll�tWn 3800. L C�. , raucvNa., 710209-89 E1P.ORTE: OBIO� I91 L9MPANC STATE P(IND ❑ Cehi�iea copy i5 her¢by IumiShed. I� Cerii�i¢U topy is hl2 .ni� lhe ci � Builtling DiviS�on. . �ate: ��v� AV7fi[ani: / 1.� E%Fh7PTI0N FNOM WONKFRS' COMPENSAPON DECUIIATION: (ih¢ secUon not Oe wmWeteO tl ihe Derm�'s la me huMre7 �5700) w kss�. I certity llw� in ��e pedar�un[e 0� Ihe work lor whiC� IIuS pefrtti� is issuetl. I Stull nai employ any De� � a(ry manner so as lo OetOme suqec� to ��e Workers' CAmOensa�ion LawS ol Cdlitomu. Date: Sgnature: NOTICE: II, alter making tnis aeclaration, you snoula Eecome subjett to ihe Wotkeri fAmpensatian pmvisions al tlle Labor coae, vou must fannwitn comv�y ��n sucn o�ovisians or tnis permit snall ee aeemea revokeU. CONSTflUCTION LENOINC BGENCY: I hereGy ailirm I�at t�ere is a conslmciion IenGing agency �or Ilre Oe�ormance ot �he work lor wM1icn this Oe�mif is is50etl (Secfion 3W7. Civ. C�. LENOEH: RODflE55: OWNEN BWLDEN UECIpppTION: I �ereGy aflirm I�ai I am ¢s¢mpi �mm I�e Coniracmrs' State Li�¢nse Law tor the follovnng reasan (Section 703t,5 Business an0 Pmfessional CoGe: Any city ot county w�ic� repuires a Dermit to conitruct, at�er, impmve, tlemolish, or renair any simcture. prior lo ils issuance, alsa repuires ina applicant far tucA Oermil Io file a signe0 statement Ina� he/she is licensetl pursuam �o ��e pmvisio�s ol �Ae Canlraclors' Sta�e License Law (Ctupter 9(wmmencinA ��h Section 7000) af Oivision 3 of the Busineu and Pmlessions Code) Or I�at �¢/5�e 6 exempl l�eatmm an0 i�e OaSK �or IAe aliep¢G enemD��on. My Nola�ion ol $ecii0n 7031.5 by any applicanl for a permil suoiecis Qre applicant lo � civil penalty of MI more tlNn live AunOr¢E aWlars (E500). I. as owner ol �ne O�aDeny or my emplpyea xitn waqes as lneu sole mmpenutpn, will Uo Ue vrork. antl �ne I❑ s�mcwre is nat {ntenaea or allereC Iw sale (Sepwn 70aa. Business anU Pmfessional Code: Tha Contractars' State License Law tloes noi apDN lo an ovmer of a pmpeny wla �ui145 or improves Ihereon, an0 who does sbch wod Nmull/�erseJf or tAmuOh �is ar �er own ¢mploye¢s, prwide0 tlut suc� �mprovemems are nol imen0e0 or allereG for sale. II, Ilowever t�e bullJinp or imDrovement is 5pltl wit�in one y¢a� ol com0�e��on, Ihe Owner vnll luve Ne burtlen of provin0 hUsl�e Gitl not buil� or impmve lor ine purpose ol salel. I, as owner ol Ihe proplrty. am evclusively WnVaclinp vnt� lic¢nsed coniractors to canstNct ihe pmject (Section 700d, Business ❑ ana Pwiessions �tl¢: The Canuactars' State License Law Aces noi apply lo an owner ol D�oPertp wAo hmlds or impmves ��ereon anu wno contracts for wcn pmjects wiln a comractaqs� license pursuam lo �ne Contracmrs' State Licensn Law�. I am aware Ihai Orool oI ��eir Worker'S CamOensation in5urance 51iouIE Oe p�witlM IU me. � I am eKemO� unOer Setlian: B. B P. C. lor this reason: Oa�e: Owner. i Do nereby cenity iha� I am aware ol ana unaerstana ihe requirtmenls of Cafi(omia Nealf� antl Safery Cade Sections 25505. 25533, and 2553< ana Ihal loranytulure Duiltling acupanlwill/vnllnot�circle one�neeEto compN �� SaiE slate co0e5 antlt�e reQuiremenislor a permit lor con5lmclion or mo0ilication tmm I�e Air ua�liiy Managem¢ni RSlntl. fle5i0eniial cOn5lmciion applicalions are eaempl �mm Nese O�ovisions. Dale: ApOLWnI: I �ereby cetlily Iha� I �dve rea0 i�i5 apD�ita�ion an0 slale I�at Ihe a0ove informalion is carrec�. I agree to compN �� all ci�y an0 counly ordinancesands�alelawsi¢IalinglobuilEingconslmc�ionantlnereM utnoraereo�� ativeSof�Aisciryloent¢ruDanlheaCove�menlione0 propeny lorinspeclion purposes. �ate' �� Signalure: orive�'s �icense or Satia� Secunty +'�: / 16aL4fi W�i�e—Bwl�ing; Green—Coae Entorcemem: Canary—AppLwm: Pmk—Pevenue; GolCenroE—Assessor � CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO; B 0;0019 PLAN CHECK NO: N CONSTRUCTION '1'YN(�:: PERMIT TYPE: STR PERM NO: B 05001 GOVT: N SUPP: N PURPOSE; ALT JOB DESCRIP7'tON : REAOOF W/HOT MOP SQ FT: 9,000 CLAZM Vi1l�lfti; 9,000.00 CALC—VALUE: 9,000.00 GROUP OCC; B-2 / COMMENTS: F�.� REROOF W/HOT MOP iE i( iEi(� if if ik iE-0f a� 1f �If dF 3E iF df iE if dE if �f��ibaf af iFif i! at iE�iFif i(� if iE if if iE �%� iF iF �ib iF df if �k -0E iE i4 �f �N �IE 3E �lf �k �lf al� �f aE iF iE if #. �)f �f �X�if �IF � if� �dE 1E IFjE �7f if if 1f iE Z O N I N G R E Q U I R E M E N T S sETBAcxs ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT; FT IN AEAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN AGHT: FT IN PARKING REO• PROV: PARCEL: 00000000 ZNE: REF NO: PLANNING Nt5'TES> ' > N- X if if iE iE 3E?f iE if iF if iE 3E 3tif 3E �f lE jf iE iF 1f if 1f if iE iE 1E if �f ?E iE iE �F if ik IE iE iF iE if k!f if if if 1f * if �f iElF iE 1E if iF iE if 1E 3E 1k ff 1F �E iElf iFfE �f iE iF iF iE if 3f iF if if D E V E.•L O P M E N T S E R V I C E S R E Q U I R E M E N�T' S ZONING APPROVED BY DATE: BUILDING APPROVED BY : DATE: APPLTCATION ISSUED BY: DATE: tI� iF iE �f iE iF iF if iF iF iE if 7f if if if !f 1E iE 1f if 1flf if iF K i: if if if if if if��FiElf 1E if �k if iF %� if IE if IE iP if if 1F iF iF if if #!E if iE 1E iE if 3t iE if if jf 3f iE iF M iE iE iF IE if it 3F �E * if M iF iE 1E iF 1f if if if iE if iF if 1f if 1f if K if if iF K if %af iF if 3f if if if if M iF k LEGAI.IZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING EiECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 708.00 PLAN . SMZPiN05—RES ISSUE FEE llUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAZD DUE TOTALS----> 109.35 0.00 0.00 109.35 109.35 .00 REVENUE DIVISION TOTALS--> COLLECTED: 109.35 OVER/SHORT: .00 HLDG PMT PLUMHING ELEC'I'RIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 108.00 1.35 k if �F �f �f� M�f if if if if * if 4 �f �E iF M if 3E aE fk 1f 1E jE )R {F M If if iE iF if 1F 3F If k iF it iE iE 1P It iF if M if M if +f jf it ff if �f M it iE �f �F * iF iE if 1f M%it 3f if if if �F ik %N if if M I N D I V I D U A L F E E B R E A K D O W N TYFE QTY D E S C R I P T I O N UNIT CO5T TOTAL COST SFC 9000 REROOF BY VALUE COENDROFAFEESNOZONE 1.00 9,000.00 41 �fl07s�lU G�074714 � iC+"� :G9.3:, DATE: 11l2Q/9Q TII'iE� 15:p5 i � CONSTRUCTION AND PLANNING POO� eL SPA �� APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole . 52. Pooi & Equipment Location 2. Soil Pipe�Undrgrnd. - � - 53. Steel Reinforcement 3. Electrical Conduit,Utiliry-Undrgrnd._ � 54. Forms 4. Electrical Conduit-Undrgrnd. ' 55. Electrical Bonding 5: Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFEfi Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footingi 58. Electrical Condui[-Undrgrnd. 8. Founilation ' � � 59. Gas Pipe, O Undrgrnd., Test � 9, Water Pipe�Undrgrnd. ./' 'r � .�� 60. Backwash Lines, P-Trap, O Undr9md. � 10. Structural Floor Svstem ' .� - 61. APPROVAL TO DECK � 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap ,2, , ,. 63. Heater & Vent-Final 13. Roof Drains � 64. Plumbing System - Final 14. Rough Plumbirig �- 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring � 67. Fencing & Access Approval 77. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT - . �. 20. 'Rouqh Factory Fireplace _ ' _ • �> qppROVALS�� Permit # � ' r. � r t r 21. Duc{s, in StructuFe ` � . + � � 70. Underground��Hydro � � 22. Ducts, Ventilating � � _ ' _ � . � ; 71, Product�Piping O'ria's ❑Oil 23. Gas Pipe�Rough & Tesc . ,� � -.�; ,;� � 7z, Underground Flush , � .� " 24.'RoofFraming '�� ._ • � :� • 73.'Undergrnd.StorageTankOGas ❑Oil' 25. Roof Sheathin � � 1 �' � � ' � ' ' ' , 9 i �,� �L p •� �� 74. Oyerhead Hydro�: 26. T•Bar Ceiling (Str' �ctural) & Monocoat �' '+' • + 75.' Dry Chemical ' ' • ' ' • . �� 27.' Frame and Flashin9 � . . � �', ; ; 76. D"ry Standpipe � ' � . � � ' 28. �Lathing & Siding � r: � � � . � . : •• •i •• � : 77,�'FIXED SYSTEM �FINALi � ' . 29. Insulation �: ' ' � . :�� I�. � 76. fIRE PREV, FINAL i 30. Drywall Nailing I i� • . HEALTH DEPT!REQUIREMENT � 31. Plaster �rown Coat ' � , . � � I _i� ; ]9.' FINAL INSPECTION ; ; 32.• Electricel Power Meter-Final � I" ,�� 80. FOOD CERTIFICATE ISSUED 33.' Final Electric ' ,,. � � { '� � I -�' "Notes: � ` i � � Q , �34., Final Heating & Air Conditioning � � � � ,�. �. . . . 1' ., . 35.� Pinal Gas PiPe-Test � .-5r' � ' ; �„ ( : �; ' •:<7 . ,, , .. .;t , 36.' Hood or Canopy ' � . . I i i � .,t. .. � �.� �h. n� 37.' Final�Factory Fireplace , • . � ° '' ( � �� i � • ;•' ' "� e � t (, .0 i �38. Final.Plumbing . .. � .. • � '� � I r. � � • r' - "39. Water $ervice�Final � - � •'•" ! '�� C, ' i � �1 + + • ,40. Gas Service-Final ;- r.- � . �� , � �� I �� ! �41. Solar pomesticFinal '. " •• ' • ! I �� " ' ' .� . � ii � � i 42. Backflow Preventer . � ` , � ; ' � , �; j . � � • � 43. Backflow irrigation ' . + t ; . � • � � .�.: � t� r 44. Landscape Irripation Sysrem �i,,i. � � � ; ,�� . � � + � i : ir • � � 45. Sound Attenuation �� ' • � ' � ' • ' ' � '��'' � ' ,' �� •�.�.i • i' . 46. Handiwp,Regulations � ' - ' � � � �� ; ' ' ' . � . . � � � � 47. FINALSTRUCTURE&BUILDING �` O O i! ��"� ,' ' „ e , . 48. FINAL PLANNING � , , i � �� . � + 49. Electric�Release to Edison � � � � 4; �'' , ' � 50. Gas Release to Southern Califomia.Gas Co � � � � � i; : ;' , ; , � . .;� ; � , 51. CERTIFICATEOFOCCUPANCY • i •+ � t•i " � ' • No. Date tl 0 � , L ;I'�V � COSTA MESA C N� .+"}.'� 1 Y I Pro� ct Address _�� 1 �� 'L c�n A�plicanYs Mayil�in.�g _A'd�dre�s,s.,,�, � c�___ Owner's me ,1K�_+.— �� p �� Phone � Address a Arch/Eng. License No. Addreu /��L � {� Contrector's Nam P\h2onet7_1��u ' � Addresslmailingl� , City License No. � � LICENSED CONTRACTOR DECIARATION I he�eDy a(firm tnat I am IicenSetl untle� provislons of Chdrt¢� 9(commencing with section �000) of Divlsion 3 of the Business antl-Pro�essions CoEe, antl my Iicense is in tull force ana effect. � � License Class LicenSe No. Date Signature WORKERS' COMPENSATION DECLARATION I helebY affirm [hat I hava a cer[ificate of consent to zelf-insure or a certi/icate ot Workers' Compansatlon Insurance, or a certitietl topy [hereof (Section 3800, Lab. C.) Policy No. Company eCertifi¢tl copy is hereby lurnls�ed. � Cer[itietl copy is (iletl wlth the Uty Bulltling Dlvisfon. Oate APPlicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thisseclion n¢ed not be Completetl it Ihe permll IS (or oJ�e huntlre0 ( 100) o� less). �/ I certlfv that in the oerf0/mance of th¢ work forJvtyt'J� th� per s ISsuetl, I Date � nCc��S9nature compiy with such provlsions or tnls pe�'rt�it snall be tleemea revakeo. CONSTRUCTION LENDING AGENCV � I nereby affi�m Iha[ tnere i5 a<onst�uctlon lending aqency fo� the per(ormance of Iho work Por which tnis permit is ISSuetl (Sectlon 3097 Civ. C.) Lentler's Name Lentleris Atltlress OWNERBUIL�ER�DECLARATION I hereby atfirm that I am exempt from the Contractor's License Law for the tollowin9 reason (Section 7031.5 Buslness antl Professlonal Cotle: Any city or coun[y which require5 a pe�mit to cOnstruCt, alteq improve, tlemoli5h o� �epair any structure, prior to Its Issuance, also requires the applicant (or such permit to file a signetl statemenl that he/shC is licensetl pursuant to the provisions of the Contractor'z License Luw (Chap[er 9.(commancing with Section �000) of "Olvition 3' oi the BuSinesS antl PrOfezvon5 Cotle) o� that he/sne i5 ezempt there/rom antl [he Ibasis for the allegetl exemption. Any violation of Section {-�03] 5 by any applicant for a permit subjects the applicant to a civil I pe�alty of not more than five huntlretl tlo11ar5 (E500). az owner o. me pruueiiy w.�.r-....w.�r== �ocatinr will tln tM1e work. antl [he StNcture LicenSe 1.2w tloes nobapo�Y to an owner o( a property wno owms or improves fhereon, antl who tloes such work himself/horsolt or through M1is or her own employee5, provltl¢tl Ihat such impwv¢men[s ar¢ not Intentletl o� otte�etl for sale. If, however,.tne.bulltling or improvement is soltl witMn one year of mm- pletion, tne owner wi11 nave the burtlen oi proving ne/she tlitl not builtl or im- p�ovG to� th< purpose ot Sal¢). ❑ I, as owner ot the property, am exclusivaly con[racting with licensetl con- tractor5 t0 con[lruct the prqect (Seclion ]044, BuSiness antl Professions Cotle: The ConVactor's License Law doo5 ml apply to an owne� of OroOerty who builtls or improves Ih¢reon, antl who con[racts tOr such projects wi[h a con- cra<tor(zf ucense pursuant to the Contractor•s License Law). I am aware that p�oof oi their Worker'S Compensatlon Insurance Shoultl be p�ovitletl to me. ❑ I am exempt untler Section B. . C. Por this reason � -�� nw� i7 J-1.--�� i na.nnvi cerfiiv that have rP,tl1�I Yo lication an tate [hat the above Signature �(� Drivers' License or 55 CMF 0865-46, rev. ]0/84 to fill in all svaces exceD� tnose within neavy boraer Ilnes ana si9n all approo��ate eeclaratians. TYPE OF.CONSTRUCTION Ll NEW LJ ADD LJ ALTE� A7.IQ N LJ REPAIR � ❑ CONVERSION ❑��EMOLISH ❑ OTHER �ySi��- G.GIS A P� . DESCRIPTION OF WORK/USE OF BLDG. ��K� S Main Bi E TVPEOF�PERMIT GRADING FOUNDATION STRUCTURAL � T Front - � TENANT ❑ ELECTRICAL �PLVMBING ❑ MECHANICAL A Rear �� OTHER ' PROJECT DESCRIPTION SQ. FT. oCCUPANCv C Right K CONSTRUCTION TYPE • VALUATION $ S Left 20NE GRADING CV.`�DS. ACRES- p�ng. Ref. # Remarks:� , � Planning No Bar Sink Backflow Preventer Backflow Irrigation Batlitubs 7rinking Fountains Floor Drains . � " Floor Sinks uas Service . Outlets Inierceptors Kitchen Sink Lavatories ' P-Trap Roof Drains ' Reinspection fee $15 Boiler Duct - Under Ground Duct - Svuctural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/FacL BIL ICBO # Heating System & Ducting� ❑ ai oo,000 sTu O i oo,000 eri Reinspection Fee Whit¢ - Builtlin9: Canary - Appllcant; Pink - Accounting; Goltlenrotl - ASsesSo� $15 Service Sink - Sewer Cap Sewer Connection � SolarCollecrors �� Solar Piping . � Solar Tank ' Swimmin9 Pool w/Spa ' Urinal Water Closet ' Water Heater Water Service Auto�Wash WundryTrays ' laue Fee Hood or Typel ❑ Canopy Type 11 '❑ Refrigeration System ❑aioo,000eru ❑ioo,000 System Repair/AI[eretion Fire Dampers Registers ' i Issue Fee FEES Construction PoleSub. Caaking Unit . Dishwasher � , 0692 �� Accessory Building: ELECTRICAL � ' Transformer ❑ 15-50 KW ❑ 50+KW Dryers LJGas ,LJEIec[ric ' Fan ' F.A.U. ' Fixtuies � ' � Device Bozes � � Outlet � � Switches- � - . Garbage Dispoul Generator �65 KW �5-15 KW Meter ❑up to 100 amps Meter pover100amps Sub Panel Motors00-1 HP�1Yh- Inc.Solar �9-15 HP �1 Microwave� Range Sign � Standing Sections Trash Compactor S' 3 Reinspection Fee $75 Issue Fee FEES DEVELOPMENT SERVICES HEQUIREMENTS: ' Zaning Approved By Building Approved By Aooliqtion Issued BY n - � � $ 3 � _ .�: 5000 'TL 2 O N I N G N E Q M T $ PEES � � SUMMARY OF FEES � � � � BUILDING PERMIT $ � SMIP . $ - � PLAN CHECK $ � PERMIT - . PLUMBING $ ISSUANCE $_ . PLAN CHECK � 25% $� _ ENERGY P.C; $ ELECTRICAL $� GRADING S PLANCHECK 50% $ MICROFILM_ �$ - MECHANICAL $ TOTALFEE ,$ �_ PLAN CHECK 25% $ " � � CONSTRUCTION ANDPLANNING POOL&SPA APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location � 2. Soil Pipe-Undrgrnd. � ' 53. Steel Reinforcement � � 3. Electrical Conduit Utility�Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. � 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. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT � 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro � � 22. Ducts, Ventilating � 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test ' 72. Underground Flush 24. Roof Framing . 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-8ar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL � 29. Insulation ' 76. 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: -- � . $ r' 34. Final Heating & Air Condi[ioning - � 35. Final Gas Pipe-Test 36. Hood or Canopy . 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final � � 40. Gas Service-Final � 41. Solar pomestic-Final ' 42. Backflow Preventer 43. Backflow Irrigation � . � 44. Landscape Irrigation System • � 45. Sound Attenuation � . 46. Handicap Regulations , 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed ' 49. Electrie Release to Edison - + 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY ,. ,y `� ' No. Date � Y' �� - - X � r,w�+�ssaem�oun 670 W 17TH .ST uHr: QYNEAg�11E1FA01Y�k PACIFIC MESA PROPERTIES "0D"� 670 W 17TH STC-4 COSTA MESA :A 92627 (714)645-6811 �vv�. wuw+o �oo�sx ANCNREpT ON FNf�P1EEN+ cartn�cran rw� catm�crars�uiwo ,�ro�ss uc. rn.: UNT: uc Ha: m uMr: UCENgED COMNAGTOR4 OEGL�P�TION: I hralry aRrm uder psuly d ppµvy tlut I em IcruM vdx pmida» al CMqm Y (mmTericM xiih Se yion )000) W Dirnun � d Hro Bua'vnn eM Pmlw�bu Code. aM mY Wsw u m lull lau eM eMad. cm Uc. No.: uc. cuss: uc. no.: EXP ; ode: camm�: OWN@p BUILOER DEC(AFATIQV: 1 AwaDy aKum uWr pw�Ny of pmjoy flW I an amnq M1an tM Commlm Lim�w law la tla 1^Ibr.'�q imaon (5eqion MI S Buanma md Ralenvn CoAs: MV W a wvaY w1uN �Wmw e pem� to muwci. etler. inwa+. 'w�N'vh. «rpai vry e4�clve, pv b b uaierce, e6o npu'vx �M pp6re�tl for wrh partn's �o fils e vipad mtenstl tlW he a eM �mwe w�*�u m ue wwviau a cr cor�reeon uum. lm. ICMa« a�mn.n«�v .w s.ac� �aaol a oiv:ion a w ��e due'vyn erd Adan"vu Codel a IMt M a eM e eaemq �heeahom ud �he baeu ta Ne e0eqed ssmmqion. My vidmion d Sedian ]W t.5 Ey e�y epp&eN la e permi abjWs tM epp4av to e dH panepy d rci mus IIm� fxe MVMied dopen �S.AO�. ❑ I.eaowsdllnP�PMYanH�Ob;wwihw+W+mNw�alowmV�.v.idoErwkendlhewic�uawnd"vuaMeJ «arteieer«.delsectbn �ou. eumnsvend Rae,sw cees: ms eauraeasumn,elm.doo ndw+PYw.new.wapacenr WM bllitl8 Of �IIG�A'M IhBIlPI. pM Wq AOlB tYd� FIXk �ITMII IX hMtG� Of dlll\Nh hO 01 Mf OMT OT�O�Mf. P�� IW Wth CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 08177 PERMIT NQ; P 081776 PLAN CiiECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH SOB DESCRIPTION : INSTALL FLOOR SINK SQ FT; CLAIM VALUE: CALC—VALUE: GROUP OCC: B / COMMENTS: THE "CATALINA FISH KITCHEN AND SEAFOOD DELI"/ PLUMBING ONLY it+r+tititiE�tif�x�+tit�t�r*x�r+tx��x�**ftie��+�+�*�*�ititiEit**�r*x��x�it�r*it*�txitx��r*it�x��t��ritxir��+t+r�rie�r�r+r** Z O N I N G R E Q U I R E M E N T S S E T B A C K 5 ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN AEAR: FT IN LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT: ET IN PARKING REQ: PROV; PARCEL: 42428123 ZNE: REF NO: PLANNING NOTES> � 1E if IE IP 1E iE ik iE iF 1E iE 1E IE 1E iF iF 1E iE iE 1E iE 1E 1E 1E 1F iE iE 1E �E iE iE 1E if� 1F if ik 1k'1F If iE iE �lE iE iE 1E�fk �E 1E iF fk if 1E 1P 1E 1f 1E 1E iF fE iE IflE IE iE iElE'IE iE fE fE 1E 1E'k 1E fE fElE 1ElE D E V E L O P M E N T S E R V I C E 5'-__ R E Q U I R E M E N T S impeovemenu en M weMed rc aflasd la eW. tl. ha+ms. iM baldmp a mpmwnM w wid wit�m msY� d epnplelm. tM �. -0uildarx�IlhewlMbukendprovieqMaNedidewbuikaimpv.elatAaW�edede) ZONING APPROVED BY . DATE• y(., owiwr �J I. v ovmer d iM PWMY. em mtlwrvaly aonVmnO rmh 1'wmnod canvectae w caneWd tM pqep (Sxfion ]PN. Bus'v�ws uM a�w,.:�.coa:rn.cw�.e«.�+.�..a�+�+awoyn�o.,+vao�wnv.+anwa.«srop.«ma.�.�a.ro BUILDING APPROVED BY : wnvecb la wrh pqws v.M a mm�edale) lironaed a+�� to Ihe Canradora limma lew) �. ❑ i,,,,,,,�,q m.,/gwA,,: e.av.c..a,. j�� APPLICATION ISSUED HY: c�- o�a: 2�Y/'�7 oMw: /(i✓v+�� itleiE+E7kieieiEleleif+EfEfEieieiEiFiEfEiEif --.�— i m n,,.sy c«W mm i.m..me a.e ma..wb u,e �.a:.m.m a cwm:. wm, w sd+r coe. s.a'vn asn. zssv..m Y55�1. xd thet I a em' Mun Mildin0 � nill / wil nal (mc4 ar) neaA ro mnply wih vN Mle aodr eM tM rpw�an+aMe br • Ge^nn Inwnswniona modfotimhvmlMAi3w�+�epnwM Oiqrip. Hwidenwl mMwion e00��imsaa axemN Imm �Ms V�e. Oma: Applcw: WORI(Efl'8 COMPEN9ATION DECWi�TON: I hmeby ellvm uMr psW y d pa'jvy aw d Ns lopox4p detlombrq: ❑ I hew vk W memten a ceNliai� M mmtl lo wlirmw� Ior wFan' mr�pwrqbn. o pwkaE la b� brfion ]]00 d �M leEa COM, la tM prlamuc� d Jr wak In Mich Me pamtl b iaued. ❑ I Me md wif ine'vaan waAan'mnPw�un bmrtdm. n'p`m�d W bwim 9]OOd Ne labarCoM. brtN pa�Mmence M tM wak la wl�irli Nq DMM b mwA. A1Y Wakr�' canD�ion iwrenca aniw md V�Y mmibr us: c.m.: PMiy NumEr: ,in�, ewim �wn ra es �w�pa.n r w c.me e ro. a. w,wee amen l+iaoi n ru./ � I oerlyy Ntl m UN Oa�lamenca a IM wak br whiUi tlb V�� b bu�E. I tluC nd m+OM �V VaA��..11^^^V mww n n lo beeane subjed ta iM rrorkan' mnqa�uetinn Nws d CeEtwnu. eM qrss �j R I ehouN �wEjM io tM Morka�' opnpaneetion mWy'on� d Satlion 3)Op d �M labor Coda, I duG lon tlh o ("�' '"o!p�a� ome: �s/•�7 Marcw: � 4T/1 G2�✓!// W�minp: F�Yw ro ucun wo� �a'a�W l� unbrM, uM �MIIWEMf �n wpleyw ro crlMn�l pwr�fllw nM NM nna �p ro ar h�nJ�M tlwurM Oc1Yn (J/G4000A a�� m IM mst el romprw(bry G�npe u prvvlME roi In 9�ctlm J106 0l fM 40or Cob, INiruL uW �ttomryY l�u. coHsmucnor+ �wrnrw �aencx: i wwr .� �.ba. c��v a w.F.y mm �. e. ovm�w� rwa ro�v ro. m. wnama,c. d ina nak k. wnia� iAe o�� e ened (seeun ao9�. civ. cl. LENDEP'4 NAYE �ENDER'S MONE49: I canM �� I have reaE thie appl' etian uM aeu Ihd ihe ebms'vdamwion m m�erl. I apise to mnply wn� N dry eM ow�My adire�� eM sWe lawa mklnY w W�1LM cauvueionW Meb/ autlror'¢s iap�awYNnr N�hu dlyro aNa w� �M ebow.maminrE p�apary lor Lypeqbn Wrposea. W LLAM B WILKINS N 2�� / , ome:---1_�"�— I Sgreture d Owris/.lperu/AppimY�Curqrma (515b16.WP) WAdw-BuiN�q 6 Se1wy, Omen-Fde: CwrY-�OG�+b: Pfnk-Rewnue:OoHauod-#semv ' DATE: � '1F��F�� DATE: �" �' '9 IFiEiElffFiFlEi6iffE k1E LEGALIZATION:N F E E �S U M M A R Y STRUCTURAL SEGMENT;N BLDG PMT PLUMBING ELECTRIC MECHANIC FIR� SMIP/RES GRADING pERMIT 825$ �'� � PLAN � SMIp/NON—RES ISSUE FEE 22.00 ' �� BUILDING—DIV—> PERMIT ISSUE P.LAN-CHECK TOTAL PAID DUE TOTALS----> 8.75 22.00 ._. 0.00 30.75 30.75 .00 REVENUE DIVISION TOTALS--> COLLECTED: 30.75 OV6R/SHORT: ,00 BLDG PMT PLUMBING 6LECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 30. 75 ,: � " 1fiflFfEfElEiEik1E1E1EiE1E41F1E1EiEfEiElEltifklEiF1t1E1EiEi6iEiEiEfEfE1E FitlEikiEiElEikiFlElEiflEklFififlkfhiEiE1E1k1f1E1EiF!liEiElEftlEiFlkifikkkiklkiE I N D I V I D U A��L 4` F E E B R E A K D O W N � n TYPE QTY D E S C R I P T I:.O N UNIT COST TOTAL COST <" PLU i SINKS, FLOOR �� /'', 8.75 8.75 �HND} OF FEES �,/ 1 1 I�l ,b \ / -;., ez-za-�v9iiez• .:— - PERMI�ieei � 6 �� CONSTRUCTION AND PIANNING POOI PA f APPROVAI.S Permit # Date inspector qppROVALS Permit # Date Inspector 1. 7emporary Electrical Service or Pole 52. Poo� & Equipment Location 2. Soil Pipe�Undrgmd. 53. Steel Reinforcement ' �- 3. Electrical Conduit UtilityUndrgrnd. • 54. Forms . 4. Electrical Conduit•Undrgmd. 55. Electrical Bonding � 5. Steel Reinfarcement 56. Rough Plumbing & Pressure Test I 6. Electrical UFER Grnd. 57. APPROVALTO COVER-GUNITE 7. Footings �58. Electrical Conduit-Undrgrnd. 8. foundation � 59. Gas Pipe, � Undrgrnd., Tes[ 9. Water Pipe•Undrgmd. • 60. Backwash Lines, P�Trap,-� Undrgmd. 10. Sv�ctural F�oor System 61-. APPROVA� TO DECK . • 11. Property Sewer Line & House Connection � 62. Backwash & Receptor•Final ; '12. Sewer Cap 63. Heater & Vent�Final � 13. Roof Drains � 64. Plumbing SYstem -�Final ; 14 Rough Plumbing . 3_G Q1 �- 65. Electrical-Final ' 75. Rou9h Electrical�Conduit 66. Solar System-Final � 16. Rough Electric Wiring � 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING : 18. Rough EleCerical-T Bar Ceiling 69. POOL/SPA SYSTEMS fINAL � 79. Rough Hea[ing & Air Cqnditioning � FIRE DEPT. REQUIREMENT 20. Rough Fattory Fireplace - APPROVALS. � Permit # 21. Ducts, in 5tructure . ,� ' 7p. :U�derground Hydro 22. Ducts, Ventilating -� 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-iiough & Test , 72. Underground Flush . 24. Roof-Framing _- - � '� 73. Undergrnd.Stora9eTank OGas OOi� 25. Roof Sheathing _' �� ' 74. Overhead Hydrp 26. T-Bar Ceiling �Strucmra4) & Monowat 75. Ory Chemical - 27. Freme and Flashin9 � , 76. Dry StantJpipe �- 28. Lathing & Siding • 77: FIXED �SYSTEM FINAL 29. insulation 78. FIRE PFiEV. FINAL = 30. Drywal� Ndiling . � HEALTH DEPT. REQUIREMENT 31. Plaster Bro1Yn Coat 79. �F�NAL INSPECTION 32. Electrical Power Meter�Final 80. FOOD CERTIFICATE ISSUEO 33. Final Electric Notc. 3_6 9'1_G�n��R S�_A_ _ I_� � IY 34. Final Heat�ng & Air Conditioning � ��-9^ �!� �� {/ 35. Fina� Gas PiPe-Test _ =� . 36. Hood or Canopy �, . 37. Final factOry Pirepiace � , 38. Final Plumbing �c61 �I�(,YjJ, / � , � - 39. WaterService�Final � ��`��f -' 40. Gas Servic¢�Final _ ' ' ' . 41. Solar pomestic-Final • 42, Backfiow Preventer , � . _ 43. Backfiow Irrigation • ' - 44. Landscape Irrigation System - 45. Sound Attenuac+on � - 46. Handicap Regulations � ' - 47. FINALSTRUCTURE & BUILDING 48. FINAL PL%�NNING . 49. Electric Re�ease to Edison � 50. Gas Release to Southern California Gas Cn 51. CERTIFICATE OF OCCUPANC No Oate ,� i1DDNF550FBUILqNO: ( ]O W 17TH ST w�xsr+�EiFa�w":pACIFIC MESA PROPERTIES ��670 W 178TH ST kC-4 C.M. 92626 714) 645-6811 �vw. �uia�o aooxess: —� � uxr: D-2 ,wcxrtEer ox e+mi�n: uc Ho.: UICH OR EN4'8 MDPE54: UNT: ��*�� PACIFIC WESTERN ELECTRIC (714)642-6941 cwm�croxs�uta+o 7005 SEASHORE DR ��%NEWPORT BEACH CA ��= 303276 926b3 uN* L10EN9ED COMNACfOHS DECL�P�TION: I hnaby elRm �mder panely d psejury thet I mn Icaned under pwisoro ai Cheqa 9 (cammercuq wGh Sxlim'l000) d DNeiqi J d Ns Buumo ud Pmlaaaiw Code. eM mY �ua e in tu0 bm en0 allsd. �� "00115 6 �c.cuss:C 10 uc.No.: 0 2 6_ EXP: OS/97 Dme: �� OW H BIIILOEfl DECL�HATION; I Mesyy elfirm unAer pmdy W pminy � � em eumq Imm ihe Comreum lieanee Lew la tlr lo wiq ramon (`�� 1.5 Bu�nwa arq Pmlwebrre Code: �M cYy a counry which repuires a peimR lo mmVu.1. Ma. imyaro. md'eh, a rapai eny eV�cture, pr'v w qe bweMa, deo repuiree iM epplimM ta wch pamiil lo file e eqmd NYsmenl iMt M a sM u IiceneeC pum�anl lo ihe powions o� IM CaNratlwe linnae law �Cheqm e(oomma�wiiq wnh SeUion ]000) d Divuion 9 d the Bueir�eu eM VrMoebu CaEel a ihel M a ehe u memq Ihaehan eM the bem la the elbpM uemqun. My vidmion W Ssaion ]Wt.5 b/ enY ��^t la a prmil aEjqpa the appliceM to e tivY peneliy W na mae �han frvs huMred Edlen �f50011. � I,e+owmrdihaprape�yormyemployeeewlhwepeeeatheiedammpemetion,willtlolhexork,enAthesVuclureendimeMeE or ollered la eele (Saction 10d6, Bu4mm eM PrWesabnaCaEe: The Con�redore Lioense law Eoas iwl eppty loen ownerd popeMy who bulda w inpwm Ihareon, erd wlp Aoee euch v.vrk HmeeM or henell or iMaqh hi a her own ampbyees. pwidsd the� euch impovameMs ve nol imrdeA a diyed lor eeb. d. howwer. tM Wikirq a vnqwaman y sold wnNn ona Y� d compluion. iM owo..a��n� �:n n.b ms w,a.� a o��o ne «.ne ed m d�u «�wa+ro. ma wmoa. a.w). � I, m owrr d Ihe propeM. � e�dyenwy ooniradiq wtl� IioenwA canirmlae b cmmrve �ha proptl (�� 1011. BwiMe� e�k Prdeoaiwa Coae: TM Contrepon ��ye {�w doea M eppy b an ovmer d qoperry wlro Wilde w'unpwr t�eraan eM w1w cnnvecb la wM projeds wiih e aoMreiaoHe) licensed punuW to the Camrarfae Licema Law). � I em ecamq ivMa Seciion: B. 8 V.C.. br Nu rea+on: Oale: � I do MreM csnih Uw I em ewue d vd uManieM iM rtawrsmems a cel'tanu IMeM eM SelalY Code 9ed'aro 25505. 255�3. ud 2yL. en0 il�m I a ury Mure buN'vp otlaqwX win / wil m� (mcb one) need ro wnpFy w'th eaN pate wEa� W �M nQivamaM tw e psmu lammwniona ridCrstionhaniAeAi�iy i+roYM� Rm�ia. Pevdemml cmprvtlion WpFmiom ua wmq hom Nms a�. Oma: AGprr�: WONKEfl'S COMPENSATION DKI.�NATION: I Mrsb/ dkm uder ps�elly al pepvy aw d Ms bpow"vp MrWa�an: � IhewmdwilmrMe�eron!'utedmmWlo�etlinsnobrwuken'm�aiuetian.afrwidadbb�8�eim3l00d�Mlebar Cods, b iM palamar�ca d Ns rM la wNc� Nu pmmi u hsued. � � nev..�a.i� meioiei� naw�• mmo�o� imweiw.... i.c��d M saaion aroo d m. �.na. coe.. ror ine o.�� a m. wak t« v.Tirh Mu WrtM b musd. M' wwMm+' mmP�+mion imu�vice ums eM W�Y numbar en: c.m. STATE FUND EXPIRES r�r�b« '�� __ 10/01/97 (ihis ssaion msd nd De candetW I lhs w�i b br aa nuMrd Cdlars R�wl a Mn.l � I oerlA' � in �M pMumenea d the wak la whieh t�u pertn! is iaeued. I eheA m� «npby arry paeon in anY menrw �o n to �.p�o�,. wbjsu o iM xarMSY aomperuNion lawa d Celilomu, eM eprw Nel A I qpuld bacanr aEjetl to IM woiken' / �v�� /+g,s.abn riao a ine iee« coe.. i wn �onngahpyWi .yn moe. po�wme. .".� We p: F Nun b�xurn rort�r�'rompeiu�tlon rov�np� l� un4vM1i( • �lull aW/sct �n xlployw ro MMrW p�vMu �M Iln�� yi b m� �urdro� fhaus�Af lvlNn /i100,0001, M ME/tlon ro cwt ol ronpm�etbn, 4mq� u prvvldM br In Sxtlan �1P6 0l M L�6ar CotY, In(WR urtl �tromryY /sls. CONSTRUCl10N LENDIIM ROENCY: � �yA1y elfirm uMn penelry d perNrv �� ro e mnatriwion MMiiq epmry br �M peAormencs N tM woA lor xfiich Ihe q�n1 ia oeued (Seeion �OB]. C'v. C�. LENDEP'S NRME: LENDEN'4 ADOFE44: I ceNh �� I limw raeE No eppliraiion aM qqe tlw tM ebove iMormetun e mmtl. l epree to cpnply rrilh M ciry eM muMy adi�wam end elete 4xe �elelinp �o buikmB ��d� enC M1araEy eNhonze �epewmmives d ihe irtyto enter upon iM ebwe-mentioneE pope�ly Iw inapedan purpoen. MIKF.. KTRCHNER � (5151-,B.WP) � '�^"�°b"a65Wy.0iee�-Fd6!Lane�y-Appimni:Rnk-Reveruq:Gddavod-Nnvar CTTY OF COSTA MESA — BUILDING PERMII' PERM NO: E 081519 PERMIT NO: E 081514 PLAN CHECK NO: N GOVT: N SUPP; N CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: REP JOH DESCRIPTION : ADD 40A 220V CIRUIT SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: F-1 / COMMENTS: ADD 40A 220V CIRCUIT �t�t�titx�*x�*atit�-�-*-��t+t*-��*atit*�eit�t+e�atatet**atat�x�it+t�tieftie*�tx�**�-*x��-at�x��t�t*�-itit�tx�atar*it*at*x-�-*�-**�t*�� Z O N I N G R E Q U I R E M E N T S S 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 IN RGHT: FT IN PARKING RE(2: PROV: PARCEL: 42428221 ZNE: REF NO: PLANNING NOTES> % 1E IFlE fF 1F 1F 1f jE 1f 1E 1E iE fE IE * IE 1F 1E 1E 1f iE 1E iE 1E if !E iF iE ii fF 1F fF iE 1E 1E IE fE iE fE 1F 1E 1E IF fE if !f 1F 3E iE iF 1f if iE it ik iF Ik fElE iE iF if iF 9F fElk 1E %fE 3f 1k 1E �E iE if IE iE IE iE D E V E L O P M E N T S E'R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY _ DATE; BUSLDING APPROVED BY : �� DATE: a 7% APPLICATZON ISSUED BY: DATE: lEIEIf1EfFlEjFil-1E1E1E1EiE3EiEfE3fff1f1F1E1E 1f1ElE1Eif1ElF1Fif1E � LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC PERMIT 27503 PLAN ISSUE FEE 22.00 BUILDING—DZV—> PERMIT ISSUE PLAN—CHECK TOTALS----> 27.25 22.00 0.00 REVENUE DIVISION TOTALS--> COLLECTED: BLDG PMT PLUMBING ELECTRIC MECHANIC 49.25 FIRE SMIP/RES GRADING SMIP/NON—RES TOTAL PAID llUE 49.25 98.50 —49.25 49.25 OVER/SHORT: 00 FIRE SMIP/TOT GRADING PLAN—CHECR ih iF 1k if iF 1E iE iE iE iE 1E �E jE if ik 16 iE if if iE fh fE iE iE iE iF 1E if 1k iE 16 if 1E 1f iE iE 1E 1E iE 1E 1E 1E �E 3E 1E iE iE iE iE IE 1E 3E iElE 1E �E iF iE 1E iE �E 1E 1E iE iF iE IE iE iE IE 1E if'k!F 1E 1F iflk iE 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 A I P T I O N UNIT COST TOTAL COST ELE 1 SERC'ICES BELOW 600 V& HELOW 201 AMP 27.25 27,25 END OF FEES 82-87-1997/18:28 AM/f49.25 RCPTq:BI—�98175A PEkMIT:081514 CONSTRUCTION AND PLANNING , POOL „ SPA � qPPROVALS Permit # ' Date Inspector p.PPROVAIS Permit # Date Inspecior t. Temporary Electrical Service or Pole 52. Poot & Equipment Location , p, $pil Pipe-Undrgrnd. 53. Steel Reinforcement � � 3. Electrical Conduit Utility-Undrgrnd. . . 54. Forms 4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding ' 5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test .�6. Electrical UFER Grnd. 57. APPROVALTO COVER�GUNITE 7. Footings 58. Electrical Conduii�Undrgrnd. - 8. Foundation _� - 59. Gas Pipe, O Urydrgrnd., Test 9. Water Pipe-Undrgrnd. 6Q. 6ackwash Li�es, P-Trap, C� Undrgrnd, 70. Structural Ploor.System 61. APPROVA� TO DECK . 11. Property Sewer�Line & House Connection 62. Backwash & Receptor•Final 12. Sewer Cap _ 63. Heater & Vent�Fi�al 13. Roof Orains 64. Plumbing SYstem - Final i 14. Rough Plumbing ' 65. Electrical-Final � 15. Rough Electrical-Conduit 66. Solar SYstem�Final 16. ROugh Elettric Wiring . . ' 67. Fencing & AceQss_Approval 17. Rough Wiring Sign 68: APPROVEp FOR PLASTERING 18. Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS�FINAL 19. Rough Heating & Air Conditioning _ . FIRE DEPT..REQUIREMENT _ 20. Rough Pactory Fi�eplace _ , , " APPROVALS- �'� Permit #� 21. Ducts, in Structure - . - � _. 70. Underground Hydro . 22. Ducts, Ventilating �� , -:+ � 77. Product:Piping �Gaz OOiI 23. Gas Pipe�Rough & Test � �, _ `_ 7Z, Underground Plush � 24. Roof Framing " . 73. Undergrnd.Storage7ank ^Gas ❑Oil 25. Roof Sheathing � � -_ , _ 74. Overhead HYdro,. ' 26. T-6ar.Ceiling (Structuraq & Monocoat �� 75: Dry Chemiwl � . -- 27. Frame and Flashing �- ' - 76. Dry Standpipe ' - 28. Lathing & Siding � 77� PIXED�SYSTEM FINAt- 29. Insulation -• - 78, F�RE PREV. FINAL ' _ 30. Drywall Naiiing . � HEALTH DEPT. RE�UIR�EMENT 31. Plaster Brown Coat 79. FINAL INSPECTION ' " 32. Electrical Power Meter�Final � 80. FOOD CERTIFICATE ISSUED . . 33. Final Efectrie �� Notes: � � 34. Final Heating & Air Conditioning �- _ ' ' , . 35. Final Gas Pipe-Test ' .� �� - � � ' � 36. Hood'or Canopy . � _ 37. Final Factory Firep�ace • ' 38. Pina��Plumbing _ _ 39. Water Service-Fina� � y � � 40. Gas Service-Final ' _ -, ' , � 47. Solar pomestio-final + - � � � . 42. Backflow Preventer ' 43. Backflow Irrigation 44. la�dscape Irrigation System � �_ - � ' 45. Sound Attenuation . � - . 46. Handicap Regulations � � - - 47. �FINAL STRUC7URE & BUILDING � 48. FINAL PLANNING , ' 49. Electric Release to Edison � - � 50. Gas Release to Southern Calitornia Gas Co � - 51. CERTIFICATE OP OCCUPANCY No Date / i � PROJELTPODNESS: (�'�O W 17TH $T OWNEP'SNAME: [JACIFIC MESA PROP. noonEss: 670 W. 17TH ST N.B. 92663 AflLHIENGINEEB: AOOflESS: flEG.NO.: uxir: G 1 UNIT: PEPMITTEE: PACIFIC WESTERN ELECTRIC ( 714 ) 645-9326 aoon[ss: 7005 SEASHORE DR NEWPORT BEACH CA 92663 LICENSED CONTNALTOP oEClANa710N: I nereoy aHirm ihat I am licensee unaer Omvisions ol Chapter 9(commencing wilh Section 7000� of Oirsion 3 0l Ihe Business antl Professians CoOe, ana my license is in full foae anE ettecl. cirvuc.: O1� 30327 as: C-10 EX : 09/95 �ate: _ Signa�ure' _ — WONNEflS' COMPE SATION OECIABATION: I here0y aflirm Ihal I havi cenificate ol consent to selbinsure or a cenificate ol workers' Compensalion Insurance. or a cerpiietl copy Ihereof (Secnon 3800, L �. C). raucvNo.: 1222250-93 EXP.ORTE: SOIOS/99 I comvnxr: STATE FUND 7 cemrea coov i ere6 Nr isheA. � Certi�ied coDY is hletl with e cdy/ BuilGinp Oivision.J Oale: ApplicanC "✓�/ E%EMPTIONFNOM PREXS'COMPENSATIONOECIABATION: (ThisSttCnneetlnotGecomDleteOilt�epermiiislarone�unEreE�E700�orless�. I cerlify Iha� in I�e perlormance ot the wOrk tor w�ich t�is permit is issuetl. I shall no� em0loy any person in any manner So as �a become su01e�� o ��e Worker5' ComDensa�ion Laws o� Calilomia. Oaie: $ignaWre: NOTICE: II. aller making this eeclaralion, yrou snoul0 become suUject ta Ihe workeR' CAmpensation pmNsions ol Ne La�or CoOe. you musl lonliwitn comply witn sucn pmvisions or this permit shall Oe aeemed revoketl. CONSTflUtT10N 1EN01NG AGENCY: I �ere�y aflitm t�at t�ere is a consimctian lentlinq aAency tor l�e Dedormance of t�e work for whitM1 Nis permil is issuetl (Seclion 3097, Civ. C�. LENUEH: aooness: OWNEP BUILUEP DECLl�NRTION: I here0y allirm t�at I am exempt imm tAe Conlractors' State License Law lor the fallowinq reason �Seciion 7031.5 Business ana Pmtessional CoGe: Any city o� couniy whic� reQuir¢s a permi� Io ConSlmct, alter, improve, aemol¢�, or repair any slmcWre, prioi to i�s issuance, also requires Ihe apPlican� lor such Dermit to lile a siAneO s�atemeni lhal �e/s�e is licensed pursuam Io I�e pmvisions ol Ihe Coniratlors' S�ate License Law �Chapter 9(cammencin0 wi�� Sectlon 7000) ol Division 3 oi the Business ana Pmiessions CoOe) or I�at �e/5he is exempl �herefmm ane the Easis Ior I�e alleBeO eeemD��an. Any vialalian ol Section 7031.5 by any applican�for a permit su�lects �he applicani Io a civil penal�y oi no� more Ihan �ive huntlred tlollars ($SW�. I, as ownet of Ihe pmpe�y or my employees with waAes as �heir sole compensation, wili Uo tha work, anU Ihe ❑ stmcmre is no� imended or offered for sale (Sec�ion 7044, Business antl Pmiessional Code: Tha Contractors' S[ate License Law tloes not aDPy ta an owner ol a pwpeny w�o builOs or improve5lhereon, anG who Uoes suc� work himseli/hersetl or ihmugh , nis or her own employees. pmviUeO tha� such impmvements are no� intentlee or oifereA for sale. Ii, Aowever the builtlinp or improvemenl is soltl within one year oi completian, ihe owner will have ine �ureen of D�ovinA he/she aiJ not 6uiltl or improve lor ihe ourpose ol Salel. I. as owner ol Ihe O�oOe��Y. am eKclusively conVactinp vrith Iicen5e0 conlractors lo conilmc� ihe pmjec� {Section 7094, Business ❑ ana Pmle55ions CoUe: T�e Contractor5' State License Law Does not apON �o an owner al proDeM1y wllo Uulltls ar imprwes IhereOn antl who COniratis lar SUCh pmletts wit� a contratbr�s)litense purSuanlio Ihe CONrat�Ofs' Sta�E Litense Law),I am aware t�al pmo� al t�eir Worker's Campensation insurance should he D�o��Oetl Io me. � I am eKempi un0er Setiion: B. 8 P. C. lor �his rEaSon: Daie: Uvner. I do �ere�y ceNty I�ai I am aware ol an0 unaer5�an0 Ihe repuiremen�s oi Caiilomia Heall� an0 $a�ery CaUe S¢CIi0n5 25505, 25533, antl 2553a ana ihal I or any fuWre buil0inp occu0ant will/witl not (circle one) nee0 b comDty with saiU state coAes antl the repuirements for a Oeimn br wnslmclion ar moA�licalion Imm ihe Air Oualiry Management UiSinct. fle5i0ential constmction apDlications are e.empt Imm I�Cse pmvisions. Date: Applicant: I hereGy cerlilylhai I have rea0��i5 application antl slate��at Ihe above inl0rmaiion is corr¢ct. I apree lo complY with a0 ciry anU counry orAinances antl 51alelaw5rela�ingio builAing cons�mtlion anA �ereby aulhoriieiepr¢sen�alives oll�is cilyto ¢nleru0on10e a0me�mentioneU propetly lor inspeclio purposes, / �ate: �_ Signalure: /1� Dri�er's Lkense or Sociai Security x.� t6aL06 Wb�ta—BuilOing; Gwen—CoOe EnlorcemenL Canary—ApPlicaM: Pink—Rovenuo; GOltlenroC—Assesaar CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: E 068435 PLAN CHECK NO: N CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE JOB DESCRIPTION ; INTALL H.C. RAMP 5 UPGRADE RESTROOM CLAIM VALUE: CALC—VALUE: PERM NO: E 068435 GOVT: N SUPP; Y PURPOSE: ALT SQ FT: GROUP OCC: B-3 / COMMENTS: REF: B-66780, SUPP PERMIT FOR METER RE:#E67045 �rx��**xx�***x�x��r�r�r****+t�tit+t�rx**�r*�r**xx�x�*+t*�tx�+rx�+rx��rx�x�*x�x�*�r*�rx�x��rx**+t�r******�rit�rx�x�*x�x��* Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT; FT IN RGHT; FT IN LEFT: FT IN AGHT: FT IN PARKING REQ• PROV; PARCEL; 42428221 ZNE: REF NO: PLANNING NdTES> i 1f 1E 1f 1E 1f !!!t k 1klklt 1f 1f !f !F!k!F!F iF iFlt k k it 1F k iF ik iE 1! i! if 1f 1E 1E 1! i! 1F 1F 1f it if 1F 1F 1! iE 1f !t fE 1E k ff �F �k iF iF if if 1E f! 1E fF 7f 1f if 1f iE i! f! ff 1! 1E iE t! 1k ff iklE fE D E V E L O P M E N T , S� E= R V I C E S R E Q U I R E M E N T S :��. ZONING APPROVED BY ' ' DATE: BUILDING APPROVED BY : • f� DATE: APPLICATION ZSSUED HY; .� DATE: Lg ��14 lE1f1E1E1EiE1k1f1Flt�F1f1E1fk�E1lififiFiF7F lf1FiE1F1fif7tfE1lfE iEif if i! i! i! it 1! tf 1F ik 1E 1ElE iE i! ik ff ft 4 fE f! 1! 1E 1E fF if if k!F 1E iFlF�if 1f.it 1f 1E ik 1f it M M fi 7f fk if iF 1t ik iE 1E 1E ik ik 1E iF tFlF i! ff fE if 1F ff if if 7t f! iF ff 1E 1E i! iElE 1E fE ik 1E 1f LEGALIZATION:N F E�E, S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 18.50 SOY PLAN ISSUE FEE 4.50 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTALS----> 18,50 4.50 0,00 REVENUE DIVISION TOTALS--> COLLECTED: BLDG PMT PLUMHING ELECTRIC MECHANIC 23.00 SMIP/NON—RES TOTAL PAID DUE 23.0� 23.00 .00 23.00�OVER/SHORT: 00 FIRE SMIP/TOT GRADING PLAN—CHECK 1F k 1F ff 1E 1t 1! 1E 1klFlt 1t iF ft iklf k itlk 1t 1E if itlE 1E iF if if if 4!f i! iE it 711! ff if if 1f k 1f !k iF it iF ff fE 1flt 1k fflF ik 1klElF i!!!!E 1Elf fk 1f iF ff 1E!! 1k if 1k iE 1t 1f fE 1! ft f! it 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 ELE 1 SERVICES BELOW 600 V 6 BELOW 201 AMP 18.50 18.50 END OF FEES V 01 QOi65741—OOt6`741 T C�T r�QQ DATE: OE/iil94 TTME: 09:20 _ _ ., �„ =�. CONSTRUCTION AND PLANNING POO .PA APPROVALS Permii# Date Inspector qppROVALS Permit� Date Inspector 1. 7emporary Electricat SerJrce or Pole 52. Pooi & Equipmenc Location 2. $oilPipe�Undrgrnd. v ; ; 53. SteeiReinforcement _' . 3, -Ele�ctrical Condv�Y_U't41iry-Un�irgmd:' � � ' 54. Forms - �,4� Electrical Condu I�J�drgrnd. v-� 55. Electrical Bonding = 5� Sreel Reinforcemetic' - 56. Rough Plumhing & Pressure 7est �- �6j'`�IectricalUFER�Gj,�,��1. y� 57. APPROVALTOCOVER�GUNITE ' I ^7: FOotings ��::'� 58. Electrical Conduit�Undrgmd, r -.. :"8. Foundat�on ' ' ' 59. Gas Pipe, O Undrgmtl., Test 9� Water Pipe�Und�rAd. , 60. Backwash Lines, P�Trap, CI Undrgmd. � 10. Structural FIooFSvsiem �� 67. APPROVALTO DECK tt. Property Sewe�;tine & HauSeCo�n�ctio� 62. Backwash & fleceptorFinal 72. Sewer Cap • ' 63. Heaxer & Vent�Final .✓ � i 3. Raof Drains . -� V 64. Plumbing System - Final 14. Rough Plumbing� - - 65. Electrical-Fina� 15. Rough Electrica`I�Condu�t 66. Solar System-Final 16. Rough Electric Wiring i 67. Fencin� & Access Approval ^� �� 1�7, qpugh Wiring Si�gn `� - 68. APPROVED FOR PLASTERING 78. Rough Electrica7�T Bar Cei�ing 69. POOL/SPA SYSTEPnS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. _f}ough Pactory FiTepiace �: r x _.� ' t�� APPR07JAL'S'� P Permit # y � �� -�.• - - . � - ;� _ v � � .�t , - 21.'Ducri,in$tru¢'tur�,. � ; � '�:' .;. - J �7�'. * j0. (tdderjro}.ipd-¢IYdio , 22.�DuctS, Ventilatinq-+': . �_' �; y ' ' " ;I. ProducbPi(�irig �'�ias ❑Oii 23.'Gas�Pfpe�houg�&T`est ' '� ' ,� ��Y" � , ., ,. � -� � - � . �2. Undergrourid Flusli , . 24. r�0of �Framing.: � �� . . � • � G - '-J3. _llnderyrod'�Storag Tank L Gas ❑ Oit r � Z5. Roof.Sheathing � „ �' � � 'n . � ' 74.`Overhead Hydro J 26. �T-BaryCe�ling (Structaral) & Monoaoat f� � '� -� m � •� 75. Dry Chemical 1 + � 27.�FrameaodFiashin • �,,,, � 76.'Dr Stand� �y; � . ' > � .� ^i ... _: r. � Y f?� P�, �8. Lathing&,Siding:�, ca y•.; ._ L. �, '..+� + 77.��'FIXED SYSFEM�FNAL , �29. Insulatior�i� �� ' '�� ;, �� ' , �y ` 78.`_FIRE PREV. FINA.W �- r v _;i � � F:;� � �' ' � I:: � � HEALTH OEPT tREQUIRE NT 30. Dry�vall Nailing . 31. Plaster Brdwn Coat � y ; � �' ?9. FINAL INS�',F�CTION'; `" " - 32. Electrical�Power MeterFinal � � ��s/{� ; ` ' �P�• � ��---_��_ - ��/I .500D CERTIFICATE ISSUED _ . .. 7 �� `, . 33.'Kinal Electric� ' - r i � V//�I�/{ ! _ , � �N�te�t:_ ��j - - ' _ , ' - ' . tJ� J 3,4..F,inal+iea4ing�&Ai�.Coridixioriing•= � � r � , 1'ti _. • � r 35. FinalGas-Pipe-Tesr* � " � I '' '�� '�S . _ i ' • r-. i � .: .� J'-� 36. �HooU.;or CanoPv : _� ' , a -1 . � � � •� 5' . . . � .. " -' 1 Y a� n 1-1 3�. Final'Factory FirePla`ce' ' -� ' i j r; z ' . . 38. FinaLPlumbing ,. � .. . .i .- � � . ' -� � � - 39. Water,Service-Final•' � • . r , ;x • .. : ^ �, 40. Gas Service-Finai ' ' � ,� .,. _ - r � � 41. Solar pomesticFinal< . ^ � %z � � ' ' . 1: -j � ,� ff � 42. Backflow Preventer� �'• - i i. � -� -� 43. Backflow Irrigation ' -� ' ; , " ' - � � . �_ 44. Landscape ircipation System y� ; , - , -7� r, ;•� . � 45. Sound Attenuation � � ' . ' - � , y •rJ � 1 . - r� . ' � n 46. Handicap Reguiations ,; �� T .. 47. P:INAL STRUGTURE & BUILDING � I,. iy - • ; � 48. FINA,L PLANNING , �, „ � � - - � i I` 49. Electoic Release to Edison � � � - -� - � � , r� • 5Q. Gas Release to Southem California Gas Co h � � . � • � • 51. CERTJFICATE OF OCCUPANCY " . .