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HomeMy WebLinkAbout2551 ELDEN AVE - Building Permits Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. STA MESA. , CD QTR UCTI ON PERMIT PERMIT NO. �j TRACT NO. LOOT NO. 17UN�IT NO, • Elden Ave- ____.___-, ,_ 23 G l LJ L� p 2313 4%02!96 r. co:: I. / TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR Address • • -• a r"•� O�°27 El CONVERSION ❑ DEM LISH ❑ OTHER -y �7� Owner's Name Ken bi i cn7u Phonehlt-pays A,P,# '1-t; — I /1 -3o (Zone • DESCRIPTION OF WORK/USE OF BLD / LO C�� S Main Building: Accessory Building: Address /s�� • /r a V - - - Z Arch/Eng. O SIOn ASSOC127 Sense No. 131401 TYPE OF PERMIT U GRADING ❑ FOUNDATION STRUCTURAL ,,s' T Front a 1 O Address IOnf W. I C•M. 92e2/ y0 TENANT ❑ ELECTRICAL El PLUMBING ❑ MECHANICAL /•'—! B Rear 1 / N �•s r yy OTHER �Ptt Gal Contractor's Name Lyne./ Properties inc. Phone ig7SQ.2gi q 3 C Right a'7,5 / N //�� 1'24, -f PROJECT DESCRIPTION SQ. FT. 24�fo OCCUPANCY`F•ty,.iffFs G Addresslmailingl a. Cox. 11410/J / e•M wZ ( CONSTRUCTION TYPE Rt.Ls3 3 VALUATION$�Dq.1¢�T L.D S Left '7. „ - R City License No. -�L7��! � ZONE R-a GRADING CU.YDS. ACRES d-�;/� 1 E Ping. Ref.# 1 e--.1;�—!f / Parking Req./Provided &Vie) LICENSED CONTRACTOR DECLARATION �//s�� C//� / ry0 I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: PC# " f /l -SS S f5'C PD /2 - / 7-�� Planning Otes:gOLD FOR SPECIAL REQUIREMENTS M with suction 7000) of Division 3 of the Business and Professions 4Code, and n T my license is in full force . def tett. 979!5° $ 7 /3/ 7 p� / S License Class / i License No. -! ! [ Cl Date 12-119-85 Signet re 4' �a i it, _, i o/ • PLUMBING FEES ! WORKERS'COMPENSATIO •ECLAR•TION ./ Bar Sink Showers . ELECTRICAL FEES I hereby affirm that I have a ert ficate of onsent to self-Insure or a certificate - J.—-- f Workers' Compensation Ins ranee, or a certified copy thereof (Section Backflow Preventer Service Sink Automatic Washer • Transformer ❑ 15-50 KW ' 800. Lab. C.) . - Policy No. Comp. y Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+'KW. 8 Certified copy is hereby turn shed. - • Certified copy is filed with t-e city Bulldi g Division. Bathtubs Sewer Connection2 '- . Cooking Unit Meter ❑up to 100arliDate App cantEXEMPTION FROM WORKER.'-COMPENSA' ION DECLARATION Clarifiers Solr CollectorsDishwasher Meter ❑Over 100(This section need not be comp! a I �he perm t is for one hundred ($100 Or less). ) Dishwasher Solr PipingDryers ❑Gas ❑Electric Sub PanelI certify that in the performance .f tWe work for which this permit Is Issued, I shall not employ any person in a•y manna"r so .s to become subject to the ^Drinking Fountains Solar TankFanLaws of Ca Iornla. Motors 1 HP ❑1 h'-B - Date jI-CJ�-Y� Signature �; /ice . - ) Floor Drains Swimming Po /Spa • `— F.A.U. Inr,�olar ❑9-15 HP 016-15+ 'NOTI E:If,after making this declar( • y• sh•-I11.o'ecome subject to the — f Workers' Compensation provisions of the -. •of i ode, you must forthwith Floor Sinks Urinal .Fixtures /Microwave comply with such provisions or this per - a all be deemed revoked. "'Microwave CONSTRUCTION LENDING AGENCY • Gas Service Outlets j tsarCloset , -Device Boxes Pole Light . I hereby affirm that there is a construction lendin • ncy for the performance - of the work for//sf.w,,,,�h�iich this permit 1i is (Section 3097 Civ. C.) interceptors Water Heater ' Lender's 'Name zyr..ni Ctrs(,..../Se p , OutlMs� Range Lender's Address Net/1 et )f t24' G .. • Kitchen Sink /��Water Service / ,• Switches-/15KW • Sin OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Co rector's License Law for the Lavatories Auto-Wash /following reason (Section 7031.5 Business and Professional Code: Any city or ! Garbage Standing Sectionscounty which requires a permit to construct,alter,improve,demolish or repair P-Trap / Laundr Tre s •any structure, prior to its issuance, also requires the applicant for such permit Y Y GeneratoTrash Compactor to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drans •,the Contractor's License Law(Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt „`' •refrom and the basis for the alleged exemption. Any violation of Section 1 `'' 31.5 by any applicant for a permit subjects the applicant to a civil • - - • nalty of not more than five hundred dollars($500). I I L] , • I, as owner of the property Or my employees with wages as'their sole • Reinspection Fee $15 Issue Fee $ 3 i- compensation, will do the work, and the structure is not intended or offered - - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional rCode: The Contractor's \MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own • DEVELOPMENT SERVICES REQUIREMENTS: / 11y' A� employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I 0 Zonis Approved By M�I1'L' nate L/ sate. If, however, the building or improvement is sold within one year of com- Canopy Type 11 g pp 1/� - '2.-1-p! pietlon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By - 1.- Date 0 7� prove for the purpose of sale). ��,�_JQ.� ❑ I, as owner of the property, am exclusively contracting with licensed con•; Duct-Structural Refrigerati ystem • Application Issued By "—Tip__ — Date �/ 86 tractors to construct the project (Section 7044,Business and Professions Codes The Contractor's License Law does not apply to an owner of property wtfo Duel-Ventilating 00- ,000 BTU ❑100,000 BTU :- SU V OF FEES builds or Improves thereon, and who contracts for such projects with a con- '3-7. 1 tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration • 'BUILDING PERMIT $ • SMIP $ J proof of their Worker's Compensation insurance should be provided to me. 844..LAN CHECK - $ PERMIT 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIL !CBO# Fire Dampers_ PLUMBING $ ISSUANCE $ Date Owner Heating System& D ng Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above 06100,000 BT 100,000= ELECTRICAL $ GRADING $ information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- - -. MICROFILM $ sentatives of this city • enter upon the above-mentioned property for PLAN CHECK 50% $ '-i I� Inspection purpos- t' [• 12. MECHANICAL $ TOTAL FEE $, A Signature ij �• -- / Reinspection Fee $15 Issue Fee I $ 3, PLAN CHECK 25% $ TJ"4-92-ret / CMF 0865-46,rev. 10/84 White Building; Canary •Applicant: Pink -Accounting; Goldenrod - Assessor I \ 6 92 .35- ., • / ITRIJCTION AND PLANNING POOL 'PA :OVALS Permit# Date Inspector APPROVALS Permit # Date Inspector porary Electrical Service or Pole 52. Pool & Equipment Location 2. ipe-Und'rgrnd. 53. Steel Reinforcement 3. •ctrical Conduit+Utility'Undrgrnd. 54. Forms t4`. _lectricalConduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement[ 56. Rough Plumbing& Pressure Test L- 6. Electrical UFER Grnd.' OM ,/C • 57. APPROVAL TO COVER-GUNITE • ' 7. F6otings . ' 58. Electrical Conduit-Undrgrnd. '� t 8. Foundation .04/$ VL, 59. Os Pipe' O Undrgrnd., Test 9. Water Pipe-Undrgrnd. .60.'Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line& House Connection -i 62. Backwash & Receptor-Final 12. Sewer Cap : ^ :; •• 63. Heater & Vent-Final .. 13. Roof Drains - ` 1 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 ' 1,7. 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 t • APPROVALS Permit# 2f: Ducts, in Structure • r"- 70. Underground Hydro • 22. Ducts, Ventilating 71. Product Piping OGas OOil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing r, i' ' 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing r ' 7// 7,/g vc. 74. Overhead Hydro ' 26. T-Bar Ceiling (Structural) & Monocoat Pak 75. Dry Chemical 27. Frame and Flashing (ft76. Dry Standpipe 28. Lathing & Siding '�""/� // �/l 77. FIXED SYSTEM FINAL 29. Insulation y/L'/ 6 DH 78. FIRE PREV. FINAL 30:Drywall Nailing 77f t�%%/ (r vG HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat . ' �,(�/ te. 79. FINAL INSPECTION . 32. Electrical Power Meter-Final 80. FOOD CERT FICATE ISSUED �f////�� �/' 33. Final Electric ' ' Notes: � d1fd6 VL_- 34. Final Heating& Air Conditioning HOLD. POR S4 (.Sez/OiA EQUIREMENTS 35. Final Gas Pipe-Test Ct At )44a9- 6OLOQ k pig- 36. Hood or Canopy ppL O� • o # tic---tic--- . 37. Final Factory Fireplace GOPtiA.42-04.tra0 38. Final Plumbing ' / `2 39. Water Service-Final ' Silk 1_ lid- I21c/g7 O- 40. Gas Service-Final �'�.K� D+ F� 41. Solar Domestic-Final 42. Backflow Preventer A-{. 43. Backflow Irrigation 44. Landscape Irrigation System . • 45. Sound Attenuation • 46. Handicap Regulations ' 47. FINAL STRUCTURE & BUILDING AVM/ /✓Q`f - 48. Special Requirements Completed 1/247/g7 Al 41 49. Electric Release to Edison 50. Gas•Release to Southern California Gas Co . 51. CERTIFICATE OF OCCUPANCY k No • Date . i • k. City of Costa Mesa Development Services Department CERTIFICATE OF OCCUPANCY No. O(JF dy g; Building Safety Division P,O.Box 1200 Costa Mesa,California The Building located at 9GCl WIAnn fl trn..c. rtni l-e. n_t n_o has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto fora Group 1)_1 Occupancy. Use of Building Dncirinn4-4 ni Legal Description A D AA1O_111 _vn (See reverse side for Metes and Bounds) Reinspection Permit No. 1823293 E23471 P23392 Building Permit No 1191701 Electrical Permit No.r'in n Plumbing Permit No. 1,911111 Mechanical Permit No. M9AA0l • Number of apartments rand/or guest rooms ISSUED TO: Building Official' Ken Robinson P.O. Box 11930 by Costa Mesa . CA 92627 Date, \r.l .- ,4 &,,, (cj f 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 sign9548 �"/ f �. ( I� Applicant to fill in all spaces except those within heavyborder lines and all appropriate declarations. OSTA MESA CONSTRUCTIONl/,P'ERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. �/ �1�/,�,� �0� R D3 23x93 IAA'S 3 I A 9548 7/16/86 ,.. ti- t Address4 /p r�/� ,`.. Applicant's Mal ling Address "PC) Ian. 11433 6 - l' .f�s TYPE OF CONSTRUCTION NEW U ADD U ALTERATION U REPAI R - eir r n 1.:1 CONVERSION CI DEMOLISH ❑ OTHER A.P. Zone 1 O . YL Owner's Name kg YI -With • •r'» SV Phone tit 7_5-49,091 DESCRIPTION OF WORK/USE OF BLDG. Address P.U • 02,NY 11 9 3 a S Main Building: Accessory Building: Arch/Eng. 6,4[1:)T` r% n C License No. TYPE OF PERMIT U GRADING U FOUNDATION U STRUCTURAL T Front O Address 17 ' ST 0 rel. ❑ TENANT ❑ ELECTRICAL El PLUMBING ❑ MECHANICAL B Rear • N Contractor's Namp A•y Yl(L:-I }'I'!1(7N!"(-/K Phone(1-1721‘29/ ❑ OTHER re-rant/ C Right 1 / PROJECT DESCRIPTION SO. FT. OCCUPANCY p N Address(mailing)� n- �n1' (I j �(� !'N1 �I CONSTRUCTION TYPE VALUATION$ int' K'ic S Left G City License No. ( Cee-' 2320t./ P3a0t n /Pr)7at f R z �,3.Z i3 > ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req,/Provided E LICENSED CONTRACTOR DECLARATION 0 1 hereby ioaffirm that) I am licensedion under provisions of Charterroi (commencing Remarks: Planning Notes: M with section 7000) of a of 3 of the Business and Professions Code, and my Insecta is In full force and effect. _ T License Class -V.4 ' License No. � 4 3 1 b _ S Date 7-((g'}'(i• Signature 9S A-c,',/(r'Mn/._.v PLUMBING FEES WORKERS'COMPENSATION DECLARATION . Bar Sink Showers • - 'hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL. FEES workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer • Service Sink �0, Lab, c.) Automatic Washer Transformer 0 15-50 KW Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. , - 0 50+KW 8 Certified copy is hereby furnished. - r Certified copy Is filed with the city Building Division. Bathtubs Sewer Connection _ Cooking Unit Meter Our;to 100 amps Date • Applicant - EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors- Dishwasher - • Meter:Dover 100 amps (This section need not be completed if the permit Is for one hundred ($100)or I less). Dishwasher Solar Piping Dryers ❑Gas DElectric , Sub Panel - I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank _ Fan .Motors❑01 HP ❑1%-8 • Workers' Compensation Laws of California. n_ / - - 1 Date 7 /i• -'�'F Signature t / '--y Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+ NOTICE:If,after making this declaration, you should become subject to the - - - Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave comply with such provisions or this permit shall be deemed revoked. ' CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes I hereby affirm that there Is a construction lending agency for the performance Pole Light of the work for which.this permit is issued (Section 3097 Clv. C.) Interceptors Water Heater . Lender's Name /�"•ni7� A'Gr^/ 7t(�•�n[{ q p Outlets , Range Lender's Address 1/(•1 Kq,^Tutt fes" " ' T,•u,Y4 L Kitchen Sink - Water Service - Switches Sign • OWNER BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage DiS osal following reason (Section 7031.5 Business and Professional Code: Any city or P Standing Sections county which requires a permit to construct,alter,Improve,demolish or repair P—Trap Laundry Trays Generator 00-5 KW ❑5.15 KW any structure, prior to its issuance,;also requires the applicant for,uch permit • _ Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of • Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he/she Is exempt -"(from and and the basis for the alleged exemption. Any violation of Section ' 1,5 by any applicant for a permit subjects the applicant to a civil ,alty of not more than five hundred dollars($500). L I I, as owner of the property or my employees with wages as their sole Reinspection Fee I' $15 Issue Fee $ 3 compensation, will do the work,and the structure Is not intended or offered - Reinspection Fee $15 Issue Fee • $ 3 • for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES - , License Law does not apply to an owner of a property who builds or improves thereon; and who does such work himself/herself or through his or her own Boiler Hood or Type I 0 DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered foryp Zoning Approved By sale, If, however,the building or Improvement is sold within one year of com- Canopy Type II 0 Date - _ - pletlon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground ,Building APProved By ' shrove for the purpose of sale).' Date LJ las owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0.100,000 BTU ❑100,000 BTU �-fs SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with a con- (fxe171SpeCt<k49s1) - tractor(s) license pursuant to the Contractor's License Law); I-am aware that Exhaust System ❑ Multiple 0 System Repair/Alteration BUILDING PERMIT , $/O SMIP • $ 1 proof of their Worker's Compensation insurance should be provided to me. - - PLAN CHECK $ _PERMIT .❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit.ICBG# Fire Dampers PLUMBING .$ • 'ISSUANCE $ . • PLAN CHECK •' 25% $ ENERGY P.C. $ Date' - Owner - Heating System& Ducting Registers ' I hereby certify that I have read this application and state that the above - 00.100,000 BTU 0100,000 BTL - - ELECTRICAL $ GRADING $ Information Is correct. I agree to comply with all city and county ordinances 'and,state laws relating to building construction,and hereby authorize repro- . • PLAN CHECK 50% $• - MICROFILM $ sentatives of this city to enter- upon the above-mentioned property for .. / 'inspection purposes. ,.) ' Signature / -Applicant; Pink -Accounting; Goldenrod - Assessor /� 417,, CONSTRUCTION AND PLANNING POOL& SPA Date ' Inspector - Date Inspemtor APPROVALS Permit# APPROVALS Permit# c ; �f • 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 FloorSystem61. 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 ❑Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush • 24. Roof Framing , 73. Undergrnd.Storage Tank ❑Gas 0 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 Domestic-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 4t70 _. _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations: - r - `$ .•: •^ - M PERMIT N!' rI TRACT NO. LOT.NO: UNIT No.. 3455 4/ 18/06 230:71 T!_ ' CITY-OF COSTA ME Ar CO iiSTyR�,UAC�TIRNCPERMIT .-- r A - Project Address #2—.-7, I �1 civc AtE.., /I . _ • - Applicant'sMailingAddress (ZiX LJr, FAST (.,n4, q t TYPE OF CONSTRUCTION '4 .NEW N:ADD M ALTERATION U REPAIR ' lI, El CONVERSION ❑ DE •LISH CI OTHER A•P•# Zone Owner's m N p4�2^g N •A,t Phon \ DESCRIPTION OF WORK/USE OF BLDG. • Address (` `•�-� •/y t• Z-.�� • S Main Building: - Accessory Building: E Z Arch/Eng. License No• . TYPE OF PERMIT ❑ GRADING U FOUNDATION 0 STRUCTURAL T Front •_ D Address L ,G�� �/� C(�` �f ❑ TENANT.ELECTRICAL 0 PLUMBING 0 MECHANICAL B Rear •- - N Contractor's NameLYL� S Aitt.. f Phone) l T lib 0 'OTHER A - I PROJECT DESCRIPTION SQ. Tzets OCCUPANCY C Right • r N Address(mailing) a► au e. • ��` K G 3' c CONSTRUCTION TYPE VALUATION $ $ Left City License No. () R ZONE - GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided ' E LICENSED CONTRACTOR DECLARATION y - I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: r/ (^LLc(, l • Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code, and FFF��� T my license is in full fq an. edict. t2`2j. 2.9 S Licen e •.ass `^ LI ens o. �) avo�T - Date S Signature All _ PLUMBING FEES WORK'RS'COMPENSATION DELLO' R, SON Bar Sink Showers ELECTRICAL FEES I hereby affirm that I have a certifi�.+e of consent to self-Insure or a certificate . _ of Workers' Compensation insurance, or a certified copy thereof (Section- 3800, Lab. C.) - Backflow Preventer Service Sink L. Automatic Washer iTransformer 0 15-50 KW Policy No. ''' Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW . �, certifietl copy is hereby furnished. - �1/� Certified copy is flled'with the city Building Division. ,Bathtubs Sewer Connection Cooking Unit Meter �up to 100 amps ,/V Date Applicant EXEMPTION FROM WORKERS'COMPENSATION DECLARATION-- - - Clarifiers-. Solar Collectors ( Dishwasher .10: Meter Lover 100 amps (This section need not be completed if the permit is for one hundred ($100) or l Dishwasher ,,,f ' less). r- Solar Piping, rev I Dryers IAGas DElectric 1 Sub Panel QQ I certify that in the performance of the work for which this rmit Is issued, I ((((( shall not e ploy any person in any man so as bee subject to the Drinking Fountains Solar Tank :!r.-- Fan Motors Do-1 HP ❑1'/s-B Workerp, a sfJ$n Laws of Califo I - - - ' Date 7 / 0 Signature. _Floor Drains Swimming Pool w/Spa: I F.A.U. Inc.Solar 09-15 HP ❑16.15+ OC NOTICE If,aft r making this tleclar u should become subject tothe • •Workers' Compensation provisions the Labor Code, you must forthwith Floor Sinks Urinal , 1 Fixtures• Microwave comply with such provisions or this. permit shall be deemed revoked. Q ZOO CONSTRUCTION: LENDING AGENCY • Gas Service "Outlets • Water Closet : Device Boxes , Pole Light I hereby affirm that there is a construction lending agency for the performance - g ' of the work for which this permit is issued '(Section 3097 Civ. C.) i- ' Interceptors Water Heater - _ "bp Outlets / Range Lender's Name - - - 9 Lender's Address • - - Kitchen Sink Water Service 1 2.. Switches Sign .1 OWNER BUILDER DECLARATION - ' , ge I hereby affirm that I 'am exempt from the Contractor's License Law for,the ; Lavatories- ' - '''' Autb-Wash '• 1 • following reason (Section 7031.5 Business and Professional Code: Any city or • Garbage Disposal ',Standing Sections l 1 OC county which requires a permit to construct,alter,improve,demolish or repair P—Trap .- - Laundry Trays r r Generator ❑0.5 KW❑5-15 KW -any structure, prior to'Its Issuance, also requires the applicant for such permit - `- - Trash Compactor ; ',to file a signed:statement that he/she Is licensed pursuant to the provisions of . ' ' - 1 'he Contractor's License Law (Chapter 9(commencing with Section 7000) of - • 'Roof Drains `%:f,8%Division 3 of the Business and Professions Code) or that he/she Is exempt _ , - _ 'therefrom and the basis for the alleged exemption. Any violation of Section , - , 7031.5 by any applicant for a permit subjects the applicant'to'a civil • • ,[ - — - _ ,penalty of not more than five hundred dollars($500). , - !irony al owner of the property or my employees with wages as their sole Reinspection Fee ' I $15 Issue Fee' $ 3 compensation, will do the work,and the structure is not intended or offered • Reinspection Fee I $15 Issue Fee $ 3 ,.for sale (Section 7044, Business and Professional Code: The Contractor's : , _ - 'MECHANICAL I FEES - License Law does'not apply to an owner of a property who builds or improves - thereon, and who does such work himself/herself or through his or her own r I DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not Intended or offered for , Boiler ' Hood or Type I 0 ' sale. If, however, the building or improvement is sold within one year of corn- . Canopy Type II 0 Zoning Approved By ' Date , pletion, the owner will have the burden of proving he/she did not build or im- , Duct-Under Ground Building Approved By - Date prove for ownerthe purpose the of oe). /J y-1G-kb ❑ I, as of the property, Se exclusively contracting with scions con- Duct-Structural • Refrigeration System Application Issued By �,(.7 Date e tractors t0 construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating • -- ❑0-100,000 BTU 0100;000 BTU SUMMARY OF FEE$ builds or improves thereon,and who contracts for such projects with aeon- _ • - tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP . $ proof oftheir Worker's Compensation insurance should be provided to me.• _ PLAN $ PERMIT ❑ lam exempt under Section B. & P.C.for this reason Firepl/Fact.BIL ICBO# Fire Dampers PLUMBINGN CHECK $ PERMIT ISSUANCE $ Date owner. •• Heating System& Ducting • Regist_ers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above 00.100,000 BTU ❑100,000BT �s GRADING $ • information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ 2. 1.frO% • and,state laws relating to b Ing construction, and hereby authorize repre- sentatives of us city nt r upon the above-mentioned pr pert ft PLAN CHECK '50% $ I 2-3� • inspection p se l t/G MECHANICAL $ - TOTAL FEE $ 3'�rYQ DSirivers' Date orlbers• a or 55 of •E -Accounting; Goldenrod - Assessor / CONSTRUCTION AND PLANNING PO.._ &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 41 ElectricalConduit-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, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. ,, 60. 'Backwash Lines, P-Trap, 0 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 7_30- 1, 67. Fencing & Access Approval 17. hough Wiring Sign 68. APPROVED FOR PLASTERING $-. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT '201-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 73. Undergrnd.Storage Tank ❑Gas 0 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 bil 1Q J 80. FOOD CERTIFICATE ISSUED 33. Final Electric Pi* v V Notes: 34. Final Heating& Air Conditioning - - - - 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 Domestic-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 E�34-F . Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - - ... - CITY OF COSTA ESAC CO(((y��� T/I����f�CiTI(9NrPERMIT I,ppRMIT ran TRACT NO. LOT NO. UNIT 3451 4/18/C6 39o; TL` Project Address .5.I Ivs p/,`r,� �I`,(4JE... lAr7�1 _ gv97/4. � t t Applicant's Mailing Addressp h i3 tISa r4,/ A�- ' TYPE OF CONSTRUCTION CHEW LJ ADD U ALTERATION U REPAIR 1 Owner's�y me 1F LA) /ld,�TdN Phone 67<-9-291 ❑ CONVERSION ❑ DEMOLISH 0 OTHER A.P..#6 I Zone JO. to,Y in3a Cr 'i2&c_c, DESCRIPTION OF WORK/USE OF BLDG. I Address l S Main Building: Accessory Building: Arch/Eng- - License No. TYPE OF PERMIT /U GRADING U FOUNDATION U STRUCTURAL T Front ZO Address / y 6 �I�(' /y/ / . ❑ TENANT �"[�ELECTRICAL 0 PLUMBING 0 MECHANICAL " A Rear N Contractor's Name^t L"-' SrAC� Lam`-r• PhOneci5-:`I7?t: 0 OTHER Ste GG �,sZ4O CJ C Right N Address(mailing) i Z/ t / r/7�C•f14- fiLC ZCO , PROJECT DESCRIPTION SQ. FT OCCUPANCY K - - G -^s CON STRUCTION.TYPE VALUATION S S Left City License No. / ! t 5. ZONE GRADING CU.YDS. ACRES R LICENSED CONTRACTOR DECLARATION • U _ Ping. Ref.# Parking Req-/Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: C�-a ( Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code, and my license is in full f�!'�antl •if¢� / (� r� , l — 'C1ti� , T Licens• C • s `- `-� ./ ense O.�( T 6�.Ce ( - - S Date 7A - Signature — • PLUMBING FEES ORK'RS'C•MPENSATION DE•i�' -TION Bar Sink • ShowersELECTRICAL FEES nereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (SectionBackflw Preventer Service Sink.3800, Lab. C.) - _ o - Automatic Washer • Transformer 0 15-50 KW Policy No: Company Backflow Irrigation Sewer Cap Construction Pole Sub. 050+KW Certified copy is hereby furnished. - - D Certified copy is filed'with the city Building Division. Bathtubs Sewer Connection Cooking Unit ' /r Meter Xup to 100 amps 5 £7 Date "'Applicant — — �r•`L�/ EXEMPTION FROM WORKERS'COMPENSATION DECLARATION - Clarifiers _ Solar Collectors ' Dishwasher Meter Dover 100 amps . i • W (This section need not be completed if the permit is for one hundred ($100)or less). Dishwasher Solar Piping ; Dryers Xas, ❑Electric ' Sub Panel ! A I certify that in the perfor.fnance of the work for which [hi permit is issued, I lJ I ' shall not em oy a yyerson in any ma r so as o be e subject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP 01%-8 Worker n [i Laws of Califo la •�� ' Date J Signature /� Floor Drains Swimming Pool w/Spa f ' F.A.U. Inc.Solar ❑g-15 HP❑16-15+ l 'NOTIC : f,alta snaking this declarafl , u should become subject to the _ - ^ ^ Workers' Compensation provisions'o-(he Labor Code, you must forthwith Floor Sinks • Urinal IO Fixtures /i� comply with such provisions or this permit shall .be deemed revoked. _ _ - - Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet 1 hereby affirm that there is a construction lending agency for the performance Device Boxes • Pole Light of the work for which this permit is Issued (Section '3097 Civ. C.) Interceptors - Water Heater �/ Outlets , ' Range Lender's Name - k Lender's Address - Kitchen Sink -. Water Service - /7 a Switches Sign OWNER BUILDER DECLARATION l I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash - / Garbage Disposal ;Standing Sections ^ following reason (Section 7031.5 Business and Professional Code: Any city or - ' ✓Q county which requires a permit to construct,alter,improve,demolish or repair P-Trap LaundryTrays Generator ❑0-5 KW❑5.15 KW any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor 'O the a signed statement that he/she is licensed pursuant to the provisions of Roof Drains se Contractor's License Law(Chapter 9(commencing with Section 7000)of - , • Jlvision 3 of the Business and Professions Code) or that he/she is exempt . , therefrom and the basis for the alleged exemption. Any violation of Section .