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Home My WebLink About2398 ELDEN AVE - Building Permits • yTO MF ,4 CITY OF COSTA MESA ;. \.! 44.4a9BUILDING DIVISION - F , r•„• kI DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J PERMIT B04-01090 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING Job Address: 2398 ELDEN AV Status: ISSUED • Suite: C Applied: 06/14/2004 Vicinity: Issued: 06/14/2004 Parcel Number: 93068432 Zoning: Applicant: UNKNOWN ISSUED BY: Address: , Phone: • . - Zip: , Owner RODELL GARY Address 2398 ELDON AVE#C _ .' \ ' - Phone: COSTA MESA,CA - - Zip: 92627-1541 Contractor: - ALL PRO,REMODELING Address: 706 N TUSTIN ST Phone: (714)288-1314 ORANGE,CA Zip: 92867 License: 574698 Arch : - . _ Eng: Address: , . - - Address: Phone: Phone: Zip: License: License: ' SCOPE OF PERMIT 7'X 16'ALUMINUM PATIO COVER ICBG 2228 P.REMOVE EXIST.8FT WIDE SLIDING DOOR AND REPLACE WITH A TEMPERED 2'6'X6'811 FRENCH DOOR AND A 4'9'X3'6'WINDOW NO CHANGE IN SIZE OF OPENING IS ALLOWED.REMOVE EXISTING GLASS ROOF AND INSTALL COMP.SHINGLES AND REPLACE SIDING. - ----FEE SUMMARY Plan Check: $72.31Calc Valuation: $4,205.44 Permit: $111.25 Claim Valuation: , $3,305.00 SMIP Res: $0.50 SMIP Com: ' $0.00 ' v Other, - •$0.00 • _ Inspection: $0.00 Total: $184.06 - PLANNING&ZONING -, - - SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 - Left 0-0 . ' Right •'-0-0 ' ACCESSORY Front .0-0 • _ Rear 17-0 Left 10-0 Right '0-,0 • PARKING Existing: 0 -Required: 0 _ Proposed: - 0. / NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) 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 2446-46(6/00) DECLARATIONS \(, -47 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 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 policy number are: Carrier: Policy Number: (This section need not be completed If the permit Is valued at one hundred dollars($100)or loss.) ❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: • Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UMAWFt1L AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($l00,OW),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,end my license is In full force and effect.Lic.4 Class# Contractor's Signature: Date: 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,Civil Code). Lender's Name: Lender's Address: Signature: 4' Date: OWNER-BUILDER DECLARATIONS: 7 I hereby affirm that under penalty of peijurythat 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 int more than fwe 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 drivers license. ❑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,end that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,"Title B,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 materiel? 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 en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ... f.t... .. _ �.... 4 II an RMPP is presently required,has Section 25534 of the California Healthh 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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑Yes 0 No (Section 65850.2 of the California Govemment 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 ❑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 prescnbed 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 penally of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws end 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. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date SoDE I INSPECTION TYPE RATE INTnAL$ CODE I INSPECTION TYPE PATE IIS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign222 Final Be • 204 Final Demolition 250 Final Building/Occupancy Nl1/4rk44.0J .� / CITY OF COSTA MESA - BUILDING DIVISION > %� .; � DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. 1 o pi • PERMIT B03-02127 44bestarato it (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.rBERLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2398 ELDEN AV Status: ISSUED Suite: C Applied: 12/11/2003 Vicinity: Issued: 12/11/2003 • Parcel Number: 93068432 Zoning: Applicant: UNKNOWN Address: ISSUED BY: Phone: • . Zip: _ Owner: RODELL, GARY MARK , IE. , Address ,2398 ELDEN AVE COSTA MESA,CA Phone:• , UNIT C / - Zip: 92626 . Contractor: ` - - . / , Address: i 'v; < , � - Phone: - • , Zip: . - License: • Arch : ' •: Eng: Address: • - Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT 153 SQ. FT. PATIO COVER/ENCLOSURE AT REAR'OF EXISTING RESIDENCE., REAR YARD LOT COVERAGE 14%-MINOR MOD REQ.FOR 2 FT ENCROACHMENT INTO REAR SETBACK. REF: MM-03-58 FEE SUMMARY .Plan Check: $54.11 - - Calc Valuation: $3,000.00 " Permit: $83.25 Claim Valuation: $3,000.00 SMIP Res: $0.50t. SMIP Corn: ', . $0.00 Other $0.00 , Inspection: $0.00 :_ . - ' : Total: $137.88 N,' „- " , PLANNING &ZONING SETBACKS v, - ' MAIN STRUCTURE'Front 0=0= ' ' ' Rear 8-0 Left 15-0 • Right 0-0— ACCESSORY Front'- 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 .Required: 0 Proposed: 0 . NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) 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 2446-46(6/00) DECLARATIONS n 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 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 policy number are: Carrier: Policy Number: (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 work for which this permit Is issubb,1&AA employ any person in any manner so as to become subject to the workers' compensation laws of California,an agree that if[`should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. r o Applicant Signature: /(/rWU/V1� Date: / U WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVE GE UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed upper provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.4C.5/}`J / Class# Contractor's Signature: .4/IM A A—/i/�y.� Date: Ii 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,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS:17', . I hereby affirm that under penalty of perjury that I amt'XEMPT 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 sheds 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.). O I am exempt under sec. Business and Professions Code for this reason: Signature: - Date: Owner ID verifiedby driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 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,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O 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: I 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 tiled 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? ❑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 Califomia 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 a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the Califomia 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 B (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 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. �( •gnature+1 s- Owner(s) /2 ,/i! /(1513 ✓G An.0 Authi•rized Applicant le ;ODE• INSPECTION TYPE • DAM INImALS CODE( INSPECTION TYPE PEI ItmIISLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 718 ,rn..,ambinr 200 Final Re-Roof ( -• __ 210, Final Electric6' s I 201 Final BIocWRera•..ny 'AN- - r / . 4; .on 202 Final Farr, ':t,-r -" _ _ 220 Final Planning Appry • 203 Final Sp 222 Final Site 204 Final Demolition 250 Final Building/Occupancy �+Z ,BE/ ( V , ' MS CITY OF COSTA MESA BUILDING DIVISION 4 PERMIT NUMBER • ,,,,,, "�,f_ DEVELOPMENT SERVICES DEPARTMENT IPPAPERMIT 604-01090 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING4398 &fl144v Job Address: -266--deANU SL Status: ISSUED Suite: C Applied: 06/14/2004 Vicinity: Issued: 06/14/2004 Parcel Number: 93068431 Zoning: Applicant: UNKNOWN ISSUED BY: Address: Phone: Zip: Owner: RODELL GARY Address 2398 ELDON AVE#C Phone: COSTA MESA,CA Zip: 92627-1541 Contractor: ALL PRO REMODELING Address: 706 N TUSTIN ST Phone: (714)288-1314 ORANGE,CA Zip: 92867 License: 574698 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT 7'X 16'ALUMINUM PATIO COVER ICBO 2228 P:REMOVE EXIST.8FT WIDE SLIDING DOOR AND REPLACE WITH A TEMPERED 26"X6'8" FRENCH DOOR AND A 4'9"X3'6"WINDOW. FEE SUMMARY Plan Check: $63.21 Calc Valuation: $3,305.00 Permit: $97.25 Claim Valuation: $3,305.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 • • • Total: $160.96 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right- 0-0 ACCESSORY Front 0-0 Rear 17-0 Left 10-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) / 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 2446-46(6/00) DECLARATIONS i WORKERS'COMPENSATION DECLARATION: I here affirm under penalty of perjury one of the following declarations: O 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. have and will maintain workers'compensation insurance,es required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued, y workers'cope sationn Insurrcu came and policy number are: -. _ I �f artier: c t ,(—� J LL.t P fry Num 07 b / l bon32/7 (This section need notffffffSSSSSSeeeeee compleZZeedd 177 the perm/ 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' corn•.nation laws of Califomi nd agree that it I should become subjec to the workers'compensation rovisions of Section 3700 of the Labor Coda,I shall forthwith er th these provisions. /1 • store: ij/ Date. —01 FAILURE TO SECURE WORKERS'COMPENSATION RAGE IS AND SHALL SUBJE EMPLOYER CRIMINAL PENALTIES AND CIVIL FINES uP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN Lrraxa OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereb ffintllhat I am licensed under provision o Chat.,9(commencing with Section 7000)of Division 3 of the Business and Pro - .ions Code,and my license Is in full and effect.ig tc.o a ass s Signature: _ •..\. .�. C`(`�,c_..o'�J 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: 4- 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 permiMo 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 DMsion 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:TO 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,end who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O 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 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,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 WIII 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 gallon, or 200 cubic feet of compressed gas at standard temperature and pressure). _._ an form _.._.._._..__._ 2 Does ar 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 greeter than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure)..ing__...._ __ .... .....__.._. ._ _._.__ 3 Does aosr will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? 