- . ' No. Date � t City of Costa Mesa y"'� ` Development Serv��es Department ' �� Building SafBty Division � ' P. O: Box 7200 Costa Mesa, Califomia � CERTIFICATE / �X / 1 OF OCCUPANCY No. �,r,yb�� ! The Building Vocated at . F7n ra ,_i a.s�, n�___,. _ ha`s been inspected and found to coinply'with the provisions o al��Ciiy of Costa Mesa Ordinances applicable thereto for a Group n_� Occupancy Use of Building nAc�.,�ra.,� Legal Description d�d—�Al _(t� - - ,` ' (See .everse side for Metes and Bounds) Building Permit No n�c7n� Electrical Permit No. A.R71 R_FEIfi15tpP�lumbing Permit NoP��+�QQ .P��7� MechanicalPermitNo. M�F��A Mt�Q�S� Numberofapartments and/orguestrooms iSSUEo T0: Building Official n; i i u.,v�a,-,a Donald L. Roaers p',r y.-�" , � 670 W. 17th Street, Suite 17 by �'• �.�'� :.c, f��,�i�l� Costa Mesa. CA 92627 � ` . Date `l • / j' Y `} This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Offieial of the City of Corta Mesa under Sec. 307 (e) U.B.C. CMF 1015'46 rev. 1/83 White -Owner; Canary - Numerical File; Pink � Bldg. Permit File Aoolicant to /III in all soaces exceot t�osa within neavY bo�0er Iines antl si9n all aOVroO��ale tleclarations. �.: CITY OF COSTA ME A/� CO ST TI O PE��jjj InT PEqGpQ1T NO.� �� TRACT NO. , l0T NO. UNIT Np9. � .�.� ��,I . I IO%/B% q� `� t , Pro)ectAddrMs ��(L�� rfr_L3!�� ` �y . L� � I .74080 Applicant's Mailing(P�/)d�ress ��- / / TVPE OF CUNSTRUCTION NEW AD� ALTERATION REPAIR � Owner'sName� ��• ' ph��p � CONVERSION ❑ OEMOLISH ❑ OTHER A.P.# , ' Zone /q �� ,�� DESCRIPTION OF WORK/USE OF BLDG. (�ddress �pl�li�• � - ' S Main Building: Accessory Building; t Arch/Eng. License No. TVPE OF PERMIT�y GRADING FOUNDATION STRVCTURAL T Front ' p ❑ TENANT � lECTRICAL ❑ PLUMBING ❑ MECHANICAL B N Address A Rear � ❑ OTHER ' Contractor'sNam �i' L � > PI ne � K Right � G � PRQIECT DESCRIPTION 5O. F7. OCCUaArvCv Address (mailing) • � Left • - CONSTRUCTIONTVPE VALUATIONS S City LiC¢n5C No. -__ Q-3�� 70NE GRADING CV. VOS. ACRES R LICENSED CONTRACTOR DECLARATION Ping. Fef. dp Parkine Req.IProvided E I hereby af(Irm tbat I am IlcenseC untler prp��5lon5 of Charter 9(commencing Remarks: s� Planning Notes: � WIIh SCCt100 %��0) O} p�V�5�011 3 of tho Business antl,Professions Cotle, antl . M my Ifcensa is in t I torce antl effect. n� �i -- T IJcense Class � Lic zn :.N/�� . S �Date ��-kT Signature . PLUMBING FEES ' - WORKERS' COMPENSATION DECIARATION Baf Sink ShOW¢r5 I nereby aftirm that 1 nave a ttrtificato of cansent to self-Insure or a carUlicate . ELECTRICAL FEES � of WotkeR' Compensation Insurance, o� 8 certifietl <opy thereof ($ection BackflowPrevenrer � Service5ink � 3800, l.ati. C�{�.eq �( ��('� '[� / %% Autometic Washer Transtormer ❑ 15-50 KW Polic No: �-�/`-/ /,�(/�_ Compan �%%lOV2f�S `�!%�i�</ BackfloW Irri ation Sewer Ca � ❑ SO+KW � Y Y 9 P ConstructionPole$ub.. + 8Certilietl copy is hereby furnisned. . . . Certi�ie0/��op� letl with the ciry, �yJy��_— Bathtubs Sewer Connection Cooking Unit Meter Qup l0 700amps �ate�(C_�i� AOP��can��LC - . . - E%EMPTION FR M WORKERS' COMP SATION DECLARATION CId�iFiC�s $Oldf C0112Ct0�5 '� Di5hwd5h¢! Mft¢� ❑Ov2� t00amps (ThiS settiOn naetl nOt be completetl if the pBrmit is tor Ona huntl�e0 (S100) or Iess). Dishvsashec SolarPiping - � ' Dryers ❑Ga5 ❑Eleciric SubPanel �'�/� - � I certity thal In the perfOrmance of [he wo�k /or whiCh this permk i5 i55uetl, I shall not employ any person in any mannor so as to Decome subject to the Drinking�Fountains Solar Tank Fan Momrs 00.1 HP 01 X- 8 O Workers' Componsa[ion Laws ot Callfornia. � Date Signature Floor Drains Swimming Pool w/Spa f.A,U. - NOTICE: It, atter making this tloclaration, ypu shoultl become subject [a tha _ Inc.Solar �9-15 HP �16�15+ Work¢rz' CompGnSd[iOn provisioni Of the �bof Cotle, y0u muzt toftllwlth FIOOf $iflk5 Ufifldl ' FixLUlQS <ompty wilh Such O�ovlslon5 Or this PO�mit Shall be deemetl �¢vOkltl. � MiC�Owdv¢ CONSTRVCTION LENDING AGENCV Ga5S0rviCe Outlets WaterCloset • DevIGeBOxei PoleLi ht �, 1 heroby afflrm [hat the�e Is a cOnst/uclion Ipntling 098n<y for the pe�fo�manc0 - 9 Ot tha wOrk !of which thls pefmit IS ISSuetl ($Cction 309] Civ. C.) IntCfc¢ptOfS W8t¢f H¢dt¢f �Utl¢[5 � �entler'z Name Range 1..entlers Adaress Kitchen Sink Water Service � Switches '- � g�9� , I. OWNER BUILDEH CiECLARATION .. I he�eby aHl�m tha[ I am oxampt trom Ihq �onVacto�'S Llcense Lnw tor [he LdvdtO�iNS AptO-W85h c. Garba 2 DIS OSdI /ollowin9 reason (Section 'l031.5 Business antl Professlonal Cotle: Any Nty or 9 P Sianding Sections county wbiCh requires a permlt to ConSt�uC(, alteq imp�ovP, tlemoli5h or /epair P-T�2p � LBUnd� T�e 5 any sVucture, prlor to its issuance, also reyuires the appliwnt for zuch permk � Y : Genera[or �0�5 KW �5-15 KW Trash Compactor [o file a Si9netl Ttatement thdl he/sh¢ is IlcenSatl putsuanl t0 the pfovitioni of ROOi Of8105 the Conlraclor'S �icense Law (Chapter 9(CryTmencing with Section ]000) oi DiviSion 3 0/ the Busin¢ss antl Protessioni CoOe) o� thal he/ihe ii ¢x¢mpt - � - - � � thereM1om antl tne ba5is far Ihe allegetl exemptlon. Any violation of Section , , . 7031.5 by any applicant 10r a permit 5ubject5 the applicant to a Uvll �enalty of not more than (ive nuntlretl tlolldrs (E500). I, as owner of 'the property or my ernployees with wages as their sole ReinspeMion Fee $15 Issue Pee � S 3 ' � . ' mmpensation, will tlo the work, antl the s[ructure is not Intentletl or ofieretl Reinspection Fee $15 laue Fee $ 3 for ule (Section 7044,- Business antl Professional Cotle: The Contracmr's MECHANICAL FEES LiCense Law tlo¢5 nol dppry lo an owner O( a prop¢rty who builtl5 O� ImprOves thereon, antl who tloes such work himself/herzelt or tnrou9h his ar her own - DEVELOPMENT SERVICES REDUIREMENTS: ' employCes, prOvltletl [nal SUGh Improvemepl5 are no[ Int¢Otl¢tl o� otte�etl lor BOiI¢� HOOd Of TypC 1 ❑ � �� s01e. If, however, tne bulltling or Improvement Is zoltl within one yaar o1 com- C2nopy Type 11 ❑ 2oning Approved By Date plotlon, tno owner wlll hava the buraon of proving ne/sne tlitl not bulltl or im- � Duct - Under Ground Buildin8 %�PProved 6y Dato prova for tho purpose of Sale). � . ❑ I, a5 Ownar ot the p/operty, am ezcluSlyply contfacling wlth lic¢nsotl con- � D�uCt -St�uCtUf81 R¢ffigEfBtiOf1 $yStEm ApplifBtiOn ISSUBd By Dat �ractorsto cons�ruct th¢ prOject (Section 7044, Business antl P/ofe55ion5 COtle: Tne Contractor'S Licensa Law does' not appty ro an owner of property wno Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARV OF FEES � � builCs OI ITproves thGrOon, antl wilo cOnt/acts for Suth prOjetts witll a Con- tractor(sl ucanu pursuant m tne Contractor's License Law). I am awaro tnat Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ proOt o( thelr Worker•s Compensation In=urance snoulE be provitlea to me. PLAN CHECK S PERMIT " ❑ I am exempt untler SecUon B. & P. C. tor this reason Firepl/Fact. BIL ICBO � Fire Dempers PLUMBING . $ �SSUANCE $ Date Owner � Heating System & Ducting Regiseers � PLAN�CHECK 25% $ ENERGV P.C. $ i hereby certify that i nave read Ihis application antl ztate tnat the above ❑0.100,OOOBTU�100,0006T ' ELECTRICAL $ GRADING $ - � inbrmatlon B correcL I agroe ro compty wlth all cily antl <ounty ortlinances - � antl state laws I" g builtlin9 conitru�(lon, antl heraby autnorize ropre- - � D MICROFILM $ sentatWes ot i to entar upon tqe above-mentionetl ropert t PLAN CHECK 50% $ (�%� inspectlon . % /-�� MECHANICAL � $ TOTALFEE $ .7��/ Signature k�Ci�-.i Date (7 . Drivers'�LI<ense or 55 � - ^ ReinspeeNon Fee $75 , Issue Fee $ 3 . PLAN CHECK 25% $ CMr Uebb-cb, rev, io/av wm�e - ouuamg; canary - atppucanq rmk -�accounong; a.eivanreu - qssessDi \ • CONS7RUCTION AND PLANNING POOL & SPA `� APPROVALS Permit # Date Inspecto� qppROVALS Permit � Date Inspectoi `"� 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. Electrica7 Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test � 6. Electrical UFER Grnd. 57. APPROVALTO COVER�GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. � 8. Foundation �� 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. • 10. Structural Floor System 61. APPROVAL TO DECK ' 11, Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 73. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing � 65. Electrical-Final - 15. Rough Electrical-Conduit 66. Solar SYstem-Final 16. Rough Electric Wiring ��`J 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 Struaure 70. Underground Hydro � 22. Ducts; Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTtON • 32. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED � 33. Final Electric �� otes: �.� � t� 34. Final Heating & Air Conditioning " - -Sl � .e 'a 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 � , • I 43. Backflow Irrigation � -; �- � � r 44. Landscape Irrigation SYstem ; . • �- , 45! Sound Attenuation - -� • - - � �. � ,46. Handicap Regulations � , 47. F�INqLSTRUCTURE&BUILDING � ,. � ' ' � �j 48. Special Requirements Completed � �� ' � 49. Electric Release to Edison � " i 50. Gas Release to Southern California Gas Cn �,, ' 51. CER7IFICATE OF OCCUPANCY . • I No. Date � , � � Aoolieant lo flll in all soaees exceot those w��nin �eavv EorEer Iines anE slan all aoorooriate Geelarelions. CiTY OF COSTA nnESA CONSTRUCTION PERMIT . PE IT NO. TRACT NO. LOT NO. UNIT NG. �`;; �530 3/06/B7 16050 ' . ProjectAddress 670 W. 17th St � , _ Applicant's Mailing Addr255 TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR , ❑ CONVERSION ❑ DEMOLISN ❑ OTHER q,p, �j6 ' Zane Owner'{Name $1Y Rogers II _Phone DESCRIPTION OF WORK/USE OF BLDG. �Address 6]0 W ��th--St ' - S Main Building: Accessory Building: E Z Arch/Eng. LicenuNo. TVPEOFPERMIT GaaoirvG FOVNDATiON S7RUCTuaA� T Front � p Addre55 ❑ TENANT ❑ ELECTRICAL ❑ PIUMBING ❑ MECHANICAL A Rear � N Contractor'SName—jr�gr_�,_��yJdm PhoneQ�l�.Z� �'OTHER - C RI ht ' N Address (mailing) 6$.�� B.La�_ 92621 PRaECT DESCRIPTION 5�. F7. oCCUPAraCv 9 CONSTRUCTIONTVPE VALUATION$ g�S. O g Left . G City LiCenSe No. ��.] 20NE GRADING CU. V�S. ACRES R LICENSEO CONTRACTOR OECLARATION Ping. Ref. # Pd�king REq./PlOvid2d E 1 nereby ailirm that I.am licensetl untler provi5ion4 of Char[er 9(commencing Remarks: Planning Notes: � witM1 section 7000)�ot Division 3 of [he Busines5 antl Profe551ons Cotla, antl Install �Fire Protection S St21R in KitcThen M my license is in full force antl effect. y T �icense C�azs ' — � e rvo. HoodS & DuCtS Plan Check Fee $ i g Date � H PLUMBING FEES z—r3--o� WORKERS' COMPENSATION D RATION ' t I hereby afiirm that I have a certlticate oi consent ro self-insure or a certi/icate Bar Sink Showers • ELECTRICP.L FEES oi Workers' Compensation.lnsurance, or a certif�etl copy thereo5 (Sectbn _ Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW 3800, Lab. CJ ' f Policy rvo. ia��LR7�5(1 �ompany[IR�tP� p��f�� Backflowlrrigation SewerCap ConstructionPoleSub. � 50+KW 8 Certifietl copy is hereby furnishetl. Certifietl copy is filetl with the cit il " Div� Bathtubs Sewer Connection Cookin9 Uni[ Meter ❑up [0 100 amps oatezz.��$� Applicant Clarifiers � Solar Collectors Dishwasher Meter ❑over 100 am s ' � EXEMPTION FROM WORKERS' C M SATION DECLARATION _ P (This section neetl no[ be completetl if t permit i5 for On¢ huntlretl (E300) or less). Dishwasher Solar Piping Dryers �Gas ❑Electric Sub Panel I rertity lhat in the petfo�mance of the work fOr Which this perm�t i5 iSsuetl, I � \shall not employ any per50n in any mdnner so as to become subject to the Drinkin9 Fountains $Old� TBnk F3n Workers' Compen5ation L.aws of Calitomia. MOLOrS �61 HP 01 h- $ Date S�9nature Floor Drains Swimming Pool w/Spa F.A.U. \'NOTICE: If, after making this tleclara[ion, you shOultl become subject to the In0. Solar �9-15 HP �16-15+ Workers' Compensation provisions of the Labor Cotle, you must torthwith Floot Sinks Urinal comply with such p�ovlsion5 or thi5 permit Shall De tleemetl �evoketl. FixtU�¢5 Microwave CONST0.UCTION LENDING AGENCV Gas$erviCe OUtlets WaterCloSet 1 M1e�eby affl�m lltat tnere IS a consiruction Ientling agency fo� the pe�to�mance ' D¢vic¢ BOx¢5 POIC Light of Ihe work (or which [his permit is issu¢d (��tion 309] Civ. CJ �nt¢tc¢pt0�5 Wdt¢t H¢et¢� �utl¢LS � �entler'S Name R2nge Lentler'S Adtlress Kitchen Sink Water Service Switches Sign OWNER BUILDER �ECLARATION , I hereby affirm [hat I am Gxempt trom the COnVacto!'s LicenSe Ldw foI tM1e � LdvdtOfi¢5 � AUtO-W85h Galbd 2 Di5 OSdI followin9 reason (SCction 7031.5 Business antl Pr0lessional Cotle: Any city or 9 P ; Standing $¢ctions county which requires a DermR [o construct, alter, improve, tlemolish or repalr p_7rap ' Laundry Trays Generator DO-5 KW �5-15 KW • any 5[lucture, pfio! to its iSSuance, also Iequirez the applicant for zuch pefmit TfdSh COTPdCtOf to file a SignCd Statem¢nt that Ile/ihe IS Iicensetl bulsuant t0 [h¢ PtOVlsion5 of ROOf Dfdi05 the Cmtracror's License l.aw (Chap[er 9_(commenung wi[h Sactlon ]000) of - Division 3 of the Business antl Protessions Cotle) or [hat he/she is exempt , lhere(rOm antl tht basis tor th< allegeC ez¢mptio�. P.ny violation of Section 7031.5 by any applicant for a permit subjec[s Ihe applicant to a civil eenalty ot no[ more than five �untlretl tlolla�s (E504I. . - LJ I, as owner ot the property or my employees with wa9es as their sole Reinspection Fee $15 laue Fea $ 3 compensation, will tlo the work, antl the structure is not Intendetl or oiferetl Reinspection Fee $15 Issue Fee $ 3 for sale (Settion 7044, euslness and Professional Cotle: The Contractor's MECHANICAL FEES License Law tloe5 n0[ apply f0 an owner Ot a property who builtls o� improves thereon, ana who tloes sucn work himzelf/hersel� or through his or her own , DEVELOPMENT SERVICES REQUIREMENTS: emv�oyees, provitle0 that sucn improvements are �ot inteneea or otfcrce for Boiler Hood or Type I ❑ . Sale. It, hOweveq the bulltling or Imp�ovement is 4oltl within one year of com- C2nopY TypC II ❑ ZOning ApprovBd By Date pletion, [be owner will have [ne burtlen of provin9 he/she tlitl not bWltl or Im-; Duct � Under Ground guildinp App�oved By Date �ove tor the purposa o( sale). I, as owner of the oroperty, am exclusiv¢ty co�iractin9 with li<ensetl con- Duct -Structural Refrigeration System Applieation Issued By �� - Dat tractor5 t0 construct the O�oject ($ection 7044, Business anE Professlons Cotle: The ConVactor's license taw does not apply to an owner ot oroperty who Duct - Ventilating ❑0-700,000 BTU ❑100,000 BTU builtls or Improves thereon, antl who <ontracts for such projectz with a con- SUMMARV OF FEES tractor�sl Ilcense oursuant m rne Contractor's Lite�se Lawl. I am aware that Exhaust System ❑ MWtiple ❑ Sysrem Repair/Alteration BUILDING PERMIT $ 1 6. 0� SMIP $ . 5 � proof o( their Worker's Comoensatlon insurance zhoultl be provitletl to me. - PLAN CHECK $ '� PERMIT ❑ I am exemot untler' Section B. 3 P. C. (or ihis reason Firepl/Fact. BIL ICBO # Fire Dampers PLUMBI NG $ ISSUANCE $ Date owner � Heating System & Ducting Registers� � ENERGY P.C. $ PIAN CHECK 25% $ . I hereby certify tnat I have reatl this ap0��atio� antl state that the above ❑0.100,OOO�BTU �100,OOOBT - , �� GRADING � $ Intormation iz correct I agree to comply with all city and county ortlinances ELECTRICAL � $ antl itate laws relatln9 to buildng constructlon, 9n0 hereby authorize repre- • sentatives of�p is city to �r upon lha abo+e-mentionetl property tor � . PLAN CHECK 50% $ MICROFILM $-C1�' i � inspection puiP6ses. ' . MECHANICAL' $ , TOTAL FEE $ Signature �a�e2=�� Reins ction Fee $15 Isue Pee � � $ 3 PLAN CHECK Z5% $ � Drivers' Lic nse 55;� ' � CMF 0865-46, rev. 30/94 WM1lte - 6W Itling; Candry � HP��nc; NInK - siccounong; me�aenrov - Hs5855of � _ CONSTitUCTION qND PLANNING POOL & SPA -' � APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector 7. Temporary Electrical Service or Pole 52. Pool & Equipment Location �2. Soil Pipe-Undrgrnq, , 53. Steei Reinforcement �- 3. Electrical Conduit Utility-Undrgrnd. 54. Forms -• 4. Efectrical Conduit-Undrgrnd. 55. Electrical Bonding � _5. Steel Reinfarcement 56. Rough Plumbing & Pressure Test � �,6. Electrical UFER Grnd. - - 57. APPROVAL TO COVER-GUNI7E ; 7. Footings _� • 58. Electrical Conduit-Undrgrnd. � -8. Foundation � � 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. '� 60. Backwash Lines, P-Trap, O Undrgrnd. � 1D. Structural Floor System � 61. APPROVAL TO DECK � 17. Property Sewer Line & House Connec[ion � 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 � r 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING i -18.-Rough Electrical-T Bar Ceiling 69. POOVSPA SYSTEMS FINAL . 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT . 20. Rough FactorY Fireplace APPROVALS Permit # 2L �DuCts, in Structure 70. Underground Hydra 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=6ar Ceiling (Structural) & Monocoat 75. Dry Chemical i�� . 27. Frame and Flashing 76. Dry Standpipe � 28. Lathing & Siding - 77. FIXED SYSTEM FINAL �/O.-4 /� 29. Insulation %' 78. FIRE PREV. FINAL � J•d j � 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 & P,i� Conditioning 35. Final Gas Pipe-Test � � � 36. Hood or Canopy 37. Final Factory Fireplace � � 38. Final Plumbing � 39. Water Service-Final 40. Gas Service-Final . 41. Solar pomestic-Final . 42. Backflow Prevenier . ' �� 43. Backflow Irrigation � � � - 44. Landscape Irrigation System , 45. Sound Attenuation � � ' 46. Handicap�Regulations . � 47. FINALSTRUCTUFE&BUILDING 48. Special Requirements Completed 49. Electric Release to Edison ' � 50. Gas Release to Southern California Gas Co � 51. CERTIFICATE OF OCCUPANCY ' � No. - Date � Applicant to fl11 In all sDaces except lnose witnin neavy Coraer Ilnes an0 sign ail aoV�oorlate aeelantions. CITV OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. ' TRACT NO. LOT NO. IINIT Nft Prolett Address �� %� � S�, �• i.LN 1'f Applica�YsMailingAddress ��7 OP.iIAIErBWO/Ip itVd , 9wneYs Name � �o %J �-�` ��5 Phone Address �%b W` . ! %� '�i%. Arch/En3._ License No. Addrgss Contractor'sNam�i�L�� GT_ �RC GT• hone�0 Addr@ss Imailing) �52� W' �QRUL�wL7J' V Qvl� City�icenseNo. ��3'2-3 LICENSED CONTRACTOF DECLARATION• I h¢reby aftirT [nat I dm Iicenl¢tl untler provi5ions of Chdrter 9(comm¢ntlng with 3ection 7000) of Division 3 ot Me Business antl Pwtessions Cotle, anG my Ilcense is in tuu torce and eHect. I�7�9,� l.icen5¢ Class L"� L icense No. Datc �Z--17�•4Sio Si9n+tve u/l.i WORKERS' COMPEMSATiON DECLA 710N I nereby afiirm that I have a certiticato of con5ent to selt-lnsure or a certiilcate of wbrkers' Compensation Insurance, or a certifiea cooY thereof (Saction 3800; �b. C.) � Pollcy No. Company ��],Ce��i(ietl coOY �s �ereby fumishetl. �S•CBrti1ieC cy PY1 S filetl with the ciry il I Wis' n oateJ'Z-i�7'£S(v APPlicanl ��u�� EXEMPTION FROM WORKERS' COMVENS ION DECLARATION �(Thissection neetl not be Completetl if tht permit IS tor One huntlretl (E100) or less). 1 certity chat In the performance of lhe work for which this perm�t is Issuetl, I sitall not employ any pe�son In any manne� so as to becom¢ sub�ect lo (he Workers' Companution Laws of Cali�ornia. Date S9natwe � NOTICE: If, aftOr rbaking thi5 tlecla�alion, y0u ihaultl bGCOme subjlCf to Ihe Workers' CompCnsatlon provisions Of thn tabor COtla, yoU must fortnWi[h compiy viith suc� provisions or tnls permit shall be tleemetl rovoketl. CON$TRUCTION LENDING AGENCV � 1 hereby afllrm Ihal there Is a Conitructlon ICntling agenGy for tbe performdnc¢ � af the work for which this permlt Is issuatl (Section 3097 Civ. C.) Lentler's Namc , Lentler's Atltlress OWNER BUILDEq UECLARATION I hOreby a}fi�m that I aT exempt trom the Cantrat[o�'S Llcense Ldw for th0 /ollo�ying rCason ($ectiOn 7031.5 BuSintss antl Proto551onal Cotl<: AnY City o� ` county which requires a permlt to <onstruct, altar, improve, tlemolish or rapair - anv 3tructur¢, prlor to its issuan<e, also requires tho applicant for such varml[ 1 to tile a si9netl statemant tnat ho/sne Is IicenSetl pursuant to the provisions of tho Qanvactor's License Law (Chapter 9(commenc�n9 with $e<tlon ]000) ol ' Division 3 of the 6usiness antl"Prolossion5 Cotle) or that ne/zne is axempt tborolrom antl tne basis for the alle9etl axempHon. Any violaHon ot Sactlon �]031,5 Dy any aOGlicant fOr a permit subjotts Ne applicant to a civil �ena�ty oi not mora than Iiv¢ huntlred t1011ars (5500). LJ I, as ownar ol tne proporty or my employees with wages as thoir sola coTpenid[bn, will CO thB work, an0 Ibe Struclure IS nOt IplCntl¢tl o� OflOretl for sala (Section 7044, Business antl Profeisional Cotle: The Contractor•s � Lice05¢ Ldw tlocs not dpP�Y (0 dn owne! of d property who bWItlS OI lmprOvei tharaon, anC who tlocs such work hlmsel(/herseH or tnrough his or hor own empl0y ee5; provltletl thal such iTprov¢men[sara nOt Intentletl or ofto�etl fOr sd10. N, howevOq tne bulltling or improvemen[ is sOltl wlthin ona year o1 Com- pletlon, ttte owner wlll hdve tba Uu�tlen 01 P�oving hC/She tlld nOt buI10 or Im- �ov� tor the purpa5o O� sale). �, as owner oi tne property, am exclusively contractin9 witn Iicensetl con- trac[ors to construtt tlte projett ($¢ctlon ]004, Buiinass antl Professions Cotla: Tho Contractor's License' law aoes not apv�Y to an owner ot o�aPerty who builtls or improv¢s tnareon, antl who contratts br such projects with a con- tractof(s) ❑tense Oursuant fo [he Contrattof's LiGonse ldw). 1 am dwara that pro0( Of their WOrker's CompensatiOn Insurance shoultl �e provlUetl to m0.- ' �] I am exempi untler Secilon � 8. & P. C. for tnis reason � Date _ I hareDy Intormati 'Si9nature _� -0riv¢rs' LlcenSe Or 5', CMF 0865�46, rev. 30/84 _ owner have reatl ih(5 application antl state lnat (he abova agree to compty wlth all Uty dntl county ortllndnCes o b aing construclion, antl hareby a�thorize reore- ' to nter upon tne above-mentionetl proparty for oata �2"�'7'g� �% 'I TYPE OF CONS7pUCTION IJ NEW L1 AOO�L ALTE(tAT10N LJ HEPAIR ❑ CONVERSION,❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLOG. TVPE OF PERMIT GRADING FOUNDATION STRVC7URAL ;O TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL � �OTHER . �IQj3 Sp�INKL'Lz/LS �5,y��A� PROJECT DESCRIPTION SQ, FT. 2(0��0 oCCUaANCv� CONSTRUCTIpN TVPE � VALUATION $ �.Z4S — ZONE GRADINGCU.YDS. ACRES Remarks:- C J f• {N �[ Bar Sink Backtlow Preventer 6ackflow Irri9ation , Bathtubs� � Clarifiers . pishwasher ' - Drinking Fountains FlOor Drains' Floor Sinks ' , GasService Outlets Kicchen Sink - ' Lavatories • • P-Trap Roof Dreins Reinspection Fee S75 Boiler ' Duct - Under Ground Duct - Structural Ouct-Ventilating ' Exhaust System ❑ � MWtiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ai oo,000 eTu O i oo,000 Reinspection Fae � $15 White - Building: Canary - Applicant; Pink - Accountlng; Goltlenrotl - ASsessor Showers Service Sink Sewer Cap �' Sewer Connection Solar Collecmrs Solar Piping Soiar Tank Swimming Pool wlSpa Urinal Werer Closet i Water Heater water Service Auto-Wash laue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System Oo-ioo.000erv Oioo,000 System Repair/qlteration Fire Dampers Registers Issue Fea � S 3 $ 3 A.P. qW : S Main Buildin� E T Front 8 Rear A C Right' K left S Ping. Ref. �k ' Planninp Notes: Automatic Washer Cooking Unit Dishwasher Dryers ❑Gas Fan F.q,U. ' Fiztures Device Boxes Switthes Garbage Disposal Generaror �0�5 KW 9926 I/OB/�7 2one Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ SO+KW 15 KW Meter ❑up to 100 amps ' Meter �over100amps" ' Sub Panel � - Motors � 0.1 HP � 7 X- 8 Inc. Solar �9-15 HP �76-15� Microwave • Pole Light Range ' Si9n Standing Sections � Trash Compector ' I Reinspection Fee �,$15 I � IssuE DEVELOP.MENTSERVICESREQUIREMENTS: 2oning Approvad By � Buildinp'Approved 9y Appliration Isued Bv 51,pp TL 2 O N I N G R E Q � M T S FEES 5 3 SUMMARV OF FEES ' BUILDINGPERMIT $ L c+��(�g�-�J�j�p g - ..S'� PLAN:CHECK $ ---�'�CC4��7` PERM17 . . PLUMBING $ ISSUANCE $ PIAN CHECK 25% $ ENERGV P.C. 3 � ELECTRICAL $ - GfiAOING $ PLAN CHECK 50% $ M�CROFILM •� $ MECHANICAL $ TOTAL FEE . . $ �. � PLAN CHECK Z5% $ . . CONSTRUCTION AND PLANNING POOL & SPA • APPROVALS Permit# - Date Inspector qPPROVALS Permit# Date Inspectar i. 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. ' 6. Foundation 59. Gas Pipe, O Undrgrnd., Test � 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.' . 10. Structural Fioor 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 i 6. 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 &%��r Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structu�e 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#ydro ' 7/ 26. T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical � 27. Frame and Flashing 76. Dry Standpipe J � / � �i / 28. Lathing & Siding 77. FIXED $YSTEM FINAL � i 29. Insulation 78. FIRE PREV. FINAL �_ "i.�'j, �r /t� ' 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-Fin81 . " 40. Gas Service-Final � � 41. Solar pomestio-Final � �- � 42. BackSlow Preventer � • . . .43. Backflow Irrigation � . • �� 44. Landscape Irrigation System ' � - 45. Sound AttenuatiOn . ' 46. Handicap Regulations ' ' 47. FINALSTRUCTURE&BUILDING ' � , .48. Special Requirem8nts Completed ' . � 49. Electric Retease to Edison � : 50. Gas Release to Southern California Gas Co � 51.� CERTIFICATE OF OCCUPANCY No. Date _ �' � . .ry� � \ `'�� ` �. ' Aonlicant to flll in all soaees exeeot ihose witM1in heavv Eortler Iinas ana si9n all aoCroD��ate tleclantions. CITY OF COSTA A,+ CONS�R TI P/E�RMI PERM=NO. TRACT NO. LOT NO. UNIT NO, ProjectAddress ��u . l� �p• �7 � 90P. �/�`-/=7 I<<�^� . AppliCant'^Mailing d�essU �./�e�Y1/�� j-/ TVPEOFCONSTRUCTION NEW /�DD ALTERATION REPAIR Own¢t'S•Name �7S�x'�,�} Phone � CONVERSION ❑ DEMOLISH ❑ OTHER q.p,.�e Zo�q (.fO ��1 S �(�(�-7)- _.•.2-„— DESCRIPTION OF WORK/USE OF BLOG. 9, , 9; `Address .�Q�T' l9' N�r^•e_ %� di S Main Buildin Accessory euildin E 2 Arch/Eng. Lic2nse No. TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front � Addf255 ��, ��/Q ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHAfVICAL A Reef N COnlfeClor'SNem 'Phone.h_]!l_L�2 � OTHER _� PRQIECT DESCRIPTION 5a. F7. OCCUaarvCv K Right N Address Imailing) Le£t G � .� ,1/`a+ CONSTRUCTIONTVPE VALUATIONS 5 e� Ciry License No. - � x'7 / 7 R .� ` ZONE GRADING CV. VDS. ACRES Ping. ReL dh Parking Req./Provided E � LICENSED CONTR , DECIARATION � I hereby affirm tbat I am li�onsetl untlar provi5ion5 oi Charte� 9(<ommencing Rema�ks: _ Pldnnin9 NOt¢5: M �wlth soction ]000) of Div151on 3 ot the Businezs antl Protessions Cotl¢, antl T Rly IIC¢f158 IS IO fUx 10fC8 anp eHet[. ��y L License Class `— � i ense No V� � 08r S �at¢ �-'�`�% Si9nature PLUMBING FEES ^ WORKERS' COMPENSATIpN DECLARATION Bar Sink Showers ' ELECTRICAL FEES �\ I he�¢�y aifi�m that I have a�¢�lificate of ConSGnl to self-insure Or a Certlflcate of Workers' Compensatlon Insurance, or a c¢r letl c py thereo (Secti n Backflow P�eventer Service Sink 3800, Lab. C�)��, / Automatic Washer 7ransformer ❑ 15-50 KW Poiicy No. ��•r �7�0.5✓� � company g Backflow Irrigation •$ewer Cap � - - Construction PoleSub. � 50+ KW BCerti(ietl copy is hereby furnishea. �n Cer;Jt� a y i' � witn the ciey�oµ{SiSyy� „„„ . � Bathtubs . Sewer Connection Cooking Unit .' . Meter �up ro 100 amps �ate Apolicant / J/tl%w•�e.a.�'�� EXE P710N ROM ORI(ERS' GOMPENS TION DECLARATION Cla�ifier5 Solaf ColleCtors Diihwasher ' Meter over 1003mp5 (Thi55ectlon eetl not be comDl¢tetl if t�e parmit IS tor One huntl�etl (5100) o� i e s s). ' Dishwdsher Solar Pi pin 9 Dr yers ❑Gas ❑Electtic S u b P a n e l ' I certlfy tha[ in th¢ pertorrtiant¢ Of the wOrk fOr which thi5 pe�mR i5 izsued I . snall not employ any person in any mannor so as to become subject to t'he Drinking Fountains Solar Tank Fan Motors �0.1 HP �1 h- 8 Worke�s' ComPensation LaWs oi GalifOmia. � Oate Signature � Flooi Drains Swimming PoO� w/Spa F.A'.U. NOTICE: It, afler making tryis deUaratlon, you shoultl Eecome Subject to the Inc.Sol2r 09�75 HP d16�15+ Workers' Compensation prp��zions ot lhe labor Cotle, you muct torthwitn Floof Sinks � Urinal � Fixtures Microwave comply with sucn proviilOns or this permit sball be tleemud revoketl. CONSTRUCTION LENDING AGENCV ' . GasServiCe � Outlets WeterCl05et 1 hCr�by affirm that ther0 i58 conSVuctiOn IenUing agenty tOr th8 peflofmdnC¢ �CviC¢ BOxC2 POIC LiPub Ot lhe wo�k for whlch tn15 0lrmit Is Issuatl (SectlOn 309] Clv. C.) ��terceptors �� Wacer Heater OU112L5 l.antler's Name Range �entler's Atltlress Kitchen Sink Water Servite Switches ' g�y� OWNER BUILOER OECLARATION I he!¢by affirm Ihat I am Oxampt frOT tho Con�racto!'s LiCGnSe l.dw fOr Ihe LBVBtOfi¢5 AutO-WdSh (�i8fb8 B Di5 OSdI lollowing reason (Seclion 7031.5 Business antl Professional Cotle: Any city or ' 9 P Standing Settions county whi<h requires a permit to wnstruct, alter, Improve, tlemolish or repalr P-Trap �� . Laundry Trays Generatm �0-5 KW �5�15 KW Trash Compattor any ilructure, pdOr to Il5 �SSuanc¢, d150 /eqWrei lhe apP��dnt Ip� such po�mit to /iie a signetl statement that he/she is Iltensetl pursuant to the provisloni of Roof Or0in5 tne Contractor's Licenze laW (Cbapter 9(mmmen<in9 witn Section 7000) of Division 3 of t�e Business antl Protessions Cotle) or that he/tho is oxompt - thC/otrom dn0 lhe basls br the alle9etl oxamptlOn. A�Y ��Olalion o1 $ection 7031.5 by any appliwn[ �or a permit subjects the applicanl to a civil pCndlty of not mole lhdn fiye huntlretl tlolldr5 (E500�. � g 3 ❑ I, ds owflat o� IhG PtOp¢rty OI my CTPIoy¢e5 wi�tl wag85 as thair sOle RBinSpBC[ion F8e $15 15uB F8e comDenSalion, will tlo lhe Wprk, antl the struclure is not IntenUetl or ofleretl Reinspection Fee $15 Issue Fee $ 3 � for sale (Seclion 7044, Buslness ana Professional Cotle: The Contraclor's MECHANICAL � FEES LicenSn Law Goes not aOP�Y l0 an own¢r of a property who builds or ITprove5 theroon, antl wno tloes suSh work himsalf/hursolf ar throu9n �is or her own DEVELOPMENT $ERVICES REQUIREMENTS: employees, proviGetl that s��h improvements are mt intentletl or oHeretl lor BOiler HOod or Type I ❑ sale. II, nowever, the bullEing or improvement is soltl withln one year of com- �anopy Type I I ❑ 2oning Approved By �ate O�otion, the owner will have the burtlen of provin9 he/zhe ditl not bulltl or Im• Duct � Undet Ground Building Approved By Date--�1q—��r-c�f�� prOve for tne putposa ot sale). %�--�� ❑ I, at owner ol tne property, am exclusiveiy contracting with Iicansotl con- Duct-Structural Refrigeration System Appliwtion Iwued By .Dat Lacton to consV uct tha prOjoct (Seclion 7044, Business antl Professions Cotle: The ConeractorR �icense l�w tloes not apply to an owner ot property who Duct - Ventilnting � �0-100,000 BTU ❑100;000 BTU SUMMARV OF FEES builtls or improves ltl¢reop� antl wno conVaclS br such projeG[z with a COn- � tracror�sl ncense pursuant to tne Conirattor'z License Law). 1 am awarn that Exhaust Sys[em ❑ Multiple ❑ System Repair/Alteration BUILDING PEfiMIT $ SMiP $ proof o( their Worker's CompensaHon Vnsuranta snoultl be provitlee to me. PLAN CHECK $ PERM17 ❑ I am axemv� ��aer SecNon B. 6 P. G(or t�it raason FirepUFact. BI(. ICBO # Fire Dampers PWMBING $ ISSUANCE $ Heating System & Ducting - Registers ENERGY P.C: 5 Date Owner PLAN CHECK 25% $ - I hereby certify that I have reaa this avP��wtlon antl state inat tho above ❑6100,OOOBTU �100,0008T ELECTRICAL � $ ,S� GRADING § InPormation is correcL 1 agree to comply with a11 tlty antl county ortlinances antl state Iaws r t'q g m puiltling mnstructlon, ana hereby autnoNza repre- - PLAN CHECK 50% $ MICROFILM $ santatives of 't enter upon lhe above-mentionetl propert or inspectlon ou � MECHANICAL $ ' Signature � Daia� . TOTAL FEE $ Drivers' License or 55 - .Reinspac[ion Fee -$15 Issue Fea S 3 PLAN CHECK 25% $ CMF 0865-96, �ev. iu/nn wnii¢ - Builtlinq; Canary - APO��ni; NInR - Hcwunun9; �oiaenroa - sas5e55o� CONSTRUCTION AND PLANNING POO� & SPn APPROVALS Permit-# Date Inspector qppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinfarcement 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, O 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 75. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring - � 67. Fencing & Access Approval - 77. Rough Wiring Sign 6S. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling . 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # _ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating , 71, Product Piping O Gas ❑ Oil � 23. Gas Pipe-Rough & Test 72. Underground Flush 24. RoofFraming 73. Undergrnd.StorageTank�Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (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 � . OOD CERTIFICATE ISSUED 33. Final Electric N . � 34. Finai Heating & Air Conditioning . 35. Final Gas Pipe-Test ' 36. Hood or Canopy 37. Final Factory Fireplace . 38. Final Plumbing 39. Water Service-Final . � 40. Gas Service•Final - 41. $olar pomestic-Final ' 42. Backflow Preventer � 43. Backflow Irrigation � � 44. Landscape Irrigation System � ' 45. Sound Attenuation . 46. Handicap Regulations 47. FINAL STRUCTURE & BUICDING ' � . , 48. Special Requirements Completed 49. Electric Release to Edison r 50. Gas Release to Southern California Gas Co � 51. CERTIFICATE OF OCCUPANCY . ' No. Date . Applicant to fill in all spaces evicept lnose within heavy borOer Iines and sign all approvriate aeclarations. CITY'OF COSTA/ p_Q�E�jn CONST�-7RU,1CTION PjERMIT � P �T I�{�O � S` TRACT NO. LOT NO: UNIT,p10.� Projeci �!{.�.'dress r_/ /Q � � /'%�T S�T O� � �� 0<6 ti Cv � . Applicant's Mailing Address `h M,� T.VPE OF CONSTRUCTION EW ADD ALTERATION REPAIR %2G4 5/04/87 � Bn(�n TL �/ ��❑ CONVERSION ❑ DEMOLISH ❑ OTHER qp *, � Zo�e Owner's Name � Phone � <�pESCRIPTION OF WORK/USE OF BLDG. Address �' S Main Building: Accessory Building: n�. �Ccfn��L'- !iU/G n�iC . � (�License No. TVPE OF PERMIT GRAOING FOUNDATION, ❑ STRVCTURAL T Front � Address . 1�0 OTHERT ❑ ELECTRICAL ❑ PLUMBING �MECHANIGAL A Rear ' N Convactor's Nam hone pqOJECT DESCRIPTION Sq. FT. oCGVPANCv C Right N Address (mailinq .� � � � K Left � G /4� COfVSTRUCTIONTVPE VALUATION$ S R City LiCenSe No. v ` ZONE GRADING CU. VDS. ACRES . LICENSEO CONTRACTOR DECLARATION Ping. Ref. � Parking Req./ProvidCd E I he�eby aftirm tnat I am licensetl untler provi5iOn5 of ChartCr 9(commencin9 �Remarks: � � • Pl2nniny NOL25: n with section ]000) of Divlsion 3 of tna Business antl Professions Cotle, antl _ M my Ilcense is in iWl torce ana eftect. �%� ,�` � T License Class License No. � - . • , � S Date Signature � .! PLUMBING FEES � � WORKERS' COMPENSATION DECLARATION � � Baf Sink Showel5 ' I hereby afiirm that I have a certificate ot consent to self-Insure or a certificate ELECTRICAL FEES of Workers' Compensation Insurance, or a c¢rtifietl copY tnereot (Section BackflowPreventer ServiceSink � 3800, �ab. C.) - Auromatic Washer Transformer ❑ 15�50 KW Policy No. Company ' Batkflow Irri tion Sewer Ca ❑ 50+ KW . 9a P Construction Pole Sub. BCertifietl copy is �ereby IurNshetl. - . Cerlifietl copy is filetl wilh the Clty Builtling Dlvlslon. � 88thtUbS ' SEW¢I COnll¢CtiOn COOking Unit M¢�¢f ❑up LO 100dfIlpS Date APplicant - _ E%EMPTION FROM WORKERS' COMPENSATION DECLARATION � Clar)fiers - $ola� Co112Ciof5 DiShwaihef � M2ter ❑aver 700 amp5 (Thi55ection neetl not be completetl if the permit is for one huntlretl (5300) or � _ less). � , Dishv�rdsher . Solar Piping . � Dryers ❑Gas ❑Electric Sub Panel , I certify that in the performance of the work !O/ which tltis pe�mi{ is issued, I snall mt employ any person in any mj np er so as ty be me subjett to the � Drinking Fountains Solar Tank Fan Workery Cop� pe 4p n LawS of Calif 'I�i)�,,��(/J MOtOrS �0-1 HP,� 1%-$ Oate S_`"r� I Si9nature !�]�"�•'�:� '�Floor Drains Swimming Pool w/SPa F.A.U. . NOTICE:If,after making this tleclaration,-you shoultl-beco subjec[ to the Inc.Solar �9-75 HP 0�6-75+ Workers' Compensation provisions of tne Labor Cotle, yo must lort�with FIoo�Sinks Urinal Fixtur25 comply with such 0/ovisions or thi5 permit Shall be tleemetl revoketl. MiC�Owdv¢ CONSTRUCTION IENDING AGENCV ' Ga55ervite Oudets WaLerCloset 1 h¢reby aftirm Nat [M1ere i5 a construction Iending agency to� tne per}o�mantt �¢viC2 BO%¢5 P012 Light Of Ihe work fo! whiCh thiz pelmit is issuetl (5¢Ctlon 309� Civ. C.) Int¢Ic2ptOR WdtE1 H¢2t2f Optl¢t5 Lentler's Name Range Lentler's Atltlrest ' - Kitchen Sink . � Wacer Service Switches ' -' Sign ' OWNER BUIL�EH OECLARATION I he�eby dffi�m that I am ezempt from the Contrdc[o�'s LlcenSe Law for th¢ LdVdtO�iCs AutO-WdSh Garba 2 Di5 OSdI ' (ollowing reason (Section 7031.5 Business antl Professional Cotle: Any city or 9 P . Standing Sections counly which r¢quires a p<rmi[ [o cons(ruct, alte�, improva, tlemoli5h or �epai� P—T�ap � LaUndf T�d 5 any structure,.prior to its issuance, also requires the applicant for such permit Y � Generator �0-5 KW 05-15 KW Trash CompactOr to (ile a signetl statement that he/sbe Is licensetl pu�suant to the provisions ot Roof Drains [he COntractor'S License Law (ChaDter 9(commencing wl[h Section ]000) of Division 3 ot the Bu5ine55 antl Prote55ions COCe) or (hdt he/she is exempt ther¢from antl tlte bazi5 f0/ [ne all¢9¢tl exemption. Any violation Of Seciion ' 7031.5 by any applicant for a permit subjects tne aoviicant lo a civil „ pendlty of not more than live huntlretl tlollars (S500j. LJ I, as owner ot tne oroperty or my employees witn wages as their sole Reinspection Fee $75 laue Fee $ 3 Comp¢nsation, will tlo th¢ wolk, antl Ihe struGlure i5 not Intentletl oI otter¢tl RBin5p8Gt100 Fee $1�J ISSue Fee §$ for sale (Section 7044, Business antl Professional Cotle: The Contractor's MECHANICAL FEES Litense Law tloes not apply to an owner ot a proparty who builtls or improves thereon, ana who aoes such work himself/herzeli or throu9h nis or ner own goiler Hood or T e I DEVELOPMENT SEHVICES REQUIflEMENTS: employces, provi0etl tha[ such improvements are not intendetl or otferetl for / YP : sale. If however„the bulltling ar Improvement is Soltl within one yea� of com- CdnOpy TypC II ❑ �Q Z�ning App�ovBd By Ddte � pletlon, the own¢r will hav¢ the burtlen of proving h¢/sne Gltl not builtl or im- Duct - Under Ground ' J BUilding App�oVed By , r ve for the purpose of salo). . . � Dateri�� 'I, as owner of the property, am exclusively coniracting wifh licensetl con- Duct-Structural fat' em 'AppliWtion ISSued By o DatC/1.-1L� � tractois to construct the Oroject (Section 7044, Business antl Professions Cotle: .�` � l � Tne Con[ra<[or's License Ww tloes not appry [o an owner o/ property who Duct - Ventilating W � � SUMMARV OF FEES ' builtls or Improves thereon, antl who contract5 tor such prOlects wHh a mn- ' � . . traclor(s1 ucense oursuant to Ihe Contractor's Litense Law). I am aware that Exhaust System Multiple ❑ System RepairlAlte�ation `� BUICDING PERMIT S SMIP $ proof o( their Worker's Compensatlon insurance shoultl be provitletl to me. PLAN CHECK $ PERMIT ❑ I am exempt untler Section B. & P. C. for this reason �FirepVFacL BIC ICBO �f`- Fire Dampers pLUM81NG • $ ISSUANCE $. Date —' ^ Owner - Heating System & Ducting Registers . ENERGY P.C. $� � ❑0.100,000 BTU �100, ' P�N CHECK 25% $ _ I hereby certiy that I have reaa this application antl st that the above 0006T ��V / ELECTRICAL $ GRADING $ intolmatiOn I5 correct: I dgr0e t0 cOmply with all city antl countY Ortlinance5 ^ ,b _ ♦ ana state laws elating to builtling construction, anG hereby auNorize repre- - / � -MICROFILM $- —"� ,��— senfatives of is city to en �5 upon tne above-mentlonetl P� PLAN CHECK 50°.6 $� . . �,�p �� inspection p rp p �/ MECHANICAL $ � Signature Y` Dat TOTAL FEE $_{_0_ILIL Drivers' License or 55 � � Reinspection Fee $15 luue Fee $ 3 PIAN CHECK 25% $ CMF 0865-46, rev. 30/84 White - Builtlln9: Canary - APO��cant; Pink - Accountin9: Goltlenrotl - Assesso� 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, � 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. Heatec& Vent-Final 13. Roof Drains � � 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final i6. 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 O Gas ❑ Oil 23. Gas Pipe-Rough &�Test 72. Underground Flush \ 24. Roof Framing ;� � 73. Undergmd. Storage Tank O Gas ❑ Oil , 25. Roof Sheathing ', 74, Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashi�,ng� , 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: �y �, � - 34. Final Heating & Air Conditioning - 35. Final Gas Pipei�� 36. Hood or Canopy ..- �� 37. Final Factory Fireplace � � � :� 38. Final Plumbing � • -� 39.•Water Service-Final � � � " i 40. Gas SerGice-Final ` ' ' 41. Solar pomestic-Final � *' � ' i -� 42. Backflow Preventer - � .� '43.Backflowlrrigation � -� ! ' . •- ', , � 44. Landscape Irrigation System , �� . .i '45. Sound Attenuation ' j � � ' '• , � 46� Handicap Regulations ,' i ' �• • � 47. FINAL STRUCTURE & BUILDING � � ` . -' ' � 1 , �. 48: Special�Requirements Completed ` � - , - � 49!Electric Release to Edison � ' 50. Gas Release to Southern California Gas Co • � 57. CERTIFICATE OF OECUPANCY . � No. ' Date � � Applicant to fill in all spaces eacept tnose within heavY Ooraer lines ana sign all avv�opriate aeclarotions. , CITV OF COSTA ME A CON STR ION PERMIT PER I N 'r7 ` TRACT NO. � LOT NO, �UNIT NO. ; � � ; _ �.9e tiJ /7�, sE G � /a ' ' , � 95f0 1,2/30/86 �1.75 ` Pro ect Addiess i ' Applicant's Mailing�Address ��2�7 L'A'� � �AS � 4J.:�/I TVPE OF CONSTRUCTION ' NEW ADD ALTERATION REPAIR , Owner's Name � 0 GONVERSION ❑ DEMOLISH ❑ OTHER �L�E�� aM Q_• q,p, # _ � . : � 2one , �� Gi t_L% Phone � DESCRI TION OF W RK/ 4SE OF eLDG. � Address -S�'r� �� ' �, �/A �9.d /)/%tO.e/i N� S Main Building: ' � Accessory Building: Arch/Eng. � � License No. TVPE OF PERMIT �❑ GRADIrvG ❑ FOUNDATIO��Nj.�❑ STRUCTV RAL T Front. ' ' • � ' ' � ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING L� MECHANICAL B i N Address � �'��'+�/ . A Rear � . � � I�ILIiV�I.� MfA-liSPhone.aFr�—"/ ❑ OTHER ' Convactor's Nam--�—�-�- ' � ' C Right' - - �' ' � ' N Address (mailing) /Z �7 L�%'t A-�LE�(/A"S .[��/�/ ' PROJECT DESCRIPTION Sc7. FT. OCCUParvCv . K Left � - ' G , CONSTRVCTIONTVPE � VALUATION$ $ • City LicenSe NO. �� _ ZONE �. GRADING CU. VDS. - ACRES - � R LICENSED CONTi3ACTOR DECLNRATION " Ping. Ref. # Pd�kiny R2q./P�Ovid2d � E 1 hereby affirrti that I am licensetl untler provi5ions of Chart¢� 9(commencing Remarks: � � �j �� 2 Q` O Planning Notes: ' . � M with sectlon ]000) pt Division 3 of the Business antl ProteSsionS Cotle, antl � . , my license is in full torce antl ettect. �`� � �•� - . � T License G ss [� i D License No.Z o 6 O . � . s Date� Signature (,J�� ---� � PLUMBING ��PEES - � - - WORK RS'-�ATIONDECIARATION • ' 62fSink . $hOw¢�5 ' . _ . . � I hereby atiirm'that 1 have a certificate of consent co self-inzure or a certificate � . ELECTRICAL. • FEES of Worke�s' Compensation InS�/ance, o� a certitietl topy�thereof (Section BaCkfloW PfCv¢nLCf S¢rvice$ink Automatir.Washer�� Transformer ❑ 15-50 KW ' 3800, Lab. CJ� • � • Policy No. � � Company .Backflowlrri9ation ' . _ Sewer.Cap . � � ConstructionPoleSub. �50+KW BCe�tifietl copy is'he�eby tumiShEtl. . ' � . , - , Certifletl copy I5 filetl with the city Builtling Division. . Bdthtubs� S¢wC� ConnBctiO� Cooking Unit Meter ❑up t0 1�0 dmp5 Da[e Applicant , ' . EXEMPTION FPOM WORKERS' COMPENSATION DECLARATION parifiers - � Solar Collectors Dishwasher � Merer ❑Ove� 100�amp5 � (Thissection neetl not be completetl if tM1e pe�mit i5 for One huntlretl (§300) or . . � _ , iess). � '. . Dishwasher � �- Solar Piping . - . Dryers ❑Gas ❑Electric Sub Panel , • � ' ` I certify that in tlte pertormanc¢ of tM1e wo�k for whith this p¢rmk i5 issuetl I , - shall not employ any person �in any manner so as to become subject to t�e � Drinking Fountains SolarTank . Fan Motors �0-7 HP �7"/x-8 .,,, Workers' mpen tia Laws of Calif�� A � � Date 1��_��_Signature �n+� � Floor-0rains � � Swimming Pool w/Spa F.A.U. ` - ' - -' NOTICE: If, aft�t making fhis tl¢cla�ation, you should bewme subject to th¢ — _ _ IOC. $012! 