• 7031.5 by any applicant for a permit subjects the applicant to a civil - - • pnalty of not more than five hundred dollars($500). LJ I; as owner of the property or my employees with wages as their sola Reinspection Fee • I $15 Issue Fee - $ 3 • compensation, will do the work,and the structure Is not Intended or offered - Reinspection Fee $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES - • License Law does not apply to an owner of a property who builds or Improves - - • - • thereon, and who does such work himself/herself or through his or her own - - DEVELOPMENTSERVICES REQUIREMENTS: , employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 Zoning Approved By Date sale, If, however, the building or improvement Is sold within one year of corn- Canopy Type II 0 pletion,'the owner will have the burden of proving he/she did not build or im• Dyct-Under Ground , - Building Approved By / Date prove for the purpose of sale). ,` ki0 /(, ❑ 1, as-owner of the property,am exclusively contracting with licensed con- i Duct-Structural ' Refrigeration System Application Issued By - of Date V`0 ---n9 tractors to construct the project (Section 7044,Business and Professions Code: -The Contractor's License taw does not apply to an owner-of property who Duct-Ventilating . 001100,000 BTU 0100,000 BTU - SUMMARY OF FEES builds or Improves thereon,and'who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that, Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ - SMIP $ proof of their Worker's Compensation insurance should be provided to me.' PLAN CHECK $ • PERMIT ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact:Bit. ICBG# Fire Dampers PLUMBING $ 0 ISSUANCE $ Date - owner - Heating System& Ducting Registers ' $ ENERGY P.C. $ I herebyPLAN CHECK 25% certify that I have read this-application and state that the above • ❑0.100,000 BTU ❑100,000BTL ELECTRICAL $ 2_1. 6� GRADING $ information is correct. I agree t comply with all city and county ordinances and state laws relating to buil g construction, and hereby authorize repre- MICROFILM $ l PLAN CHECK 50%, $ :4_2a) isnspection of t pu city t en upon the above-mentioned Pr erty.for I -. - - __. _. I p/ inspection pu s. i p G ' - MECHANICAL $ -3C1 l' O ' Signature Reinspection Fee I •$15 Issue Fee $ 3 PLAN CHECK 25% $ • a CMF 0865.46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting;Goldenrod - Assessor CONSTRUCTION AND PLANNING PC & 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. i • 54. Forms 4 r Electrical Conduit-Undrgrnd. y12i ea\i 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. i 60. Backwash Lines, P-Trap, 0 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.E Rough Electric Wiring '7 3p-g ' En 67. Fencing & Access Approval 17. Rough Wiring Sign i 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar-Ceiling j 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT 26: *tough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating - 71. Product Piping O Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 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.E Electrical Power Meter-Final it/ 80. FOOD CERTIFICATE ISSUED I}l 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 Domestic-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 ` -. ,-. Applicant to fill in.all spaces except those within heavy border lines and sign all appropriate declarations. - - -3120 - 4/15/85 RaaLT tan. . TRACT NO. LOT NO. Ug O/ / -- I - -i.zITY OF COSTA MESA CONSTRUCTION PERMIT �,/p pYrF -� 7 Pro ecYAddre?r tar-CI q _t7��(„r�� fix/x l •-;9',/ • • ."Applicant'sailin ddress /5s/ • L TYPE OF CONSTRUCTION ANEW U ADD U ALTERATION EPAIR - • • ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# I Zone Owner's Name Phone DESCRIPTION OF WORK/USE OF BLDG. ' Address `0 r O �- t /`130 (�J�'�/+'��'�--' S Main Building: Accessory Building: E - - Z Arch/Eng. License No. TYPE OF PERMIT ❑ GRADINGpn' FOUNDATION ❑ STRUCTURAL - T Front ' 0 Address -, - ❑ TENANT. ❑ ELECTRICAL t -PLUMBING 0 MECHANICAL B Rear _ N Contractor's Name'.V- -' . - l-+-C7=•-i Phone o ye�C. '�^ ❑ 'OTHER .iti°•(•' A I ]'r PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N' Address(mailing) / 7 3 - / >`lauc✓� - K G ��� C O N ST RUCTION TYPE .. VALUATION$ S Left R City License No. ZONE GRADING CU.VOS. ACRES - LICENSED CONTRACTOR"DECLARATION // Ping. Ref.# Parking Req-/Provided• E I hereby affirm that I am Iitense3 under provisions of Charter 9 (commencing Remarks: .79./e4,:.... //yam A' a`3 X74,.' Planning Notes: _ a with seclion,7000)'of•Division 3 of the Business and Professions Code, and �[/r/ J P/ M my license is in full force and effect. -� -. p CCr /� • T License Class C- • „ }Jceryge No.��e"+7 ! S t oat( a Ignature ' U f"' ffly-cr'GV • PLUMBING FEES ' N, VOR- ERS'CO PENSATION D LARATION '- Bar Sink Showers \` hereby affirm that I have a certificate of consent to self-insure or a certificate i ELECTRICAL ' FEES \ of Workers' Compensation Insurance, or a certified -copy thereof Sec on ' - -- O s,. I Backflow Preventer - Service Sink I Automatic Washer Transformer 0 15-50 KW 3800, Lab, C.) Policy No. ���� �r Company •J % Backflow Irrigation Sewer Cap IConstruc[ion Pole Sub. ❑ 50+KW • N. r�'-II Certified copyIs hereby furnished. �f 1� -Certifie4 pony I;�IleArl ffith the city Buil ng�iviti n4' ./ • ,,Bathtubs • / Sewer Connection %1/ Cooking Unit Meter 0u to 100 amps • '(7ateJ/-4•1 1Y /7.." pplicant en." •i+r'!— EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers _ .$plat Collectors -- Dishwasher - - Meter Dover 100-amps- - - (This section need not be completed if the permit is,for one hundred($100)or less). • . / Dishwasher Solar Piping Dryers ❑Gas DElectric Sub Panel I certify that in the performance of the work for which this permit is issued,I • shall not employ any person in any manner so'as'to become subject to the Drinking Fountains Solar Tank Fan Motors❑0-1 HP ❑1%-8 Workers' Compensation Laws of California. - , - , Date Signature / - Floor Drains Swimming Pool w/Spa F.A.U. 'NOTICE: If,after making this declaration, you should become subject to the - • Inc.Solar 09:15 HP 016-15+ -Workers' Compensation provisions of the Labor Code, you must'forthwith- Floor Sinks Urinal ' comply with such provisions or this .. Fix!ures,, Microwave , , permit shall be deemed revok¢tl. n_ I CONSTRUCTION LENDING AGENCY / ' Gas Service Outlets 3 Water Closet • " • I fit, i I l - POie• Light I hereby affirm that there is a construction lending agency for the performance Device Boxes of the work for -which this permit is issued (Section 3097 CIV. C.) Interceptors . Water Heater r( 0 •L Lender's Name • • /ry/,R(/,• fl�7� Ou?lets-^ l Range • • Lender's Address ' _ Kitchen Sink / Water Service • 00 ' Switches Sign OWNER BUILDER DECLARATION . ' I hereby affirm that am exempt from the Contractor's License Law for the 3 Lavatories ! Auto-Wash /q f, .�- Garbo a Dis Oral ' following reason (Section 7031.5 Business and Professional Code: Any city or ,s�-rs 9 P ;Standing Sections ' county which requires-a permit to construct,alter,improve,demolish or repair P-TrapLaundry Trays r Generator ❑0-5 KW ❑5-15 KW -any structure, prior to its issuance, also requires the applicant for such permit ' ' - Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions o1 Roof Drains -- • -. he Contractor's License Law (Chapter9 (commencing with Section 7000) of • r °"-` • ' )i vision 3 of the Business and Professions Code) or that he/she is exempt . j', r therefrom-and the basis for the alleged exemption. Any violation of Section - - s . 7031.5.by any applicant for a permit subjects the 'applicant to a civil - I •penalty of not more than five hundred dollars,($500). - . I .•. • L I I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee- $ 3 -compensation, will do the work,and the structure is not Intended or offered 1 Reinspection Fee • $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's _ MECHANICAL FEES a_ License Law does not apply to an owner of a property who builds or'Improves _ _ _ _ _ _ thereon, and who does such work himself/herself•or through his or her own _ - - -- - DEVELOPMENT SERVICES REQUIREMENTS: • • employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 1;. sale- If, however,the building or improvement is sold within one year of com- - Canopy Type II 0 Zoning Approved By Date ' Mellon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground i Building Approved By Date prove for the purpose of sale). - - - - - �( (` ❑ I, as-owner of the property, am exclusively contracting with licensed con- Duct-Structural - • Refrigeration System . ( Application Issued-By '4/�+' Date / / Q� tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does.not apply to an owner of property who Duct-Ventilating - ❑0-100,000 BTU ❑100,000 BTU -• • s' SUMMARY OF FEES - builds or improves thereon,and who contracts for such projects with a con- - lraclor(s) license pursue tit to the Contractor's License Law). am aware that • i BUILDING PERMIT $ SMIP • $ ' of Exhaust System 0 Multiple System Repair/Alteration proof their Worker's Compensation insurance should be provided to.me. ! ' $ PERMIT 1 ❑•I am'exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers r- - PLAN CHECK r• • „,.. •-, PLUMBING • • $ i i ►q -ISSUANCE $ - Date Owner Heating System& Ducting Registers !.1 - 1 'PLAN CHECK 25% $ - ENERGY P.C. $ I hereby certify that I have read this application and state that the above • 0o-100,000 BTU 0100,000 BTL - Information is correct. I agree to comply with all city antl county ordinances • + ELECTRICAL GRADING $$ - and-state laws relating to building construction,and hereby authorize tante- I MICROFILM $ inspection sentatives of his city en upon t. e above-mentioned Ipreperty. for ,PLAN CHECK .50% $ inspection Du os 1�0 /- MECHANICAL $ 1 Signature �. ' - Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK '25% $ • r �� CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 'ir CONSTRUCTION AND PLANNING APPROVALS Permit# Pt. &SPA• . Date Inspector APPROVALS Permit# Date Inspector _i 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location .2.' oil Pipe-Undrgrnd. ,4//L/fl !/ 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54.-f/ 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, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. .9/1,9( L1 2/' 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System �L�� 61. APPROVAL TO DECK I 11. Property Sewer Line & House Connection fr./VP P seer 62. Backwash & Receptor-Final 12. Sewer Cap !� • 63. Heater & Vent-Final 13..-Roof Drains . 64. Plumbing System - Final . 14,.Rough Plumbing G�;4,/y( fere 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final . 16.;fiough Electric Wiring 67. Fencing & Access Approval 117, Rough Wiring Sign - 68. APPROVED FOR PLASTERING 18.E 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 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 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: 49 .-/a -5'4- en9 34. Final Heating & Air Conditioning /fat / -- / �- _../ C i . IJ /lwdLK )trt� _i�'7C 35. Final Gas Pipe-Test ,%/p7 �,�� '�'� J�� ,/ e • 36. Hood or Canopy , �'�N. -.u�lr�- + !�� L 37. Final Factory Fireplace 38. Final Plumbing dim. lies 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 1 • 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 1 51. CERTIFICATE OF OCCUPANCY _ No. _ Date • Applicant to till in all spaces except those within heavy border lines and sign all appropriate declarations. - - 3119- 4/4 5,436 - /'• c PE IT NO- TRACT NO. LOT NO. UNIT NO. . CIiY OF COSTA MESA CONSTRUCTION PERMIT2 _ fi��_ - - Prolect Address �� Vb1' - • - Applicant's Mailing A rens - /CST ..yY[/rwL.Lr-s..ee• TYPE OF CONST,�UCTION �-NEw U ADD U ALTERATION U REPAIR ❑ CONVERSION 0 DEMOLISH 0 OTHER A.P.# .,I tone Owner's Name - - Phoone DESCRIPTION OF WORK/USE OF BLDG. Address /00e��- //9, o l�%`�- .7.---a"--.4---- S Main Building: Accessory Building; : Arch/Eng, _ _ - License No: f1 TYPE OF PERMIT 1:1 GRADING U FOUNDATION U STRUCTURAL E Front - 1 O! Address • I 0 TENANT 0 ELECTRICAL r-� LUMBING ❑ MECHANICAL - A Rear _ - N �l�C^� �,4-- Contractor's Namwt. Phonpr �"�/�03" 0 OTHER - 'ROJECT DESCRIPTION SQ. FT, OCCUPANCY C Right N Address(mailing) i4oL.vss tea• - K - G City License No. /,'�� �_- i CONSTRUCTION TYPE • VALUATION $ S Left �_ , R / • ZONE GRADING CU.YDS. ' ACRESE • LICENSED CONTRACTOR DECLARATION Ping. Ref.# • Parking Req./Provided whereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: /f f/)-� e'a /�. Planning Notes: - - ., M with section 7000) of,Division 3 of the Business and Professions Code,and 2 ""•,," T my license isi full force and effect. , License Class Cr LI 'ns- - o. _ S Date rev/i-4..? i•nature • 4d/' PLUMBING FEES ! . WORKERS'COMPENSATION DE • RATION - Bar Sink • . Showers , • hereby affirm that I have a certi . e.of consent to self-insure or a certificate ELECTRICAL FEES of Workers' Compensation Insu ante, or a certified -copy-then f (Se ion Backflow Prev¢hter Service Sink - (� 3800, Lab. C.) a�� �S d-'st-F- Automatic Washer: Transformer 0 15-50 KW x Policy No. T- Company �"" / - Backflow Irrigation '• Sewer CapConstruction Pole Sub. • ❑ 50+KW I q Certified copy is hereby furnished. r 4J Certiflee copyy is/fi'lej&with the city in Di j ron _j f_. • ,ieathtubs • if Sewer Connection ' /�l i 0 Cooking Unit ' . • Meter ❑up to 100 amps / / ! .'"/ Applicant c. /-2➢„°�pY 1 EXEMPTION F�M WORKERS'CO ENSATION DECLARATION - - Clarifiers Solar Collectors - • _ . Dishwasher • _ Meter Dover 100 amps, _ (This section need.not be completed ' he permit is for one hundred ($100) or less). ' •,.� / Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel \ I certify,that in the performance of the work for which this permit is issued, 1' , shall noemploy any person in any manner so as,to become subject to te" Drinking Fountains Solar Tank , Fan • ' Motors❑01 HP ❑1'h-B Workers' Compensation Laws of California. .JI _ Date • Signature • Floor Drains • Swimming Pool w/Spa F.A.U. _ Inc.Solar 09.15 HP 016-15+ 'NOTICE:If,after making this declaration,you should become Subject to the - • -,..‘• Workers' Compensation provisions of the Labor Code, you must forthwithFloor Sinks • Urinal • Fixtures Microwave comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY. / - `�, - 81 ' O Device Boxes POI¢ Light ! Gas Service 'Outlets Water Closet ' I hereby affirm that there is a construction lending agency for the performance - qn • of the work for 'which this permit is issued -(Section 3097 Civ, -C.) Interceptors Water Heater y, i6 Outlets Lender's Name _ �/ Range Lender's Adtlress - / Kitchen Sink / Water Service Y St Switches• • .,. OWNER BUILDER DECLARATION _ 6 Sign I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories '/ Auto-Wash • £ Dc p • following reason (Section 7031.5 Business and Professional Code: Any city or { Garbage Disposal ;Standing Sections • county which requires a permit to construct,alter,improve,demolish Or repair '. P-Trap - LaundryTrays ' any structure, prior to its issuance, also requires-the applicant for such-permit - -- y Generator ❑0.5 KW❑515 KW Trash Compactor to file a signed statement'that he/she is licensed pursuant to the provisions of ' .Roof Drains , ' ' the Contractor's License Law (Chapter 9(commencing with Section 7000)of , ' Division 3 of the Business and Professions Code).or that he/she is exempt • _ • - herefrom and the basis for the alleged exemption. Any violation of Section - - - - - ' 7031.5.by any applicant for a permit Subjects the-applicant to a civil . y ' enalty-of not more than five hundred dollars($500). • • LJI; ai owner of the property or my employees with ages as their sole Reinspection,Fee ' ' $15 - • Issue Fee . , $ 3 compensation, will do the work,and the structure is not Intended or offered - - - Reinspection Fee I $15 Issue Fee' $ 3 for sale (Section.7044, Business and Professional Code: The Contractor's ' , MECHANICAL . FEES I License Law does not apply'to an owner of a property who builds or improves - 1 thereon, and who does such work,himself/herself-or through his or her own • DEVELOPMENT SERVICES REQUIREMENTS: , employees, provided that such.improvements are not intended or offered for ' Boiler Hood or, Type I ❑ , sale. lf,'however, the building-or improvement is sold within one year of com Canopy Type II 0 Zoning Approved By - Date pietion, t the owner will have the burden of proving he/she did not build or im- Duct-Under Ground i Building Approved By' Date___///f_ ' prove for the purpose of sale). 0 I, as owner of the property, am excluSively contracting with licensed con- r Duct-Structural • . Refrigeration System Application Issued By �A �f i - Date tractors to construct the project (Section 7044,Business and Professions Code: ' The Contractor's License Law does not apply to an owner of property who - Duct-Ventilating . - - - 00-100,000 BTU. 0100,000 BTU SUMMARY OF FEES • builds or Improves thereon,and'who contracts for such projects with a can- — - 1- traclor(z) license pursuant to the' Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 • System • Repair/Alteration ' BUILDING,PERMIT $ $MIP t-• '1$ • proof of their Worker's Compensation insurance should be provided to me.- • IPLAN CHECK $ PERMIT 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact,Blt, ICBG# Fire Dampers PLUMBING $ R059 ISSUANCE. • $ Date • Owner. - Heating System&Ducting • Registers PLAN CHECK 25% $ ENERGY P.C. $ - I -hereby certify that-I have read'this application and state that the above - 00-100,000 BTU'❑100,000 Ira GRADING $ Information is correct. I agree to comply with all city and county ordinances ' ELECTRICAL $ ' and state laws relating'to building construction,and hereby authorize repro- • PLAN CHECK .50% $ MICROFILM • $ sentatives of is city o,Wer u o the above-mentioned property for ) Inspection p > - tie. 00 Signature //h - a _ ' Date ri/' M� I - MECHANICAL $ TOTAL FEE $ tie. Drivers cense or 55# / Reinspection Fee ,$15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 086546,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor • & 'CONSTRUCTION AND PLANNING POC I SPA Date Inspector Date Inspector /F APPROVALS Permit# APPROVALS Permit# 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 'SW&L Alec 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 UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. . 9//7/43/ ,9pf' 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection c//04 /ii r 62. Backwash & Receptor-Final 12. Sewer Cap /✓,r 63. Heater & Vent-Final 13.,Roof Drains 64. Plumbing System - Final 14. Rough Plumbing I.„23-flgfic 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 P. 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 0 Oil 23. Gas Pipe-Rough & Test - 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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 //4/f ' }fief 36. Hood or Canopy - 37. Final Factory Fireplace 38. Final Plumbing 1/4/19f' 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-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 -- _," Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 28.00 - • • CLTY OF COSTA MESA CONSTRUCTION PERMIT PERMIT 1 NO. / TRACT NO. LOT NO. UNI NO. 9122 . 7/09/86 - Project Address 2551 ELDEN ST. M��i'y` ��44 LI - M1 ' Applicant's Mailing Address 2121 S. GRAND AVE. , SANTA ANA TYPE OF CONSTRUCTION t.7 NEW u ADD Li ALTERATION LI REPAIR • f 's Na • 'Owner ROBINSON Phone 645-7300 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,# • Zone P.O. BOX 11930 COSTA MESA - DESCRIPTION OF WORK/USE OF BLDG. . ' Address S Main Building: AccessoryBuilding: Arch/Eng. _ ' License No. TYPE OF PERMIT ❑ GRADING Li FOUNDAT •y ❑ STRUCTURAL E Front o ('k Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING Y MECHANICAL B Rear . , , N Contractor's Name'SIERRA ENVIFCfifENPAL. SYSTEMSghone 957-8991 ❑ 'OTHER - - A . •• 1 • PROJECT DESCRIPTION 50. FT. OCCUPANCY C Right N Address(mailing) 2121 S. GRAND AVE. K - G g - CO N ST RUCTION TYPE VALUATIONS S Left CityLicenseNo_ 024912 ZONE GRADI NG CU.YDS. ACRESE N ' ' LICENSED CONTRACTOR DECLARATION . Ping. Ref.#' Parking Req./Provided . I hereby affirm that I am licensed under rovi ions of Charter 9 (commencing Remarks: BUILDING PERMIT # B23293 -Planning Notes: • - Q • with section 7000) of Division 3 of h Bus ess ro dons Code; and • - M 2�my license is in full(orcedetfect' 45194 ' $ ,License Class I •e,.� \ -s Date 7/3/86 Signature PLUMBING FEES ' • �J WORKERS'.COMPENSATION DEC RATI N • Bar Sink Showers ELECTRICAL FEES I hereby affirm that I have a certificate of consent to se f-in re or a certificate 1 \ of Workers' Compensation Insurance, ora certified co• thereof (Section Backflow Preventer Service Sink - - - - - _ -- 3800, Lab. . .. Automatic Washer -r -Transformer•❑ 15.50 KW'.- 50j071230WC F''+ Ig \- Policy.No. Com•.ny 14 Backflow Irrigation Sewer Ca '❑ 50+ KW Cap; I Construction Pole Sub. ].Certified copy Is hereby fur cit '// L. / rtifietl copy is filed with the city Bu .i . Divi •n. Bathtubs • j Sewer Connection Cooking Unit Meter ❑up to 100 amps Date 7-246 Applicant 4 �,� , EXEMPTION FROM WORKERS'COMP=NSATION DEC ATION I• Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the permit Is for one hundred($100)or • Qless). Dishsnasher ' Solar Piping Dryers OGas ❑Electric Sub Panel I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any.manner so as to become subject to the Drinking Fountains . Solar Tank Fan \ Workers' Compensation Laws of California. ' , Motors�o-1 HP ❑1'h-8 - Date Signature Floor Drains I; . • Swimming Pool w/Spa r' F.A.U. Inc.Solar 09-15 HP 016-05+ 'NOTICE: If,after making this declaration,you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks ' . Urinal - -- Fixtures - - - ' - -- .-- complywithsuch provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY - Gas Service Outlets Water Closet • ' I hereby affirm that there is a construction lending agency for the'performance Devic¢Boxes POIe Light of .the work for which this' permit is issued (Section 3097 Civ. C.) Interceptors - Water Heater Outlets Lender's Name Range Lender's Address - - ' Kitchen Sink . Water Service- SwitchesSign - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories . . Auto-Wash . Garbage Disposal ' following•reason (Section 7031.5.Business and Professional Code: Any city or 9 P Standing Sections county which requires a-permit to construct,alter,improve,demolish or repair • P-Trap Laundry Trays Generator any structure, prior to its issuance, also requires the applicant for such permit ❑0-5 KW❑5.15 KW Trash Compactor • to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains the Contractor's License Law (Chapter 9(commencing with Section•7000)of Division 3 of the Business and Professions Code) or that he/she is exempt , therefrom and the basis for the alleged exemption. Any violation of Section • 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars($500). . r U I, as owner of the property or my employees with wages as their sole , Reinspection Fee $15 Issue Fee $ 3 compensation, will do the work,and the structure is not intended or offered - Reinspection'Fee $15 Issue Fee . , $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's ' MECHANICAL FEES ' License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own - DEVELOPMENT SERVICES REQUIREMENTS: • • employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0 - ' sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 - Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground prove for the r the'p Building Approved By Date of sale). % c.......• 7/ itt ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structufel Refrigeration Sysiem Application Issued By -/% c.......• Date J A 10 tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who •7 Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with aeon- - - M tractor(s) license pursua • nt to the Contractor's License Law). I am aware that System Repair/Alteration - BUILDING PERMIT $ SMIP : , J , proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT 0.1am exempt under Section - B.& P.C.for this reason '-Z Firepl/Fact.Blt. ICBG 4b/Z9 Fire Dampers ' C ISSUANCEERMIT $ . PLUMBING $ _ ' Date ! Owner - a- c He ting System& Ducting Registers ENERGY P.C. $ PLAN CHECK 25% $ - I hereby certi y- hat I have read this application and state that-the above Z 100,000 BTU 0100,000 BTL ga DJ ELECTRICAL $ GRADING ' $ information,is o rect. I a,ree to c. ply with all city and county ordinances b and state laws r b i tlin• •nstruction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ sentatives of h y - ter u'•n( he above-mentioned pro er y for q inspection pur•. I yyy //- MECHANICAL $ a•C-3' �� TOTAL FEE $ �� en) Signature I I, 1�. -..- Date /i/X� D� c Drivers' Licen or SS;$ T7��"—• Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $ 5' �� `\CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor -, CONSTRUCTION AND PLANNING POO1 ,PA e Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit# 1. Tdmporary 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 `7 . 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, 0 Undrgrnd., Test 1 9. Water Pipe-Undrgrnd. - 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System - • 61. APPROVAL TO DECK 11. Property Sewer Line & House-Con'nection 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. 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 0 Oil 23. Gas Pipe-Rough& Test - 72. Underground Flush • 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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 PREY. 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 ;/yfr ,'//7 ' • 35. Final Gas Pipe-Test / 36. Hood or Canopy 37. Final Factory Fireplace th/.r7 of 38. Final Plumbing 39. Water.Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer • ,e ' :r C r 43. Backflow Irrigation t 44. .Landscape Irrigation System i.• 45. Sound Attenuation - ' 46. Handicap Regulations • e . 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison ' . i) 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY 4 - • No. Date - - _ A City of Costa Mesa Development Services Department CERTIFICATE OF OCCUPANCY No. UJ Building Safety Division 0�+ P.O.Box 7200 Costa Mesa,California 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 n_i Occupancy. Use of Building Rsaci, an+i �1 Legal DescriptionA o 4AlQ_171_In Reinspection Permit E23464, (See reverse side for Metes and Bounds) P26593, Jo. 2823295 E23374, E23466 , P23396 , • Building Permit No 823295 Electrical Permit No. E2346S Plumbing Permit No.no,10•7 Fire Permit No. F24215 Mechanical Permit No. M944Q1 Number of apartments - and/or guest rooms ISSUED TO: Building Official William T. . Howard Ken Robinson 2 - P.O. Box 11930 by ;/ ..v x' .'