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 II an RMPP is presently required,has Section 25534 of the Celifomia 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&permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 WTI-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 Nes',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 tar the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safely Code Section 42303 been made? ❑Yes ❑No 8 (If yes'.attach certificate of compliance from the appropriate air pollution contra-officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all slate laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penally 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. A . S•natu • e al • ner(s)MIO' ---01Data MIO' nd/•rA h'.r e•1'•plicant D a ) CODE it INSPECTION TYPE BM MAt.S OODE! INSPECTION TYPE Mil RDIDELS 1816 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 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 v CITY OF COSTA MESA •• • 0 qa BUILDING DIVISION F I I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 0 "°%roe PERMIT 4tsain le /04-01198 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2398 ELDEN AV Status: ISSUED Suite No C Applied: 11/12/2004 Vicinity: Issued: 11/12/2004 Parcel Nunmber: 93068432 Applicant: RODELL, GARY MARK ISSUED BY: Address: 2398 ELDEN AVE COSTA MESA,CA Phone: UNIT C Zip: 92626 Owner: RODELL, GARY MARK' MARK' F • Address 2398 ELDEN AVE , COSTA MESA,CA Phone: UNIT C Zip: 92626 Contractor: Address: - Phone: Zip: License: SCOPE OF PERMIT REF:B04-00704-264SF ADDITION TO EXISTING GARAGE. ELECT.PERMIT IS FOR 12 LIGHTING FIXTURES,8 RECEP OUTLETS&4 SWITCHES.UPGARDE SERVICEPANEL TO 200AMP."INCLUDES ELECT. FOR ABOVE GROUND SPA/POOL FENCING HANDOUT GIVEN TO PROP.OWNER" i . FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package. $0.00 , -. Standing Section $0.00 „ 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $18.20, '71 New Res(3+units) '$0.00 0 Transformers up to.1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw, $0.00 0 Lighting Fixts $13.20 12 up to 50 kva/kw $0.00 0 Recept Outlets $7.70 7 up to 100 kva/kw $0.00 0 Switches $4.40 4 over 100 kva/kw , $0.00 0 Non Res Appl , ' - $0.00 0 Low Voltage Equipment ' .$0.00 . 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt ' $0.00 0 Service to 200a $0.00 0 Misc.Conduit $18.20 1 Service to 1000a $0.00 0 Misc.Conductor $18.20 - 1 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 , 0 - Christmas Tree Stand ' $0.00 0 Motors to 50hp $0.00 - 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) 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 244646(6/00) DECLARATIONS i \ WORKERS'COMPENSATION DECLARATION: • 1 I hereby affirm under penally 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 work 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 Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed 1f the permit Is valued at one hundred dollars($100)or less.) O 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 California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FWES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 em licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lie.4 Class 4 Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: O 1 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). 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 fallowing 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(commenting with Section 7000)of Division 3 of the Business and Professions Code)or-thathe 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 chit penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,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 i::::76S_ Code:The contra•.•rs License - . ... not a••ly • an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license urs • he Contra •r cense - - p I ex= ••=r sec. Business and Professions Code for this reason: i _ Signet : =ifl/la - Expires: —26` CJ 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,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 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 prani 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.application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes u No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). _.._. _ _ ..._ 8 Will any part of the facility to be constructed under this permit be within 7000 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 contra 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 CERTIFICATE OF 0 MPLUWCE AND THO•• ' %N •: -Y:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agro: Eco .y with all s e la • .n• -Ir:noes relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-des'. ), for ins ti• ••.• •o tte not to occupy or allow occupancy of any building authorized by this pe ' until I inspection. Zr Sigmoid . • �. er(s) And/Or Authorized Applicant Date CODE E $NS MEMEEi sPEc oN TYPE Peg ILi)IIAU CODE it INSPECTOR TYPE PATE MEM 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 2" ek—C3t 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 CITY OF COSTA MESA . � BUILDING DIVISION > N .. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F t 2 PERMIT // J' ' /Boa-00704 (714)754-5273 • Fax(714)754-4856 • www icpsta-mesa.ca.us 77 FAIR DRIVEE✓,C COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2398 ELDEN AV Status: ISSUED Suite: C Applied: 04/09/2004 Vicinity: Issued: 05/18/2004 Parcel Number: 93068432 Zoning: Applicant: ROTHMAN, RICH ISSUED BY: Address: Phone: 714 846-3188 Zip: Owner: RODELL, GARY MARK' Address 2398 ELDEN AVE , COSTA MESA,CA ' " - - - Phone: UNIT C - - Zip: 92626 Contractor: Address: Phone: Zip: License: • • Arch : ROT,HMAN, RICH Eng: Address: 6232 SHIELDS DR. .\ Address: Phone: 714 8463188 - Phone: HUNTINGTON BEACH,CA - Zip: 92647 License: License: SCOPE OF PERMIT 264 SF ADDITION TO EXISTING GARAGE FEE SUMMARY Plan Check: $90.51Calc Valuation: $6,415.20 Permit: $139.25 _ Claim Valuation: 50.00 SMIP Res: $0.64 - SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $230.40 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left, 0-0 - Right 0-0 ACCESSORY Front 0-0 Rear -0-0 `- - Left 0-0- Right - 0-0 PARKING Existing: 0 Required: 0 ' -Proposed: 0 NOTES: _ NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(5'00) DECLARATIONS I WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'corn.:nsatien insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workorM o.n.a on Insur'n • :flier and policy number are: Cartier. C JPolicy Number: This'section need not be corn.eted i i•. •:rmif Is valued of•••hundred dollars($ 00)or less.) �/ I certify that In the perfo - ce o e work for whi� s permit is ssu hall not employ any person in any manner so as to become subject to the workers' ��"`Baa compensation laws of :Ifo -,and agree that Id b: •- as t to the workers compensation provlslons of Secti 3700 of a Labor e,I shall forthwith comply with these pr.;is'.• i CD Applicant Signature: � / Date: / - WARNING:FAILURE TO SECII" ORNERS'•• PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES D CIVIL Fl S UP TO ONE HUNDRED THOI'SAND DOLIARE($100,000).IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE.INTEREST,AN ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force end effect.Lis.# Class 4 Contractor's Signature: Date: 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,Civil Code). Lender's Name: Lender's Address: Signature: c - Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penaltyof perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any ty 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 ned 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 Bust and Professions Code)jor that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore permit su ' cls the applicant to a civil pdnalty of not more than live 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 o •mpletion,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 th: .'wrty,am EXCL ' 'ELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The co :ct•s License La •oes not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pur-.:nt the Contra t• -License La ❑ I am ex:,Pi••. sec. i al Business and Professions Code for this reason: �// / (O' Signature: V/ea r Date: I k(/s 7 Owner ID d by d .er's license. es 0 No Driver's License No. Expl Verification of Ownership by(type of clot t,Le.-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,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 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 tho California Health end Safety Code been fully complied with? 0 Yes 0 No T _ Does orwi _ applicant ._ _ ... 5 Does h So the oast Air present future building occupant at require for the work which is the subject of this implication a0p Nnit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI 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? ❑Yes 0 No (If'yes•,the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 Callfomia Health and Safety Code Section 42303 been made? 0 Yes ❑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: i i CERTIFICATE OF COMP ' C . ORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state th t the Information given is , correct.I agree to co:-• nom • - -ws and .' • ordinan :- -,'mg to building construction,and authorize representatives of the City of C a Mesa to enter upon the above-d:- i be . • ' -.-10:u ••;: a• •: . to• upy or allow occupancy of any building authorized b this 'nit un final n ion. � at 3 , Air Signature Of Legal Owner(s) Dat And/Or Authorized Applicant Date JADE I INSPECTION TYPE PATE EMU PODEt INSPECTIONTYPE PATE. I[IMILE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final ' 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final BIock/Retalning Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site _ �.�A 1 1.' 204 Final Demolition 250 Final Bullding/Occupancy Z ry 3 �,' CITY OF COSTA MESA 4'4". BUILDING DIVISION o,j,�.. F i '. 1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t• PERMIT MflAJt0070 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2398 ELDEN AV Status: ISSUED Suite No C Applied: 02/18/2004 Issued: 02/18/2004 Vicinity: RIGHT SIDE SFD ' Parcel Number: 93068432 ISSUED BY: .-e/ a Applicant: CROCKER, CURTIS Address: 706 N TUSTIN ST Phone: (714)288-1314 ORANGE,CA Zip: 92867 Owner RODELL, GARY MARK Address: 2398 ELDEN AVE COSTA MESA,CA Phone: UNIT C Zip: 92626 Contractor. ALL PRO REMODELING Address: 706 N TUSTIN ST -Phone: (714)288-1314 ORANGE,CA Zip: 92867 License:574698 SCOPE OF PERMIT MECH PERMIT FOR WOOD BURNING FIREPLACE AT THE RIGHT SIDE OF AN EXISTING SFD. ICBG#NER-492 1 FACTORY FIREPLACE NO OTHER WORK AUTHORIZED WITH THIS PERMIT. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 - Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k.BTU - $0.00 0 Factory Fireplace $10.65 1 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mach Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp • $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0- - Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) 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 end 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 244848(8410) DECLARATIONS ' 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 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 policy number are: Carrier: S 1 t r FtiVA 0 Policy Number: /9 4(6 —86 (This section need not be completed i1 the permit is valued at 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 California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these prevision U Applicant Signature: `� Date: 2/P—D Y WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under revisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.4 7y le f-es Class# Contractor's Signature: rs= /�L Date: 7 — /&-0Y 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,Civil Code). Lenders Name: Lender's 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 requireb 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 owiTemployees,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 drivers license. Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of docum t,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,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 tiled 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 ❑No 5 Does or will the applicant or present or future building occupant require(or the work which is the subject of this a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U 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 Califomia 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 (It'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 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. igneture Of Legal Owner(s) tete 2 /JC % And/Or Authorized Applicant Date CODE I Fixed TYPE PAIS LfRgls4S CODE! INSPECTION TYPE • 9 1616 Fixed System Final Fire Prevention 206 Final Mechanical J 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 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 - r E 9 CITY OF COSTA MESA BUILDING DIVISION > 4:14 -01i) rr• , DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER v. 1 ippii i PERMIT 03-01149 ikblinsemst 4. (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa,ca.ILsCTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2398 ELDEN AV tLLt Status: ISSUED Suite No C • Applied: 12/11/2003 Vicinity: Issued: 12/11/2003 Parcel Nunmber: 93068432 4p....._ Applicant MORTON, EVONNE ISSUED BY: Address: 706 N TUSTIN ST , Phone: (714)288-1314 . ORANGE,-CA " Zip: 92867 , Owner: " RODELL, GARY MARK - . Address 2398 ELDEN AVE " " - -- COSTA MESA,CA Phone: _ " . " SilialigilliallTh UNIT C, Zip: 92626 Contractor: ALL PRO REMODELING Address: 706 N TUSTIN ST Phone: (714)288-1314 ' ORANGE,CA Zip: 92867 ' License: 574698 SCOPE OF PERMIT ELECTRICAL FOR PATIO ENCLOSRE. REF: B03-02127. ELECTRICAL TO INCLUDE:3 LIGHT FIXTURES,6 OUTLETS,2 SWITCHES: - ' ' ' FEE SUMMARY Quantity . Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft , $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 - New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts - $3.30 3 up to 50 kva/kw $0.00 ,. 0 ' Recept Outlets $6.60 6 up to 100 kva/kw -' $0.00- 0 Switches $2.20 -2 over 100 kva/kw $0.00 0 Non Res Appl , $0.00' . 0 Low Voltage Equipment $0.00 0 Res'Appl $0.00 0 Low Volt Wiring System/Ckt $0.00' 0 ' Service to 200a $0.00 0 , Misc.Conduit $0.00 0 Service to 1000a $0.00 0 ' Misc.Conductor $0.00 0 - Service over 1000a _ $0.00 ' - 0 Circus(gen or ride) $0.00- 0, Motors to 1 hp $0.00 0 Circus(mech ride Or lights) . $0.00 - 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 . Fireworks Stand , - $0.00 0 Motors to 100hp $0.00 0 - Other Electrical Fee $0.00 Motors over 100hp $0.00 0 - ' Communication drops $0.00 0 Investigation Fee ' $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) 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 2446-46(6/00) • DECLARATIONS WORKERS'COMPENSATION DECLARATION: r I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure Ica 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 policy number are: Carrier: Policy Number: (This section need not be completed it the permit Is valued at one hundred dollars(5100)or less.) ❑ 1 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 California,a agree that If I should become subject to the workers'compensation provisions of Section 3700 of Labor Cade,I shall forthwith comply with these provisions. ,�yPyy,``•. U3 Applicant Signature: WARNING:FAILURELT SECUREINOWORKERS' TO PE� $pJ FIR.AND GESDSHALL SUD BJECT CT ASECTION YE TO OCTi/��TIES D CIVIL FINES AUP TO OONE FHHUNDRED THOUSLICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full lone and effect.Lk.p F � tt Ii± Class q / / / Contractor's Signature: / Vl/Nl iw� Date: /91/4 1 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,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury tha'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 hg 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 Art 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 drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-properly 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,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 feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present a future building occupant need to fila a registration form for acutely hazardous materials? Ter (Section ❑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 Safely 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 from any other air pollution control district or agency? Ll Yes U 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 polluutionon control ottica0. 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 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. ig :tura Of Legal Owner(s) ,t P! /1 I And/Or Aut •ri -: •plicant Oat INSPEOTONTYPE PATE =AU yODEt INSPECTION TYPE PATE INIMAL3 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbingn 200 Final Re-Roof 210 Final Electrical cal roc v/`'-? 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 City of Costa Mesa Development Services Department Building Safety Division CERTIFICATE OF OCCUPANCY No. 002037 P.O.Box 1200 Costa Mesa,California The Building located at '/OA Plelon Trt,onno, TMif r• has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group of/:,t Occupancy. Use of Building renanmini„m Legal Description 419-7n7_1A (See reverse side for Metes and Bounds) Building Permit NotalacoA.nvloCP Electrical Permit No. P A7r).CnC.ACOPlumbing Permit No. P 24 Q1 Mechanical Permit No. M 1P21AA Number of apartments and/or guest rooms ISSUED TO: Building Official co;114nm m wn,-,=,-A Robin Ryan 3711 Long Beach, Blvd., 0419 by t% J.. , 1. rZet -• Lonq Beach, CA 90807 Date .Tarn,ft,”„ 10. loan 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;Ca '-Numerical File;Pink -Bldg.Permit File • 1 Applicant to fill in all spaces ee#cept those within heavy border lines and sign all appropriate declarations. r, P MIT NO. TRACT NO. LOT NrO1,, Uy1,T NO. y - G (OF COST•A ME -' CONSTR� CTI SaPERMIT _ Z� S9dD _��' Z F�Z/Ll (� ,,,% I . �. P'roject Address - !'• r /I �•1�� _ —�`-� B 08 7/22/86 381.66 TL A 9 I �(� .1 [ � l TYPE OF CONSTRUCTION NEW I' ADD ALTERATION REPAIR '�� '- a a, ' PPlicant�s.fj•.1Jil' Add — n. • R .. Is. - Ownef.ffl • �1 `4' CI CONVERSION E-.1 DEMOLISH ❑ ER A.P.*,' L.� a/tea ^//L IZone Lia P +Mlj;�yll��f�pE ,°�¢ DESCRIPTION OF WORK/USE OF BLDG )N/i111L'S0'�UNIUM\ "T LY IT !C Address•.•.�J ►► ri_9r� +.. s arnittf L- rry/ 'S Main Building: Accessory Building: Arch/Eng s,�'� �. AL S it' se No. TYPE OF PERMIT U GRADING LJ FOUNDATION LJ ST RUC7u RAL T Front / 440 c/ bl O Address, Si,1`+$/` r4 1'-a,.►-s '& ❑ TENANT ❑ ELECTRICA 0 PLUMBING ❑ MECHANICAL ,t, B Rear / N - „`..^, ("C' ID OTHER f44e• 443-3 /t -/ A �� _. I Contractor's Nam' t_. St Phone `fir s i'..-,� TI C Ri ht / N Address(mailing) II Ps.- �,r.s B?�S IOL 5,040[4.132 Ft DESCRIPTION SO F`r �Z_�1 OCCVPAN[GJY K g -�r G /•v .- � aye CON STprU�CTION TYPE ``/v VALUATION$ 9O 907 $ Left /Q City License No. l ' a i -)Lo ZONE A "Z GRADING CU.YOS. ACRES - / LICENSED CONTRACTOR DECLARATION �-s / Ping. R¢(. 91[ �(ps��7 Parking Req./Providesf3'/'(� 8 E I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks:) C 7.86 L. PC rEe P� 1 .7, g, Co Planning Notes: HOLD FOR SPECIAL kEQullichlera ad M with section 7000) of Division 3 of the Business and Professions Code,and T my license is in full for .nd effect. r' rJ" EE �/�/� 418 • 1 S License a - SP Lice-. • No. CI!' CYa� Date Signature 1�.If-0.1r...... PLUMBING FEES •h WORKERS'C•MPENSATION DECLARATION Bar Sink Showers I • I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL - FEES •+f Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer - • Service Sink ' '00, Lab. • Automatic Washer- Transformer 0 15:50 KW .die No.'L0'-C+/--�/l-4 Comp-any - (4`.�P_ -FFat P'k Backflow Irrigation • Sewer Ca --- 0 50+'KW vv 9 P. * Construction Pole Sub. ��Certified copy is hereby furnished" r-�r InTAco� red with the city euiltl i,�9 plus`s �` Bathtubs Sewer Connection; ,-, - Cooking Unit • Meter ❑up to 100 amps Dl'r ale // a/a� APplicant �\•``/Y - E%EM TIO ROM WORKERS'COMPENSATION DECLAR ION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for one hundred ($700)or less). • .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❑0-1 HP 01%-8 Workers' Compensation Laws of California. s 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 forthwith Floor Sinks Urinal Fixtures _ - Microwave comply with such provisions or this permit Shall be deemed revoked. .� • NCONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boz¢!' 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 ,� s.% Lender's Name t_ Range nzs i Lender's Address Kitchen Sink Water Service - Switches - • Sign I J1 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 l 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 ,tet - Pa 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 r Y - 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 • r _, - / 031.5 by any applicant for a permit Subjects the applicant to a civil • malty of not more than five hundred dollars($500). $ 3 s r . ] I, as owner of the property or my employees with wages as their sole Reinspection Feg I $15 Issue Fee , compensation, will do the work,and the structure Is not intended or offered RejnspeetiOn 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 REQUIREMENT AL employees, provided that such improvements are not intended or offered for Boiler Hood or Type I Cl G ZoningA roved B Sale. If, however, the buildinge or Improvement Is sold within one year of Com- Canopy Type II 0 i pp Y � �dY"" D.. -7-15-.8 plotion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground -fe-E�/p y' //7/136. prove for the purpose of sale). Building Approved By v^�'4 Date 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 protect (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 SUMMA V OF FEES builds or Improves thereon, and who contracts for such projects with a con- - • - proof reflicense pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ 7 00 SMIP $ .C:66 proof of their Worker's Compensation insurance should be provided to me. PLA• N CHECK 2 $ PERMIT ❑ 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt.ICBG 4 Fire Dampers PLUMBING • $. ISSUANCE $ Date Owner Heating System& Ducting Registers - PLAN CHECK 25% $ ENERGY P.C. $ I pereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BTU— GRADING $ infilrmatlon_L correct. agree to comply with all city and county ordinances ELECTRICAL $ and state I.wsrelating to building constru Ion,and hereby authorize repre- MICROFILM $ sentatives if this c •'to'enter upo above-mentioned propert for i a PLAN CHECK 50% $ j� inspection •urpdses. • Signature - - /[ -Accounting; Goldenrod - Assessor ., -.err • I CONSTRUCTION AND PLANNING POOL A Date , Inspector Date Inspector 'APPR((��OVALS Permit# 1 APPROVALS Permit# 1: Terpl�rarctrical Service or Pole 52. Pool & Equipment Location Ttnn it Pipe-Undrgrnd. . ' 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd: 54. Forms '4:Electrical Conduit-Undrgrnd. It- 5. Electrical Bonding 5. Steel Reinforcement p 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd8. tithe Ott- 57. APPROVAL TO COVE R-GUNITE 7. Footings 0. g TEALgate tag1 i(„ 58. Electrical Conduit-Undrgrnd. 