09-15 HP 016-15+ Workers' Compenwtion provisions of the Labor Cotle, you must forthwittf FloorSinks ' � ' U�inal � Fixtures � i Microwav¢ - comply with such�ptovisions o� thi5 permit shall be tleemetl revoketl. � I ' LONSTRUCTION LENDING. AGENCV ' Ga55ervice � Outiet5 � � Watef Closet � � ' Device Boxes ' � � Pole Li ht � 1 hereby affirm that there is a construction lentlin9 agency for the performance 9 ' of the work for �which thi5 permit is issuetl (Section 309] Civ. CJ Interceptors ' Watef Heater � ' � . Outlels ' y ' flange ' '� Lentler's Name �entler'sAtltlress ' , Kitchen5ink • WaterService,__.. � . Switches ' - . .� - Sign � -� - -� � �- -� OWNER BUILDEH DECLARATION . ' ' ' ' I hereby aftirm mat I am exempt from�the Contractor's License�Law tor tne^ Lavatories Auto-Wash � ' Garba e Dis osal following reason (Section ]031.5 Business antl Grofessional Cotle: Any cify or i .9 P : Standing Section5 � county which requires a permit to construct, alter; imprave, tlemolish or repair P-Trap ' � Laundry'Trays ' Generator �0-5 KW�05-15 KW � ' any structure, prior ta its issuance, also requires tne applicant for such pe�mit . . TfdSh,CORlpdCtO� to tile a signetl statement that ne/she i5 litensetl pursuant to tne p�ovi5ions,ot ROOf DldinS • - ' � ' � ' � ' ' the Cmtractor's License Law (Chapter 9(commencin9 with Section 7000) of t ' � � , Aivision 3 of the �Business and-Protessions Code) or.that M1e/she.i5 exempt - . . . ... _ _� __ _ _ _ .. _. . _ -_ � _ _ � _ , , '� therefrom antl the basis for the alleqetl exemption. Any violation of Section ' 7031'.5 by any applicant for a permit subjects the aOP��ant [o�a civll � �enalty o( not more than five huntlretl tlollars ($500). � - 1, zs� owner of the property or my employees with wages as their sole AeinSpeMion Fee � $15 �. � ' Issue Fee , $ 3 � � � � � compensation, will tlo the work, antl the structure is not intentled or offeretl Reinspection Fee = $15 luue Fee . , - �$ 3 for-sale (Section 7044, Business anE Professional Cotle: The Contractor's MECHANICAL . FEES ' ' I License Law tloes not apply to an owner of a property who builtls or improves - . tnereon, antl who tloes such work nimself/nerself or throu9h nis or her own � ' � � - , �DEVELOPMENT SERVICES REQUIREMENTS: i , i� -_ ' employee5, provitled tha[ such improvements are not Intentletl or ofte�etl for � gOil¢! HOOd O� TYPQ I ❑ _ � � _ sale.'It, however, the builtling or improvement Is soltl within one year of wm- � Canopy � Type I I ❑ � 'Zamng Approved By � Date �' pletion,�tne owner will have the burdnn ot proving he/sne aia not buila ar im- ; Duct - Under Ground . ' � Building Approved By � - Date ' �rove for the purpose of sale). ; , � - � . lJ I, as owner of-the oroperty, am exclusively contractin9 with licensetl'con- Duct - Structurai � Refri9eration System � Appliption Issued By Dat �Z tractorsto construct the project (Section ]044, BusinesS antl Professions Cotle: � j� � The ConVactor's License law does�not apptylo an owner ot property who Duct- Ventilating � , g��00,000 BTU "�100,000 BTU `�U . , � SUMMARV OF�FEES � �� - - ' , builtls or improves thereon, antl who cOntrac[sfo� such Orojects with a com � � � � . � tractor(s) �ucense pursuant to the Contractor's License Law). I'�am aw5re tnat. Exhaust System ❑;MWtiple ❑ System Repair/Alteration BUILDING PERMIT $ - : SMIP . .$. proot of their Worker's Compensation insurance shoultl,be orovitletl to me. '' p�AN CHECK $ PERMIT � ' � ❑ I am.exempt under Section e. & P. C.tor tnis reason = Firepl/Fact. Blt. ICBO # i� Fire �ampers PLUMBING , .$ � ISSUANCE i $� oate Owner ' " ' � � � Heating System & Ducting� . - /�' -Registers � . ' � ' ' p�p,N-CHECK , 25% �$ ' ENERGY P.C: $,: ' ' � I hereby certity that I have reatl this aoPlitation antl state that the above ❑0.100,OOOBTU �100,0006T . , - � - GRADING �$-' information is mrrect. I agree to comply with all city and munty oreinances�= ' ' ELECTRICAL $�_ . antl state laws relating to buildingsonstruc[ion, antl hereby authorize repre- , , . .. -� �� - MICROFILM $ � sentatives of this city to enter, upon the above-mentionetl property for , ;. . ' . PLAN CHECK 50% $. , ^ Inspection purpos�y .c�n ' 6 � ' MECHANICAL $ TOTAL FEE $ � a • `, Signature �.(l ' ��CSl� �-�-� � Date/y/3o�i ' . _ _ - Drivers' License or 55 � -_�.. F7einspec[ion FeB " $15 , Issue Fee � $ 3 ' P�AN CHECK 25% $ t CMF OB65-4fi, rev. 10/84 White - Builtling; Canaty - Applicant; Pink - Accounting; Goltlenrotl - Assessor � 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-Undrgmd. � ' 53. Steel Reinfarcement ' , 3. Electrical Conduit Utility-Undrgrnd. 54. Forms � � 4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding � " 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE' , 7. Footings � . ' 58. Electrical Conduit-Undrgrnd. 8. Foundation .� 59. Gas Pipe, � Undrgrnd., Test ' 9: Water Pipe-Undrgrnd. . . 60. Backwash Lines, P-Trap, � 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. RougFi I-leating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace ' APPROVALS Permit # _ _ 27. Ducts, in Structure 70. Underground Hydro , 22. Ducts, Ventilating 71. Product Piping O�Gas ❑Oil ' 23. Gas Pipe-Rough & Test � 72. Underground Flush • i• 24. Roof Freming 73. Undergrnd. Storage Tank O Gas ❑ Oil � 25. Roof Sheathing . 74. Overhead Hydro , 26. T-Bar Ceiling (Stru�fural) & 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 MeterFinal 80. FOOD CERTIFICATE ISSUED ��-- • 33. Final Electric , Notes: f /3 � � �� ^ �J � 34. Final Heating & Air Conditioning � � . , - 35. Final Gas Pipe-Test y� ' � ' 36: Hood or Canopy � , 37. Final Factory Fireplace � _ . � ,� 38. Final Plumbing , � „ 39: Water Service-Final _ � ,, � , 40. Gas Service-Final � . - � � , . ' ��41. Solar pomestic-Final � ' ' � � 42. Backflow Preventer � ' �n 43: Backflow Irrigation � ' ' � ;�, . � ,_ 44. Landscape Irrigation System � , � . . ' . , �' �45. Sound Attenuation - ' � ' ' , ; � 46. Handicap Regulations � ' ' � ' ;! 47. FINAL STRUCTURE & BUILDING , �� . '� ' 48: Special Requirements Completed � ' . ' 49� Electric Release to Edison - 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY � � No. Date , AOGlicant to fill in all ipaces excapt t�ose wit�in neavy Dortler Iinas ana sign a1l apDroD��ate tleclarations. J CITY OF COSTA SA CONS R CTION P RMIT PERMIT NO. � TRACT NO. ' LOT NO. UNIT NO. � Project Address w I ��a w, h�. s�. �-�- �3�-� . . ApplicanYs Mailing Address �/ /' �P�/ r%!� � TVPE OF CONSTRUCTION NEW , ADD ALTERATION REPAI R Q '❑ CONVERSION ❑ DEMOLISH ❑ OTHE/� A p.# Owner's Name ��/S Phone � DESCRIPTION OF WORK/USE OF BLDG. ` An._i.CG � Addiess � � � ' S Main Building: ` � Arch/Eng. � License No. Address Contracmr's Name r ,/ Phone -�� Addresslmailing) ��C/ Mr�'/1U / �� City License No. %� 7� 7Z � UCENSEDCONTRACTORDECLARATION ' I hereby affi�m lhat I am IiC¢nsetl untler proviSions of Charter 9(commencing with section 7000) of Division 3 bt the Business antl Protes5ions Cotle, antl my license is in t�yf fmcqyatl eHect. O License Cla s �� Jb nse Date Si9nature WORKE 5 OMPENSATION DECLARAT ON � 1 hereby aftirm thac 1 have a certiticate of consent to selt-insure or a tertiticate of Workers' Compensation Insuran<e, or a certifietl copy tnereof (Section 3800, LaD. C. q/� / I , PolicY No. �� /Q /�"q ComP e /�- �` , � r[i(ie0 copy i5 her¢by futnishetl. Certit'etl tl ith the city B Itlin D o. Oate APPlicant � EXEMPTI N F M WORKERS' CO ENSATION DEC A ATION� (Thi55ectiOn neetl not be completetl if the pevml[ Is fo� one M1untlretl (EI00j'o� Iess) I cerUfy thal in the performance of the work fot which tnis pe�m�t ISISsuetl, I Shall not employ any pe�son, in any manne� so as to become Subj¢CI to the Workers' Campensation Laws of California. Date Si9nature NOTICE: It, aiter makin9 tnis aeclaration,.you shoWa become subject to tne Worke�s' COmp¢n5ation provi5ion5 Of the Ldbor Cotle, you must forthwith comply with such orovisions or this permit shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV 1 nereby aiflrm tnat'tnere is a construc[ion lentling agency tor lhe partormance of tbe work tor which thfs permil is issuetl (Settlon 3097 Civ. CJ Lentler's Name Lender's Aaaress OWNER BUILDER DECLARATION � ' I hereby af(irm that I am ¢xempt f�om [he Contracto�'S License Law torthe toliowing reason (Section 7031.5 Busine55 antl Profe55ional Cotle: Any city or county wnich requires a oermit to construct, alter, Improve, tlemolizh or reoair any structure, prlor to its issuance, also reqWres tha applicant for such parmit to tiie a si9netl statement that he/she is Iicensetl pursuant to the provisions of the Contractor'S License Law (ChaD�er 9(wmmencing wilh SeCUon 7000) ot � DiviSion 3 ot lhe Busine55 and P�otessioni CotlG) o� tnat he/shG is exempt ther¢t/om antl the basis tor the allegetl ex¢mp[ion. Any violdtion o( $ectlon ]031.5 tiy any aOP��ant tor a permit subjects the applicant to a civil �enalty of not more than five huntlretl Uollars (5500�. 1, as owne� of the pro0erty o� my emplOy¢¢5 witn wage5 as Ihei� Sol¢ compensation, will tlo lhe work, antl the struc[ure Is not in(entleA or o/feretl for ssle (Section 7046, Business antl�Crofessional COGe: The Conlractor'S Licenu Ldw tloes not apply to an owner o( a property who builtls or improves Ihereon, antl who tloe5 Su<h wo�k himself/Ite�seli or thrOu9h his or he� own emDloyees, provltled that such improvements are not intentletl or offeretl for sale. If; hOwever, Ne builtling or improvert�enl is soltl wl(hin One year ot com- pletiun, tne owner w111 nave tne buraen oi proving he/sh¢ tlitl mt builtl or Im- �rov< for the pur0ose of zale�. 1, as owner oi the property, am exclusively contracting with licens¢tl con- [ractors [O mnstruct the project (Section ]044, Business antl PrOfessions Cotle: The ConVa<torY Licanie 12w doe5 mt apply [O an owne� of prOPerty who builtlz or' Imoroves thereon, antl who mntracts tor such proje<ts with a con- tractor(s) license.pursuant to thC Contractor's License Law). I am aware Ihat proof ofrtheir Worke�'s COmpensation insurance snoultl be orovlGetl to me. ❑ I am ex¢mpt untler Section B. 6 P. G Por IhiS rea5on Date Siqnature � Drivers' Li<ense or 55 CMF 0865-46, rev. 30/B4 Owner have rea aoove E TVPEOFPERMIT GRADING FOVNDATIDN STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL �PLUMBING ❑ MECHANICAL 6 Re9r ❑ OTHER � ' � A PROJECT DESCRIPTION Sq. F7. oCCUat�rvCv C Right � K Left CONSTRUCTIONTVPE VA�UATION3 �$ ZONE GRADING CU.YDS. ACRES p��g, Ret. # Remarks: Z ' ' Planning Notes: Bar Sink Back(low Preventer Backflow Irrigation Bathtubs " Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service . Outlets Kitchen Sink . Lavatories P-Trap Roof Drains Reinspection Fee- $15 Duct-UnderGround Duct-St[uctural , Duct - Ven[ilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating SyStem & Ducting ❑ a 100,000 BTU � 100,000 BT Reinspeaion Fea. � $15 White - Builtling; Canary - Applicant; Pink - Accountln9; GOItl¢nrotl - ASsetSor Showers Service Sink Sewer Cap.. Sewer Connection Solar Collecmrs Solar Pipin9 Solar Tank Swimming Pool wlSpa Urinal Water Closet ', Water Heater Water Service• Auto�Wash Laundry Trays � laue Fee $ 3 IANICAL - FEE Hood or Typel ❑ ' Canopy Type I I ❑ Refrigeration Sys[em ❑o-i oo,000 eTu' O i oo,000 � System Repair/Alteration 1 Fire �ampers • Registers laue Fee $ 3 Automatic Washer Construction Pole. Cooking Unit . Dishwasher . Fan F.A.U. Fixtures Device Bozes . Outlet5 Switches Garbage Disposal Generator �0.5 KW Fee 15 K1 $75 iF. . , . � •••Zone tloUU T� Accessary Building: � Z O . N I _ N G R Parking Req./Provided � E Q M T S EIECTRICAL - � ' Transtormer ❑ 15-50 KW - � SO+KW ' � Meter ❑up to 100 amps' ' Meter ❑ovei 700amps - Sub Panel Motors�0.1 HP�1h-8 InaSolar �9-15 HP�16-75+' Microwave � � Pole Light � � Ran9e �. Standing Sections Trash Compatmr � Issue DEVELOPMENT SERVICESREQUIREMENTS: . " 2onin9 APProved BY I Building Approved By , _ %.,� �� ' I � . _ SUMMARV OF FEES � i � .. ' � BUILDINGPERMIT $. SMIP - $'. � . , PLAN CHECK $ _ PERMIT. . PLUMBING . '< § %I'•60 �� ISSUANCE'- �$. ._ '� PLAN CHECK 25% S �.� ENERGY P.C. $` ELECTRICAL $ - GRADING ., $ �� ' PLANCHECK 50°6 $ MICROPILM i$ ��{J -�' - MECHANICAL $ 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: � 7 fi� 53. Steel Reinforcement 3. Electrical Conduit Utility�Undrgrnd. � 54. Formt 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test � 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings , 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System . 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 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. POOUSPA SYSTEMS FINAL 19. 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 �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 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION � 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED � 33. Final Electric Notes: 34. Final Heating & Air Conditioning ' 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing � 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer � 43. Backflow Irrigation 44. Landscape Irrigation System . � 45. Sound Attenuation � 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison , � 50. Gas Release to Southern California Gas Co � 51. CERTIfICATE OF OCCUPANCY . No. Date �:,J . . �� I � I l\1 AOP��ant to flll In all spaces except those wit�in CITY OF COSTA MES��9� C�,Q)NS��T�f'I ��Ta.ON P MI� Project Atldress —uc._/_a.c_ "f Applicant's Mailing Address � eY/`J�� ! Owner's Naa�e/� ' �/P�hone Address ab' � �/� � �X` M' ��{,,. �� Arch/Eng. qfj'I� � V�"d Licenu No. Address Contractor's Nam � hone (sU^.?JztT Addresslmailingl�� MKii�� /'I. CitylicenuNo. a��,z LICENSED CONTRACTOR DECIARATION I bereby aHirm tnat I drtl IIC¢OSetl Ufld¢! Provi51045 Of ChartOr 9(CommBflCiflg witn sectlon ]000� of Divlsion 3 ot the Buiiness antl Professlons Cotle, ane my license is in f W�«�� e«e«. � �. License CIa55 ' ens No. Date� Signature WORKE 5' C MPENSATION DECLARAT N , 1 herCby attirm that I have a certifiwte of consent to selt-InSu�e or a cerUficat¢ of Workers' Compensation Insu�ance, o� a cert�fiea copy the�eot (Sectlon 3800, Lab. C. pr �/ � / r J��/ Policy No. �/r�_� Company �yf� iL Ff. C ifietl copy Is hereby furnishetl. ertit etl c py is ' etl with tbe city Bui i Di ' . Oate ApP�� EXEMPTI F0. M WORKERS' COM SATIbN OECLARATION (This sectio nee not be completea if tha permit is for one huntlretl (5100) or less�. I cCr[Ity tnat In [be pe�fo�mante o( the wo�k fOr �yhich this pe�m�t is isiuetl I snall not employ any persOn in any mdnne� zo a5 to become Subject to t{�e Workerz' Compensatlon Laws o( Calitomia. Date Si9nature — NOTICE: If, aiter making thi5-tl<claration. Yau Shoultl bOtOme suDject lo lha workers' Compensatlon provisions of the Labor Cotle, you must (orinwilh comply with suth proWsion3 or thi5 perTit inall be tlaemGtl revokatl. CONSTRUCTION LENDING AGENCV ' 1 hereby aHlrm tha[ there is a conSVuttion lentliny agency for the performance . of Iho wbrk for wnich thls permit is Issuetl (5¢ction 3097 Civ. CJ �' Lbntle�'s Ndme Lentler's Atltlress OWNER BUILDER UECLARATION ' I hereby aHlrm lha[ I am axempt frOm Ino Con[racto�'S LlconTO Law tor the followin9 reason (Sectlon 7031.5 Business anC 7rofessional Coda: Any city or county wni<h reqWres a perTit to ConStruct, altar, improvo, aemolish or repair any structuro, prlor to Its Issuanco, also reqWros the appllcant for such permit t0 file d Sl9natl Statement that hC/She is IICCnsetl purSudN to Itte provi5ions ot the Contractor's �Icense Law (Cbapter 9(mmmencing with SotUon 7000) of Division-3 of the Business antl Proteszions Coqe) or tnat ne/she Iz exem0� thereirom �antl the baiis for the alle9etl axamption. Any vlolatlon of 5octlon ]031.5 by any apDlicant /or a permit 5u07eCts tna applicant to a civil �enalty of nol more Nan flva huntlretl tlollars (EB00). I,'a5 Ownof of the propOrty ol my, empl0ye85 with wage5 d5 [h0if SOIB comp¢nsatio0, will tlo t08 wOfk, antl lhe s[NCtUfB I5 nOl IOtOnCetl of oft¢rOtl ior sala (Section 7046, Businesz an0 Protassional Cotlo: The ContractoYs Licenu Law tloas nol apply to an owner ot a property who builtlz or improves thoreon, and who tloe5 such work himself/heriqlf ot [nrou9h hls or hBr Own employeez, p�ovitl¢tl that such Imp�ov¢menls ar@ �ot intnntlatl or 01fe�etl iOr salo. It, nowever, the builtlln9 or improvemont is soltl wlthin one year ot com- pletlOn,- the Owner will have th¢ bu�tlen of Pwvlhg h¢/Sh¢ tlitl not build or Im- �rOve forlha purpose ofsalo). 1, as.owner af the D�operty, am ezclusively �ontracting wlth licensetl con- [ractoRtO Construct Ihe pwjeCt (Settion 7044, Business antl Prof¢SSIonS Code: Th¢ ConVaclor's License Law tloes no[ apply to an'owner of proper[y who bulltls or Improves the�eon, antl who contrdCtS 1ot SUch oroiects wicn a con- [ractor(51 I�conS¢ pursuant [O t�e Conlydtto�'S L��enie Law). I am aware that proof of Ihel� Wo�ket's Compen5ation insuranCe ihOultl De provitleU t0 me., ❑ I am exempt untler SecUon B. d P. C. for this reason Oate� " Owner _ I hereDy certity that I have reaa Ihis inrormation is �recL I aweofto.como Drivers' above iances �ep�e- y for DorGer Ilnes ana sign all aporaoriata tleclarations. LOT NO. UNIT NO. , TVPE OF CONSTRUCTION LJ NEW U ADD KJ� ALTERATION U REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. —o �� TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICFL � PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SGt. F7. oCCUPANCY CONSTRUCTION TVPE VALUATION S ZONE GRADING CU. VDS. ACRES Remarks:� � � 78� � 2 F' : � S� �..2 F�"�-`.sC� f�6� - � PLUMBING �FEES Backflow Preventer � Backflow Irrigation Bathtubs Clarifiers - � Dishwasher , � Drinking Fountains Floor Drains � Floor Sinks Gas Service ��OuUets Interceptors ' Kitchen Sink - - Lavatories � P—Trop Roof Drains • Reinspactian Fae � 515 Boiler Duct - Under Ground • Ouc[ - Strucmral Duct - Ventilating Exhaust System ❑ Multiple � firepl/Fact. BIL ICBO •# Heating Sysrem & Ducting - ❑6100,000 BTU �100,OOOBTi � I Reinspection Fee � �$15 CMF 0865-46, rev. 10/84 Whi[e - Builtlinq; Canary - qpplicanq Pink - Accounting; Goltlenrotl - Assessor SIIOWCfS Service Sink � Sewer Cap Sewer Connection Solar Collectors Solar Piping 'Solai Tank .Swimming Pool w/Spa Urinat Water Closet � Water Heater Water Service - Aum�Wash Issue Fee Hood or Typel ❑ Canopy Typeli ❑ � Refrigeration System Oaioo,oaoeTu ❑ioo,000eru System Repair/Alteration Fire Dampers � Registers Iswe Fee $ 3 $ 3 A.P. ,W S Main Bui E T Front B Reur A C Right K Left S Ping. fief. # . 6312 10/30/86 ' 40o50y TL Zone Accessory Builtling: Z � O N I N G R Parking Req./Provided E � M T S , ELECTRICAL FEES Automatic Washer . Construction Pole Sub. � Cooking Unit, _ Dishwasher ' Dryers ❑Gas ❑Electric Fan � � F.A:U. Fixtures � Device Boxes Outlets ' Swirches - � - Garbage Dispoul Generamr �0�5 KW OS-75 � '7ransformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 ampr Sub Panel Mocors �P7•HP �1'h - B Inc Solar �9-15 HP 0�16� Microwave • , Pole Light , Sign " ' Standing SCctions Trash Compactor I Reinspection Fee I$75 I ' I luue Feo DEVEI.OPMENT SERVICES REQUIREMENTS: 2onin8 Approved By BuildinB Approved By 5 Appliotion laued Bv � � ' m+-a - I $3 � . . SUMMARV OF FEES � � BUILDIIVG PERMIT $ ' SMIP $ — PLAN CHECK S PERMIT . - PLUMBING S yd•S� - �SSUANCE $ _ NdP�PLAN"CHECK 25% 3 ENEPGV P.C.' $ - P��LECTRICAC - �$ � GRADING $ PLAN CHECK 50% $ MICROFILM . $ MECHANICAL � $ TOTALFEE $ y0,� PLAN�CHECK � Z5% $ 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 Gmd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit�Undrgrnd. 8. Foundation � 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. , 60. Backwash Lines, P-Trap, O Undrgrnd. 70. 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 SYsiem - Final - 14. Rough Plumbing � �� 65. Electricat-Final 15. Rough Electrical-Conduit � 66. Solar System-Final 16. Rough Electric Wiring � , 67. Fencing & Access Approval 17. Rough Wiring Sign . 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning � � FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # _ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil • 25. Roof Sheathing 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 8rown Coat ,�, 79. FINAL INSPECTION • 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 0 9{ d�� . n Y 34. Final Heating & Air Conditioning 9, .G ' Q 35. Final Gas Pipe-Test , .- .. � 36. Hood or Canopy 37. Final Factory Fireplace �. �+'; 38. FinalPlumbing � ' ' - ,' � � . ;� � 39.�Water Service-Final ' � , , 40. Gas Service-Final • • . , 41. Solar pomestic-Final . � ` � 42. Backflow Preventer �� - � � � 43. Backflow Irrigation � • , � • 44.�Landscape Irrigation System `� , `� . � � ' .. . 45. Sound Attenuation � • . 46. Handicap Regulations ' ., 47. FINALSTRUCTUfiE & BUILDING • •� - ,� �'' 48. Special Requirements Completed ' � • " < ' 49. E�ectrie Release to Edison • - �� 50. Gas Reiease to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY ' No. Date t � i � Applicant l0 1i11 In all spaces axceot tnosa witnin neavr Dareer Iinas ana sign all aporoo/�ate eeclaratfons. EITY OF COSTA ME O STR O P IT PERMIT NO. � . TRACT NO. LOT NO, 11NIT NC�. � �">� �r Y�� 'i� e-�' Project Address � � � Applicant's Mailing ddress . �l �� Owner's Name ' Phone Address Arch/Eng. Licenu No. - Address ' i Convacmr's Nam � • Phone f AddressfmA�'��I� /ilfMrr:�/ �• . Ciry License No. 2y 1�7Z LICENSEO CONTRACTOR DECLARATION , I hereby alfi�m lhat I aT Iic¢nsetl untler Orovi5iOn5 Oi Chdrt<r 9(Commencing with section 7000) of DiviSlon 3 Of the BuSin¢i5 antl Prote55IOn5 COtl¢, antl my Iicense is in full fpfce ay ,eftecL �, _ry license Clas �� S icensa y. Y� Oate Signature 'j' � � i � (o WORKER ' OMPENSATION DECLARAT ON I hereby affirm lhal I have a certlflwte ot tonsent to selNnsure or a certlticate of Workers' Gompensation Insurance, or a certlfietl copy [hereo/ (Section 3800. Lab. C �` �� L/ Policy No. '�' Q�� Company v� t�tiea copy Is nereby turnishea. Certi i iled witn the city B m i . Date APplicanl EXEMPT ON FROM WORKERS' CO VENSATION DECLARA ION (Tnis section neetl not be com0�eletl it the permit it for one huntlratl (5300) or Iess). I certity that in the performanco of t�e work for which tnis perm�t I5 issuetl I shall no[ employ any person in any mannGr So a5 [0 0¢COmB Subject to t�e Workers' Compensation l.aws of Califomia. Date Signature NOTICE: 1f, atle� making thii tletlaratlOn, You Shoultl becoma sub/acl to the Workers' Compensation proNsions o( tha Labor Cotla, you must torthwlth comply wlth Su[h 0/ovi5ion5 or thli P¢rmlt Shall be tloeme0 ravoketl. CONSTRUCTION LENDING AGENCV 1 nereby altirm that there is a coni[rutUon Ien0ing agoncy far the pertormance ot the wOrk tor whiGh tni5 permit is issuetl (Setlion 3097 Civ. C.) Lentler's Name , i �enaer's AtlCress �'� OWNER BUIIDER pECLARATION � I horeby dfflrm tnal I dm exempt lrom the ConVd<tor's UUnse L.aw tor Ihe tollowing reason �Section 7031.5 Buzlneis antl Professlonal Catlo: Any cllY or councy whlcn requires a permit to conttruct, alter, imorov¢, tlemolisn or repalr any ztructure, pdor to Its issuance, aIm requlras the app11<ant tor such pormit to /l�e a signetl sWlement Ibat he/sne I5 II<ensod pursuant to the provisioni ot tne Cm[ractor's License Law (Chapter 9(commencing with Sectlon �000) 01 Oivision 3 of the 6usiness antl Profnssions Cotle) or that ha/she ii exempt Iherehom an0 lne basis �or the alle9etl Oxomp[lon. F�y violallOn ol Secllon 7031.5 by any applicant for a permit sub)acti the appllcant to a civil �¢nalty oi not more than tive huntlrcU tlollars (5500). I, as owner of tha prooerty or my emD�oyees wltn wages as lhalr sole compensation, will Go'l�e work, antl lhe s[ructura Is nal IntentleC or oflewtl /or wle (Section 7044, Business antl Professional Cotle: Tho Con[ractor'z License Law tloes not apP�Y �o an awner ot a proparty who bullOz ar ImProvas thereon, anE who aoes sucn work himseli/hersalt or throu9h hls or ner own employees, provltletl that such improvements are not intenantl or oHerca for sale. It, however, the building or imvrovoment Is soltl witnin ono year of com- Olelion, tne owner will �ave the burtlen of proving h0/z�e OIE not bulltl Or im- prove forthe purpose oi sale). ❑ I, az owner oi the oroperty, am extlusively concracting with Iicensetl ton- tractor5 fU conStNct the project (SeCtion 7044, Busin855 antl PrOfe55Ion5 COUB: The Contractor's License Law does not appty to an owner ot property who builtls or improves thereon, antl who contracts lor suGh projects with a con- t�actor(s) lit¢nse pu�suant to the ConUacto�'S License Ldw). I am awdra that proOf O( itlei! Work¢r'S COmpBnSd[Ion InSuranCO ihoultl be OrOvItl00 IO m0. ❑ I am exempl untler Sectlon B. & P. C. �or this roason Date antl state ia s ia in sentatives his c' inspection os Si9nature Drivers' License or SS $ owner abova TYPE OF CONSTRUCTION IJ NEW LJ ADD W ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A,p. q�t DESCRIPTION OF WORK/USE OF BLDG. � � ' S Main Buildi TVPE OF PEHMIT GRADING�Q FOUNDATION � STRVCTURAL T Front ❑ TENANT ❑ ELECTRICAL y� PLVMBING ❑ MECHANIC/1L 8 Reer ❑ OTHER %� PROJECT DESCRIPTION Sp. FT. OCCUPANGV C Right � K Left CONSTRUGTIONTVPE VALUATIONS $ � ZONE G0.ADINGCU.VDS. ACRES p�ng.Ref.!� Remarks: Q -. �(� 'j,Q'Z � Planning Notes: 3ar Sink 3acktlow Preventer 3acktlow Irrigation Bathtubs � - Clarifiers Dishwasher Drinking Fountains Floor Dreins Gas Service Interceptors Kitchen Sink �avatories P—Trop ROOf Drains Reinspection Foe �UII2L5 $15 Dutt - Under Ground Duct - Structural Duct - Ventilating ' Exhaust System ❑ Multiple � Firepl/Fact.Blt.IC80q'k . Heating System�& Ducting O P7 00,000 BTU � 100,000 BTi Reinspection fee $15 CMF 0865-46. rev. 10/84 White - - Applicant; Pink - Ac<oun[in9; Goltlenrotl - Assessor PLUMBING Service Sink Sewer Cap Sewer Connec[ion � Solar Collecrois Solar Piping Solar Tank Swimming Pool w/Spa Urinal water Closet Water Heater . Water Service Auto-Wash Laundry Trays laue Fae Hood or Typel ❑ Canopy Typell ❑ Fefrigeration System ❑o-i oo,000 sru' o i oo,000 Sys[em Repair/Alteration Fire Dampers � Registers - Issue Fea 9� FEES Automatic Washer Construction Pale Sub. Cooking Unit ' Dishwashe� : Oryers �Gas ❑Electtic Fan F.A.U. Fixlures Device Bozes . Outlets i 6781 II/05/86 Parking Req./Provided ELECTRICAL Garbage Dispoul Genereror DOb KW �575 KW 2one Transformer ❑ 75-50 KW ❑ 50+ KW Meter �up to 100 amps Meter �over 100 amps Sub Panel - : Motors 067 HP 01 Y, - 8 InaSolar 09-15 HP �1E75+ Microwave i Pole Light _ Range � Si9n - Standing Sections Trash Compactor S 3 Reinspection Fae 315 laue Fee FEES DEVELOPMENT SERVICES RE�UIREMENTS: Zoning Approved By Buildine APVroved By � , Application Issuad By .$ 3 � IOo50 TL Z O N I N G R E Q M T S FEES S 3 . SUMMARV OF FEES BUILDING PERMIT' $ SMIP $ PLAN CHECK ,$ PEFMIT PLUMBING $, 'O� ISSUANCE 3 � � PLAN CHECK � 25% $ ENERGY P.C. $� ELECTRICA� $ GRADING S -, ' PLAN CHECK 50%' $ . MICROFILM ,$. MECHANICAL S TOTALFEE $ /Q, � � PLAN CHECK 25% $ . � • � CONSTRUCTION AND PLANNING � POOL & SPA � APPROVALS Permit# Date Inspector qppROVALS Permit�h Date Inspector 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. �� 53. Steel Reinforcement ' 3. Electrical Conduit Utility-Undrgrnd. . 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical�Bonding 5. Steel Reinforcement , 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation � 59. Gas Pipe, O Undrgrnd., Test , 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 67. APPROVAL TO DECK 11. Roperty 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 i 6. Rough Electric Wiring 67. Fencing & Acce55 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 # � 21. Ducts,,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil - . 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil ' 25. Roof Sheathing 74. Overhead Hydro 26. T-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 c 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 Attenuation 46. Handicap Regulations " � , ' 47. FINAL STRUCTURE & BUILDING " - 48. $pecial Requirements Completed � 49. Electric Release to Edison . 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY . No. Date �� Applicant to /ill in all spaces except tnosa witnin neavy Coraer Ilnes ana slgn all approoriate tivclarations. ciYvo�c`8Sr esa CONSTRUCTION PERMIT �'Prolt=iAddress�� w• ( ^rH S � C.�1.+ �` � APPlicant's Maiff g A�N�a« �-1 O��7T N 5T ^7 1n . �1�1w,, �C�✓� Owner'syame�UaNR�..A l., 1ZobER�S Phone ""�a� 7—� Address �.� � E 11T11- ST �JTL �1 C M -12..:.i.1 Arch/Eng. Licenu No. Address Contractor's Nam Phone Addreu Imailing) Ciry License No. LICENSED CONTRACTOR OECLARATION 1 he�eby aftirm that I am Ilcensetl untle� provi5ions o1 Cbarter 9(COmmenCin9 with section �000) 01 Divislon 3 of the Business anE Professlons Cotle, anC my Iicense is in fu11 force ana eifect. . License Class llcense No. � Date Signature 'VORKERS' COMPENSATION DECIARATION hereDy af/irm tna[ I �ave a certifiW[e of consent to self-Insure or a cerlHitate of Workers' Compensation Insurance, or a certifietl cop ther f(Sectlon 3800, Lab. CJ Policy No. Compan Certifietl copy is ne�eby turnishe0. Certitietl copy B filetl with the tlty Builtling Dlvislon. , .� ' Oate Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section neetl not be com0le[etl i( the permit is tor one M1untlr80 ($100) or Iess). • I cer[ify that in the performanca of Ihe wO�k fOr which this p¢rm�t is lizuetl I shall not employ any parson in any ma er so a t b c e subject to t�a Workej s' Co p s n Lawi of Califo i Date/ Si9nature NOTICE: It, a er making th15 tleclara ion, you ihOultl bacom ub70ct' l0 Ihe Workers' Comp¢nsaUon provislons oi the Labor Cotle, you uil torthwlth Comply with such p�ovlsions or [ni5 p<rmlt Shall b< tl¢emotl rovoketl. CONSTRUCTION�LENDING AGENCV I hereby a(firm tna[ Ih¢ie i5 a coniVuclion Ientling agency to� t�e performance oi lh¢ wo�k ior -which this permlt i5 IsSuctl (Se<tlon 3097 Civ. C.) Lenaer's Name � Lentler's AOtlress OWNER BVILDEN OECIARATION I hereby a(ilrm•thal 1 am ezempt Irom tha Contractor's Ucense Law lor tne following reason (Settion 7031.5 Bu5lness antl Profasslonal Gotlo: Any cltY or county which requires a permil to construct, alter imvrovo, tlemolisn or ropair any svucture, prior to.ils issuancn, alw reaWrcs t�o applicant tor such permit to fi18 a signetl'Statem¢nt that ne/ihe IS IICOnsetl pursuant to lhB prOvision5 of the Contractor's Ucense Law (Chapter 9(commentln9 �+�th SecHon 7000) of Dlvlsion 3 ot tne BuSiness antl Profeislons Cotla) or that ho/ino Is exempt therefrom and lhe bazis for the allo9otl exomplion. Any violation o/ Su<tion , 7031.5 by_ any applicant 10r a permit subjects lne applitant l0 a civll �enally of not more than five nuntlro0 tlollars (5500). 1, as own¢r ot lha proDerty Or my OmDI0ye0i with wdges a5 Ih01r sole � COmpenSdtiDn, wlll tl0 ItIB work, dntl Ih0 StruCtufO Is nOt Intentl8tl Of oHeletl for sale (Seclion 7044, Business an0 Protessional Cotle: The Conlractor's License Law tloes nol apply to an owner o/ a properry wbo Dulltls or Improves ' the�eOn, antl whO;tloes such work himsatl/hersal/ or tbrOugh bls or he� own employees, vrovitletl that such Improvemants are not IntanCetl or offoretl tor sale. It, nowever, the buil�ing or improvamant is soltl within ono year ot com- pletl n, the owner wlll nave the burtlen o1 proving na/she OIa not Duiltl or Im- p� a tot tn¢ pu�po5e of Shco). I, as owner of tne proverty, am exclusively contractin9 with Iicansea con- tractoR to ConsVutt tha pfo7aGt ($¢ctlon 7044, Bu51na55 dntl PI01eS5ions Catla: Tha Contrd<tOr'S LlcanSe ldw dol5 nOt appty to an owne� of p�oDerty who bulltls or Improves thereon, ana who contracts lor suth projects witn a con- tracto�(51 license pursuant.t0 Ihe ConbaGtOr'S Llcen50 Law). I am awar¢ tM1at proof of thei� Worke�'S Compensa � j,pyura�j.CZa��oultl be OrOvi00tl to me. �L7 1 am exempt untler Sectlon S� � B. 8 P. C�or thls reason /v�j_(�=- pwner - — rertiiy that I have reaa thls applica8on antl stat tnat the abov¢ n is correct. 1 a9ree to compry wlth all city antl c unty orEinances laws relatln9 �o builtlin9 COnstructlon, antl he�lby aulhorize ra0r¢� of jhjs city�j4 entp,� upon tha abova-mentlonetl Property for � as�ga I �� TYPE OF CONSTRUCTION NF ❑ CONVERSION ❑ DEMOLISH DESCRIPTION OF WORK/USE OF ADD LJ ALTERATION LJ REPAIR "HER TVPEOFPEbM1T ❑GRADIrvG C�FOUNDA' ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ OTHER -' PROJECTDESCRIPTIOIV 'S . F . � � CONSTRUCTION TVPE_ r n 20NE GRADINGCU.YDS Remarks: � Bar Sink ' _ Backflow Preventer Backflow Irrigation . Bathiubs � Clarifiers� -" Dishvwasher . � � D�inking Fountains � Floor Drains' � Floor Sinks � ' Gas Service Outlets Interceptor5 "� �� Kitchen�Sink Rooi D ins � Reinspection Fea $15 Boiler Duct - Under Ground • 1 Dutt-Structural ` Duct - Ventilating Exhaust Sy,stem ❑ Multiple ❑ Firepl/Fact: Blt. ICBO # Heating System & Duc ❑0�100,0006T t00,0006T DriverY License or 55 � I� Reinspection Fee ' I $75 CMF OB65-46, rev. ]0/84 White � Builtlin9: Canary - Appliwnt; Pink - Accounting: Goltlenrotl - Assessor J MECHANICAL — OCCUPANCY - LUATION S �. u v� �. AC R ES T .� � FEES Showers Servite Sink Sewer Cap Sewer Connection Solar Collectors � Solar Piping . Solar Tan Swi mg Pool wl5pa Water Closet Water Heater Water Service Auro�Wash laue Fee Hood or Type I ❑ Canopy Type tl ❑ Refrigeration Sys�t +� ❑o-ioo,o�fu ��oo,000 �SK�t me RepairlAlteration f ire Dampers Registers , Issua Fee A.P. qW d S Main Bu E T Front B Rear � A C RightE K Left S Ping. Ref. # Automatic Washer Construction Pole Cooking Unit Dishwasher Dryers ❑Gas C Fan F.A.U. ' Fixtures Device Boxes Outlets Garbage Disposal Generaror D0� § 3 __ . � Reinspection Fee §.3 5219 10/15/96 2one Accessory Building: O1�Pll4�fd77 S c i %%%Pi4�7 �iJLLKi �[!a. �/.eo � Parking Req.IProvided /�� . �ELEC7RICAL � � Transformer ❑ 15-50 KW ' b , � .� 50+KW Me[er ❑up to 100 amps � • Meter ❑over.100 amps / actriu Sub'Panel - � � � ' Motors OO-1 Fj 1 h- S Inc.Solar�9-15 HP �16�15+ .Yole Li9ht Range $ign Standing Sec[ions Y �5�75 KW Trash Compector DEVELOPMENT SERVICES Zaning Approved By Building Approved By � Aoolintion lauad Bv Si5 � I �uue Fee � / 274014 TL 2 0 N I N G R E Q M T S FEES 53 SUMMARV QE FEES � BUILDING PERMIT $ a33•��b SMIP $ �, 6q X�aPLANCHECK $ ��qSpERM1T- . PLUMBING $ - �SSUANCE � $ PLAN CHECK � 25% $� ENERGV P.C. S � , ELECTRICAL $ � GRADING $ PLANCHECK 50% $ MICROFILM $ n� (�/(/ ' MECHANICAL � $ TOTALFEE $ $zJ� � 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 L�ocation 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 Undrgmd., Test 9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, O Undrgrnd. • 10. Structural Floor System 61. APPROVAL TO DECK 1 t. 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 � i 6. 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 i 20. Rough Factory Fireplace APPROVALS Permit # • 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil � 23. Gas Pipe-Rough & Test 72. Underground Flush � 24. RoofFraming � 73. Undergrnd.StorageTank�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 13 �7 HEALTH DEPT. REQUIREMENT � 31. Plaster Brown Coat - 79. FINAL INSPECTION �' � 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE SUED - 33. Final Electric Notes: Z 7 �fa•-y�L �n Wl�Gs C 34: Final Heating & Air Conditioning �OLD �OR SPECIAI. � 35. Final Gas Pipe-Test �� 7 � 36. Hood or Canopy " 37. Final Factory Fireplace _ . � 38. Final Plumbing � . � 39. Water Service-Final ♦_ �• V 40. Gas Service-Final � . 41. Solar pomestic-Final , 42. Backflow Preventer - .. i 43. Backflow Irrigation � _ ' .. . ,44. Landscape Irrigation System �, i � . �45. Sound Attenuation -' ' � I 46. Handicap Regulations � , `' 47. FINALSTRUCTURE&BUILDING �Z; � � 48. Special Requirements Completed ��3 $� M� ' ' �•r 49.- Electric Release to Edison .. . , i... 50. Gas Release to Southern California Gas Co '� , 51. CERTIFICATE OF OCCUPANCY . . ' �' No. Date . ' \ \ ADG��ant lo till in all s0aees excepl t�ose wlthin �eavy DorOe� Ilnes antl fign all apOroprlate Eeelaratlons. CITV OFCOSTq MESA CONSTRUCTION PERMIT Projec�Address 6.70. W.. 17th. $t. Applicant's Mailing qddress .Owner'sNnme S1T RO&PiS IZ � phone Address 67Q W l�th Gt Arch/Eng. License No. Address aster rotection - 3 Contracror's Nam Pho�� Addresslmailing) Lunar Srea Ciry License No. 3 3 � LICEfJSED CONTpACTON DECLARATION I hCreby afti�m lhet I am Iicensetl untler provisions of Charte� 9(commencing with section 7000) of Divlslon 3 oi the Business and Professlons Cotle, antl my Iicenze is in fuq {omr ae�eifect. 3��(307 �+ v Liconsc las ' ense No. Date �-�- Si9 � �"�� WONKERS' COMPENSATION DEC RA ON � I hereby affirm tnat I have a certificate of con5ent [o self-insure or a cerU(icate of Workers' Compensation Inmrance, Or a certitiGtl COpy tne�eof (Section aeoo, un.��r6487350 United Pacific PoliGy No. Company C¢rtifietl mpy Is hereby fumishe�. Cer[ifietl o is 1 with tne <it uiltling D' on. �` Oate � � � � � APO��dnt E%EMPTION FROM WORKERS' C NSA ION DECLARATION (ThiS section neetl no[ bo completetl if e permit is for one huntlretl (E300) or less). I certify that in [he per/ormance o1 tbe work for whiGh [his perm�t is issuetl I shall not employ any per50n In any manner so az to becom0 Subject to t�¢ Workers' CompensaHon Laws o( California. Date Si9nature 'NOTICE: If, atter making tnis tleclaration, you s�oultl be<ome subject to the Workers' Compen�tion provizions o1 the labor Cotle, you must (orthwitb comply wiln suc� D�oviSions o� lhis Oe�mil Shall be tlaBm<tl �evoketl. CONSTRUCTION LENDING AGENCV I horeby aHirm tha� (here is a conSV uctlon lentling agency for the periormance of Iha wOrk fo� wMch thi5 petml[ is izsuetl (SettlOn 309] Civ. CJ LenEer's Name LenOer'S AtltlreSz OWNER BUILDER �ECLARATION I horaby aftirm tqat I am oxempt from [ne ConVactor's Licansa Law tor the tollowin9 reason (5¢ction 7033.5 Business antl Protesslonal Cotla: Any city or County wM1ich �equiras a pOrmil to <onst�uct, alte�, improve, tlemolish Or �epair , anv struttum, prior to Itz issuanco, also requires the appli<ant for such oermlt thereirom an0 the basls tor tne allegetl exemptlon. Any vlolation ot 5ection 7033.5 by any applicant for a Permil subjetts tna applicant lo a civil �enalty o1 not more than ilva huntlretl tlollari (5500). I, as owner qf Mn o�oporly or my amployeas with wages as their sole compunsation, will tlo tha work, antl the structure is not Intontletl or ot(ere0 lor sale (Seclion 7044, Buslness antl Professional Cotla: Tha Contractor's LlcenSG Law does not aoPly to an owner of a property who bulltls or Improves tharaon, dntl whp does Sucn wOrk M1imzelf/h¢rselt or thrOugh h15 0� qar own empby ees, provitletl tha[ such Improvements ara not intentlotl or olt¢re0 io� sUle. II, M1oweve�, �h¢ bulltling o� ITPtovOment it SOItl wl[hln ono Year of com- plolioq the ownQr will have lna burtlon ot prOving �e/ShC tlitl not bulltl or Im- �rove �or lne purposc ol sale). I, as owner of �he property, am nxcluzively contractlng with Iicensetl con- tractors to constrUct tne project (Section 7044, Buziness antl Profaszlons Cotle: The Conlractor's License Law does not apply to dn owne� ot ptoperty who builtls or imo�oves thereon, antl wno contracts for suth pro�ects with a con- tractor(sl Ilcens¢ pursuanl to the ConVaCtOr'S Llcen58 Ldw). I am awa�e Nat proof o( tneir Worker'S CompenSallon insurance shoultl be pravitletl to me. ❑ I am uxempt untler SectlOn 8. 6 P. C. lor thi5 rea5on, oate I hereby ttrtify�tha� In�OlfTdtl011 IT COYI¢C' 3Od SLd�O IdWS l2ldl�f smEatives ol t �i inspectlon purp z. Signature Drivers' License CMF OB65-46, �ev. 30/84 — Owner I have�reatl tbis applicat(On antl stdte that t�2 dbov¢ I agree to comO�Y �+�th all city antl coun[Y ortllnances � to bullAing construction, antl hereby authorize repre- y to enter upon tbe above-mentlonetl Oroperty for %" � Date 3-9-87 -�{'�� - Applicanq Pink - Accountin9: GolAenrotl - AsseSsor Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Warer Heater Water Service Auto-W05h �aundry Trays Issue Fee Hood or Typel lJ Canopy Typell � Refrigeration System ❑0.700,OOOBTU ❑100,000 Sysrem Repair/Alceretion Fire Dampers Registers Fee 3/IB/87 2onB Accessory 8 ELECTRICAL Automatic Washer ' " Transformer ❑ 15-50 KW Construction.PoleSub. � 50+KW Cooking Unit D ishwasher Dryers ❑Gas �Electric Fan F.A.U. Fixtures Oevice Boxes Outlets Switches Garbage Disposal Generator �0�5 KW �5-15 KW Meter �up to 100 amps Meter ❑over 100 amps Sub Panel MOmrs �67 HP � 115 - 8 Inc.Solar �9-15 HP �16�15+ Microwave Pole Light Renge $ign ,' Standing Sections Trash Compacmr S 3 I � Reinspection Fee $15 laue Fee FEES DEVELOPMENT SERVICES RE�UIHEMENTS: Zonin9 APProved By Building Approved By Aoulication laued Bv � S 3 16.50 FEES $ 3 SUMMl,1RV QS,FEES BUILDING PEFiM1T $ lb V V SMIP $ � PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $, GRADING $ PLANCHECK 50% $ MICROFILM, $ MECHANICAL $' TOTAL FEE $ 16. 50 PLAN CHECK 25% $ � , Z O N I N G R E Q M T S � CONSTRUCTION AND PLANNING P�� " SPA � Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit# . 1.'Temporary Electrical Service or Pole 52. Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement � 3. Electrical Conduit Utility-Undrgmd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7. Footings � 58. Electrical Conduit-Undrgrnd. 8. Foundation ' 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe�Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System t 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Orains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final _ 1�6. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 78.� Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19:� Rough Hea4ing & Air Conditioning FIRE DEPT. REQUIREMENT 20' Rough Factory Fireplace APPROVALS Permit # • 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating � 71. Product Piping O Gas ❑ Oil 23. �Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas OOiI 25. Roof Sheathing �74. Overhead Hydro 26. T-Bar Ceiling lStructural) & Monocoat � 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe -28. Lathing & Siding • 77. FIXED SYSTEM FINAL � 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat . 79. FINAL INSPECTION - �� 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: - 34. Final Heating & Air Conditioning - 35. Final Gas Pipe-Test , 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final . 40. Gas Service-Fina� 41. Solar pomestic-Final 42. Backflow Preventer � � 43. Backflow Irrigation � 44. Landscape Irrigation System ,, , 45. Sound Attenuation ' 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison . � 50. Gas Release to Southern California Gas Co . 51. CERTIFICATE OF OCCUPANCY ' � - No. Date �1 AGOlicant ta fill in all fpaces a:cept u CITY OF COSTq nnESA CONSTRUCTION PERMIT � P,��C�d� ��^—�.��--m� W. 17th StreetR3,,��/�' �Applicant'sMailingAddress f�90 1'1• 17th Street 'Owner'sName yM�/arsh�ll Uuffield Phone645�6811 Address �� p• �-�th St1"PP� �OStd Mesa CA 92627 n�onie�y.