. . _� Costa Mesa, CA 92627 Date / 7% fs 7 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 r'': Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - - 2315 4/02/BE /'icor. I IL, TSA CONSTRUC♦TION PERMIT C3` T 232 TRACTNO L%TNO. UN NO. 51 rldey✓ Aye., G LLi la L d -LL77LL C i • ailing Address •• L. a Lill . . , • TYPE OF CONSTRUCTION NEW U ADD Li ALTERATION U REPAIR ( ' I nt�,,,� ❑ CONVERSION ❑ DEMOLISHOTHER Owner',s Name k a - '.vbnostnv Phone �7sva91 DESCRIPTION OF WORK/USE OF BLDG a��L C D d!p A.P.A-P,# (�-9-4/71 -30 Zona i� Address 't o . GO 3L 1 14 3 0 C. n� 5-,'L' '2-7 /.1/ p,L/, gift a S Main Building: Accessory Building: , Arch/Eng.a &'esign... ASSOC. License No. 11/oO-7 TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION LM.STRUCTURAL,A E Front /e� � 0 Addreas I QQ I (,t]- 1 t �- C.- N1 4i ab a 7 1❑C TENANT_ ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL Mil BA Rear Ivo f .. • _ N Contractor's Name L-i 'w' -Props Jill,Phone Al> 11. �.yOTHER �eTelYa_( 2-z !74 f P ) - !� Jf-. C Right �bf N 7 PROJECT DESCRIPTION SQ. FT. 247�a • OCCUPANCY Address(mailing) tips D. /3 rix 31 C{ 3O , CM 9-74, 27 K G y CONSTRUCTION TYPE ✓ VALUATION$�o4 7. L0 .$ Left Oa 1 R City License No: _a 11/ ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION _ Ping. Ref.# Pe...--b9 -� ' Parking Req./Provided /�) 8 E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: PG ' 9/G.. ' "5 FCE pp 5 Ge BLoG A Planning Notes: V M • with section 7000) of Division 3 of the Business and Professions Code,and Mall FUR Sri:Lltw stn ULztsa,1 .st4 T my license is in full force and effect. t2 .License ClassLl once No.a 73s 0 . - - S Date' Signature el A .S /J07y/ . PLUMBING FEES WORKERS'COMPENSATION DECLARATION Bar Sink i Showers I hereby affirm that I have a certificate of consent to self-Insure or a certificate ELECTRICAL .FEES - Workers' Compensation Insurance, or a certified copy thereof (Section 00, Lab. C.) .- r• Backflow Preventer Service Sink,... Automatic Washer Transformer 0 15-50 KW -- 8 olicy No. - Company, ' - • Backflow Irrigation Sewer Ca -. •< . 0 50"+KW' P Construction Pole Sub. y-. Certified copy Is hereby furnished- I Certified copy is filed with the city:BuildingDivision, Bathtubs Sewer Connection- Cooking Unit Meter Dug to 100,amps Date Applicant - Clarifiers I EXEMPTION FROM WORKERS'COMPENSATION DECLARATIONSolar:Collectors Dishwasher Meter Cover 100 amps (This section need not be completed If the permit Is for one hundred ($100) or less). _ Dishwasher Solar Piping -j Dryers ❑Gas DElectric Sub Panel -; f I certify that In the performance of the work for which this permit is Issued I' `•-' shall not employ.any person in any manner so as to become subject to the Drinking Fountains Solar Tank .'" - Fan Workers' CompensatjtLonJ.aws of California, • /� ,�" • - - V_ Motors 00-1 HP'❑.1,%-8 Date j,7-�/e '$' Signature c" 4 0ele-.11. >' ' Floor Drains Swimming Pool w/Spa'J — F.A.U. 'NOTICE:If,after making this declaration,you should become subject to the Inc-Solar 09-15 HP 016-15+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal • comply with such provisions or this permit shall be deemed revoked. Fixtures Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet - • Device Boxes 1 hereby affirm that there is a construction lending agency for the performance ._• Pole Light of the work for :hich this pe U is iss -d (Section 3097 Civ Interceptors Water Heater Outlets Lender's Name •�••'+ - - vZ1[A1I . - . Range Lender's Address to !' de A-- Gael. Kitchen Sink Water Service Switches . Sign OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the ' Lavatories , ' - Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal ;Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap LaundryTrays any structure, prior to its issuance, also requires the applicant for such permit Generator 00-5 KW 05-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains .. the Contractor's License Law(Chapter 9(commencing with Section 7000)of cf. -- Division 3 of the Business and Professions Code) or that he/she is exempt , '-ierefrom and the basisfor the alleged exemption. Any violation of Section : b 31.5 by any applicant for a permit subjects the applicant to a civil - laity of not more than five hundred dollars($500). J I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 _ compensation, will do the work,and the structure is not Intended or offered 'Reinspection_Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: J�//' employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I 0 - T•a '.a • sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By e-+/"�"_'ts Date �f pietion,the owner will have the burden of proving he/she did not build or im- • Duct-Under Ground Building Approved By Date'2- /-� prove for the purpose of sale). '1 / ❑ I,'as owner of the property, am exclusively contracting with licensed con- Duct-Structural i Refrigeration System : Application Issued By Date 7 z/ Cfs‘ tractors to construct the Project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property Who Duct-Ventilating 00-100,000 BTU ❑100,000 BTU $U Y OF ES builds or improves thereon, and who contracts for such projects with a con- tractOr(s) license pursuant to the Contractor'sLicense Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ 7n SMIP $ /..3 I proof of their Worker's Compensation Insurance should be provided to me. PLAN CHECK $ PERMIT 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers PLUMBING $ ISSUANCE $ Date • owner _ - Heating System& Ducting Registers • ! ' • ENERGY P.C. $ _ I•,,:PLAN CHECK' 25% $ i i hereby certify that I have read this application and state that the above -- - ❑0.100,000 BTU 0100,000Bit - • - - r,r, GRADING $ information is correct! I agree to comply with all city and county ordinances - ELECTRICAL $ and state laws relating to building construction, and hereby authorize repro- - - MICROFILM $ inspection sentatives of this city to enter upon the above-mentioned property for PLAN CHECK 50% $ inspepurpose . ' Signature . „ s.% Date a1,7�G-d!S MECHANICAL $ TOTAL FEE $ tat - - ^� Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% -S'2 .�/ Drivers' l-stance or SS# � $ / • CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor ;TRUCTION AND-PLANNING POOL 'PA - OVALS Permit Date Inspector APPROVALS Permit# Date • Inspector / nporary Electrical Service or Pole ' 52. Pool & Equipment Location - ;.il Pipe-Undrgrnd. • 53. Steel Reinforcement . Electrical Conduit Utility-Undrgrnd. - 54. Forms n4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement . 56. Rough Plumbing & Pressure Test '. 6. Electrical UFER Grnd. - // Oa° /� 57. APPROVAL TO COVE R-GUNITE • ' 7. Footings PO 58. Electrical Conduit-Undrgrnd. . • -8. Foundation 7�/I v�•/- 59. Gas Pipe, ❑ Undrgrnd.,Test - :' 9. Water Pipe-Undrgrnd. (!/ 60.'Backwash Lines, P-Trap, 0 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 - 1.1. Rough Wiring Sign 68. APPROVED FOR PLASTERING 181 Rotigh 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 r' i 70. Underground Hydro • 22. Ducts,Ventilating -., • 71. Product Piping O Gas ❑Oil , 23rGas Pipe-Rough & Test ' • - 72. Underground Flush - 24..Roof Framing / 73. Undergrnd.Storage Tank 0Gas 0 Oil ' 25. Roof Sheathing 1 , I' 7 i 71“ Vc 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical • .- - 27. Frame and Flashing - ,�. '�/�/N leo 76. Dry Standpipe 28. Lathing & Siding 1�) /K 77. FIXED SYSTEM FINAL • • 29. Insulation Vu/84 1)hi 78. FIRE PREV. FINAL 30. Drywall Nailing '%;., S ,//V I/C} HEALTH DEPT. REQUIREMENT 31 Plaster Brown Coat •. /`I/4 tIt 79. FINAL INSPECTION ' 32. Electrical Power Meter-Final ' - 80. FOOD CERTIFICATE ISSUED /�/,is = 33. Final Electric _ r Notes: /. , Ivo i d 34. Final Heating & Air Conditioning HOLD.FOR SPE • REQUIRE!• T3 Vai 35. Final Gas Pipe-Test - 8(/f 6 64 -no-k 11e.d t-eaSkev *- 36. Hood or Canopy lb . �� - 37. Final Factory Fireplace ' �� D� d7�/� 38. Final Plumbing - ((( IL91 M _�1711gIcr7 Q12- - 39. Water;Ser'vice-Final • • • • 40. Gas Service-Final ' A 41. Solar Domestic-Final 42. Backflow Preventer. - - • f. 43. Backflow Irrigation, 44. Landscape Irrigation System - • - _ 45. Sound Attenuation . 46. Handicap Regulations . 47. FINAL STRUCTURE & BUILDING /y/ 48. Special Requirements Completed l/f,4 /i7 nit • 49. Electric Release to Edison 1 -• 50. Gas Release to Southern California Gas Co . 51. CERTIFICATE OF OCCUPANCY ' No. Date• • - - ' - '. ._ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations, - CITY MESA :CONSTRUCTION PERMIT PERMIT NO. - TRACT NO. LOT NO., UNIT O. Iry 9550 7%16786 18.00 it Project Address o'z SS/ /p�/-j�/��► �i/l�y / 1:492 3.2 s d/2 4�f% / Ci - - • Applicant's Mailing-Address /7 -1 �/ ? U TYPE OF CONSTRUCTION 'R NEW' U ADD �( ALTERATION Li REPAIR i • .•� I '❑ CONVERSION; ❑ DEMOLISH ❑ OTHER • Owner's Name. : /r / 6.6/J' CO "YPhone_L7 f C_20 - - . - - -- -— - - -- A.P.# _- - ..._ - _ Zone • 'DESCRIPTION OF WORK/USE OF BLDG. • I Address �J(>K //Q '�Q t IS Main Building: Accessory Building: , Arch/Eng. I - /� - License No./360 -7 TYPE OF PERMIT •'❑ GRADING ❑•FOUNDATION ❑ STRUCTURAL T Front ' - I i p Address - I/ - y❑I TENANT :❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BB Rear ; • . ' N • Contractors Name L is d� • Phone%-. •1•W OTHER.__��r/2//2LL.O _. �- f 7 ,,Once C Right , I • -� N �r PROJECT DESCRIPTION' SG. FT. OCCUPANCY G Address(mailing) �c,5^ ' /13U, C e :/1-'7 /044#11.7.1.20 K - ' 1 - r , 'CONSTRUCTION TYRE VALUATION$ S Left S r I I , City License No. ,77/.// •• ZONE I +GRADING CU.YDS. ACRES ' R LICENSED CONTRACTOR DECLARATION - - .Ping. Ref.# . ' Parking Req./Provided • . , E ' I hereby affirm that I am licensed untler'provislo ns of Charter 9 (commencing Remarks: l r ' t_ • Planning Notes: - M . with section 7000) of Division 3 of the Business and Professions Code, and - - - my license is in full-�r�rce and effect: .-t _ - 1 , _ s_ r S License Class I /S �}cen e No. or 7965 d - - -• i ' Date 7^'/t• `s'/p Signature / ' /ice-��^x 3'�- - " - - •, • , PLUMBING , - •• _ .FEES . ;2 ,-' r [ i WORKERS'COMPENSATION DECLARATION Bar Sink : 4 - Showers i • ereby affirm that I have a certificate of consent to self-insure or a certificate - , - I - ? •�, ELECTRICAL' I -FEES • Workers' Compensation Insurance, or a certified copy thereof (Section - - _ _ • - r _ ...cid!), Lab. C.) l Backflow Preventer , I I ;Service Sink - , - •_ Automatic Washer' - Transformer'❑�15-50 KW Policy No. Company Backflow irrigation - 'Sewer-CapI I - , .• r i '❑-50+.KW 1 .• Construction Pole Sub. BCertified copy is hereby th thehed. i - - - - ' - - Certified copy is filed with the city Building Division. Bathtubs I .Sewer Connection Cooking Unit r - amps Meter ❑up lb 100 Date Applicant Clarifiers - EXEMPTION FROM WORKERS'COMPENSATION DECLARATION ' ; + Solar Collectors Dishwasher 9 .4 _,Meter ❑over 100 amps (This section need not be completed/if the permit is for one hundred ($100)or - - 1 _ less) . Dishwasher • - - -Solar Piping . , , - , Dryers ❑Gas ❑Electric' Sub Panel' • I certify that in the performance of the work for which this permit is issued,I - - - - shall not employ any person in any manner so as to become subject to the Drinking Fountains :Solar Tank Fan, - I Motors Ill 0-1 HP ❑1Yr-8, - Workers' ompensation Laws of California - , - - Date ,{ - p( ' Signature 5 a,_4_,.....,_ - Floor Drains I " 'Swimmin Pool vv/Spa"a" - " " l , 9 P F.A:U. 'Inc.Solar❑9-15 HP ❑16-15L - NOTIC if,after-making this declaration, you should become subject to the _. I - - . " , _ _ -. _ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks • Urin• al Fixtures " Microwave+ comply with such 'provisions or this•permit shall be deemed revoked. _ . CONSTRUCTION LENDING;AGENCY Gas Service -Outlets , :Water Closet • Device Boxes I hereby affirm that there is a construction lending agency for:the performance j Pole Light • of the work ,for w cch this permit •,is.{pyued:_($ectior ••• 3097 Civ. C.) Interce tors I • • •Water Heater ' ! ' Lender's Name /�a+""X` L P I : I Outlets .. 1 (• /��d ea„ 1 Range Lender's Address_ fl A DMawr� !`di FCS' ' Kitchen Sink. - l- - 4 -' Water Service- ._- ' OWNER BUILDER DECLAR TION • -' $witches -Sign I hereby affirm that am exempt from the Contractor's License•Law,for the Lavatories 1 I I Auto-Wash I Garbo a Di5 oral I I following reason (Section 7031.5 Business and Professional Code: Any,city or 9 P Standing Sections ' county which requires a permit to construct,alter,improve,demolish or repair P-Trap t , Laundr Tra s • any structure, priori') its issuance, also requires the applicant for suchpermit - - - - , y• y , , - Generator ❑0.5KW ❑5-15 KW ) Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains - the Contractor's License Law (Chapter 9(commencing with Section 7000) of j + 'vision 3 of-the Business'and Professions Code) or-that he/she-is-exempt - - - — , - , -•- -- - - - . --' - -' - - -- -- - '-' . - - - refrom and the basis for the alleged ion. Any violation of Section r r ' ' . ,31.5 by any applicant for a permit I subjects the applicant to a civil - - ! 1 "penalty.of not more than five hundred dollars . + I - • I4 . • 0 :, as owner of the property or my employees with wages as their sole Reinspection:Fee l $15 .; Issue Fee' $ $ _ ' + compensation, will do the work, and the structure is not intended etl or 's f - '" - - ' Reinspection Fee I $15 Issue Fee _ -$ 3 •for sale (Section 7044, Business and Professional Code: The Contractor's -'' I MECHANICAL ! e FEES -' 'License Law does not apply to an owner of a property who builds or improves _ - - - _ - ,. 'thereon-rand who does such work himself/herself or through his or her own - +. I DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler ; Hood or ;Type I ❑ ' ZiA ed B ' 12 sale.'If, howevekthe buildinglor improvement is sold within-one year of com- - _- Zoning Canopy 'Type II 0 ( 1 pProvy Date 'pletion,-the owner will have the burden of proving.he/she did not build or im- Duct-Under Ground - Building Approved By Date ' prUve for the purpose of Sale). , 0'1,'as owner of the property,am exclusively contracting with licensed con- ' Duct-Structural Refrigeration System - Application Issued By ' Date • - tractors to construct the project (Section 7044,Business and Professions Code: The.Contractor's License Law does not apply to an owner je property who Duct-Ventilating - ❑0.100,000 BTU ❑100,000 BTU (�Y/� t ''.SUMMARY OF FEES - builds or improves thereon, and who.contracts for such projects'with a con- S C�(07y>. tractor(s) license pursuant to the Contractor's License Law)- 1 am aware that Exhaust System ❑; Multiple ❑• System'Repair/Alteration •- ' . BUILDING PERMIT $ - I'S" SMIP $ - . -- proof of their Worker's Compensation insurance should be provided to me. - PLAN CHECK • $ ' _ PERMIT C.G. ' '❑ am exempt,untler Section B.& P.C.for this reason ' Firepl/Fact.BIt. ICBG# Fire Dampers ; .- - PLUMB• ING $ • ISSUANE $ ' 'Date - Owner ' - Heating System& Ducting Registers - ''ENERGYPE $ :'- .I hereby certify that J-have read this application and state that the,above ❑o-100,000 BTU 0100,000 BTU : • _ PLAN CHECK 25% $ _ _ -information is correct.-I agree to comply with all city and-county ordinances' - - ` ELECTRICAL ' , $ - GRADIN .$ - antl}state laws relating to building construction, and-hereby authorize repre-= _ - - , - - ! MICROFILM "' $ • • sentatives of this ,city,-to --,ter upon the abve-mentioned property.for - •, - -- PLAN CHECK ,50% ,$: , , • - ' inspection purpose - i 7/i�/y/ MECHANICAL. $ _TOTAL FEE $ Signature ' . �" - - -- Date -°-F} • - Drivers"License or SS ` � Reinspection Fee -$15 I Issue Fee, $ 3 - PLAN CHECK X25% $ - , • CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor L CONSTRUCTION AND PLANNING POOL &SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector •T 1. Temporary Electrical Service or Pole 52. Pool & Equipment'Location , 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement • 3. Electrical Conduit Utility-UndFgrnd. 54. Forms - ' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding m 5. Steel Reinforcement '56. Rough Plumbing & Pressure Test ' i ' • N 6. Electrical UFER Grnd. 57. APPROVAL TO,COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. iu 8. Foundation, _ .59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P-Trap, 0 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 FireplaceAPPROVALS Permit# • - 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0Oil 23. Gas Pipe-Rough & Test - 72. Underground Flush , 24. Roof Framing _ 73. Undergrnd.StorageTank 0 Gas 0 Oil , 25. Roof Sheathing , . 74. Overhead Hydro - 26. T-Bar Ceiling (Structural) & Monocoat - 75. Dry Chemical 27. Frame and Flashing ;,'5- J ' 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. F I NA L 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 Domestic-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 4 No. - Date - , , 3 - . • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - 3(153 4-/I e/U6 �; '.. .50:17 Ti. CITY OF Co srM S1 CzLTRUCTION PE • RMIT "'T O �m ' • TRACT NO. LOT NO. UNpq� Project Address �E N Avg - - l , F- 2. 311-6 ,S- • Applicant's MailiogG dQreS �3)[(�� V/-1� � C./v( TYPE ur a:UNSTRUC(ION IEW U ADD U ALTERATION L-I REPAIR -- *. IIRCNjjj •P• /sxsp , qtr c'D9r ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# I Zone Owner's fQ� _ Phori)�_/�1� DESCRIPTION OF WORK/USE OF BLDG.Address( •a 6 Th<a7L7 2 • f S Main Building: Accessory Building: • Arch/Eng. License No. TYPE OF PERM LJ U GRADING L I FOUNDATION U STRUCTURAL T Front . - 0 Address i / �,/ QC' ❑ TENANT �ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N. Contractor's NampLt �,�J``q"v_ E"�^�r!- one.�� l,J:`/j4 CI -OTHER C Right - N Address(mailing) 1.._.?,,- ACS-rf� • PROJECT DESCRIPTION SQ. FT. 120° OCCUPANCY K g -- -- - O City License No7 773 5 CONSTRUCTION TYPE VALUATION$ S Left . R . ZONE GRA ING CU.YDS. • ACRES • LICENSED CONTRACTOR DECLARATION - Ping. Ref.# Parking Req;/Provided .. E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: a(���'''�VVJ �,�, _- Planning Notes: O with section'7000) of Division 3 of the Business and Professions Code, and M • my license is in full to • and eft). , - T Lice .e :ss -•- CJJ / Li •nse I - S- v 4 L 5 $ Date _ Signature — _ - PLUMBING - FEES WOR ERS' OMPENSATION Die - ION ' - - her •y aft rm that I have a cert. to •f consent to self-insure or a certificate Bar Sink Showers ELECTRICAL - FE_E_S • Sf Workers' Compensation Insurance, or a certifiedcopythereof (Section - t, 3800, Lab. C.) ':i. . Backflow Preventer Service Sink t_. Automatic Washer Transformer 0 15.50 KW ' Policy No. Company - -Backflow Irrigation Sewer Ca - 050+KW ACertified copy is hereby furnished. . •p - j GDri$tludtldn Pole Sub. Certified copy is filed with the city Building Division. ' Bathtubs • Sewer Connection Cooking Unit ( Meter YCJup to 100 amps • S — Date -Applicant - �/"" _ EXEMPTION FROM WORKERS'COMPENSATION DECLARATION - - Clarifiers - Solar Collectors - -- ( Dishwasher Meter Clover 100 amps • • ( 00 _ (This section need not be completed if the permit is for one hundred ($100)or , - / less). ; Dishwasher , ' Solar Piping .aL / Dryers Baas ❑Electric Sub Panel /so I certify that I. the performance of the work for which th mit is Issued, I yl shall not em• oy an person in any r so as b to subject to the . - Drinking Fountains Solar Tank i z Fan Motors OQi HP Dm-8 IVVJ Worke sa o• .ws of Calif nia , Date Signature Floor Drains Swimming Pool w/Spa • - F.A.U. - - I 'NOTIC If,after making this deci a u should become subject to the — _ - _ _ _ _ Inc.Solar 09-15 HP 016-15+ Workers Comp: sation provisions th Labor Code, you must forthwith Floor Sinks Urinal comply with such provisions or this permit shall be deemed revoked. ,_ a Fixtures MiClOwav¢ el-CC ! ' CONSTRUCTION LENDING AGENCY • Gas Service -Outlets Water Closet j Device Boxes • l—��• I hereby affirm that there is a construction lending agency for the performance - 1 Pale Light of the work for which. this permit is issued (Section 3097 Clv. C.) • Interce •ptors - - Water Heater Outlets n Lender's Name - •` - ' Range r (1 2,1 Lender's Address - - Kitchen Sink Water Service •• - /I t Switches I ' Sign •{/1 OWNER BUILDER DECLARATION _ l 1 1 hereby affirm that I am exempt from the Contractor's License Law for the , Levatories • Auto-Wash ' - - „ following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal I;Standing Sections ` .� county which requires a permit to construct,alter,improve,demolish or repair) P-Trap - - LaundryTrayi , - { L any structure, prior to its issuance, also requires the applicant for such permit ' Y Generator ❑0-5 KW 05.15 KW Trash Compactor to file a signed statement•that he/she Is licensed pursuant to the provisions of • Roof Drains - the Contractor's License Law (Chapter 9(commencing with Section 7000),of _ - 'Division 3 of the Business and Professions Code) or that he/she is exempt „ -- . ' therefrom and the basis for the alleged exemption. Any violation;of Section - -_ ' - ' - - ' '7031.5 by any applicant for a permit subjects the applicant' to,a civil - - - ;LIenalty of not more than five hundred dollars ($500). - - . I • I, as owner of the property or my employees with wages as their sole - Reinspection Fee , $15 Issue Fee,' -_ $ 3 , - ' Compensation, will do the work,and the structure is not Intended or offered ' — - for sale (Section 7044, Business and Professional Code: The Contractor's - - MECHANICAL , FEES Reinspection Fee (I $15 Issue Fee $ 3 LicenselLaw does not apply to an owner of a property who builds or improves - ' - thereon; and'whodoes such work himself/herself pr•through his or;her own ( . DEVELOPMENT SERVICES REQUIREMENTS: , employees, provided that such improvements are not Intended or offered for1Boiler 1 Hood or Type 1 0 1 I sale, If, however, the bullding'or improvement is sold within ono year of com- . Canopy Type II 0 I ' C Zoning Approved By Date -pletion, the owner will have the burden of proving-he/she did not build or Im- ' Duct- Under Ground , Building ApprovedB By Date • prove for the purpose of sale). nom /� 4/ / /(��p/ 0 i,;as,owner of the property, am exclusively contracting with licensed con- Duct-Structural 1 Refrigeration System ' ': , Application Issued:By �+� /YfJ Date l 4/""FEL ' tractors to construct the project (Section 7044, Business and Professions Code: - -The-Contractor's License.Law does not apply-to an owner of'property whoDuct=Ventilating - OQioo 000 BTU 0100,000 BTU •builds or improves thereon,and.who contracts for such projects with a con- - SUMMARY OF FEEStractors) license pursuant to the Contractor's License Law). I am awarethat • I BUILDING PERMITproof of their Workers Compensation insurance should be provided to'me. Exhaust System 0 Multiple 0' System Repair/Alteration , $ • SMIP $ PLAN CHECK $ • PERMIT 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.-Blt. ICBO,# , Fire Dampers ISSUANCE $ Date ' Owner • Heating System&Ducting ' Registers PLUMBING $ -- - - - • - -- PLAN CHECK 25% $ ENERGY P.C. . $ I hereby certrry that I have rood this application and•stale that the above , 00.100,000 BTU 0100,000 BTU GRADING $ information is correct. I agree to cop' with all city and county ordinances r ELECTRICAL $ Z7.6(� ' and state laws rela ng to building coif'uctlon and hereby authori - re•re- 1 MICROFILM $ 1 1 inspection fives of thi icy to eater up the above-mentioned-pr• ;erty fo PLAN CHECK 50% $ ( Z.Zn inspection pu •• -•. % er 1 Signature / /_ /7 • 1 MECHANICAL $ TOTAL FEE , $ •3 (e ( Q Drivers' Li rep/S# _ '' - Reinspection Fee ' I $15 Issue Fee $ 3 _ PLAN CHECK 25% $ ` - CMF 0865-46,rev.10/84 White - Building: Canary - Applicant; Pink -Accounting; Goldenrod - Assessor • CONSTRUCTION AND PLANNING - POG_ 4 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. 414 lac 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings r 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd.,Test • 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 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 161'•'Rough Electric Wiring -p3e..-� LC"eb 67. Fencing &Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING r 18.' Rough Electrical-T Bar Ceiling I 69. POOL/SPA SYSTEMS FINAL 19..Rlough Heating& Air Conditioning! FIRE DEPT. REQUIREMENT 20.E Rough Factory Fireplace - APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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 (p ! 80. FOOD CERTIFICATE ISSUED 33. Final Electric `it1 t ic)0 Notes: 34. Final Heating &.Air Conditioning 1 . 1 - -. 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 Domestic-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 • .• . - • Applicant o fill -all��s eept those within heavy border lines and sign all appropriate declarations. l - ' ' - P R IT O. TRACT NO. LOT NO. UN U CITY OF COSTA MESA., CQD T,lpf•UCsT1ION PERMIT j f/ I C 3450 4/18/06 3oa11 L Project Address 2 5 J / I t`DEPS vee�rAA!�,Q „..716..., ONS 1 Applicant's Mailing Address 213 `tet-I— AST- AL, TYPE OF CONSTRUCTION NEW U ADD U ALTERATION REPAIR - / KE / iWJ71 h �Yf6/ ❑ CONVERSION ❑ DEM DEMOLISH ❑ OTHER Al'.• ql6 Zone Owner's N 0711 Phonal 2 / DESCRIPTION OF WORK/USEOF BLDG. Address ea. ` oda I (1.70 . C. M - /21;2-6 ' - - S Main Building: Accessory Building: Arch/Eng. License No. TYPE OF PERMIT El GRADING ❑-FOUNDATION E - 0 ❑ STRUCTURAL Front Address CI TENANT ELECTRICAL El PLUMBING ❑ MECHANICAL B Rear N Contractor's Nam Lee •�/e ,,.s�0 - ✓K11one.Ll S7X El OTHER C Right • N Address(mailing) / Z/3 . ,4 ,4tez PROJECT'DESCRIPTION SQ. FT. r2o0 OCCUPANCY C Rig { CONSTRUCTION TYPE VALUATION S G City License No. 3 / R �'�.7 ZONE __ GRADI�G CU.YDS. ACRES , E LICENSED CONTRACTOR DECLARATION }/s, Ping. Ref.'# • Parking Req,/Provided CI I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: .