8. Foundation e 1 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. , ; 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System f y III ' 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap . r 63. Heater & Vent-Final 13. Roof Drains - 64. Plumbing System - Final 14. Rough Plumbing_ : _ 65. Electrical-Final 15. Rough Electrical;,Cohduit 66. Solar System-Final 16: Rough Electric Wiring 67. Fencing & Access Approval r, '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 L\ 20. Rough Factory Fireplace1. c� APPROVALS Permit# Ij'- 21. Ducts,in Structure , ` 70. Underground Hydro i 22. Ducts, Ventilating '-1 71. Product Piping 0 Gas 0 Oil l ✓- 23. Gas Pipe-Rough& Test r. . 72. Underground Flush 24. Roof Framing " •- i 73. Undergrnd.Storage Tank 0 Gas 0 Oil J` 25. Roof Sheathing • r'/f41 &4 . 74. Overhead Hydro - • 26. T-Bar Ceiling (Structural) &Monocoat ! 75. Dry Chemical (ft27. Frame and Flashing (' 12476. Dry Standpipe28. Lathing& Siding od 77. FIXED SYSTEM-FINAL 29.• Insulation r 78. FIRE PREV. FINAL 30, Drywall Nailing r 1 �7 7 pit- HEALTH DEPT. REQUIREMENT 31.i Plaster Brown Coat ,} I� Dr 79. FINAL INSPECTION • I . 32. Electrical Power 10eter-Final r 80. FOOD CERTIFICATE ISSUED Ir 33. Final Electric Notes: . 34. Final Heating & Air Conditioning HOLD FORnSPECInAL RE UIREMctr ep 35. Final Gas Pipe-Test 101e` /tom` ,,,,rZ r 36. Hood or Canopy 37. Final Factory Fireplace 78(//'fDa b Q a e�tr • A 38. Final Plumbing C / . ALL /.a or. 7 39. Water Service-Final - (lll2/�,7 y.,�- •a. no 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation- 44.2:Landscape Irrigation System 45. Sound Attenuation 46.:Handicap Regulations • - 47.tFINA L STRUCTURE & BUILDING I/rV% DA- 48. Special Requirements Completed leirlwg AA 49. Electric Release to Edison /VV 50.1Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY al No. 1.t Date • �_ - ) . c Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION gCONSTTR UACTION PERMIT I l - PEAT NO. �� TRACT NO. LOT NO, UNIT Ne 118818 I /Q`L7/87 10050 IL Project Address 213'1 5-- C��' C Lew` J� C �1 ��LLLLLL 3 (� Applicant's Mails`A A�f�rensI r ✓f� TYPE OF CONSTRUCTION LI NEW U ADD U ALTERATION U REPAIR ' Owner's(game 140.(Pa _L7�•'�) Phone Q.ZLeL ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A•P,,f Zone S, DESCRIPTION OF WORK/USE OF BLDG. - Address S Main Building: Accessory Building: E Z Arch/Eng.' License No. - TYPE OF PERMIT U GRADING U FOUNDATION ❑ STRUCTURAL T Front o Address q��( ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BA Rear N Contractor's Nam- A� Phon:_,T��(�Z5 ❑ OTHER I / !t PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N Address(mailing) .1 Lor a — K — G • �� .� CONSTRUCTION TYPE VALUATION$ Oa S Left R City License No. , ZONE G APING CU.YDS. ACREE LICENSED CONTRACTOR DECLARATION -� 72".- /�yy �./V(�//{/ _J. Ping. Ref.# Parking Req./Provided I hereby affirm that I am IIC¢nsetl antler prOVislOns of of or 9 (commencing Remarks i/1` �� • U • Planning Notes: M with section 7000) of Division 3 of the •. • an. Pr•fessions Code, and L (((�� T my license is in full force and e ct. ��x�'7 /[ License Cla ice c- O, T`/ sT L $ Date It in Signature .. _ ,. Al PLUMBING FEES 1 WORKER C MPENSATION DECLARAT •N Bar Sink Showers • I hereby affirm that I have a certificate of c• sent to self-Insure or - certificate • ELECTRICAL FEES of Workers' Compensatio nsura(Ice, •r a certified copy thereof (Section 0 Lab (/L� 7 Backflow Preventer Service Sink Automatic Washer Transformer 0 15-50 KW - :y No. Compan 0 a o 4 101 Backflow Irrigation Sewer Cap0 50+ KW Construction Pole Sub. „Certified Is hereby th thehed.tifie s filed with the cit : Bathtuhs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date APPIica• ` _EXEMP I NM WORKERS' a ON •E ARATION - Clarifiers Solar Collectors Dishwasher Meter ❑Over 100 amps (This section not be completed if the per, it is for one hundred ($100)or less). _ Dishwashers Solar Piping Dryers ❑Gas- ❑Electric Sub Panel I certify that in the performance of the wo for which this permit is issued, I shall not employ any person in any ma er so as to become subject to the ' Drinking Fountains Solar Tank Fan Motors 00-1 HP Ell'A-8 Workers' Compensation Laws of Californ'4. - Date Signature Floor Drains Swimming Pool vv/Spa F.A.U. Inc.Solar ❑9-15 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 comply with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets , Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performancePole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range Name an 9e 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 county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator 00-s 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 -^31.5 by any applicant for a permit subjects the applicant to a civil •alty 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 S 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 n, the owner will have the burden of proving ne/she did not build or Im- Duct-Under Ground ProveBuilding Approved By Date Prove for the purpose of sale). 1,11_11❑ 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 property who Duct-Ventilating 00-100,000 BTU ❑100,000 BTU SUMM EES �S builds or improves thereon,and who contracts for such projects with a con- (J tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System El Multiple❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ s proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT ❑ I am exempt under SectionB.& P.C.for this reason Firepi/Fact.Bit. ICBG# Fire Dampers _ PLUMBING $ ISSUANCE S Date Owne• Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that ve r•-el is application and state that the above ❑0.100,000 BTU 0100,000 BTL information is corre• . I a ree o c•mply with all city and county ordinances ELECTRICAL $ GRADING S and state laws rel Ing t. btu' din• construction, and hereby author' e r re-51LMICROFILM S sentatives of t city . : te- upon the above-mentioned pro ert/ / PLAN CHECK 50% $ inspection pur••ses. Signature _ // MECHANICAL $ TOTAL FEE $ l D� I Drivers' Lic Reinspection Fee 1 $15 Issue Fee $ 3 PLAN CHECK 25% $ J CMF 0865-46,rev.10/8' White - Building; Canary - Applicant; Pink -Accounting;Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL & SPA K. Date' Inspector Date Inspector APPROVALS •Permit.#' APPROVALS Permit# - 1.; ctr Temporary Eleical,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 r 20. Rough 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 ❑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 -.1 28. Lathing& Siding 77. FIXED SYSTEM FINAL lit,2 29. Insulation • 78. FIRE PREV. FINAL 30. Drywall Nailing - HEALTH DEPT. REQUIREMENT L" r� 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 !:i di �/1, ,'� - 35. Final Gas Pipe-Test ....)efaiis 36.Hood or Canopy (.,. i^ 1 ',h 37;;:;Final Factory Fireplace ^r. • . 'i �' ,- S8!-Einal Plumbing - `. .7:::-.'t) 39: Water Service-Final ''-•r i. ---- ; . 7 40. Gas Service-Final :�•' `r • - .41. Solar Domestic-Final �' (° •tib>'' _• i-- `;42. Backf low Preventer t .r • 2; ;1 �• - '43•,Backflow Irrigation '! • f•" -44::Landscape Irrigation System , I --A5.'Sound:Attenuation • 46/-Handicap Regulations - 1 - 1 47. FINAL STRUCTURE & BUILDING •- .-' %:• '-1. 48. Special Requirements Completed j// g/ MM./ ;- \ ' '49. Electric Release to Edison v .•.. • 50. Gas Release to Southern California Gas Co -- •` ' 51. CERTIFICATE OF OCCUPANCY i _ No. Date - Applicant to fill in all spa ces.except those within heavy border lines anti sign all appropriate declarations. _ - ,,,r OSTA ME�F�, (y'( I$T�CyTJON PEITTZ �� TRACT NO. .LOT NO. UNIT N • X534 7/31/86 ' zzs 4:2 !.� 19'., / Project Address /� - Ch � f / • Applicant's Mailing dre55/� e°y 37, TYPE OF CONSTRUCTION NEW U ADD• U ALTERATION U REPAIR. • � Owlter•sName OYC'` Phone .�� ❑ CONVERSION DEMOLISH -❑ OTHER_ A.P.# . _ - - 4 _'I.Zone ' . _. f ' //Kt. S�- �—{, DESCRIPTION OF WORK/USE OF BLDG. i, Address C• ��C�1 aL- S4/ e. Zm S Main Building: Accessory Building:' Z Arch/Eng.' License No. TYPE OF PERMIT ❑ GRADING p-K FOUNDATION ❑ STRUCTURAL T Front , - O Addr9ss - ❑ TENANT ❑ ELECTRICAL rU PLUMBING ❑ MECHANICAL B Rear N t *C _ _ _ Contractor's Name ❑ OTHER q If, h> 4.4.7. `t- Phone d ` Y PROJECT DESCRIPTION' SQ. FT. OCCUPANCY C Right • N Address(mailing) ��7 Z9�,• VALUATIONn 9/ -2-- CONSTRUCTION TYPE . S S Laft R City License No. Q J - ZONE GRADING CU.YDS. ACRES - LICENSED CONTRACTOR DECLARATION Ping. Ref.4 Parking Req./Provided E I hereby affirm that.I am licensed under provisions of Charter 9 (commencing Remarks: l • - Planning Notes: IQy1 with section 7000) of Division 3 of the Business and Professions Code,and • my license is in full rce an ffect. I /� T License Class - ' LiC-nse - - S • Date - Signature -.tai'. - • PLUMBING FEES . + - ' WORKERS'COMPENSATION DECLARATION Bar Sink Showers I hereby affirm that I have a certificate of consent t• self-insure or a certificate - ELECTRICAL• - . . FEES of Workers' Compensation Insurance, or a certified copy thereof (Section - J 3800, Lab: C.)' Backflow,Preventer Service Sink- _ ' Automatic Washer _Transformer 0 15-50 KW Policy No. Company Backflow Irrigation •_ Sewer Cap - Construction,Pole Sub. _ ' f'50+ KW ' [f,Certified copy Is hereby furnished. 1 • • edified copy is filed with the city Blinding Division. Bathtubs 'Sewer Connection • Cooking Unit Meter Dup to 100 amps - Date Applicant - " EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers ,Solar Collectors • _Dishwasher - • Meter [lover 100 amps ' (This section need not be completed if the permit 15.f or one hundred ($100)or ' less). - Dishwasher Sola 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 manne so as to become subject to the Drinking Fountains Solar Tank Fan. I Worke ompepsat�y� Laws of Calif. -�^ Motors ID 0-1.HP Dl'A-8 Date ? I^7f`• Signature >- / �� Floor Drainr • Swimming Pool w/Spa F.A.U. -NOTIC If,after making this declaration,you sho d-beco.•- subject to the ' -L ' _ .. - . 1 -._ ,Inc.Solar D9-15 HP 016-15+ • ' Workers' Compensation provisions of the Labor •de, you must forthwith Floc}Sinks , Urinal comply with such provisions or this permit s all be deemed revoked. Fixtures Microwave ' . CONSTRUCTION LENDING'AGENCY Gas Service 1 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 - - RangeI l i •- • Lender'rAddress • - - - -. - - Kitchen Sink - - Water Service - - Switches '' - Sign - • . OWNER BUILDER DECLARATION - ' I hereby affirm that.) 