�an-��P1 o/Ri ercan Inc License No. C-11gO1 Address .3.�� !- Ramnart St..�Suite F O�a;i�n, .,�_ Contractor'sName KY'Al1CP rO1lCYP'll('Y7011 pho�e�� Addreu (mailing� � p-7� C City License No. �p�� i.A �iFi4Fi LICENSED CONTRACTOR DECLARATION I her y afti�m that I am Iicensetl untle� proWSions o� Charte� 9(Commencin9 wit section 7000) of Division 3 0l lhe Busina55 anG Protessioni Cotle, antl license iz in tuli i ce antl eitect. censeClass Licen � 0�7��1 Date �� " Signa[ure � WORKERS' COMPENSATION OECLARATION 1 hereby atfirm that I �ave a cerHticate of consent to salf-iniure o a certlticale of Wo�ke�Y COTpensa[io InSurance, or d Certl tl copY Ih ¢Of ( ction 3800, Lab. .C� • Policy No. Company � �❑ Cer Hietl cop i5 hereby fumi 0. . 1� tifJ"e copy�'S f�1etl wit e City'BUIltliqp�IWSion// � /� /'YT pplitdnt �� J�+�' �EXEM7TION FROM WORKERS' COMPFN�SATION �ECIARATION (This section neetl not be comple[etl if the Oermit is for one huntlrea (5100) or less). . - 1 certiry tnat in the per(ormance o! tne work for wbich this perm�t is fssuetl, 1 snall not employ any p¢rsOn in any manne� so a5 to bCCOme subject t0 Ihe Workers' Compensation Laws of CalifOrNa. . Date 99nature 'NOTICE: If, attar making this tleclaration, you ihoultl bacome subjnct to tha Wo�ker5' Comp@n5ation provisions ot lhe LaDo� Cotle, y0u must Io�tnwith comply wilh SUch prOviSions o� thi5 pe�mlt Shall b¢ tleemetl rnvoke0. CONSTRUCTION LENDING AGENCV ' 1 hereby atfirm that there Is a constructlon lenein9 a9ency for tho performanco of tne work for wnich tnts perml[ is issuetl (Section 30B] Clv. C.) Lentler's Name Lentler's AOtlrCsS � OWNER BUILOEH �ECLARATION � I bereby aflirm that I am ezampt irom tho ConVactor's Licenio I,.aw for Ihe following reaso� (5ectlon ]031.5 Buslness antl Professional Cotle: Any cl[y or county whicM1 �Cqui/es a P¢�mlt to cOniVUC[, alte�, Improvo, tlemOlislt or rOpai� any structure, prior to its issuanco, also requlres tho applicant lor suth permit to file d signetl stat¢Tent [hal he/sh¢ Is Iicensatl pursuanl t0 tne prOvisions 01 � the Contrac[or'g License Law (Chapter 9(commencing with Saction 7000) of Division 3 ot tha Businesi antl PrOfesslonz Cotla) or that be/She is exempl theretrom anC (ha basis tor the allegetl exemption. Any vlolalion ot Sectlon 7031.5 by any appliCanl �Or a permit subjeGtz llte app��cant to a civll �e0dlty of not rt�ore Ihan fiva buntlretl t1011ars (5500). I, a5 owncr o1 th0 prOp¢rty�or my employces with wagoz ds lhBi� sol9 com0ensation, will tlo [he work, an0 tha structure is not Inlentlotl or oltero0 ior zale (Sec[iOn 7044, Busineiz antl Professional Cotla: The Contrattor's License Law tloes not apply lo an owner ot a property who builtli or improves thereon, antl who OoeS sucn wOrk nim5Cl1/hCrS¢II Or ln�ou9h nii or ha� own ¢mployees, proy�tletl that suCh improvements a�e not int¢ntletl ot oflerotl f0/ sale. 11, however; the buil0ing or Improvoment is soltl wi[hin one yoar of com- pleUon, the owner will have the burtlen o1 proving he/sh¢ altl not bulltl or Im- prove for the OV�pose of sale�. ❑ I, as owner pt tne-property, am axclusively contractln9 with Iicansetl con- tractors to cons[ruct Ih¢ projuct (Sectlon ]044, Business anG Protessions Coda: The Contratto�'S Licenie Lavi tloe5 not appty lo an Owner at prOPerty who builUs or ImprOveS Ihe�eon, antl who cOn[racts �or such projaGts with a con- Vactor(s Ilcan4e pursuant [o tne Contrac[or's Licanse Law). I am aware that proof o� tbei� WorkePs Compensatlon Inzuranto ShOultl bo prOvitletl to me. ❑ 1 am exempt un0er Sectlon B. & P. C. for this reason \Date , Owner 1 nereby certify.tM1at'I have reai Info�mation i5 Correct. I agrCu to antl state laws relatlng to buil0ln ��\ se#tatives ot this citv_ to enter License or 55 � Ihis appllcation 2ntl State tnat tM1e abOvO �m01y with all clty antl county ortlinances constructlon, antl hereby aut�orize repra- ipon the abovs-mentio tl/Proporty fo� � Date� -� � . � Iines an0 sign all apOroprlate Eeclaratlons. _ 15 - a/ yS'7 I niw4tne5d� �.vr5o� � a�� - E TYPE OF CONSTRUCTION � NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER � DESCRIPTION OF WORK/USE OF BLDG nxfl fP�Ttl(IIIC1'Y'l a� �RPY.iI � TVPE OF PERMIT U GRADING LI FOUNDATIO�N[ IAJ STRUCTVRAL ❑ TENANT/� ELECTRICAL �LUMBING,�fJfJ MECHANICAL ❑ �OTHER 5�� PRQIECT DESCRIPTION 5�. FT. j,�.� �A�a � oCCUPANCv� CONSTRUCTION TYPE V-�I Cn��Mi nk�C•:^_P(�/ALVATtON 9� ZONE GRADING CU.YDS. AG`{� B Remarks: [�U� � Q� n(� low Prevenrer low Irrigation Dishwasher Drinking Fountains F.loor Drains Floor Sinks Gas Service Interceptors Kitchen Sink Lavatories . P-Trap Roof Drains P� /i�+'�/ � a ` i`1 ABIMG $howers Service Sink ," � � , SevierCap �- ,J SewenConnection �Solar Colfectors Solar Pipin9 � �, Solar_Tank .- ' ' _ Urinal' _ WatenCloset Water Heater Water Service Auto�Wash Reinspection Fee $15 laue Fee : S 3 Mood or Typel U Under Ground �nopy Type Ii ❑ Duct - Ventilating Exhaust System � Multiple ❑ Firepl/Fact. Blt. IC80 # � ` Heaiing System & Ducting. ❑o-roo;000 eTu Qioo,000en n Heinspection Fee I S15 rev. 7p/84 White - Builtlin9; Cana�y - qppllWnt; Pink - Accountin9; GOltlen�otl - A55055or Refrigeration System . ❑aiao,000'eTu ❑ioo,000 System Repair/Alteration FireDampeis ' fiegisters � Issue Fee S 3 A.P. qW �S Main Building: E T FrOnt A Rear � C Right � � SLeft Ping. Ref. �I`- p�'• Planning Notes: Automatic Washer Cons[ruction Pole Sub. Cooking Uni[ Dishwasher Dryero �Gas ❑Elecuic Fan F.A.U. Fixtures , '� 3471 II/UI/85 Parking Req «r�oa�� ,t. zone � Z O N 1 N G R � s ELFC7RICALV , , Transiormer � 75-50 KW Q'50+KW • Garbage Disposal �� Generator, �0.5 KW �5-75 KW . f ` ''� . ti., ,- ,' . Reinspection Fee DEVELOPMENTSERVI Zoning Approved By_ Building Approved By � AppliCdt1011155ued BV_ Merer ❑up ro 100amps , Meter ❑over 100amps Sub Panel Mocors �41 HP � 7'h = 8� Inc.Solar �9�75 HP �16=1 Microwave - ' � Pole Light . -Range ' � . . Sign � ; Standing Sections _ Trash Compactor, . $15 Isiue Fee � � REaUIREMENTS: �„ .�L.,. FEES S3 F-' � S MM pay OF FEES � �'BUILDINGPEFiM1T $ ��] �% SMIP �� $ �33�6� �LAN CHECK � $ �5 PEfiM1T . � • :. PCUN181NG; . $ ISSUANCE� $- �%. PLAN CHECK 25% $ ENERGY P:C. $ �, � ELECTRICAL $ GRAOING , $ � PLAN CHECK 50% $ MICROFILM $ � •� MECHANICAL� $ � TOTAL FEE $ �� j ' PIAN CHECK . 25% $ • �/ � CONSTRUCTION AND PLANNING � POO� a SPA A�PPROVALS Permit # � Date ' Inspector qppROVALS Permit # Date inspector 1-:°remporary Electrical Service or Pole 52. Pool & Equipment Loca[ion � 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.�eetin�s �� ,�7 � 58. Electrical Conduit-Undrgrnd. .8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System . 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final . 12. Sewer Cap 63. Heater & Vent-Final � 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough 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 I19. 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 0 Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing �,27 G 73. Undergrnd. Storage Tank � Gas ❑ Oil � I 25. Roof Sheathing � a G 74. Overhead Hydro , . 26. T-Bar Ceiling (Structural) & Monocoat �f 75. Dry Chemical 'i 27. Frame and Flashing � 76. Dry Standpipe I �i 28. Lathing & Siding _ 77. FIXED SYSTEM FINAL I29. •Insulation 78. FIRE PREV. FtNAL 30. Drywall Nailing L�j $�L HEALTH DEPT. REQUIREMENT 1 31. Plaster Brown Coat 79. FINAL INSPECTION � 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED �� 33�Final Electric Notes: _ ._ ! 34. Final Heating & Air Conditioning� � 1 35. Final Gas Fipe-Test � '�� _ d�j � v I1 36. Hootl or Canopy ' ..Fv� aF � �QyL . I 37. Final Factory Fireplace �3 �� %N d _�f��K/� t i � 38. Final Plumbing �. �� v �[//��'�o � �. � I�{ 39. Water:Service-Final . .. �� S � � I40. GasService-Final �� F"'��ti� b O� 41. Solar pomestic-Final ' S.FyC�r _ 42. Backfl'ow Preventer ' � g a �' UL L�: �- 43. Backflow Irrigation . '- � _ ' 44. ,Landscape Irrigation System ' � i 3r7 S+IeS� w / Nc 45. Sound Attenuation � �. �l-,�)�$� �t7N�e� U(L . 46. Handicap Regulations I/Q � � /0 Fj� %(�.L p-v��(�'�pN � 47. FINALSTRUCTURE & BUILDING " G �/9 g'G mUK S� l� /� �� I 48. Special Requirements Completed �7 G �/ � a� 8G �f}�/N �{(i%-/?P' CJI� 49. Electrie Release to Edison� _ �'�� m�� - �.P J--�j��7� 50. Gas Release to Southern�California Gas Co ' 7 51. CERTIFICATE OF OCCUPANCY ' , No Date , �� , �I AoO��eant to fill in all iDaees eacept those within heavy Eo�Oer Iines antl Si9n all apOroO�iale tleclarations. CITY OP COSTA MESA CONSTRUCT��ION PERMIZ PERMIT NO. TRACT NO. LOT NO. UNIT NO. � Projecr.Address �7 � G� Applicant's Mailing Adtlress �Q � �' Owner's Name M��S��'L�--�%uF� 6L� Phone G 5�S Gyl� Address � �d Gl /7� 3� C�Cd37??-�i%G�fi¢� Arch/Eng. Licenu No. Address // Contractor's Nama (S%L�'� - � Phone /�i Address (maili� �� s✓ s��'f0� CI�LC� B.�C�;�A Ciry License No. �''�"�� Y'!e LICENSED CONTRACTOR OECLHRATION 1 he�ebY aHirm Ibat I am liwnsetl untler provisions of CbartGr 9(commencin9 with se<[ion 7000) of Division 3 ot the Business antl ProfeSslons Cotle, tl my license is in (ull force etfect. 7 � LICCIlSC CI 5 Date Si9nat e WOR ER CO ENSATION D A N - I hereby aflirm [hat9 M1ave a certiticate o! o self-insure or a c rtificate of Workers' Compen5ation Ins rance, o a certifietl copY Ihereof (Sectton 380D. Lab. � ^ � ry�„ / vp PoliGy No. t 'S� Company CertifiEtl c py is he�eby furni5hetl. � Certi '� opY �'I with the cit Buil ' ision. e � APPlicdnt EXEMP ION ROM VJORKEFS' CO SA L RATION � ' (This section neetl not be completetl if th,e Oermit � or ona M1untlretl (EI00) or IC55). ' 1 certify tnat in the pertOrmance of the work (or whlch thi5 permR i5 iSSuetl, I sM1all not ¢mploy any pe�son in any mann¢r so a5 [o become subjeci to the Workers' Comoensation Laws of California. , Date Signature - N0710E: If,.after makin9 this tleclaralion, you shoultl become SubJecl to the Workers' Compensation provisions of tne Labor Cotle, you must torthwith complY �+'�th sucn p�ovlsion5 or thi5 permit Shall b¢ tle¢metl revoketl, CONSTRUCTION LENDING HGENCV 1 nereby aifirm that there is a cons(ruction lentlin9 a9ency for the performance o( the work tor which ehis permit iz issuea (Section 3097 Civ. C.) I..entler's Name _ Lentler's Adtlre55 OWNER BUILOER �ECLARATION � I heteby atflrm that'I am exempt trOm the Con[ractorY Lic¢nse Law for th0 following reason (Settion 7031.5 Buzlness antl Professional Cotle: Any city or county which requires a permit to construct, alter Imorove, tlemollsh or repair any zt�ucture, prio� to�its is5uan<¢, alm �eqWreS [�e applicant fo� SUCh pe�mit to flle a signetl statement Ihat he/sne is Iicensetl pursuant to the provlsions of the Contractor's Ucense law (Chapter 9(mmmencing with Sectlon 7000) o� Division 3 0( [he BuSinozS anC� Pro1¢s5ion5 Cotle) or thdt he/zhe is� axempt therefrOm antl th¢ basis for the alle9etl exempUon. Any violation ot SectiOn ]031.5'by any applicant for a pe�mit SubjeClS the appllcant tO,a civll ��enalty oi not more than five nuntlretl Aollars (E500). 1, as owner of the proporty or my employees with wages as their 5ole compensa[ion, will Eo tne work, antl thn structure is not intentletl or offeretl f0! ShcB (SBCiIOn 7044, BUS(n¢TS dOtl PfOt¢SSi011dl COtlC: Th¢ COOIIdC[OI'S License Law tloes not apply to an owner of a property who builtls or improves A h tl es such work �Imself/herself or Inrough his or her own r- � TVPE OF CONSTRUCTION� �: NEW ADD ALTERATION REPAIR ❑ CONVERSION� ❑ �EMOLISH ❑ OTHER � A P,� Z DESCRIPTION OF WORK/USE�OF BLDG. - S Main Buildi E TVPE OF PERMIT GRADING FOUNDATION STRUGTVRAL ' T FrOnt ❑ TENANT � O ELECTRICAI ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER .�'� .' A PROJECT DESCRIPTION 54. F7. OCCUPANCv C�Right CONSTRUCTIONTVPE ' VAWATION�G��S� g �eft ZONE GRADING CU. VDS. AC ER 5 Ping. Ref. �k Remarks: � - � - Planning Notes: �i�. i . . i— _ . � �! � C / � Bar Sink � - � . - . . Backilow Preventer ' Backflow Irrigation ' _ , Bathtubs - - ' Clarifiers� � ' Dishwasher- ' . Drinking:Fountains Floor Drains , ' � Floor Sinks . � , GasService I Outlets . Intercepmrs � Kitchen.Sink _ _ __ . _ _ Lavatories P-Trap Roof Drains ; � Reinspection Fea $15 thereon, an w o 0 Cmployee5, prOvitletl that Suth Improvements are not Intentletl o� oHeretl tor BOiIC� � sale. I/, however; the builtling or improvement is soltl within one year of com- pletlon,'the owner will nave tha bu�den ot proving he/she tlitl mt bulltl or Im- DuCt - UOtl¢� G�OUnd �rOva for Ihe Ourpose of Sal¢). I, as owner of the property, am exclusivery mntracting witn Ilcensetl con- Duct - Structural . tractors to construct the project (Se<tion ]044, Businesi antl Professions Cotle: The .Contractor's License Law does .not aOPly to an owner of Oroperty who Duct - Ventilating � builtls �or improves tnereon, ana who contracts for such projects with a con- tractor(sl �icense.pursuant to tM1e Contractor's �icense Law). 1 am aware tnat Exhaust System ❑ Multiple ❑ : proof o( thelr Worker's Compensatlon insurance s�oultl be provitletl to me: ❑-1 am exempt untler Section B. & P. G�or this reason FirepVFact. BIC ICBO # �� Date ' owner Heating System & Ducting = I nerebvi certity that 1 have reatl tnis application an0 state that the above ❑0.100,000 BTU �100,0006T1 " Signature �_ �river5''L CMF 0865-46, rev. Showers Service Sink ' Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank '. Swimming Pool w/Spa � � Urinal Water Closet ' Water Heater � Water Service � � Auto-Wash Laundry Trays � Isue Fae � $ 3 Hood or Typel � Canopy Type II ❑ � Refrigeration System ❑o-ioo,oaoeTu Oioo,000 System Repair/Alteration 'FireDampers . Registers o compy wit� all city antl county ortlinances ' - ing c(� uction, ana hereby authorize repre- - • [he above-me�tionetl properry for' ' . - Aeinspection,Fee $15 � laue Fee Builtlin9: Canary - qpplicant Pink - Acmunting; Goltlenrotl - Assessor $ 3" Automatic Washer _ ' 6985 '6706/86 � , i- • u Parkin'g'Req./Provided � 1: . _ - � � . , - ELEC2RICAL .- " .t :� 1 . � Transformer`CJ 15-50 KW - :� 50+KW up to 100 amps Over100 ampi Cooking Unit ' _ , _ Dishwasher ; � - Dryers �.�Gas ��Electric � Fan � F.A.U. � ' �� . Fixtures ' � ' Device Boxes - I � � Outlets � � � � � ' Switches -� - � ' - Garbage Disposal ' Generator �0-5 KW��5-75 KW Meter Meter Sub P: Motors � 0. 7. H P � 1 h- 6 Inc:Solar �9-15 HP �1E7 Microwave . •� � '� Pole Light ' " Range 'rash Compactor � ti ' I Rainspection Fee � = � $15 � Issue Fee d `` ' DEVELOPMENT SERVICES REUUIREMENTS: ZoninB APProved BY � ' . ,. . Building Approved By ' APPlication Issuad Bv ' ��.. — ". 'j. 46.70 ' T4 _ 2 O N I N G R E � M T $ �. � SUMMARY OF FEES ' � , . �] ,. BUILDING PEFMIT $ •D�+ � .SMIP $ i �S 7 PLAN CHECK ; $ ' � '�-O PERMIT . PLUMBING � .. $ ISSUANCE ' $ : PLAN CHECK 25% $ ' ENERGY. P.C. �$ ELECTRICAL $ � GRADING $ ' PLAN CHECK 50% $. MICROFILM�� $ � ' MECHANICAL� $ ' TOTALFEE _ $ � PLAN CHECK � 25%� �$ " " - � ; CONSTRUCTION AND PLANNING POOL & SPA � APPROVALS Permit#° Date Inspector qppROVALS Permit# Date Inspector ci 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility�Undrgmd. 54. Forms �, 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �, 5. Steel Reinforcement�G/( G,F/y ` 6�{j 56. Rough Plumbing & Pressure Test d 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE r� 7. Footings -H S�l-.t.tL 6�(j 58. Electrical Conduit-Undrgrnd. y 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 PLASTERING 18. Rough Electrical-T Bar Ceiling ' 69. POOL/SPA SYSTEMS FINAL j• � 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT � �- � � � 20. Rough Factory Fireplace APPROVALS Permit # _ i 21. Ducts, in Structure 70. Underground Hydro �, 22. Ducts, Ventilatin9 71. Product Piping O�Gas ❑ Oil . 23. Gas Pipe-Rough & Test 72. Underground Flush . 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25._ Roof Sheathing . , 74. Overhead Hydro 26. T-Bar Ceiling.IStrucwral) & Monocoat 75. Dry Chemical ` 27. Frame and flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL � Z�j' r. 29. Insulation 78, FIRE PREV. FINAL . 'Z �,: 30. Drywall Nailing . HEALTH DEPT: REQUIREME T 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 � � 3¢:.:Hood or Canopy �, � � � 37. �Final Factory Fireplace �. � .� ` ' r � 38'r Final Plumbing � �� ' • • ' ,', ' j: ; � - . 39. Water Service-Final ' . � � • . � � . `5 . '40. Gas Service-Final ' • �. ` '{...• �� /41'. Solar pomesticFinal � ' . � ' � � ' 42. Backflow Preventer � . � � .t � , �43. Backflow Irrigation . � � � . ` �. � , . �, � . 44. .I:andscape Irrigation System '� / � �v - ' . � . •45.' Sound Attenuation • . . , � .46. Handicap Regulations ` � � ,'„ � �+ ' � - � -� � 47. FINALSTRUCTURE&BUILDING ��//l8'� �i . ' '48..Special Requirements Completed , . . ' ' '49. Electric Release to Edison � - � � ' '- . 50. Gas Release to Southern California Gas Co ��: :.� . 57. CERTIFICATE OF OCCUPANCY No Date ^ ' Applicant to till in all spaces except those within heavy bortler Ilnes anA sign all appro0riate aeclarations. Ci7v OF cOST.�MESA CON�TRUCTION PERMIT PE MIT NO. _, / " TRACT NO. LOT NO. UNIT , �"� 3528 I I/O4/B5 '' 3Fo50 p / � r � '� . ' ' Project Address � 7� W � � p �e � /�/l G . �_�1'' � .. � , . Appli�nYSMailingAddre55 P4SSZ�i�7UM�2�.GJdGI<W. .a.Ui? YPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OT ER + ' • - A.P. # - i Zone �Oyner's Name � �aT—Phone � DESCRIPTION OF WORK/USE OF BLDG. ��FNT/:� _ U.� � f � - Address �7� ��1 .��STQ /%iESfJ � E Main Building: Accessory Building: Z 4�' Aroh/Eng. LicenSeNo. TVPEOFPERMIT GRADWG FOUNOATION STRUCTURAC � T FrOnt ' 0 ' Address ' / � O TENANT ❑ ELECTRICAL �.7LUMBING ❑ MECHANICAL A. Rea� ' - ' N � - NC r�;�'q9�h ❑�OTHER ' ., C Right N \ Contractor's Nam Phon�7 , - � � PROJECT DESCRIPTION 54. FT. oCCUVANCV � Addre55(m'�I"nnl %4�SZ. gL^ L�4 L2C'L�n$�'w��+S7C-.T �ONSTRUGTIONTVPE VALUATION$ g Left � � � G ^` City License No. �Z.S�I % ZONE GRADING CU. VDS. ACRES - . R �� LICENSED CONTRACTOR DECLHRATION �. � Ping. Ref. # Pd�king R2q./Provided �E J her¢by affi�m that I am licensetl untle� provisions of Charte� 9(mmmencing Remarks: . � L � � Planning Notes: � . ' -�' - M with section 7000) of Division 3 of the Business antl Protessions Cotle, antl - . , �my Ilcense is in tull force} nC effect � � . , � - , , ' � - - T Licen CI C'zS� � Li�n No.23�37� ' ' � . - S Date '� �� '¢ 5'9 t �(�-r-;��!l � ' PLUMBING fEES ' . = - ; ' WORKERS' COMPENSATION DECLA ATION _ , - Ba� Sink � $hOWE�S •_ . � , _ _ ' 1 hereby aifirm that I have a certificate of wnsent to selt-insure or a certi(icate' ELECTRICAL • FEES of Workers' Compensation Insurance, or a certifietl cooY tnereot (Section'. @ackflowPreventer ServiteSink . �Aummatic Washer � Transformer ❑ �15-50 KW i 3800, Lab. C.) 6b1 �Jl�P.v FRS�� Policy No.N LS - 00 � i Company _� Backflow Irrigation ' Sewer Ca � . ❑ 50 + KW �Cer[ifietl copy is hereby tumishetl. P Construction PoleSub.� Certifietl copy. is filetl with the city B m Divi � n. Bathtub5 / y p P � `yt�";p �Q SewerConnection , Cookin Unit Meter ❑u to700am s Date A=A�J �/ 8f qpplicant �'+ ' EXEMPTION FROM WORKERS' COMPENSATION DECLARATI ' Clarifier5 ' Solaf ColleCtorS Di5hwa5her' ' Meter �ove� 100 amp5 (This section neetl not be completetl if the permit is for one huntlretl (5100) or � � , iess). Dishwasher Solar Piping Dryers ❑Gas DElectric Sub Panel . I certify that in the performance o( the work for which this perm�t is issuetl, I- ' � - shall not employ any person in any manne� so a5 to bewme Subject to the Drinking Fountains .Solar Tank � Fan ' � Workers' ComOensa[ion �aws of Califomia. �%' Motors �0-1 HP 07X-8 � . Date Si9nature Floor Drains . Swimming Pool w/Spa � F.A.U. � 'NOTICE: If, after making this tleclaration, you shoultl become subject to the ' Inc Solar 09-75 HP �16-15+ Worke�s' Compensation p�ovisions ot th¢ Labo� Cotle, you must forthwith _ FIOOf SiOkS - U�iOdl � � - -- -- - -� - comply wilh such provi5ions .or tM1is pe�mit shall be tleemed revoketl. Fixtures MiC�Owdv2 CONSTRUCTION LENDING AGENCY. �-• ' 8 Gas$¢fviC2 OuL12t5 ./ WatEfC105¢t�� ' D¢viCC80X25 POI¢Liht I hereby affi�m that tM1ere i5 a 2onstruction lentling a9en[y tor the perfoimance 9 of the wo�k for which this pe�mit is issuetl. (Section 3097 Civ. CJ �nterceptors ' �. � Water Heater : — OuNets ' Lenaer's Name � - '�y � Range Leritler's Atltlress � Kitchen Sink . � Water Service ' ' p�. ' Swi[ches Sign - � OWNER BUIL�EN'OECLARATION � ' � ' - . . I hereby affirm [hat b am exempt from'the ConVactor'S License l_aw fo� the l'avatories . . \Auto-Wash � �7 Garba 2 Di5 OSdI ' following reason (Section 7031.5 Business and Professional Cotle: Any city'or � - ' IXi 9 P ; Standing Sections counly which requires a�permit fo construct, alter, improve„demolish or repair P-Trap - - Laundry Treys � Generator 00.5 KW �5-75 KW ' ' any�st�ucture, p�ior to ifs issuance, also requires the applicant to� such permit Trash Compactor r to file a signetl s[atement that he/she is licensetl pursuant to the provisionsbf , Roof Drains ' . ' ' � � ' � the Contractor'S License Law (GM1apter 9(commenang with Section 7000) ot _ � " DiviSion 3 of the Business antl P�ofes5ion5 Cotle) o� that he/She is.exempt therefrom antl the basis for the allegetl ezemption. Any violation of Seccion ]031.5 .by any ,applicant for a permit subjects the applicant to a civil - � �enalty of not more tnan five huntlretl tlollars (§500). - - � � I, a5 Owner of the p�operty'o� my emplOyees with wag¢s as thei� sol¢ R¢inSpectl0ll'F¢0 ' $15 : � Issue Fee _ $ 3 , . compensation, will Go the wo�k, antl the sttuctu�e is not intentletl o� of(eretl� RelOSpBCtiOn F08 $15 Issue Fea . � $ 3 �for sale (Section �044, eusiness antl.Protessionai Cotle: The Contractor's , ,� MECHANICAL - FEES LicenS¢ Ldw tloes not apply to an owne� ot a property who builtls o� improves' '� thereon, antl who does such work himself/herself. or tnrougn his or her own � _ , ' - - DEVELOPMENT SERVICES REQUIREMENTS: ,, employee5, provid¢tl that such improyement5 are not intentletl o! otteretl for BOiIEI ��` � HOOd OI Typ21 ❑ , _ sale. Il, howev¢/, the builtling or improvement Is soltl within one yEar of mm- . C2nOpy Typ¢ I I ❑ ZOning ApplOVed By DdtB ' � pletlon, thelowne� will have the burtlen oi p�oving h¢/she tlitl not builtl o� im- DuCt - Untl¢� GlOuOd � Building Qpp�ov0d By � DdtB prova for the purpose of sale). - . , , . ❑ I, as owner ot the property, am exclusivety rontractin9 with licensetl coM Duct= Structural � Refligeration System .-� . Appliption laued By Y� �1atg� tractor5 to construct the project (Section 7046, Business antl P�ote55ions Cotle: - , The Contractor's License Law does .nof apply to an owner of oroperty who Duct - Ventilating �_ _ � ❑0.700,000 BTU ❑100,000'BT.0 i , � SUMMARV OF FEES � �~�— builtls'ov Impraves tltereon, antl'who contracls fo� Such,pwject5 with a con- - � ' - ' , ' , tracror(sl license,pursuant to the Contractor's �icense Law). I am aware rnat Exhaust System ❑ MWtiple ❑ System Repair/Alteration BUILDING PERMIT' $ SMIP $� proot of their Worker's Compensation insurance shoule be provitletl to me. _ PLAN CHECK $ PERMIT� ❑ I am exempt untler Section ' B. & P. C. for this reason� Firepl/Fact. Blt. ICBO # Fire Dampers � i Daie Owner � y y 9- ' 9 ' � � PLUMBING $;�'ENERGYP.C. $' Heatin S stem & Ductin Re isters � PLAN CHECK 25% $ .S I hereby certity that;l have read rnis application antl state that the above� � ❑0.100,OOOBTU �100,OOOBT '^ � ' GRADING $ Intormafion is correct. I a9ree to comply with-all city antl county ortlinances i ELECTRICAL $ , antl state laws relating to builtling construction, and hereby authorize repre- � PLAN CHECK . 50% $ � MICROFILM, $� sentatives of city o en�q upon the above-mentioneA property for � � /'�� insoection / /� � � � ' MECHANICAL $ � � �� Signature �%+� ��/ CPY rt/--� �i�i Date %� d v � 8Q� � - � , , , TOTAL FEE $ orivers' Li � '-� ��- `� ' Reinspec[ion Fee $�5 � Issue Fae i •$ 3 PLAN CHECK 25% $ CMF 0865-46, rev. 30/84 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor , � � � .CONSTRUCTION AND PLANNING , , . POOL & SPA . . ' APPROVALS Permit# ' Date - Inspector qppROVALS Permit# - Date Inspector r' - 1. T mporary Electrical Service or Pole , 52. Pool & Equipment Location . � 2. Soil Pipe-Undrgmd. .� /f. �1 � 53. Steel Reinforcement . - � �� 3:� Electrical, ConduibUtility-Undrgrnd. ' ' 54. Forms � �� '� 4: ElectricabConduit�U�drgmd. . 55. Electrical Bondiag .r 5:��Steel_Reinforcement 56. Rough Plumbing & Pressure Test ' -,;''�._ � ' 6..Electrical UFER Grnd. • � 57. APPROVAL TO COVER-GUNITE , � �7: Footing4� , - ' - '`� 58. Electrical Conduit-Undrgrnd. ' - � 8� .Foundation '- { 59. Gas Pipe, � Undrgrnd., Test � n 9.`Water Pipe-Undrgrnd. �- � 60. Backwash Lines, P-Trap, � Undrgmd. -�� 10.'Structural Floor System ', . 61. APPROVAL TO DECK i t: �Property Sewer Linz & House Connection � 62. -Backwash�& ReceptorFinal . . 12: Sewer Cap „ . r � , „ �4 � . 63. Heater & Vent-Final "� 13. Roof Drains • .� ; "� . � 64. Plumbing System - Final �_ „ . 14. Rough Plumbing`,� � 65. Electrical-Final , , p' 15. Rough Elearical-Conduit 66. Solar System-F.inal - . . 16: �Rough Electric Wiring 67. Fencing & Access Approval 17.. Rough Wiring,Sign 68. APPROVED FOR PLASTERING 18., Rough Electrical-T 6ar Ceiling 69. POOUSPA SYSTEMS FINAL � - 1.9, Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # , . �. 21. Ducts, in Structure _ 70. Underground Hydro � 22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil 23. Gas Pipe-Rough & 7est - 72. Underground Flush -- , � 24. Roof Framing` � �- 73. Undergrnd. Storage Tank O Gas ❑ Oil � - 25. Roof Sheaihing � � 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 i 78. FIRE PREV. FINAL 30. Drywall Nailing • HEALTH DEPT. REQUIREMENT 31,iPlastei 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 rf� �� l� � �' � � 39. Water Service-Final . � �j-yG, l��A ' 40. Gas Service-Final 41. Solar pomesticFinal ' • , 42. Backflow Preventer � � . 43. Backflow Irrigation ' � • , � � ' � "� 44. .Landscape Irrigation System � . ' 45. Sound Attenuation � , � � 46. Handicap Regulations � 47. FINALSTRUCTURE & BUIL'DING � � 48. Special Requirements Completed • , , � 49. Electric Release to Edison � � � _ �,! �' 50. Gas Release to Southern California Gas�Co � ' �� 'S 51. CERTIFICATE OF OCCUPANCY � •% .- - ' �' No. Date , � - CI AOP��ant to fill in all s0aces ezcept thase within neavy Gortler Iines antl sign all aDvropriate aeclarations. CITY OF COSTA MESA CONSTRUCTION PERMIT �-7 T:� $i.�G.'�7 Projecf Address —�! � .�, l )w117 \n Applicant'sMailingAddreu ��'c ' Owner'sName ��fE:�(� Phone Address Arch/Eng. License NO. Address �1 Contractor'sNam N oneCJCI�%.� Address(maiting) I3��) �N!L��1%r wCtTM1A�'if Ciry License No. .� 3 �p � ' LICENSED CONT�RACTOR OECLARATION 1 hereby a(firm that 1 am IiCensetl untler provl5ion5 of Charter 9(commencing wilh section 7000) of Division 3 ot the Business antl Professionz Cotle, anG my license is In fuJl.force _antl �effect. License CI ss �� Qr_ /'� r�� Licey Na. � � Date� •��'�-r�y/ S�9n8t —1�y( � WORKERS' COM7ENSATIpry DEGLARATION I hereby aHirm that I have a certificate ot consent lo s -msure or a certificate of Workers' ComOenSatfon Insurance, or a cer[ifietl <opy [hereof (Section 3800, l.ab. C.) Polity No. Company Ccrtiiletl copy is hereby fumishee. Certifietl copy i5liletl with Ihe city Bullding DivlSion. . Date Applicant EXEMPTION FROM WORKERS' COMPENSATION OECLA(tAT10N (This 5ectlon neetl not be completetl if the permit is for one huntlretl ($100) or less). 1 cer[i/y titat in [he pe�(orrqance of th¢ w'TiO� which this pe�rnit is lssuetl, I shall not e ploy y perso� in any m er so as ecome iQbject to Ihe Wo/ke p � � Ws Of Calit i Da[e ignature """� 'NOTIC . If, after making this tleclaratlon, you sh0 Itl bec me Subject to the Workers' COmpenSation prq�isions of Ihe Labor C u must (orthwith wmply with such provisiOns or Ihis pe�mlt sttall b¢ tleerbetl revoketl. CONSTRUCTION LENDING AGENCV I hereby atfirm that there is 8 constructlon Ientling agency for tne per(ormance of the work for which this permit is issuetl (Sectlan 3097 Civ. C.) � LenCer's Name Lentler's Hdtlress - OWNER BUILOEH �ECLARATION � I hereby a�firm that I am exemPt t�om the Con[�actor'S Licenie Law for the following reason (Sectlon �031.5' Businezs antl Professional Cotle: Any city or � county which requires a permit to construct, alteq Improve, tlemolish or repair any structure, prior to its issuance, also requires the applicant 1or such permii to file a signetl Statement that he/she is licensetl,pu�suan� to the provisions ot the Contractor'S License Law (Chapter 9(commenang with SecUon 7000) of DiviSion 3 ot [he 6u51ne55 and Profess�on5 Cotle) o� that he/sh¢ is exempt there(rom antl the basiz for the allegeE exemptlon. Any violalion ot Sec[ion ]031.5 by dny applicant fOr a pe�mi[ subject5 tM1e appliGdn[ to a civil p¢nalty of not more lhan fiye huntl�etl tlollan (E500j. � ❑ I,'as owncr of tne property'or my employees with wages as their sole ' compenSatiOn, will tlo the Work, antl ihe structure is not intentleC or offeretl for sale (Sec[ion �044, Business antl Professional Cotle: The Contractor's License Law tloes not appiy to an owner of a property wbo builtls or improves thoreon, antl who tlocs SUCh wo�k himself/nerSClf or th�ou9h hls or he� own employee5, provitletl tM1at sUCh improvemenis a�e not intentletl o� ofteretl fo� sale. If, howev¢r, tlte builtl�ng or improvement i5 Soltl wllhln one year of com- ' pletlon, tho owner will have the burtlen ot provin9 he/she tlitl not bulitl or im- �rove for lhe purpose of sale). �I, as owner ot the propprty, am exUusivery contracting with Iicensetl con- t�act0�5 to Construct the prpject ($ectiOn 7044, Busine5s antl Ptofessions Code: The Contractor's Li[ense I�w tloes not_apply to an owner ol property who builtls or improves thereon, antl who contracts tor such projectz witn a con- iractor(s1 Ilcense pursuant �o the ConVac[or'S Litense Law). I am aware that proot Of tbeir Worker's Cpmpeosation insurance shoultl be..provitletl to me. ❑ I am exempt untler Section - B. & P. C. tor Ihis reason Date bwner I hereby certity tnat I naye rea� intormaUon is t aqree to antl state laws elating o buil ir sentatives oi is ci�y to ¢n e in5pection r ses. Siguature Drivers' License or 55 i this applicatlOn antl 5[ate that th2 above comply with all cily antl county ortlinances g mn5 ructlOn, anC har¢by authori e r¢pre- �pon abOve-menllone0 pr0 rty � Y'Y`� Date .'S � % �/�� TVPE OF CONSTRUCTION xJ NEW U ADD LJ ALTERATION IJ REPAIR ❑ CONVERSION ❑ OEMOLISH ❑ OTHER A p.�6 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TVPEOFPERMIT GRAOING FOVNDATIOf�y STRUCTURAL T Fton[ ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING f� MECHANICAL B Reer ❑ �OTHER _ / A pROJECT DESCRIPTION 5a. Fr. OCCUaArvCY • C Right — K Left CONSTRUCTIONTVPE VALUATION$ $ ZONE GRAOING CU. VDS. ACRES Ping. Ref. #` Remarks. � ��.} % . PlanningNotes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs _ r.)dI1f1E(5 Drinking Fountains Floor Drains � . Floor Sinks ' Gas Service Outlets � Interceptors Kitchen Sink - � - - Lavatories P—Trap � �Roof Drains � Reinspenion Fea , � ' $15' Boiler Duct - Under Gwund ' � � D uct - Struc W ral Duct - Ventilating Exhaust System Multiple Firepl/FacL Blt. ICBO # Fleating System & Ducting ❑0.100,000 BTU � 100,000 dBING . $hOW2f5 - Service Sink - Sewer Cap � � Sewer Connection Solar Collectors ' Solat Pipin9 , ' Solar Tank Swimming Pool w/Spa Urinal � Water Closet � Water Heater WaterService -� Auto�Wash laue Fee Nood or Typel ❑ � Canopy ' Type I I ❑ �43e igeration System , 100,OOOBTU �100,01 System Repair/Alteration .- Fire Dampers � Registers Reinspection Fee •I $15 I I'� � Iwue Fee� ' .� CMF OB65-46, rev. 10/84 White - Builtling; Canary - Applican[: Plnk - Atcountin9: Goltlenrotl - Assessor FEES $ 3 FEES �. $ 3 Automatic Washer Cqnstruction Pole Su Cooking Unit Dishwasher � Dryers �Gas ❑EI� Fan F.A.U. Fixtures' � ' Device Boxes OU�ICSS Switches G�rbage Dispoul ' Generator 065 KW � Reinspection Fee DEVELOPMENT SERVICE Zonin9 APProved BY _ Builtling Approved By — Aoolication luued Bv— 6458 6%89%86 Zone Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Mecer ❑up to 100 amps � Meter 1]over 100 amps � 15 KW Sub Panel , Motors DO-1 HP �1'h - 8- . Inc.Solar �9-15 HP �16-75+ Microwave Pole Light ' Range ' Si9n ; Standing Sections Trash Compactor $15 � � luue Feo ! FiEQUIREMENTS: 1 � .�� -. ' 19.26 TL FEES $ 3 Z O N I N G R E � M T S � SUMMARV OF FEES - ' BUILDING�PERMIT $ - - SMIP : $ � PLAN CNECK $ ' PERMIT � PLUMBING $ �SSUANCE $ PIAN CHECK 25%. $ ENERGY P.C. S ELECTRICAL; $ GFADING $ PLAN CHECK 50% $ � � MICROFILM $ ' - MECHANICAL $ •�� TOTALFEE $ 19.as PLAN CHECK 25% $ _ .� � a��J , ` M CONSTRUCTION AND PLANNING POOL & SPA °i � APPROVALS - Permit # Date Inspector qppROVALS Permit #- Date Inspector 1. Temporary Electripl Service or Poie , 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd: 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms m 4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding � 5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test �' 6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE m 1 7. Footings � � ' 58. Electrical Conduit-Undrgrnd. 'O� 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, O Undrgmd. 10. Strucwral 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. POOUSPA SYSTEMS FINAL 79. Rough Heating & Air Conditioning 4_yy� L� FIRE DEPT. REQUIREMENT � 20. Rough FactorY Fireplace APPROVALS Permit # 21. Ducts�, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72, Underground Flush ✓ 24. Roof Framinc7 73. Undergrnd. Storage Tank 0 Gas O Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (St�ctural) & 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 Pi� Test . - � i �� 5, 36. Hood or CanoPY � _ , • 37. Final Factory Fireplace ' . , ,.� 38rFinal Plumbing � , „ �� ' 39. Water Service-Final ; � � • 40. Gas Service-Final ( ,� / ' •• , .. �41. Solar pomestic-Final � ' . ' 42. Backflow Preventer � ' ' � . �43�. Backflow Irrigation '� �� , . � � � 1.' � �'44. �andscape Irri9ation System ; � ` � 45. Sound Attenuation . . � ' � ' 46. Handicap Regulations . . - . 47. FINALSTRUCTURE&BUILDING '�,� ' � 't'; 48. Special, Requirements Completed ' '••" �. � . 49:�'Electric Felease to Edison� � q � 50. Gas Release to Southern California Gas Co ~.' ' � � ' 57. CERTIFICATE OF OCCUPANCY No. Date , Applicant to fill in all spaees exce0< t�ase within heavy Gortler lines anE Si9n all apvrooriata Oeclarations. �� , ,cOSTAMESA CON R TI PERMI . Proj`t Address �5� � �., • Applicant's Mailing Addr s �� , Owner's Name Phone Address Arch/En9. License No. Address � Contractor's Nam Phon2 Address (mailingl �City Llcense No. ` LICENSED CONTRACTOR OECLARATION I hereby aHirm [bat 1 am Iicensetl untler provl51on5 of Charfer 9(commenCin9 Iwith section ]000) Of Divislon 3 ot lhe Buslness antl Ptofe55ion5 Cotle, antl. my Iicense i5 in /ull forte antl efiett. � � License CI s � i nse No.�� . Date Signature QWORKERS' MPENSATION DECLARAT-ON . \I hereby at(irm that'I have a certillcate ot content to self-Insure or a certiflcate. oi Workers' Compensation Insurance, or a certlfietl c oY.Ihereof (Section 3800, Lab. �C.) / • P icy No. f Company • tifietl c p s hereby�rnishetl. � Certifi ' wlt the city i i n. ate PP�kant EXEMP N ROM WORKERS' COMP SA ION DECLARATION (Thissection neetl not be completotl if ihn pe it is for one huntlretl ($1�0) or ' less). - I certi(y tha[ in [he. performance of the work fOr which thi5 perm�t is issuetl I� shall mt employ any peYSOn in any �mdnn6r so as to become subject to t�e Workers' Compensatlon Caws of Calitomia. � • Oate Si9nature 'NOTICE: If, after making this tleclaratlon, you shoulG become subject to the Worker5' Compensation pravisions ot the_LabOr Cotle, you muzt fOrthwith wmply with SUCh provisions or IhiS p¢rmit shall b¢ tleemeG revoketl. CONSTRUCTION LENDING AGENGV �'• �` I hereby atfl�m tha[ thete is a con5tru[tion Ientling agency fOr the pe�fo�mance of the work lor which this permit is issuetl (Sectlon 309� Civ. CJ Lentler's Name � _ � � �en0er'sAtldress� � _ OWNER BUILOEH �ECLARATION � 1 hereby aHlrm that I am ezempt from the Contractor's License l.aw for the . tollowing reason ($ectlon 7031.5 Business antl Grofessional Cotle: Any city or county which requires a Oe�mit lo Construct, alter, improve, tlemoli5h or repai� any strucWre, prior to Itz Issuance, also requlres the applicant (or zucti permit to file a sign¢tl statem¢nt that he/she IS licensetl pu�suant to the p/ovi5ion5 of '[he Con[rac[or's License Law (Chapter 9(commentin9 with Section ]000) Of Division 3 of the Bu5ine55 antl Profe55ions Cotle) or that he/she is exempt [nerefrom an0 the basis for the allegetl exemption. Any violation ot Section 7031.5 by any _appllcanl for a permlt zubjects the apP�i<ant to a civil �enalty of not more than tive��untlretl tlollars (y500). 'I, as owner ot the property or my employees with wages as their sole compenwtion, w111 tlo the work, anE tne structure is not intentletl or offeretl tor sale (Sec(ion 7044, Business antl Professional Cotle: The Contractor's License Law �oes not apply to an owner of a property who builOs or improves [he�eon, antl who tloes Su<h wo�k hlmself/he�sell o� throu9h his o� her own � employees, prOvltleE lhat such ImprovGmen[5 are not intentletl or offeretl fo� sdle. It, however, the bulltling or Improvement is soltl wlthin one year of com- D�etion, the ownCr will havo IM1e burtlen Of Proving he/She Oltl not builtl o� im- �ove tor the purpose ot sala). , I, as owner ot ihe property, am excluiively mntracHng with licensed con- t�actOrsto consVuct the Orojec[ ($ectlon 7,044, Bu51ne55 antl Prote55ions Cotle: The Contractor'S License Law doe5 n0[ apply to an owner ot property who builas or Improves'thereon, ana wno contracts for such projeces'with a con-- tractor(sl lirense pursuan[ to tne Contrac[or's license Law). I am aware that prOof o{ tlteir Worker'S ComOensation insuranGe shoultl be provitl2tl to me. ❑ I am ezemOt untler Sectlon B. 6 P. C. for [his reason �ate � Owner _ P nerebvi certitv tnat I have reatl tM1is antl state laws reiam sentatives Of this inspection pu Signature Drivers' �icense or 5: CMF 0865-46, rev. 30/B4 that t�e above TVPE OF CONSTRUCTION L� NEW LJ ADD LJ ALTERATION LJ REPAI R ❑ CONVERSION ❑ DEMOLISH ❑�OTHER - p�,p,�6 ' DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TVPE OF PERMIT GRADING FOUNDATION. O STRUCTURAL T Frant ❑ TENANT ❑ ELECTRICAL ❑ PLUM8ING ❑ MECHANICAL ' B Rear ❑ OTHER A PRQIECT DESCRIPTION Sq. FT. ' � oCCUPANCv C Right K Left CONSTRUCTION TVPE VALUATIONa^ $ ZONE GRA�ING CV.YDS. � ACRES Ping. Ret. # Remarks: p-��/ Plaltniny NOL25: Bar Sink Backtlow Preventer Backflow Irrigation Bathtubs � Clarifiers Dishwasher Drinking Fountains Floor Drains ' Floor Sinks Gas Service Outleti Kitchen Sink Lavatories ?-Trap Roof Drains . Reinspec[ion Fee� $15 Boiler ' Duct�.UnderGround Duct - Strutmral Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. BIL ICBO # Heating System & Ducting ❑ ai oo,000 eTu O i oo,00a Reinspection Fee White - Bulltlinq; Canary - Appllcant; Pink - Accounting; Goltlenrotl - Atsezsor $15 Showers Service Sink - . Sewer Csp • Sewer Connection Solar Collectors Solar Pipin9 � Solar Tank� Swimming Pool w/Spa Urinal �V�3[Cf CIOSCL ' � Water Heater Water Service Auto-Wash , � _ Issue Fee Hood or Typel ❑ Canopy Typell ❑ FEES Automatic Washer --� =-� ConstructionPole$ub. V Cooking Unit `� Dishwasher Dryers ��Gas OEleci Fan F,A.U. Fixtures' - . �j '�' A. Garbage Disposal • ' � .Generator �0.5 _ ' • . $ 3 � Refrigeration System � 00.100,000 BTU ❑ 100,000 BTU System Repair/Alteretion � Fire Dampers laue Fee � 3553 II/04/65 Zone Accessory Building: Parlcing Req./Provided � � 1_ � � - . ' ELECTRICAL , � � Transforme� ❑ 15-50 KW i , ❑ 50+KW aMetef up to 100 amps� Meter ❑over100amps Sub Panel � Motors OO-7 HP �' Inc.Solar �9-15 HP Microwave " • Pole Light ' ,.�� Si9n � � ; Standing Sections ❑5-15 KW ' Trash Compactor . • /� - Reinspection Fee ^ $15 luue Fee � DEVELOPMENTSERVICESREQUIREMENTS: � Zonin9 APProved By Building APProved By - Applimtion lauod By i 0 $ 3 � � SUMMARV OF FEES � ' � " 1 � BUILDING PERMIT $ SMIP $� � • °PLAN CHECK $ � PERMIT - � � �.PLUMBING $ ISSUANCE $ . , PLAN CHECK 25% $ ENERGV P.C. $ `ELECTRICAL $ S�. GRADING $i _ ' PLANCHECK 50% $ --s� MICROFILM $ �_ ' "'�MECHANICAL $� ' �TOTALFEE $, � '�'S $ 3 ,� � 1PLAN CHECK � 25% $ � i �� r CONSTRUCTION ANppLANNING POOL&SPA APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector 1,. Temporary Electrical $ervice or Pole - 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � � 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. -s� ,� 7� G'L 54. Forms _ - 4. Electrical Conduit-Undrgmd. � ��! �� 55. Electrical Bonding 5. Steel Reinforcement � � 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. �� 7� e� 57. APPROVAL TO COVER-GUNITE � 7.-Footings , 58. Electrical Conduit-Undrgrnd. � 6. Foundation �� 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAI TO DECK 1.1. 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 � 9j(� 6 � 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T 8ar �eiling . 69. POOUSPA SYSTEMS FINAL 19. �Rough Heating & Air Cpnditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Struaure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil � 23. Gas Pipe-Rough & Test , 72. Underground Flush , 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro Z6. 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: �� S ` i I 34. Final Heating & Air Conditioning ' ' 35. Final Gas Pipe-Test a � L 0` 36. Hood or Canopy 3 �` �` e� 37. Final Factory Fireplace . � a � � 38. Final Plumbing ' 39. WaterService-Final' � 3, G�ou K LL -a . - � c.i C9• 40. Gas Service-Final . 41. Solar pomestic-Final � 42. Backflow Preyenter � i j y , 43. Backflow Irrigation , . 44. ,Landscape Ir'rigation System � � 1 45. Sound Attenuation, , , . 1 46. Handicap Regulations . �� 47. FINAL STRUCTURE & BUILDING ' � 48. Special Requirements Compieted 49. Electric Release to Edison , • � _ . . � � 50. Gas Release to Southern California � ' 51. CERTIFICATE OF O �� ' , No. • , �, �- J \ i ,, �. � � - ' i AGP��ant to fill in all spaces except"tnose wilhin heavy DorGer lines antl sign all appropriate Ceclarationz. CITV OF COSTA MESA CONSTRU�TION PERMIT '� . Proje�tAddress �O �U. �1tM ST. '�)�n�L �v � � Applicant'sMailingAddress�4�� -n nte T Q ��-i 0. w Owner's Name Phone Address Arch Eng. r{� • License.No. .Address , �� N. ��1nwQw.�T Sr �Yl4w�LE .� C d ' Contractor's Name � D�-n�r-6—� ti�flti ��4� Phone SZL' 22� �. Address Imailingl �S1 W. La...t�c�r �in L• �inn�.., f♦ , City;License No. �A \fe�S(� ��31 LICENSED CONTRACT00. DECLARATION ' I heieby aftirm that I am licensetl untle� provi5ions o( Charter 9(commencing ��with, section ]000).ot �ivision 3 ot the Business antl ProTe551ons Cotle, antl my license is in full force antl effect. � . License Class '� Li en p.� Oate �Z��O'i3$ Signature � S WORKERS' COMPENSATION DECL ATION � 1 heieby aiti�m that I have a ce�titicate ot con5ent t0 self-inzure or a ce�ti(Icate of Workers' Compensation Insurance, or a certifietl cooY thereot (Section 3800, Lab. C.) . \ Poliq No�IK�Q•�4+2•OZ�IO\S'O\S ComPanY r\9FriT�_��uT�f� L �yI Certifietl coOY is hereby (umishetl. ' � � qq.CGrtitietl co is filetl with the city Builtlin9 Division. Date`�-'�O•A� Appiicant�Q,ovewica(R.