� lea 'C ct i Planning Notes: - M with section 7000) of Division 3 of the Business and Professions Code,and 1111 my license is in full lyfi-a • ef{ect. di/( ir•s/s / (cj -2 2 c 5 T • Licen • s G� C/ Livens: ( `7/V/•� (0 `? ` ` - S Date . Signature �/ PLUMBING • FEES - WOR • RS' OMPENSATION DiefrION Bar Sink Showers • ELECTRICAL FEES hereby affirm that I have a cer ate of consent to self-insure or a certificate - . . -- 3800, Lab. C.) Jf Workers' Compensation Insurance, ora certifled-copy thereof (Section - Sink , Automatic Washer Transformer 0 15-50 KW - • Backflow Preventer Service Policy No- '' Company - Backflow Irrigation Sewer Cap j j Construction Pole Sub. 0 50+KW 8 Certified copy is hereby furnished. Certified copy is filed With th¢city Building Division. Bathtubs Sewer Connection ,,;— Cooking Unit / Meter X1ip to 100 amps i W' Date Applicant 7 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifier$ - Solar Collectors / Dishwasher Meter' payer 100 amps - - ' eQ (This section need not be completed if the permit is for one hundred ($100)or less). ' Dishwasher 1 Solar Piping' I Dryers Xas DElectric •! Sub Panel I 6)90 I certify that in the performance of the work for which t is p /fit is issued, I - • snail not e ploy ny person in any man o as to co subject to the - Drinking Fountains Solar Tank - 1 Fan' • l Motors❑0.1 HP ❑1%-8 Work s/Sy,/mle tbLfLa Si a Calif a _ 1 Date C /, �,llill ((// din Signature �/S Floor Drains Swimming Pool w/Spa' F.A.U. IncSolar ❑9-15 HP 016-15+ ' NOTIC If,aft r making this deciar should become subject to the - - ' -Workers' Compensation provision t Labor Code', you must forthwith Floor Sinks ' Urinal - • Fixtures Microwave comply with such provisions or •thi ,permIt shall be deemed revoked. - - - CONSTRUCTION' LENDING AGENCY- Gas Service ' Outlets - Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance Pole Light of the work for which this permit is. Issued (Section' 3097 Civ. C.) Interceptors Water Heater •� Outlets ! ZO Lender's Name Range (L Lender's Address • Kitchen Sink . ' -Water Service 1 '7 Switches • ,i .40 OWNER BUILDER DECLARATION - — - -.-- I ` Sign I hereby affirm-that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash ` - ' ^ following reason (Section 7031.5 Business and Professional Code: Any city or ( Garbage Disposal !$tending;Sections 1 ✓� county which requires a permit to construct,alter,Improve,demolish or repair P-Trap . - Laundf Tra 5 , -any structure, prior toils*issuance, also requires the applicant for such permit y y - Generator ❑0.5 KW ❑5-15 KW Trash Compactor 1 to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains - • - -the Contractor's License Law(Chapter 9(commencing with Section 7000) of i 'Division 3-of the Business and Professions Code) or that he/she is exempt - - ,herefrom and the basis for the alleged exemption. Any violation of Section - - 7031.5 by any applicant for a permit subjects the applicant to a civil • p natty of not more than five hundred dollars($500). _ - ' - U I, as owner of the property or my employees with wages as their sole ' Reinspection Fee $15 • Issue Fee $ 3 l compensation, will do the work,and the structure Is not Intended or offered - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's i •• MECHANICAL ' FEES License Law'does not apply to an owner'of a property who builds Or improves • - _ thereon; and who does such work himself/herself or,through his or.her own SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ , - , sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By • Date pletion, the Owner will have the burden of proving he/she did not build or dr:- Duct-Under Ground Building Approved By Date • prove for the purpose of sale). - • ^ 1, 0 I,�as owner of the property, am exclusively contracting with licensed con- • Duct-Structural 1 Refrigeration System Application Issued'By ' /a. Date 117/a .•-g-.41 tractors to construct the project (Section 7044,Business and Professions Code: • -The-Contractor's 'License Law does not apply to an owner of,property who-. - Duct_Ventilating - . ❑O-100,000 BTU ❑100,000 BTU ' - • SUMMARY OF FEES , builds or improves thereon,and who'contracts for such projects with a con- - , tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ j SMTP $ proof of their Worker's Compensation insurance should be provided to,me.. PLAN CHECK $ PERMIT ❑.i am'exempt under Section - B.& P.C.for this reason Firepl/Fart.BIL ICRO# Fire Dampers PLUMBING $ • ISSUANCE $ Date - - Owner' Heating System& Ducting , ' Registers PLAN CHECK 25% $ ENERGY P.C. ' $ I hereby certify that I have read this application and state that the atiove 00100,000 BTU 0100,000 BTL - , , information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ 2'J�n GRADING $ and state laws re lingtobuilding c•��s{•-truction(and hereby authors repre- I PLAN CHECK 50% $ Z ,70. MICROFILM $ ' sentatives of, city to - er, u. the above-mentioned !pr art f0 • l j i l G`� �j/j� inspection •��.s. ._��-, (f '��1�/2 - - ` 1 MECHANICAL - $ - TOTAL FEE $ 37, /1 Signature _ • ' - - Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ , sr /Sm"sa CMF 0865- rev. 10/84 white - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor • CONSTRUCTION AND PLANNING POO. -SPA APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole • 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. - - "i• 53. Steel Reinforcement ` 3. Electrical Conduit Utility-Undrgrnd. • 54. Forms • 4. Electrical Conduit-Undrgrnd. 44u'� Qt.. 55. Electrical Bonding , 5. Steel Reinforcement +�1 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE i ' 7. Footings /58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 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 7 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 Wiringr 67. �-3ar �-b Fencing &Access Approval 17.,Rough Wiring Sign • 68. APPROVED FOR PLASTERING 184 Tough Electrical-T Bar Ceiling • 69. POOL/SPA SYSTEMS FINAL • 1:�.: rtough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 201,,Rough Factory'Fireplace -. .I APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro • 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush • 24. Roof Framing 73. Undergrnd.Storage Tank 0 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 at, J80. FOOD CERTIFICATE ISSUED 33. Final Electric .'1" ,s8 or Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 1 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-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 • - -, , Applicant to fill in all spaces except those within heavy border lines and sign all approprlate.declarations. • CITY OF COSTA MESA CONSTRUCTION PERMIT - PERMIT NO. TRACT NO. LOT NO. UNIT NO.• - 2551 ELDFN ST. 112�y2S � . 9120 7/09%86 28.00 TL . Project Address mss,,' rr I -^ - •^ ••- .- -• 2121 S. GRAND AVE., SANTA ANA TYPE OF CONSTRUCTION X� NEW LI ADD LI ALTERATION H REPAIR I ' Applicant's Mailing Address .4^ .Owner's Name KEN ROBISON ' Phgn 645'7300 ❑'CONVERSION ❑ DEMOLISH El OTHER A.P.# Zone • P.O. BOX 11930 , COSTA MESA 926627 ' DESCRIPTION OF WORK/USE OF BLDG.' • Address S Main Building: Accessory Building: E - Z Arch/Eng. License No. TYPE OF PERMIT. LI GRADING LI FOUNDATION�, ❑ STRUCTURAL - T Front 0 Address ❑ TENANT ❑ ELECTRICAL ❑-PLUMBING ) MECHANICAL B Rear N SIERRA aV1RE TAL 957-8991 ❑ OTHER A - I Contractor's Name Phone • - Address(mailing) 2121 S. GRAND AVE., SANTA ANA 92705 PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right G 024912. C ON STRUCTION TYPE VALUATION$ S Left R City License• No. — - - , ZONE GRADING CU.YDS. ACRES - LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E . ,/hereby affirm that am licensed under prey ions of Char er 9 (commencing Remarks:. Planning Notes: _ ' . M • with section 7000) of Division 3 of theess and -r• es ions Co. and BUILDING PEISIIT # B23295 I my license is in full force and effect. , / T 'License Class C20 Lic se ., e.- st A $ • Date 7/2/86 • Signature S/ ��t PLUMBING FEES _ \c\ WORKERS'COMPENSATION DECLA TION Bar Sink Showers . I hereby affirm that I have a certificate o consent to self-insure or a certificate ELECTRICAL FEES of Workers' Compensation Insurance, r a certified copy thereof (Section Backflow Preventef Service Sink -- - - - - } - ., 3800, Lab. C.) Automatic Washer Transformer ❑ 15-50 KW \ Policy No. N010719"i(T,J(' Co ny FARMFRS Backflow Irrigation< Sewer Cap Construct ion.Pole Sub. 0 50+KW .Certified copy is hereby furnished. ](,`.'ertified copy Is filed with the city ilding D(vision. Bathtubs Sewer Connection Cooking Unit Meter 0u to 100 amps S. dale .2./86 Applicant �f� EXEMPTION FROM WORKERS'COMPENSATION DECLA TION Clarifiers Solar Collectors Dishwasher' ; Meter Dover 100 amps (This section need not be completed if a permit is for one hundred ($100)or \ less). Dishwasher ,, Solar Piping ,- Dryers ❑Gas ❑Electric Sub Panel : I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank' Fan Workers' Compensation Laws of California. Motors 00-1 HP 0114-8 I ^``\ Date Signature - Floor Drains:. , Swimming Pool w/Spa F.A.U. ' Inc.Solar ❑9-15 HP 016-15+ V I 'NOTICE:If,after making this declaration,you should become subject to they • Workers'-Compensation provisions of the Labor Code, you must forthwith —Floor Sinks- Urinal Fixtures- . . • - Microwave - ' comply with such provisions or this permit shall be deemed revoked. • CONSTRUCTION LENDING AGENCY Gas Service - Outlets. .Water Closet- Device Boxes Pole Light I hereby affirm that there is a construction lending-agency for the performance - 9 of -the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Lender's Name - - Range . Lender's Address . Kitchen Sink Water Service ; Switches Sign ' OWNER BUILDER DECLARATION _ - ' I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories - , Auto-Wash ' following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal ;Standing Sections ' county which requires a-permit to construct,alter,improve,demolish or repair P-Trap. LaundryTrays - • any structure, prior to its issuance, also requires the applicant for such permit y Generator ❑0.5 KW ❑5-15 KW Trash Compactor ,to file,a signed statement that he/she is licensed pursuant to the provisions of - -- , ..._,_ Roof Drains'' the Contractor's License Law(Chapter 9 (commencing with Section 7000) of Division 3 'of the Business and Professions Code) or that he/she is-exempt . therefrom and the basis for the alleged exemption. Any violation of Section • '7031.5 by any applicant for a permit subjects the applicant to a civil - - - enalty of not more than five hundred dollars($500). I, as owner of the property or my employees with wages as their sole ' Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work, and the structure Is not Intended or offered - Reinspection Fee f $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES ' License Law does not apply to an owner Of a property who builds or improves • thereon, and who does such work himself/herself or through his or her ownr, I DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 ZoningApproved sale: If, however,the building or improvement is sold within one year of corn- Canopy Type 11 ❑ pP By Date , pletion, the owner will have the burden of proving he/she did not build or im- - Duct-Under Ground Building Approved By Date prove for the purpose of sale). — ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By _�' Date 7 tractors to construct the project (Section 7044,Business and Professions Code: -- ' The Contractor's License Law does not apply to an owner of property who —L Duct-Ventilating 00-100,000 BTU ❑100,000 BTU /l a SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with a con- — i i tractor(s) license pursuant to the Contractor's License Law). I am aware that System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT ❑ I am exempt under Section B.S P.C.for this reason —Z Firepl/Fact.Bit. ICBG#/e2,9 Fire Dampers 9 DV PLUMBING $ ISSUANCE $ Date Owner Hefting System& Ducting Registers ENERGY P.C. $ gating PLAN CHECK 25% $ I hereby certify hat-I have ead this a.plication and state that the above �' 0.100,000 BTU 0100,000 BTL d A' J GRADING $ information i c. rect. I agr:. to com• ) ith all city and county ordinances D L/v ELECTRICAL $ and state laws r lacing to b icing co f- ] ction, and hereby authorize repre- PLAN CHECK 50% $ inspection • MICROFILM $' fives of •is cit to - t above-mentioned proper y r pur,.ses. �� - MECHANICAL $ ..2.�'© � TOTAL FEE $ 02*i 0 C) Signature r . A,' Reinspection Fee , 1 $15 Issue Fee $ 3 PLAN CHECK 25% $ •5- CD I CMF 0865-46,rev. 10/84 white - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor •-• 0 . • CONSTRUCTION AND PLANNING POC. s 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, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 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.r /�Rough Heating & Air Conditioning 09/vc' d/Pr FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace o9/y �4 APPROVALS Permit# 21. Ducts, in Structure SIL 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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 //y/G+7 L//j�/' 35. Final Gas Pipe-Test / I ' ,/!/, 'J 36. Hood or Canopy 37. Final Factory Fireplace /1747;Fife 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-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 • 51:1Gas Release to Southern California Gas Co • 51? CERTIFICATE OF OCCUPANCY • • No. Date C ' • • Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. - v� _. CITY OF COSTA MESA CONSTU/CTION PER MI PE MIT NO. /�� TRACT NO. . LOT NO. U T NO ' • - •Project Address g5-5-7r C-7 ..t o'�/` ��`�'" Ips -L. • 31 24 4/15/85 n_ T!, Applicant's Mailin ddress / 't--r-re • TYPE OF CONSTRUCTION '�LNEW U ADO U ALTERATION U REPAIR �. ❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ A P #', • - Zone Owner's Name Phone _ DESCRIPTION OF WORK/USE OF BLDG. ' Address �r -�+'� /jj30 - S Main Building: . Accessory Building: Arch/Eng., License No. 3/n'Er TYPE OF PERMIT U GRADING��IU FOUNDATION ❑ STRUCTURAL E Front'. - • p. Address �{� �� l/` <❑ TENANT ❑ ELECTRICAL 'LTJ-P6UM BING 0 MECHANICAL BA Rear N Contractor's Narnenely-i 12-e Phone �7V /� 0 OTHER ` � PROJECT.DESCRIPTION SQ. FT. OCCUPANCY C Right • G N Address(mailing) /�q 3/278' CON ST RUCTION TYPE 'VALUATION$ S Left City License N0. ZONE GRADING CU.YDS. ACRES R LICENSED CONTRACTOR DECLARATION /nq Ping. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: �r r 3 -236175-• Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code,and ��� _���`-� r/ my license is In full=0 a and effect. L _ T ' Li Cense Cies a •nye $ DateO/`f y&Signature - /�. r PLUMBING I FEES \(� WOR ERS'COMPENSATION ARATION Bar Sink • Showers ; ELECTRICAL ' FEES \' I hereby affirm that I have a c t cate of consent to self-insure or a certificate if Workers'-Compensation Insurance; Or a certified copy tb eof•(Se tiop. - - - -- r- Backflow Preventer Service Sink - 3800, Lab. C.V.. r Automatic Washer Transformer ❑ 15-50 KW i Policy No. '7-t'OD� a'- ��Company �" ` Backflow Irrigation Sewer Cap ❑ 50+ KW Construction Pole Sub. Certified copy,is hereby furnished. Cer ifielJ Cop�yyyJ��'is f' with the city (ding D i o �• •�• Bathtubs / Sewer Connection /�'01 Cooking Unit Meter ❑up to 100 amps \ alevri / Applicant '�"'�R'f� , • EXEM ION FROM WORKERS'COMPENSATION DECLARATION- Clarifiers .Solar Collectors Dishwasher - Meter Dover 100 amps' (This section need not be completed11 the permit is for one hundred ($100)or,I less). :� / Dishwasher • Solar Piping Dryers ❑Gas ❑Electric Sub Panel UI certify that in the performance of the work for vihiCh this permit is issued ,Ir shall not employ'any person In any manner so as!to become subject to'the Drinking Fountains Solar Tank I • Fan \ Workers' Compensation Laws of California. �) _ Motors❑0-1 HP 011,4-8 . Date Signature Floor Drains Swimming Pool w/Spa .A.U. olar ❑9.15 HP ❑16.15+ 'NOTICE: If,atter 'making this declaration,you should become subject to the _ - Inc.. Workers' Compensation provisions of the Labor Code;you must forthwith '' Floor Sinks L Urinal Fixtures Microwave comply with such provisions or this permit shall be deemed revoked- - • i CONSTRUCTION LENDING AGENCY / Gas ServiceOutlets 3. Water Closet ' 8 Oo Device Boxes, I Pole Li ht I hereby affirm that there is a construction lending agency for the performance - 9 of the 'work for which this permit is issued (Section 3097 Civ. C.) ' Interceptors1 - /, Water Heater OQ Outlets I Range Lender's Name - r• 9 Lender's Address ' 7 Kitchen Sink ' �- Water Service T�/ d4 Switches Sign OWNER BUILDER DECLARATION ' o �/q I hereby affirm that I am exempt from the Contractor's License Law for the � Lavatories ' : Auto-Wash O f/ Garbage Disposal g ' following reason (Section 7031.5 Business and Professional Code: Any city or - / O 9 P !Standing Sections county which requires a permit to construct,alter,Improve,demolish or repair, - P-Trap . LaundryTrays any structure, prior to its issuance, also requires the applicant for such permit - re y Generator ❑D-$KW ❑5-15 KW Trash Compactor to file a signed statement that he/she Is licensed pursuant to the provisions of ROOF Drains the Contractor's License Law(Chapter 9(commenting with Section 7000)of -Division 3 of the Business and Professions Code) or that he/she is exempt - - ' ' herefrom and the basis for the alleged exemption. Any violation of Section - . , 031.5 by any applicant for a permit subjects the applicant to 'a civil - . enalty of not more than five hundred dollars($500). _ •' U I, as owner of the property or my employees with wages as their sole Reinspection Fee $ 3 ' compensation, will do the work,and the structure is not Intended or offered - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's - MECHANICAL F . —___--._ --_— - - thereon, and who does such work himself/herself.or through his or her own - • - - DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such Improvements are not Intended or offered for Boiler Hood or Type I ❑ sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ • Zoning Approved By Date plebe t the Owner have the burden of proving he/she did not build or Im- Duct-Under Ground Building Approved By Date prove for the purposese of sale). ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System - Application Issued By Oat tractors to construct the project (Section 7044, toBusiness and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0.100,000 BTU ❑100,000 BTU - , builds or Improves thereon,and who contracts for such projects with a con- ' - SUMMARY OF FEES tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof oftheir Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT - • ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ < 1 ' G`) ISSUANCE $ • Date Owner. - • Heating System& Ducting - Registers PLAN CHECK 25%' $ ENERGYP.C. $ ' ' I'hereby-certify that I have read this application abd'state that the above 00-100,000 BTU-0100,000B $ information Is correct. I agree to comply with all city and county ordinances ELECTRICAL $ and state laws relating to building construction, and hereby authorize repre- MICROFILM $ • sentatives of this city o enter u t above-mentioned prop rtty for/ - PLAN CHECK 50% $ inspection p p % • s./- 4%� - Date • •"sIU MECHANICAL $ TOTAL FEE $ / - ' C20� Signature �'' Driver ..?cense or SS# Pink -Accounting: Goldenrod - Assessor CONSTRUCTION AND PLANNING POO. SPA Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit# 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. . 5�K .19471° 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. 4J/7/de , �P 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11.4,Property Sewer Line & House Connection w/,/to Aj 9 ° 62. Backwash & Receptor-Final 12.I Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing L4?/,/ jfirm, 65. Electrical-Final 15. Rough Electrical-Conduit • 66. Solar System-Final 16. 'Rough Electric, firing 67. Fencing & Access Approval i• 171iRough Wiring Sign 68. APPROVED FOR PLASTERING 18:Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19.1 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 0 Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0Gas 0 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 !/j/r7 yr • 36. Hood or Canopy / 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final • 40. Gas Service-Final / - -� S 41. Solar Domestic-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 • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 3125 4�I x(86 I [o j I. • • CITY'OF COSTA MESA COf��'•TRU'CTION PERMIT C-e2 PER IT NO. TRACT NO. LOT NO. UNIT ND - - ' ' Project Address '''3.3-/ 6o.•Oe4?t9•t (w!�• -t- + a-NEW e,--;:)-- • - �' TYPE OF CONSTRUCTION YJ NEW U ADD LJ ALTERATION REPAIR Applicant's Mailing rens' s3 7 �'(e a+-�•TM'K� • Owner's Name �-TL Phone 0 CONVERSION 0 DEMOLISH 0 OTHER A.P.# - I Zone _ - • DESCRIPTION OF WORK/USE OF BLDG. Address ( ��� Y��• - - . S Main Building: . Accessory Building: •3/C X. TYPE OF PERMIT Li GRADING 0 FOUNDATION 0 STRUCTURAL E Front - • Z Arch/Eng: License No. T 0 Address ��1 / • ❑ TENANT ❑ ELECTRICAL�.PLUMBING 0 MECHANICAL • BB Rear _ N. '{�• .// //1 /�i II�.S S El OTHER • Contractor's Nam =r phone C Right . . - - N I. PROJECT DESCRIPTION SQ. FT. OCCUPANCY • - Address(mailing) S ? ' %t7,• 1- -v._ K' G �� �79 ' . CON STRUCT,ION TYPE VALUATION$ S Left • City License No. T!! ZONE - GRADING CU.YDS. ACRES - R LICENSED CONTRACTOR DECLARATION Ping. •Ref.# Parking Req:/Provided E NOI hereby affirm that I am licensed under provisions of Charter 9`(commencing Remarks: ���7--. Q , 13 -aq a fps5 Planning Notes: • - QM with section 7000) of Division 3 of the Business and Professions Code, and J my license is in full force and effect, r1.,C�a l . . - . _ S Licensef�a / ns-4, o. P I Date1.S.. 4 L / ignature -.its _ - _ O PLUMBING , I FEES WOR ERS'CO PENSATION • ARATION Sink Showers ELECTRICAL FEES I hereby affirm that I have a •r ' irate of consent to self-insure or a certificate N r/ Workers' Compensation N surance, or-a certified copy thestof (Sect n Backflow Preventer - Service Sinkl 3800, Lab. C.)' j 7 . Automatic Washer . Transformer'0 15-50 KW. PolicyNo. 7 a000a- g� Companfiry r Backflow Irrigation i ❑ 50+ KW y 9 Sewer Cap Construction Pole Sub. ' , tifled copy is hereby furnished. - j '/ Ce if'-tl copy I f le•99 tp the city Bui g Division. ' • Bathtubs / Sewer Connection • /IA Cooking Unit Meter ❑up to 100 amps N.\ Dat- i /b t9KERS'Ct �` __ " - _ . -- ' _- " - EXEM'TION FROM WORKERS'COMP NSATION •E LARATION Clarifiers .Solar Collectors Dishwasher .Meter_❑over 100 amps._ . (This section need not be completed if per mit,is for one hundred($100) or• . less). - •i / Dishwasher Solar Piping Dryers ❑Gas DElectric • Sub. Panel I certify that in the performance of the work for which this permit is issued,I- - - shall not employ any person in any manner so arta become-subject to the Drinking Fountains Solar Tank r I • Fan Motors 1110-1 HP ❑1 h-8 Workers' Compensation Laws of California. ,c . - Date Signature - Floor Drains Swimming Pool w/Spa F.A.U. Ina Solar 09.15 HP 016-15+ 'NOTICE:If,after making this declaration, you should become subject to the ' _ _ _ _ - - __ • _. - - -- _ Workers' Compensation provisions of the ,Labor Code, you-must forthwith -- - Floor'Sinks,- -' Urinal - Fixtures ' Microwave comply with such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING -AGENCY - / Gas Service ' .Outlets - 3 Water Closet - �"v Device Boxes , ' • I hereby affirm that there is a construction lending agency for the performance -- - Pole Light of the work for which this permit Is issued (Section 3097 Civ. C.) Interceptors , / Water Heater 2-00 Outlets Range Lender's Name - - Lender's Address - / Kitchen Sink _ Water Service gab Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the ' 3' 06 Auto-Wash �� Garbage Disposal g following reason (Section 7031.5 Business and Professional Code: Any city or :Standing Sections county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays Generator ❑0-5 KW❑5.15 KW Trash Compactor any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of -Roof Drains 4 -the Contractor's License Law(Chapter 9.(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he/she Is exempt • - 'ierefrom and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subjects the applicant'to a civil - ginalty of not more than five hundred dollars($500). $ 3 U I. as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee compensation, will do the work,and the structure is not Intended or offered • - --- - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's ; MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves _ _- __ thereon, and who does such work himself/herself or through his or her own - DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ sale. If, however,the building or improvement is sold within one year of coca- • Canopy Type II 0 Zoning Approved By - Date pletion, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground i • Building Approved By Date drove for the purpose of sale). ,JJ s,,� / y1 LJ I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By /7 1� Date tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating- - ❑0-100,000 BTU .0 100,000 BTUSUMMARY OF FEES • builds or improves thereon,and who contracts for such projects with a con- - tractor(s) license pursuant to the Contractor's License Law). I am aware that ! Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ ,SMIP $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT ❑I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit.ICBG# Fire DampersPLUMBING $ �/g•Ov ISSUANCE $ Date Owner - • Heating System&Ducting Registers PLAN CHECK 25% $ _ ENERGY P.C. $ I hereby-certify that I have read-thii apulication arid state that the above- - 00.100,000 BTU 0100,000 BTL ELECTRICAL $ GRADING $ information is correct,l agree to comply with all city and county ordinances and state laws,relating to building construction,and hereby authorize repro- - MICROFILM $ -. sentatives of this' n to enter upon the above-mentioneqy, property or • PLAN CHECK 50%. $ [,J /7i� inspection (poses 7a.ec - L /�/% MECHANICAL $ / �"C.`u/ Signature P'l Date / TOTAL FEE $ Drivers', (cense or SS /* Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor • • CONSTRUCTION AND PLANNING POOL ;PA Date Inspector Date Inspector ri APPROVALS Permit# APPROVALS Permit# 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 9 /44 53: Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. ''YY 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, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. dorm at 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11.I Property Sewer Line & House Connection c%/� 4 fl" 62. Backwash & Receptor-Final 12.1Sewer Cap 7 SOL 63. Heater & Vent-Final 13.' Roof Drains 64. Plumbing System - Final 14. Rough Plumbing L/n/ff f 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16:4tough 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 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 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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:/1//.A/a,G � iaK 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 7///r7Or �/r7 36. Hood or Canopy 37. Final Factory Fireplace • 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-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 - X 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY • _ No. Date • • • ` ' Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. • CITY OF COSTA MESA CONSTRUCTION PERMIT PER IT NO. TRACT NO. LOT NO. UNIT NO. �' a337y 1 S3 • Project Address cSi5'tY! F/�JdP72 0+JG 're-r.r'irTPr.e - ' • ?�R7 !./I !'