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 structure, prior to Its issuance, also requires the applicant for such permit p • 'Laundry Trays Generator 00.5 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 ' 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 $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 ❑ -sale. 1f, however, the building or improvement Is fold 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- e ' prove for the purpose of sale), • Building Approved By Date r� ❑ I, as owner Of the property, am exclusively contracting with licensed con- a Refrigeration System Application Issued By ! -31—W tractors to construct the project (Section 7044,Business and Professions Code: Date- ' The Contractor's License Law does not apply to an owner of property who • a 00-100,000 BTU.❑100,000 BTU • builds or Improves thereon, and who contracts for such projects-with a con- i r . $U7fjpARy QF FEES _ __ g -- tractor(s) license pursuant to the Contractor's License Law). I am aware that ■ ■ System Repair/Alteration La Ill IT $ .SMIR $ proof of their Worker's Compensation Insurance should be provided to me. - • ❑ I am exempt under Section B.& P.C.for this reason :• Fire Dampers PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ Date - • ' Owner Heating System& Ducting Registers - ENERGY P.C. $ ' I hereby certify that I have read this application and state that the above ■I ar sas D100.000: - PLAN CHECK 25%_ $ information Is correct. I agree toicomply with all and and y countyh ordinances ELECTRICAL - $ - • 'GRADING $ 4 and state laws relating building construction,and hereby authorize repre- - • ' MICROFILM $ , - sentatives of-thi�y}�-tv�enter upon the above-mentioned property for PLAN.CHECK 50%-,$ /> .inspection p�pa3SY', ?�- — �2/„ �Y MECHANICAL $ - - TOTAL FEE $ !" Signature i---• "' V Date / 50 ' -1 Drivers' License or 55 ' ' • CMF 0865-46,rev. 10/84 White - Building; Canary • Applicant; Pink -Accounting; Goldenrod - Assessor lr . - ! RUCTiON 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 i 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test n 6. ElectricalUFER•Grnd. 57. APPROVAL TO COVER-GUNITE 58. Electrical Conduit-Undrgrnd. ;i 7. Footings g 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 Electricat-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 '1 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 PI 36. Hood or Canopy • r 37''Final Factory Fireplace i. ' 38. Final Plumbing 39.4Water Service-Final '1.tom 40. Gas Service-Final ' 41. Solar Domestic-Final ,:, ;•42. Backflow Preventer - • '43. Backflow Irrigation 44. Landscape Irrigation System ; ' - 45. Sound Attenuation 4 46. Handicap Regulations i i 47. FINAL STRUCTURE & BUILDING 3�� 'IF iro oiA , - , J 48. Special Requirements Completed - ( ' r / 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co • 4 51. CERTIFICATE OF OCCUPANCY - I. ( No. _ Date _l \• r l ' _ �-L :� _ - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. . CITY FICOSTAMESA ^ CONSTRUCTION PERMIT ,4,<- _A PE.QMITNO U I/�-sem/-`{� TRACT NO. LOT NO. UNIT NO. 0076 7/24/86 38.63 'TLS • - Project Address p��S ,Y. ' L F-kJern SLA-Sic J �a rt 1, 1 V 1 ! I • .. . . .. _ .... v•Applicant's MaAing Address P.O. 4zi Ryadis. glom) TYPE OF CONSTRUCTION jNEW U ADD U ALTERATION U REPAIR f ❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ _ q,p,# _ -- _ Zone Owner's Nance Phone • DESCRIPTIONOF WORK/USE OF BLDG. Address'' S Main Building: Accessory Building:, Z Arch/Eng. License No. TYPE OF PERMIT Li GRADING IDI FOUNDATION Li STRUCTURAL T Front ' . , • O Address �.( El TENANT El ELECTRICAL PLUMBING ❑ MECHANICAL B Rear N L/ Contractor's Name I + Phon(E1 221-0 ✓-I ❑ OTHER - - A _ • I r1 �.,^ ClPROJECT DESCRIPTION SQ. FT. -- OCCUPANCY C Right N Address(mailing) •O. • 1421 /p CCldl4. If�' CONSTRUCTION TYPE I VALUATION$ - _ 5 ' Q,. K Left G City License No. 3�C/gr ZONE GRADING CU.YDS. - ACRES R LICENSED CONTRACTOR DECLARATIdN Ping. Ref.# • Parking Req./Provided E I hereby affirm that I am licensed under.provislons of Charter 9 (commencing Remarks: t 1- - '_ ''}�1�� ` 1 [.(' �/ ing Notes: M with section 7000) of Division 3 of the Business and Professions Code,and \�yrtgT �n `)Q ft l -!O _ ! T my license is in full fo�r_Lc•eans Iffect. '/ 1-al• Ae n" }'T- .I__ a License Class ` /Y' Licans5 No.9�!G 4�g _ R ,Atei4.ni] Ld ed„.L S Date '] 7.4 '�Q Signature "-tct, " oteirs r' - = PLU NG metal FEES , WORKES'CdMPENSATION DECLARATION Bar Sink Showers I 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. C.) ^ C 1 11 t� JJAutomatic Washer • _ Transformer 0 15-50 KW • - Policy No. � � g-Is'T2" 5 Company It T rh0. Backflow Irrigation Sewer Cap0 50+ KW - ' 8 Certified copy is hereby furnished. _ Construction Pole Sub. \ Certified cop i filed with the city Building plvisiop Bathtubs Sewer Connection �G Cooking Unit Meter ❑up to 100 amps l` Date TION FROM Applicant elCATI �15CN1 - - - EXEMP ION FROM WORKERS'COMPENSATION DECLARATION Clarifiers • Solar CollectorsDishwasher Meter Dover 100 amps f;', 4 (This section need not be completed if the permit Is for one hundred ($100) or _ - ' less). I '� Dishwasher • Solar Piping - Q^ Dryers ❑Gas DElectric Sub Pane? • I certify that in the performance of the work for which this permit is issued,I Nshall 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 . Signature Floor Drains . 'Swimming Pool w/Spa' F,A.U. _ • - NOTICE:If,after making't his declaration, you should become subject-to the _ _ Inc.Solar ❑9-15 HP- 016-15+ 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. • 'I _ Microwave CONSTRUCTION LENDING AGENCY jQ 4L. Gas Service COutlets 3 Water Closet - 5' Device Boxes 1 hereby affirm that there is a construction lending agency for the performance - Pole Li• ght i of the work for which this permit is issued- (Section 3097 Civ. C.) •. Lender's Name - 3097;C • :Civ. I i Water Heater 2 ea Outlets',; . R• ange -Lender's-Address - --- 'vV ,/ Kitchen Sink - '/ Water Service -- /� C7& Switches Sign - _ OWNER BUILDER DECLARATION A /I hereby affirm that I am exempt from the Contractor's License Law for the ,.y Lavatories I • '/ Auto-Wash /? ;p1 Garbo a Di5 osal • following reason (Section 7031.5 Business and Professional Code: Any city or f+, (7V 9 , P Standing Sections county which requires a permit to construct,alter,improve,demolisq 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 Pa to file a signed statement that he/she Is licensed pursuant to the provisions of t Roof Drains �1 • the Contractor's License Law(Chapter 9(commencing with Section=7000)of i .� „[ Z ) 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 • ' • LJenalty;of not more than five hundred dollars($500). 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 'J $15 Issue Fee -$ 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 ❑ Zoning Approved By • Date _rotation, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground , ,BUildipg Approved By Date ' rove for the purpose of sale). 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 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). I am aware that Exhaust System ❑ 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.BIL ICBO# Fire Dampers - • PLUMBING - $ ISSUANCE' $ ' Date ' Owner' Heating System& Ducting Registers - - I - PLAN CHECK 25% $ /3• ,ENERGY P.C. $ I hereby certify that I have read this application and state that the above 0o-100,000 BTU 0100,000 BTGRADING $ • '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 to.enter upon the above-mentioned property for ' PLAN CHECK 50% $ - inspection purpos MECHANICAL $ Q Signature . (.Vp" �/, Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting;Goldenrod -Assessor N _11. .STRUCTION AND PLANNING • POOL &SPA Date Inspector Date Inspectoi ./PROVALS Permit APPROVALS Permit# / r: /1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. i/,/ffy( J,7t 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 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. . p/r/c( rife 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 2/9/ 7JiAr65. 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 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: - 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test c-1007 #Y7C 36. Hood or Canopy "/'c7' //�( 37. Final Factory Fireplace 38. Final Plumbing 1//447 39. Water Service-Final �7 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 1 • I 2983 2/21/d/ _ • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. . 130 1 � CITY OF COSTA MESA 'CONSTRUCTION PERMIT PEI/(J/yT NO. 51k TRACT NO. LOT NOD. U IT NO. • Project Address -r2. 34 -r'�:J•-/ C11. CT/lD1�L J� --C,....Applicant's NTailing Address ^te/ 5Cote-V/GW sQ-t S. A. TYPE OF CONSTRUCTION NEW CJ ADD lJ ALTERATION ❑ REPAIR ' 0 CONVERSION ❑ DEMOLISH ❑ OTHER A,P•.N. I Zone Owner's Name Phone 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 U STRUCTURAL T Front O Address / 0 TENANT ❑ ELECTRICAL 1:1 PLUMBING MECHANICAL B Rear N Contractor's Name EU6CnC sA-VkL•..l Phone S"7-1-141‘,5- ID OTHER A I PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N Address(mailing) 3101 .5. FA IR .Z 0. -• 4421- s . A . K G �, �j4 CONSTRUCTION TYPE VALUATIONS $ Left • City License No. pZONE GRADING CU.YDS. ACRESR LICENSED CONTRACTOR DECLARATION _ Ping. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: /3 ',2 Y,5- Tt Planning Notes: M a with section 7000) of Division 3 of the Business and Professions Code, and ! O f� my license is in full force and effect. z r/ T .L ` Licens ClassLicense Ne�?' O • S Qt Date •••••‘---2-7�FS7 signature C� PLUMBING I FEES - - i - ,` WORKERS'COMPENSATION DECLARATION Bar Sink Showers - . I 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 Backf low Preventer Service Sink ' ' - ' 3800, Lab. C.) /� Automatic Washer Transformer 0 15-50 KW Nr Policy No. t Sot SS✓�y�ompany S>��TF FK NIL Backflow Irrigation Sewer Cap — -D 50+KW - - • Certified copy Construction Pole Sub. is hereby furnished. Certified copyY is filedwith the city Building Division. �js Dori Sewer Connection • - Cooking Unit Meter Outo 100 amps _ Date ••�-1 l-D / Applicant frC'� t-�"+'�� EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers • Solar Collectors Dishwasher - Meter Dover 100 amps (This section need not be completed if the permit is for ono 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 00-1 HP 01%-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 UrinalFixtures comply with such provisions or this permit shall be deemed revoked. Microwave • CONSTRUCTION LENDING AGENCY ' GIs Service Outlets Water Closet , I hereby affirm that there is a construction lending agency for the performance •e Device Boxes 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 - - OWNER • BUILDER DECLARATION • - Switches 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 - �s Garbage Disposal Standing Sections 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 GOmpactdr 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 penalty of not more than five hundred dollars($500). LJ 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: Boiler Hood or Type I employees,hprovided that such or improvement are not Intended year c for yp 0 ZoningApproved Bynate salt. n, however,hewthe building dopro i g within one your of rim- Canopy Type II ❑ pp ' elation, the owner se 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). - 0'I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date tractors là 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 00-100,000 BTU 0100,000 BTU „ 06 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 mo. PLAN CHECK $ PERMIT 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt.ICBG# Fire Dampers .y PLUMBING $ ISSUANCE $ Date Owner • Heating System& Ducting , Registers 019 ENERGY P.C. $ - PLAN CHECK 25% $ _ _ 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 d property for PLAN.CHECK 50% $ MICROFILM S inspection fives of this city to enter upon the bove-mentioned property for - inspection purpose /1 �e - ^_�7 8-7aSVic Signature a p- T ( ff'-^-R---�`--s_• Date-Y s+ i - MECHANICAL $ TOTAL FEE $ /3-046 Drivers' License 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 i 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 !