�c�e�.�-c.Ti��,� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION -(ThiS section neetl not be'completetl i( the permit i5 tor One huntlr¢tl ($100) or less). I certify that in Me performance ot the work for whi<h this permk is issuetl, I. shall not employ any pe�son in any manner so as to become subject to the Worker5' GomOensation Laws of Califomia. . oate Si9nature 'NOTICE: It, aftei making this aeclaration, you shoultl become subje<t to the� Worke�s' Compensation p�ovisions o( the. Labor Cotle, you must forthwi[h comply with such p�oyisions or Ihiz permit shall be tleemetl revoked. CONSTRUCTION LENDING'AGENCV.'- " � 1 hereGy atiirm�that there is a construction Ientling agency toi lhe oerformance ` of the wo�k for. which this Oe/mit is issuetl (Section 309� Civ. CJ• Leutler's. Name - � Lentler[s atltlress OWNER BUILDER DECLARATION \I hereby�aifirm that 1 am exempt irom the Contractor's'Llcense Law for the following reason (Section �031.5 Business antl Professlonal Cotle: Any city or �\ munty which� requires a�permit to consbuct, alter, impwve, tlemolish or repalr ' aw ctn¢ture_ orior to its issuance, also requires the applicant for suth permit 0 'therefrom antl the basis for.the alleqetl exemption. Any violatlon ot Sectlon 7031.5 by any,applicanb for a pe�mit Subjects the applicant to a civil �enalty of not more than tive huntlretl tlollars ($500). 1, as owner of the property or my employees with wages as thei� sole mmpensation, will do the'work, antl the structure is not intentletl or ofteretl for �sale (Section �044, Business antl Professionai Cotle: Tbe ConVacmr's License Law tloes not apply to an owner of a property wM10 builtl5 or improve5 thereon, antl wM10 tloes sucM1 work himself/herself ar [hrough his ov he� own employees, provitletl that such improvements are not intentletl o� otteretl Po� sdlC. It, M1owever, tM1e builtling or improvement I5 Soltl withln one year o4com= pletion, the owner will have the bu�0en of Orovinq h¢/she ditl not builtl or irn+ prova tor the purpose of sale). ❑ I, as owner of the'property, am exclusivety contracting with licensetl con- tractorsto construct the project (Section �044, Business antl Professlons Code: The Contractor's License Law does not apply to an nwne� ot property wbo builtls or imOroves"tnereon, antl wno tontracts for Such.projects wlth a con- tractor(s} license pursuant:to-the ConVacto}'s License Law). I am'aware that O�oot'ot their Wo�ker's Compensation in5u�ancE shoultl be prOvitletl to me. � ❑ I am exempt untler Sec[ion ' B. & P. C. for [his reason Date Owner 1 hereby certity that I nave reatl tnis application antl state thaYtne above intormation is correcL I aq�ee to comply wrth all City antl county ortlinances antl state laws relating to builtling mnsVuttion antl hereby authorize repre- sentatives of [h' 1� to entp upon [he�a bove-mentioneU property tor inspection pur ses. _ U ' Signature ✓�/ f� o i 12-\p-A S TVPE OF CONSTRUCTION � NEW U ADD LJ ALTERATION LJ REVAIR ❑ CONVERSION' ❑ DEMOLISH ❑ �THER DESCRIPTION OF WORK/USE OF SLDG. T.� cy�.�e�i c�c IJ�r�o SP - c TVPEOFPERMIT ❑GRADING ❑FOVNDATION STRUCTURAL ❑p� TENANT• ❑ ELECTRICAL ❑ PlVM81NG ❑ MECHANICAL �p��OTHER � 'F\etTe �n.�wi�c.�f�C�S. ' PROJECT DESCRIPTION 5r3. FT. oCCUaANCv CONSTRUCTION,TVPE � VALUATION $ ��.000.00 ZONE � GRAOINGCV.VDS. ACRES Remarks: , ' 1 Bar Sink Backflow Preventer . Backflow Irri9ation � , rinking Fountains loor Drains • - loor Sinks � 25 $2fVICE - �US12t: rterceptors - � . itchen Sink. , r Lavamries • � P-Trap . Roof Drains ; SIIOWCfS - - Service Sink - � Sewer Cap� • Sewer Connection Solar Collectors � Solar Pipin9 Solar Tank Swimming Pool w/Spa Feinspec[ion Fee � � $15 Boiler Duct - Under Ground Duct - Strucmrel . Duct - Ventilating � ExhaustSystem ❑ Multiple❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑0.100,000 BTU 0100,000BT IDrivers' Lirenze . 55 �k ) I I-Reinspection Fee CMF 0865-46, /ev. 10/84 White - Builtling; Canary - AppliGdnt; Pink - AtCounting; Goltlenrotl - Assesso� $15 0 �nnn� - Water Closet - Water�Heater - Water Service Auto-Wash ' Laundry Trays IIssue Fee ', I $ 3 iCHANICAL • ' ' FEE Hood or Typel ❑ Canopy Type II ❑ . Refrigeration Sysfem , Oo-ioo,000eru ❑too,000aru Fire Dampers � I Fegisters ' , ' . �, , laUe Fee, • ' $ 3 i .•)• " r 1'1 A.P. # S Main euilding: E T Front A Rear C Right K Left S Ping. Ref..# -Plannin9 Notes: Automatic Washer' Construction Pole Sub. Coaking Unit � Dishwasher � Dryers ❑Gas ❑Elec Fan F.A.U. Fiztures Device Boxes OUtI¢t5 Switches Garbage Disposal Generator 065 KW C ' . � I'�/`J4 J/IdlOb. __ _ iL.-o�x__ �. 'Zane AccesSory Building: ' � Z O N � ' N . G R Parking Req./Provided ' � E Q . '_ � � M . . . , � , . . � . i"' T S _ � ELECTRICAL ' i - Transformer'�-15-50 KW � ❑ 50+KW � Meter ❑up to 700 amps Meter ❑over100amps 5KW Sub Panel MotorsDO-1 HP�1%'-8 ' Inc.Solar 09-15 HP �16-75+ Microwave - - - - Pole Light Range . Si9n ; Standing Sections Trash Compactor , � I Reinspection, Fee �$15 I .I Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zonin9 APProved By Buildin9 Approved By , '��e%, 'L- � I I $ 3 � � . SUMMARV OF FEES - � BUILDING PEPMIT $ ��wSC%• _ � SMIP $ .�IT' PLAN CHECK $ S�e�23 pERMiT PLUMBING $, � ISSUANCE $, PLAN CHECK 25% $ ENERGV P.C.. $� � ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM: $ MECHANICAL $ TOTAL�FEE $ 143.So PLAN CHECK � 25% $ � , I� CONSTRUCTION AND PLANNING� APPROVALS, Permit# Date 1. Temporary Electrical Service or Pote `, 2, Soil Pipe-Und'rgrnd. , , 3.`Electrical Conduit Utility-Undrgrnd. . 4�'Electrical CdndLiYUridr�md. � 5. Steel Reinfqrcem'ent' . ' N � � 6:• Electrical Uf E�tfGrrid. • ,.. �. 7. .Footings . , - - � � . . � I . .• , � 8. Foundation ,'�:• 9. �Wa�ter Pipe-Undrg�rnd? �' ' 10. Structural Floor System _ �� 11.,Property Sewer,Line& House Connection 12. Sewer Cap ,. , � 13. Rdof Dreins � + � � � 14. Rough Plumbing..; ' '� 75. Rough Electriral-Conduit i6. RoughElectricWiring 17. Rough Waring Sign- 18. Rough ElAarical-T Bar Ceiling 19. Rough Heating & Air Conditioning 20. Rough Factory, Fireplace 21. Ducts, in•Structuie 22. Ducts, Ventilating 23. Gas Pipe-Rough & Test 24. Roof Framing . . 25. Roof Sheathing ;. 26. T-Bar Ce'eling (Structural) & Monocoat • 27. Frame anil Flashing 28. Lathing & Siding 29. Insulatioh 30. Drywall Nailing 31. Plaster Brown Coat ' 32. Electrical Power Meter-Final 33. Final Electric � 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy I 37. Final Factory Fireplace ' 38. Final Plumbing 39. Water Service-Final � 40. Gas Service-Final � 41. Solar pomestic-Final � 42. Backflow Preventer 1 43. Backflow Irrigation 1 44. ,Landscape Irrigation System 45. Sound Attenuation i 46. Handicap Regulations I 47. FINALSTRUCTURE&BUILDING � 48. Special Requirements Completed J49. Electrie Release to Edison ' `50. Gas Release to Southern California Gas Co Date POOL r'A Inspector qppROVALS Permit# i 52. Pool & Equipment Location -., 53. Steel Reinforcement � �� 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test . 57. APPROVA�TOCOVER-GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test ' 60. Backwash Lines, P-Trap, O Undrgrnd. � 61. APPROVALTODECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System - Final 65. Electrical-Final . 66. Solar System-Final � 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL � FIRE DEPT. REQUIREMENT APPROVALS Permit # _ 70. Underground Hydro 71. Product Piping OGas OOiI 72. Underground Flush � 73. Undergrnd. Storage Tank O Gas ❑ Oil • 74. Overhead Hydro 75. Dry Chemical � 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL � HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: � Date �Inspector 0 � � � � � � � Applicant to fill {n all spaces except those witnin neavY��oraer lines anA sign a11 apD�oPriate aeclarations. -- CiTY OF cosra, /MESA CONSTR CTION PERJ�y/IT ; 7rojeCt Address [�J 70 �� 5%- CO // � Applicant's Mailin9 Address � Q S�: - Owner's Name Li � Phon��7 Address r A / Arch/Eng. Zu License No.`" ' - Address '� /�� '�'L' Contractor's Name�.�s nd✓% PhOn „ Address Imailingl 2 �'� BRQ^' g City License No. � D3 CSA a'l � ' LICENSED CONTRACTOR DECLARATION � - I h¢reby a(fi�m that I am licensetl untl¢r prdvisions of Charte� 9(commencing = with section 7000) of Divislon 3 of the Business antl Grofessions Cotle, a tl my license is in full totc�tl eflect. �/ License ss a Lice Dat ,Si9nature � WO KER ' COMPENSATION DECLARAT � I hereby atfirm that I have a certificate of c sent to self-insure r a certiticate � �f Wo�kerY-Compensation Insurance, o� a certitietl �copy thereof�(Section= 3800, Lab. C1ys��/.��.� ' '-/ PoIiCY No. L j �r� romPanY G7' Ceriifietl copy is hereby furnishea. � Certifie copy ile with the city Buil " ' ion. y� AppliCant EXE ION ROM WORKERS' COMPENSAT N L ATIO (This section neetl not be completetl if the permit one huntlretl 100) or - less). i ' t nce t the work �or which this erm t is issued I� 1 certify thal in the per orma o P . shall not employ any person in any manner so as to become subject to the . Worke�s' Compensation laws of Calitornia. , • � �ate � Signature � � 'NOTICE: If, 5fter making this declaration, you sM1oultl become Subject to the Workers' Compensation provi5ion5 ot the'Lnbor Cotle, y0u must forthwith � comply with such provisions o� this pe�mit, shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV ' • ' ' ' I hereby aHirm tbat there is a const�uction lentling agency tor Ihe perfo�mance of the work for wM1ich this permit is' issuetl (Section 3097 Civ. CJ . Lentler'z Name � Lentler's Adtlress OWNER BUILDER �ECLARATION � � - - � I M1ereby attirm that I am exempt from the Contrac[or's LiGense Law tor the followin9 reasan (Section 7031.5 Business antl Protessional Cotle: Any city or coun[y which requires a pe�mif [o construct, alter, improve, tlemolish or �epair any st�ucture, prio� to it5�izsuance, also requires the applicant t0/ such permit , to tiie a sianetl statemen[ thabhe/She is licensetl pursuant to the provisions of �' Divisi6n -3 of the Business antl Protessions Cotle) or tnat ne/sne a exemp[ herefrom antl the basis tor the allegetl exemption. Any violatlon ot Section � 031.5 by any applicant for a permit subjects the applicant to a civil , eerldlty ot not more than five huntlretl tlollars ($500). LI I, as owner oi tne properry or my, empioyees witn wages as their sole compensation, will tlo the work, antl the structure is not intentletl or offeretl for sale (Section ]044, Business antl Professional Cotle: The Cont�a[tor'S' License Law tloes not apply to an owner ot a property wno builtls or improves tbereon, antl who tlaes such work himself/heroelf or throu9n nis or her own employees, provitletl that such improvements are not intentletl or oitered for sale. If,.howeve�, the builtling or improvement is soltl within one year of com- Dlation, tbe owner will have the burtlen of proving'he/she tlitl not builtl or im- ❑ I, as owner ot'the properiy, am exclusivery contracting witn licensetl con- tractors�to construct Ihe project ($ection ]044, Business antl Professions Cotle: .The Contractor.'s License Law_ tloes not apply to an owner of property who builtls or improves the�eon, antl who conVacts for such projects with a con- Iractor(sl license PurSuan[ [o tM1e Contractor's License Law�. I am aware tM1at proof of their Worker'S Compensalion insurance Shoultl be provitletl to me. ❑ I am exempt untler Section B. & P. C. tor this reason Date Ownen � [ha[ I have reatl tlW�pPlication an� stale [ [am TVPE OF CONSTRUCTION IJ NEW LJ ADD LJ ALTERATION U REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER . DESCfiIPTIONOF_WORK/H3E9{�8'�R6 �� '��ti� TVPE OF PERMIT � �J GRADING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT� 0 ELECTRICAL ❑ PLUMBING ❑ MECHANICAL � ' O �OTHER - ' � , " ` PROJECT:DESCRIPTION Sq.FT.� � oCCUParv'CV'jj �' CONSTRUGTION,TVPE VALUATION$ / Y�/S � . , Remarks:- ` - - ' • t � Bar $ink � Backflow Preventer eackflow Irrigation Bathtubs � � r��.��e.� � i GRADINGCU.YDS. A( r Drinking Fountains � Floor Drains � Floor-Sinks - �� Gas Service -Outlets Interceptors� � ' "" KitchenSink ' Lavatories � � , � P—Trap r. Roof.Drains Feinspection,Fee � $75 Duct- Under Ground Duct - Strucmral Duct-Ventilating � - Exhaust System ❑ MWtiple 0 FirepVFacLBlt ICBO #'' Heating System & Ducting ❑P100,000 BTU 0100,OOOBTi ispecti urp � � ' � iqna re Da _ )river Reinspection Fee $�5 OB65-46, rev. 30/84 White - Builtling; Ganary - qpplicani; Pink - Accountinq; Goltlenrotl - Assessor . Service Sink� � Sewer Cap Sewer Connection � Solar Collecmrs Solar Piping Solar Tank � ' Swimrtiing Pool w/Spa Urinal � • �� Water Closet � � ' Water Heater ' WaterService � � � Auto-Wash Laundry Treys Issua Fee Hood or Typel ❑ Canopy Typell ❑ � Refrigeration System ❑o-ioo,000aTu ❑ioo,000 System Repair/Alteration FireDampers � Registers Issue Fee i A.P. � - S Main Building: E T Front A Rear C Right K Left S Ping. Ref. # . Planning Notes: � 96�5 2/20%�6 :50:o i:. Zone Accessory Building: 0 Parkin9 Req./Provided ELECTRICAL . Automatic Washer Transformer ❑ 15-50 KW - ❑ 50+KW � Constructian Pole Su6. ' ' Cooking Unit Meter ❑up to 100 amps � Dishwasher � - - Meter ❑over 100 amps - � Dryers ❑Gas ❑Electric . Sub Panel . . Fan Motors D O-1 HP � 1'f. - 8 F.A.U. � , � � Inc.Solar �9-75 HP �i6-15+ Fixtures ' � Microwave • Device Boxes . Pole Light � Outiets Ran9e � ' Switches' . gi9� , ' Garbage Dispoul ; Standing Sections' Generator �0-5 KW OS-15 KW Trash Compactor $ 3 ' Reinspection Fee $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning APProved BY . Building Approved By' �+ Aooliwtion Issued Bv !�� A+•�' $ 3 0 FEES $ 3 Z O N I N G R E � M T S SUMMARV OF PEES � � �.-�y BUILDINGPERMIT $ �4� SMIP � . $ !U_ � PLAN CHECK $ PERMIT � PLUMBING $ ISSUANCE ' $ PLAN CHECK 25% $ � ENERGV P.C. $ ELECTRICAL $ � � GRADING 5 PLANCHECK 50% $ MICROFILM 5 ��j MECHANICAL $ TOTAL FEE $ (�2"� PLAN CHECK 25%_ $ , . � � CUNSTRUCTION AND PLANNING - � , Date ' Inspector j APPROVALS Permit# , :i, 1, Temporary ElectficBl Service or Poler� - i . 2. Soil Pipe-Undr9rnd. �' . i � . 0 _ -,-.;..--;r�.-r-::--t.--;i �.; r 6: �Electricsl�UF�F2�Grni1.�!) ." i, 7. Footings.. • . f ` ,;� . : . , . S:�foundation� „ ;, , 9.�Wa4er,%Pipe-Undrgrl�d:�� 10.. Str`;ucturaf Floor System- ,,'•V�� 11,. Property Seyvei• Line�&' �Hause Connectior r,�i 12: Sewer.CaR' �' i '/ •r i' �J' �y �, ±' .� . 13: Roof DraiPs. �a ; �.• ' �y. . �i . 14. Rough;Pl(imbing c -- '15'r`Rough Electrical-Conduit 16? Rough Electric Wiring ! 17. Rough Wiring 5ign � � 18: Rough ElectricEl-T Bar Ceiling � 19. Rough Heating & Air Conditioning 20. Rough Factory Fireplace ' � 21. Ducts, in Structure 22. Ducts, Ventilating 23. Gas Pipe-Rough & Test 24. Roof Framing . 25. Roof Sheathing , � 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing 2S. Lathing & Siding � 29. Insulation 30. Dr � ' ywall Nailing ,i 31. Plaster Brown Coat .•� _ 32. Electrical Power Meter Final 33. Final Electric 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-rest � 36. Hood or CanopY � � 37. Flnal Factory Fireplace 38. Final Plumbing � � 39. Water Service-Final � 40. Gas Service-Final I41. 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 5outhern California Gas Q �•51. CERTIFICATE OF OCCUPANCY /`'o. Date � � 0 POOL ;PA APPROVALS Permit # Date Inspector 52. Pool & Equipment Location � 53. Steel Reinforcement % j' ; 54. Forms • � - , � � 55. Electrical Bonding f! 56. Rough Plumbing & Pressure Test t�� r�_%, 57. APPROVAL TO COVER-GUNITE , ,� , "' � � 58. Electrical Conduit-Undrgrnd. � ' � ,+, ,., 59. Gas Pipe, O Undrgrnd., Test � � J 60. Backwash Lines, P-Trap, O Undrgrnd. � 61. APPROVAL TO DECK 62. Backwash & Receptor-Final i ,� 63. Heater & Vent-Final 64. Plumbing System - Final . , ', 65. Electrical-Final � 'f 66. Solar System-Final � 67. Fencing & Access Approval . 68. APPROVED FOR PLASTERING 69. 'P00 L/SPA SYSTEMS F I NA L FIRE DEPT. REQUIREMENT � � APPROVALS Permit # 70. Underground Hydro j � L 71. Product Piping O Gas ❑ Oil 72. Underground Flush � 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe ' 77. FIXEDSYSTEMFINAL '�I %.' �i 78. FIRE PREV. FINAL / �;' .).;�• i HEALTH DEPT. REQUIREMENT 79. FINALINSPECTION 80. FOOD CERTIFICATE ISSUED Notes: 0 City of Costa Mesa Development Services Department Building Satety Division P. O. Box 7200 Costa Mesa, California CERTIFICATE OF OCCUPANCY No.�}�gdF4� The Building located at R7n w i 7fH c+r�ot e�.; t„ r� r. o has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B-2 Occupancy. Use of Building Fleet Automobile Leasina Legal Description 424-281-02 (See reveru side tor Metes and Bounds) Building Permit NoG23812 Electrical Permit No.G23812 Plumbing Permit No.�+��i7 7 Mechanical Permit No.C��A� � Number of apartments and/or guest cooms -� ISSUED T0: Duffield Proearties 670 W. 17th Street Suite D2 Building Official, � /�L� �� by Costa Mesa, CA oa�e /' / `�l/J This Certificate of Occupancy SHALL BE ported in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CnnF 1o15�a6 rev. 1/83 Whice -Owner; Canary - Numerical File; Pink - Bldg. Permit File C I � � CITv OF coSTA nnESA CONSTRUCTIrON� PERM�IT+ Project Address �� l*-� � ! � �/ �%- �Y'L Applicant's Mailing Address r � � �"�'��- � �-��',� > �j Owner'sName ��'e'�� PhoneC-=c�=��c1� ilddress �A �n tl ) / � r �-•_;! ArchlEng. /�'��-��; �icenseNo. � Address �/ Controcror's NameJ��='��Y'�C ��"��"4 �"�-� Phone�s,.,[.�E'`�y'�.,: AddreSs (mailing) �J�72 c�+:•:-' •o�/ �i/ l'/ J Ciry License No. � �03 LICENSED CONTRACTOR DECLARATION � � I he�eby affirm Ihat I am licensetl untl¢r provisiOns oi Charter 9(Commencinq with section ]000) of Division 3 ol the Busine55 dntl Prof¢SSions Cotle, antl my Iicense is in full �orce anG eifect. License Clas/s �� Lice ze No- � 7 7�� Date�C. c��ar��. _ .�rn ��..a` , WORKERS' COMiENSATION DECLARATION • I hereby aHirm that 1 have a certificate of mnsent to self�insure or a certlficate ot workers' Compensation Insurance, or a certlfietl cooY thereof (Section 3800, Lab. C y� �f — �} PoIicY No. �•✓'� �4I ComPanY -S/�?G �i//�'!.� . Certifietl mpy is �ereby furNshetl. Certifletl.copy IS filed wi[h the <ity Bu'�nqAlvi on. Date��•�� %'/ APPlicant� ��%< << EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' (Thisseclion neetl nol be completed if the permit is lor one hunaretl ($300j or less) I Ce�lify tnat in the performance of the wo�k for which th15 pe�m�t is Issuetl I shall not employ any person in any manner so as to become subject to t�e Worker5' Compen5dtion LdwS Ot Cdli(Ornia. , Date Signatura 'NOTICE: Ii, after making this tleclaration, you snoulE become sub�ect to the Workers' Compensatlon provisions of the Labor Cotle, you must torthwith comply with such provisions o� this permit Shall b¢ tleem¢tl revoketl. , CONSTRUCTION LENDING AGENCV ' ' � I hereby aillrm that there is a construction lentling a9ency for the pertormance of the work for whicn tnis permit is issuetl (Section 3097 Civ. CJ Lender's Name � Lentler's Aatlress ' OWNEft BUIL�EH bECLARATION I her¢by affirm tbat I am-exempt irom the ContrdctOr's Llcense Law for the � followinq reason (Sectlon 7031.5 Business antl Professional Code: Any�city or county which r¢qulres a perm@ to const�uct, alter, Improve, tlert�otlsh o� repdir any s(ructure, prlor lo its issuance, also requires the applicant for such permit lo tile a signetl slat¢ment thal h¢/She is IicenSetl pUrsuant to lhe provisions o� the Contracror's License Law (Cnapter 9(commencing with Sectlon 7000) of DiviSion 3 ot the Bu5ine55 antl P�otessions Cotle)��o� that he/sbe is exempl th¢retrom antl the bazis 10� the allegetl exemption. AnY violation ot SectiOn ]031.5 by any applicant for a permit subjects the applicant [o a civil I�¢nalty of not more tM1an five huntlretl dollaR (E500). . , U I, as owner ot the properly or my employees witn wa9es as tneir sole compensation, will do the work, and tne sVuctWe Is not intentletl or offeretl 1or wle (Section�]044, Business antl Protessional Cotle: Tna Contractor's' �� <e ..� nnnc nm annw tn an nwner o/ a orooertv who builtls or imoroves ana who Coei such work hlmselt/herself or throu9h nis or ner own :5, provitletl that such improvemEn[5 al8 nOt fntentletl Or Offeretl fOf iowevlr, Ihe builtlin9 or Improvement is soltl within One year ot com- he owner will have lna bUrtlen of proving he/She tlitl Ool builtl or im- the purpose of sale). - �wner o( �tne property, am exclusivery contracting wi[h Ilcensetl con- o const�uct the projec[ (5¢Ction 7044, Buslness antl Pro�esslons Cotle: VaGtor's License Law tloes not apply �to an owner ot property who f h " cts with a con- bullOs or im0�ov¢s thereon, antl who tOnt�act5 or Suc Pro)t tractor(sl license pursuant�to [ne Contractor'S License Law�. I am aware that p.00r of tneir Worker's Compensstion inzurance shoultl be Drovitletl to me. ❑ 1 am exempt under Section . B. & P. C. �or thls reason Dale ' Owner I hereby �certi(y that I have reai iniOrma[ion is CorrecL 1 agr¢e to and sta[e laws relating to builtlin sentatives oi tnis city, to enter inspection purp s. Si9nature � �t -l% Drivers' License or 55 � �� ihis appliwtion antl siate that the above omply with all city antl county ordinances construction; antl hereby authoriz¢ repre- upon the above-mentione0� ^��oper(y( �for 'C� ' Da[eJ 7��0'� 1F 0865-46, rev. ]0/84 Whlte - Builtling; Canary - APPilcant; r in all soaces exceo<'�hose within heavy Ooraer Iines ane sign alt aoorooriate tleelarations. VO_ ^�,., � RACT f�10. LOT NO.(bRS"o UNIT NU.� 3`� 'L .ti,F�'a2T �R bo�l/� ) /"�t�'� OF CONSTRUCTION� LJ rvEW LJ ADo CONVERSION ❑ DEMOLISH ❑ OTHER SCRIPTION OF WORK/USE OF BLDG. � TVPE OF PERMIT LJ GRADING LI FOUNDATION LJ STRUCTURAL �TENANT ❑ ELECTRICAL- ❑ PLUMBING ❑ MECHANICAL� . OTHER PROJECT DESCRIPTION Sq. FT. �/� oCCUaarv CON STRUCTION TYPE VALUATION $ � ZONE GRADINGCU.VDS. AGRES_ 'pemarks: , Bar Sink t._ Backflow Preventer Drinking Fountains Floor Orains � Floor Sinks Gas Service � Interceptors Kitchen Sink Lavatories P-Trap Roof Orains Reinspaction .Fea FEES Showers Service Sink � ;° Sewer Cap' . Sewer Connectibn Solar CollectOrs - � Solar Piping ' i' Solar Tank Swimming Pool w/Spa Urinal Water Closet � � Q�j Water Heater Water Service � � r' . Auto-Wash � - Laundry Trayf � ' `�� J $15 Issue Fee" � $ 3 , y � MECHANICAL FEES •'.: Boiler Duct - Under Ground Duct-Structural � Ouct - Ventilating - -- Exhaust System ❑ Multiple � Firepl/Fact. BIL ICBO # � �Heating Sysfem & Ducting �100,000 BTU 0100,000 B' Reinspection Fae � $15 Acwuntin9; Goltlenrotl - Assessor Hood or Type I ❑ , Canopy Type I I ❑ Refrigeration System � ❑o�ioo,aooeru Oioo,000sru � System Repair/Alteration Fire Dampers . , luue Fee ' � I $ 3 A.P. # L _ S Main Building: E T Front ARear C Right S � Left Ping. Ref. •# � Planning Notes: /) Auromatic W� Construction Cooking Unit Dishwasher - Dryers ❑Ga� Fan F.A.U. Fixtures Device Boxes Outlets � __ _ F39? 5/ I fi/e:: � � � _ � � � �� Zone %%'� lj '" Accessory Building: �Z O, 'N . N , G �' R Parking Req./Provided � � E � J V ELECTRICAL . Transformer ❑ 75-50 KW ❑ 50+ICW Meter ❑up to 100amps Meter �over700amps Sub Panel � � `.� Q„ Momrs�0.1HP�1Y.-Ba Inc.Solar �9-15 HP �16-15+ Microwave Pole Light . Range � 'Garhage Disposal '. Generator DO-5 KW 05�75 KW ' � . .:S r . `�: Reiuspection Fee $15 OEVELOPMENTSERV SREQUIR 2oning Appraved By Building Approved By T y BUILDING PERMIT $ PLAN CHECK $ PLUMBING 5 PLAN CHECK �25% $ EIECTRICAL $ PLAN CHECK �50%� $ MECHANICAL $ PLAN CHECK 25% $ Standing Sections Trash Compacror . Issue Fee. ,—� T FEES $ 3 SMIP . $ _(,,/�� PERMIT j • I ISSUANCE $ ENERGV P.C. $ � GRADING 5 MICROFILM � $ � �/��+ �.� TOTAL FEE $ `�Q./r �� J� ' CONSTRUCTION AND PLANNING I APPROVALS Permit # Oate ' 1. Temporary Electrical Service or Pole 2. Soil Pipe-Undrgrnd. I 3. Electrical Conduit Utility-Undrgrnd. 4: Elect�ical Conduit-Undrgmd. 5. Steel Reinforcement � , , 6. Electrical UFER Grnd. 7. Footings � 8. Foundation 9. Water Pipe-Undrgrnd. 10. Structural Floor System ' 71. Property Sewer Line & House Connection 12. Sewer Cap 13. Roof Dreins 74. Rough Plumbing , 15. Rough Electrical-Conduit "I��S b� w 76.:�Rough Electric Wiring 17. Rough Wiring Sign ' 18. Rough Electrical-T Bar Ceiling ` }9: Rough Heating & Air Conditioning 20: Rough Factory Fireplace 21. �Ducts, in Structure 22. Ducts, Ventilating 23. Gas Pipe-Rough & Test 2A. Roof Framing 25. Roof Sheathing � 26. T-Bar Ceiling (Structural) & Monocoat G � 27. Frameand Flashing 2S. Lathing & Siding _ 29. Insulation 3Q. Drywall Nailing ' 31. Plaster Brown Coat 32. Electrical Power Meter-Final ( 33. Final Electric L 34. Final Heating & Air Conditioning 35. Fi�al Gas Pipe-Test 36. Hood or Canopy 37. Flnal Factory Firepiace 3S. Final Plumbing � v 39. Water Service-Final 40. Gas Service-Final � ' 47. Solar pomestic-Final ' 42. Backflow Preventer 43. Backflow Irrigation 44. Landicape Irrigation SYstem • 45. Sound Attenuation 46. Handicap Regulations (! 47. FINALSTRUCTURE BUILDIN 48. Special Requirements Completed � qg. Electrie Release to Edison �50. Gas Release to Southern California Gas Co 51. CERTIF_IC9T�OFOCCUPAfyCY �, Date 0 n POOL,.SPA Inspector qppROVALS Permit# 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical6onding 56. Rough Plumbing & Pressure Test 57. APPROVALTOCOVER-GUNITE 58. Electrical Conduit-Undrgrnd. � 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, O Undrgrnd. 61. APPROVAL TO DECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System - Final 65. Electrical-Final ` 66. Solar SYstem-Final i 67. Fencing & Access Approval ' 68. APPROVED FOR PLASTERING � 69. POOL/SPA SYSTEMS FINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # i � 70. Underground Hydro 71. Product Piping � Gas ❑ Oil 72. Underground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical � 76. Dry Standpipe 77. FIXED SVSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: S'a � Date �Inspector � + '; City ot Costa Meu Development Services Department 8uilding Satety Division P.O.Box 7200 Costa Mesa, California CERTIFICATE OF OCCUPANCY No.��3 Tj�g Building located at 670 W_ 1.71.t�i Strar?t Gnitf? AA has been inspec[ed and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group ti-2 Occupancy. use of Buildiny Wholesale Wheels and Tires Legal Description 424-281-02 ISee reverse side for Metes and Bounds) Building Permit Nor73�14 Electrical Permit No. �+2�51 d Plumbing Permit No.rt79'�F1 d Mechanical Permit No.G23S14 Number of apartments and/or guest rooms /� � ISSUED T0: BuildingOfficial ./1. �f /' -�%�� Duffield Properties ` �"" ' aiu w. 1 th street suite Dt by Costa Mesa, CA � � '�� Date This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF1015-46 rev.1/83 White-Owner;Canary-NumericalFile;Pink-BId9.PermitFile - Appllcant to fill In all spacm etce0t ihose wNhin �eavy Cortler Iines ane sign alt apo�oo��ate aecla�atlons. ciTv oF cOS7A MESA CONS—T7RUCTION P R� Project Address � 7 L7 l.J � �/� Applicant'sMailin Address -Z��i'/�� ^'v`�'+°" ��`�`�'��"/�2� Owner's Namc �• �"� ��-t�A Phoneps�c_� Address ' �Q � ' � Arch/Eng. � � _ License No. Address '/ Con[racror'sNama /1��"`GS (�>^-u,� Phone��'�`�y� Address Imailing) ^� � `v�! 2 �" �U�-ti'•�� d-f �� City License No. -3y ��-3 LICENSED CONTRACTOR �ECLARATION I hereby alfirm tnat I am licensetl untler provisions of Charlar 9(commencing wit� section 7000) ot Oivision 3 of ihe Buslness antl Profezsions Cotle, ana my licensa is ln full force antl offect. ( License Class �� c Ucense No.•; 77Ary Date Ci�$i. - ae�an. � r �= +-, � WORKEHS' GOMPENSATION DEGLARATION � � I hereby altirm that I have a mrtifiwte ol tonunt to setl-inswe or a certifitate Ji Workers' Compensation Insurante, or d Certl(letl cOOY �hereof (58cllOn \3800, L. D. C.) � � � / PoIiCY No. 'r �� _ , � / ComPdnY ��n��< ��[t�-Y l�� Q C¢r[itietl coOY IS hereby fumishetl. � A]I C¢rtifietl capY IS ��eE with th< <Ity BUIItli isio l y Date u' �' �' � APPlicant ��-u� � E%EMVTION FROM WORKERS' COMPENSATION DECLARATION (This section neetl not be completetl it lhe pGrmit is fOr One nuntlreU (§I00) or. lesz). I cerUty that In ihe performance of lhe work for whlch this permR Is Issuetl, I shall not emo�oy any person in any manncr so as to become subject to tho � Workers' Compensatlon Laws of Califomla. ' Data - Si9natwe � 'NOTICE: I(,atter makin9 Ih15 tleUa�atlon, you Shoultl 0¢COme Tublect to t�o Workers' Compensation provisions of tha LnEor Cotle, you muzt forthwith- comply wilh suGh O�ovl5ion5 or [his Oe�mit shall �be tleemetl revokeU. CONSTRUCTION LENDING AGENCV - I heroby alflrm tnat there is a construcUon Ientlin9 a9uncy for lho perlormanco Oi Iho w0/k for which this permit IS ISSuetl (Sectlon 309] Civ. CJ �Ontler'S Name- � �ondor's AOtlress OWNER BUILDEH OECLARATION I horuby affirm Ihat I am exempt from ih¢ Contractor's Llcenso Law tor tho iollowin9 �eason (Sactlon ]031.5 BuSinoss nntl Profo55lonal Cotla: Any clty or county wnicn requiwz a Dermit to const�uct, altor Impwve, tlemOlish o� repolr any structura, prior to Iti Issuanca, also reqWres t�e applicant tor suth pormlt l0 1llo a signCtl StdlOment thdt ne/SM1O I5 Ilcan58tl pursuant to 1118 prOvislons ot the Contractor's Licenso Law (Ghaptur 9(commancing with Sectlon 7000),01 ilvision 3 0l lhc BuSinoss antl Prolessions CoOo) or that he/she is exumpl � ierelrom antl the basis lor lho allegetl oxempllon. Any violatlon o1 Sectlon /031.5 by dny apP��ant fOt a parmlt sub)etti thC apPlicant to a clvil penalty of nol mare tnan fivn huntlro0 tlollars (E500). , LJ I, as owner o1 [ho oroporty or mv employees with wa9es as thelr salo COmpanSaHon� will tlo �h owork� antl [n0 Strutturo I5 nol Inlentletl or olteratl _' _�_ .._ �_.. ��....... �.,n o...r�«i��a� cnne. Tno eontraefor's a CmplOy aa5, Plovltled Itlal Suth Improvaments are pOt Intentlotl o1 at18ra0 !Or salu. II„�owaver, lho bull�ing or Improvament Is soltl within ona yaar of com- oletlon, tna owncr wlll have the burtlen ot proving he/she tlitl not bulltl or im-' prove far tho Purpose ot sale). , ❑ I, as owner Of lne OrOpmty, am azGlusively Conlracting with IICCnsetl con- IractofSlD conStruct the pfo�ecl (SecNOn 7044, Bu5Ine55 dntl Pfof¢SSIOnS COE�: Tho-ContracloYS Llconso Law do¢5-nol aP01y lo an owner ot prOPorty who builtls or Improves thereon, ana wno conVacts lor such projecls wllh a con- tractor(51 Ilcenso pursuant [o fhe Contractor's Utonse Law). I am awara tha[ proot o( lheir WorkerR Compensation insurance snoultl bo provltletl lo ma. ❑ I am axEmpt untlo� Sectlon , B. & P. C. tor thl5 r0ason Date • � Owner � � ' � I hereby certily that I havo reatl tliis appllcaUon antl state that the above IniO�mation I5 correcl. I agrec to comply with dll cily antl couniy o�tlinance5 antl stato laws ralatln9.to builtlin9 wnitructlon, antl�hereby authorize reprn- sentatives o/ tnls GitY to enter upon the above-mentloneC ,properly tor Inspection pu�pwef�/� � • ' i � Signature "��—�d -� � y, Da[e1p 21� 6'0 Driverz' �License or 55 $ �� — CMF OB65-46, �ev. 10/84 TYPE OF CONSTRUCTION LJ NE ❑ CONVERSION ❑ DEMOLISH DESCRIPTIAN OF_WORK/lJSE OF TVPE OF PERMIT U GRADiNG �.TENANT ❑ ELECTRICAL ❑ OTHER PROJECT DESCRIPTION 51Q) FT._ CONSTRVCTION TVPE"_u 20NE GRP 3ar Sink 3ackflow Preventer Backflow Irri9ation Bathtu6s Clarifiers. � Dishwasher Drinking Fountains Floor Drains ' Floor Sinks Gas Service OuUets Interceptors Kitchen Sink , Lnvatories ' Roof Orains Reinspection Foo ' � $15 Duct�UnderGround Duct - Structural . Duct - Ventilating - � � Exhaust System ❑ Multiple �� Firepl/Fact:BILICBO��h � Heating System & Ducting / ❑a700,000 BTU 0100,0008TI Fea I $15 White - Builtlin9: Canary - Applicant: Plnk - Accounting; Gol�enrotl - Asse55or ADD LJ ALTERATION Ll REPAIR J FOUNDATION LJ STRUCTUi3AL PLVMBING ❑ MECHANICAL � � OCCUPANCV �� 2-- VALUATION 5 ��N� i CU.VDS. ACRES $hOw¢�S Service Sink. r'^ SewerCapj_ . r- Sewer Connection Solar Collec(ors Solar Piping '�, Solar Tank' Swimming Pool w/Spa Urinal Wacer Closet " / Wacer Heater Water Service Auto�Wash Laundry Trays Issue Fee Hoodor Typel ❑ CanoPV TVPe II ❑ � Refrigeration System � �0.700,000 BTU 0100,000 System Repair/Alteretion FireDampers � Fiegisters . , FEES A.P. # � S Main Buildi E T Front B Rear A C Right K Lefi S Ping. Ref. # Planning Notes: ✓� ' AutomaticWasher, . � �. Construction PoleSub. � ' Cooking Unit, ' Dishwasher - � � - I Issue Fee ' $ 3 Boxes . 3621 4/2"/3u 2one M / Accessory Building: Req./Provided ELECTRICAL Transformer ❑,75-50 KW ' ❑ 50+;KW � Meter up to 100 amps Meter ❑over�100.amps -� � Sub Panel •; � MOtors�0�7 HP' 1S4'� � Inc.Solar �9-15 HP �16-15+ Microwave ' Pole Light � ' � Disposal �r DO-5 KW �5-15 KW 9 • , iinspection Fae $15 LOPMENT SERVICES FEQUI I Approved By Fg Approved 8y� � '{ 1/ , �BU�LDING PERMIT , $ . ..��PLAN CHECK i $ �- -�� PLUMBING $ _ `� PLAN CHECK 25% $ ! � ELECTRICAL $ _ � PLAN CHECK 50%, $ _ ` �� MECHANICAL $ _ � PLAN CHECK 25(0° $ t ��.��(/i9�J ; Standing Sections Trash Compactor Issue Fee 9 5 3 O N I N G R E Q M T FEES � SMIP $ � � e �� PERMIT ISSUANCE $ ENERGV�P.C.' S GRADING S ' MIC(70FILM S ^ ' TOTAL FEE . $ �`q �.u3 1 -CONSTRUCTION ANDPLANNING POO SPA , APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Po�e 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � y'-t�•yb c,P./> 53. Steel Reinforcement � 3. ElecVical Conduit Utiliry-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 Cqnduit-Undrgrnd. 8. Foundation 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10, Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection ' ' 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing � S-u-�� C.F.D 65. Electrical-Final 15. Rough Electrical-Conduit C! 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 b [� • CI 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning • FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure . 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil . 23. Gas Pipe-Rough & Test - 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing .• 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat /� ,f�' G 75. Dry Chemical , 27. Frame and Flashing "��'G 76. Dry Standpipe � 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nai�ing /,3 �� HEALTH DEPT. REQUIREMENT 31. Plaster 8rown Coat 79. FINAL INSPECTION . 32. Electrical Power Meter-Finel 80. FOOD CERTIFICATE ISSUED 33. Final Electric �� Notes: yLs�-�6�-c.�qtTC £�✓&�dr-Cs/�• 34. Final Heating & Air.Conditioning �� f( L` � �� '� 35. Final Gas Pipe-Test 6'?�-y� -L'� L, 36. Hood or Canopy 37. Final Factory Firep�ace 38. Final Plumbing 39. Water Service-Final s-g-�6 �� 40. Gas Service-Final � . 41. Solar pomes[ic-Final . 42. Backflow Preventer � 43. Backflow Irrigation � 44. Landscape irrigation System 45. Sound Attenuation � 46. Handicap Regulations � glp 47. FINAL STRUCTURE & BUILDING a G 48. Special Requirements Completed �� 49. Electric Release to Edison 50. �Gas Release [o Southern California Gas Co �� 51. CERTIFICA E OF OCCUPANCY �,A� _ ��- N0. � Date �� l � � � � Ciry of Costa Mesa Development Services Department Building Safety Divisian P. O. Box 7200 Costa Meu, Califomia CERTIPICATE OF OCCUPANCY No.��`g��rc�' The Building located at 670 S9. 17th StYeet Suite G3 has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B-2 Occupancy. Use of Buitding Wholesa&e Zmnort Aufao Part.s Legal Description 424-781-02 ISee reverse side for Metes and Baundsl Building Permit No. r�'�S1 � Electrical Permit No. (:7iS1 � Plumbing Permit No.(=��+1 i Mechanical Permit No. G23513 Number of apartments - and/or guest rooms �� ISSUED 70: BuildingOfficial .�'• //.�lI.G/ K/�� Duffield Proporties - � " G70 W. 17th Street Suite D2 by Coata MHsa, CA o�e_ 7- 7 - o � This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 1015-46 rev. 1/83 White - Owner, Canary - Numerical File; Pink - Bldg. Permit File . � CITY oF COSrA MESA CONSTRUC�7TION PERMIT Projact Adtlress �� ) . � / � 3 Applitant's Mailing Address ��-J �'� � S-.�'e�; �<5cv � Owner'sName ��"`�"G'�TX' Phoner.•�K-l.Si/ . AddrBss �� D ii) . /� f i% 1- Arch/Eng. � 1�-5 LicenSe No. Address Convactor'sNam �� - hone-r3E ��7- % Address Imailingl 2 iS4 «,�..o ✓.� :�,.� �-�� .�N�O.i � City License No. LICENSED CONTRACTOR OECIARATION I her0by atfirm tnal 1 aT IlcenS¢tl untlet pwviSiOni ot Cnarler 9(Commentlng with section 7000) of DlviSion 3 ot tho Business antl Vrotessions Coae, antl my IlCense Is In fu L rce antl eltect. License Ga s Littnse No. �� -� ��T' Date � •' .� Si9naWre - �� WORKERS' COMPENSATION DECLARATION I nereby affirm that I hava a cerqiicate of consent to seli-inzure or a certliicate' -of Workers' Compensation Inzuranca, or a certifietl cooY tnereof (Sectlon 3000, �b. C.) = r ( (� POIicY No. .=� �� ' � �/ ComPanY ��J i �Ct^�"�-'� � �Certifietl copy iz �ereby fumis�etl. 'Certitietl copy is tlietl with the ciry ?Wltliq9 INsya�' . Date "7- %rZ L%( Applicant r�� -E _ � EXEMPTION FROM WORKERS'�COMPENSATION DECLARATION • (This g¢�[ion ne¢tl not be compl0tetl If the permlt is tor One huntlretl ($300) or less). � I Certjfy that in�tho Perto�mdnCC OI Ibe wOrk f0i whith this pe�mk i5 i55UeQ`I shall not employ any oerzon in any mannar so as to become subject to thC Workers' Compensatlon Laws of California. Date Signaturo ' 'NOTieE: It, after makin9 this tloclaratlon, you zhoultl become subjett to the Workers' Compen�tion proWslons of Ihe Labor Cotle, You mus[ forthwith� comply wlth sucn provislons or this Dermit shall be tleemea revoketl. � CONSTRVCTION LENDING AGENCV 1 herCty allirm that thlre is a construcllon IGntling agency fOr tne performanca of the work for whicb lhis parmit Iz IiSueE (Sectlon 309� Civ. CJ LenOpr's Name Le�tler'S ACtlresi � OWNER BUILDER �ECLARATION . I herlby alflrm that I am BxeTpl 1mm lh0 ConVdttor's LJCGnse Law toqlh¢ followi�g reason (Sactlon 7031.5 Buslnosz antl Professlonal Co�e: Any tity or ' county wblch rnquirei a permit to Conit�uCt, dlttr Impmve, tlemolislt or repalr any ;tructuro, prlor to Its issuancu, aIw requlres t�e aoP�icant (or such Oermlt t0 tile a signetl Sld�ement lhat ho/slle IS Ilcop58tl pursuant to tM18 prov(Sions O( �[he Contractor's Litensa Law (Chapter 9(commencin9 wtth Section ]000) of ' DiviSion 3 0l lhC Bu5Ino55 antl Pro1C5sIon5 Cotlo) or Ihdt no/sne i5 exempl tner8lrom antl t�e basis 1or [ho allegetl exomption. Any vlolation ot SecUon 7031,5 bY anY applicrnl �or a purmit sub�eGts lha appllcant l0 d civll �enalty o1 not moro tnan five huntlr¢tl tlollars (5500�. �, a5 Owner OI the prOpCrly Or my em0�0y¢es with wag¢5 as th0ir zole comp¢nsa[ion, will tlo iho worM, an0 tba structu�e is no[ intentled or oHeretl for sale (Section 7044, Businoss anE Protasiionat Cotle: The Contractor'S' Liceni¢ Law tlocs'not apply to an owner ot a properry who builds or.improves lherCon, anC wno tlooT such work himseu/herselt or tnrough his or hor own ', �mployC¢s, prOvitlotl lKat SUCh�lmprovemenlb ar0 not intandetl of oHeretl for . sale. II, howevor, lhe building Or ImprovemCnt is SOIE wit�in ona y¢ar oi com- pletlon, the owner wlll havo tho burEen ol provin9 he/she tliE not buIIC or Im- prove for lhe OurpoSa ot Salc). ❑ I� as ownel ot Ihe prOPerty, am B%clu57vCiy COnifacti0g with licensetl con- � Vactorsfo construct [he Oroject (Section 7044, Buslnessantl Pro/esslons Cotle: Tha Conlractor's LiGenso ldw doe5 nol apply to dn owner oi'pmperty. who bulltls or Improves u�ermn, antl who contracts tor such projects with a con- � Vactor(s1 liconse pursuanl to tne Con6actor•s Licenze Law). I am aware that proDf o( lheir WOrkor's Compensallon inwranG¢ snoultl be prOvltletl to me. ❑� am'exempt untler Sectlon B. & P. C. tor this reason Applicant to fill In all sD��es avicept those withln �eavy bo�tler Iines antl slgn;ail apP�oGriate Gecldratlons. PE IT NO. TRACT NO. LOT NO. UNIT NU. 3 �n3- �-3 TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISM ❑ OTHER DES�RIPTION.OFWORK/USE OF BLDG. �� TVPE OF PERMIT LJ GRADING LJ FOUNDATION �STRUCTV RAL � TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ.FT. �• �� oCcuaAraCv CONSTRVCTIONTVPEV'N S'PfL VALUATION$ �oo ZONE GRADINGGU.YDS. ACRES_ Bar Sink Backflow Preventer � Backflow Irrigation Bathtubs � � Clari(iers � . Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service I Outle Interceprors • � Kitchen Sink Lavatories P-Trap ' Roof Drains , �'4 � � dl I O. (%f u181NG Showers Service Sink . Sewer Cap , �s Sewer Connectian Solar Collectors - . Solar Pipiri9 Solar Tank Swimming�Pool w/Spa Urinal Water Cbset Water Heater - Water Service Auco-Wash � .Reinspection Feo ' � $15I I�, Isue Fee � I g 3 I � BUiler . Duct-UnderGround . � Duct - Snuctural Duct - Ventilating - Exhoust System ❑ Multiple ❑ Pirepl/Fact BIL ICBO,dk � � Data - owner ' ' Heating System & Ducting 1 nereby certiry that 1 have reaC this apo�icatlon ana scate that the above �,�0.700,000 BTU �100,0006TI intormation Is correct. I agree [o como�Y �+�th all city antl couniy ortlinances antl state IawS rGlating t0 builtling COnstruction; dntl he�¢by authorlie �epre- , sent8tives ol tnis city to tB% upo - the above-mentlonea p!oper�y.for ' inspp�tio� pur0o5e5. ' � �� ` Si9nature r . �-'L� �ate� , Driver5' License or 55 $ �� RBinSpee[1on Fee $15 NF 0065-46, rev. 30/84 White - Bulltling _Ca�ary - Aaolicant: Pink - AtcounUn9� Goltlenrotl - Asiessor Hoodar Typel ❑ Canopy � Type I I ❑ Ae£rigeration System � �ai oo,000 sru ❑ 100,000 BT System Repair/Alteration " Fire Dampers /Ea Registers ` .i• : Iswe Fee'" � $ 3 A.P. 5I6 5 S Main Bu E T Front B Rear A C Right K Left S Ptng. Ret. # Plannin9 No�� Auromatic Washer. � Construction Pole Sub. Cooking Unit' , Dishwasher - � - - Dryers ❑Gas ❑Elec� Fan " F,A.U. . Fixtures Dyvice Boxes Outlets � Swi[ches� Garbage Dispoul _s{ Generator 00�5 KW C �. /� . RetnsPecti�— a /ELOPMENT SERVICI in9�APProved BV _ Iding'Approvad By . 3620 4/,^ / ; - ; Zone Accessory Building: � �r ng Req./Provided ELECTRICAL Transformer ❑ 75-50 KW ��50 + KW � Meter up ro 1,00 smps -. � Meter ❑over 100amps ic � Sub Panel ' ` � � Motars �O7 HP �1 `rS,- InaSolar 0945 HP�016-� Microwave ' Pola Light Sign ;Slanding Sections 5 KW Trash Compactor $15 Issue Fee �� ! , �i . ,J ='BUILDING PERMIT g — -�RLAN CHECK $ — �n' PLUMBING � 5 d�PLAN�CHECK 25%. $ �j� ELECTRICAL $ : •r � PLAN CHECK ,50% g MECHANICAL � 5 'r PLAN CHECK �25% g � N I N G R E Q N} FEES '? 0 3 3 FEES � SMIP . $ � � � � PERMIT �SSUANCE $ � ENERGY P.C. $ � GRADING S • M�CHOFILM 5 � TOTALFEE S ■ � CONSTRUCTION AND PLANNING POOL & SPA �� APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector � 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. ��(-116 �,(i/J 53. Steel Reinforcement , 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. ElecUical 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. 70. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connectio� 62. Backwash & Receptor-Final 12. Sewer CaP 63. Heater & Vent-Final 13. Roof Drains 64, Plumbing SYstem - Final 14. Rough Plumbing S 1,(-YG c.EO 65. Electrical-Final 15. Rough Electrical-Conduit ..1 � (� � LI. yL 66. Solar System-Final W 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling � �� 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT, � 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts. �n Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat � a�� 75. Dry Chemical 27. Frame and Flashing �j � 76. Dry Standpipe 28. Lathing & Siding _ 77. FIXED SYSTEM FINAL 16' ; 29. Insulation 78. FIRE PREV. FINAL /�/' 30. Drywall Nailing G 3 G HEALTH DEPT. REQUIREME � 37. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final / 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:y� �.�-Y(; wiqq�� Lh,p , 34. Final Heating & Air Conditioning Q,�� a� 8'/_ �� / �� /' 10 b 35. Final Gas Pipe-Test b=21-YG� a � 36. Hood or Canopy 37. Final Factory Fireplace � 38. Final Plumbing � 39. Water Service-Final ,�('.�-�b C,.,� � 40. Gas Service-Final � 41. Solar pomestic-Final � 42. 8ackflow Preventer � � 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations G� G 47. FINAL STRUCTURE & BUILDING a g� 48. Special Requirements Completed 49. Electric Release to Edison . 50. Gas Release to Southern California Gas Co � 51. CER IFI TE OF OCCUPANCY �o` 7�� No. Date �� ` -. - � �1 t. •�ti�� City ot Costa Mesa Development Services Department Building Sa(ety Division P. O. Boz 7200 Costa Mesa, Ca�itornia CERTIFICATE OF OCCUPANCY No.�Qh��7! The Buiiding located at 670 W. 17t-.h Sf,rppt Siii i-a C:5 has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group R-T. Occupancy. Use of Building Wholesale Marine Hardware Legal Description 424-281-02 (See reverse side for Metes and Bounds) Building Permit No G2351S Electrical Permit No. (��'i51 5 Plumbing Permit No. r�iSl S Mecfianical Permit No. G23515 IVumber of apartments and/or guest rooms ISSUED T0: Daffield Properties 670 W. 17th Street Suite D2 Costa Mesa, CA �, ��/ Date �tJ � BuildingOfficial -r/� �"/��-/ !/�/� This Certificate of Occupancy SHALI BE posted in a conspicuous place on the premises and SHALL NOT BE remdved except by the Building Official of the CitV of Costa Mesa under�c. 307 (e) U.B.C. CMF t015-a6 rev. I/B3 White -Owner: Canary - Nu rical File; Pink - Bldg. Permit File � ��• . ADPlicant to till In all soaeas exeept those within neavy Oo�aer lines ana sign all apo/ooriata aeelaratlons. . CiTVAF COS7A ME�Sa CONSTRUCThION /PERMIT Projec� Address � �� • � �c `T � Applicant's Mnili Address � �-T� r•��--^ Owner's Name � � �/ � </E`'� '� Phone��'ZSr�F// Address h 7 � � � L.� � Aroh/Eng. �'�' � � License NO. Address Contrecmr's Nam � �k � • � Phone ��'�%�� Addresslmnilingl-��'`�� G /�� City LicenseNo. •��f �� LICENSED CONTRACTOR DECLARATION 1 horoby allirm ihal I am Ilcansetl untla� proviilOni Ot C�arte� 9(comm¢nCing with sectlon 7000) of Divlsion 3 ot tho Business antl Pro/essions Coae, antl my Ilcense i5 in tull force an0 eflect. License Class �� Ucense,No �7 �a�v Date�'2�- � Signature ��^^�' �*� — - WORKERS' COMPENSATION DECLARATION . • 1 hereby altirm [hat I have a certiBtate�ol consent lo self-insure or a terUficale. � of Workers' Compensatian •Insuranca, or a certitietl copy tnereo!'(Settion 3800, L.ab. C.) . p r A • Polity No, a /•�i ��Z� Company ��YTa rw++-z�� CertifiBtl Copy i5 he�Gby fum(shed. �Cf�1�IBC� CO Y �5 ��Cd Wl�h (flE C�iy BY� fl ��V�S�Op:,G T Dalo �"' �Z � APPlitant .��6�' � — E%EMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissaction neetl mt be completetl it lno perml(,is for one �untlretl (SS00) or loss). � - I wrtity Ihat in the p¢rfOrmance ol the wOrk fOr whlch thls pe�mR Is ISivatl,.l shall nol amploy any person In any mannor so, as to become subjnct to the Workars' CompensaUon l.aws ot California. • Da[u Si9naturc 'NOTICE: If, after making this tloclaratlon, you shoultl be<omo suDjoct to the Workers' Compun5ation provisions ot the Labor COEe, you must Iorlhwith comply wilh such pwvisions or Ihiz p¢rmil shall be tleematl revOketl. CONSTRUGTION LENUING AGENCV . 1 hmeby aiflrm that there is a construcUon lentlln9 agancy for lha perlormance o/ lho work for whicn thi5 permit I5 is5uetl (SettlOn 3097 tiv. C.) Lpntler's Namc. � Lentler's AtlOress OWNER BUILDER DECLARATION � I bereby afflrm thal I am exomp[ from tho Contractor•s Llcensa I..aw lor tho following raa5on (Sa<tlon 7031.5 Buslncis antl Protasilonal Cotlo: Any city or Counry whi<h reqWr<5 a permlt t0 cOnstruGt, alt¢r, ITProvB, tlCmolish or repolr dny stluC[UrC, PdOr IO Iti ISSUdnCO, 315o fequires lha appliCdnt for suCh pUlml[ to tiie a si9natl statement thaLhe/sna Is II<onsatl pursuant to tne provlslons of ❑�e Contractor'S Licanse Law (Chapter 9(commenNng wllh Soction 7000) ot Dlvision 3 of tho Businoss antl Prolosslons COCo) or inat ho/iha Is exampl lnerofrom antl the bazls lor the allegetl exomptlon. Any vlolatlon of Sectlon 7031.5 by any' appllcanl ror a permll SUDjectS th0 applicanl t0 a tivll .� enalty ohnol more lhan tivc nuntlretl tlollars (5500). I, ds ownC/ ol thC propelly Ol my emplOyCcs wllh wa9es as thoir SOIa <ompansation, wlll tlo ino work, anG tho structure is not Inlentlotl or olforatl lor sab (SatUon 7064, Businesi antl Prolessional Cotle: Tno Contractor'S LI<ensa L.dw'OoeS not apply �t0 an owner OI a proparty who bulltli Or Imp�ove5 lbe�aon, �ntl' who tloe5 SUGh wo�k himzell/hoRatl O� lhrough hii a� nar own emplOycas, prOvbatl lhat such ImprOvemenl5 ara not'Intentloa or offBretl fo� � sala. Il,.however, thu Dulltlin9 or improvemnnt I5 soltl withln ono yoar of com- pletlon,;tna Owner wlll havo tM1a burtlan ot Proving I�o/she tlltl nOl builtl or Im- � prove for tne purpose of salc>. ;, . ' 0 I, as ownar ol the property, am azclusively contracting with Iicensotl con- � VaCto�s t6 consbucl tha projoct �SUCHOII IO44� BII5111055 d11C PIO�OSSI005 COOB: � � Tho Conlractor'i Liconsa L. w oas nol apply to an;owner ot property who builtls or improves thcreon, antl'wlto contracts lor sUth projetlz with a mn- Vactor(sl liconsc Oursuant to the Contractor's Llcense �aw). I am aware that �� prOof of Ihnb Worker'S Coinpensalion InSurdnGa shOultl be provitletl [o me. ❑ I am'exempt untler 5ectlon B. & P. C. for this reason � Date - Owner • � • 1 hcreby certlfy that I have reatl this aDo!�<atlon ana state Inat tne above intormation Is corracL l agroe to comply with all city antl county ortlinances antl�state laws relating to builtling construcUon, antl h¢reby authorize ro0/e- ' sentatives o� ti�o entC� upon the above-mentlonetl proparty for � inspecti6n purpose5. ' Signature / �ss-. DateLf'�2•� Drivers' License or 55 # �� -�_� � TVPE OF CONSTRUCTION LJ NEW U ADD I�ALTE TION ❑ CONVERSION ❑ DEMOLISH ❑ OTHER � DESCRIPTION OF WOtiK{USEQF BLDG. _ TVPE OF PERMIT U GRA�ING LJ FOUNDATION �`f-STRVCTU ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ.FT. �� OCCUaArv�Cj�� CONSTRUCTIONTVPE ��' S�n-- VALUATIONSy� ZONE - GRAI]ING CU. VDS. ACRES_ Bar Sink Backflow.Prevencer Backflow Irrigation Bathtubs Clerifieis� Dishwasher � Drinking Fountains Flaor Oroins Floor Sinks - GasService ' Outletr Interceptors - � Kircheri Sink Lavatories. P—Trap Roof Drains � � Reinspection Foa � $15 oouer ; .-� i Duct- UnderGround Duct � Structural � � Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/FacL BIL ICBO # ' � j Heating Sysrem & Ducting ; ( �]0100,OOOBTUO100,OOOBTi NG Service Sink � �' Sewer Cap , " Sewer Connection Solar Collectors Solar Piping' Solar Tank' ^' Swimming Pool w Urinal Water Close( Water Heater Weter Service Auto-Wash Leundry Treys laue Fee Haod or Typel ❑ Canopy Typell ❑ Refrigeration Sys[em ❑aioo,000eTu Oioo,000 System Repair/Alteretion Fire Dampers Registers ' i � Reinspeaion Fee S15 _ Ittue Fee CrotF 0865-46, rev. 30/84 White - Bulltling; Canary - Applitant: Pink - Accounting; Goltlenrotl - Assessor REPAIR A.P. qY+ ' S Main Building: E T Front ARear C Right S Left Ping. Ref. # Plannina Notes: Fl FEES �' Automatic Washer ' �� Construction Pole Sub. . ��' �� y 'Cooking Unit Dishwasher • , Dryers �Gas ❑Electric ' ' � 'Fan ' F,A.U. . 3622 4/2; /dG ••^ �, a : — Zo�a n-, - Accessory Building: ELECTRICAL Trensformer � 75-50 KW ��50+;KW .- .i" �/ Meter upto-700amps Meter- ❑over 100 amps - '� Sub Panel � Motors �0.1 HP:.�h'' 8 � Inc. Solar �9-75 HP �16-15+ Microwave . Pole Light � Generator �0-5 KW �5-15 KW _ � � � - i 7.' ..�. S 3 r' �d R . � . f�, Reinspection Fee $15 FEES ; DEVELOPMEN7 SERVICES RE�U f ning Approved By ' 8uild�9 APVroved By�e Y I Appliwtion Issued By RTII . _ . • ' c� BUILDING+PEfiMIT $ PLAN CHECK " $ P�UMBING • $ PIAN CHECK 25%� $ E�ECTRICAL ; $ PLAN�CHECK 50% $ MECHANICAL �$ PLAN CHECK �25% $ J �'� I N G R E Q FEES ^, Sign Standing Sections Trash Compactor � Issue Fee' ' § 3 it.�l � ,t'�i1c_. ..-•- ^Y- o? c� RV OF FEES ..�,o SMIP g � . 4� a�3 PERMIT .. oa ISSUANCE $ • SQ ENERGY P.C. $ ' • 3n � GRADING $ ' �•� /r�s/� MICROFILM $ � =y� TOTAL FEE $ �.J-S � � • 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. �� 7i'ff6 C.S/1 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Elec[rical 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 ,SU-�6 (.� 65. Electrical-Final 15. Rough Electriral-Conduit W� ` � 1� CI 66. Solar System-Final � 16. Rough Electric Wiring 67. Fencing & Access Approval . 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T 8ar Ceiling � (�' 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing - 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro . 26. T-Bar Ceiling (Structural) &,Monocoat (, Q686 � 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 3�/ HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat � 79. FINAL INSPECT�ON 32. Electrical Power Meter-Final G 80. FOOD CERTIFICATE ISSUED 33. Final Electric NdEes:�.s�J-yb w�� VF+n-T'OK.•c.�E/� 34. Final Heating & Air Conditioning � Z��+ � � 1 . 35. Final Gas Pipe-Test ,j -21-ti�+ l.E? jL� vM� 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing � 39. Water Service-Final � ��-p�b (�!) 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 6 47. FINAL STRUCTURE & BUILDING Go�l'f 8G 48. Special Requirements Completed , � .�49. Electric Release to Edison _ ' 50. Gas Release to Southern California Gas Co ' � 51. CER/�TC��yFAIC q►T�E� OF OCCUPAN Y [/ No._LL't.� Date �'6� �� i, City ot Costa Meu Development Services Department Building Safety Division P. O. Box 7200 Costa Mesa, Cali(ornia CERTIFICATE OF OCCUPANCY No.�U��'�;� The Building located at 670 W. 17th .Straat 6ui ta (;6 has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B-2 Occupancy. Use of Building Who�lesale Automobile Stereo � Legal Description 424-2II1-02 � (See reverse side for Metes and Bounds) ' Building Permit No, 9E23512 Electrical Permit No.BE23512 Plumbing Permit No. Mechanical Permit No. Number of apartments and/or guest rooms - ISSUED T0: BuildingOfficial �I" ��!!� i4� Duffield ProDerties �' 670 W. 17th S�reet D2 by � Costa Mesa. CA y /j/- � Date / � �' F7 (o This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the CitY of Costa Mesa under Sec. 307 (e) U.B.C. CMF 1015-46 rev. 1/83 White - Owner; Canary - Numerical File; Pink - Bldg. Permit File ✓ AOV��ant to fi11 in all soaeRs ezeeo�'�hose within heavY eoraer lines anC sign all aoP�oOriale eeclarations. CrrY oF coSTA MESa CONSTRUCTI�ONLPERMI� Project Address � � � �' � � � r'TY � � APP�icant's Mailina Address J�� '� . C . Owner's Name '�C• ��'��+'� `�� i� � Phone C�:� ��i/ Addr@ss � � � � ' � � L � Arch/Eng. ` `--� , License No. Addrass � '- /y Contracror'sNamalS.�n-�•� �� Ph/o�n[e,.��6��YyS Addr@u (mailin9l -.� �aS2/� 2/` C-�"'-f��w �N /'> > Ciry �icense No� -�� Y n Q LICENSED CONTRACTOR DECLARATION I h¢r0by atfirm that I am Ilcensetl untle� provi51on5 of Cha�te� 9(commenCing with y¢ctlon �000) of Dlvision 3 ot [ne Business antl Professions Cotle, antl ' Ty IiCense is in full fOrce antl eftect. License Class Lice se No. -+' 7% T/ �% -` -� Dale k� �% -�%- Siqnature -� � WORNERS' COMiENSATION DECLARATION I nereby atfirm that 1 have a certiticate ot consent to selLinsure or a<ertitiwte 1 ot wprkers• Co�m�p�e+nsaHon Inzurance.'or a certifl�etl /�co�DY Mer/e�ot (Se��c(U�on A 3800. Lab..irrY/"�/ �' ��il �.�"/ � fhs`oCi`� L� Policy No, Company n"� ❑ C4rtlfietl copy I5 hereby furnishetl. � ' ' - 0.Certl8ep 'copv Is tiletl witn tne city Bu��Id%i� i4isidn. Oa[e `+'��f7 APPIiCan[ ✓`��+� � � EXEMPTION FROM WORKERS' COMPENSATION DECLARATION � (This seclion neetl not be compleletl if the permlt I5 for one huntl�etl ($300) o� less). I c¢�lify that in th¢ po�tormdnce of the work t0� which this pe�mit is iSsuetl, I Shail nOt employ any pCrsOn In any mdnne! so a5 f0 beco�Yte subject [o th¢ Workers' Compensatlon I�ws of Califomia. � Date 519naWre � "NOTICE: If, after makfn9 �hfs tleclara[ion, you zhoultl become subject to the Wo/kers' Com0en5atlon OrOviSions o( th¢ Labot COCe, you must for[hwith cOmpty with such prOvisions o� this pe�mih shall �Ee tleem¢tl revoketl. CONSTRVCTION LENDING.AGENCV � '� I nereby afflrm that the�e I5 a mnstruction lentling agency for the Oe�to�mance of the work for wbich this permit•is izsuetl;.�5ection'309] Civ. CJ Lentler'z Name - Lentlpr's AtltlreSs OWNER BUILDEH dECLARATION - � � � • I hereby affirm that I am exemOt irom the COntrdclor's LiCense Law tor the tollowin9 reason (Sec[lon 7031.5 Business antl Profe55ionaPCotle: Any U[y br county wnich requires a permit to consGuct, alter, imOrove, tlemolish or repair � any Etructure, prior to Its Issuance, also requlres the applicant (or zuch oermit [o file a sl9netlstatemenYtha[ he/she is licensetl pursuant to the Orovislons ot -the Contractor's License Law (Chdpter 9(wmm¢n<Ing with $ection ]000) Ot �- Div"ision 3 oi the Business antl Pro�essions Gotlo) or ihat ne/she is exempt . therelrom antl the ba5is IOr the allegetl ezemption. Any viOlalion af $ecHOn 7031.S,by any ap0lican[ tor a permit subjects [he.applicant to a civil � endlty oT not move than five nuntlretl'tlollar5 ($500). ' '�� I� as owne� oT tho property or my"EmP1oy005 with wd9es a5 thelr SOIe � Compensation, will tlo the work, antl the st�uCtu�e is not intentletl dr off6�etl ' for sale ($ection 7044, Buziness antl Professlonal Cotle: The Contractor's Liceps¢ �aw tloes nol apply to an owner ot a D�operly who quiltls or improves the�pon, antl wbo tloe5 such work himself/nerself or tnrougb his o� her Own employ ees, orovitleC that such improvements are not Intenqea or afieretl tor Sale. I(, how¢ve�, the bulltling or improvemenl is soltl wiNin one yea� ot COm- pletioq the owner w111 have the burtlen of proving M1e/she tlitl not builtl or Im- ' provG for tM1e�purpo5e oi Sal¢). � ❑ I, as owner of the oroperty, am exclusivety contracting witn Iicensetl con- tractoRto consiruct the project (Section 7044, Business antl Professions Cotle: -The Contraclor's,Li<ense 12w tlOes nOt apply to an owner ot pro0erty who ' bulltls or imp�oves inereon; ana who contracts lor sucn projeccs with a con- tractor(s) Ocense pursuant to the Contractor's Litense Law). I am aWare that prop� o( thei� Worker�s Comp¢nsation insurdnca shoultl be provltletl to me.' ❑.I am�exemot untler Sectlon 8. & P. C. for this reason ' Dace ' Owner �I beieby certify�that I have rea� Inbrmatlon is wrrecL I agr¢e to antl,state laws rela[in9 �o builtlir Sentetiv¢s oh Ihis clty lo enter insp¢Ctlon Pu�pos¢5. L��G � Sig ture ��< ��ers' License or 55 � _— a a :oy au[norize repr¢- ionetl 'praperty for Date�� GZ.�� TVPE OF CONSTRUCTION . IJ NEW IJ ADD LTERATION LJ REPAIR '' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER - _ A p # '� DES RIPT ON F R�C/ E OF BLDG S Main Building: TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL� T Front � QTENANT Q ELECTRIGAL ❑ PLVMBING ❑ MECHANICAL � B Rear Q OTHER %� PROJECT DESCRIPTION St�Pj.. Q.... �� oCCUPANCv � C Right CONSTRUGTIONTYP�IL—n� ,�a�-jL_ VALUATIONS �� J>•_ g Left ZONE ' GRADINGCV.YDS. � ' ACRES Ping. Ref.# �.R�narks: � � , �� '��.�_R�n � � • PlanningNOtes:�� Bar Sink Backflow Preventer Backflow Irtigation , Ba[htubs ' � Clarifiers . . .. Dishwasher Drinking Fountains Flaor Dreins , Floor Sinks - - Gas Service Outiets Kitchen Sink � Lavatories . - P-Trap . . • � Roof,Drains � Reinspection� Fee � � $15 eoiier � Duct - Under Ground ' ' Duct - Struciural Duct � Ventilating � . Exhaust System ❑ Multiple Firepl/Fact.�Blt ICBO # Heating Sys[em & Ducting ❑ ai oo,000 eru 0 i oa,000 ' ; � Reinspection Fee � S75 GMF OB65-46, rev. ]0/84 White - Builtling; Canary - APPlicant; Pink - Accountin9: Goltlenrotl - A55essor Showers ServiceSink , Sewer Cap , Sewer Corinec Solar Collecro�� Solar Piping.: Solar Tank; Urinal � Water Closet Water Hea[er ' Water Service . � Auto-Wash '� Laundry Trays i Issue Fee'- IANICAL Hood or Typel ❑ Canopy Type I I ❑ FEES L/b�Q y u-dTo � �s� f� Automatic washer �'`%r • Construciion PoleSub. • °'y �(� Cooking Unit ' r.., - Dishwasher ^ � . 7' �� Dryers ❑Gas ❑Electtic � Fan � �,. F.A.U, Fiytur¢s �.`- Device Boxes . ? Outlets � - )�� •Switches r � �,� �. Garbage Dispoul � p . . . �Generator �0-5 KW �5-15 KW � �� . � r Refrigeration System ❑0.100,000 BTU ❑100,000 Bl System Repair/Alteration Fire Damperi � Registers , 3619 �1�G�rI.1:l ':r;"_ : .. Zone /K � _ AccessOry Building: _ _ , 0 LECTRICAL � ITl8f15f0lTEf ❑� 'I N , G, . R jt . � E t Q � � M n T � $' o I. FEES',i KW :W . � Meter Ll,��to t00�Amp Merer �]over 100 amps Sub Panel ' . Motors�0.1 HP:�iX7� IncSoWr �975 HP d� Microwave Pole Light � Range � Sign • Standing Sections Trash Compacmr $ 3 K :✓ .. � � I � Reinspection Fee 1$75 luue Fee FEES t - DEVELOPMENTSERVICESREQUIREMENTS: ,..� Zonin9 APPraved BY '._ i Building Approved By �' AppllCdtlOO ISSUed BV Issue Fee � $ 3 0 � SUMMAHV OF FEES ,! ��'a BUILDING PERMIT $ 2� s a SMIP $ 2' T5 �� PLAN CHE�K ,$- � 0: PERMIT J��. PLUMBING � $ ' ISSUANCE § �� PLAN CHECK 25% 6 ENERGY P.C. $ ELECTRICAL '$ GRADING $ • - PLANCHECK �50% $ MICROFILM $ � � � MECHANICAL � $ SOTALFEE � $ �.3 .S• - '� PLAN CHECK .25% $ . ! . ' CONSTRUCTION AND PLANNING � APPROVALS Permit # 7. Temporary Electrical Service or Pole 2. Soil Pipe-Undrgrnd. ' 3. Elec[rical Conduit Utility-Undrgrnd. 4. Electrical Conduit-Undrgrnd. 5. Steel Reinforceme�t 6. Electrical UFER Grnd. 7. Footings � 8. Foundation � 9. Water Pipe-Undrgmd. 10. Structural Floor System 11. PropertY Sewer Line & House Connection i 12. Sewer Cap 13. Roof Dtains 14. Rough Plumbing 15. Rough Electrical-Conduit � � �� 76. Rough Electric Wiring , 17. Rough Wiring Sign 18. Rough Electrical-T Bar Ceiling 19. Rough Heating & Air Conditioning 20. Rough Factory Fireplace 21. DuCts, in Structure 22. Ducts, Ventilating 23. Gas Pipe-Rough & Test 24. Roof Framing 25. Roof Sheathing 26. T-Bar Ceiling (StructuraQ & Monocoat C 27. Frame a�d Flashing � 28. Lathin�g & Siding �29: �Insulati0n 30. DrYWaII�Nailing , ` 31. Plaster Brown Coat � 32. Electrical Power Meter-Final 33. Final Electric 34. Final Heating & Air Conditioning • 35. Final Gas Pipe-Test . 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final ; 41. Solar pomestic-Final � 42. Backflow Preventer 43. Backflow Irrigation � , 44. Landscape Irrigation System 45. Sound Attenuation ' 46. Handicap Regulations � 47. FINAL5TRUCTUR BUIL I � 48. Special Requirements Completed 49. Electric Felease to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY �, � Date ! � ! � Date POOL & SPA Inspector qppROVALS Permit# 52. Pool & Equipme�t Location 53. Steel Reinforcement 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER-GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test 60. 8ackwash Lines, P-Trap, L] Undrgrnd. 61. APPROVAL TO DECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final � 64. Plumbing System - Final 65. Electrical-Final �{ 66. Solar System-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING LD� 69. POOL/SPA SYSTEMS FINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hydro 71. Product Piping OGas ❑Oil 72. Underground Flush 73. Undergrnd. Storage Tank � Gas ❑ Oil 74. Overhead Hydro � 75. Ory Chemical � 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL 1 HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION � 80. FOOD CERTIFICATE ISSUED . �✓l� Notes: .C� e 9 �?/_ Ae ��... / _7 .,.. . r Date �Inspector � �. AVD��ant to /ill in al1 soaces exceDt thase witnin heavy borEer lines ana sign all appropriate tleclarations. CITY OF COSTA M SA CONSTRUCT�IO+N P�RMIT �RMIj NO.,,, A� �� TRACT NO. LOT NO.• UNIT NO.� Prolect Address —�7U %L� �� ( � �� 5 j� ' L Applicant's Mailin9 Address �5��.��0��/�1G1 Owner's Name �/ �� a P on��—�� Address �� ! � �_ � � Arch/Eng. License No. Address G Contractor's Name yP�h�o/9e Addresslmailingl � � ��:p/"tr��7 � City License No. O � � LICENSED CONTRACTOR DECLARATION I hereby affirm t�at I am licensee unaer Orovisions ot Charter 9(commencin9 with section 7000) ot Divislon 3 of the BuSinesS antl Profe sion5 Cotl¢, antl ' my Iicense is in full force a ifect. � License C ss L � Date ' Signature � ` WOft ERS' OMPENSATION O ARATI ( � nereby attirm tnat 1 have a certificate of consent ro self-insure or ertificate ' �f Workers' Compensatlon Insurance, or a certlfietl copy thereof (Sectlon 3800, Lab. C. �J �.�f��•�+ PolicY No. ��J � �2� ' ComPanY �//iT/ � NZ/Nr% �ertifietl copy i5 hereby furnl5h¢tl. ertitie co le with the cit Buily 9 DIy' on. ' � � Date PY AOa��cantYrX�is/✓�i_i�a%� EXE TIOML�RKERS' COM6EFSAT�ON� LARATI � (ThiS sec[iOn nee0 not be compleletl if the pe�mlt is fo� one huntlred{E100) or less). I C¢rtify that In �ne pe�7o�mance of Ihe wo�k to� whlch this perm�t i5155ue0, I znall not employ any person In any manner so as lo become subjecl to the Workers' Compensation Laws of Calitornia. Da[e S�9nature �NOTICE:1(,af[er makinq.[his tlCClaratiOn, y0u ShOWtl become subjett to [he Workers' Compensation provislons of Ihe Ldbo� Cotle, you muzt forthwl[h comply with such provisions or this vermic shall be tleemetl revokea. CONSTRVCTION LENDING AGENCV 1 nereby af9rm lhat there is a consVuction lentling agency tor the performance ot the work far wnich thiz permlt is issuetl (Sectioni 309� Civ. CJ Lentler's Name Lentler's Aatlrass OWNER BUILDER �ECLARP.TION � - I hereby afflrm that'I'Sm exempt from the Contractor'S License Law for the following reason (Sectlon 7031.5 Business antl Professional Code: Any city or county which requires a permlt to tonstruct, alter, Improve, tlemolish or repalr any structurq pNor to its issuance, also requires the applicant tor�such permit to ti�e a siunetl 5[a[ement that he/sne Is licensetl oursuant to the D�ovi5ion5 ot Dlvision-3 ot Ihe Business antl Profes5ion5 COO¢) or that ne/she is ex¢mpt [he�efrom antl the basis for (he alleqetl ezemptlon. Any violation Df Section 7031.5. by any appliCant tor a permlt 5ubject5 the, applicant to a civil �enalty of not more than tive huntlretl tlollar5 ($500). I, as ownor of the 'p�operty or my, employCes with wages as thelr sole compen5ation, wlll tlo the work, antl the structure is no[ intentletl or otieretl for sale (Sectlon 7044, Business antl Professional Cotle: The Contractor's Licenze Law tloCs not apply t0 an owne� ot a property wno builtls o� Imp�oves lhareon, antl wlio tloes SucM1 work himsel(/hersel/ or tM1rough his or her own ¢mplOyees, p�ovitletl thaDsuch Improvemenl5 ar¢ n0[ intentletl o� offeretl tor sale. It, however, lhe builtling or improvement Is soltl within one year of com- pletion, the owner will have Ihe bu�tlen of prOving h¢/She tlitl mt Gulltl or im- �1rove �or tne purpOze of sale). �J 1, as owner Of [he O�operty, am ezclusively cont�acting with licensetl con- lractors[o cons[ruct(he project (Section ]044, BuSiness antl Professions Cotle: The ConVactor'S License Law tlOCs not apply to an owner ot propMtywM10 builtls or Improves thereon, antl who contracts tor such projects with a con- bac[or(s) license pu�suant to Ihe Cont�actor's Li<ense Lawj. I am aware that proof of [hGir WOrket's COmpanSatlon inswance Shoultl be 0[ovitletl lo me. ❑ 1 am exempt untl¢r SCctiOn B. & P. C. for Ihis reason Date Owner I hereby certify that 1 have reatl lhis appliwtion antl state that the above �Inbrmation is correcL I agree to comD�Y with all tlty ana counry ortlinances antl state laws relat�ng to builtling yEnstruction, antl hereby authorize repre- sentativez ol thi(/tlty to enter.Qoon the aGoveimentionetl oroperty.for - �jPEOFCONSTRUCTION IJ NEW LI ADD LJ�ALTERATION LJ REPAIR. � � CONVERSION ❑ DEMOLISH ❑ OTHER DES RIPT O�NSt F� R USE OF LDG. p Q��S ��!/��6 � �.G TVPE OF PERMIT LJ GRADING ❑ FOUND 10 STRUCTVRAL ❑ TENANT �LECTRICAL ❑ PLUMBING I�.MECHANICAL ❑ OTHER PROJECT DESCRIPTION S4.FT. �� oCCUaANCv L CONSTRUCTION TYPE VALUATION $� ZONE GRADINGGU.V�S. ACRES Remarks: „ ,_ yy � �. � � Sink Irtigation Drinking Fountains Floor Drains Floor Sinks Gas Service I nrercepmrs Kitchen Sink Lavatories Reinspection �Fee �, PLUMBING Showers Service Sink Sewer Cap Sewer Conm . Solar Collec $15�� Boiler Duct � Under Ground Duct - Structural Duct-Ventilating - Exhaust System ❑ Multiple FirepllFact. Blt. ICBO # Heating System & Ducting ❑ a � oo,aoo aru O i oo,000 I Drivers• Uce se o 55 �/ '��—� I I Aeinspection Fee I E15 CMF 0865-46, r¢v. ]0/84 WhitG - Builtling; Canary - Applicant; Pink - Accountin9; GOltlen�Otl - ASSesso� _- -- �961ar Tank Swimming Pool w/Spa" Urinal Water Closet ' Water Heacer Water Service Auto-Wash Laundry Trays Isue Fee Hoodor Typel ❑ Canopy Typell ❑ Refrigeration System ' ❑0-100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers laua Fee A.P. # S Main Buildir E T Front B Rear A C Ri9ht ' K Left S Ping. Ref. # Planning Notes: � i Auromatic Washer Construction Pole Sub. Cooking Unit Dishwasher � F.A.U.' Fixtures Device eoxes Outl¢t5 Garbage Di Generaror $ g � ' FEES Reinspection Fee - DEVELOPMENTSER ' 2oning Approved By— Buildin8 APProved BY S 3 3 9983 7/23/86 _ . - � Zone Accessory Buildiny: Parking- ELECTRICAL � � � Transformer ❑ 15-50 KW � ❑ 50+ICW - Meter ❑up to 100 amps . J Meter � Dover 100 amps Sub Panel� � . � Motors �0.1 HP O1 h- 8 Inc. Solar �9-15 HP 076-75+ Microwave Pole Light Range • 74.98 TL Z O N I N G R i E � M T $. FEES Standing Sections 5 KW Trash Compacror ' i $15 il . ' Issue Fea � EQUIREMENTS: $ 3 � SUM R�nV�O,,F FEES . � , . BUILDINGPERMIT $��f,_ SMIP $ •S� PLAN CHECK $ �+ d3 PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERG� P.C. $ ELECTRICAL $ GRADING . $ - PLANCHECK 50% $ MICROFILM $ MECHANICAL $ 0 TOTALFEE $ PLAN CHECK 25% $� t'f� r. �- �= POOL & SPA • CONSTRUCTIONAND,PCANNING �r-':� "� Date ' Inspector Date� Inspeitor � APPROVALS ��Permit # APPROVALS Permit # Y I '!� 1,.,h'emporary Electrical Seivice or Pole ' S2. 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. _ i � '8., Foundation i� � 59. Gas Pipe, O Undrgrnd., Test 9�. Water-Pipe-Und�grnd: � 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 � y:�, �pP� 66. Solar System-Final 16. Rough Electric Wiring �.G�a t:��fi 67. Fencing & Access Approval 17. Rough Wiring Sig� ' � 68. APPROVED FOR PLASTERING � 16. Rough Electrical-T�Bar Ceiling _2�'�.6� ��(.j 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # _ 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 77. Product Piping O Gas ❑ Oil � 23. Gas Pipe-Rough & Test 72. Underground Flush . 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical , 27. Frame and Flashing � 76. Dry Standpipe • ' 28. Lathing & Siding 77. FIXED SYSTEM FINAL r 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 f �S''Q(t, Y �l„ Notes: �� '� ' 34. Final Heating & Air Conditioning ��y� � � , 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 pomesticFinal � - � . . ' - .42. Backflow Preventer ' -} . . � 43. Backflow Irrigation . �� 44. Landscape Irrigation System ' � ' 4• 45. Sound Attenuation � ' - ,, � , _ '. 46. Handicap Regulations � _ - - ' ' ,' 47. FINALSTRUCTURE&BUILDING 8 � ' " �� ' . ' � 48. Special Requirements Completed � • � �' � . 49. Electric Release to Edison . � 50. Gas Release to Southern California Gas Co /�' . 51. CERTIFICATE OF OCCUPANCY . � � � No. Date ,,. . \ `' � - ,'� l � , . . � I � � PN0.IECT ADDflESS: 6"J O W 17 TH $T _-n�3�Ep's�+Arne: pACIFIC MESA PROP, � aoudiss: 670 W. 17TA ST � N,B. 92663 AHCHIENGINEEN: RD�flESS: UNIT: G 1 HEG.NO.: UNiT: p(PMITTEE: PACIFIC MESA PORPERTIES ( 719 ) 645-6811 PODRE55: (j"JO W 17TH ST C.M. CA 92626 LICENSEO CONTflACTOB DECLAPqTION: I hereby aflirm tAal I am Iicen5e0 untler pmvisions o� Chap�er 9(cOmmencing with Sec�ion 7000� ol tlivision 3 0l I�e Business ana Pmlessions Cotle. and my license ie in tull lo¢e antl enect. CITY LIC.: STATE UC.: CUSS: Oate: Signamre: WOHI(EPS' COMPENSFTION DEClANR710N: I Aere�y allirm iAa� I Aave a cenilicaie al cansem m seli-insure or a certiticale of Workers' Compensz�ion Insurance, or a cenilietl copy t�ereol (Section 3800. La6. C�. POIICY NO.: E%P. DFTE: COMPRN�: 7 Cenilie0 copy is nereby lumisnee. ❑ Ceniliea cooY is liletl vnth ihe city Builtling Oivisian. Da[e' Ppplicant EXEMPtION FNOM WOBHEBS' COMPENSR710N OECLRRF710N: (This section need not Ue campleteG itihe permit is Iorone AunUretl �5100) or less�. I cenify inal in Ihe OeAormance ol t�e work for whic� Ihis permit is issue4 I shall nol employ any person in an manner so as to become sublecl lo �he�y o'rkers' Compensa�ion Laws ol Caiilornia. (/_'7 � oa�e. 7' �� `q_`� Signalure: �� `� � NOTICE: II. a112r making IhiS aeClaraiion, y0U ShoW�CCCome SUble�� a lhe �y rkers' Compensation pmvisions oi tAe La�or CoG¢. You musl forlhvnt� camply wi�h such provisions Or tks permii shall Ge Geem¢E revoke0. CONSTHUC710N LENDING PGENCY: I nereDy allirm thai �nere is a constmctian lenaing a0ency far ihe oedormance oi the work lor which ��is permil is issued (Seclion 3W7. Civ. C). LENOEB: AODflESS: OWNEB B�ILOEfl OECUflRTION: I hereGy atfirm Ihat I am exempl lmm �he Contracrori Slate License Law lor Ihe �ollowing r¢ason (Seciion 7U31.5 Business antl Profe55ional Code: Any ciry o� caunry wAich requir¢5 a permii to constmct, alt¢r, impmve, dertrolish, or repair any simclme. prior to i�s issuance. also requires Ihe epplicant �or such permit �o lile a 5igne0 slatemenl lha� he/5Ae i5licen5etl Dursuant �o �he O�ovisions ol Ihe Coniractors' S�a�e License Law (GhaD�er 9(commencing witA Seciion 7000) ol �ivi5i0n 3 0l �he Business ana ProleSsions Coae) or that ne/sAe is erempt Iherefmm ana ihe Casis for ihe allepetl e�emption. Any vialation ol SeCtion 7031.5 hy any applicant br a Dermit su0iecls t�e applicant to a civil penally of not more tAan live huntlretl dollars (E500�. I, as awner ol ihe pwDe�y or my employees with waAes as tAeir sole compensation, will tlo ihe work, antl the ❑ sirocNre is not intended or o��ere0lor sale (Secuon 70ne. Business anG Pmless�onal CWe: T�e Coniractors' State License Law aaes noi apply m an owner ol a pmpeny who builas or impwves ihereon, and who does such woM �imself/heneti or thmupn hi5 a� her own employees. proviGeG ihat such impmvemenis are not inlentled ar alfere0 far ule. If, however t�e builtlinp or imOmvemenl is so10 �nl0in one year o� comple�ion, I�e Owner will have t�e 6urAen ai provinA he/sAe 4� noi builE or improve tor ine purpose ol sale). I, as owner ol the oropeny, am eMclusively contractinp wilh licensed coniractors to tonstruct Ihe pwject (Section 704d. Business � antl Pmiessions CoOe: ihe Coniractors' State License Law aces not appry m an owner ol OroDenY who 6wltls or impmves therean and wAo toniraCtS for SUCh pmle[I5 with a ContraClor�s�liCense purSuanli0 Ihe CantlaCtorY State License Law�.l am aware Ihat O�oo� ot ��eir Workefs Compensa�ion insuranc¢ s�oultl �e pmvi4e0 lo me. � I tm evempl untler Setlion: B. 8 P,. C. ` �o� Nis teason: n � � �� 7 � ` ` �ate: Ownec � 140 hereUY �e�ily Ihal I am aware o� an0 un4eRlanA Ihe requiremen�s at Cali�omia Heallh an0 Sa�e oAe Sections 25505, 25533, antl 2553a and that I or any lumre �uilding occupam will/wiil noi �circle one) neetl to comply with saitl s�ate cotles antl IAe requirements for a permil br �ons�mclion or modilication Iwm Ihe Fir Ouality Managemen� Oi5Vic1, fleSiJen�ial constru[�ion apDliCations are eeemp� Imm I�ese proNsi0n5. Oale: Applicani: I �ereby ce��y Na� 1 �ave read Ihis application anE slate ��at I�¢ aCove inbrmation i5 mraci. I agree Io comON �'^�h all city anG County orainance5rntlsta�eiawsreia�inglobuil0ingconsimc�ionanOnereOyam�orizerepresen�atives ' ci�y oenterupo d¢aGore�mentionetl pmpetly lar inspection purposes. / �` ',� �/ //-9`f •f Da1e: 2'"' SignaWre: //f�'�� Driver's Ucense oi Socia� Securi�y u: 16a1<6 H'�i�e—BuilEmg: Green—CoOe Enlorcemenl: Canary—rlppliwn�; Pink—Revenue: GdOenroO—Assessor CITY OF COSTA MESA — BUILDING PERMIT pERM NO; B 06678 PERMIT NO: B 066780 PLAN CHECK NO: 00720-94 A GOVT; N SUPP: N CONSTRUCTION TYPE: V—N pERMZT TYPE: STA PURPOSE: ALT JOB DESCRIPTION : INTALL H.C. RAMP 6 UPGRADE RESTROOM SQ FT: 25,000 CLAIM VALUE: 25,000,00 CALC—VALUE: 25,000.00 GROUP OCC: B-3 / *�***�**ir***��*��rt�r*�rx ir4x****`x��**�**�+Et+r�***ROO**��r*****��**�r*�***�r***xx**x��rxx Z O N I N G R E Q U Z R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT; FT IN REAR: FT IN FRNT: FT IN REAR; FT IN LEFT: FT IN AGHT; FT IN LEFT; FT IN RGHT: FT IN PARHING REQ: •PROV; pARCEL: 42428221 2NE: MG REF NO; PLANNING NOTES> TENAT IMPROVEMENTS TO INSTALL AN INTERIOR HANDICAP BATHROOM. � . fElf iF iE iE 1E if iE 1f iF if iE 1E if ih 1k iE 1ElElE �E fE 1E if if 1F iE i! iF 1! iF 1f ff if 1E fE if M iE fE if if 1ElE fE iE i! 1f 1E 1f if iF iE iE 1f 1F iE fE 1f ff fE if 1F M i� if 1F if iE iE fE 1E iE fE fE ff ff iE iF D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY ��• DATE; «� y BUILDING APPROVED BY : DATE: APPLICATION ISSOED BY; S� DATE: 1«� 1f9FiFiFifiFiF�FiFififiEiEiEiFIEiFiEiElfiFit iF�1FiFiEiEifiEkiFif ifiE iE aF iE iE if 1E 1f iE iE iE iE iE iE if 7F iF iE if iF if if it iE 1E 1f fF fE iF it If 1f �f iE iF iE iF iE 1f if k iF iF iE iE 1E 9E it jf 1E iE it it it iF M ik iE 9E iF fF iE fE iF if 1! �E 1f iF iE iE iE if iE 1f k iE iF 1f 1E LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PERMZT 252.00 PLAN 90.95 ISSUE FEE PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING SMIP/NON—RES 5.25 BUILDING—DIV—> PERMIT ISSUE PI;AN—CHECK TOTAL PAID DUE TOTALS----> 257.25 0.00 °,40,95 298.20 298.20 .00 REVENUE DIVISION TOTALS--> COLLECTED: 257,25 OVER/SHORT: .00 BLDG PMT PLOMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CFIECK 252.00 5.25 k it i! if 1f 1! it it it iE if if i!!f 1f �E it if iE 1f iF 1F �t i! if k iE ff 7! 1!!F!f 7t 1F iE if it if iE 1! 1k if it 1f 1f �! 1f it 1f 1F fk %if it fk if ff if 1f !f it fF ip k 1t 1F iP if it 1f 1! iF iE 1E k M i! if jE I N D I V I D U A L :F E E B A E A K D O W N TYPE QTY D E S C R I P T I O.N ,' UNIT COST TOTAL COST SFC 25000 ALTER HY VALUE COMMERCIAL NOZONE END OF FEES 0 1.00 25,000.00 OS OOS:�S769-0015377p T G T Zgj,zg DATE: 04/1�/94 TIHE: 16:40 . w � � �� ONSTRUCTION AND PLANNING P�L ^ SPA NAPPROVALS Permit # Date I�spector qppROVALS Permit # Date Inspector 9� Temporary Electrica{ Service or Poie 52. Pool & Equipment Location : � 2. Soil Pipe�Undrgrnd. 53. Steel Reiniorcement , •�. Electricai Conduii UtilitY-Undrgrnd. 54. Forms - 4.-Electricai Conduit-Undrgrnd. 55. Electrical Bonding � • 5. S[eel Reinforcement 56. Rough Plumbing & Pressure Test � . 6: Electrical UFEF? Grnd. 57. APPflOVAL TO COVER�GUNITE - � 7. Footing5 �� 58. Electricai Conduit�Undrgrnd. 8. Foundation , 59. Gas Pipe. � Undrgrnd., Test � 9. Water Pipe�Undrgmd. ' 60. Backwash Lines, P�Trap, O Undrgmd. - 10. St.uctural Floor.Svsiem 61. APPROVALTO DECK 71. Property Sewer Line & House Connection • 62. Backwash & Recepror-Pinal 72. Sewer Cap 63. Heater & Vent-Finat � � 13. Roof Drains • 64. Plumbing System - Final �, 74. Fough Plumbing ' 65. Electrical-Finai ' i 75. flough Electrical�Conduit � 66. Solar SYstem-Final �� 76. Rough Electric Wiring 67. Pencing & Access Approval 77. Rough Wiring Sign 68. APPROVED FOR PIASTERING " 16. Rough Electricai-T Bar Ceiling 69. POOL;SPA SYSTE�S FiNAL /9, Rough Heating & Air Condit"toning FIRE DEPT. REQUIREMENT 20. �Rough Factory Fireplace - APPROVACS. �• Permit � 21. DuCts, in Structure � . � - . . ., ��70. U�dergrovnd Hy�fro � 22. Dutts, Ventilating. � ' 77. Product Piping �G�s ❑Oil , 23.GasPipe_Rough&Test ,.� � -_]2. UndergroundFlush �� " , 24. RoOf Framing� • - 73. Undergmd. Storage 7ank O Gas ❑ Oii 25. Roof Sheathing `� , 74. Overhead Hvdro � 26. T-Bar Ceiling (Structuratl & Monocoat ' 75. Dry Chemical _ � � - �_ , 27. �Frame and Flashing �A�LS �(, G� 76. Dry Siandpipe . � � � � 28. La.hing & Siding �. -' • 77. FIXED SYSTEAI FfNAL 29. Insulation ', ' - �� 78. FIRE PREV. FINAL . .30. Dry�vall Nailing HEALTH OEPT. REQUIRE�ENT _37. Plaster Brown Coai � 79. FINAL INSPECTIQN �' ' ' 32. Elzctrical.Power Meter:Finai . 80. FOOD CERTIFICATE ISSUED 33. Final Electric -� � Notes��Q�,� f�G,�.!/ ,vQ Sv�j�% � �/ :34. Final Hea_ting & Air Conditioning � �- , s// A�� - . 9.(r_ f7 9T 35. Pinal Gas Pipe-Tesf ' ' •f i 36. Hood or CanopY , _ � � . • � .: - 37. Finai Factory Pireplace . � ' . . ' 38. Final Plumbing � ` _ • � ' � 39. Water Service:Final *-� ' « � 40. Gas Service-Final . � � ' � � 41. Soiar pomesticFinal � -' • . , 42. Backfiow Preventer � • ' � - � 43. Backflow Irrigatiori � . .. , ,• � . � ' `. . 44. LandscapelrrigationSystem; '� � . . �- • � _ 45. Sound Attenuation� - � " � � � ' ' - �' ' `. � -46. Handicap Regulations ' � ' � � -� - 47. FINAL STRUCTUflE & BUILOING :" �� 5+y '� - 48. FINAL PLANNING . ' � _ . ��. . - � 49. Electric Re�ease to Edison � � - , 50. Gas Release to Sou2hem California Gas Co .� . ' 51. CEflTIFICATE OF OCCUPANCY • No. Dace �wecr aoosess: 670 W 17TH ST t' OWNEfl'6NAME P;�CIFIC MESA PROP. ADDflF55: (j'J� j.j, 1']'j'i�j $'j' 1 N.B. 92663 I� � . ' � , - ABLH7ENCINEEfl: noox¢ss: HEG.NU.: uNiT: G 1 UNIT: � PEBMITTEE: LEE CONNOLLY ( 714 ) 534-7314 FOOFESS: '� B 1 p. �. H�7( GARDEN GROVE CA 92692 LICENSED CONTflACTOfl OECIAflATION: I hereGy aifirm I�a� I am licensee un0er pmvisions oi C�apler 9lcammencing wilh Se[Iion 7000) ol Oivision 3 ot Ihe Business aiW Pmlessions Cotle. antl my license is in WII lorce and ef�ect. c c.:r0J12597 srnreuc.:y3gz7 cuss: 36 ie: � ( �� R v Slgna�ure: _ �� EPS' COMPENSATION OECLABA710N: I �ere6y affirm tlwl I have a cenilicate al consent to sell�insu�e or a cenilicate of Workers' Gompensalion lnswance. ar a WUIieA tppy l�eRol (Section 3BQ0, LaU. C�. roucrNo.:1091742-99 E%P.OATE: O3/OS/9S comranr: STATE FUND ] CeflilieE wpY 6 �ere0y lumis��Jetl. � Certifiee coOY �s li= wit� Ihe city Builtling Division. Naie' `-/ — �"� Cj-I POOlitmt'. —�/`�� EXEM IONFBOMWOflKEflS'COMPENSATIONDECINflpTION: Q�is5eclianneetlnatGecompleleaill�eVermili's�manehu�rM�5�00�orleu). y l�al in lhe PedormanCe o� the watk br w�ich Ihis Dermi� i5 issu¢a, I 5hall nol employ any p¢r6on in any manner 50 a5 �o beCome Subleci lo Ihe Workers' Lompensation Laws o� C3lifomia �� pate: �- Signalurer ' NOTICE: If. a�ier making Ihis Oeclaration. you 5�ouid 6ecom¢ SuDlect ta tAe Workers' Compensation;Dro isions ol �A¢ Labor CoOe. you mUSYtanM1wii� [omply wii� SUCh prOvi5i0n5 or �his permii shall b¢ UeemeE revoketl.-- , LONSTflUCTiON LENOING ACENCY: I hereby atlirm �ha� there is a<onsvuction �entling agency lor the pedormance ol lhe work ior wnich Ihis oermil iYissoed �Senian 3097. Civ. C�. '�' � LENDEN: nooness: OWNEP BUILOEB OELIAflRTION: I hereby a��irm Iha� I am exempt �mm Ihe Conlrac�ors' Sia�e License Law �or �he lollo�ng rea5on (Section 70.37.5 8usine55 an0 Pro�essional Catle: Any city oi county w�ic� requires a permit to co�5lmci, alter, impmve, demoli5�, or reDau any stmcW(e, o�or to ils issuance, also repuires ihe applicant lor sucn permil l0 lile a signea statement ihat he/she is licensetl pursuanl la I�e O�a��sions ol the fAniractors' Slale License Law (Chapter 9(commencing wilh Sectian 70W) of Divivon J ol �he Business and Prolessions Coae) or Ihal ne/she is erempl I�eretmm and ihe basis for t�e allegeA ecemption. My violation o� Section 7031.5 by a�y aOGlicanl for 2 De�mil su�lec6 I�e aOPlicanl Io a civil penallY ol noi more Ihan �ive hunaretl tlollar5 (E5011). I, as owner ol ��e Ompeny or my employees wi�h waqes as their sole compensalion, will tlo �he work, antl Ne ❑ siruclure i5 no� intenGetl ar otleretl �or sale (Section 70aa, 9uvneu anG Pmleuional CoOe: The Coniractars' Siate License Law Ooes not apO�Y to an owne� ol a O�openy wlro builds or Impmves t�ereon, ana w�o OaM such wofk Mmsell�herselt or ihrooph Ais or �er own employees. pmvidea ihat such impmvemenis are not inlended or offered for sale. I( however tAe builtling or improvem¢nI is sold wilhin one year o� com0le�ion. �he owner will have 1�¢ Eurden of pmvinp he/SAe tlitl not builtl or imDrove lor ine purpose ot sale). I, as owner of �he pmpetly, am erclusively r.anlractinp with IicenSeA contraclors �o consimci �he pmlect (Seclion 7044. Business ❑ a�W P�ote55wn5 Codel The COnitactar5' Slale license Law Uoes nol apD�Y to a� own¢r ol pmpertp wba Omlds or im0�oves ��ereon anG wh0 Contrati5 �ar Suc� O�oletl5 wii� a CanVatlor(S) IicenSe pu6Van1 lo I�¢ CAntratlar5' State License Law�. I am aware �hat p�oo� 01 I�eir Workef5 ComOensa�ion in5uranCe StwU10 be pmvitleU t0 me. � I am eeemD� untler Section: B. 8 P. C. tor ihis reason: Daie: Owner. I eo nereoy cenny ihat I am aware of ana unAerstane Ine reVuiremenis oi Calitornia Healin an0 Safeiy CoOe Sections 25505, 25533, anU 25534 anG Iha� I or any IWure Guilding acupan� will/wi11 not (circle one) need �o camON'M�� itl stale codes antl I�e repuirements br a permil for consimGtion or matlilication Imm Ihe Air �uali�y Management �iSlrici. FeSiDeniial cons�mction applicalions are exempt fmm �hese pmvisions. Date: ApplicanL I �ere0y tetlilY �hai I �ave �eaa IhiS applicalion anG slate ttul t�e atwve inlormalion is torreci. 1 agr¢e to comply wilh aH clty antl co�nty o�dinanc¢sana5tatelawSBlatingtobuilDingwnslruclionan0�er ul�oni��pre ative50�INscily�ahovp-mentione0 pmpetly lor inspec�ion pwpases. / g�¢; " 2 �� Signalure: `or r'sticenseo�Socia�Seariiy+: 16aLa6 Wbne—Builtling: Green—CWe Enlo¢9menq Canary—Ap0licant; Pmk—R¢Venue; GolOenrOtl—Ass¢ssar CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: P 066971 PLAN CHECK NO; N CONSTRUCTION TYPE; V—N PERMIT TYPE: PLU JOB DESCRZPTION ; INTALL H,C. RAMP E UPGRADE RESTROOM CLAIM VALUE: CALC—VALUE: PERM NO: P 066971 GOVT: N SUPP: N PURPOSE; ALT SQ FT: GROUP OCC: B-3 / COMMENTS: ERF: B-66780 +t �r-�t +F at * at * ir -� it �r �r * �-* * +r it ar * ir it �t �t �t �r � �r �t �r it ir it �t x- it * +r � -� +t * it,r+e �r �t it ie �t at-�- it+t -x� �t +r ir ar ir *+r * it+t� �t ir �r * x- �t ir * *+r +t �r+r Z O N Z N GS ERTEB�AUCiy(RSE M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY SUILDING ------- — FRNT: FT IN REAR: FT IN FRNT: ET IN REAR: FT IN LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN PARKING REQ• PROV; PARCEL: 92428221 ZNE; REF NO; PLANNING NtSTES> i , " ***��x�r+rx***��r****��r+�+�r+r�r**+r�*��r*�*x��+e«�rx*+c�i�r��r**+r*r+�«�e«�*«+�*�**�+�+�*�r*,e�+�x�r�* 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 ,.� r , c �.' ZONING APPROVED HY DATE: � ' „1- BUILDING APPROVED BY : ' -� __ DATE: APPLICATION ISSUED BY: �� ,�� ! DATE: � ic�x�****�*x�*r****x�*x�x�*�*�F1F"iF?Fi�*iFiF"iFTiF'�F .i��r 3F+��.�F}��F'3F'i�r3F****f�+�x�t** � +�+t*�it*+�it+�rt*+�+�+�***�r*�ritx��******�r*�*�it*��r*��*�ir**itr'*��te***+rx�it*it**it**it*ie * +�*+r�+� LEGALIZATION;N F E E S.,U M�M A�R Y`--J STRUCTURAL SEGMENT:N � .. � l.� BLDG PMT PLUMBING ELECTR�IC MECHANIC FIRE SMIP/RES GRADING PERMIT 19.00 -' . 25x `^` .', ' � •� SMZPJNON—RES PLAN � ' , � '. ISSUE FEE 2Q,OQ � - ' HUILDING—DIV—> PERMI'T ISSUE PLAN—CAECK �,��' TOTAL PAID DUE TOTALS----> 19.00 20.00 '� �.00 � 39.00 39.00 ,00 REVENUE DIVISION TOTALS--> COLLECTEI7;'� ;.jzr39.00 OVER/SHORT; ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC,' ,FSRE SMIP/TOT GRADING PLAN—CHECK 3 9. 