_ t'n TI. r0. &30y J 14 ' O e, TYPE OF CONSTRUCTION NEW U ADD U ALTERATION U REPAIR - Applicant's MailingAddress . I[J 1 r� I' NO 7 ❑ CONVERSION" ❑ DEMOLISH ❑ OTHER Owner's Name(fir 7( P*L11 Ctfl3i Phone �p/.S' �1 - - A.P.yp I Zone DESCRIPTION OF WORK/US •e F BLDG. —.-�l�fii7fa.��•uiii. Address P.Q.Go- 119 '3f] p 1 Mt �V A• r C --cit - S Main Building: Accessory Building: �1� E Z Arch/Eng..rrr OPCN/y7 G License No. 3�7 TYPE OF PERMIT M GRADING U FOUNDATION MI STRUCTURAL T Front O Address ICC ! LU )7r'' Cr M. 9t.27 0 TENANT X.ELECTRICAL-❑ PLUMBING 0 MECHANICAL B Rear - N Contractor's Name L -Add -Prop._!'-tin. Phone �e17s y?9, ❑ 'OTHER �1�.._. _._' O Right N Y I PROJECT DESCRIPTION SG. FT. 0. - OCCUPANCY K G Address(mailing) (� sole Y i1 [ U CONSTRUCTION TYPE VALUATION$ Left S R City License Na. 37/1 / ZONE GRADING CU.YDS. ACRES Ping. # . r- /zE LICENSED CONTRACTOR DECLARATION 9 cup.. _1..;t%' Parking Req./Provided I.hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: edagegfagn aspzipap Siegsrapivo Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code,and _ my license is in full force and effect. •. T License Class License7*CQ No. $ • Date. Signature (2ia✓P'ltt2'a1.- PLUMBING I FEES . WORKERS'COMPENSATION DECLARATION. Bar Sink • Showers !hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 3800, Lab�CJ Automatic Washer ' Transformer 0 15-50 KW Policy No!-- Company ' Backflow Irrigation Sewer Ca 0 50+KW P Construction Pole Sub. A certified-copy is hereby the Cit Certifi d.cppy is filed with the city Building WI . Bathtubs • Sewer Connection Cooking Unit Meter Pup to 100 amps Gate _ Applicant —`' EXEMPTION FROM WORKERS'COMP TION DECLARATION - ) - Clarifiers - - Solar Collectors Dishwasher - Meter Clover 100 amps (This section need not be Completed if the permit is for one hundred(5100)or less): Dishwasher ' Solar Piping Dryers ❑Gas ❑Electric Sub Panel • I certify that,in the performance of the work for which this permit is Issued I ort ' employ any person inf any manner so a nip subject to the Drinking Fountains Solar Tank Fan Workers' Compen tpi n Laws of California./ MOLOrs❑0-1 HP ❑1'h-8 Date • -.2- ' ' Signature 1�j' C�2 Floor Drains • Swimming Pool w/Spa F.A:U. 'NOTIC If,after eking this tleclaratlon, Ou s oultl become subject to the _ Inc.Solar ❑9-15 HP 076.15+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks • Urinal • comply with such provisions or this permit shall be deemed revoked. Fixtures Microwave CONSTRUCTION LENDING AGENCY • Gas Service , Outlets Water Closet Device Boxes • Pole Light I hereby affirm that there is a construction lending agency for the performance 9 of the work for icn this pen Is Jsjued j$ectlonz 3097 Civ. C.) Interceptors Water Heater Outlets Range Lender's Name CH'sis ,�7-' 7j,� , Lender's Address - Kitchen Sink - Water Service Switches • Sign OWNER BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal :Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P—Trap - Laundry Trays Generator ❑0.5 KW ❑5-15 KW any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor to file a signed statement that he/she Is licensed,pursuant to the provisions of Roof Drains - ' the Contractor's License Law(Chapter 9(commencing with Section 7000)'of - 1 / �y Division 3 of the Business and Professions Code) or that he/she-is exempt . I Tir twortl rfainer R`(c S.pv heref ram and the basis for the alleged exemption. Any violation of Section . I 7031.5 by any applicant for a permit subjects the applicant to'a civilr _ eenalty of not more than five hundred dollars($500). . U I, as owner of the property or my employees with wages as their sole Reinspection,Fee $15 Issue Fee $ 3 compensation, will do the work,and the structure is not intended or offered - Reinspection Fee $15 Issue Fee 5 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves _ _ _ _ _. _ _ -. Type thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such Improvements are not Intended or offered for Boiler Hood or T e I 0 - sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II ❑ Zoning Approved By Date pietion, the owner will have'the burden of proving he/she did not build ogim- Duct- Under Ground - rove for the purpose of sale). Building Approved By ^ Data I,as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By /�JA Datfl tractors to construct the project (Section 7044,Business and Professions Code: rn The Contractor's License Law does not apply to an owner of property who • Duct-Ventilating + 00-100,000 BTU 0100;000 BTU builds or improves thereon, and who contracts for such projects with a con- - - SUMMARY OF FEES I tractor(s) license pursuant to the Contractors License Law). I am aware that Exhaust SystemBUILDING PERMIT , $ SMIP proof oftheir Worker's Compensation insurance should be provided for me., V 0 Multiple❑ System Repair/Alteration $ ❑ lam exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers • PLAN CHECK $ PERMITPLUMBING ' $ ISSUANCE $ Date Owner Heating System& Ducting Registers ENERGY P.C. $ ❑0100,000 BTU ❑100,000 BTL PLAN CHECK 25% $ I hereby certify rect I haverread thismapplication all and o that the above — GRADING $ information motion is correct. I agree dtoi comply with all city and county ordinances ELECTRICAL $ and state laws relating to building construction,and hereby authorize repro- MICROFILM S inspection sentatives of this city to rater upon the above-mentioned property for PLAN CHECK 50% $ inspepurpose, % Pink -Accounting;Goldenrod - Assessor •, -CONSTRUCTION AND PLANNING POOL .. SPA [APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole y/I a 04 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. B. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 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 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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 B0. 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 Domestic-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 a-3 Y& ' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - - - , -- CITY OF COSTA ESA CONSTRU TI N PERMIT PERMIT NO. TRACT NO. LOT NO. 3449 4/18M6 I Co 3,C TL Project Addrid's' J �I �f 7�2 a�, aA�uE. e .a34,'" / ` Applicant's Mailing Address Z t 3 •-mak-w," + C..514, TYPE OF CONSTR(UGLION NEW H ADD U ALTERATION U REPAIR •� / i ❑ CONVERSION ❑ DEMOLISH ❑ OTHE Owner's yyNNNJJaaame �f N _ 7 d��11nn P one�7�• 7 2 4 A.P.AP # Zone Address r.2- • •, IC 3Q ! f, (120209 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: ' EZ Arch/Eng. License No. TYPE OF PERM! ❑ GRADING ❑ FOUNDATION U STRUCTURAL • T Front 0 Address �1 G��,,/�� ❑ TENANT LECTRICAL ❑ PLUMBING ❑ MECHANICAL - B Rear -- . • N Contractor's Nam L((� R5 "'--z V�hbne �y7 ❑ 'OTHER • - C Right _ N Address(mailing) I Zi rnsr- H PROJECT DESCRIPTION SO, F, et. OCCUPANCY K Left G • 31']35 CON ST RUCTION TYPE VALUATION$ $ R City License No. - ZONE GRAD! G CU.YDS. ACRES E LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided ///J�� Q I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: .(j�' -`�� House rot A •P Planning Notes: M with section 7000) of;Division 3 of the Business and Professions Code, and C 1 1 T my license is in full fic a tl act. i O�! ' Licen e .ss �.� lL / LicIP NoH -/ l0 S Date 1rL • Signature _A' ^� ' PLUMBING - FEES WORKERS'C MPENSATION � ELECTRICAL ATION 'Bar Sink Showers FEES ' I hereby of firm that I have a ce}}}}}}������c •of consent to self-insure or a certificate • of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer s.Service Sink 3800, Lab. C.) Automatic Washer Transformer 0 15-50 KW ' , Policy No. Company - , Backfloyv Irrigation Sewer Cap . (Construction Pole Sub. • 0 50+ KW 6 Certified copy is hereby furnished. • �n Certified copy is filed with the city Building Division. . Bathtubs Sewer Connection Cooking Unit / Meter pp to 100 amps L O� Date "rApplicant — J EXEMPTION FROM WORKERS'COMPENSATION DECLARATION • Clarifiers - Solar Collectors - Dishwasher Meter Clover 100 amps - - - (This section need not be completed If the permit is for one hundred($100) or - less). .1 Dishwasher Solar Piping '- Dryers ❑Gas ❑Electric / Sub Panel ' 504' I certify that in the performance of the wo for which hi rmit Is Issued, I shall not coot a pl person in any m.. 1r so as .e • subject to the Drinking Fountains Solar Tank -- 1_, Fan Motors 041 HP OVA 8 WOrke Laws of Calif. i Date Signatur. a Floor Drains • Swimming Pool w/Spa F.A.U. Ina.Solar 09-15 HP 016-15+ 'NOTIC If,of r making this declar u n, should be ome subject to"the ' Workers' Com ensation provision•the Labor Code, you must forthwith-. Floor Sinks Urinal • Fixtures - Microwave comply with such provisions o _this permit shall be deemed revoked. . - - - - . CONSTRUCTION LENDING. AGENCY Gas Service Outlets - Water Closet ' I Device Boxes ' I hereby affirm that there is a construction lending agency for the performance _ Pole Light • n Of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater • /- 'w Outlets Range i Lender's Name - - ((J • Lender's Address - • Kitchen Sink _ Water Service , Switches - Sign • OWNER BUILDER DECLARATION • . ' I I hereby affirm that I am exempt from the Contractor's License Law for the ' • Lavatories' Auto-Wash ,• • i following reason (Section 7031.5 Business and Professional Code: Any city or - - Garbage Disposal ;Standing Sections county which requires a permit to construct,alter,Improve,demolish or repair P-Trap - any structure, prior to its-issuance, also requires the applicant for such permit Laundry Trays Generator 00.5 KW 05.15 KW ' Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains - ' the Contractor's.LICense Law(Chapter 9(commencing with Section 7000)of -Division 3 of the Business and Professions Code) or that he/she is exempt • - - - ' - , - • herefrom and the basis for the alleged exemption. Any violation of Section • - ' 031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars($500). f O I, as owner of the property or my employees with wages as their sole . -Reinspection Fee I $15 - Issue Fee • $ 3 compensation, will do the work,and the structure Is not intended or offered Reinspection Fee ` $15 • Issue Fee $ 3 for sale (Section 7044. Business and Professional Code: The Contractor's ' MECHANICAL I FEES _ - - License Law does not apply to an owner of a property who builds or improves , thereon, and who does such work himself/herself or through his or her own - - - DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not Intended or offered for Boiler , ) Hood or Type I I. 0 , - sale. If, however, the building or Improvement Is sold within one year of com- 1 • Canopy Type II 0 , Zoning Approved By Date plotion,-the owner will have the burden of proving he/she did not build or im- Duct-Under Ground prove for the purpose of sale). _ Building Approved By if,r___. Date ' U I,1as owner Of'the property, am exclusively contracting with licensed con- Duct-Structural , Refrigeration System Application Issued By 6/'sr- /@ Date g-/O 442 tractors to construct the project (Section 7044,Business and Professions Code: , •- The Contractor's License •Law does not apply to an owner of property who.• --- Duct-Ventilating - 04100,000 BTU 0100,000 BTU - SUMMARY OF FEES builds or Improves thereon,and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that - Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT . $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT 0,1 am exempt under Section B.& P.C.for this reason , Firepl/Fact.,Bit. ICBO,# Fire Dampers PLUMBING $ ISSUANCE I $ Date - Owner Heating System& Ducting Registers ' • PLAN CHECK 25% $ ENERGY P.C. ' $ I hereby certify that I Have` read this application and state that the above • ❑0-100,000 BTU 01oo,0d0 BTL ELECTRICAL $ GRADING $ • Information is correct. agree t. omply with all city and county ordinances ' i and state laws re -ting to bull construction,and hereby authorize repre- , PLAN CHECK 50% $ r Co MICROFILM $ ' • sentatives of • city - e upon the above-mentioned pro ty or . f • inspection p es �- �7 i MECHANICAL $ TOTAL FEE $ I9 • lAO Signature // Date Drivers' I —• SS# Reinspection Fee _$15 Issue Fee _ $ 3 PLAN CHECK 25% $ CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor r - t CONSTRUCTION AND PLANNING POOL ,PA Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit# t , - 1. Temporary Electrical Service or Pole" 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 2 ' 53. Steel Reinforcement ' 3. Electrical Conduit Utility-Undrgrnd:. '' 54. Forms • •• t 4'. Electrical Conduit-Undrgrnd. 1 L{\IA`3 P 0 55. Electrical Bonding 5. Steel Reinforcement- -. i F 56. Rough Plumbing & Pressure Test 6. Electrical UFER G'rnd. , I57. APPROVAL TO COVER-GUNITE 7. Footings • 58. Electrical Conduit-Undrgrnd. ' 8. Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test , 9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System ' - 61. APPROVAL TO DECK A.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 , -40-$c (TA 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 X22. Ducts, Ventilating 71. Product Piping O Gas ❑Oil 23. Gas Pipe-Rough& Test 72. 'Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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 • �1 80. FOOD CERTIFICATE ISSUED 33. _Final Electric - . .4M ITU 1 Notes: 34. Final Heating & Air Conditioning 1 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 Domestic-Final 42. Backflow Preventer - - • 43. Backflow Irrigation 44. Landscape Irrigation System •4' 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 CERTIFICATE OF OCCUPANCY . Np Date v rt Y--iApplicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION'PERMITPE, MIT NO. TRACT NO. LOT NO. UNIT NO. , Project Address 2-SSI -C1-4=1E-C1-4=1-C1-4=1E-N) .eve. , C. 'C5-17.o• Nan %` -2 6p677l3 ' ' . 8799 12/16/86 21000 TL Applicant's Mailing Address TYPE OF CONSTRUCTION r L I NEW L I ADD L I ALTERATION Li REPAIR ' iZOdress OE-J ❑ CONVERSION ❑DEMOLISH ❑ OTHER A.P.# • _ I Zone Owner's Name Phoneb'-31• DESCR IPTION OF WORK/USE OF BLDG. - - • Address 2'c'i CL-L�-N 'cht15• I ! COSTf> h-{�-�,Ga - - S Main Building: I Accessory Building: ' Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front ZO • • Address - • • ' Li TENANT j❑ ELECTRICAL ❑ PLUMBING III MECHANICAL BB Rear N Contractor's Nama7Ap'AN Lfat PPI h1G Phone 596.4=525 ❑ OTHER ' P.O, SOX' 4ba WFSTh11NISt62. GT2=6-3 PROJECT DESCRIPTION SQ. FT. . OCCUPANCY C Right i 'G Address(mailing) / ! Left ' I R • hRb� CON ST RUCTION TYPE • VALVATION$ - $ _ ' City License No. • ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION • - ' , Ping. Ref.# , Parking Req./Provided • E I hereby affirm that am licensed under provisions of Charter 9 (commencing Remarks: P S c T,,,/n 'M e �J 1 - Planning Notes: ( M With section 7000) of Division 3 of the Business and Professions Code, and ` tw•� "ter^`� t T IVmy license is in full force and effect. ' 11\\� License Oa C.-21. ` License •• sconce, - - - S `vD Date - AI signatur l�___ MA PLUMBING 'FEES ft - I• I WORKE'S' •OMP NSATION D•• AR'w� i ' Bar Sink • Showers - I hereby affi m that I have a certificate of consent to self-insure or a certificate ELECTRICAL - FEES of Workers' Compensation Insurance, or a certified copy thereof (Section .Z _ • ' - 3800, Lab. C.) Backflow Preventer Service Sink Z- ">7 Automatic Washer - Transformer 0 15-50 KW . fl Ce No:WP8G'solD7/ • Company NT IND Backflow Irrigation - Sewer Cap '• - 0 50+KW - \ Construction Pole Sub. Certified copy i hereby furnished. t .. Certified qopy �/f�'J-etl with the city ui ing Division Bathtubs :Sewer Connection Cooking Unit Meter Duo to 100 amps I • Date ` LV q{f/ Applicant - - • , EXEMPT ON F OM WORKERS'COMP ATI N ARATION Clarifiers ,, - Solar Collectors 1 - Dishwasher Meter Dover 100 amps (This sec ion n ed not be completed if the permit is for hundred ($100) or Dishwasher less). Solar Piping - • Dryers DElectrid SubPanel _ I certify that in the performance of the work for which this permit is issued, I .• _ - shall not employ any person in any manner so as to become subject to the Drinking.Fountains Solar Tank ' Fan , Motors❑0-1 HP ❑1%-8 ' Workers' Compensation Laws'of California. . . i Date Signature • Floor Drains: - I Swimming Pool w/Spa - ' '• - F.A.U. -' NOTICE:If,.after making this declaration, you should become subject,to the in __ . _ -_ - . Inc.Solo; ❑9-15 HP 016-15+ • Workers' Compensation provisions of the Labor Code, you must forthwith . Floor Sks 'Urinal Fixtures ' comply with such- provisions or this permit shall be deemed revoked. Microwave' CONSTRUCTION LENDING' AGENCY Gas Service Outlets Water Closet • Device Boxes Pole Light 1 I hereby affirm that there is a construction lending agency for the performance 9 of the work ;for which this permit is issued (Section 3097, Civ. C.) - Interceptors Water Heater Outlets Range ' • Lentler's Name - _Lender's Address Kitchen Sink _,_• . _ Water.Service'.. - Switches Sign - - - -- OWNER BUILDER DECLARATION ' • • I hereby affirm that I am exempt from the Contractor's License Law:for the • Lavatories • Auto-Wish - Garbage Disposal Standing Sections following reason (Section 7031.5 Business and Professional Code:.Any city.or - county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundr Tra s any structure, prior to its issuance, also requires the applicant for such permit V, y Generator 00-5 KW'05-15 KW Trash COrripaCtOr - - ) to file a signed statement that he/she is licensed pursuant to the provisions of • the Contractor's License Law(Chapter 9(commencing with Section,7000)of Roof Drains ' ,Division. 3 of-the Business-and-Professions-Code)•or-that he/she is-exempt .- . • _. _ - _ - _ • here Vom antl'the basis-for the alleged exemption. Any violation of Section ♦1t.- `'�� 1 1� G� • ! t /031.5 by any applicant for a permit subjects the applicant to a civil V 114::\15-S-- _ penalty of not more than five hundred dollars($500). , • . , ' ❑ 1,1 as•owner of thel property or my employees with wages as their Sole Reinspection Fee' I $15 , Issue Fee $'3 • compensation, will do the work,and the structure Is not intended or offered for;sale (Section 7044, Business and Professional Code: The Contractor's - MECHANICALReinspection Fee _,! $15 Issue Fee - $ 3 License Law does not apply to an owner of a property who builds or improves FEES thereon, and who does such work himself/herself or through his or her own --1 ,DEVELOPMENT SERVICES REQUIREMENTS: (' • employees, provided that such improvements are not Intended or offered for •Boiler Hood or Type I ❑ sale, if, however,.the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date �� prove f;r owner will have the burden Of proving he/she did not build or im- Duct- Under Ground _ Building Approved By :ien......„.._ Date r{,.prove for the purpose of Sale). - - ' e L/�//�'X�j❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System' Application Issued By - Dat tractors to construct the project (Section 7044,Business and Professions Code: -_- •-- - The Contractor's'License Law does.not apply to an owner property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU '- SUMMARY OF FEES t - builds or improves thereon,and who contracts for such projects with aeon- - _ tractor(s) license pursuant to the Contractor's License Law). I am aware that • Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP . ' $ - proof of their Worker's Compensation insurance should be provided to me. 13r1 I am exempt under-Section ' • e-'& P.C:for this reason - Firepl/Fact.Bit. ICBG# • Fire Dampers - . PLAN CHECK f $- I PERMIT _PLUMBING $ i• Pa ISSUANCE $ _ Date • Owner Heating System& Ducting . Registers - - PLAN CHECK 25%, $ - ENERGY P.C.- $. • ` I hereby certify-that I have read this application• and state that the above ❑O-100,000 BTU ❑100,000 BTL, • _ - ELECTRICAL S. - . .GRADING $ - - • information is correct. I agree to comply with all city and county dirances- - _ and state laws relating to building construction,and hereby autho ze repre- - - - - - - I PLAN CHECK '50% $ MICROFILM $ • sentatives of t it to ter •on. abve-mentioned pr erty f r -- - , - , inspection Pur•.S— �� ,! p� 1" '; ' 1 l • MECHANICAL $ TOTAL FEE $ 2/• Ob- Signature O'__ �_ Date O 6 . • ' Drivers' License Pink -Accounting;Goldenrod -Assessor - l• CONSTRUCTION AND PLANNING POOL &SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms • 4. Electrical Conduit-Undrgrnd. 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, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 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. Duets, in Structure 70. Underground Hydro ' 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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 - tc� ff/f 4! 39..Water Service-Final �/ ✓/ 40. Gas Service-Final 41. Solar Domestic-Final . ' r 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 . - . . Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. — - - - CITY OF COSTA MES C9NSTR UCTIQN PERMIT - PERMIT NO. /�/ TRACT NO. LOT NO. yj�IT Q -• _ 7794 - - Project Address L 84.1 H 9-`T v ' 5 "J f - . . • _ ___ 6%18%86 45.00 TL 15R • NEW Mailingn1 �Address V 00� sC..11�0{' fp•••27--- TYPE OF CONSTRUCTION (ry,NEW Li ADD H ALTERATION LJ 14EPA•'R . Owner's Name /••.VILJf�TMrJWS ML�One - ❑ CONVERSION ❑ DEMOLISH ❑ OT R - _( q q,p•# - Zone -DESCRIPTION OF WORK/USE OF BLDG. 1 -V "I I �- Address 1 F N^ S Main Building: • - Accessory Building: • Arch/Eng.. License No: TYPE OF P:RMIT U GRADING ❑ FOUNDATION N STRUCTURAL E Front': ZO Address A/� //�� ll ❑ TENANT El ELECTRICAL El PLUMBING ❑ MECHANICAL B Rear - I N •Contractor's Name "L. . ""` a 'P3 11�3a ❑ 'OTHER - C Right - N g p 5 ,A ' ,�� • PROJECT DESCRIPTION SQ. FT. OGCUPA CY _` 'K Left - G Address.lmailin ling) ���a V Z `���""" 111 CONSTRUCTION TYPE VALUATION$_ $ R City License No. 30 Zc. , 1 I ZONE GRADING CU.YDS. ACR Ping. Ref.# Parking Req./Provided E LICENSED CONTRACTOR DECLARATION • • I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: ,,/ �/ n -s o p Notes: , Q • with section 7000) of Division 3 of the Business and Professions Code, and Yid Y' nezue 5-4745 G "*" 87. 3 Planning • a3a9S`� - T. my license is JI fo e and c_ �.I /' - $ Liceny Cla s License Nol�6^,I `-3 • Date -OJ Sign. _ PLUMBING FEES ' WORKERS'COMPENSATION • C ' RATION Bar Sink 1Showers ' • I hereby affirm that I have a cer ifica - of consent to self-Insure or a certificate ELECTRICAL FEES • of Workers' Compensation I ur. ce, or a cer Pied copy eof (Section - - - - - 3800, Lab. n [� , � Backflow Preventer Service Sink. A'litomatic Washer Transformer 0 15-50 KW , • Policy No. ]^ b�^ pony Backflow Irrigation • Sewer Cap 0 50+KW - f38 Construction Pole Sub. Certified copy is hereby furnish:. ' , — • DaleC If' co J1,filed with the ci 1 9 Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps "/ (-•a S— Applicant - EXEMPTION FROM WORKERS'-0O ' NSATION DECLARATION - I.. Clarifiers .- -- Solar Collectors -. _ - Dishwasher • -- - - Meter Thayer-TOO amps,- - - -- (This section need not be completed' e permit is for one hundred ($100) or • - less). Dishwasher Solar Piping , Dryers ❑Gas DElectric Sub Panel • , I certify that In the performance of the work for which this permit is Issued, I • , shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors❑0-1 HP 01%-8 Workers' Compensation Laws of California. Date I Signature Floor Drains Swimming Pool w/Spa — F.A.U. ,` 'NOTICE: If,after making this declaration,you should become subject to the ' ' _ _ Inc.Solar ❑9-15 HP ❑16-15+ �]V. Workers' Compensation provisions of'the Labor Code, you must forthwith-' Floor'Siriks Urinal Fixtures Microwave .....‘N comply with such provisions or this permit. shall be' deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes, I hereby affirm that there is a construction lending agency for the performance _ Pole Light of the work for which this permit is issued -(Section 3097 Civ. C.) ( ` Interceptors Water Heater - Outlets Lender's Name • Range Lender's Address - Kitchen Sink �- _ _ Water Service _ Switches Sign OWNER BUILDER DECLARATION •- - - _ I hereby affirm that I am'exempt from the Contractor's License•Law for the Lavatories' ' , - Auto-Wash •' •, - Garbage Disposal following reason (Section 7031.5 Business and Professional Code: Any„city or 9 P Standing Sections I county which requires a permit to construct,alter,improve,demolish or repair • P=Trap Laundry Trays - Generator 00-5 KW 05-15 KW any structure, prior to its issuance, also requires the applicant for'such permit - Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of ” ' -ROOf Drains • • - -the Contractor's License Law(Chapter 9(commencing with Section 7000)of - - , Division 3 of the Business and Professions Code) or,that he/she is exempt ' herefrom and the basis for the alleged exemption. Any violation of Section • ,- - ' _ - ; 031.5 by any applicant for a permit subjects the',applicant to a civil ' ' ' - •� - -benalty of not more than five hundred dollars($500). i • - LJ I,.as owner of the property or my employees with wages as their sole i ' Reinspection Fee $15 Issue Fee • S,3 compensation, will do the work, and the-structure is not intended or offered _ for sale (Section 7044, Business and Professional Code: The Contractor's - MECHANICAL - ,- FEES Reinspection Fee I $15 Issue Fee; • $ 3 License Law does not apply'to an owner of a property who builds or improves _.- -_-_- thereon, and who does such work himself/herself or through his or her own - - - DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for ' Boiler Hood or, Type I 0 , • sale. If, however, the building'or improvement is sold within one year of com- • DanOpy Typ¢II ❑ ' Zoning Approved By Date • pletion, the owner will have the burden of proving he/she did not build or im- . Duct-Under Ground " • �arove for the purpose of sale). • - "Building Approved By• Date • LJ I, as owner °tithe property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By ` ' Data ' tractors to construct the project (Section 7044,Business and Professions Code: I -The•Contractor's License Law-does not-apply to an owner of property who . Duct-Ventilating - •• I ❑0-100,000 BTU ❑100,000 BTU - builtls or improves thereon, and-who contracts for such projects with aeon-. _. - .SU(yIMQF1V OFEE$ tractor(s) license pursuant totheContractor's License Law). I am aware that - y"BUILDING PERMIT $ -1/..J G/./•J�7/ SMIP •$ (( Exhaust System ❑ Multiple 0 System Repair/Alteration proof O their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT ❑.1 am exempt under Section B.