/07 9€C FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace /, APPROVALS Permit# _ 21. Ducts, in Structure y/f/F, J4 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 ,/ç47ee 35. Final Gas Pipe-Test ��C 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 t 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 __ V Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. IT,y OF COSTA MESA CONSTRUCTION PERMIT PERMIT N . I TRACT NO. LOT NO. UNIT NO. I `y Project Address 3 U `Ee'E'(�� Q ,/+�-� �' �� - - /274/ e hfle G. • or TYPE OF CONSTRUCTION • EW I• ADD is ALTERATION fid REPAIR • 0173 7/25/86 I I R.PD TI. Applicant's Mailing Addnress �J l "' Owner's Name ''T q if DPI/7 Gfie>,i-Phone ❑ CONVERSION ❑ DE OLISH 0OTHER A.P.# - • Zone DESCRIPTION OF WORK/USE OF BLDG. • Address • S Main Building: • Accessory Building: Arch/Eng. License No. TYPE OF PERMIT -CI GRADING Li FOUNDATION U STRUCTURAL T Front • 0 ~Address ' �/ /�/ /. 0 TENANT ELECTRICAL ❑ PLUMBING 0 MECHANICAL B Rear N Contractor's Nam¢ f/~7 Pe4'es NLC Phone S3mlam-Zy. ❑ OTHER I - PROJECT DESCRIPTION SQ. FT. OCCUPANCY • C Right N Address(mailing) - 3/7/,o CONSTRUCTION TYPE VALUATIONS S Left City License No. ////O\ .ZONE GRADING CU.YDS. ACRESR LICENSED CONTRACTOR DECLARATION Ping. Ref.# • - Parking R¢q./Provided E I hereby affirm that.l am licensed under provisions of Charter 9(commencing Remarks: Planning Notes: - - M • with section 7000) of Division 3 of the Business and Professions Code,and ' T my license is in full force and effect. //�)� 7 I-L�pq • • 1 License Cl ss �'/0 .License No. n �� 1✓ 9/ 2 • , S Date 7, z. Signature /��+' /�Q! �?///!lt'.0(T✓"� - PLUMBING FEES , • WORKERS'COMPENSATION DECLARATION - Bar Sink Showers - I - ELECTRICAL: FEES I hereby 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 - ' 380o; Lab. C.) 21'(V e.;ip L rr, Automatic Washer _ . Transformer 0 15-50 KW colic No. HO/At" X1 - pp„r '� �)I"�"/r:' r ArJH-e - -' ®, ❑ 50+ KW Y l 'C d5rr� Backflow Irrigation Sewer Cap . Construction-Pole Sub. ►� /� 'I\ Certified copy Is hereby furnished. ' \' ertifiee.d� opy IS}11 d.with the city Builtha9 plvision. • .Bathtubs' _• . Sewer Connection ■ Cooking Unit. ' - Meter '-s p to 100 amps Certified 'r .-zT ( y4 Applicant fx itfl '71? &1 a(t.4,7 \ EXEMPTION FROM WORKERS'COMPENSATION DECLARATION ,Clarifiers • Solar Collectors ®,� Dishwasher - ,Meter Dover 100 ampsMI(This section need not be completed if the permit IT for One hundred ($100) Orless). Dishwasher Solar Piping_ Dryers ❑Gas Aglectric 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❑Ori HP ❑1%:8 / _ Workers' Compensation Laws of California. - t_.<1 DateOSignature ,Floor Drains Swimming Pool w/Spa' , F.X.U. Ina Solar 09-15 HP❑iG15+ NOTICE:If,after making this attire declaration, you.should become subject to the t� N. Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks • Urinal , Fixtures Microwave • • II \U comply with such provisions or this permit shall be deemed revoked. i `U CONSTRUCTION LENDING AGENCY GeS Service Outlets Water Closet Device Boxes Pole Light I hereby affirm that there is a construction lending agency for the performance Ill9 of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets • Lender's Name - Range /a Lender's Address . .Kitchen Sink - ■ Water Service.. �■ - `/ r OWNER BUILDER DECLARATION Switches Sign 7 1 hereby affirm that 1 am exempt from the Contractor's License Law for the I.Lavatories.• ' ® �S r following reason (Section 7031.5 Business and Professional Code: Any city or Auto-Wash Garbage Disposal Standing Sections Al I 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 . ' penalty of not more than five hundred dollars($500). I i • LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee , I $15 Issue Fee 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 - 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 com- Canopy Type II ❑ Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or Im- Duct-Under Profes • 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 - 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 i 00-100,000 BTU 0100 000 BTU SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- ' tractor(s) System license pursuant to the Contractor's License Law). I am aware that Exhaust 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' Firepi/Fact.Bit. ICBG 46 Fire Dampers PLUMBING $ PERMIT ISSUANCE $ Date ' Owner • Heating System&'Ducting Registers PLAN CHECK 25% $ - 'ENERGY P.C. $ L hereby Certify that I have read this application and'state that the above ❑0100,000 BTU ❑100,000 BT ELECTRICAL $ GRADING $ • nformation is correct. I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize repre- sentatives of this city to enter upgp the above-mentioned property orr • nspection purposes.VoA 27 • • . Reinspection Fee $15 Iswe Fee $ 3 PLAN CHECK 25% $ -086-.46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor - VCONSTRUCTION AND PLANNING POOL &SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date 'r Inspector c 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location - 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement I 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 enn 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 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 z-s-17 ��G'- 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 ❑Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank O 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 r 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 9. FINAL INSPECTION .' f 32. Electrical Power Meter-Final 1% � / 0. FOOD CERTIFICATE SSUED 33. Final Electric , Notes: /236,4 /d4Qr t 2 '+' 34. Final Heating & Air Conditioning �llw i7 • 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. Backftow Preventer 43: Backflow Irrigation , 44. Landscape Irrigation System - - - 45. Sound Attenuation 46. Handicap Regulations di 47. FINAL STRUCTURE & BUILDING • 48. Special Requirements Completed - ' r 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co • `,51. CERTIFICATE OF OCCUPANCYI J,,' Nr”..„. Date _ --1 • Applicant to fill in all spaces except those within heavy border lines and sign all_ appropriate declarations, _ • - PERMI NO' TRACT NO. LOT NO.' UNIT NO: I BD4• BI22/B6 !CITY OF COSTA MESA/n CONSTRUCTION PERMIT 8e00 ' TL Project Address 39A I V ZP\ St L•S'iP �I/I[Sq 1 �� 1- i TYPE OF CONSTRUCTION L I NEW Li ADD LJ ALTERATJ,ON L I REPAIR ' ' Applicant's Mealy Address 55��' 11 22 St: gr.S1•o( $.w"'tf1/4-A • n 1y�" tie 9S7'E4.SS• ❑ CONVERSION' CI DEMOLISH '. 'tr 'row /O wee A.P. - - ,_ Zone• Owner's Name ,t.�, Mike• • Phone - , V DESCRIPTION OF WORK/USE OF BLDG. ' rr+iJ/n1-v EX4 • Address A- I E Main Building: ; 'Accessory Building:. Z Arch/Eng. License No, TYPE OF PERMIT 'L I GRADING ❑ FOUNDATION DSTRUCTURAL T Front I 0 ' Address I+ /n� ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear , ( I , N Contractor's Name �A"Z- Q.Qv Ac(Iw/' Phone '�-C7-afi•Cc ❑ OTHER . • __ A ..--_ _.. _ _ _ D PROJECT DESCRIPTION 'SQ. FT. OCCUPANCY C Right • N • Address(mailing) 11r)-.CE pllFi.,/. t,.•e Jaat{4...4, et)." K - • - - - - G CON ST RUCTION TYPE VALUATION$ $ Left _ City License No. /^7 OSQ ZONE - _ I G RAIDING CU.YDS. ACRES' R LICENSED CONTRACTOR DECLARATION _ P,Ing. Ref.# PdrkiOgR¢q,/Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: _ . . - , Planning Notes: I - , M with section 7000) of Division 3 of the Business'and Professions Code,and - T my license is in fu force and effect. •Z I II �� - License Class Len No I S Date Q [.m Signature L^ a ❑s�-- - PLUMBING FEES , - - WORKERS' COMPENSATION DECLA ATION I/ Bar Sink - Showers ELECTRICAL - FEES hereby affirm that I have a certificate consent to self-insure or'a Certificate - - Workers' Compensation Insurance, r a certified copy thereof (Section - - .. qG /� Backflow Preventer Service Sink Automatic Wisher Transformer D 15-50 KW - POB y No. 7r.ei t I G C. rang Backflow Irrigation - Sewer Cap • < ❑ 50+IKW 5 ('r WW / Construction Pole Sub. w 1 • miffed copy is hereby thrnie het. .I - - er 'fr'etl co p15`fi led with the city 'I I ling • vi Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps •` 1 Date g+n.t> %L. Applicant 11%• I -1 _ C" EXEMPTION FROM WORKERS'COM!E ATION ' E� ARATION Clarifiers, Solar Collectors _ Dishwasher 1 Meter. Clover 100 amps ' - (This section need not be completed If[le permit is fft o e hundred ($100) or - 1 less). I Dishwasher ' Solar Piping , . - - Dryers ❑Gas ['Electric Sub Panel �•(� I certify that in the performance of th=work for which this permit is issued, I - . I - ` 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.h-.6 , Workers' Compensation Laws of California. ' Date i I Signature - Floor Drains i Swimming Pool w/Spa F.A.U. I Inc.Solar ❑9-15 HP ❑i6-15+ • -. .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 I comply with such 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 bevice Boxes I POI¢ Light I 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 -f - Switches -' --' "' Sign r -- '- _ - - OWNER BUILDER DECLARATION • - 9 I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories ' Auto-Wash 4 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 • ' Laundry Trays Generator ❑0-5 KW ❑5-15 KW any structure, priof'to its issuance, also req ulres 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 i • Division 3--of the Business and'Professions Code) orthat he/she is exempt - • - - "' '" - ' - - " "' therefrom:and the basis for the alleged'exemption. Any violation of Section II , , •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 . $13 ' i compensation, will do'the work,and the structure is not Intended or offered - Reinspection Fee II$15; I Issue Fee : I • -, $ 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 • Hood or •Type I 0 DEVELOPMENT SERVICES REQUIREMENTS: : - 1 - - employees, provided that such improvements are not intended or offered for Boiler • ( I ZoningApproved By1 sale- If, howeveq-the building or improvement is sold within one year of corn- - - - Canopy Type II 0 pP - - 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 Of sale).