0 0 ✓ h' ;, p �',—• 1E jF if iE if iE if fElE fE if 1E iF 1E 1F it iE %iE iE if iP iE iE 1f if iE iE it dF iE 1F �E iE jF if iE ff 3E iE ff lF,fE it iFlf iE�iElE fF ff if if if if ik if ik iE 1E iE if itlE ik 1E iF if iF 1E if i! 1ElE k iE k if iE I N D I V I D U A L' ^:F�E fi` B;R E A K D O W N .� TYPE QTY D E S C R I P T I O.N j,�,r `�•� UNIT COST TOTAL COST � �1 d I,�i . PLU 1 WASH BASIN %' ' •� �' 7,00 7,00 PLU 1 WATER CLOSET (TOILET)'' ' '; � 7,0� 7,00 PLU 1 GAS PIPING SYS OF;' 1 T.O 4' 6UTT,ETS 5,00 5.00 END OFj FEES� � � ` � r. , i � . � � J • j• . S „1 9 i � O1 00159d41-0015964i TU T 39.00 �� , DpTE: 04/28/94 TIME: 1`:!7 ;— , � r �� s� �,' r a� �-=r.' J CONSTRUCTION AND PLANtVING APPROVAIS Permii �' �. Temporary Electrical Serv�ce or Pole 2. Soil Pipe-Undrgrnd. �� Electrical Conduit UuhtY-Undrgmd�. � 4. Eiectricai Condurt Undrgrnd. 5. Steel Reinforcement 6. Electrical UFER Grnd � 7. Footings � � . �i 8. Founuation • - 9. Water Pipe�Undrgrnd, v , 10. Structural Fioor System 11. Property Sevder Line & Ho�sc Connection 12. Sewer CaP _. 13. Roof Dreins 14. Rough Pfumb�ng 75. Rough Electrical�Contlult 16. Rou9h Eleciric4Viring 17. Rough WirirsQ $ign 18. Rough Electrical-T Bar Ce�ling 19. Rough Heating & A,r Cor.diLomng 20. Rough Factorv Fireplace ; 21. Ducts,in Structure . 22. Ducts, Veniitanng 23. Gas Pipe-Rou9h & Tesc 24.�floof Framing ' 25. Roof Sheathing 26. T�Bar Ceilin9 (Structural) & iVlo�ocoat 27. Frame a�d Flashing 28. Lathing & Siding . 29. InSUlation � 30. Dryrva!I Naitmg 31. Plaster Bro�vn Coat . , 32. Electricai Po�ver hlete�-Fir.ai ^ 33. Final Electria � 34. Fir.tl Heating& Av Co^tlifc�i�y 35. Final Gas Pipe�Test 36. Hoori or CanoPY • 3�. Final Factory Fireplace _ 38. Final Plumbing 39. l+�ater ServicB-Final ' 40. Gas Service-�inal A1. Solar pomeslio-Final 42. Backflow Preventer 43. Backflow Irrigation � 44. Landscape irriqation Syste�r 45. �aund Attenuation 46. Handicap Regufations 47. PINALSTRUCTURE&BUILDING 48. FINALPLANNING 43. Electric Release to Edison 50. Gas Release to Southern California Gas 51. CERTIFICATE OF OCCUPA�CY Date � ' � PO(._ .� SPA Date Inspector qppROVALS Permit � 52. Pool 6� Equip.mem Loraticn Ze�� 53. Steel Reinforcement 54. Forms 55. Electrical Bonding 56. Rouqh Plumbing & Pressure Test 57. APPROVAL TO COVER GV�!iTE 58. Elactncal Condurt�Undrgmd 59. Gas P�pe, C Urdi grnd., Tes[ 60. Backwash Line;, P�Trap, O Undrgrnd, 61. APPROVAL TO DECK � 62. D.eknash & Retzptc••Gi:ia� 63. Heater & Vent-Final �_ 64. ?lumbing System - Fl�iai � .C�/� 65. Electrical�Fnal � 1�'� 66. Solar SYst�m-Fina� 67. Fencing & Access ApP�oval 68. APPROVED FOR PLASTERING 69. POQL/SPASYSTEPl�SFINAL FIREDEPT.REQll!RENEN7 APPROVALS Permit �'r 70. Underground Hydro . 71. Product Pipir.9 _. Gas L' Oi� 72. Undergroun�i F�us�� 0 . � Date Inspectnr � 73. Undc: gmd. St�rac,�Tank �� Gas ": U„ ' � 74. Overhead Hvctro , - - --i 75. Dry Chemical � - ' -� 76. Dry Stand�p;pe . �' i -- - - i 77. FIXED SYSTEM FINAL � 78. FIHE FREV. FI?;AL �__ _�__ y HEALTH DEPT. REQUIREfdcNT . 79. FINAL IRS.'�CTIO'� ~� B0. FOOD CERTIFiCATE ISSUFD � � - --�--1-r�-, �- Noces:s Z d �iLC�- -C-'"�-`'-+7��0� D.Q/��y'" �•' -�-�-�- - � � � �� .,� _ �� _� : -'7' � `�i_`� 'f-d�2.lL�'sGl�/---/�G�-Zl� -%�`7�;-57� r�`rr �Q�- - - - --:� _ ��-,'L /2�.-c'C_�xr �EC� �l GCT _� � � PR0.IECTF�OBESS: 67O W 17TH ST � OWNEN'SNRME: PACIFIC MESA PROP. � napAcss: 670 W. 17TH ST ' N.B. 92663 l AHCHIENCINEFfl: ROONESS: flEC.NO.: UNIT: G i UNIT: PfflMITTEE: THE ZIMMER COMPANY (714)d95-278d noosEss: 1 3 2 81 ANAWOOD WY WESTMINISTER CA 92683 LICENSEO CONTPACTOP OECLAPATION: I here�y allirm ��at 1 am li ensed unEer pmvisions of C�apter 9(cammencinq wiih Seclion ]000� ol Division 3 of Ihe Business ana Pmiessians COEe. an icen is in full torre antl efiect. uTruc�.:0736362 STRTELIC.:O43B�^' C—s.v�EXP: OO/OO a�e: —/�� Sipnature: _ ""' "" HNEPS' COMPENSFTION OELNNATION: I hereby aitirm iha� I have a niliwte cansent to selt-insure or a certitiwte oi Workers' Compen5ation Insurance, ar a Certdied coDY �hereoi (Secuon 3800, la�. C. POLILY NO.: E%P. ORTE: COMPANY: ❑ Cenitied coDY is hereby lumishetl. ❑ Cetlifie0 copy is �ile0 with �he city Building Uivision. Date: ApDlicant: E%EMPTION FXOM WONREBS' COMPENSATION OECIABpTION: QAis ' nee0 nat be complete0 if I�e permit is lorone hunOreU �5100) or less�. I cetlify �hat in the Dedormance �he work lor which Ihis per is issue I shall not em�le7-enppa[son in any manner so as Io become 5u0ject to Ine WorMers' ComO nsation Laws ol Calilomia. —_� ,e: �' — � Sipnalure: TILE: If, alter mak� g t�is Ueclaration, you shoul0 become sublect o the Work r5' Compensation provisions al iha LaUor Cade. you must lan� ith comply with such pmvisions or Ihis Dermit metl revoketl. CONSTHUCTION 1EN01NG RGENLY: I hereGy allirm Ihal �her¢ i5 a con5imtlion lentling apenty fof ��e peAormant2 af lhe waM lOr w�ich ihis permii is i55uM (Seclion 3097. Civ. C�. LENDEfl: AOONESS: OwNEB BWLDEN oELLAl1ATI0N: I hereby allirm tnat I am eeempt imm ihe Contractors' Stare Licensa Law lor tne lollovnnp reason �Senion 7031.5 Business an0 Professianal Code: Any ciry ol county w�ich requires a Dermit to wnsWct, atter, impmve, demolisR or repait any 9mcture. prior to its issuance. also reQuires t�e applicant for suc� permit to file a siA�ed statement tlut hPJslle is IicenseU pursuant ta ihe pmvisions ol tne Canvactors' State License Law (Chapter 9(commencinA ��n Section 7000) of Division 3 of the Busineu anC Pmiessions Cotle) or I�al he/s�e i5 ecemp� I�er¢�mm anE I�e Uasis lor �he allegeG eKemD��on. Any violali0n o� SEciion 7037.5 by any aOP��ant lor a De�mit su0jeti5 tlle aDVliWni Io a civil penalty al noi more Ihan frve huntlre0 Gollars (55110�. I. as Ovmer of Ihe pmpeny or my emplayee5 vnth wages as their sole campensation, will do �he wark, anE I�0 ❑ s�mcture is noi imentlea or oilered lor sale 15ection 70aa, Business antl Pmiessional Cotle: The Contractors' State License Law Ooes not apDly lo an owner ol a pmpefiy wno huiltls or impmves thereon, and who does such work himself/Aersell or tnmuAh �i5 Or her own emDloye¢5. proviCea Nai SUCh im0�ovem¢nis are no� in�¢ntl¢tl Or O��ereU /of Sale. II, �ow¢v!r ��0 �uil0inp or imD�ovement is sold wilhin one year oi comole�ion, Ine owner vn11 Aave the burUen of pmNnB he/she Oitl not EuilA or imD�a�e for ihe Durpose ol salel. I, as owner ol I�e pmpeny, am eKclusively contrac�inA wi�� licensetl contrac�ors to conslmc� �he proleci (Sec�ion 7044, Business ❑ an0 Pwlessions Cotle'. The Coniracmrs' Slate License Law does no� appry to an owner af pmDertY who Euilds or improves lhereon and w�o comracls lor suc� O�ojecis wilA a commc�or�5) license Dursuam m[he Cantmc�ars' Stale License Law�. I am aware inal Dmol al iheir Warker's Comvansation insurance shoul0 6e D�ovieetl to me. I� I am ezempt untler Semion: B. 6 P. C. �or Ihis reason�, �a�e'. Ownec I Oo hereoy cenify Ihat I am aware ol ana unAerstantl tne requiremenis of Calilomia Healtn and Safery Coae Sections 25505, 25533, ana 25534 antl that I or any iNure builtling accupani will/will nol (circle one) need Io comply wi�h sai0 s�a�e cotles and t�e reQuiremen�s for a permii lor conslmclion or motlilica�ion Imm Ihe Air Ouahry Management OislricL Nesitlential constructian aDVlications are exempt imm these orovisions. Oaie: Applicani: I nere�y c¢r�ity t�al I have r¢ad l�is applica�ion antl sta�e ihat 1� 60. ' brmation is correcl. I agree to compty with all city anU caunty or�inances and 9a�e laws relaiing �o Ouilning cansimttion ana �e Gy amho e reD�esen�atives of t� emer upon t�e above�mentioneG o�openy far inspeclion purp0 es. Oa � �� Signamre: ii odver's ucense or Sociai Securny r: 16at�a6 W�i�e—Budding: Green—Co7e Enbr[¢menC Canary—Applicant; Pink—Revenue; GolEenroC—h55essor �. CITY OF COSTA MESA — BUILDING FERMIT PERM NO: M 067913 PERMIT NO: M 067913 PLAN CHECK NO: N GOVT; N SUPP; N CONSTRUCTION TYPE: V—N PERMIT TYPE; MEC PURPOSE: ALT JOB DESCRIPTION ; INSTALL H.C. RAMP 6 UPGRADE RESTROOM SQ FT: CLAZM VALUE: , CALC—VALUE: GROUP OCC: B-3 / COMMENTS: REF: H-667$0 iF *-N� iE iE-)E-If iE-1F iE jEif �lh �)4 aE iF iE-1F iE if -tE ih af if i41E 3E it # dE if # iE �14if �X� jFi@ k# if dF-k iP -lE �)k �)f �kiF # iE dt -lE �lt -Y-1E dFi4 �k �lf� ## iF �� if �k # aF #�)f -IE-IF ii if df iF i-1F # Z O N I N G R E Q U I R E M E N T S s E T B a c x s ------------ MAIN BUILDZNG ---------- --------- ACCESSOAY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN PARKING REQ; PROV; PARCEL; 42428221 ZNE: REF NO: PLANNING NOTE;S> > iE#iflEiFkif161EiFiE�Y:ikiE#iEiEiEiEifiEiEiE#1EiEiEkiEifiE#it#iliE')EiEiEifiFiE#ftifiEiEifiEiRiEiEiEifiEitiEYriEiEifiE#iE##fEiEi!#iEiEiEiE#iEiF*it D E V E L O P M E N T S E R V I C E S R E Q U T A E M E �1 T S 20NING APPROVED HY ' DATE; BUILDING APPROVED BY : DATE: APPLICATION ISSUED BY: E'/� DATE: C� x1k�lEiEifiEiEiEiflfiFifi(�1fiEiFiEiEfllE�kitfFiFitiEiFiFiEftiFit##iPiE lf�iFiFiEil�#itiEiflFi'�itifilitiEiEiclf�Yrif###iEiEkiF#rt11 EiFEiclf1�if�k/F iFitiEiliElFiEiFifi4iEiEiF#1EiEiFfE�kikiEitiEi(�iEiEiFililifil�iEifiliEiEicfEiF�FiE9FifiFiE#icifi!ltiEiFiEitiEiliFfFiE1F#!f#lfifjE�EElEifieiE .iElf if3E# LEGALIZATION:N F E E S U M M A R Y STROCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 22.50 25R SMIP/NON—RES PLAN IS5UE FEE ' 15,00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 22,50 15.00 0.00 37,50 37.50 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 37,50 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECFIANIC FIRE SMIP/TOT GRADING PLAN—CHECK 3,% . 5 � if i; iE it iE if iE iF if� 9F �lE iE iE iF it 3E iE iE it it i4 iE iE i4 iF it iE it i! iE iE if 1f iF %iE it it i! 1f iE iF iE �1E iE iE if il` iE # iE IE iE iF it iF if iF iE iF iE �E if if 1E iE �)E iE if iE # 1E ii� �1E iE iE iE ic iE I N D I V I D U A L F E E B R E A K D O W N TYPE �TY D E S C R I P T I O N UNIT COST TOTAL COST MEC 1 REPAIA/ALT COOLING UNIT/SYS WICNTLS 9,00 9,00 MEC 1 REPAIR/ALT HEATING UNIT/SYS W/CNTLS 9,00 9,00 MEC 1 VENTZLATION FAN CONN TO SINGLE DUCT A.50 9,50 END OF FEES O1 �0163434—�D163489 T C�T 3).50 DATE= 07/O5/94 TIIfE: 13�4E _ CONSTRUCTION AND PLANNWG POOL ,;PA � APPROVALS Permit #'� Oate Inspector AppROVALS Permit # Date Inspector i. Temporary Electriwl $ervice or Pole 52. Pool & Equipment Location � 2. Soil Pipe-Und�9rnd. 53. Steel Reinforcement 3.�Electrical Conduit Utility-UntJrgmd. � 54. Porms 4. Electrica� Conduit-Undrgmd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Gind. 57. APPROVAL TO COVER�GUNITE 7. Footings 58. Electrical Conduit-Undrgmd. 8. Foundation . , i� 59. Gas Pipe, Cl Undrgrnd., Test , � 9. Wa[er Pipe�Undrgrnd. � 60. Backwash Lines, P�Trap, O Undrgrnd. t 10. Structurel Floor SYstem :' 'i 61. APPROVALTO DECK � 11. Property Sewe� Line & HouseConnection 62. 9ackwash & Receptor�Pinal j � 12. Sewer Cap �' � 63. Heater & Vent�Final , 13. Roof Drains 64. Plumbing System - Fina� 14. flough Plumbing 65. Electrical�Final 15. Rough Electrica6Conduit 66. So�ar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Fough Wiring Sign 68. APPR6VED FOR PLASTEflING 18. Rough EfectricaFT Bar Ce�fing 69. POOL/SPA SYSTEMS FINAL 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Firepiace APPROVA�S Permit # 21. Oucts, in Structure 70. Underground HYdro 22. Ducts, Ventileting 77, Product Piping OG2s OOiI 23. Gas Pfpe�Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof SheatM1ing , 74. Overhead Hydro 26. T-8ar Ceiling IStructurall & Monocoat 75. Dry Chemical 27. Frame and Fldshing 76. Dry Standpipe 28. Lathing & Sid�ng 77. FIXED SYSTEM P�NA� 29. Insu�ation 78. FIRE PREV. FINAL 30. Drywali Nailing HEALTH DEPT. REQUIREMENT 37. Plaster Brown Coat 79. FINAL tNSPECTION 32. Electrical Power Meter�Final 80. FOOD CERTIFICATE ISSUED 33. Final Elec:ric Notes: 34. Final Heating & Air Conditioning �� _ � Pu _G �K�� 35. Final Gas PiDB•Test .,J,. 36. Hood or CanoPY ' 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backfiow Preventer � ' 43. Backflow Irrigation 44. Landscape lrrigation System 45. Sound Attenuation 46. Handicap Regulations 47�. FINAL STRUCTURE & BUILDWG • 46. FINAL P�ANNING 49. Electric Release :o Edison , 50. Gas Release to Southern California Gas Co ` � 5L CERTIFICATE OF OCCUPANCY " ' _� No. Date !'i `I .ret�craooxess: _670 W 17TH ST awNeesrmme: pACIFIC MESA PROP. aeoRess: 670 W. 17TH ST • , N.B, 92663 ARCHIENGINEEB: FDOflES$: flEG.NO.: uNiT: G 1 UNIT: PEPMITTEE: PACIFIC WESTERN ELECTRIC <71•4?695-9326 noonEss: '7005 SEASHORE DR NEWPORT BEACH CA 92663 LICENSED CONTBRCTON OECLAflATION: t hereDy allirm ihal I am Iicen5e0 untler O�ovisions ol Chapter 9(commencing wit� Section 7001q ol Division 3 0� the Business antl Pmlessions CoGe. antl my license is in full force anG e�feci. �*iic.: 011 66 sTaTeuc.:303276 ��S .C-10 e. Signalure: — W Efl5' LOMP NSpTION OECLAflATION: I A¢re�y allirm I�al I ave a cenilicate oi consem m selbinsure or a wrtifiwte ai Workers' mpensation Insurance. or a certilied cooY �hereol (Section 3800, Lab. CI. roucrr+o.: 1222250-93 E%P.ORTE: SO/OSI99 carnraxr: STATE FUND eNheO copY is h�ereb/y fumishetl. � Cenilie0 coOY �s fileC witA Ihe ciry Builtling Oivision. EkFA1PI `_'`'�� , � t . e. —!T-/--(�`�— AOOlicanl: : � IONFBOMWOflNENS'COMPENSATIONOELUBRTION: (Th�55eqw neeGno�G¢completeJif11ie0��s�oronehuMrM�51U(norkss�: �, I certily Ihat in Ne pedormance o� Ihe work far whic� this permit is i55ue4. ISAaII nol employ any person in any manner so as to 6ecome su�jectto t�e Workers' Compen5aiion Laws ol Caldomia. /+..- j' " Date: Signaiu2: NOTICE: I�, a�ter making I�iS UeClaraiion, you should beCome Sublec� �o Ihe WOBers' Compensalion pwvision5 0/ the Labor ,�� Cade. you must fort�with comDly wilh such Omvisions or t�is permi� s�all Ee deemed revoke0. . ,f CONSTHUCTION LENOING FGENCY: I hereby a��irm ��ai Ihere is a conslmc�ion lenaing agency for Ihe peAormance o� the work for which I�is permii is i=.suetl (Sec�ion 3097. Civ. C�. • _ ` � LENUEN: � ADDflE55: OWNEfl BUILOEB OECIAflATION: I hereby allirm ihal I am exempi Imm t�e Conlraciors' Sta�e license Law for �he Pollowing reason (Seclion 7031.5 Business an0 Pro�essional Code: Any ciiy ol tounly w�ich r¢quires a permii to conslmct, aller, impmve, tlemolis�, or repair any 9mciure, prior �o i15 issuance. also iepuires Ihe ap0licani for suc� permit to �ile a signed sta�emen� �hat he/s�e is licensetl pursuam m Ine provisions a� ��e Comracmrs' S�ale license Law (C�ap�er 9(cammencing wit� Seclion 7000� o� Division 3 oi the Business and Prolessions CoOe� or ihat he/she is e�empt IOerelmm antl I�e �asis lor �he alleged exemplion. Any violation o� S¢clion 703L5 by any applicanlior a Oermit suGlacts I�e applicanl Io a civil penally of nOt more Ihan live huntlreU tlollars (5500). ❑ I, as owner of the pmveny or rtry employees witn wages as t�eir sale compensation, will tlo ine work, ana Ihe stmnure is noi in�entleC ar oflereG �or sale (Seciion 7044, 6usineu anG Pmiewionai Code: The Conlraciors' Slaie License Law does no� apply Io an owner ol a pmpetly who �uilds or improves ihereon, ana who does such work Nmself/h¢r5ei� or ihmug� his Ot h¢t own employees, pmviOeE Ihat Such impmvemenls ar¢ nal mfenCetl or oft¢r¢A �Or sale. Ii, hOwever lhe Ouiltlinp or im0�ovemen� is sold vnl�in one year ol complelion. I�e awner will �ave Ihe burden o� pmving he/she did no� 6uiq ar improve for Ihe ourpase o� Sale1. 1, as owner ol tne O�oOeny, am exclusively conlrac�ing wii� licensed comracmrs m consimc� �he pwjec� (Section 704a, Business ❑ anE Pmtessions Cotle: The Contractors' SWte Lkense Law Eces not appy �o an avmer of O�oDerty� �NICs ar imprw¢s ihereon antl w�o cOnVdC6 �or 5uch pmjecl5 vnl� a conirac�a��s)license pue5uant�0 ��e Conha[�ors' $tale License Law�. I am aware Ihal D�oo� al �Aeir Worker'S Compensa�ion insurance shaultl 6e D�oviOetl to me. i� I am exempt untler Sectian: B. 8 P. C. lor I�is reasan: Dale: Q«nec I tla �ereby ceNty ��a� I am aware ol an0 untle�stand I�e repuiremenis ol Californu Healih anC Sa�ery CoOe Sec�ions 25505. 25533, and 25534 and I�at I or any fuWre builtlmg occupanl willlwill na� (circle one) neeU lo complY wilh said state cotles antl Ihe requirements lor a permiltor canstmaion or modi�ication Imm I�e Au Ouahry ManaAement DisUic�. flesitlen�ialconstmnion aOP�ications are eaemD� hom Inese provisions. Date: Nppli[anl: I herehy cerlitylhal I �ave read��is a001icalion antl slate��al Ihe above inlarma�ionis correct.lagree to comply wi�h ail city ana counly or�rmr�ces antl siale laws relatinp ta �uilaing conslmction ana �ereby auihoriie re�resentaiives oi �Ais city �o enter upon �he above-mentiane0 SignaWre: OriverS L¢ense 8� Social Secunry �: 1641<6 WN�e—Bmltling; Green—Code Enlo¢emenl: Canary—AOP�iwnf. Pink—Povenue: Goltlenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: E 067045 PLAN CHECK NO: N CONSTRUCTION TYPE; V—N PERMIT TYPE: ELE JOB DESCRIPTION : INTALL H.C. RAMP 6 UPGRADE RESTROOM CLAIM VALUE: CALC—VALUE: PERM NO: E 067095 GOVT: N SUPP: N PURPOSE: ALT SQ FT: GROUP OCC: B-3 / COMMENTS: REF: B-66780 *��-*�*�r�-�r*+t�-x��er�t****+�-x�*�-�r-�***+ex-�*x-�**�r��r-�r*�r*�*****�r*-�r�-�x-�-***��+�****+t+e�r+��r**+��*�r** Z O N I N G R E Q U I R E M E N T S s E T B A c x s ------------ MAIN BUILDING ---------- --------- ACCESSOAY BUILDING --------- FRNT: FT IN REAR• FT IN FRNT: FT IN REAR: FT IN LEFT; FT IN RGHT: FT IN LEFT: FT IN AGHT: FT IN PAAKING REQ; PROV: PARCEL: 42428221 ZNE: REF NO: PLANNING NOTES> i �r***+�*�r+r*x�*****�r*x��r�r*+�**�-*x�*�t��r*�r+�.*x-**+r�**�t+��*�r**x�******�c-*****+r+�*x�*�t****�ri�*�t*+�-+r D E V E L O P M E N T S E-R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE; BUILDING APPAOVED HY : DATE: (�^ APPLICATION ISSUED BY; • DATE: ��Q`- iE iE iElf iE 7E 1E if iE 1E %1E iF iE iE iE iE iE iE if iE if iF iE fE 4�)f if jE iE iE iF iEiEiFiFiEiFiFiElEiflEfffElElfifiElEifiFiEikdFififfkiEaflEiFjFiFifiEiFiEfEiFiflk1E1E1EififikififiFffiEiFifjfiEiFiE*iEiEiEaEiEif�fiEiF9EaFififtfiEaE i4iFiEiE LEGALIZATION:N F E E� S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 28,25 503 SMIP/NON—AES PLAN �— ISSUE FEE 15.00 BUILDING—DIV—> PEAMIT ZSSUE PLAN—CHECK TOTALS----> 28.25 15,00 0.00 REVENUE DIVISI�JN TOTALS--> COL�LECTED: BLDG PMT PLOMHING ELECTRIC MECHANIC 43.25 TOTAL PAID DUE 43.25 43.25 .00 93.25 OVER/SI-IORT: .00 FIRE SMIP/TOT GRADING PLAN—CHECK iE 1� iE �h if 1f }f !F iF %iE 1E 1f %!E 1F iE K* IElf 9E iE iE iF jL if 3FlF if if iFlE iE {E iE iE if iE iF iF iE 1F K f�lE IE iF 3E 1F 1ElE IF jF 3E iE aE iF aF af ff iF #F iF iF iF if 1E iE iE iF iF * 1f ik %if 1tlE I N D I V I D U A L F E E H R E A K D O W N TYf'�. {;TY P E S�' H 2 P T I t� N UNIT COST TOTAL COST ELE 8 FZXTURES, LIGFiTING� 1 ST 20 EA, ,75 6.00 ELE 10 RECEPT/OUTLET 1 ST 20 EA, ,75 7.50 ELE 5 RECEPT/SWITCH 1 ST 20 EA, ,'JS 3.75 ELE 1 SUB—PANEL 11.00 11.00 �£ND OF FEES 01 oD1Go027-00160027 T�3 T 43.?5 DATE: OS/OSl44 TItIE: 09:26 � CUNSTRUCTION AND PLANNt�IG APPROVALS Permit,'k ' ' ,1.` Temporary Elecvical Servrce or Pole , '2. Sod Pipe•Undrgrnd. ' 3. Electrical Cond�it Utility�Undrgmd. 4. Electrical Condmt•Undrgmd. 5. Steel Reinfiorcement 6. Electrical UF�fl Grnd. 7. Footinqs � . B. Fpundation 8 Water Pipe•Undrgrnd. � 10. Structural Floor System ' 71. Property Sewer line & House Conr�ction 12. Sewer Cap 13. Roof Drains 14. Rough Plumbi�g 15. Rough Electritai-Conduit 16. Rough Electric Wiring 17. Rough Wiring Sign 18. Rough ElectriWl�T Ba. Ce��ng � 19. Rouqh Heatinq & A�r Cor.diLoning 20. Rough Factory Firep:ace ' , 21. Ducts, in Structure . . 22. DuctS, Vantikting 23. Gas Pipe�Rough & Test 24 Roof Praming � 25. Roof Sheathing 26. T•Bar Ceding IStructurall & �,lcrocoat 27. Frame and Flashing 28. Lathing � SiUing 29. Insula[ion � 30. Dry�vall Nail�ng 31. Plaster Brown Coat , _ 32. Electncat Power Meter-Final� 33, FinBl E�ectnC 34. Pi^�I Heatirtn $� A�r Conditionirn "s5. Finat Gas Pip2•Test 3G. Hood or Canopv 37. Final Factory Fvepl;ce � � ! 38. Final Plumhing 39. Water Service�Final• 40. Gas Servite-Final . , 41. So�ar pomestit-Final G2. Backtio�v Prev¢�ter 43. Backtlavi Irr,gation 44, Landscape irripation System 45. Sound Attenuation ` 46 Handicap Regulations 47. F�NALSTRUCTURE&BUILDWG 48. FINALPLANNING � 49. EteCric Reiease to Edison 50. Gas Release to Southern Caiifornia Gas Co 51. CEftTiFICATE OF OCCUPANCY Date -- PGc,� & SPA D�te Inspector qppROVALS Permit;� 52. Pool & Equipment Locat�on 53. Steel Reinforcement 54. Forms 55. E!ectrical Bonding 56. Rough Plumb�ng (L Press�re Test ' 57. APPROVAL TO COVER GUNITE ' 58. Elactncal ConduiPUndrgrnd. . 59. Gas Pipe, O Undrgmd., Tes[ 60. Backwash Lines, P�Trap, G Ur.drgmd. 67. APPROVAL TO DECK 62. B�ckr:ash & A.ec2p'c�-Finai 63. Heater & Vant�F'n�� 64. Plumbing System � Final 65, Electrical�Final �/ 66. Solar System-Finai i��'y�/ � 67. Fencing & Access AnP�cvai 1 68. APPROVED FOR PLASTERING 'Q' i 'Z�}ry 69. POOVSP/\SYSTE:1SFIiVAL � ! IFIR� DEPT. REQUIREMENT APPROVAIS' Perurt �: � � 70. Undergrounu Hydro 77, Product P:pin9 CGas OOiI 72. Underground Flush � - 73. Underpmd. St�r&7^-,:r.k C-' Gas .": J;I - 74. Ooerheatl Hv�rn ' 75. Dry Chemual � 76. Dry St:.ncri;-.c � 77. PIXEO 5"SicAr FIMAL 78. FtRE PREV. FIf�IAL HEALTH�DEPT.REQUIRENiENT Date InspeCtor � 79. FINAL INSPECTIO'J, „ 7�. FOOD CEkTIPICA: E ISSUED __ . -"�--- - r- _.{'r.. �otes� -Jr"` � -GZ(/ � i'T/�t/� %� O fG ! y PN0.IECT ADONE55: ( 7O td 17TH ST ' OWNEP'SNAME: �ACIFIC MESA PROP, "RUbflE55: 6'�O W. 17TH ST N,B. 92663 AflLH/ENGINEEN: RDDNESS: flEG.NO.: uNir: G 1 UNIT: PENMITTEE: R. V.�,.� . � 3 1 Q)�( 7— S'� 1( noosess: 10130 ARTESIA PL BELLFLOWER CA 90706 LILENSEU CONTBACTOP OECIABATION: I here�y affirm Ihat I am Iicen5e0 under pmvisions oi Chapler 9(commenting wiih Sec�ion ]000) o� �rvision 3 0l Ine Business antl Prolessions Lode, anQ my license is in �ull force an0 e��ec�. cl�lc-: sraTeuc.:667457 c ss �-16 � 2 Signature: _ — WOFNEPS' CO PENSATION OELIAMTION: I �ereGy a��irm I�ai I have certilicate ot consent �o sel4insure or a cenifiwie oi Wnfrcers' Comoe�salion Insurance. or a cenJiea copy Ihereol (Section 380U. Lae. C1. POIICY NO.: E%P.ORTE: COMPANV: ❑ Cerii�ied coOY is hereby WmiS�eG. ❑ CertilieE coOY �s litetl wit� the ciry Builtling OiNsion. Date: ApDlicanL E%EMPTION FNOM WONNENS' COMPENSFTION OECIRNFTION: (This section neeA no� be compleied it ihe Oermit is lor one hunaretl (51W) ar less�. I cetlily Ihal in I�e pedormance o� �he work br which �his per� , I s�all not employ any person in any manner so a5 io 6ecome sub ecl Io t� rkers(' Co�mpensation Laws ol Calilomia. 0 � �i�—( � `� SipnaWre: ✓NOTICE: If, atler making ihis tleclara�ion. you ShoulG �ecome su�je[t ro lhe Workers' Campensation provisions ol IAe Labor Cotle. you musl fotl�wil� tompty with Suth pmvi5i0n5 ar IhiS permit S�all be deemeA revOketl. CONSTflUCTION LENDING AGENCY: I herehy allirm �hai IM1ere is a consimclion lentling agency lor ��e petlormance ol ��e work br w�ith I�is Oetmii is issuetl ($¢c�ion 3097. Civ. C�. LENOEfl: � p00flE5S: UWNEB BUILOEB OECLAHATION: I hereby allirm I�ai I am exempl Imm �Ae Conlractors' S�a�e License Law �or Ihe I011owing reason (Section 7091.5 Business antl Prolessional Cotle: Fny tiiy ol counly whi[h repuires a permit �o conslmc�, al�er, impmve. Oemolish, or reDair any slmcture. prior to iis issuance. also reQuires the applicant for such permil �o file a 5igneC 5latemen� ��a� �e/she is licensetl pursuam �a Ine Omvisions ol �Ae Conirac�ors Slate License Law �C�apler 9(commencing wilh Seclion 7000) o� Divivon 9 0l ��e Business ana Pmlessians CoOe� or Ihal �e/she is ecempt therelmm anA Ihe basis for Ihe allegeG exempiion. Any violation ol Seclion 70.iL5 Ey any applicant lor a permit su�le��s �he applicant lo a civil penal�y ol not more ihan live huntlretl Oollars (E500�. I. as owner o� Ihe pmDehy or my employees with wages as Iheir sole compensalion, will Uo Ihe woB, and Ihe ❑ slmciure is no� imenaetl or ollered for sale (Section 7044, Business and Prolessional Code: t�e Contractors Slale License Law tloes not aoDly to an owner of a D�ooeny who builtls orimpmves ihereon, antl who does sutn work nimselflherseli or tnmugn hi5 or her own emplayee5. pmvidetl ��ai Suc� imD�ovemen�s are na� in�enUetl or attered taf sale. 11, how¢ver �Ae OUiltling or improvement is sola wilnin one year oi comvletion. ihe owner will have Ihe bur0en af pmvinA he/she tlitl not ouild or impmve lor ine Ourpose ol salel. I. as owner ol Ihe proDeny, am exclusively canVac�ing wi�h Iicense0 conlracmrs Io constmc� Ihe pmle�� (Sec�ion 7044, Business ❑ ana Proleuions Code: The ConVac�ors' Slaie License Law Ooes no� apDly Io an mvner o� propetl9 w�o Gui1a5 0� imOmves thereon anE who coniracts lo� such pmjecR wih a mnVactor�s) lit¢nse Dursuant to t�e Contraciors' Slate License Lawl. I am aware Itu1 proof oi t�eir Worke�'s Compensation insurance s�oulG Ee provided to me. 'I � I am eR¢mD� un0¢r Seclion: e. d P. C. lor Inis reason: Da�e: Owner: I tlo heee�y cenily ihal I am aware ot antl un0ers�ane t�e repuiremenls ol Cali�amia Heal�h antl $alery Code Seciions 25505, 25533. antl 2553G an0 t�at I or any IWure Guiiding occupant will/will not (circle one) neee lo comDly wilh said slaie coaes an41�e re0uirements �or a permit lor conslmciion or motli�icalion trom Ihe Air Oualily Management Dislrict. FeSiAeniial conslfuclion apPliWlions are exemp� imm IheS¢ prOvi5i0ni Oa�e: Applicani: I �e�eGy cetlily Nai IhavereaA I�iS applica�ion an0 Slatei�al I�e aEoveinlormali0n is tOrreti. I agreeto Comply vni� alltily antl coun�y orainanceSanUstatelaw5relatingto�uil0inqconSlmc�ionanChereO aulhonzerepre5en�alivesotth6cilyloenieruponlheabove-mentionea pmpeily br In/spection purDases. pa ¢j : �( �" � / �� Signa�ure: rivefs License or Sodal $ecurny >: *� � �� 16<t-46 W��ie—Builtling: Green—Coae EnlorcemenL Canary—Applicant; Pink—Revenue; GoltlenroE—Assessor CITY OF COSTA MESA - BUILDING PEP,MIT PERM NO: F 067279 PERMZT NO: F 067279 PLAN CHECK NO: 01570-94 L GOVT: N SUPP: N CONSTRUCTION TYPE: C'-N SP PERMIT TYPE: FIR PURPOSE: ALT JOB DESCRIPTION ; INSTALL 6 SPRINIiLER HEADS SQ FT: CLAIM VALUE: 750.00 CALC-VAL(]E: GROUP OCC: B-3 / COMMENTS: RE: H66780 iE iE i%'1E iE 1E iE iE ih 9(-iE iF iE iF iF9F if'1F if'K' 1E iE'lE iE if -lE if iF iF ik iF dP �If iF iE dk iFiF dh if if if -1f ih if if if af-1E -1EiE iEaE-0K iE-Y iF if iF'N' �7f ik �i' iF iF iF �)E iF �3E Y a(- ii aE iE±f i4 iK'N' if Z O N I N G R E Q U I R E M£ N T S S E T B A C K 5 ------------ MAIN BUZLDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: r^T IN PARKING REQ: PROV: PARCEL: 42428221 ZNE: REF NO: PLANNING NOTES> > *�r�r*x***x*�r*��*****��**x**x�r�r*x**��r*�***�r��r+r�r**�*****��r**�r�*�*+r*��r�r�r*�c****.*** D E V E L O P M E N T S E R V 2 C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVEP BY :� � DATE: ��- �' APPLICATION ISSUED BY; � � DATE: 5�23� iEiRiEiEiflEiEiFiFlfifiE9EiEifiEiEiEMlfiEif3F3F x{tiF x . ifififiEiElPIFfEifififfc yE �F*i4 1E�)EififlFiFiElfiElEiEif�fiEiFiflfiFiflEififlF1hi41FiEiEiFiklEiE'lEiEiEikifiEiFiEili4 �EiEiEififlFifYiEiEiFifafihlM1'1E1E1EiEiFiEiE'1F'lkifa:iEifY?FiFifif�ElFik LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT;N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PEAMIT 21,00 - 65Y SMIP/NON-RES PLAN 13.65 ISSUE FEE HUILDING-DIV-> PERMIT ISSOE PLAN-CHECK TOTAL PAID DUE TOTALS----> 21.00 0.00 13.65 34.65 34,65 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 21,00 OVER/SFIORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK 21.�� it jF if if i! iF ih if jk i! it it it k iF iF if dE it jt iEif it 1f if M it if V if it iF iE iE iF if jf if it iE i� if it iFiE �Y if i! it if if iF iE iE #E if it ik iE 3F if if �E iF it jt-%# 1E if iE iF aF {t?! iF it iE iE I N D I V 2 D LT 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 FIR 21 FIRE EQUZP FEE (FROM BLDG VAL TABLE) 1.00 21.00 END OF FEES � 01 U0160982—OD16U982 T r,T 21.00 DATE= 05/2;/94 7IME: 15:4t --�- - -- - CONSTRUCTION AN� PLANNING ,4PPROVALS Permit �`- 1: Temporary Electnwl Servicudr_Po�e _� l Z. So�l Pipe�Undrgmd. " 3. E�ectr�ca� Conduit UD�ity-U�idrqmd. G. Electricai Condu�,t�Untlrgr;zd. � 5, Steel ReinforcemCnr G. Eleet�ital UFER Grnd 7. Footings 8. Foundat�on 9. 4"vater Pipe�Undrqrnd. 10. Structural Ftoor SYstem � ' 11. Properry Sewer Lme & Ho�se Connection 12. Sewer Cap 13. Roof Drains . , 14. Rough Piumbing 15. Rough Electrirai-Condwt 16. Rough Elettricbl�iring 17. Ro�9h bVirinq Siyn 18. Rough EleGtrical-T Bar Ceiling 19. Rough Heating & Air Cor.dironing 20. Ro;.gh Factory Fireplace 21. Ducts, i� Structure 22. Oucts, Ventlating 23. Gas Pipe�Rough & Test 24. Roof Framing 25. Foo+ Sheathing 26. T-Har Ce�lin9 (Structurei; & hlonocoat 27. Frume and Hashing 28. Lathing & Sidiny 29, insulation 3Q D�y�vau Nailmg 31. ?:ast:r Bro�vn Coat 32 Eicct��cal Potrer ^lete�.F,r.al 33. Finai EleCtf�c 34. F�,nal He3Ung & Air Coraitionir,a 35. Finu( Gas PiPe-Te;t 36. Haod or C3nOpy - 37. Finai Facto� Firepiace 38. Final Plumping 39. �1�ater Service•Final 40. Gas Service-Final 47. Solar pomEstic-Fins� 42. 8acsf(ova Prevente� 43. Backflow Irrigation 44. Landscape Irriyation System A5. Sound Attenuation 46. Hardicap Regulations A7. �INAL STRUCTURE & RUILDING 48. FtNALPLANNING 49. Electric Re�ease to Edison 50. Gas Release to Southern Californ(a Gas Cc 51. CERTIFICATE OF OCCUPANCY Date Date •�,Inspector c n 0 9 POO�..SPA - --: '. APPROVALS Permit : Date inspeotor I 52. ?ool & Equipment Locat�on 1 53. Ste�i Reinfiprcement 54. Forms ' � 55. Electricai Bond�ng _ 56. Rough Piumb�ng & Pr,;ssurc Test ' 57. APPROVAL 10 COVER�GUNiTE , 58. Eloctrica'. Condult�Undiqmtl. -�� 59. Gas PiPe. � Urd��md., Tcst i 60. Backtvash �ines,P�Trap, O Urdr,•nu. -� I 61. APPROVAL TO UECK - -i 62. Backwash & Heceptr� (i.�:' ! 63. Noater & Vent-Final _� j_ � 64. �lumbing SYstem Final � � 65. Eiectrical F nal I 66. Solar SYstem�Fina� I j 67. Fencing & Access AnP�uo�l � 68. APPAOV£D FOR P�.4STEfl1iVG j 69. POOVSPASYSTEM1ASFINAL � FIRE DEPT. REQUIREfv'ENT APPRUVAtS Perniit;: 70. Ur,dergrOu^.0 Hyr.�o � �-1 75. Procluct Q�ping � Gas '-' O i � 72. Underground Flust� � � - - ' 73. Undergm�.Smrsg: Ta�k "lGas =:G� - --- -- -�--- - - � 74. Overhead �� y� � --- - � $ � 75. D�v Chemiw� �---. 76. Dry STandp oe 77. FIXEO SYSTENI FINAL '�p_g,cjc( W� I �--- i 78. FIRE PREV. F!NAL _ 1_(cj-qU t.�).�__ � HEALTH DEPT. REQUIREPo;c'f��T ' 79. FINAL INSPECTipN I 80. f00DCtRTiFIC'�:F 155UED _ _,___�_ y Notes: � -------- -- --� __ '--'-_-_-_ _._____ _i - -- ----- - -- - -- -- 1 monrssaem�ara: 6`]0 W 1�7TH ST OWNERSNWEIFqlOMN:pACIFIC MESA PROPERTIES ��670 W 17TH ST NC-4 COSTA MESA,CA 92626 �645-6811 �vx. �uiwo �oo�ss: �� urcxrtEcr ow �+ax¢x: CONINICTON'S NAI�: CQAHACTORS YYlII10 ��: uc. ra.: uc r+o.: � °Nf G8 CITY OF COSTA MESA - SIGN PERMIT PERM NO: SB U81954 PERMIT NO: SB 081954 PLAN CHECK NO: 00969-97 S GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: STR SIG PURPOSE: OTH JOB DESCRIPTION ; SIGNS, 21SF 6 9SF ON AWNING, 2-1SF LOGOS SQ FT: uMr: UNT: 110EN5ED COMRRCTOXS DECLAH�TION: I MraDy dlim uMx ps�yy d perjury Me� I am Ifwnasd uMer pai�ims d Gheqr 9 (cwnmena1p xith Seclion ]ODD) d Drviaun 9 W Ne Buvinm ard P�sio�s �s. enE my liaenw w in lull forta erd sMod. cm uc. No.: uc. cuss: uc. No.: Dme: Cameea: OWNEH BUILDEN DECL�RATION: I heisb/ elfirm uMer psiWy tl pe�ry �hp ��mq Imm IM WMroqan llroroa lew /a ihe tdbv.r9 �Mm�n (SeCion ]W1.5 Busimt end P�dWinu COAe: M1' c�Y a caun�y MfiiA �N�� e W�tl to mvYucl. ada. uMow. aemdah, n raper enY euucWn, priar b Ys iwenoe. ebo rtquins �ly Appliunl la weh pe�mn lo Rb e� sb�mwn Mn M n sM ia licenaed W�� io �M proviciona d iM Contradwe Limnae LaW �Cheper 8(mmme��q xiih Sedion ]000) d Di+oion J d Ib Bummn eM Prdaaiom Codsl a ihtl In a ehe u e�amq �has�mm ud iha beaa la Ne NMO� eammqbn. My vulmion W Satlion )031.5 by my eppRUN la a psrme ampG+iM epN� �o e dvY pp�yry d nol man Ihm fxe Mvd�ad EOGen �5500�. � I.moxnerWiMpW�YnmVamMW�wihwepa?ea�heisdemmG�mlion.wi9do�hewak.erdNsmiwtunerwliMadeE aMered fa eds (Sedion )aa. Bueiroo end Pmleswne Code: The Gonvaeon Lioerue lnw Eam na avdY�oen owrord popeny wno d,u� «mww., nw�,..d.ro doe..w, � nm.ea «na,.� «wwon ne «ne� o.,� .mobr«•. wo+a� �n.� w�n impwemeNa re ro�'vuerdeE o H1e�eE la aa4. tl. howaver. lly p�ydinp a inqwanM u wtl rmlJn one Y+p a aomGM�o^. d+ " owfwr-0�ilier will hew IM WMm d pwiiq M a ehe Ck mi Mnld p impove la IM qiryosa d Wel. 1 �� . m orm« a �ne ww«�v..m sstluLwtr canirad�ro wN, 4a.nma convepa, �u cmmw Ne w9� (seaun rou. a�.:,e,..m viamson. code:.ns camreaa. lian.. �.. ms, oa wwv ro.� a n�w�v � wtm «:�w�'« in...on .oa .m ronvav br wMi popas we� e mareuor(e) liuned pueueN �o IM mia� Liwma lew�. � I em manq u Sxfion: B. 8 PA.. br �A� : � �a.. �/ �% � a.�., �_ �.�.�— ae sww�. zsws. zssa�..�e mEm W IM �qu�amaNa br plrmiomNwmqlmnNw a�+. Dme: �Od� WONKEP'S COYVENSATON DECWIAliON: I hereby elfvm �vMqr py�eryy d paMvy wr d tlr b0owinp Jedxtlba: � I hew eM r.i1 meiMen e cendrete d coneeni to eMimun lor Wpl�en oompemyinn. u pwiEeE la Ey Satlion 9]00 d tM labor COM.Ia �he pMmrerce d the wvk Iv whirJi Nu pemil b q��. ❑ i n�e.�d w�,�.:�.,onw.• oomv�� w„�o.... �.c,,;,a ny sea� s�ao a m. �m coe.. u� u. o.r�... d w wwk la whidi Nu P�A u mued. MY wakan' camD�ian "vnurenca miw eM PdKY m�mber ve: c�«: Pafry Number: (Thi: uaion ,�eed,br w wmwx.e r m. n�. A ro. o�. nin,eme aomi. a�w� a �w.� � 1 mIN �� IM perlmrerce d IM work M xTiJi Ihu pem�p p m�yp, 1�MO m� anWry erry pa�on In ury menew n n �o beconr wbib to Ihe xahxa' mmpenmtian kwe d CNEortiie. enE epir IIW Y I YUJd Eecanr n4b lo �M wahm' cwnpxmtbn povcixm d Setlian 3'!00 d �M lebor CoM. I�p IonAwuA oompl� M'uh Yoe pvrmiw�+. oma: nop�: Waminp: F�Nun ro s1eun nortw+'rompxuatlon eovwp� l� u�p�� W µ�0 wONet en Nrploy�r ro cabrYivl pwWtlp uM c/Hl flnp �p b am h'ntlr�d fhouund AWNn (f10C{OOUA „btlltlon b tln cwt ol rompw�wfbn Gm�pu u poHWtl br In 9xtlon 31P6 0/ tli� Lebor Cotls, Inbruf, uM �ttomry i/wx � CONST11UC110N LENOINO �OENCY: I Iweby df�m iuWr penlCy d par'�ay IIW tMn b e cautiurlion MM'up apacy br tlr parlamanoe d tM wark M xfiidi the pormi e uuwd (Sodion JOB), CN. C�. LENDER'S NAME: LENDER'S ADDNE55: I cenily ihm I law reed thia eppliWion eM tlma tlw iM ebovs iManW pn ie corteq. I epree to compy wilh NI dry uk wunly ad'venc» eM etate kvn relelirq b buiNvp conabumon eM Mraby au�Mrize ipp'�ntelivae d ihu dlY ro om« upon �M ebow.meMioneE properry �« �svedim w�w*e.. � S[ISAN WHITE . _ _ Dna: T 7� (5151Je.WP) W�Gs-BuiNiqBSafNy:OeaemFN:Cenery�pp{�i:Rnk-Rs.anw:Oddovod-Muev CLAIM VALUE: 450.00 CALC-VALUE: 450.00 GROUP OCC: B / COMMENTS: "CATALINA FISH KITCHEN" WALL, AWNING 6 LOGOS NONILUUMINATED SIGNS 1t 1k i! i! iE 1E 1f iE 1f� k 1k k 1F ik k 1t i! 1E 1E 1E iE IE 1E iE iE IE 1f Ik if if 1F iE 1F fk 1E 1E 1F 1E ik 1E 1E 1E i! IE 1E 1l' 9F 1E iE 1k i! 1E 1E 1E 1E 1E 1! iF iF iI' k 1E 1F 1k 1k 1f�ll' 1E 1E 1E 1E dl' 1E �F 1F 1E 1k iE f4 S I G N I N F O R M A T I O N DISTRICT: 1 TYPE: WALL ILLUMINATION; NON CATEGORY: NEW DIMENSIONS: 8FT OOIN X 2FT 081N AREA: 32.00SQFT LETTER HT; 12 STREET FRONTAGE 1: 282.00 STREET 1: W 17TH ST STREET FRONTAGE 2: 0.00 STREET 2: PARCEL: 42428123 ZONE: MG LOCATION > FRONT: X REAR: BUSINESS NAME: CATALINA FISH KITCHEN > LEFT: RIGHT: O T H E R T O T A L S G R O U N D S I G N THIS ACTIVITY . 32,OOSQFT OVERALL HEIGHT: OFT OIN THIS SITE . 1.00SQFT GROUND CLEARANCE: OFT OIN ITEMS OF INFO : 1 PLANTER AREA: O.00S(jFT ITEMS FOR ACTIVITY: 1 HLDG SET BACK: 20FT COPY VERHIAGE : CATALSNA FISA KITCHEN + LOGOS PLANNING NOTES: 2ND STORY SIGN(21SF),9SF 1ST STRY,2LOG0 iE fE ik 1E 1F 1F �If 1E iE 1E 1E1E 1E fE1E iE ik If iF iE 1E 1E 1E 1E iE 1E ii k iE �f iF 1E 1E'lE 1E iE fF 1E 1! 1E iE 1k IE 1E iE 1E i! i! it 1k 1f if iF if 7k ik ik ik 1E 1E IE IE 7E iE M i! M 1(' IE ik 1E ik iE iE ik 1f 1E if Ik D E V E L O P M E N T S E R V I C E S R E(] U I R E M E N T S ZONING APPROVED BY K�P DATE: 'J�-I �S�I BUILDING APPROVED HY : APPLICATION ISSUED BY: x��r**x��*x*x*�r*+rx�*«��r�r LEGALIZATION:N F E E S U M M A R Y BLDG PMT PLUMBING ELECTRIC MECHANIC PERMIT 21.00 PLAN 13.65 ISSUE FEE BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTALS----> 21,50 0.00 13.65 DATE: DATE: �l l�� r��+�**�r*�r� ** STRUCTURAL SEGMENT:Y SIGN SMIP/RES GRADING SMIP/NON-AES .50 TOTAL PAID DUE 35,15 35.15 .00 REVENUE DIVISION TOTALS--> COLLECTED; 35.15 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/TOT GRADING PLAN-CHECK 21.00 .50 13.65 iE if 1E 1F if fF 1f 1E fF ff iF iF 1f if iE 1E iflE iE IE IE iflE if If iE iF if iE iE if iE iE 1E 1E if iE iF IE 1E 1F iF iE iE if if iF �E 1E iE 1k iE 1F IF 1F iE 1E 1E 1E 1F 1F iE 1f fE 1E IE iE If 1F 1f if If iF 1E iF 1E 1E iE iE „_ I N D I._V I D U A L F E E B R E A K D O W N TYPE�,,._,_QT.Y._._ . D,E._S C. R I P T I O N $ � T COST TOTAL COST ,,,,�y � NO FEES WERE SELECiqi��i�I ir' ' - � �A�� 83-87-1997/88:57 qM/f35.15 PERMITeT08195� ,_, r-. CONSTRUCTION AND PLANNING , � - POOL & SPA APPROVALS Permit # ' Date Inspeaor , APPROVALS Permit # Date Inspector 1. Temporary Electricai Serviceor Pole 52. Pooi ffi Equipment Location 2. Soil Pipe�Undrgrnd. , � ' 53. Steei Reinforcement � �'�;3. _Electrital Conduit Utifity�Undrgrnd. 54. Forms � "`;.4; ;Electricai Conduit-Undrgrnd. 55. Electrical Bonding . :' S: Steel Reinforcement . � � - 56. Rough Plumbing & Pressure Test �;;,6; .Electrical UFER Grnd. �� , 57. APPROVAL TO CQVER•GUNITE ' _r�7. Footings 58. Elecirical Conduit�Undrgrnd. �8. Foundation 59. Gas Pipe, � Undrgrnd., Test -�� -9.,Water Pipe-Undrgmd. � 60. Backwash Lines, P•Trap, L� Undrgrnd. 10. $tructurai Floor Svstem .� 61. APPROVAI TO DECK �7;1. Properri Sewer Line & House Connettion -62. Backwash & ReceptorFinal 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electricaf-Final . � 15. Rou9h 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 Heatiny & Air Conditioning F RE PEPj. f�EQU1�3EMENT - Y r^��.Ri^'[L f-. r�Hi r f v1 9 �i•• � Y• 20.�,Rough F.actoFY F�eplace �c- �' "' •:i-.na. ; < - �1PPR�VAL� :7ei�u.# ^ . 21. Ducts,in`-StrUciuCe' �"=R'�"'_T'�C `t+��, ��" _ -70.�i.IpdergrAund.Hyd�o' = T Y Y H.��-� � a', ' • - t...l. ^:� ..SUI".'l -1�'I-� ,�� .: - „! � L� - a 22. _DuC[s. Venti�ting,� - �v�-r C: F �^rJa' (.'.� �� 71.�Pcoduct Plping:C.j;j'ias ❑Dil .. 23. Gas Pipe-Rough & Test r'C ��'-l�� r-� � _:i -' o' e72. Undarground Flush �- '✓'_�� Cr .IC �"1 ' 24. Aoof Framin ' t� a F• t. •,, �. F �: � � �� H> - o, �,.. _,,, � _ 9 �� r �.:-�c^a': CH�-�, � ;73.�Undeigrnd.StorageTar�k.�Gas.00il 25. Roof+Sheathing cy � z ,,.� > •� J G�7q^p�yerheadHydro - 26. _T-88i Gei�ing {StrucLurall &'Mono ` �' "� � r Y .., � - _ . .� ,C: "x f_ �� 75.tDry Chemica4 _ 2�.=Frame 0nd Flashin i ` � - - 9 �^- :��r .. .� ..t.- j•76.-QiYStandPipe -�r r �- 28. Lathing'& Siding�,;; =n "G � � _ ' ; £ " �57. ��IXEA SYSTEM�FINAL? . - ' .� . . . V .� -J • V . 29. Insulation • � 5 -_ • •�',t• �f:� - r �8, gIR�PREV. FINAL � - - . 30. Drywall�aili'ng �".'- ' � �_''�j � r; , Y _ � tit: ." HEAL7H DEPT�RE�UIkiEMiENT - 31. Plaster 9rown Coat �� F, .. C� :. �- "� ! 79, FiNA�L INSPEC'fJON - - _ � 32.�ElectricaTPo�ver MeierFir�al �,"_ r"' " `''•` � 80. F�,pO��CERTIFICATE,iSSUED ; ' _ , - G � t; .. i � .-. � e I � i . . ' � 33.�ina! ElectriC ?x - S a r-: �'k Note �^ - - _ 4� = 34.�Final�Heatin§;& APr�Candi� nin� y � � � �� `-' _•� � - 35. -Final Ge3Pipe�Test' _. r -" _ . . � tr = ,r.._ c: - - `- 36. Hood or=fanoPY �? � .. � -y • q< [' s EF C' � :. _ . - - :; r. N�ti i- G t�.' x c- � ti� [ 3 .mp H-� ] l. C"i.�.� � .. . ' 37. F.inal.Factory Fireplaee,... .r� m C * � I * 5 ' � =38._Fin$IPlumbing y'�""�-T�•�Fr `: � `'�' �` �= - •-: ,- .:�,:� . ..ii�. :+: ., t.r C J r ` . 39., Wat�r Service•Fina� � �'r _-�_.�•y - � � : �"- "-� � � : > � -_. J �- �_ 40. Gas�Servlce•Final,- �C{� 4 K�� ' "T ' ' L -'�� - - m - r - t.. � _ �._ . ' 41.`Solar OnmesUoFinal ,-" - ` ' � .': `''�� I ` .� . _. , �. : �-- ^ n.1t�� C a I k C: ' " � ~ 42. Backflow PreventErt �• F r[*? - � * � � ' � � � `' ' - n - r."^ :e: t :*7 �.. , .. _ 43. Backflow irrigation` S''� �� : r,�: �. � �, ` y �.. � . _ .� M4. Landscape Iniga�ion Syste'm � �,F r� '. •. �. � c e- ^_ * s;c.: _ - _ ' ' J S' 45..Sound Eltte(suat on, „ �`t;d` • s- y �. -". . ._. a � _ _ �-F. K;:; :i; I [*;' r^ - 46. HandicaP Regulations C;�.. .. ^'"l-' " 'T' + '' � G' • - - - ' c c - r . .� 47.�FIP}ALSTRIiCTUi3Effi;�U�LDING ' �t ' _��' ''� . � 48.�FINAL PLANNING �- -:' '" �� ' ' r - r: 49. -EleMric Release tti� Edison '� _ ! ' ' ` ',, c _ � :50.:6as.Release to Southem Califomia Gas Co �� -'- C_' } - bt. CERTIPICA7EOF�OCCUPANCY x ' • � - •• ' ' No Date A �I / � PHOJECTAOOflESS: ('�O j'� 1'�'1`H �r'I` OWNEN'$NAME: ilUFFIELD A9ARINE AODHESS: Jr��' AFCHIENGINEEFl: R�OHE55: HEG.ND.: UNIT: PEpmiTTEE: MARSIiALL DUFFIELD ( 71A ) 695-6812 aooness: 670 W 17TH ST D-2 C,M. CA 92626 LICENSEU CONTPACTOH OECLl�NATION: I hereby allirm that I am IirenseG untler pwvisions of C�aO�er 9(commencing wiU Section 7000� of �rvision 3 of the Business and Pmfessions CoOe, antl my license is in full brce and e��ec�. ciTv uc.: sTare uc.: cwss: EXP : �a�e: Signamre: WOBKEPS' COMPENSA710N OECLANATION: I �ere6y atfirm ihat I �ave a ceniliwte of consent co self-insure or a cenificate of Workers' Compensation Insurance. or a cenifie� cooY �hereof ISectmn 3800. Lab. CI. POLICY NO.: E%P. OATE: COMPRNY: � Cerii�ietl caDY is hereby lumished. ❑ Wrtilied coDY is filed wi�� t�e cily Building Division. da�e'. Applicant E%EMPTION FBOM WOBNEBS' COMPENSPTION OECIANpTION: Qhis section nee0 nol be completea ii t�e Dermit is br one hunOred ($100) or less�. I cetlify �hai in �he pedormance ot ��e work lor which t�is per issue hall not employ any person in any manner so as �o became suble�� o Ihe Workers' Compensaiion Laws ol Califomia Oa�e: �-�3- 9.f SignaNre� � � NOTICE: I�, a�ter making Ihis Oetlarali0n, y0u shouid hetome Subjeci to tTOfkers' Compen5aiion provisions O�Ihe La6or Coae. you must Iorthwiih compty wilh such pmvisions or lhis permit sAall be deemetl revoke0. CONSTBIILTION IENOING RGENCY: I hereby allirm that there is a constmction lentling agency for the pedormance of ihe xrork for w�ich I�is Oermit is i=_sued (Seclion 3091. Civ. C�. LENOEfl: ADDNESS: OWNEP BUILDEF UECLAflATION: I hereby a�6rm that I am exempl Irom I�e ConVac�ors' State License Law �or the �ollowinp reason (Sec�ion 7031.5 Business antl Pm�essianal Code: Any ciry o� counry which requires a permi� to constmc6 al�er, improve, tlemolish, or repair any SlmcWre. pnor ta ils issuance. also repuires Ihe applicant �or such permil to file a signed sta�ement �Aa� he/s�e is licensetl pursuam m �he pmvisions oi Ne Coniracmrs' Slate License Law (Chapler 9(commencing wi�h Section 7000) o� Division 3 ot ihe Business and Pwlessions Caae) or Iha� �e/she is exemp� therefmm antl �he basis �or Ihe allege0 exemption. Fny viola�ion ol $ection 7031.5 by any applican� �or a permil suble��s �he apDlicanl Io a civil penalry ol not mare t�an five hundred Aallars (5500). I. as owner ot Ihe pmperty or my employees with wages as Itleir sole compensation, will tla lhe work, an0 the � simc�ure is not intentletl or ol�ere0 br sale (Seciion 7044, Business an0 Pro�essional Code: T�e ConVaciors' Sfate License Law does not apply to an owner of a propeny who huilds orimproves I�ereon, and who tloes such work himself/herself orthmugh �is or Aer own emDloyees. pmvitled that such impmvemenis are not intentlea or ofiereA for sale. Ii, Aowever ihe buiitling or impwvemen� is sold wi�hin one year ol complelion, �he owner will have �he �urden of pmvmg he/she tlid noi huiltl of improve tor �he purpase a� sale�. I. as owner of Ihe pmpeny, am exclusively contracling wi�� licensed contrac�ors lo constmc� �he Omlec� (Secfion 7044, Business ❑ antl Pmfessions Cotle'. T�e Contracmrs' State License Law does not aDPly to an owner oi pmperty who bwltls or improves thereon and who coniracis for such prole��s wiih a contractor�s) license pursuani Io �he Contracrors' S�a�e License Law�. I am aware �hat pmof o� their Workefs Compensation insumnce shoultl be pmvided to me. � 1 am exem0� untler Section: 8. 