& P.C.for this reason • Flrepl/Fact:Bit. IC80',# • Fire Dampers• J , PLUMBING $ ISSUANCE $ • 1 Date - Owner' ' • Heating System &Ducting Registers I - PLAN CHECK 25% $ ENE RG V'P.C. $ • i I hereby Certify that I have read this application and state that the above ❑o-100,o000-TU 0100,000 BT GRADING $ informatio orrec I agree to comply with all city and.county ordinances - - • - . ' ELECTRICAL $ and state relay%. to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ ' sentative • isi. to enter upon the abve-mentioned property for inspecti0 ,os, ` Signature I% c�, Date Y7� MECHANICAL i $ TOTAL FEE $ /•� '�� . Drivers' ins- _ Reinspection Fee _$15 Issue Fee - $ 3 ,- roman PLAN CHECK 25% $ CMF 0865- rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - 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-Undrgrnd. i '., - 53. Steel Reinforcement -' , 3.electrical Conduit'U9l ty'-Undrgrnd. 1 7 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 •-•"1 7.,Footin6s `r ! i-. 58. Electrical Conduit-Undrgrnd. ' 8. Foundation -'i . I • 59. Gas Pipe, 0 Undrgrnd., Test 9. Wace ,Pipe-Undrgrnd. i 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10.-Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Lihe & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap r 63. Heater& Vent-Final 13. Rodf Drains -,1 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 Eledtrical-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 0 Oil 23. Gad Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil ' di 25. Roof Sheathing 74. Overhead Hydro �;�r //"� 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe i:. 28. Lathing& Siding 77. FIXED SYSTEM FINAL / 4 ,,,m7-7 29. Insulation v�n 78. FIRE PREV. FINAL 4 •' �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: fief . -24-4 - n7[j/ FIK-� 34. Final Heating & Air Conditioning y�/Ae y C S<fr�� 35. Final Gas Pipe-Test /4/112 Jl/b� // { r ..2,z.,9 -->"------ /� t� O r,/ /- f 36. Hood or Canopy / �j l/•' (f (I/` - 37. Final Factory Fireplace 38. Final Plumbing ' 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation V a. . 44:9 Landscape Irrigation System 45. Sound Attenuation 46:Handicap Regulations 47(FINAL STRUCTURE & BUILDING M 48. Special Requirements Completed 49. Electric Release to Edison 50.,,Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY 0 No. c Date CITY OF COSTA MESA ). 4 BUILDING DIVISION h' ' DEVELOPMENT SERVICES DEPARTMENT r J. " PERMITPERtvRF-NUMBER "'2����44. B99-00048 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2551 ELDEN AV Status: ISSUED Suite: A001 A003- Applied: 01/08/1999 Vicinity: BLDG A Issued: 01/08/1999 Parcel Nunmber: 93775023 Zoning: • • Applicant: JEFF MAXWELL Address: 03460 JULIAN AVE Phone: 562-596-0694 LONG BEACH CA Zip: 90808 Owner ROBINSON, KENNETH G Address ROBINSON,SANDRA L P O BOX Phone: ' %LYNDY MANAGEMENT CO - Zip: 92627 Contractor: JEFF MAXWELL- Address: 03460 JULIAN AVE Phone: 562-596-0694 LONG BEACH CA Zip: 90808 License: 487972 Arch : Eng: Address: Address: - Phone: - Phone: Zip: License: License: • SCOPE OF PERMIT GO OVER EXIST 1 LAYER COMP.SHINGLE WITH 20 YEAR COMP.SHINGLES. BLDG A UNITS Al &A2 • FEE SUMMARY Plan Check: $0.00 • Calc Valuation: $1,267.00 Permit: $43.00 - Claim Valuation: $1,267.00 SMIP Res: $0.50 • SMIP Com: $0.00 • Other: $0.00 Inspection: • •$0.00 Total: $43.50 • PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0--0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: • EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS WORKERS'COMPENSATION DECLARATION: . I hereby affirm under penally of perjury one of the following declarations: t. ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and poli number are: Carer: ,,57MTE refH D. 285r-V2,- Policy Number: (This section need not be completed If the permit is valued at one hundred dollars($100)or less.) ❑ I c: that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers' •• pensation laws of Califomie,and agree that If I s .me subject to the workers'compensa'.: • 'visions of Section 378•of the Labor Code,I shall forthwith c. •. - •:se• ovisions. r. I . ..ice �nt Signetu`l �s�� Date: • WARNING:FAQ--•SE 's- it , '' -e•-r ON COVERAG IS UNLAWFUL AND SHALL SUBJECT EMPLOYER T.CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED .,•U : • RE 100.078),IM'ADDfrjpry TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR I CTI• •.OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSE NTRACTO- DECLARATION: I her a irm that I toff'lice sed u cler• ovisions of Chapter 9(commencing with Section 7000)of Divisio o •: :. •- Lss P • •ssions Code,and my license is in full rc and effect.Uc.# • —. ass# ' • • Contractors Signature' Date: _Zt7 CON TION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): • DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2.Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feel of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or Irom any other air pollution control district or agency? 0 Yes Ll No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials end Emissions. Signature: _ Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. ttl1R[#•y1�. ,•.,+,.)T7l 11 Date Dat: LQIE_L , a ym, ;r pe¢ 11 15 MEI INSPECTION TYPE RASE =AU 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing 200 Final Re-Roof j/C210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site _ 204 Final Demolition 250 Final Building/Occupancy 2446-46 CITY OF COSTA MESA . .-. �`y' •� BUILDING DIVISION /// 1-' " 'i' ' DEVELOPMENT SERVICES DEPARTMENT l(d �. 4.�k* PERMIT P IT NUMBER / "grownco B99-00049 V/ (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 • BUILDING PERMIT Job Address: 2551 ELDEN AVyy11 Status: ISSUED ���� Suite: 6000" ) 600 / / F" O3 Applied: 01/08/1999 Vicinity: BLDG B Issued: 01/08/1999 Parcel Nunmber: 93775026 Zoning: Applicant: JEFF MAXWELL Address: 03460 JULIAN AVE Phone: 562-596-0694 LONG BEACH CA Zip: 90808 Owner ROBINSON, KENNETH G Address ROBINSON,SANDRA L P O BOX • Phone: %LYNDY MANAGEMENT CO Zip: 92627 Contractor: JEFF MAXWELL Address: 03460 JULIAN AVE Phone: 562-596-0694 LONG BEACH CA Zip: 90808 License: 487972 ' Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF OVER EXIST 1 LAYER COMP WITH 20 YEAR COMP.SHINGLES. FEE SUMMARY Plan Check: $0.00 _ _ Calc Valuation: $1,267.00 Permit: $43.00 Claim Valuation: $1,267.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other $0.00 Inspection: $0.00 • Total: $43.50 • PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0.0 Rear 0-0 Left 0.0 Right 0-0 ACCESSORY Front 0-0 Rear 0.0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed:. 0 NOTES: • • • EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 .1 ' • • DECLARATIONS '`-". I . WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: .: . • .\ ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the ficwork for which this permit is issued. I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'rkrsCom nation Insurance carrier and policy number are: (7 /�j +7.7 Carrier: - IRT-rt/-40 Policy Number. paS' 77 l7z. (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the w.I. • ,is permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Calico , : • . agree that 11 I shout.'become subject to the workers'compensation • •/shorts of Sectio 37••of the Labor Code,I shall forthwith corn. ice^��• �_ t��� ADS;, ne !y_.��� _ Date: \ ARM • , iat•I:Ir•r'-........44 --.7.--.....----- • ' SATION DOVE- E IS UNLAWFUL AND SHALL SUBJECT AN EMPL• - •CRIMINAL' ' TIES AND CML FWES UP TO ONE HUNDRED THOUSAN• •-•-,-...a.......IN ADDmON TO THE COST OF•• "-ENSATICN,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED +•% •ACT•RS DECLARATION: I here•- - irm that I am : :• � • -. ening with Section 7000)of Division 3 of urine - a • Prof: for _,ode,and my license is in full fop: -nd effect.UC. - a o lass '�' rectors •Si. ; ore: —�-- -massis — am.. _aidfisc CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued.(Sec.3097,CMI Code). Lenders Name: Lenders Address: .Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner 0f the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: In I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling(hereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safely Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? Q Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan bo filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health end Safely Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicantpor present or future building occupant need to prepare an RMPP(Risk Management end Prevention Program for acutely hazardous materials)? ❑Yes (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes ❑No (Section 85850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part Of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this appllcatlon,have all of the disclosures prescribed by California Health and Safely Code Section 42303 been made? 0 Yes 0 No 8 (If Yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above Is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state : . . • .inances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for i on purposes.I a• .:not to occupy or allow occupancy of any building authorized by this permit until final inspection. ._ n:,, 7,.: Date C —'" - NOr AAWAFP.a t ate was ItISPECT1ON'Fyn air DATE II®!IS DOH INSPECTION TYPE PATE IIOIDALS 1616 Fixed System Final Flre Prevention 208 Final Mechanical 1266 Pool Spa Final ``q 9 208 Final Plumbing 2-1111r200 Final Re•Roof le 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site _ 204 Final Demolition 250 Final Building/Occupancy 2446-46 City of Costa Mesa Development Services Department CERTIFICATE OF OCCUPANCY No. 001622 Building Safety Division P.O.Box 1200 Costa Mesa,California The Building located at 2551 Elden Avenue. Units R-1 . R-7 . n-1 has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group R-1 Occupancy. Use of Building Resitlential Legal Description A.P. 1439-171 -1n Reinspection E23469, ISee reverse side for Metes and Bounds) Permit No. IB23294 E23467, E23374, E23468, P26593, P23395, P23393 Building Permit NoR23794 Electrical Permit No.F.234fi4 Plumbing Permit No.P23394 Mechanical Permit No. I<124492 Number of apartments 3 and/or guest rooms ISSUED TO: Building Official- William T. '1nntari Ken Robinson /J F.O. Bon11930 by ,/ / - Costa Hoca, CA 92627 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 lel U.B.C. CMF 1015-46 rev.1/83 White-Owner;Canary-Numerical File;Pink-Bldg.Permit File Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. If IT NO TRACT NO LOT NO. UNIT O. A CONSTRUCTION_PERMIT 2314 4/02/36 2"C ni IL si Elden Adr Mw&rny 8 2/32.9 4 �a�1 3 i n ailing Address AO. �/1X 1/9 7 TYPE OF CONSTRUCTION NEW ADD U ALTERATION ileREPAIR �/ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER171 Q� Owner's Name t en Within 1091/ Phone bZS4.27,/ A.P.AP `H' .'�� -.so (Zone /�, DESCRIPTION OF WORK/USE OF BLDG. ''3 Y1ft" C' h',/yO Address P t /dad //?36 C,A'? , y94�7 A/ DEL .FGa S Main Building: Accessory Building: Arch/Engr-er" •540)1 S [ License No. 1 3b' 7 TYPE OF PERMIT LI GRADING Li FOUNDATION STRUCTURAL T Front /OJ I O Address /00/ /0. /7 ...-e-- GM V.?L.27 �❑l TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL IN B Rear '/ / N yp,OTHER .r—aneov'G J A V Address Ima Name Ly nay PIY, ^ 21/ /711. Phone A$-1.294 f /t,{ C Right oZ r 5/ N PROJECT DESCRIPTION SQ. FT._ -� OCCUPANCYs Address(mailingl'� O. OX r/4 30 /1 ,H/� 424 ;77 r :�� G CON STRUCTION TYPE VALUATIONS �7ur ' PO $ Left 7� �/ R ' City License No. 371,j ZONE 1 GRADING CU.YDS. ACRES r••� �/-� / LICENSED CONTRACTO DECLARATION o // sr�s - Ping. Ref.# l/a YJG,'-b + Parking Req./Provided `B /8 E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks:fie t# ! /W -9_ L F66 PD 5 E Stro A Planning Notes:HOLD.fUR SPECIAL Ktt JIithLicA�'S QM with section 7000) of Division 3 of the Business and Professions Code,and my license is in f II force and effect. T License Class LLiiyens No. 273Q $ nate /1'/G- yS Signature .�. /•f ,yy/nr- PLUMBING FEES A - )RKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES .ereby affirm that I have a certificate of consent to self4nsure or a certificate of Workers' Compensation Insurance, or a certified copy thereof,(Section . ._ Backflow Preventer - Service Sink . - - - ' 3800, Lab. C.) Automatic Washer Transformer 0 15-50.KW • Policy No. Company Backflow Irrigation Sewei Cop :j - Construction Pole Sub. • 0 50""+'KW 8 Certified copy is hereby furnished: - Certified copy is filed with the city Building Division. Bathtubs Sewer Connection - Cooking Unit Meter ❑up to 100'arnps Date Applicant - • ' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar-Collectors • Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for one hundred($100) or - - less). Dishwasher Solar Piping _ ,r ,I Dryers ❑Gas ❑Electric Sub Panel �. } I certify that in the performance of the work for which this permit is issued, I . shall not employ any person in any manner-so as to become subject to the Drinking Fountains Solar Tank . • t , Fan Motors • ❑0.1 HP ❑i 14-8 Workers'ate / Copens lion Laws California. �Ja-` �� Date ra Te —� S Signature- /�( K O'irn Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+ 'NOTICE: If,after making this declaration,You should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal _ Fixtures Microwave comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light I hereby affirm that there is a construction lending agency for the performance _ of the work fon which thisM � qr It�i'snissue (S¢CiJ�.3097 Civ. COn� Interceptors Water Heater Outlets " g Lender's Name G.1 '' 1 N/' M .(J Range Lender's Address p4jp0/`- k Kitchen Sink Water Service • Switches .. ' Sign I OWNER BUILDER DECLARATION I - I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash . 'Garbe Di osal. following reason (Section 7031.5 Business and Professional Code: Any city or - t 9a P ;Standing Sections county which requires a permit to construct,alter,Improve,demolish or repair P-Trap LaundryT any structure, prior to its issuance, also requires the applicant for such permit re yS Generator 00-5 KW ❑5-15 KW Trash Compactor . file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains e Contractor's License Law(Chapter 9(commencing with Section 7000)of .vision 3 of the Business and Professions Code) or that he/she is exempt , .nerefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil • • penalty of not more than five hundred dollars($500). - ❑ I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 • compensation, will do the work,and the structure is not Intended or offered - Reinspection Fee I $15 Issue Fee $ 3 / for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES ' License Law does not apply to an owner of a property who builds or improves - thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I 0 • 1 DEVELOPMENT SERVICES REQUIREMENTS: ,, ' / employees, provided that such improvements are not intended or offered foryp ,. [� "%-a • v sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II 0 • 2.oning,Approyed By' a'_'-- yyy to .tSI25 pletlon, the owner will have the burden of proving ha/she did not build or im- Duct-Under Ground • - • Building Approved By Date 2 ec" rove for the purpose of sale). VVV -I/Z/sT6 I,U as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System - Application Issued By nate tracors to construct the project (Section 7044,Business and Professions Code: . The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU •- • SUMMARY acFEES builds or improves thereon,and who contracts for such projects with a con- - - C tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration Bill LD ING PERMIT $ 5-1"7.Do SMTP $ I0•q7 proof of their Worker's Compensation Insurance should be provided to me. _ •PLAN CHECK $ PERMIT 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. !CBO# Fire Dampers PLUMBING $ ISSUANCE $ Date OwnerHeating System& Ducting Registers PLAN CHECK 25% $ - ENERGY P.C. $ I hereby certify that I have read this application and state that the above ❑0100,000 BTU 0100,0006 - ELECTRICAL $ GRADING $ • • informdtlonlis correct. agree to comply with all city and county ordinances - t and state laws relating to building construction,and hereby authorize repro- PLAN CHECK 50% $ MICROFILM $ sentatives of this city to enter upon the above-mentioned property for �/' ,t'] inspection purposes •r MECHANICAL $• TOTAL FEE $ C76•4T Signature _4.0- - Date Drivers' Licen - or SS# �� — // - Reinspection Fee $15 laue Fee $ 3 PLAN CHECK 25% $ _ i .CNCMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor I ;TRUCTION AND PLANNING F &SPA OVALS Permit# Date Inspector APPROVALS Permit # Date Inspector III porary Electrical Service or Pole 52- Pool & Equipment Location Pipe-Undrgrnd. 53. Steel Reinforcement • rical Conduit Utility-Undrgrnd. 54. Forms •4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ,5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ,16. Elecfrical LIFER Grnd. fig, 57. APPROVAL TO COVER-GUNITE 7. Footings fig, Y `, 58. Electrical Conduit-Undrgrnd. 8. Foundation - tlDet/4y t/r _ 59. Gas Pipe, 0 Undrgrnd.,Test ' 9. Water Pipe-Undrgrnd. Ott I/ (/ �/ 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK '11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final ,12. Sewer Ca'p 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 . t • 71. Product Piping 0 Gas 0 Oil -23. Gas Pipe-Rough & Test f ' 72. Underground Flush 24: Roof Framing 1 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing � V/7184 VC- 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing t;r 122,10 Vr 76. Dry Standpipe 28: Lathing & Siding ' • am�""�� �� 77. FIXED SYSTEM FINAL 29. Insulation 3tj.t,$t Yv 78. FIRE PREV. FINAL 30. Drywall'Nailing .` ' , �,4llry,,/(, v� HEALTH DEPT. REQUIREMENT 31-..Plaster 13i-own Coat , • • �j/AY!!/` /A, 79. FINAL INSPECTION 32. Electrical Power, Meter-Final' 80. FOOD CERTIFICATE ISSUED /1 33. Final Electric j, )44 12- Notes: Alai, ,&t/ i// 34. Final Heating &'Air Conditioning HO• 7,. LDFOR SPECIA Rt:4u•s�*_..._ .a 35. Final Gas Pipe-Test t - ,-,.....„ ,,, _, H, 36. Hood or Canopy eL O� 76 irtc��� 37. Final Factory Fireplace M 38. Final Plumbing LIS Olt IZ,I ej gi ale 39. Water_Service-Final . 40. Gas Service-Final , 41. Solar,Domestic-Final , ' - 42. Backflow Preventer ' • 43. Backflow Irrigation, . , - 44. Landscape Irrigation System 45. Sound Attenuation • 46. Handicap Regulations • - 47. FINAL STRUCTURE & BUILDING I in 48. Special Requirements Completed . //IA 7 M/6� 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co • • 51. CERTIFICATE OF OCCUPANCY No. Date r • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. " • COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. ress Z/3 23a 9 /z�{J 3 / .1B.00 TL ass% /dc r/ �/d `� 9549 7/16%86 �,pi U R PAIR I TYPE OF CONSTRUCTION ycv NEW ADO U ALTERATION ant's Mailing Address x//934 • !: f�d�h f >� aft-C-29/ ❑ CONVERSION Cl 'DEMOLISH CI OTHER A p �6 • - i. • Zone '- _ Owner's Name ��•• Phone 'DESCRIPTION OF WORK/USE OF BLDG. Address Ser), //Q '3v C/vi _ S Main Building: Accessory Building: Arch/Eng. E14 rC"O[ 'T. E Z 9 fJ S' License No. / 36n7 TYPE OF PERMIT IE CI 0STRUCTURAL T Front O Address //zit' S7' rt - • ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 0 MECHANICAL B Rear r NOTHER . 6�in/.�,G- A I Contractor's Name / �.�tet to y/ - Phone - - • 'C Right - - - N Address(mailing) /nx // f/ 3 D , PROJECT DESCRIPTION SQ. FT. - OCCUPANCY K • I CON STRUCTION TYPE VALUATIONS I,5'% 71e..2.0 $ Left • G City License No. 3 7/// - / - - R LICENSED CONTRACTOR DECLARATION l - ZONE - 'GRADING CU.YDS.. ACRES Ping. Ref.# . • Parking Req./Provided • E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: i . Planning Notes: M . with section 7000) of Division 3 of the Business and Professions Code, and - • T my IlCenae Is in lull force and effect. ' ^ �/ CO _ S License Class / License No. 2-t--9 ., 1 I - . Date 7 /L •—ti Signature .��O oaQ /% ^� PLUMBING I I "FEES - . I 7R KERS'COMPENSATION DECLARATION Bar Sink ' t r Showers r - - ELECTRICAL' FEES ,ereby affirm that I have a certificate of consent to self-insure or a certificate ___ • • • of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow,Preventer - Service Sink '0 15-50 KW 3800, Lab. CJ - . Automatic Washer l Transformer Policy No. Cap Construction Pole Sub. . Company Backflow Irrigation Sewer - D 50+KW 8 Certified copy is hereby furnished. ^ Certified copy is fled with the city Building Div n. Bathtubs - Sewer Connection - Cooking Unit Meter Our:to 100 amps ._ Date ApplicantiCe—s.ri • ' w-/ EXEMPTIONFROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher , Meter Clover' 100 amps , . (This section need not be completed if the permit Is for one hundred ($100) or less). Dishwasher . Solar Piping - Dryers (]Gas ❑Electric Sub Panel I certify that in the performance of the work for which this permit is issued, I - shall•not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank - - Fan Motors Do-i HP 01%-8 Worker mpj nsatioy.Laws of California. /�_,�/�� - - - . Date /4 yG Signature /tv�-'>��7C!-�•� Floor Drains Swimming Pool w/$pa - F.A.U. - - -Ina.Solar ❑9.15 HP ❑16-15+ . NOTIC If,after making this declaratini, you should become subject to the - - Workers' Compensation provisions.of the Labor Code, you must forthwith Floor Sinks • Urinal Fixtures Microwave comply with such 'provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCYGas Service Outlets • I - I hereby affirm that there is a construction lending agency for the performance Water •CIOs¢t Device Boxes • POI¢ Light of the work for which this permi is lss -d ( tion 3097 Civ. C.) - Lender's Name • A �. v - Interceptors Water Heater Outlets Range - Lender's Address �i. i i/ Kitchen Sink _ ' . . :Water Service . • - Switches . - - - OWNER BUILDER DECLARATION • - - -- Sign I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal , Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P-Trap • Laundry Trays Generator 00.5 KW ' 05-15 KW Trash Compactor ' any structure, prior to its issuance, also requires the applicant for such permit 1 a file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains - • • e Contractor's License Law(Chapter 9(commencing with Section 7000)of . ' vision 3 of the •Business and Professions Code) or that he/she is exempt - • -- nerefrem and the basis for the alleged exemption. Any violation of Section • ' 7031.5 by any applicant for a permit subjects the applicant to a civil ' enalty of not more than five hundred dollars($500). . I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work,and the structure is not intended or offered • - Reinspection Fee .I $15 Issue Fee $ 3 for sale (Section 7044. Business and Professional Code: The Contractor's MECHANICAL FEES • ' License Law does not apply to an owner of a property who builds or improves _ _ thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: ' employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 - • . sale. If, however, the building or improvement is sold within one year of corn- Canopy Type II ❑ Zoning APProved By D• ate pletion, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground - - Building Approved BY - Date Trove for the purpose of sale). LI I, as owner'of the property, am exclusively contracting with licensed.con- Duct-Structural Refrigeration System. • Application Issued By Date tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00.100,000 BTU ❑100,000 BTU +A`!k, C �� SUMMARY OF FEES builds or Improves thereon,and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's Ll cense Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ /� SMTP $ proof of their Worker's Compensation Insurance should be provided to me. PLAN CHECK $ PERMIT • - 0 I am exempt under Section B.& P.C.far this reason Firepl/Fact.Blt. ICBG# Fire Dampers - PLUMBING $ _ ISSUANCE $ . Date Owner - Heating System& Ducting Registers - - PLAN CHECK 25% $ ' - - 'ENERGY P.C. $ " i-hereby certify that I have read this application and state that the above -00.100,000 BTU 0100,000BTL - GRADING $ " • information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ and state laws relating to building construction,and hereby authorize repre- MICROFILM $ a sentatives of this city to enter upon the above-mentioned property for PLAN CHECK 50% $ /�2— inspection purposed ^ / 7 /� f/ MECHANICAL $ _ TOTAL FEE $ Signature �j/� / • - Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK "•25% $ _ 1 - -. _ . - - - CMF 0865-46,rev.10/84 White - Buil-cling: Canary -Applicant; Pink -Accounting; Goldenrod - Assessor ti CONSTRUCTION AND PLANNING • POOL &SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date ' Inspector e C7 1. Temporary Electrical Service or Pole I 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 i 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, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 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 0 Gas 0Oil 23. Gas.Pipe-Rough & Test. 72. Underground Flush • 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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 Domestic-Final t 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 it �" -(0 . • _ ••Applicant to fill In all spa es except those within heavy border lines and sign all appropriate declarations. - - • CITY OF COSTA MEQ$ CO�ISTR UC 10 P -MIT _1 PERM:-•- ^'^. " r'rst, TRACT NO. LOT NO. UNI O/ 'Project Address2,-,-( (L-0I).'� /��ys� ..r -:�_�" `s I - den ( • 3452 4/15/e6 ' 'r'•Scf' TL Applicant's Mailing Add ess (*Zl._1 - ,Y 4 r T•.♦ , OF JQD���'r�'EW U ADD U ALTERATION REPAIR ' / �L^f - ' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER • q P # - Zone Owner's N e "- �.,/A AGf . OPhon: DESCRIPTION OF WORK/USE OF BLDG. AddressD• 1 O� �� C To �rM. /9'.(a2�j 5 Main Building: Accessory Building: E Z -. Arch/Eng. License No. TYPE OF PERMIT /tU GRADING El FOUNDATION IJ STRUCTURAL T Front • p Address - ec' ppO�� v�a ' ❑ TENANT 7��P(I_LECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear A _ , N .5 Frey E'{ •PyI,, Cl 6 ❑ •OTHER C Right - N Contractor's(mailing)Name .Let1Jc ��t PROJECT DESCRIPTION SO. FT. OCCUPANCY Address �L� ` Cali. K G 3 l 7 5", - CONSTRUCTION TYPE VALUATION$ 5 Left R ' City License No. ZONEGRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION 1 / - Ping. Ref.# Parking Req./Provided E I hereby affirm that-I am licensed under provisions of Charter 9 (commencing Remarks: 1� 1 C-1 �'/C•� Planning Notes: - M with section 7000) of Division 3 of the Business and Professions Code, and my license is in full -rce .nQfeffect. O/j / 7 Z9 ' T Licens• I.. •� �./ _ icense t(,/ `! I S -`yore Signature — - i PLUMBING FEES ' :'CORK "S'C•MPENSATION •LeL• -ATION j • Bar Sink Showers "`I hereby affirm Cthat I o a Insurance,nsui kale of consent tofi d copy or a certificate ELECTRICAL • of Workers' Compensation or a certified copy thereof (Section .: Backflow Preventer Service Sink Automatic Washer i Transformer 0 15-50 KW ' 3800, Lab. C.) _ Policy No. • '" Compo nY • Backflow Irrigation Sewer Cap0 50+ KW Construction Pole Sub. Certified copy Is herebyfurnished. 