{ - �� LI 1,-as owner'of the property, am ekclusively contracting with licensed con- Duct-Structural Refrigeration System • 'Application Issued By /” ()at: IOW' 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). I am aware that Exhaust System 0 Multiple 0 • System Repair/Alteration - • BUILDING PERMIT , $ SMIP $ t. - proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK ' $. • - I PERMIT- ❑ I am exempt under Section B. & P.C.for this reason Firepl/Fact,Blt. ICBG# ' ' Fire Dampers •I ISSUANCE • $ ^ - ' - PLUMBING - - $; Date - - Owner Heating System Ducting& _Registers • PLAN CHECK 25% $- 1 ENERGY P.C. $ • hereby certif that I.have read this application and state that the above D0-100,000 BTU 0100,000 BT ELECTRICAL $' D�. (� GRADING $ - ' information I ••rrect.-I agree to comply with all city and county ordinances • - - + _ •and state la elatin• to buil•ing'construction,and hereby authorize repre- sentatives o �t cit to er u•on•the above-mentioned property for - . - . - - ' : ? _, PLAN CHECK 50% $,. •inspection p • -5. A Q l Signature p/'.♦,`Z�Qt MECHANICAL $ TOTAL FEE ,, $ go O(J' 1•. 1 Y Date + , + Drivers' Liceni- or 55# - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL &SPA - APPROVALS Permit# Date Inspector - APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 1_�.Z,5-_,Tb Pp}, 52. Pool Si Equipment Location 2. Soil Pipe-Undrgrnd. Y/(J53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms • _, 4: Electrical Conduit-Undrgrnd. 55. Electrical Bonding C 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, 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 . . 4. 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil . - 23. Gas Pipe-Rough & TestI 72. Underground Flush 24. Root 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 Cot , UGtN i 35. Final Gas Pipe-Test Cot 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 -'- -1 -43. Backflow Irrigation • - 44. Landscape Irrigation System - • • 45. Sound Attenuation . ' i -- 46. Handicap Regulations - , . 47.-FINAL STRUCTURE & BUI LDI NG - f• . . - 48: Special Requirements Completed , .. C 49. Electric Release to Edison 1- • ,. 50. Gas Release to Southern California Gas Co 'r " •.. A , • 51. CERTIFICATE OF OCCUPANCY / No. Date L_ • Applicant to fill in all spaces except those within heav• y border lines and sign all appropriate declarations. • CITY OF COSTA SA N /UCTION 'ERMIT PERMII�[,NO. /// TRACT NO. LOT NO. UNIT NO. ,4220 11 /15/85 I EtefC TI.. • Project A� �49 °, Z/i.€ .� / / I(Q�/ - ✓ t- C -A TYPE OF CONSTRUCTION LJ NEW U ADD U ALTERATION ❑ REPAIR - ' Applicant's Mailing Flddr¢ss �- _ - S `A '� - -f ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A,P,# • Zone Owner's Name�i/•O'/ r �j" U Phocne7,5 /6157 DESCRIPTION OF_WORK/USE OF BLDG. Address �� p S.�" 'J /S��- ' /� H S Main Building: Accessory Building: Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION STRUCTURAL T Front ZO Address yJ • y1 / ElTENANT ❑ ELECTRICAL ❑ PLUMBING 1i1 MECHANICAL B Rear • • N Contractor's Name , �,i U Phone�7J 5 C7 )3 ❑ OTHER . ' CA Ri ht N v PROJECT DESCRIPTION SQ. FT. • OCCUPANCY g - Address(mailing) K" G +� 7� 7\ CONSTRUCTION TYPE /'' VALUATION$ �� $ Left R City License No. P lJ ZONE GRADI IG ACRES LICENSED CONTRACTOR DECLARATION Ping. Ref.# • Parking Req./Piovided E 0 I hereby affirm that I am licensed under provisions of charter 9 (commencing Remarks: • �� Planning Notes: ' I M with section 7000) of Division 3 of the Business and Professions Code, and ' T my license is in full force and effect. '� � • f` Incense CI.- _ License No • 4 • - - $, `7c Date 4 r )Signature .' `rs�/ " _ PLU FEES N WOR RS' ••MPENSATION DECLARAT!l Bar Sink Showers I he -by 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 1v3800, Lab. Cd • (—I 737;a r I - - - Automatic Washer - ' Transformer - -' Poli y No. LN 1 mpany15-50 KW Backflow Irrigation Sewer Cap Construction Pale Sub. 0 50+KW Cyl Certified ••py i hereby fur shed. • Certify • copy' lied it he city 4•i•• Divis"on Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date 4 pplicant'�J // Ii)i -A • • EXEM• ION" -OM WORKERS'CO F. S ON i CL•R' ION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the per t is for one hundred ($100)or less). . Dishwasher Solar Piping' Dryers OGas ❑Electric Sub Panel - I certify that in the performance of the work for which this permit is issued, 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%-B ' Workers' Compensation Laws of California. _ Date Signature Floor Drains Swimming Pool w/Spa i 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 Fioor.Sinks - -. Urinal. -- Fixtures - • comply with such provisions or this permit shall be deemed revoked. Microwave • CONSTRUCTION LENDING AGENCY Gas Service Outlets Water ClosetDevice 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 9 Lender's AddressKitchen Sink Water Service ' R OWNEBUILDER DECLARATION Switches 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 CoderAny 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 '- ' Ltmalty 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 $ 33 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- Canopy Type II ❑ 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 C prove for the purpose of sale). - , A 1 I/_/5-*%C ❑ I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By �� Date U 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 Duct-Ventilating ❑0.100,000 BTU ❑100,000 BTU SU RY FEES - �1 builds or improves thereon,and who contracts for such projects with a con- - - - f'� tractor(s) license pursuant to the Contractor's License Law). I am aware thatBUILDING PERMIT $ //S SMIP $ /S� proof of their Worker's Compensation insurance should be provided to me. Exhaust System 0 Multiple 0 System •Repair/Alteration - - PLAN CHECK $ PERMIT • ❑ 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 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 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 repre- PLAN CHECK 50% $ MICROFILM $ sentatives of.this city to enter upon the above-mentioned prop=rty hr inspection purpo - Reinspection Fee $15 . Issue Fee $ 3 PLAN CHECK 25%, $ CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor 7 CONSTRUCTION AND,PLANNING POOL.n SPA ' APPROVALS Permit# - Date Inspector APPROVALS Permit# Date Inspector -1',-emporary 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. 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 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. Backf low Irrigation - 44. ,Landscape Irrigation System 45. Sound Attenuation a. FINAL STRUCTURE & BUILDING ilix g---;-.........) 48. - Requirements Completed , - 49. Electric Release to Edison . • N.....,:\_,,,,, 50. Gas Release to.Southern California Gas Cu 51. CERTIFICATE OF OCCUPANCY No, Date - 1 - `i Project ro ecrOgdCOSTq MESA 'Applicant's dress COIV cant's Mai � �ST1116/C7-ION C Owner•s ling Addr l./ TION q Name ss 6/ Petite dress �� n Addh/Fng, at/41.11 � lL ��j_Y PERMIT/ �� RMN; ^/T IIyO ah spaces except those die - ', MN ii _ within C/cites tpr,s Na Phone .� Ty�OF CO T TRACT NO heavy border lines an Cdtlress lmailing� license No D:Es SODNVERSIpUCTION LOT NO.anti sign all appropriate tir Peclara t?ons. I hereby a�CONTgA �77 Q .hoe �Y(lP��E OF pER WORK/USE Op o OTH f0 �'qlT NE: tWi lic�ctlo�lr' that !CTO•R OEC `�-s� • Ll TENANMIT . BLDG R fRATIGN . /� licens@nse is/n��l of D?vf vision oRA710ry • T Q GRAOI ll�� qfP p�v Wote % rOrce and ern °r the B0W5iQ°t of PRO`IECT DFSC Li. CTRICgI GWf�POUryDq TI AIR U RKf- �, s Ch. CO RIP LV ON • CIL gyp. l herebya S CO P Signal and . .!erg(tom 2 NSTRt/CON SQ. MB/NG C.-3 •STRU •aC' P/'. �t 00°lay stir otnhipen liege aON OEC • ns: ..o ts/ons Codana�d ONE Ti1= FT_MECI"IANIC yT` UR 4:./ 7 \ r�o}fe'y No C,) n5alion In rlilfcate RATI• "� c i C:c 'C ,�7 sur //[�� °rc ` 1 T• EXUEMPl7 leo op Yis Ieo With r°!shop omPany enr/ed tolpy°the eol erti/!tate ZR/DING Cu.I.OS.VAIItA=NCR NCV_ C Accessory Builtli le his sett! ry F the cls i (Sectip .: ES_ K Bonding: ne W Plic ss)- on M AP v 6 n I Cert?i ed not 60RKE Sant a. S pa t in t he N TI r t C m°Pensat onPe�;:nonaf: itecillti n e heE eSm t O/��e ' .Bac%low lIMF aankfkliv�venter Plan n Rg N 111111 O cair o°rker E'11 atter er latndn°rk for w Pne A�tl etl N . 9ation. Otes: N•nPIY Cornpe Makin pini net Sp hich (S]C �ONSTgVith such tion phis declae a. as to beco Permit i 0pJ or . , w Parking/Ill Nere6CTIO Prov? Pvlslp ratio mesp s Issue • roI Y ail! NL Sion nspt n, yp b%ect ° I Ir .• OVitl rrLalhP Wormthat EryOlrytor theu shout to tl/d ' Dishcats �f . °�floe,•, rk for !hereI G qG this pI-abor d be her _.. Rlenders Namewhichsfp/pnslrvc CYermit sfCiall°p' You° 3Obiect orinkin Au EcooNv^�eVrrneD hR DECL tP@,mit°nseps�eddg(SeC�oruhe veoect t o thelPloorDain�untains : Solar Co//ec[Ors �.ons�ruo•tWasher Mef. 16 1111 unt eas at I ARq 4op Perl' •• dofpY st�p�Ihlch oe (Sect/odxemTlON :e.p �omaflce . lialln Pale Sub . Tralh a sl Orlo ape 1.5 m th J Ser . S . .. ns7ptDivi CO^tra gladstat !OIts Irntto Bvticonness° COntrviceWimmip Dish mer dl55obYdao,theibut ne�u'ata ygtsolceulei5efh frnPro 'Cade An `dru . Outlets : Urinal gPWl w/Spa -�.D'Yams QGas Meter OSKWWty p fly alis ane erg rased aP •o@ e u s.V lrnot aPPli rot t Pr to !co Pvr Plica molls Y cllyo OEIe P tp co dspmonocantIhe airs es9onshlr^eflti scan[ f rat /pr s hpr rd rcar . cRicMeterQ Iprmoensat wnvr pf tnan Ii ve°� a Pe°p axe Co@o) ^9 w![h°th4 Prptu Per Palr � • `, • . ov Ps ' _. on ! h r m or Se ov! mil er i _. sal h u ml Pl/ th Ct1 si 0 assi license@ rSocti wAt uoe Proper ^Oreo tl i tvbie °n. An al by °^ J00°ns o/ .• .' .• Dames fhcr La Pn the lY lar cls Y vi /she 0 eon, w do J094 wor Qr m t(SS the olati is p J o! Sall plO�'nes ntl who^ot aP Bvsines d°d Ilia°Melo 00), amel/tdnt O/Sec°,Pl a�00fDrains . . . Motors e. 1 Pr tlo P Y t t do sur Yces to tion s 1. PIOV h0 OVItl et 5 pan P P UCt Pr wif11 a Ci . 1111: atram _..Device . I Cal . lid' waver °d the vtb Wo °caner roless! a Is p wage civil ce BO Inc, MP OI@lorffhO PU�erf woll�bllofngpor^Prove se�/hers P¢rt9°tle °Th OeOSp�Pb sol@ . / 'e�OQl1615 xet $O dr Q9.1$ Ojb BS/� Trat Il b111 Cof lomO1sttactorsOC^en,@p°Plaewlp(oe�l/opn�ve/yltl°9ph /n idpende�ol ped h tl i�lt _..R@ nsppctiop F@d $js ., 4 ' I .Garbage Disposal •simHP • j _8 ft Pose oft:, V heir vyo ursuanl°•and syh not ap94,Bus lattin vlltl pr icensed im- .:. . GenealOr Q 111 dm imp . eke/p kunderers P lh o Cp Ply facts r ness g cats ' _ _ On@@reby_tCp°Pensd°Q Ara OSVan rs et ynse CLaWrOIeCQan owner f•tro @rM,PC tySSIOnS Ch°,he: �DOCtt. Undef Grpbnd • _ t).5 KVp � $Idndln9$eCt14 'immi� dp ormboce,tl/Y O °uld be 1 am lib a con Strutt H°pd or . ns BY sentatiate laws tOrrhdt 1 hdv Wner B. p prOwdedare to thatall Duct. ural Canop TVPe I -- .S7sPectlon Pu.