8 P. C. lor ihis reason: p � Date: 2 � �3 � /S Owner. I do �ereby cenity Ihat I am aware o� anU understantl the requiremems o� Cali�omia Healih antl Sa�e� Code Sec�ions 25505, 25533, antl 25534 an0lhat I or any WWre huilAing occupant wllllwlll not (circle one) neatl to comply with saitl sta�e cotles antl t�e requirements to� a permii lor consimctmn or matlificalion Irom ttre Air Ouality Managemen� OiSVic�. Residenlial constmction applications are exemp� �mm I�ese provisions. Dale: Apvlicant: I hereby cerlily Nai I have reatl Ihis aDPlicaiion and slaie �hat the above iniormaiion is rorrect I agree Io comply wi�� all ciry antl counry orEinance5 an0 5lalelaw5 relatinglo builOinA �on5lmclion an0 here� aui�orizerepresenta�ives otthis tiry�o ¢nt¢ruponihe ahove-menti0netl properlY �ar inspection purposes. oate:� � � s � /� Signamre: �, Oriver's License or Social Security a: 16aLa6 White—Bmltlmg; Green—Code Eniorcemenl, Canary—Apppcan�; Pink—Revenue; Goltlenmtl—Assessor CITY OF COSTA MESA — BUILDING PERP9IT PERP9 NO; B 071U9U PERMIT D70: H 071090 PLAN CHECK NO: N GOVT: N SUPF; N CONSTRUCTION TYPE: FERMIT TYPE: STR PURPOSE; DEM JOB DESCRIPTION ; DEMOLISH CARPORT BIIILT WITHOUT PERMIT SQ FT: CLAIM VALUE: 1,000.00 CALC—VALUE; 1,000,00 GROUP OCC: B-2 / COMMENTS: DEMOLISH CORB FOR BETTER DRAINAGE **+r�t+��t+r+r*�r*+r**r**+r**�*xr**�rx�x****�t*�**+r�r**,�s�r�*�+r***�r*****�r��cv�-�r*+�**ri��r****<*�t�* Z O N Z N G R E Q U I R E M E D] T S S E T B A C K S ------------ A9AID7 bUILDING ---------- --------- ACCESSORY bUILDING --------- FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN LEFT; FT IN AGHT; FT IN LEFT; FT IN RGHT; FT IN PARKING REQ: PROV; PARCEL; OOOOOOQO ZNE: ' REF NO; PLANNING NOTES> > 1�iE+tiE*�E:E�f�(-itiE******i�ititiErEilit�Eft�t*�t**ik�fi�iE*iE*****�liE.ex�?fi��-*�t**�**�t***1E*�f�u*ft*,c*ir�lc�i�a�*�tE*#i�* D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED HY ; DATE: B[JILDING APPROVED BY ; DATE; APPLICATION ISSUED BY; DATE: 2 I� %if iE if if iE iE �tE �u if i4 �lf iE if it iF if iE if i(� if iE �FiF i�iF iF i�iF iFiF7F3FiZ $F�7F�F'iF'iF itiF . Y3F'�F'TfiFiFT'iF� �lE i(� iE if iF i4 �lf iF if iF it if 3f af iE it 1(� if * iE �lE �lE ** if if if if if if jf �lf if 3t if �lf * if if iE if iE if if if iF+E if if �)f # iE iE iE if if if iF iF aR 3E M�IE if aF iF jf iF+f iE iE 1E 1E # 3E �IE iE if if i� if� aF 1t #'� i4 # iR if iR {f iF �% LEGALIZATION:Y F E E S U M M A R Y STP.UCTORAL SEGMENT:Y BLDG PD9T PLUMBING ELECTRIC MECHANIC FIRE SMIP/AES GRADING PERMIT SU.00 SMIP/NON—RES PLAN ,50 ISSUE FEE BUILDING—DIC�—> PERMIT ISSUE PLAN—CHECK TOTAL PAID LUE TOTALS----> 50.50 0.00 0,00 50.50 50.50 .00 REVENDE DIVISION TOTALS--> COLLECTED; 50.50 OVER/�AORT; .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADZNG PLAN—CHECK 5�,�� ,50 iF if 1t 1E if iF iE iE iF iE iF 1F iF if if iE ff iF iF if if k �F fE iE if if i! if 1! if 1f if jf aF if iE if if if iE �f �f it iF {f �f ?f �4 af K M if jf i1 if af af �E if jE iE 4 iE �! iF it iF �E ac iF �f �F if i�+f iE if iE I N D I V I D U A L F E E B A E A K D O Y/ N TYPE QTY D E S C P. I P T I O N UNIT COST TOTAL COST NO FEES WERE SELECTED FOR THIS PERMIT EXPIRED �� O1 0017dS30-00176531 T�� T �0.54 GATE: 02:13/9� TIME: 11:4E CONSTRUCTION ANOPLANNING POOL 'A Date Inspector Date Insqector APPROVALS Permit# APPROVALS Permil# .. i� 1. 7emporary Eiectncal Service or Pole 52. Pool & EGuipment Location � � Z, $oil Pipe�Undrgmd. � 53. Steel Reinforcement � 3. Electrical Conduit Utility�Undrgrnd. 54. Forms j - 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plum6ing & Pressure Tzst 6. Electrical UFER Grnd. 57. APPflOVAL TO COVER�GUNITE 7. Footin�s - 58. Electrical Conduit�Undryrnd, 8. Foundation 59. Gas Pipe, O Undrgrntl., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lir.es, P�Trap, �7 Undrgrnd. . 10. Struciural Floor System 61. APPROVAL TO DECK ^ ' 1 t. Property Sewer Line & House Connection _� 62. Backwash & Receptor•Final '�� _ 12. Sewer Cap 63. Heater & Vent�Final ' r � 13. Roof Drains ' '✓ 64. Plumbing System - Final � ' 14. Rough Plumbing . 65. Electrical-Final " 15. Rough Electrical-Conduit 66. Solar System-Final _ 16. Rough Electric UJir(ng 67. Fencing & Access Approvai ,, 17. Rough Wirin9 Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEM1IIS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground HyAro 22. Ducts, Venti�atin4 77. Product Piping �Gas ❑Oil 23. Gas Pipe�Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergmd. Smraye Tank O Gas ❑ Oil 25. Roof�Sheathing 74. Overhead Hydro _ 26. T-9ar Ceiling {Structural) & Monocoat 75. Dry Chemical 'y+ ��, 27. Frame and Flashing • 76. Dry StandPipe '- x�, 28. Lathing & Siding 77. FIXED SYS7EA1 FINAL ' ' 29. Insulation . 78. F�RE PREV. FINA� .� � 30. OrYwall Nai3ing HEALTH DEPT. REQUIREMENT �. 31. Plester Brown Coai 79. FINAL INSPECTION 32. Electrical Power Meter�Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric , Notes: . 34. Fi�al Heatfng & Air Conditioning 35. Ffna� Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace � � 38. Final Plumhing • 39. Water Service-Final . 40. Gas Service-Final 41. Solar pomesticfinal - 42. Backflow Preventer - 43. Backflow Irrigation 44. Landscape trri9ation System � 45. Sound Attenuation 46. Handicap Regulations � 47, FINAL STRUCTURE & BUILDI(VG 48. FINAL PI.ANNiNG 49. Elsctric Release to Edison 50. Gas Release to Southern Calitornia Gas Co 51. CERTIFICATE OF OCCUPANCY No. Dace � �� Pfl0.1ECT�ODflESS: 6']O W 17TH ST owxen�sNnMe pUFFIELD MARINE ROOflE55: $AME RRLNIENGINEEfl: RO�HESS: PEG.XO.: uxiT: D_q UNIT: PEflMITiEE: BAY SECURITY & CQMM. ( 714 ) 650-6560 �oos¢ss: 770 W 19TH ST C.M. CA 92626 LICENSED CONTBRC70P DECUMTION: 1 �eteGy affirm Itwt I am IkenseU un0er pmvi4ons ol Ciwptu 9(commenqnp vrilh Seclion 7000) Of Drvision 3 ot I�e Bu5ine55 antl Pwl¢SSwnS CaUe, an0 my Irc¢nSe i5 in lull 10¢e anU Elfeci. cmuc.: p480p68 srnreuc.:491261 �u C //�' Date 7' 6' /.� Si7�ulure: _ f"" WOBREBS'COMPENSATIONOECUMTION: IlrcreUyallirmtllatllwveacenib otconsenitosell�inwmoracerlilicateofWorkers' CAmDensali0n InSunnte, or a fRnAietl capy tneRol (Sepion 3800. �a0. C. roucvxo.: 10t6693-92 exP.onTe: a4/O1/93 coMvnxr: STATE rI Cem�ieC capy is �ereDy turrds�etl. I$ CenilieE copy is`Iile�O y.-9��p tl�e city Bm/� �0 avi '�'1 , / --y / p^ �//,�(/�V'�'��Ye .are: �/ "'C: — / �` MWicant: —/L{C r '/� /J ESEMPTIQN FflOM WOPKEfl$' COMPENSITION OELUIUTION: (INS SCYpn nre0 n01 EE iW il Ine pam� is �a one nunCiW IS100� a lett�. I c¢fiity IIW( in tlle plflorrtWntt ol �Ile wOrk �or whkllllli5 p¢rmil i5 k5UlE. I Stldll tl0i emplpy any p¢r50�1 N a�ly mdnner 50 az Io blfAme suqec� �a ine workers' Campensation Laws al falitomu. Oa�e: S�p�awa: NOTILE: II, aliet makinq itu5 Oecldration, y0u 5�oulU become SUGI�� a the WorkpS' CAmpenutqn provisions al tlre LaCOr CaEe. y0u mu5i �artlrvni� mmply wi�h SutA D�avivan5 or INS perml S�all EE OCCmeE fewkM. ' CONSTBOLTION lfNU1NG RGENCY: 1 here0y allirm �Oat ��ere R a rppsimction IenEinp apency lar tAe ce„ormance al ttle wark lar which this oermil ¢ issueG (Stttion 3097, Civ. C�. IENOEP: ROOflESS: ' OWNEN BUIILEH OECIAMTION: I �ereby ailirm tlat I am e�em0� tmm Ne Controctors' Slate license Law Por t�e lallowing reason (Sedion 7031.5 Busin¢55 an0 Protessional CaOe: Any tily Oi wUn�y whit� requirts a permi� IO conSlrutL alier, imprwe, tlemolish, or re0air any slNcture, O�io� to its iuuance. a150 reQuires t�e aD7�iWnt lor suc� permit to lile a siqne0 statement ihat treJs�e i5 licensea pursuanl to i�e O��sions al t�e Comractors' State License Law (Clapter 9(commencinp m�h Section 70W� of Division 3 0l lhe Businew and Pmlesvons COUe) or Ihdl IWshe is exempt t�erefrom and tlle Oisis br I�e allepeG eRemplion. My vialalian ol Settion 7031.5 Ey any applicant lor a permil suUjects the ap0liwnt to a civil penalty of nol more ihan INe hunUreO Oollars (5500�. I, as owner oi tAe propenY or my employees with wdpes as t�eir sole campenution, will Aa lhe wod, and the ❑ snucWre is no� imenOeA or otlereG lor saie (Section 70aa. BuSiness anG Pmieuional Cotle: TAe Coniractors' State Lic¢nse Law Goes not apO�Y to an owncr o� a o�operty wlro builGs or Imprpves t�ereon, an0 wlio tloes such work Oimself/lierull or t�roup0 1115 Of I@f OWII C111pI0yQC5. Qf�vIdCO ItWI Sut� IIIIOf0Y2111E111E dfC f10i 111120EC4 Of O��CfCU 10! 5210. I�, hOWEvfl �I10 bUIl010Q 0� imorOvement is sol0 wilnin one year ot complelion, ihe own�r will nave ine Ouraen ol pravinp ne/sne ditl not EuitO or improve for t�e purpose of sale�. . I. as awner ot IAe O�opertY. am exclusiveI� conVactinq with lic¢nseE coniracmrs io cons�mti IAe pmlect (Seclion 70a1, Business ❑ aiM Pmfus�ons Code: T�e Contractors' Slate License Law Oo� nol apply to an owner of Drocerry who 6mI0s or imD�oves thereon an0 who contracis lor such D�ole��s wii� a cantractoqs) iice�se Dursuam �o i�e Contractors' State Llcense Law). I am aware I�al pro01 0l Iheir WOrkCi 5 Campen5ali0n in5urance S�OWd p¢ pmvitle0 l0 me. � I am e.empl untler Seciion: B. d P. C, IOf UliS f¢250n'. oaie: �er: I ao Aereby cenify �hat I am aware af antl uneersianA Ihe iequiremenis ol Calibmia Mealtn and Salery CoOe Seclions 25505, 25533, an0 2553< and I�al I or any INure �uil0in0 occupanl wlll/will nol �circle one) neetl to compty wil� sai0 state c04es antl Ihe reQuiremenis lor a permil lOr [on51mtli0n or moailiwiion Imm Ihe Air Ouahry ManaOemeni Oislrit�. NlSiE¢ntial COnSIruCIiOn aOGlica�ion5 ar¢ Ex¢mp� Imm these pmvisfons. . � Date: Applicanl'. I �ereGy cetlify Ihat I �ave rea0lnis ap0licalion antl state ihat I�e a0av¢ inlormalion is correcl. I aAree Io camply wit� all City anC county or4inanreSanOsta�etawsrela�inqtoGui�Ginqconsimc�ionanA�eaDya��Imrizere0resenaliuesofiMscnytom�erupontllryaGwe�mentione0 pmpeny br insce��ion purpases. � �// % / �7� -�`- � /�/ /j.� Daie', 7 � �' / � SignaWre: / '�'�/ '� �� <—z'� b'-�-^ _ Oriver's iicense ar Social Securiry M: � I6at�a6 Wbi�e—Builtlina; Green—CODo Enb¢emenl: Ganarv-�poolicanl; Pink—Revenue: GoManraA—Asseswr CITY OF COSTA MESA — HUILDING PERMIT PERM NO: r 05806 PERMIT NU: F 058060 PLAN CHECK iJO: 02914-92 S GOVT; N SUPP; N CONSTRUCTION TYPE: PERMIT TYPE: FIR PURPOSE: OTH JOB DESCRIPTION : CENTRALLY MONITORED SMOKE DETECTION SYST SQ FT: CLAIM VALUE: 2,100.00 CALC—VALUE: GROUP OCC: B-2 / COMMEN'1'S: NO STRUCTURAL PERMIT ON FZLE x*��*x*��e �**xx x*x��e��+�x+��**��**x��r**��*��**��*+�*��**�t�*�t�r�*x x**��x��r*�t�r�xx 7. U N I N GS ERTEBQAU�IKRSE M E N T S ------------ MAIN BUILDING ---------- --------- ACCE550RY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ• PROV: PARCEL: OOOOOOOU ZNE: REF NO: PLANNING N(7TES> > if 1E if iE if iE K�E rt iF 3E if� if if iE iE 3f iE iE iF �f ff 1F ff jf iF iE if iE iE iE 3E iE iF %N� if 3f IE )F iF iE K 3F 1F iE if If iF iF k if if if if iElC IE iF 1f jE if' ik iF iF iE � if ?F iF iF iF If iF i@ iF if iF iE 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 20NING APPROVED BY DATE: BUILDING APPROVED BY ; DATE; *�*******�****�**D�B**��3F�'rF�'�F'r��#s��'r��'�pt��'��****D*�*�i��i � L �r* i(� iFif 9E iE iF iE iF iE iE if iE 1E i!-1F iF iF iF iE iF iF M ik jE iF iF iE iF iF if �k 1E it iE aF fE iF ik if if * if ik iE iF M!E iF iE iF iF iE iE iE af iE 3F iE iE if if iF iF K iF �E ie iE IF If iE if ik If jE 1E iE ie iF LEGALIZATION;N F E E S U M M A R Y STRUC'1'URAL SzGMzNT:N PERMIT BLDG PMT PLUMBING ELECTRIC MECHANIC SqR�E� SMIP/RES GRADING �SY SMIP/NON—RES PI,AN 35 . 10 ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 54.00 0,00 35.10 89.10 89,10 .00 REVENUE DIVISION TOTALS--> COLLECTED; 54,00 OVER/SHORT; 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECH J9.�0 If dE �E df iFif iE it %-�1F if iF �iF�1E jFlE jF iE iE-)E �If �E �M� iE �if iF �!F iF jf iF jF �%iE 9f �� %iF �fE 3f �1E iE if iE �}f dE ��if 9f df jf iE �1F dE�?F�if if if �14 k�IF iF iE OF �1E 1E jE iF�1f �%dF If �lf aF aF if -1h Y.-�E I N D I V I D U A I. F E E A R E A K D O W N 1'YPE QTY D E S C R I P T I O N UNIT COST TO'TAL COST FZR 54 FIRE EQUIP FEE (FRENDBOFGFEES �LE) 1.00 54.00 ., � u i � EXPIREO :f; ��P.lete Inspectior� Date �� CONSTRUCTION AND PLANNING POOI 'A APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Spil Pipe-Undrgrnd. _ 53. Steel Reinforcemeni 3. Electsical CondUK Utifity-Untlrgmd. 54. Forms 4. Elsttrical ConduibUndrgrnd. 55. Electrital Bonding 5. Steel Reinforcement 56. Rough Plumbirtg & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation .� 59. Gas Pipe, O Undrgrnd„ Test . 9. Water Pipe-Undrgmd. - 60. Backwash Lines, P�Trap, O Undrgmd. ' 10. Structural Floor System ' 61. APPROVAL TO DECK 17. Prpperty Sewer Line & House Connection 62. Backwash & Receptor•Final 12. $ewer Cap �-� 63. Heater & Vent-Final s 73. ROof Drains � 64. Plumbing System � Final �� 14. Fough Plumbing . 65. Electrical�Final � 15. Rough Efectrical-Conduit , 66. Solar System-FinaV i6. Rough Electric Wiring ' � 67. Fencinq & Access Approval t7. Rough Wiring Sign _ 68. APPROVED FOR PLASTERING 18. Rough Electrica{-T 8ar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � APPROVALS Permit # 21. DuCts, in Structure 70. Underground Hydro 22. Duc[s, Ventilating 77. Product Piping OGas ❑Oil 23. Gas Pipe�Rough & Test . 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T•6ar.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. Plasrer Brown Coat � � 79. FINAL INSPECTION 32. Eleciriwl Power MeterFinal � j 80. FOOD CEiiTIFtCATE ISSUED •- - 33. Final Electric Notes: - 34. Final Heating & Air Conditioning ! , - 35. Final Gas Pipe-Test . , ,, 36. Hood or Canopy . - 37. Final Factory Fireplace 38. Fi�al Plum6ing 39. Water Service�Final 40. Gas Service-Final 41. Solar pomestic-final - 42. Ba�kflow Preventer � . 43. Backflow Irrigation � 44. La�dscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations � 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release ta Edison , 50. Gas Release to Southern California Gas Co • 51. C�RTIFICATE OF OCCUPANCY No. Date ApD��ant to till in all spaees except those within heavy borEer Ilnes ana si9n all approo��ate Oeclarations. CS�'�oF'COSTA MESa CONSTRUC�ION PERMIT Project Address �p� � - q � � 7 � � . � J Applicant's Mailing Addreu ��C) r 8 � �n(� U�� ['-� 1.��•� 0��.� Owner's Name �'�E'� r e- �� - Phone-]JLL�—.i'�`q Address � � 5 `� z 5 u r V=.� V r Arch/Eng. License No. Address ,/ ��,C�, y Contractor's Nam=�� j��O.1.� C�� ' Phone �.J.Sp_.]_]_�O Addresslmailing) z3�U CSI IFnfNVa,�4_� • City License No: Qb 7 g�' LICEMSED CONTRACTOR DE�LARATION 1 he�eby afti�m that I am li[ensetl untle� proviSiOns of Cha�te� 9(commencing with sectlon 7000) oi �ivision 3 ot the Business antl Professions Cotle, antl my Iicense is in tull torce antl effect. - License Clazs Li nse N ��7� Y�� Date � e' � U- H� Si9nalur¢ _ WORKERS' COMPENSATION bEC RATION ' hereby atfirm tnat I have a certi(icate of consent to Selt-insure or a tertificate ' Wotker5' Compen5ation InsUrance, o� a ce�tifietl copy�the�eof (SeCtion J00, Lab. C,.11 � } PolicY No. ^��" �� ComPany �T�� eCe�tifietl coOY i5 hereby fu�n�5hetl. ' /� . Certifietl ropy is (iletl with the city Bui Ing Divislor+,.� � v,"'p ' Date 1.- 1�-f - O� S AOPlicant �n hhN . 1)i� D D.'lL] � EXEMPTION FROM WOF2KER5' COMVENSATION DECLARATION (This section naed mt be comolatetl ii the permit is (or one huntlred ($100) or � less). �� ' - I certiy that in the p¢rformanCe of th¢ work for whlch thi5 p¢rmR'is Issuetl I shall not employ any pe�son l� any manne� So a5 to become subject� t0 l�e Workers' Compensation Lawz oY Calltornia. � i• . Date Si9ndture ' 'NOTICE: It, atter making this tleclaratlon, you shoWtl become subject to the Worke�s' Gompensation provisions Oi the Labo� Cotle, y0u must �orthwilh comply with such D�ovisions or this permit zhall be tleemetl revoketl. CONSTRUGTION LENDING AGENCV I hereby afilrm that there is a construction lentlin9 a9ancy for the performance of lne work for wbich this permil is issuetl (SectiOn 3097 Civ, C.) Lentler's Name Lentler's Atltlress '. OWNER BUILDER DECLARATION '� 1 nereby affirm [hat 1 am exeTpt f�om tne ContrdGto�'S License Law fOr [he followin9 reason (Section �031,5 BuSiness antl Professlonal Cotle: Any city or county wnich requires a permlt to construct, alter, Improve, tlemolish or repatr any structure, prior to its issuance, also requires th¢ applicant for such parmi[ IO fil¢ a si9netl Slatement that he/she is Ilcensatl pu�suant to the proviSiOns of [he Contractor's License taw (Chapter 9(commencing wiih Section 7000) of Division 3 of the' Business antl Professions Cotle) or that M1e/she.is exempt heret�om an0 the bazis for [he alleg¢tl exemptiOn. Any viola[Ion ot 5¢�tion 031.5 by� any applicant for a permit subjects the applican[ to a civll �enalty of no[ more tnan five huntlretl tlollars (4500). ❑ I, as owne� o( the property or my employees wlth wages as thelr sole compeniation, will Co the work, antl the-5tructure is not intentletl or ofteretl fo� sdle (SeGtion']044, BuSin¢55 antl PrOfessiondl Cotle: The Cont�aCtOr's License Ldw tloez no[ dpPly to an owne� at a Orope�ty who bUi1tl5 or Imp�ove5 thereOn, antl who tloes such Work nlmself/h¢rsetl or throu9h nis or ner own employees, p�ovitletl that such improv¢m¢n[5 a�e nOt Intentletl o� o((er¢tl fo� sale. It, nowever, the builtling dr improvemant is so�C within one year of com- pletion, the owner will have the burtlen of proving he/sne tliC not builtl or im- prove 10r tne purpose ot sale). ❑ I, a5 owner of the property, am extlusively Contracting with Iicensetl Con- tractors to cons[ruct the project (SeCtlon 7044, Bu51ne55 antl Profe55ion5 COtle: The Contraclor's License Law tloes not app1Y to an owner of prOPetty who bulltls or improves thereon, aqtl who contracts for such projects with a con- trdcto�(51 license pursuant to tM1e Cont�actor'S License Law). I am awa�e that proof of [heir Worker's Compensa[ion insutance shoultl be provitleC to me. ❑ 1 am exempt unCer Section B. & P. G. for this reason ' Date Owner I nereby certiry tnat 1 have reatl fnis application antl'state tbat the above information is correct. I agree to comply wlth all clry antl county ortlinances antl state laws relatin9 to buildinq construttion, antl hereby authorize repre- sentatives ot this1 tlry to e u n tne above-mentioned property for inspeCUOn purpOt�s. e I n-`� 1�C/1 $ignd[ure _e*��!� _ Oate �� '� �� DNvers' License tfr SS � TVPE OF CONSTRUCT� LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION DEMOLISH ❑ OTHER DESCRIPTI N F WORK/USE OF BLD TVPEOFPE MI GRAOING FOUND N STRVCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLVMBI G MECHANICAL ' ❑ OTHER PROJECT DESCRIPTION Sa. FT. oCCUaA v� CON STftUCTION TYPE VALUATION $ � ZONE GRADINGCU.VDS. AC�ES Remarks: Sink <flow Preventer kflow Irrigation Drinking Fountains Floor Drains � FloorSinks � Gas Service Outlecs 1 nterceprors Kitchen Sink Lavatories P-Trap Roof Drains qeinspectian Fee � $75 Duct=UnderGround Duct - Strucmral Duct - Ventilating Exhaust System ❑ Multiple Firepl/fact. Blt. ICBO # Heating System & Ducting ❑6100,000 BTU �100,000 Reinspection Fee � $15 CMP 0865-46, rev. 30/84 White . Builtlln9; Canary - ApPliwnt; Pink - Actounting: GOltlenrOtl - Assessor Showers Service Sink Sewer Cap Sewer Conneciion Solar Collectors Solar Piping • Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash laue Fee FEES $ 3 A.P. # S Main Buildi E T Front B Rear A C Right K Left S Ping. Fef. # Planning Notes: Automatic Washer Construction Pale Sub. Cooking Unit Dishwasher Dryers ❑Ges ❑Elec Fan F.A.U. Fixtures Device Boxes Outle[s Switches Garbage Disposal Generator �0.5 KW C 4977 6/i7/85 Zona Accessory Building: Parking Req./Provided ELECTRICAL � Transformer ❑ 15-SO.KW � ❑ 50+`KW r . Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel ' .-i Motors � P7 HP � 1 SS - 8 Inc. Solar 09-15 HP 076-75+ Microwave Pole Light � Range ; Standing Sections 15 KW Trash Compactor Rainspection Fee $15 luue Fee IANICAL FEES Hoodor Typel ❑ DEVEIOPMEN7SERVICESREQUIREMENTS: Canopy Type 11 ❑ Zoning Approved By Building Approved By Refrigeration Sys[em ❑6700,OOOBTU ❑100,000 System Repair/Alteration F ire Dampers Registers Issue Fea � $ 3 2�oQ� 2 O N I N G R E Q M T S FEES $ 3 S/U �MARrV O/fi1 FEES ' � BUILDING PERMIT ' $ J� SMIP $ , �a PLAN CHECK $ �� PERMIT PLUMBING $ � . ci (/ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELEC7RICAL $ GFiAO1NG S PLAN CHECK 50% $ MICROFILM $ �y MECHANICAL $ TOTAL FEE $ �.�� PLAN CHECK 25% $ . � � n ) ; CONSTRUCTION ANDPLANNING . POOL ,PA ,- '� APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector ` 1. Tempora,ry Electrical Service or Pole� 52. Pool & Equipment Location - 2. Soil Pipe-Undrgmd. .� _ � 53. Steel Reinforcement � i. 3. 6lectrical;Conduit UtilitY-Undrgmd.� � . 54. Forms -� - 4. Electrical Conduit:Undrgrnd. - .. 55. Electrical Bonding ' �, 5. Steel.Reinforcement �; � � 56. Rough Plumbing & Pressure Test �`i , . , � 6. Electrical UFER Grnd. �� •,` 57. APPROVAL TO COVER-GUNITE " �i �7.:Footings , ' • � � ; 58: Electrical,Conduit-Undrgrnd. � 8. Foundation - � "' � 59. Gas Pipe, O Undrgrnd., Te:t ' �� 9. Water Pipe-Undrgrnd. '� • 60. Backwash Lines, P-Trap, L� Undrgrnd. '� 10. Structural Floor System , - 61. APPROVAL TO DECK • - , 11. Property Sewer Line & House Connection ' a 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 Struaure 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 F�ashing � i 76. Dry Standpipe 28. Lathing & Siding � 77. FIXED SYSTEM FINA�L 29. Insulation • 78. FIRE PREV. FINAL 30. Drywall Nailing • � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' 79. FINAL INSPECTION 32. Electrical Power Meter-Final • . 80. FOOD CERTIFICATE ISSUED . 33. Final Electric Notes: ' 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-Test � � ' 36. Hood or Canopy � - ' � 37. Final Factory Fireplace � " . 38. Final Plumbin9 � � 39. Water Service-Final , 40. Gas Service-Final - 41. Solar pomestic-Final � � ' ' ' ' 42. Backflow Preventer ' � 43. Backflow Irrigation � -- � . ' 44. ,Landscape Irrigation System . � 45. Sound Flttenuation ` � � , � 46. Handicap Regulations , - � ' � 47. FINALSTRUCTURE&BUILDING �d.s..g� (,� 48. Special Requirements Completed. � 49. Electric Release to Edison - ' , , - - - 1 . 50. Gas Release to Southern Calitornia Gas Co � ' \ 51. CERTIFICATE OF OCCUPANCY ' � - , � \ No. -- Date' _ , 1 �- AOP��cant to (i11 in all sDaees exceol ehose within CITY OF COSTA M�E7SA CONSTRUC�T/7ION PERMIT PERMIS NO. _ TRACT I . Project Address �/ �� ,L/ f� .sr . Applicant's Mailin AddreSs a-3V� C a � �«<�Q� C/wner's Name �'� �� Q-u S� - Phone ' � I Address -��5�7 Sur vevr>r Cn Arch/Eng. License No. Address � Contractor's Nam T�N ��%� �' Phone ��' 3y�� Addresslmailingl �300 Ca{-{ F'pfN_lal {•(9_� atN Cicy License No. 00 7 g z.. ( LICENSED CONTRACTOR DECLARATION ' I he�eby affi�m that I am licensetl unde� provisltl�s O( ChartGr 9'(commencing with section ]000) Of Division 3 Of the Bu5ine55 antl Pro1¢ssions Cotle, antl my Iicense Is In full force antl efte<[. LicenSe Cla � cense Date Signature WORKERS' COMPENSATION DECLAR ION. I nereby affirm Ihat I have a certifica[e of consen� to selt-insure or a certificate of Workers' Compensation Insurance, or a certif�e0 copy thereof (Section �. ieoo. un. c. p�� Si .r,. '�w....�- PolicY No. � 0 .• [i_ ComPanY � Iy�.�I Certiflea copy is neraby turnishetl. �� pl Certifletl cop�j � tiletl with the <ity tling D��{ on. /� . Date �^- � �"� - T� � Applicant �n(j.�� •�n00 lA • EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This sectlon neetl not be completetl it the Oermit is for one huntlreU (E100) or less). � I certify that in the performance of tbe wo�k foY H'hictt this pe�m�YlS�issuetl I snall mt omploy any person in any manner so as to betome subject to.t�e Worke�s' Com0en5ation Laws of Califomia. '�� . Date Signature ' ' 'NOTICE: I(, atter making this tleclaration, you shoultl become suoject to the Workeri' COmpensation provisions ot the Labo� Cotle, you must fortnwith comply wi[h such p�ovl5ion5 or thi5 p¢rmit Shall b< tl¢emetl ravoketl. CONSTRVCTION LENDING.AGENCV • ' ' I hereby ailirm that there is a cans[ruction lentlin9 a9ency�for Iha peiformance of the work ,tor which thls Oermii . is' issuetl ($ection 3097. Civ. CJ Lentler'i Name - Lentler's Atltlress .. OWNER BUILDEN OECLARATION � I hereby affl�m'that 1 am ezemp[ from the Coq«ac[or's License Law tor th¢ ' following reason (Sectlon 7031.5 Business an� i'wfessional Cotle: Any ci[y or county which requires a permit t0 const�uct, alte�, improve, tlemolisn o� repair any structure, prbr [o its issuance, also reqWre54he applicant for Such permi[ ' to tiie a signetl sta[emen['that he/she is licensed Pursuant to lhe provislons of tne Contractor's License Law (Chapter 9(comm¢ncing witb Sectlon 7000) of Division 3 01 the Business antl' P�ofessions Cotle) or that M1¢/She is exempt Iherefrom antl the ba5i5 for the allegetl exempt�e�. A�Y ��olation of Se<fiOn '031.5 by any dpplicant tor a permit subjects [he appllcant_tO,d civil . ienalty ot nol more [han five huntlretl tlollars (E500). ❑ 1, as owner of the prope/ty o� my�employees with wages as their Sole com0en5atiOn, will tlo the wo�k, antl the struct�/e I5'not intentletl Or off¢retl (or sale (Set[ion 7044, Business antl Piote55ional Cotle: The Contractor'S " License ldw tloes not apply to an owner of a prOPerty who builtls or Improves thereOn, antl wh0 Uoes such work himselt/berSelf or thrOu9h his o� �e� own employees, provitletl [hat such.improvements are not intentleA or ofteretl for sale. If, howeveq tha �uiltling or improvemen[ Is soltl within one yea� of com- Oletion, tne Owner will have the burtlen of proving he/She tlitl not builtl or im- p�ove tor lhe pu�0o5e of sale). � ❑ I, a5'owne� of the prope�ty, am excluzively �ont�acting wlth Ilcensed con- tractorsto construct tho Oroject (Sec[ion 7044, 6usiness antl Profassions Cotle: The Contractor'S License Law doe5 nof apply to an owner oi Property who builtls or improves thereon, antl who contracts for 5uth pro�ect5 witM1 a con ^ tractor(51 Ocense pursuant�to tne Contractor'S ��cense Law). I am aware that proof of their Workar's Compenzation insurance shoultl be providetl [o, me. ❑ I am exempt untlar Section B. 6 P. C. for this reason Oate Owner I hereby certify that I have rea intormation is correcL I agree to antl state laws relatlng to builtlir sentatives of his Ury t ter inspectlon pur os . Siqnature �rivers' Licen e or 55 � DorAer lines antl sign all avvropriate aeclaretions. TYPE Of CONSTRUCTIO LJ NEW LJ ADD LJ ALTERATION LI REPAI R ❑ CONVERSION DEMOLISH ❑ OTHER DESCRIPTI F ORK/USE OF BLD TVPEOFPER I GRADING FOUNDAT O STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL ❑ �OTHER . - - PROJECT DESCRIPTION Sq.FT. OCCUaaNCv � CONSTRUCTION�TYPE VALUATIONSL� r ZONE GRADING CU. VDS. ACRES Remarks: � � Bai $ink Backflow Preventer Backflow Irrigation eathtubs Clarifiers ' Drinking Fountains Floor Drains ' FloorSinks � GasService :Outlets Interceptors � � Kitchen Sink • Lavatories � � P—Trap - Roof Drains � I Reinspeetion Fee PLUMBING Showers Service Sink - Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Wrinal Water Heater ' ' � Water Service � ' Auto-Wash - � ' Laundry Trays_ $15 Issue Fee - �MECHANICAL Duct - Under Ground Duct - Structurel . Duct - Ventilating Ezhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑6100,000 BTU 0100,0008T Reinspection Fae � $15 CMF 0865-46, rev. ]0/84 White - Builtling; Canary - APPlicant; Pink - Accounling; Goltlenrotl - Assessor Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0.100,OOOBTU ❑100,000 System Repair/Alteration ' Fire Dampers Registers ' Issue Fae FEES $ 3 $ 3 A.P. � S Main Buildini E T Front ' B Rear � A C Right K S Left Ping. Ref. # Planning Notes: 4978 6/17/B5 • Zone Accessory Building: Parkin9 Req./Provided ' ELECTRICAL � Auromatic Washer Transformer -� 15�50 KW Construction PoleSub. � ❑ 50+KW , Meter ❑up to 100 amps Meter ❑over 700amps Sub Panel . Motors�0.1 HP�1�h-8 Inc.Solar �9-15 HP��76-15+ ' Microwave -- - Cooking Unit Dishwasher Dryers �Gas ❑Electric Fan F.A.U. Fixtures ' ' ' Device Boxes � ' Outlets Switches Gar6age Dispoul Generator �0�5 KW �5-75 KW Fange Si9n ;Standing�Sections Trash Compactor I Rainspection Fee I$15 I� .I luue Fee DEVELOPMENT SERVICES RE�UIREMENTS: Zoning ApOrovad By Building Approvetl 8y Appliption Issued By i� SUMMARV F FEES BUILDING PERMIT � $ SMIP PLAN CHECK $ -- �� PERMIT P�UMBING $ ,�O U ISSUANCE PLAN CHECK 25% $ ENERGV P.C. ELECTRICAL $ GRADING PLAN CHECK 50% $ � MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ 23s00 TL Z O N I N G R E � M T $ FEES CONSTRUCTION AND PLANNING � �ti . POOL. .rA 'APPROVALS Permit# _ Date Inspector pppROVALS Permit# Date Inspector 1. Tempora�y Electrical Service or Pole 52. Pool & Equipment Location . � 2. Soil Pipe Undrgmd. � 7;� .. .,, 53. Steel Reinforcement �'~' 3.'ElectFica�.ConduiYU[ility-Undrgcntl 54: Forms + ', 4.'Electrical ConduitiUndrgrnd. , .- 55. Electrical Bonding � � � - ��' �� . 5. Steel �Reinforcement ��', 56. RougFi Plumbing & Pressure Test ' 6:_ Electrical UFER Grnd.' 57. APPROVAL TO COVER-GUNITE =�� , - . 7. Footings_�' " � , {-, � • 58. Electrical Conduit-Undrgrnd. . 8. Foundation � , � � 59. Gas Pipe, � UndrgFnd., Test � 9:�Water Pipe-Undrgrnd'. �� -- 60. Backwash Lines, P-Trap, O Undrgrnd. � 10. Structural Floor System �� '-ti 61: APPROVAL TO DECK - 71. Property Sewer Line�& House Cdnnection - � 62. Backwash & Receptor-Final 12. Sewe�'Cap ' , ' ' �`�` � � 63. Heater & VenbFinal - � 13. Roof Drains i_; - � , 64.� Plumbing System - Final 14. Rough Plumbing•. _ 65. Electrical-Final � 15. Rou'gh Electrical-Conduit , 66. Solar System-Final ' 76. Rough Electric Wiring • 67. Fencing & Access Approval � 17. Rough Wiring Sign , , 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL 19. Rough�Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 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 � 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 Elearic Notes: � 34. Final Heating & Air Conditioning , � 35. Final Gas Pipe-Test . � 36. Hood or Canopy � 37. Final Factory Fireplace , � 38. Final Plumbing , � - ' 39. Water Service-Final 40. Gas Service-Final . 41. Solar pomestic-Final � � _ � ' ' 42. Backflow Prebenter . � � � 43. Backflow Irrigation . ' � � ' - 44. ,La�dscape Irrigation System � � 45. Sound Attenuation , ' ' � 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING �` 48. Special Requiremenis Completed � 49. Electric Release to Edison , � . - �- : i .50. Gas Release to Southern Califomia Gas Co , � i 51. CERT�FICATE OF OCCUPANCY _ � � ' No. - Date , � City of Costa Mesa Building Safety Department P.o. sox izoo Costa Mesa, California CERTIFiCATE OF OCCUPANCY The Building located at has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group Occupancy. Use of Buildi Legal Descriptio Building Permit No ISSUED TO: (See reverse side for Metes and Bounds) lectrical Permit No. Plumbing Permit No. Number of apartm and/or guest rooms Building Official by This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Form BU 34 Rev. 11/l0 Ciry of Cos[a Mesa Building Safety Department P.o. eo. i2oo Costa Meu, Califomia CERTIFICATE OF OCCUPANCY The Building located at has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group Occupancy. Use of Building Legal Description (See reuerse side for Metes and Bounds) Building Permit No Electrical Permit No. Plumbing Permit No Number of apa ISSUED T0: and/or guest rooms Building Official by Date This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Form BU 34 Rev. 11p0 P.VD�icant to fill in a11 spaces except those within neavy bortler Iines antl sign all appropriata tleclaratloas. CITY OF COSTA MESA ,�;,_ � ,� . � � PERMIT NO. � TRACT NO. LOT N0. ' BLD . . � - - - CONSTRUCTION PERMIT . • ' — 9� S=- +' � - � � Project Address - ' ' Applicant's Mailing Addrett � � _ • �� Owner'sName `>�'� �Phone�� Address ,�=-��'t1t� a !Na 7-y�f�x-,.('a i Arch/Eng. License No. Address Contractor's Nam�`�% /��'� Phone Addresslmailingl-LJ . , City Li<Pnse No. `l _ LI�CENSED CONTRACTOR DECLARATION . I hereby aftirm that I am licensetl untlar proWsloni o( Charter 9(commentlng ' wilh section 7000) ot Dlvision 3 of tha Business antl Profes5ions Cotle, antl ' my (icense is in tWI rorce and elloct. ' Lic¢nse Class License No. Date Signalure 'ORKERS'COMPENSATION DECLARATION � iereby affirm tha[ I nave a cerUficate of consent to selNnsure or a certlficate �f Workers' Compensation Insurance, pr a cerUfieC" copY tnereo( (Sectlom ' 3800, 12b. C.) ' - � � Policy No. Company 8 Certifietl copy is hereby fumisFietl. � 1 Cer[ifietl coOY �s filetl wilh the clty Builtling Divizlon. , • Date ApP��cant E%EMPTION FROM WORKERS' COMPENSATION DEGLARATION - (This section nBeO nat be coTpletetl if t�e permlt IS 1or One huntlretl (5300) or Iess). • I certity�that in tne performance of lhe work for which thls permR is'Issuetl, 1� shall not emPloy any person in any manner 5o�as to become subject [o the Workers' Comp¢n5ation LawS of Califomia. • , . �, Date Signatuw ' ' NOTICE: If, a(lor making [his tleclaratl0n, you shoultl become sub7ect to.the Workers' Compensatlon provlslons of the labor Cotle, you must forthwith-� comO�Y �+'�th such �provlsions or tblg,-Oermit shall be tleemetl revoketl. ' CONSTRUCTION LENDING AGENCV' � � 1 hereby aftlrm that there is a tonslructi0n lentling agoncy (or the perforrriance • of the work tor which � this permit is Izsuetl (Se<Hon• 3097 Civ. CJ Lentler's Namn Ixntler'S Atltlress r � � � OWNERBUILDER�OECLARATION ' - i� ' I hereby atfirm that I am ezempt (rom the Contractor'i License Law for the tollowing reason (Section7031.5iBusin¢ss antl Professional Cotle: Any ciry or county which requires a permit to construct, alter, ImDrove, tlemoilsh or repair any structure, prior to Its issuance, also requlres the applicant tor such permit , Gto file a signetl ztatement thal he/she li Iicensetl pursuant to tne orovisions of -.he Contractor's Litense Law (Ghao�er B �commencing with Settion 7000) of- ' TVPE OF CONSTRUCTION � NEW � ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH� [❑� �/pTH/ER '�,/ q,p, # ', DESCRIPTION OF WORK /� )L0�4�'/rn--Y ��/i/ �T� � S Main BUildi TVPEOFPERMIT GRADING- FOVNDATION STRUCTVRAL T, Front � ❑ TENANT, ❑ ELECTRICAL ��PLUMBING ❑ MECHANICAL A Rear � ❑ �OTHER . � - � , C Right PROJECT DESCRIPTION Sq. FT.� �%��n '-�.00CUaaNCv K CONSTRUCTIONTVPE�Ar%��t VALUATION$ g �ef[ ZONE GRADING CU. VDS. ACRES Ping. Ref. �k Remarkz: _ � Parking Req./Pri . _ , � . Use of Buildin9: , � PLUMBING PEES P�anning Noces: 8ar Sink . Showers 8ackflow Preventer Service Sink , Backflow Irrigation � Sewer Cap � Bathtubs Sewer Connection Clarifiers . • Solar Collectors � � Dishwasher ' � Solar Piping - � DrinkingFountains , SolarTank � ! Floor Drains� FloorSinks � Gas Service Interceptors Ki[chen Sink .� lavatories� P-Trap � � Roof Orains� '- : Swimming Pool w/Spa . Urinal . Outlets Water Closet . � . Water Heater � � Waie� SerOice ro� 3 ot tne euvness ana rroies;ions Coae), or tnat ne/sne is exemp[ . �: - rom �antl the basis for'the alle9etl exemplion. Any.violatfon of Section ', , i by, any�applicant for a perr�lt subjects [he applicant� to a civil � '' y of not moro than five nuntlretl tlollars ($500). , � :Reinspee[ion Fee . $25 as owner of the property or my employees with wa9es as thelr sole � , :nsation, will tlo the work, antl tqe structura is not intentletl or offeretl , � employees, provmea [na� sucn improvemenis are noi m�enaea or m�area ror sale. It, howeve�, th¢ builtling or It�p/o�ement IS SOItl wi[hin one yea� of Com- pletion, the owner will have the burtlen of proving he/she tlitl not builtl or im- �rovl�fo� the pu�po5e Of sale). 1, as bwner oi the Oroperty, am ezclusively contracting with Ilcensetl con- tractorsto construct the projecf (5ectiory 7044, Business and ProfeSsionS Cotle: T�e Contractor's Llcense Law does not apply to an owner of pro0erty who . builtls o� improves the�eon, antl who Sontratts to� such projects with a con- tractor(5) Iirensa pursuant to the Contractor's License law). . ❑ I am exempt unaer Section B. & P. C. for Ihis reason Date Owner i nxrehvi certiN tM1at I have reatl thls anolicatinn antl state t�at the above Boiler . Duct�- Under Ground Duct - Structural Duct - Ventilating ' Exhaust System �' Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑0.100,000 BTU 0100,OOOBT' Drivers' License or 55 � -' -� ' ; I I F7einspeetion Fee I $25 �CMF 0865-46 rev. 7/83 -' �"/hite • Builtlinq; Canary - Appliwnt: Pink - Accountin9: Goltlenrod -�Assessor -- - . ' IssueFae• � . :: $�3 Hoodor Typel � Canopy Type II ❑ Refrigeration System ' ❑0-100,000 BTU ❑ 100,000 BT System Repair/Alteration . laue Fee ' �I 5 3 y - -c215 ll/I%/9�l_ ' � � '- ,. - • Zone - Accessory Building: i, . Park.Fees $� _ , . � Automatic Washer � Construc[ion Pole Sub. Cooking Unit " ' ' "-' Dishwasher � i Dryers ❑Gas; �Electric F.A,U. Fiztures ' Device Boxes � Outlets � Switches Gar6age Disposal Generator �0.5 a 4 �:oi;' 7: Z O N 1 N G R E Q U I R � E M E T ' ELECTRICAL ' FEES Transformer ❑ 15-50 KW ! ' ❑ 50+KW i ' - - �MeterOupto,100amps - � � Meter �overi00amps Sub Panel �Motors OP7 HP 01'h-8 Inc.Solar�09-75�HP�16-15+ � �Pole Light � Range ' . � Sign. Standing S¢ctions KW �TrashCompactor IRainspectian Fee � I$25 I Issue Fee PUBLIC SERVICES REQUIREMENTS: � Zoning Approved By Appliwtion APProved BY . Aaolication luuad Bv � � �' � $ 3 � SUMMARV OF FEES ' , , BUILDING�PERMIT $ SMIP $ PLAN CHECK $ PERMIT . PLUMBING $ ��UANCE $ PLAN CHECK $ ENERGY P.C. , $ ELECTRICAL $ � GRADING $ � PLANCHECK ' $ ' MICROFILM $ MECHANICAL $ � TOTAL FEE � $ � O � PLAN CHECK � $ ' "' /� ' CONSTRUCTION AND PLANNING . _ PO� ,� 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 Reinforcemen[ � ��.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, O 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 � 13. Roof Drains 64. Plumbing System • Final 14. Rough Plumbing • • 65. Electrical-Final 15! Rough Electrical-Conduit' -� �- � �66. Solar System-Final i . 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 2�. Ducts, Ventilating � ' 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test . 72. Underground Flush 74. Roof'Framing ' ,-... , �, � 73. Undergind. 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. 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 , L,'�err�7 ; �,� � ' , � 35. Final Gas Pipe-Test � , � � . � � � � � 36. Hood or Canopy � . � : � 37. Final Factory Fireplace � , 38. Final Plumbing ' � ' 39. Water Service-Final � • � 40. Gas Service-Final � ! ' � 41. Solar pomestio-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 Southem California Gas Co ��- � � ' 51. CERTIFICATEOF.00CUPANCY . ' No. Date � � , , � � . � _ , , _.._ . JAN 18-71PAI�OO 493� ***240.�5 :32639 �NS^ COSTA MESA BUILDING-SAFETV DEPAflTMENT �,�µ.' � { P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 � � APPLICATION FOR BUILDING PERMIT Fo� A pli a to Fill in Completely /l �y/ RECEIVED BY DATE RECEIVED DATE ISf$ UED BUILDING '�'f�s ST' `-`///- .—�IJ ADDRESS OWNER 1�/� -�Y'i�L-L UF 'L P..P.NO. � OU ��O PERMITNO. � f w r/ BUILDING /-� �y 1/� ADDRESS I��^' L�� c-ULJS� �L��r! � P.DDFESS I` '/ Z r y �/ 1 y aU CITV��j�(/�(%/P'/ pX3�%7�'P-/7• NOL �-ij�Q TFACT{' ��• lOT BLOCK ZZ Q CONSiFUCTION � ' O N LENDER am _ J � BRANCH ' � J � a w ADDFESS — R] J J m ARCHITECT TEL. Q OR ENGINEER � ��" ��U n' . ��/ a� N y W� ADDRESS J"rO�- _� S��fTj EN.�/UC� � W �/� / 1...0 iGo-s J O CONTRACTOF m Z • J � AODRESS W W TEL. �= CITV NO. Z OW STATE CITV y� LIC. NO. �IC. NO. _ � SLZE '7 / / NO.OF BLDC.S. OF LOT } OO ^ l� � NOW ON LOT O VSE OF EXI5TING BLDG. �� SIZE OF / w NO. OF Z NEW BLDG. (FOX •(� ROOMS STOFIES a EXTERIOR WAL � A«�p� ROOF 1Wµ� n. V COVERING �LrU/ COVERING J USE OF BUILDING AND WORK TO BE PERFORMED a O 'f� a �a . 0 ' t`� FT !/A�l.t/ M ~ � z �o yV I hereby acknowledge ffiat I have reatl this epplication antl state �� thet the abova information is correct and aBree to comply with �� ell laws reguletlnB builtling construction, antl I shall mt employ F any person in v�olation ot t�e workman's compensation laws ot (n [he Stete af Cal�tornia. ? I hereby cerUty ihat I am properly licensetl as a contrector untlar ffie State of Cal�fornia Businass antl Profewio�s Code,,Divisicn 3, Chapter 9, antl such licenses are in full forca and effect, or I � em exempt m t provisions ot ihe Stata of Celifornia Business n entl Ptote ions C e, Division 3, Chapter 9. ' \� Sip^amr Permittee Authorizetl Apant � � OWNER VA i S • 5 FIRE J ) � 20NE� TVP GROUP / APPROVED % � '/'/ gy DATE Q E NO.OF USE OF NEW � PLAN$ � BUILDING VARDSAPPROVED YARDSAPPROV D MAIN BUILDING ACCESSORY BUILDING MAIN BLDG$ T�S � I BET. MAIN & ---�� ACCESS. BLD VAR.aW I DATE C.U.P.� I APPROVED - Baov � S�. FT. J o THE AMOUNT SHOWN UNDER VALUATION IS FOR ' THE PURP06E OF ESTABLISNING A PERMIT FEE ONLV: Q LUATION oy pERM1T FEE 5 �Oi SCj �" � y�N m ,r PLAN CHECK 5 O O i�L S E `o n LL TOTAL FEE S` �/ S 1 �-_ t �_,�,__, :, � .�2C�3S � � JAN 1 f3-��Ai� t�9q� *,t� � R9.75 COSTA MESA BUILDING-SAFETY DEPARTMENT � � L'� P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626 � APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Comp/etely A�� B� . DATE RECEIVED �j (� DJATEISSUED AODRESS / � � �� '�M / �/� OWNER /,{'/yn0/TN�� /��/ A.P.NO. — � ( � PE� MAIL �A BUILDING �/ / /( , t � ADDRESS'I '�` �"�� ADDRESS �(O k7 Y' J CITV /��LL(J/Q�+/ 15»v,u�,! . NOL�S � YOTSO� BLOCK CONSTRUCTION a. W AD A P AODRESS ARCHITECT RESS �Q--J ADDAESS " CITV STATE LIC. NO. saE 3.� �,sc 6 3� OF lOT USE OF EXI5fING BLDG.' ' 512E OF / O y�� NO.OF NEW BLDG. w �� ROOMS EXTERIORWAL1119fSL/w ROOF USE OF BUILDING AND TEI. TEI. NO. CITY LIC. NO. �__ INO. OF BLOGS. NOW ON LOT � RMED V haraby acknowletlBe ihet I have reatl ffiiz appltcaiion entl stnte that the above intormation is correct and agree ro comply with all lews reguleting builtling consttuttion, antl I shall not emplay any person in violotlon of the workman's compensation laws ol tha State of Calitornia. 1 hereby certify that 1 am properly licensetl as a controcior ontler tha Stete of California Businass entl Professions Code, Divisicn 3, Chapter 9, antl ihat such licenses are In f�ll forca antl eftect, or I am ezempt from the provisions ot the Srote ot Calitornia Business antl Protessions /Gyo�tl�e, Division 3, Chapter 9. Sipnawre of �/ ^- �^, "�"" � � Permlttee `�� / 7�.�� Authorize0 Agent %� � OWNER VALUE IRE V /// . � y � DNE TVPE�f•�"� GROUP / YPROVED DATE /�/ d �// DNE NO.OF USE OF NEW PLANS BUIL�ING � VAfiDS APPROVED VARDSAPPflOVED . MAIN BUILDING ACCESSOflV BUILDING DI5TANCE BET. / BET. MAIN & MAIN BIDGS. �S ACCESS. BLDGS. VAR. � DATE C.U.P.qy+ APPflOVED APF E � $ '� i c .. " ' (00 dL7 � SQ. FT. o THE AMOUNTSHOWN UNDER VALUATION IS FOR � THE PURP06E OF ESTABLISHING A PEAMIT FEE ONLV: m r� / ¢ VALUATION pERMITFEE $ / G�OISD � ��V G PLAN CHECK $ � �• �5 E 0 I 8 9 is LL TOTAL FEE $ �