8 Certified copy is filetl wills the city Building Division. .Bathtubs • ■ Sewer Connection ' • .�. il Cooking Unit Meter •1' p to 100 amps Date Applicant -EXEMPTION-FROM WORKERS'COMPENSATION DECLARATION Clarifiers - ■ Solar Collectors -- Dish. IIwashe 'Meter Clover 100 amps• , (This section need not be completed if the permit is for one hundred ($100)or less). / �S Dishwasher ' Solar Piping Dryers :.Gas ❑Electric Sub Panel I certify that in•the performance of the work for which t permit is Issued I shall not em toy any person in any ma •-r so as to by•me subject to the . Drinking Fountains Solar Tank p Fan � Motors 00-1 HP 01%-8 Worker ' pensation L3Si of Calif. C. F q U Inc.Solar ❑9-15 HP ❑16-15+ Date Signature 4 Floor Drains Swimming Pool w/Spa - 'NOTIC ' f,after making this de on -fu Should become subject to the •_ - �' Workers Compensation provlsio• f the Labor Code, you must forthwith1.Floor Sinks Fixtures comply with -such provisions or this permit shall be deemed revoked. 'I Urinal ■ . Microwave CONSTRUCTION LENDING -.AGENCY. -- Gas Service "Outlets Water Closet il: I hereby affirm that there is a construction lending agency for the performance Device Boxes I Pole Light iof the work for 'which lois permit is issuetl (Section 3097 Civ. C.) ,Interceptors, - . Water Heter Outlets 'Lender's Name Range & ' Lender's Address -- - _ .Kitchen Sink — ■ Water Service . Switches r-! OWNER BUILDER DECLARATION Sign 47.—.:-(0 I hereby affirm that I am:exempt from the Contractor's License Law for the a Lavatories- ' • O Auto-Wash , • ® following reason (Section 7031.5 Business and Professional Code:-Any.city or ■ ' Garbage Disposal ;Standing Sections 4.46 county which requires a permit to construct,alter,improve,demolish or repair - , any structure, prior to its issuance, also requires.the applicant for such permit P—Trap - Laundry Trays Generator ❑0.5 KW ❑5-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of • ROOF'Dralps the Contractor's License Law(Chapter 9(commencing with Section 7000)of - Division 3 of the Business and Professions Code) or that he/she is exempt • , - , ,_therefrom and the basis for the alleged exemption. Any violation of Section , - - - - - 7031.5 by any applicant for a permit subjects.theapplicant to a civil . ' :;penalty of not more than five hundred dollars($500). - , - _u I, as owner of the property or my employees with wiges as their sole Reinspection;Fee ' $15 Issue Fee ' $ 3 compensation, will do the work,and the structure is not intended or offered ' for sale (Section 7044, Business and Professional Code: The Contractor's ' MECHANICAL - I FEES • Reinspection Fee J $15 Issue Fee $ 3 License Law does not apply to an owner of a property who builds or improves : _.__. thereon, and who does such work himself/herself or through his or her own • DEVELOPMENT SERVICES REQUIREMENTS: , employees, provided that such improvements are not intended or offered for Boiler a Hood or Type I ❑ I - sale. If, however, the building Or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or Im• Duct- Under Ground ' prove for the purpose of sale). • - Building Approved By C J /�� Date 41',4--4, ❑ I, as'owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System . Application Issued By -'/ / n(,y Date tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating " - ❑0.100,000 BTU ❑100;000 BTU builds or improves thereon,and who contracts for such projects with a con- - - SUMMARY OF FEES tractor(s) license Pursuant to the Contractor's License Law). I am aware that ' BUILDING PERMIT $ - SMTP • proof of their Worker's Compensation insurance should be provided to me. Exhaust System 0 Multiple 0 System Repair/Alteration $ ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBG# ' Fire Dampers PLAN CHECK $ PERMIT • PLUMBING $ ISSUANCE $ Date • Owner - Heating System& Ducting Registers ' PLAN CHECK -25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above 00.100,000 BTU 0100,000BT - • GRADING $ Information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ 21. -,Q- and state laws relating to building c•nstruction,and hereby authorize repre- MICROFILM sentatives of thi :ty to enter •'.n the above-mentioned •p�rrooff/�rrtty/y or' PLAN CHECK 50% $ 1 2. 30 $ et'? c� inspection our.. e -y� ! (,� MECHANICAL $ - TOTAL FEE $ 't Lr / O Signature a Date Drivers' LI :• / - Accounting; Goldenrod - Assessor - • CONSTRUCTION AND PLANNING P.-.�L&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. - 6lD � JL I% Q . 55. Electrical Bonding 5. Steel Reinforcement - ' 56. Rough Plumbing & Pressure Test 6.. lectri-caIX/FERGind:,; • ' 57. APPROVAL TO COVER-GUNITE . r . 7. Footings - . , , 58. Electrical Conduit-Undrgrnd. - • 8. Foundation • 59. Gas Pipe, O Undrgrnd.,Test , 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System • 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 1 63. Heater & Vent-Final 13. Roof Drains - r 64. Plumbing System - Final 14. Rough Plumbing t. 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final - I 16! Rough Electric Wiring r 30-g‘ (Eh 67. Fencing &Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING • 18: slough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL • 19. f lough Heating & Air Conditioning' FIRE DEPT. REQUIREMENT 2O' Rough Factory Fireplace • APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush ' 24. Roof.Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing74. 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 .451L i J 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 Domestic-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 • E..,35t&Z • n Applicant to fill in.all spaces except-those within heavy border lines and sign all appropriate declarations. 3454 4/� 8/r -n CITY OF COST M SCp� C T,lpUC,TI}ON PERMIT FF•R..... A�•{��r/'' ✓pT•' TRACT NO. LOT NO. UN T t, -•CI IL Project Address J F4LV'�JV AOC. • �i'w "�•`•FS• - _-te �//•_Z , • • ZI 3 � � :'•c OF CON$rn�s.,,ON IEW U ADD U ALTERATION. REPAIR . Applicant's Mail'ng Address ( ,f l - -A.%) 014/4)1 O✓ leV d� Ph0 / T ,❑ CONVERSION ❑ DEMOLISH ❑ OTHER A,P.# Zone - Owners Nine IV qP�7 ^,r DESCRIPTION OF WORK/USE OF BLDG. Address O. 77 3 G<� r'` v - S Main Building: Accessory Building: - Arch/Eng. License No. TYPE OF PERMI;/'U GRADING 0-FOUNDATION E - - - O � ❑ STRUCTURAL Front Address /^�s�'ager 'Y / ❑ TENANT ELECTRICAL ❑ PLUMBING O MECHANICAL - B Rear N YLZ' fC /F� c C C ne�ys 2[/ . ❑ 'OTHER A Contractor's Nam Pho / 2OO .. - - C Right N Address(mailing)/Li 3 a�ra/.(C�-s�'�%C�. �t�'Z�p PROJECT DESCRIPTION SQ. F7. ( OCCUPANCY K Left • G ���� j CON ST RUCTION-TYPE VALUATIONS S R City License No. •J ZONE ' - GRADI�G CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION l — Ping. Ref.# Parking Req,/Provided' E I hereby affirm Chari am licensed under provisions of Charter 9 (commencing Remarks: ,cie �'y.l G� Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code, and ` I ' ` my license is In full fore• nd of ev - ^ / j ' 9 y • S T License Cies — LI ens! V IS— C �i` ` 7 `ate - _ Signature I FEES /ORK ,S'C• PENSATION Dlir R• ION Bar Sink Showers I hereby affirm that I have a certificate of consent to self-Insure or a certificate E LECTR ICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Pr2venter Service'Sink Automatic Washer Transformer 0 15-50 KW 3800, Lab. C.) ,' I Policy No. Company Backflow Irrigation Sewer Cap ' Construction Pole Sub. 0 50+KW E Certified copy is herebyefurnlshed. • ���.../// 500 ' � , Certified copy Is filed'wlth'the city Building division. Bathtubs ' Sewer Connection • l I .2 Cooking Unit i Meter 1GWp to 100 amps Date j VAppllcant / ' EXEMPTION FROM WORKERS'.COMPENSATION DECLARATION- - Clarifiers . ' - - Sdlar Collectors -f / Dishwasher„�5--✓✓ Meter Dover 100 amps 1- co (This section need not be completed if the permit it for one hundred($100) or + Dishwasher Solar Piping • l / Dryers”( as ❑Electric / Sub Panel less). i / cc I certify that in the performance of the work for which this p rmit is issued,I - , - ��-w shall not em y y person in any ma so as to becof� e subject to the • Drinking Fountains Solar Tank • .-. Fan Motors❑01 HP ❑1 X-6 Worker t Laws of Califo a / // ' - Date Signature �C�a{� ould c� Floor Drains Swimming Pool w/Spa• `Y' / F.A.U. Inc.Solar ❑9.15 HP ❑16-15+ � ( (� ' NOTIC f,aft making this nectar t shoultl be Come subject to the - I Workers Compensation provisions o the bor Code, you must forthwith Floor Sinks i Urinal G ti Fixtures comply with such provisions or- this ,permit shall ,be deemed revoked. - - Microwave 2W. CONSTRUCTION LENDING 'AGENCY ' ' Gas Service - Outlets - • Water Closet Device Boxes I hereby affirm that there Is a construction lending agency for the performance , Pole Light of the work 'for which this permit-1s issued .(Section 3097 Civ. C.) Interceptors , - Water Heater Outlets Range 6• -1/� Lender's Name• - _ - - - 4�! Lender's Address • Kit • chen Sink _ -Water Service,. - - / 7 Switches, • �Q OWNER BUILDER DECLARATION - - - Sign —^ I hereby affirm that am-exempt from the Contractor's License Law for the Lavatories - • Auto-Wash , - j Garbage Disposal I O I following reason (Section 7031.5 Business and Professional Code: Any city or - 9 p ;Standing Sections DO county which requires a permit to construct;alter,improve,demolish or repair - P=Trap • l[aundry Trays' • Generator ❑0.5 KW❑5-15 KW Trash Compactor 'any structure, prior to its issuance, also requires the applicant for such permit ' " - l0 file a signed statement that he/she is licensed pursuant to-the provisions of Roof Drains ' the Contractor's License Law(Chapter 9(commencing with Section 7000)of - 1 ' Division 3 of the Business and Professions Code) or that he/she is exempt _ , , 7031.5 and the basis for the allegedperexemption. Any violation of Section -. I 7031.5 by any applicant for a permit subjects- $50 .the applicant to a civil . . - - • 4 hairy of not more than five hundred dollarploye 0). I • I, a5 owner of the property' or my employees with wages as their sole ReinSpecllOn',Fea $15 Issue Fee- I $ 3 • ' salecompensation, will do the Business and the structure is not :Intended C or offered Reinspection Fee $15 Issue Fee $ 3 for sale (Section'7044, Business.and Professional Code: The Contractor's ' . . , . .- MECHANICAL . I. FEES License Law;does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own J Hood or Type 1, ❑ • - DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are riot intended or offered for r Boiler ' - , Sale. If, the the building or improvement is sold within one year of com- - Canopy' Type I I ❑ Zoning Approved By Date ',lotion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground - - ' Building Approved ByDate prove for the purpose of sale). . �/ r' p/ 0 I,as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System ' Application Issued By YS G Date f�Q ap tractors to construct the protect (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating - 00100,000 BTU 0100,000 BTU r . SUMMARY OF FEES ' builds or Improves thereon, and who:contracts for such projects with a eon- • tractor(sf license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑- System Repair/Alteration their BUILDING PERMIT : $ SMIP ; $ proof off Workers Compensation insurance should be provided to me. _ PLAN CHECK ' $• • 'PERMIT 0.1 amlexempt under Section B.S. P.C.for this reason Firepl/Fact.Bit. ICBG# , • Fire Dampers PLUMBING $ 'PERMIT $ • Date Owner Heating System& Ducting , • , Registers CHECK 25% $ ENERGY,P.C. $ l hereby certify that Ihave read this application and state that the above 00-100,000 BTU ❑100,000BTELECTRICAL $ Z4.k� GRADING $ • information Is correct. I agree to co•-•ly with all city and county ordinances and.state laws relating to buildin• • struction,and hereby author a repre- l PLAN CHECK ;50% $ Z, 3� MICROFILM $ sentatives of .is cityt• enter n the above-mentioned or ort or inspection •. p..es. `�� �� j�'�j MECHANICAL $ TOTAL FEE $ 37. 70 Signature Date / : _Drivers se or S >; _ Reinspection Fee $15 , Issue Fee $ 3 • PLAN CHECK ;25% $ so- CMF .CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod -Assessor CONSTRUCTION AND PLANNING P�-,L&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 UtilityUndrgrnd. •- 54. Forms 4. Electrical Conduit=Undrgrnd. 447A 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 1 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd: 60. Backwash Lines, P-Trap, 0 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. RoughPlumbing a 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring r • - 3D„47' £°e(p1, 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 0 Gas 0 Oil 23.'Gas Pipe-Rough & Test 72. Underground Flush • 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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 n L 80. FOOD CERTIFICATE ISSUED 33. Final Electric _Dr 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 Domestic-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 • • Ea 3 (a9 .. Applicant to fill in alllspaces except those within heavy border lines and sign all appropriate declarations. - - ' • Pc- IT No f TRACT NO. LOT NO. UNIT . �. CITY OF COSTA M r�" C�Q��ISJT�RUCTIO P RMIT �- �3 3456 4/18/E6 3°o%C TL Project Address' S I it" ` - OJ '�' -re� i/ r Applicant's Maili g Address 1.-2-.- i 4 Jir C.- // TYPE • OF CONSTRUCTION re' EW II ADD a ALTERATION a ,REPAI R i °i ❑ CONVERSION• ❑ DEM•LISH El OTHER Owner's/p1✓am/ C. �fNSQ Phoo/n • `� A.P.# • I Zone Address) �'�� / b/ I 3 �^r/•�, ( Z67-6 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: - ' Accessory Building: - • Arch/Eng. , - - License No. • TYPE OF PERMITrr U GRADING U FOUNDATION Li STRUCTURAL E Front Z Address .,/ ❑ TENANT /`ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N- Contractor's Nam L 0p S f I Phona� El OTHER / A I /r PROJECT DESCRIPTION SQ. FT. r�7 OCCUPANCY C Right • N Address(mailing) nse N g)r �3 ( #7 3 `e • CONSTRUCTION TYPE VALUATION$ S Left . - R City License No. 3 ZONE GR NG CU.YDS. ACRES - • LICENSED CONTRACTOR DECLARATION E (((``` C _ Ping. Ref.# Parking Req./Provided E 1 hereby affirm that'I am licensed under provisions of Charter 9 (commencing Remarks: �}•{/� C _ • Planning Notes: - G with section 7000) of Division 3 of the Business and Professions Code, apd ?fig ` TT - • my license is in full for • and eff1. ,-/i/L[/yJ /_ ✓� -�7 9 ( / T License I. s - Linse `Z l T C/�•10 v ` 7 - - S 'ate- _ Signature �` /- PLUMBING I FEES . /ORK' RS' •MPErvSArIOrvA- •TION ' Bar Sink Showers ELECTRICAL • FEES I hereby affirm that I have a cer ate,of consent to self-insure or a certificate of Workers' Compensation Insurance,'or a certified copy thereof (Section Backflow Preventer Service Sink 3800, Lab. C.) J.L. t" Automatic Washer Transformer 0 15-50 KW Policy No. "r" Company Backflow Irrigation Sewer CapConstruction Pole Sub. la-Certified •• ❑ 50+ KW • copy is hereby furnished. 'Certified copy is filed-witli-the city Building Division. I Bathtubs • Sewer Connection .�. Cooking Unit J Meter �up to 100 amps ' *5 .0 Date -Applicant • — • EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers - -- Solar Collectors • - 1 Dishwasher- - •- Meter 0over,100 amps - I -�1n (This section need not be completed if the permit is for one hundred($100) or W less). Dishwasher ' Solar Piping- f, ' Dryersl4ias DElectric / Sub Panel 6 I certify that in the performance of the work for which th' permit is issued I - - �� shall not em• oy an person in any nor so as o be me subject tg,the Drinking Fountains Solar Tank Fan 1 • Motors 00.1 HP 01%-8 Worker • .ws of Calif a. •y_ • Date r• • i Signature Floor Drains ' , * Swimming Pool w/Spa - / F.A.U. ' Inc.Solar 09-15 HP 016-15+ ' L X 'NOTIC' • I.afte making this decia 0 u Should become Subject to the - - ^ Workers' Compensation provisions Labor Code, you must forthwith Floor Sinks' Urinal Fixtures • Microwave. i comply'with such provisions or this permit shall be deemed revoked. _ I O CONSTRUCTION, LENDING AGENCY Gas Service ' Outlets- • Water Closet Device Boxes ' I I hereby affirm that there is a construction lending agency for the performance - Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Interceptors Water Heater -912Range1 zb Range Lender's Address - _ . Kitchen Sink Water Service I Q OWNER BUILDER DECLARATION Ztwitthes Sign t/ I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories r , -Auto-Wash Garbage Disposal • ell following reason (Section 7031.5 Business and Professional Code: Any city or - ( I 9 p :Standing Sections j county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays . r' Generator ❑0.5 KW ❑5-15 KW ` any structure, prior to its issuance, also requires the applicant for such permit , - - _ • Trash Compactor ' .o file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains - - - , ' the Contractor's License Law(Chapter 9.(commencing with Section 7000) of - _ • ' Division 3 of the Business and Professions Code) or that he/she is exempt • - ' therefrom and the basis for the alleged exemption. Any violation of Section ' ' 1 - • ' '7031.5 by any applicant for a permit subjects the.applicant to'a civil - - • , penalty of not more than five hundred dollars($500).• I, as owner of the property or my employees with wages as their sole Reinspection Fee ' I $15 • Issue Fee'- $ 3 compensation, will do the work, and the structure Is not Intended or offered - - Reinspection Fee I $15 Issue Fee 1 , $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's I MECHANICAL FEES ' License Law does not apply.to an owner of a property who builds or improvesi. - - thereon, and who does such work himself/herself or through his or'her own - - DEVELOPMENT SERVICES REQUIREMENTS: ' - employees, provided that such improvements are not intended or offered for Boiler - Hood or Type I 0 ZoningApproved By I • sale. if,•however, the building or Improvement is sold within one year of com- - - Canopy. Type II ❑ I pp oved ' Date ' pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date - 0 I,,ve for the purpose the f oale). - • /� [k ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System - Application Issued By Date s-Y tractors to construct the project (Section 7044,Business and Professions Code: I ` The Contractor's License Law does not apply-to an owner of property who Duct'Ventilating - . ❑o-100,000 BTU ❑100,000 BTU SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- - tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple ❑ System Repair/Alteration BUILDING PERMIT $ : SMIP I $ proof of their Worker's Compensation insurance should be provided to me. 1 - I PLAN CHECK $ - PERMIT , 0 I amiexempt under Section B.& P.C.for this reason Firepl/Fact.Bit.ICBG# Fire Dampers PLUMBING $ ,ISSUANCE $ _ _ _ _ I PLAN CHECK 25%- $ ENERGY P.C. $Date • Owner • Heating System& Ducting Registers i hereby certify that I have read this'application and state that the above ❑0-100,000 BTU 0100,000 BT I ELECTRICAL $ Zee 6o GRADING $ Information is correct. I agree to'comply with all city and county ordinances • and state laws relating to building -nstruction, and.hereby authorize repro- MICROFILM ' $ sentatives of ty. to a r; •.n the above-mentioned prop ty r PLAN CHECK 50% $ ' I Z.j n inspection p ose . i 1 I MECHANICAL I $ TOTAL FEE $ -?9•4•910 • Oate Drivers'Signature e or 96 Reinspection Fee $15 I Issue Fee $ 3 PLAN CHECK 25% $ ' i CMF 0865-46,rev.10/84 White - Building: Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING F. ,L &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. Zl �o to, . 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. , - . 57. APPROVAL TO COVER-GUNITE 7. Footings• 4 - 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 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 .1 13. Roof drains n 64. Plumbing System - Final ;,�,�• 14. Rough Plumbing' ' 65. Electrical-Final • 15.-Rough Electrical-Conduit 66. Solar System-Final 16. 'Rough Electric Wiring / 30 it flA 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 0 Gas 0 Oil 23.'Gas Pipe-Rough &Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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 Goat 79. FINAL INSPECTION 32. Electrical Power Meter-Final j- 80. FOOD CERTIFICATE ISSUED 1' 33. Final Electric , Notes: 34. Final Heating& Air Conditioning !1- - 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 Domestic-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 ' , r No. Date • 111— Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. %F CITY OF COSTA MESA CQNSTRUCTION PERMIT PERMIT NO. TRACT Q.y TRACT NO. LOT NO. uNlt o. - - •9'121 7/09_/8_6_ 40.50 TL Project Address 2551 ELDEN ST. I m if T/�'^ {Vq_i' ���,(.�fl(� -• • Applicant's Mailing Address 2121 S. GRAND AVE., SANTA ANA TYPE OF CONSTRUCTION LJ NEW U ADD U ALTERATION LJ REPAIR 1�t ROBINSONy+�7300 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone Owner's Name Phone DESCRIPTION OF WORK/USE OF BLDG. Address P.O. BOX 11930 , COSTA MESA - S Main Building: Accessory Building: TYPE OF PERMIT ❑GRADING U FOUNDATION ❑ STRUCTURAL E Front Z Arch/Eng. License No. �t T - O ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING' Ib[MECHANICAL B Rear N Address - - SIERRA F IRCNME TAl. 957-8991 ❑ -OTHER A.Contractor's Name Phone C Right N Address(mailing) 2121 S. GRAND AVE., SANTA ANA 92705 PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Left G 024912 CONSTRUCTION TYPE VALUATION$ S City License No., - ZONE GRADING CU.YDS. ACRESE LICENSED CONTRACTOR DECLARATION _ Ping. Ref.# Parking Req./Provided . Q • I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: 'BUILDING PERMIT B23294 Planning Notes: M • with section 7000) of Division 3 of the Bu iness and Profes ons Code;and # • my license is in full force and effect. / • , • T License Clas4 *rase o �/�A 2•a v S W• , r PLUMBING ; FEES Date Signature r f. -t\$\ - WORKERS',COMPENSATION DECLA•ATION Bar$ink Showers ELECTRICAL FEES I hereby affirm that I have a certificate •f consent to self-insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section _ Backflow Preventef- Service Sink - 3800, L.ab. c.) I - Automatic Washer Transformer ❑ 15.50KW •Policy No. N01071Z3(7d' Comp.ny ='Ivl•M: Backflow Irrigation Sewer Cap' • a /Construction Pole Sub. • 0 50+ KW Certified copy is hereby furnished. el )•Certified copy Is filed with the city Buil. 9 Divisio /���, Bathtubs �. Sewer Connection COOking•Unit Meter 0u to 100 amps • Date Applicant z: • EXEMPTION FROM WORKERS'COMPE •� ON OECL• - -TION r Clarifiers l Solar Collectors •f Dishwasher Meter Dover 100 amps' (This section need not be completed If the •ermlt is for one hundred ($100)or < - . less). Dishwasher Solar Piping Dryers OGas DEleciric Sub Panel I certify that in the performance of the work for which this permit Is issued, I • 1 shall not employ any person in any manner so as to become subject to the Drinking Fountains . Solar Tank Fan Motors 00-1 HP 01K-8 ((c- Workers' Compensation Laws of California. • . nate Signature - —Floor Drains /l ' Swimming Pool w/Spa • ) F.A.U. Inc.Solar 09-15 HP 016.15+ ' 'NOTICE:If,after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave comply with such provisions or this permit shall be deemed) revoked. CONSTRUCTION LENDING AGENCY - ' Gas Service Outlets . Water Closet" Device Boxes I hereby affirm that there is a construction lending agency for the performance Pole Light of the work for which This' permit is issued (Section 3097 Civ. C.) Interceptors • Water Heater • Outlets Range Lender's Name - ' Lender's Address ' - Kitchen Sink - - - Water Service- l Switches Sign OWNER BUILDER DECLARATION - I I -- - I hereby affirm that am exempt from the Contractor's License Law for the Lavatories Auto-Wash - ' Garbage Disposal ;Standing Sections following reason (Section 7031.5 BusIness and Professional Code: Any city or ' ' county which requires a permit to construct,alter,improve,demolish or repair - P—Trap - Laundry Trays - ( Generator ❑0-5 KW❑5-15 KW , any structure, prior to Its issuance, also requires the applicant,f or such permit - Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof -• Drains l - the Contractor's License Law(Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt . - - therefrom and the basis for the alleged exemption. Any violation of Section .. I 7031.5 by any applicant for a 'permit subjects the applicant to a civil - . onalty of not more than five hundred dollars($500). ' • LJ I. as owner of the property or my employees with wages as their sole Reinspection Fea $15 Issue Fee $ 3 compensation, will do the work,and the structure is not intended or offered Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's , MECHANICAL FEES -License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for , Hood or Type I 0 , sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II ❑ - Zoning Approved By Date plebe n, the owner will have the burden of proving h¢/she did not build Or im- • Building Approved By Date prove for the purpose•of sale). fl, ❑ I,as owner of the property, am exclusively contracting with licensed con- II Refrigeration System Application Issued By A"'i` Dat tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who —. • • ❑0.100,000 BTU ❑100:000 BTU �ryL SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that -. � : II System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. /� D PLAN CHECK $ PERMIT 0 am exempt under Section • B.Si P.C.for this reason :• - Fire Dampers v PLUMBING $ ISSUANCE $ • Date Owner /, H`e�ting System&Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ ' I I hereby certify•t at have re.. is application and state that the above-- 3 hd'6100,000 BTU 0100,000 BT • - - - �� �Q ELECTRICAL $ GRADING $ information is can ct I agr-e t•t•••/ppl with all city and county ordinances /" and state laws rel i • to y-• • '�'.c66nsl union, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM Si sentatives of this c' y -n 'pa a• •ve-mentioned prop rty for - ,+t inspection purpose 451#4, , Y D C, Signature 1 I �• Date 7 Z MECHANICAL S - TOTAL FEE $ 5 Drivers' License or 5$# Reinspection Fee $15 Issue Fee $ 3 • PLAN CHECK 25% $ Alo CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING F..JL &SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location k 2. Soil Pipe-Undrgrnd. 53. Steel'Reinforcement r 3. Electrical Conduit Utility-Undrgrnd. 54. Forms - r 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding )i i • <,-• 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test i . 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgind. j�;_ 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:-.7 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 Conditioningy„,//�a i SrIRE DEPT. REQUIREMENT 20'' Rough Factory Fireplace %/ Jf' 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 - 73. Undergrnd.Storage Tank 0 Gas 0 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 dile, /Me • 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace ;/7/7,7 '/- fir 38. Final Plumbing / • 39. Water Service-Final 40. Gas Service-Final • 41. Solar Domestic-Final 42. Backflow Preventer ' r43. Backflow Irrigation -44. .Landscape Irrigation System t45. Sound Attenuation c46. Handicap Regulations i 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison X50. Gas Release to Southern California Gas Co ' c51. CERTIFICATE OF OCCUPANCY - • No._. Date - - 111r - • Applicant to}Min all spaces except those within heavy border lines and sign all appropriate declarations. - (� F COSTA MESA CONSTRUCTION PER I? PERFl�IT NO�'j TRACT NO. LOT NO. UNIT NO. 3121 4/ Ina/86 ' /ate a, T . .'PI Address ,J �l /- .' ry2�G�., �) /�_5� =tea, p} LI I • 1/ Applicant's Mailin ddress !'�J, �"'PsKh-nt TYPE OF CONSTRUCTION T)-NEW LJ ADD Li ALTERATION U REPAIR , Owner's Name ' - Phone_ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.9I6 Zone n -DESCRIPTION OF WORK/USE OF BLDG. Address et) ®Ot // 29O .,Cs: r-4.c_ , - (, S Main Building: Accessory Building: • • Arch/Eng. License No. ���T� TVPE OF PERMIT U GRADING,��LII_//1���FOUNDATION U STRUCTURAL E Pront O Add• ress ®® ❑ TENANT ❑ ELECTRICAL .tB.H�V MBING 0 MECHANICAL ATHER Rear N Contractor's Nam. 5 Phone ✓ Address(mailing) 4SJ' 9 if� PROJECT.DESCRIPTION SQ. FT. OCCUPANCY rK Right G �, a.7� • CONSTRUCTION TYPE VALUATION$ - S Left City License No. • ZONE RAIDING CU.YDS. ACRES _ _ - R ' LICENSED CONTRACTOR DECLARATION »• /AGI'' /� _ q Ping. Ref.# I , Parking Req./Provided E 0 I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: �iG(,✓G� (/ /-7 c2 3a ! / Planning Notes: 1 M with section 7000) of Division 3 of the Business and Professions Code,and ff �` • my license is inoand effect. .2,� G T License Class it• • No. 1 O - S • mat ignature ... - , PLUMBING FEES , OR ERS'COMPENSATION DE ,.ARATION ' Bar Sink Showers h ' ELECTRICAL FEES N .hereby affirm that I have a certificate of consent to self-insure or a certificate 1 - _ - _ _ of of Workers' Co{npensation Insurance,-or-a certified copy thereof.(Section Backflow Preventer Service Sink (\ 3800, tab. L,)/XO 8� L-=/d '� Automatic Washer' Transformer ❑ 15-50 KW \�fT�.1 Policy No. ooZ Company f"�` Backflow Irrigation Sewer Cap Construction Pole Sub. • ❑ 50+KW Certified cop• y hereby furnished. ice, Certified copy is filed with the city Building Division. 1,1.7 ' r .,Bathtubs / Sewer Connection �p Cooking Unit Meter pup to 100 amps \ Dae Applicant - / _ - - - -• - EKEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers _ " -s Solar Collectors Dishwasher. ' .Meter. ❑over-100.amps -- (This section need.not be completed if the permit is for one hundred ($100) or, 1 less). • "' , , / Dishwasher • Solar Piping Dryers ❑Gas ❑Electric 1 Sub Panel Ic--. certify,that,in-the performance of the work for,which this permit is'issued,Ir \, \J shall not employ,any person in any manner so as to become subject to the, Drinking Fountains I Solar Tank • \ Workers' Compensation Laws of California. /Jr I _ Fan 010-1Motors 1 HP 01X-8 Date Signature Floor Drains I Swimming Pool w/Spa F.A.U. — Inc.Solar ❑9.15 HP ❑is-is+ 'NOTICE: If,after making this declaration, you should become subject to the Workers' Compensation provisions-of the Labor Code, you must forthwith " Floor Sinks,_ _ _ —r Urinal • - Fixtures, comply with such provisions or this permit shall be. deemed revoked. - Microwave CONSTRUCTION LENDING•,AGENCY . - " J Gas'Service • Outlets 3 Water Closet ' •- p. Q0 Device Boxes Pole Light I hereby affirm that there is a construction lending agency for the performance 9 ' , of the work for which this permit is Issued (Section 3097 Clv. C.) - Intefceptors j Water Heater .r Lender's Namo - - ' • • - - ^ - • A. acc Outlets Rang¢ Lender's Address / Kitchen Sink • I Water Service • OWNER BUILDER DECLARATION if�Q Switches Sign r I hereby affirm that I am exempt from the Contractor's License Law for the r3 Lavatories' ` Z -Auto-Wash ' • p following reason (Section-7031.5 Business and Professional Code: Any'city or Jl /), 00 Garbage Disposal ;Standing Sections • county which requires a permit to construct,alter,improve,demolish or repair any structure, prior to its issuance, also requires the applicant for such permit P-Trap Laundry Trays - Generator ❑45 KW 05-15 KW Trash Compactor :1;m file a signed statement that he/she is licensed pursuant to the provisions of • - he Contractor's License Law(Chapter 9(commencing with Section 7000)of Roof Drains 5-W - .'"Division 3 of the Business and Professions Code) or that he/she is exempt - - therefrom and the basis for the alleged exemption. Any violation of Section • , 7031.5 by any applicant for a permit• subjects- the applicant to a civil - - ' enalty of not more than five hundred dollars($500). . - o I, as owner of the property or my employees with wages as their sole ' Reinspection Feq $15 Issue Fee - $ 3 • , compensation, will do the work, and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee I $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL i I FEES License raw does not apply to an owner of a property who builds or Improves - thereon, and who does such work himself/herself or through his or her own l _ DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not Intended or offered for Boiler • Hood or Type I' ❑ , sale. If, however,the building or Improvement is sold within one year of com- Canopy' Type II ❑ Zoning Approved By Date elation, the owner will have the burden of proving he/she did not build or en- Duct-Under Ground Building Approved By Date prove for the purpose of sale). • ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System • Application Issued By L Dat: /L7 ., tractors to construct the project (Section 7044,Business and Professions Code: ' The Contractor's License Law.does not apply to an owner of property who - Duct-Ventilating •-• - ❑0.100,000 BTU ❑100,000 BTU - • builds or Improves thereon, and who contracts for such projects with a con- �$UMMARV OF FEES tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration BUI LDING'PERMIT $ SMIP $ proof off their Worker's Compensation insurance should be provided to me.. PLAN CHECK $ PERMIT 0'1 am,exempt under Section B.&P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers PLUMBING $ 15-200 1 ISSUANCE $ Date Owner. Heating System& Ducting ' Registers PLAN CHECK 25% $ ENERGY.P.C. $ ' I hereby certify that I have read this application and state that the above ❑0-100,000 BTU Di 00,000 BT . GRADING $ information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ and state laws relating to building construction,and hereby authorize repro- - MICROFILM $ sentatives of t is city to, ente upon th- above-mentione �rr71 �y fir)( •' PLAN CHECK '50% $ Inspection pu • Y./'� 7 • Signature /' ' ' •-- ar-Sr Date �� MECHANICAL $ TOTAL FEE $ C2C..) Drivers' nse or SS# � Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor iv/CONSTRUCTION AND PLANNING - 13,.. _& SPA ..! ��APPROVALS Permit # Date Inspector APPROVALS Permit# Date Inspector / 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 000 44'( 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. /7/n/n �[�c�'/� 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK 11.,Property Sewer Line & House Connection c./0 see 62. Backwash & Receptor-Final 12. Sewer Cap //1C 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final - 14. Rough Plumbing (4,/yG irgf 65. Electrical-Final 15. Rough Electrical-Conduit - 66. Solar System-Final 16..Rough Electric Wiring - 67. Fencing & Access Approval 171'Rough Wiring Sign . 68. APPROVED FOR PLASTERING • 1. 1871 Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19:IRough 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 0 Oil 23. Gas Pipe-Rough&Test72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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 PREY. 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 /AM // 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-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 Sduthern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date - - Applicant to fill in all Spaces except those within heavy border lines and sign all appropriate declarations. % - 1" 1,OF COSTA MEA CONSTRUCTIONUCPERCM`�IT A, PE AIT NO - TRACT NO. LOT NO. U�p�yfry/,N y_ • �t• Project Address es/ .a. �/ Dia i .i. . •, sI // 1 C 4/I rj/c ' _ q U TJ f Applicant's Mailin ddress �5 3 /4'��v-z-e->"' TYPE OF CONSTRUCTION NEW U ADD ALTERATION REPAIR \ % ❑ CONVERSION 0 DEMOLISH 0 OTHER - A.P.g(!, I Zone Owner's Name •�j Phoneme/ - DESCRIPTION OFWORK/USE OF BLDG. Address �// 30 I I '! S Main Building: • Accessory Building:: - , Arch/Eng. License No- -9I n 7t-' TYPE OF PERMIT 0 GRADING FOUNDATION 0 STRUCTURAL f T Front 0 Address •• - ❑ TENANT 0 ELECTRICAL LUMBING 0 MECHANICAL B Rear , N Contractor's Name //r=1`� / Phone �O y6//t5 0 OTHER • _ • C Right - N p `fes . PROJECT DESCRIPTION SQ. FT. - OCCUPANCY G Address(mailing) '/5-3 / --24-2.0,---... - K - .- 2f -7f C ON STRUCTIONTYPE VALUATION$ / $ Left City License No. ZONE GRADI NG CU.YDS. ACRES - R LICENSED CONTRACTOR DECLARATION V Ping. •R@f.# • Perking R¢q,/Providtd E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: M'.•_ r / A3 P39-7 Planning Notes: 0 with section 7000) of Division 3 of the Business and Professions Code,and Vr+r'�' F ! - - mY license is in f I force and effect. ���T(�' • _ _ T License Class i - License - Oath f.e f-*ature f% A - - :! PLUMBING I FEES , VOR ERS'COM'ENSATION 0 LSA RATION Bar SinkShowers ELECTRICAL FEES ' I hereby affirm that I have a certiflcdte of consent to self-Insure or a certificate ' -of-Workers' Compensation Insurance;or a--certified copy thereof (Section - Backflow Pre-venter • Service Sink Automatic Washer' Transformer 0 15-50 KW 380cO Lab. Policy No. Cr':7�ODm eg•- er Company -•YF% Backflow Irrigation Sewer Cap ❑ 50+KW �'""� Construction Pole Sub. ertifietl copy is hereby furnishetl. ��''��SI 00 Cerlif�e• cop Is file• with[he city Bynv,ng Dlvi yn. �' a-Bathtubs ' / Sewer Connection ,yf Cooking Unit' Meter ❑Up to 100 amps Dat — -JI Applicant cc.. / -'- �- •et, - •_ - _ 4 - - - Clarifiers EXE- PTio .ee•OM WORKS RS'CO -E`5•TION DECLARATION- Solar Collectors Dishwasher .Meter-❑over-.100 amps, \ lThis sfe ctlon need not bef completed 1 tele permit is for one hundred (5100) or , less). in - �� / Dishwasher Solar Piping • .Divers OGas' ❑Electric Sub Panel certify that lo,the performance of the work for which [h15 permh i5 issuetl I•' - shall not employ any person in any manner so as to become subject to the • Drinking Fountains Solar Tank �� Fan Motors 00-1 HP Oils-8 • w j Workers' Compensation Laws of California. . - �_ Date • Signature - Floor Drains i Swimming Pool w/Spa F.A'.U. • Inc.Solar 09-15 HP 016-15+ 'NOTICE:II,after making this declaration,you should become subject to,the - - _ _ I Workers'-Compensation provisions of the Labor-Code, you must forthwith Floor Sinks- -- - - ' Urinal - 1 comply with such provisions or this permit shall be deemed revoked. • - ^ 1 Fixtures , • Microwave \ CONSTRUCTION LENDING AGENCY -• - / Gas Service ,Outlets' - Water Closet S • 00 Device Boxes , g • I herebyai firth that there is a construction lending agency for the performance Pole Light • of the work for which this permit is issued (section '309] Civ. C.) — Inlerdeptors / •Water Heater - - 'a 00 Outlets Lender's Name - ' - - ! Range • Lender's Address / Kitchen Sink ' '/ Water Service Switches Sign OWNER BUILDER DECLARATION ' • 1 • IF I hereby affirm that I am exempt from the Contractor's License Law for the .j Lavatories • . ' / Auto-Wash . , 6 00 following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal ;Standing Sections countywhich re uires a permit to construct,alter,Improve,demolish or r¢ air any sucture, prior to Its issuance, also requires the applicant for such permit P-Trap Laundry Trays Generator ❑0-5 KW 05-15 KW ,Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains • 'he Contractor's License Law(Chapter,9(commencing with Section 7000)of Division 3 of the Business.and Professions Code) or that he/she is exempt • _ .therefrom and the basis for the alleged exemption. Any violation-of Section - 7031.5 by any applicant for a permit subjects- the applicant to a civil - penalty of of not more than five hundred dollars($500). - •' . - ' Ll I, as owner of the property Oi my employees with wages as their sole Reinspection Fee I $15 Issue Foe - $-3 compensation, will do the work,and the structure is not Intended or offered - - Reinspection Fee I $15 Issue Fee ' $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's - MECHANICAL FEES License'Law does not apply to an owner of a property who builds or Improves ' thereon, and who does such work himself/herself or through his or her own - DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such Improvements are not Intended or offered for Boiler Hood or Type I 0 sale. If„however, the building or'Improvement is sold within one year of com-I Canopy Type II 0 ' Zoning Approved By Date pletion, the owner will have the burden of proving-he/she did not build or im- Duct-Under Ground _ Building Approved By Date rove for the purpose the of pope). � J ��� I, rs owner of the property, Se tion 7044, contracting with licensed con- Duct-$truCiurel Refrigeration System Application Issued By rl Z_te Date tractors to construct the project (Section 7044,Business and Professions Code: - - The Contractor's License Law does not apply to an owner of property who - Duct-Ventilating - ❑0-100,000 BTU ❑100,000 BTU builds or Improves thereon,and who contracts for such projects with a con- SUMMARY OF FEES tractors license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of' their Worker's Compensation Insurance should be provided to me. - - PLAN CHECK $ PERMIT • ❑ I am)exam pt under Section • B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers • PLUMBING $ Lfer oQ ISSUANCE $ Date - - Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY:P.C. i $ I hereby certify that-I have read tills application and state that the above 00-100,000 BTU 0100,000 BT - GRADING - S information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ and state laws relating to building construction, and hereby authorize repro- , - MICROFILM $ ' inspection of.. t to ertteyupon a above-menti oneA_,PC_operty;for PLAN CHECK 50% $ • inspection ourgo}ss ice`_/�ILNG. o/ass•�>% y�y ' MECHANICAL $ ,•���d Signature Dat �f%/ I • TOTAL FEE $ "7 Drivers' Llys se or SS# _ Reinspection Fee 1 $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor • ,f •CONSTRUCTION AND PLANNING Pt,. _&SPA 4 APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location . 2. Soil Pipe-Undrgrnd. 90/ of 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. ��71 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. B. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. '/d, "Pr 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection f//$ .„we, 62. Backwash & Receptor-Final 12. Sewer Cap /� 63. Heater & Vent-Final • 13.•Roof Drains 64. Plumbing System - Final 14. Rough Plumbing L/;j/,‘ lona' 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final • 16;,Rough Electric Wiring 67. Fencing & Access Approval 17i Rough Wiring Sign 68. APPROVED FOR PLASTERING 18;1Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL • r 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 0 Oil 23. Gas Pipe-Rough&Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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 /4/f7 le( 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final • 40. Gas Service-Final 41. Solar Domestic-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 %2";`51. CERTIFICATE OF OCCUPANCY - ` N Date • SW"- - - - _- - __ Applicant to fill In.all spaces except those within heavy border lines and sign all appropriate declarations. / 3123 4/16/96 b.2,- T. 3 - pEljp4j IT•NO. _- ' , TRACT NO. LOT NO. U IT ' On OF COSTA m�e7$n CONSIRRJJ TION PERMIT OJ .�Q Project Address �" S`�1 z_'�`Q"`� •-%• s.:hf'✓'Fl 1p1 _ • Applicants MailingQddryss IS-5 / TYPE OF CONSTRUCTION KNEW L I ADD U ALTERATION EPAI R f/-/ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER - • - A,P•# - •- (Zone Owner's Name /P�^G`-" ,,9�o-," / /�r11 Phone - DESCRIPTION OF WORK/USE OF BLDG. Address / '� ' / ( � 3G/ rrr---��t - ' S Main Building: • Accessory Building: - 1 Arch/Eng. - - - License No. � - TYPE OF PERMIT H GRADING FOUNDATION E- - . _ o U STRUCTURAL Front Address ' ❑ TENANT ❑ ELECTRICAL LUMBING ❑ MECHANICAL B Rear _ N • Contractor's Name nvQ'�- Phone &V6/�s- 'LI OTHER - . - - A /5-.-' J G7sp�� PROJECT DESCRIPTION 50. FT. OCCUPANCY, C Right _ N Address(mailing) C S � - / Le{( _- �/ CONSTRUCTION TYPE VALUATION$ - $ • City License No. 3 '717 ' ZONE - GRADING CU.YDS. ACRES ' - R LICENSED CONTRACTOR OEC LARATION - Ping. Ref.# Parking Req./Pfovided E Q hereby affirm that.:I am licensed under provisions of Charter 9 (commencing Remarks: �Qt� a3a�j s' Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code, and «s.....����444���''��``'"""KCC// ( - T. my license is in II f• c- and effect. • ��g� �j ' I • _ $ License Class �' iL�'cens$ o.—� t ( - i 'ate ws.• Z - .'nature �� �` !-�- /> 1 PLUMBING • 'FEES ' \ ( /ORKERS'COMPENSATION D CARATION, - 1 , �X 1 hereby affirm that I have a cern'Cate of consent to self-Insure or a certificate • Bar Sink Showers ELECTRICAL FEES • • R -of Workers' Compensation-Insurance, or a certified copy cher f (Sectio - -' "' - - ( " - i \1fv\ 3800, Lab. C.v -7� � l • Backflow Preventer Service Sink Automatic Washer Transformer 0 15-50 KW Policy No. ��` ��� a'8-�Compiny -•^'�r'-/' `" t ' Backflow Irrigation Sewer Ca 0 50+ KW Gip I Construction Pole Sub. \ Certified copy li hereby furnished- - arti i cojay Isj a�with the city B din iv" n- ' }' �athtubs i' Sewer Connection • /Air eV Cooking Unit' I Meter ❑up to 100 amps I Date /77 Applicant • • Y ._ -_ _. - EXE PTION ROM WORKERS'COb ENSA ONor RATION Clarifiers Solar Collectors Dish Washer Meter ❑over 100 amps -(Thissection need not be completed the permit Is for one hundred ($100) or , • \\ less). is • '/' Dishwasher Solar Piping i • s' • Dryers ❑Gas ❑Electric • Sub Panel I certify that ',lithe performance of the work for wpieh this permit is Issued,I \ shall not employ any person in any manner so sato become subject to the Drinking Fountains Solar Tank • Fan Motors 00.1 HP ❑1'/x-8 Workers' Compensation Laws of California. . — Date - Signature • ,f 1... Floor Drains Swimming Pool w/Spa Inc.Solar ❑9'15 HP ❑16.15+ , NOTICE: If,after'making this declaration,you should become subject to the - _ _ _ _ _ -• _- Workers' Compensation provisions of the Labor code, you must forthwith Floor Sinks Urinal • Fixtures comply with such .provisions or this permit shall be. deemed revoked. Q• - MICfpW¢V¢ , CONSTRUCTION LENDING AGENCY Gas Service ' . Outlets .J Water Closet " e 9Q`- • Device Boxes ' 1 hereby'affirm that there is a construction lending agency for the performance , Pole Light , of the work rfor which this permit is issued (Section .3097 Civ. C.) Interceptors , Water Heater a:bp Outlets Range ' Lender's Name - . / �1 g ' Lender's Address I - - �' Kitchen Sink Water Service e-/DO Switches Sign ' OWNER BUILDER DECLARATION - . _ ',i� • I hereby affirm that I am exempt from the Contractor's License Law for the 4' Lavatories - Auto-Wash ®a • following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap , Laundry Trays Generator ❑0.5 KW ❑5-15 KW any structure, prior to its issuance, also requires the applicant for such permit - , Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains • , .the Contractor's-License Law(Chapter,9(commencing with Section 7000) of , Division 3-of the Business and Professions Code) or that he/she is exempt . therefrom and the basis for the alleged exemption. Any violation of Section • 7031.5'by any applicant for a permit subjects the applicant to a civil 1 - - . penalty of-not more than five hundred dollars($500). ' •- • • o I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee - $ 3 , compensation, will do the work,and the structure is not intended or offered - Reinspection Fee $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves • thereon, and who does such work himself/herself or through his or her own - Hood or Type 0 - DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler sale. If, however, the building or improvement is sold within one year of com-' • Canopy Type I 0 Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or im- • Duct-Under Ground - ' Building Approved By Date • prove for the purpose of sale). - - ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural • Refrigeration System • , Application Issued'By 13 C- Date'y/� tractors to construct the project(Section 7044,Business and Professions Code: — The Contractor's'License Law does not apply to an'owner of property who , Duct-Ventilating- ❑0-100,000-BTU ❑100,000 BTU ' - SUMMARY OF FEES ' builds or improves thereon, and who contracts for such projects with a con-) - - tractor(s) license pursuant to the Contractor's License Law). 1 am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ $MIP $ proof oftheir worker's Compensation insurance should be provided to me., - - PLAN CHECK $ PERMIT ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIL ICBG# Fire Dampers PLUMBING • $ KQ • C" ISSUANCE • $ • Date - Owner - Heating System& Ducting • Registers PLAN CHECK .25% $ ENE RGV'P.C. $ • 'I hereby certify that 1 have read this application and state that'the above 00-100,000 BTU 0100.000 BTL ELECTRICAL $ • GRADING $ information is correct. I agree to comply with all city and county ordinances and-state laws relatingito building construction,and'hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ sentatives o tt is city to ent• upon the above-mentioned property for G� • inspection puc)iy3ps. �C' �pfs(ff, d MECHANICAL $ • TOTAL FEE $ L�c 00 Signature {�/"s f/ Dater/ t Drivers"Lieense or 55 Reinspection Fee $15 Issue Fee -$ 3 PLAN CHECK 25% $ CMF 0865 46,rev. 10/84 white - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING t_ &SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. y/,�/j` ///t f( 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, 0 Undrgrnd.,Test • 9. Water Pipe-Undrgrnd. 4L/�y/4 ,�sr 60. Backwash Lines, P-Trap, U Undrgrnd. 10. Structural Floor System • / /f'� 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection OMf ,(/l 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 1`:'Rough Wiring Sign 68. APPROVED FOR PLASTERING 18i,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 U Gas U Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing • 73. Undergrnd.Storage Tank 0 Gas 0 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 PREY. 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 )4/t7 4! t• 36. Hood or Canopy 37. Final Factory Fireplace ' 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final • . 41. Solar Domestic-Final • i 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 - ' MF CITY OF COSTA MESA ,yA, BUILDING DIVISION a0li4t' ) . ; ..4.: DEVELOPMENT SERVICES DEPARTMENT /J \//� v• PERMIT ✓ PERIGHT NUMBER 899-00050 • (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 . BUILDING PERMIT Job Address: 2551 ELDEN AV Status: ISSUED . Suite: e�1 , e-0a a- Applied: 01/08/1999 Vicinity: BLDG C Issued: 01/08/1999 Parcel Nunmber: 93775029 Zoning: Applicant: JEFF MAXWELL Address: 03460 JULIAN AVE Phone: 562-596-0694 LONG BEACH CA ' : Zip: 90808 - Owner: ROBINSON, KENNETH G - Address ROBINSON,SANDRA L P O BOX Phone: - - %LYNDY MANAGEMENT CO - Zip: 92627 , Contractor: JEFF MAXWELL Address: 03460 JULIAN AVE - , • Phone: 562-596-0694 , • LONG BEACH CA Zip: 90808 License: - 487972 Arch : ' ' - Eng: , Address: Address: Phone: Phone: • Zip: License: License: • SCOPE OF PERMIT REROOF OVER EXIST. 1 LAYER COMP.WITH 20 YEAR 1 LAYER COMP: • - FEE SUMMARY Plan Check: $0.00 Calc Valuation: $1,267.00 Permit: $43.00 Claim Valuation: $1,267.00 • SMIP Res: $0.50 SMIP Corn: $0.00 • Other $0.00 Inspection: $0.00 • Total: $43.50 ' PLANNING &ZONING . , SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0' , Left - 0.0 Right 0-0 ACCESSORY Front 0-0 Rear . 0-0 Left 0.0 ' Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: . • • EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS .WORkERS'COMPENSATION DECLARATION: " U •I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the OKwork for which this permit is issued. O\ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation�-aInsurance carrier and policy number are: 965---21- �j�J Carrier: _47sf I— FcF-'D Policy Number: `C \ ., (This section need not be completed it the permit is valued et one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califo r'. • :• :_ should become subject to the workers'comps ovLslDOs of Section 3700 t Labor Code,I shall forthwith complywit %�• —= • y., COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE E AND CIVIL FINES UP TO ONE HUNDRED --.n•• .•. . •',COO),IN ADDmON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SEI,I ION 37060E THE LABOR DE,INTEREST,AND ATTORNEYS FEES. LICENSED CO • • TORS-DECLARATION: I hereb hit I am licensed un.: • o, "• s• pier 9 commencing with Section 7000)of Division 3 of the Business and P ofe: i,.s Code,and my license is in full • e: deffect.Lic.# ♦_..or ---ss# L _ Contractor's�y — -- a Date: CONSTR• - :. .. NG AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors license Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a clv i penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to en owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I em exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,wilt be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this pplication appemit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes•,the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above Is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application end state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ner(s) (( Date 1r- , - ' D rra INsPFminN TYPE DATE MEALS C4QE1 INSPECTION TYPF DATE MALE 1618 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final /�7� 208 Final Plumbing _ 200 Final Re-Roof ZA 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site _ 204 Final Demolition 250 Final Building/Occupancy 2446-46