• ,'s ch log•-a�/�, oo his dp ' C./pr lhls red me. gag Exh Van tilating V TVp011 Q .Rei s 9natu,e oses, to��p,�Qamg prnP!y sP'I?Cation t°n Aust SVst Relr%ger n Pectipp E _ Drivers• _r v°^ lructih ah tlt p° stat ill Fir ens Q • anon Sys DEVF ea itei' _. CMI=0665 license pr S- - =I.' . On ;sOB Re I^Pers n ^Issued BY allii7 te APPIICan . gislers bat t Pink .Accovnting;GOI R@insPpttion Fee . PLAIN$1"1-DING PERMIT SUMM % Qatee_ oenroo _Ass PLUMBING $ ARY OF FEES4111' Dat: Assessor . MBING S . PLAN CHECK S .= SMIP 0. ELECTRIC 25% S is MIT ® ` ENRAN S_ MECHgN c K 5p% $ SESRGYP. S PLAN CHECKL 25% $ ` M CROF LMC- GRADING $ `_ TOTAL FEE $ ' " ..t 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 i 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, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK -• 11. Property Sewer Line & House Connection r/f//r7 fr 62. Backwash & Receptor-Final 12. Sewer Cap l //,r)�ij�LJ4 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 P• ermit# - 21. Ducts, in Structure • 70. Underground Hydro - 22. Ducts, Ventilating I1' 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test i' , 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 _ i • 1 • _ ,. 38.'-Final Plumbing leg ft I ( �' h i ' • • 39. Water Service-Final - / Q. '•_' - ' I' - 4P. -. 'ce-Final ` { i,,41. Solar Domestic-Final tR42. Backflow Preventer - �' . 43. Backflow Irrigation I � , . t;-1 -1°,44.. Landscape Irrigation System '' - , --45: Sound Attenuation ` - ) 46. Handicap Regulations 47. FINAL STRUCTURE & BUI LDING • i _ 48. Special Requirements Completed I ' , 49. Electric Release to Edison • . i. / 50. Gas Release to Southern California Gas CO i 51. CERTIFICATE OF OCCUPANCY - No. Date I Applicant to fill in all spaces except those within heavy border lines am _-..-declaiatlons- CITY OF COSTA MESA CONSTRUCT! •N PERMIT PER Ai "°� ,.,• TRACT NO. LOT NO. dp17 ND / 8816 11 /02/87 I Op50 Ta' �i •• r / ' ' - ..YCJ z 7�/1 . _ y`r�/(1/�Iy"i/�/l 4 Project K&iress Ay4iilicant's Mailingt�Add/s_oss >V/ Lo." t - , .I • ' •••• TYPE OF CONSTRUCTION NEW IJ ADD LI ALTERATION REPAIR - Owner's Name 1�6N �J � ''�� III CONVERSION 11! DEMOLISH ❑ OTHER - - - A P # I Zone Phone DESCRIPTION OF WORK/USE OF BLDG. Address St' S Main Building: Accessory Building: •Arch/Eng. _ License No. TYPE OF PERMIT ❑ GRADING C FOUNDATION U STRUCTURAL T Front 0 Address 'A n ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N Contractor's Name C4 -4- r - P o ;1)' ZtZ ❑ OTHER A • I PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N Address(mailing) V.761 Lo 1 ,0-9'� K G .Lr CON ST RUCTION TYPE VALUATIONS $ Left City License No. JJ "�� • ZONE GRADING CU.YDS. - R LICENSED CONTRACTOR DECLARATI jsl��/�/,�� J �•9�yj Ping. Ref.# Parking Req./Provided E hereby affirm thatI am licensedion under provisions nf C r 9(commencing Remarks:./" '-_"_ �// QT iii () - rJ S! Planning Notes: M with section 7000) of Division 3 of the - ess antlessions Code, and [is•sir^�� • _ my license is in full force . d eftct. � (� T License Class icon - ./ - S Date 7 Signature i�7 PLUMBING I FEES - WORKERS'COMPENSATION DECLARATI,N Bar Sink Showers ELECTRICAL FEES I hereby affirm that I have a certificate of c. sent to self-Insure of a certificate _ - - , Workers' Compensati n Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 3 , Lab. C. Automatic Washer Transformer 0 15-50 KW rot' y No. o •-• y rib rt acw Backflow Irrigation Sewer Ca 0 50+KW Certifie py is er by furnishetl p Construction Pole Sub. Cert ifietl op filed with the c' y Building Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date Applican _ • EXEMPT! N F O WORKERS'COMPENS• ION DECLARATIO Clarifiers Solar Collectors Dishwasher Meter Cover 100 amps (Thissection n ed not be completed if the pe nit Is for one hundred ($100)or less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the w.rk for which this permit Is Issued, I shall not employ any person in any manner so as to become subject to te Drinking Fountains Solar Tank FanMotors❑0-1 HP 01%-8 Workers' Compensation Laws of California. Date Signature Floor Drains Swimming Pool w/Spa F.A.U. _ 09-15 HP 016.15+ NOTICE: If,after making this declaration, you should become subject to the - - - — Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Lender's Name - Range ' Lender's Address Kitchen Sink .Water Service OWNER BUILDER DECLARATION Switches - Sign I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash - following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap • Laundry Trays any structure, prior to Its Issuance,also requires the applicant for such permity Generator ❑0-5 KW ❑5-1$ 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 - 'serefrom and the basis for the alleged exemption. Any violation of Section 131.5 by any applicant for a permit subjects the applicant to a-civil nalty of not more than five hundred dollars($500). ' ti 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 ❑ sale. If, however, the building or improvement is sold within one year of Com- Canopy Type II ❑ Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or in- Duct-Under Ground Building Approved By - Date trove for the purpose of sale). /� LJ I, as owner of the 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: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00.100,000 BTU ❑100,000 BTU SUMMARY OF FEES builds or Improves thereon, and who contracts for such projects with a con- CJ tractor(s) license pursuant to the Contractor's License Law). I am aware thatBUILDING PERMIT $ 'e SMTP $ O proof of their Worker's Compensation insurance should be provided to me. Exhaust System ❑ Multiple 0 System Repair/Alteration PLAN CHECK $ _. _ PERMIT ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $ Date Own- a ENERGY P.C. $ _ PLAN CHECK 25% $ I hereby certify that ave ea• this application and state that the above 00-100,000 BTU 0100,000 BGRADING $ information Is corre , I •gr• to comply with all city and county ordinances ELECTRICAL +$ and state laws re . ing o • ild g co truction, and hereby authoriz repre- MICROFILM $ sentatives of - s city to e yyy r •. the above-mentioned prop ty /for PLAN CHECK 50% $ Igspection p -•uses, / jq /Oa MECHANICAL $ TOTAL FEE $ 10.SO / Signature ',// Date t •�O/ Drivers' re or • Pink - Accounting; Goldenrod - Assessor : CONSTRUCTION ANDLANNING POOL& SPA ! ;PAPPROVALS :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 Sy.fern' 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 f 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 : 9HeatingConditioning •-.,__` 7 FIRE DEPT. REQUIREME.NTr'. t, L ' 19. Rough & Air n s' 20. Rough Factory Fireplace c H,APPROVA'LS Permit# •.:t'`" "''', - �> i r . . 1' t � i ../ 21. Ducts, in Structure 70�Uirground Hydro -i_- �. , ��YYYYY 22. Ducts, Ventilating 71. Product Piping 0 Gas 00iI' •: "- 23. Gas Pipe-Rough & Test 72. Underground Flush :'; -2 . 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 1 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, - - ren 33. Final Electric Notes: / 34. Final Heating & Air Conditioning '>' 35. Final Gas Pipe-Test 36. Hood or Canopy •^' "�` \r. N 4:, 37'-Final Factory Fireplace -ice ^,-,'tn • 38:-Final Plumbing L. r. n� •. _i .:'1 ;f' •- "" :!.....a•-•/ 39'Water Service-Final ' �'- •••/ '' It' _, 40. Gas Service-Final ' •-- - " 7,co. Solar Domestic-Final2.;P -);�' :f 'A2. Backflow Preventer• ir43. Backflow Irrigation - , f� '/ ' '1.-; -- • 44:=landscape Irrigation System l„ , 45/Sound Attenuation ; y 46,1Handicap Regulations 2: ••!- L. ?J8AB Lw- A. ' 47.,FYNAL STRUCTURE & BUILDING y. - `48.` Special Requirements Completed / '+L r' • 49_•Electric Release to Edison - °�• f 450. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY _. _ r - No. Date ' . `,:,Z,'j Y . ,' r Applicant to fill in all spaces except those within heavy border Ilnes and sign all appropriate declarations. ouseCJ COSTA MESA CONSTRUCTION PERMIT P MIT NO. p TRACT NO. LOUT NO. UNIT NO. ' ' [ ProjA,Mddress 9398 Elden - 2� S7 9 C3-+ -38z Pts - 9.90:1. r 7%22%86 24.42!- TL •Applicant's Mailing Address 1132 S.G. Bristol. S.A.p TYPE OF CONSTRUCTION IJ NEW U ADD U ALTERATION I_J REPAIR ' ,, Owner's Name Cal Pacific Develo hent '957-8455 ❑ CONVERSION ❑ DEMOLISH 0 OTHE: • p # l -a�a.— Lf. Zone Ra A t Phone DESCRIPTION OF WORK/USE OF BLDG. 4��/airigi 1W Address 1182 S.G. 'Bristol, Santa Ma. Calif. - U S Main Building: Accessory Building: Arch/Eng. l.onDvar - License No. • • TYPE OF PERMIT U GRADING U FOUNDATION STRUCTURAL T Front • if. 1 • 0 Address 13001 Sky Parc-South 4.1 0 TENANT ❑ ELECTRICAL 0 PLUMBING 0 MECHANICAL B Rear • Jr f N Contractor's Name Rh- -1DevelOD:nent Phone 957--x 155 ❑OTHER - A Address(mailing) 1132 S.E., Bristol PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right D ._ N CONSTRUCTION TYPE VALUATION 5_IrO e' $ Left 4V a G City License No. U''705:1 • - /'�� R LICENSED CONTRACTOR DECLARATION - • ZONE GRADING CU.YDS. ACRES Ping. Ref.# 1s1/•I .L35 —th'7 Parking Req./Provided ' E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: ' . • Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code,and - - Licnsensaislnf Lorca and effect. 3(/ ° �..1�/'I js 'ir, n/ A,/vr S, License CJa � ' [�� Licen�/ o J NYJb{I r y/�C..VIJ t[K Date NZ 5ignatur ✓�iu ii/S • PLUMBING F ES 4- WORKERS' WORKERS'COMPENSATION DECLARAT' •N - • Bar Sink Showers • I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES '.Workers' Co�y e�ns29 1nsu ce, or a certified copy thereof (Section Backflow Preventer Service Sink 10, Lab. h7,�/7 _ Automatic Washer Transformer 0 15-50 KW trey No. �UU f- company S t' Farr Backflow Irrigation Sewer Cap — 0 50+KW Certified copy is hereby furnished. A/ > Construction Pole Sub. l , Certifiptl(q4p $filed with the city B.' / Division. od Bathtubs Sewer Connection . Meter ❑up to 100 amps Date h/l 1 (] App1ice n ///L. -- Illir EXEMPTIONFROMWORKERS'C• PENS•SON DECLARATION Clarifiers - -. - Solar Collectors - I l Meter Dover,100 amps . (This section need not be completed if the per is for one hundred ($100) or • less). Dishwasher . Solar Piping ' Dryers ❑Gas ❑Electric Sub Panel-S I certify that,In the performance of the work for which this permit is issued, I - P shall not employ any person in any manner so as to become subject to the —Drinking Fountains ' — Solar Tank Fan • �fulota&❑0.11HP ❑i 4.9 Workers' Compensation Laws of California. „i (C.\\:: Date Signature - Floor Drains Swimming Pool w/Spar F.A.U. ,- - )1I:c.pr •9.15 HP ❑16.15+ , 'NOTICE: II,after making this declaration,you should become subject to the - +•,"'�• 13 \ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal f'. " comply with such provisions or this permit shall be deemed revoked. �.tr)fes n 1; { • antic cOwOye CONSTRUCTION LENDING AGENCY - Gas Service Outlets • s I hereby affirm that there is a construction lending agency for the performance Water Closet • - • , vi: :o es , -_ �, Pole Light ' ‘&9,.., Of the work for which this permit -is issued (Section 3097 Cho. C.) —Interceptors' - Water Heater , r „t t�, �' • Lender's Name a • M Lender's Address —Kitchen Sink •_ • t `\\ OWNER BUILDER DECLARATIONWetef Service •' tp11¢5 J� I hereby affirm that I am exempt from the Contractor's License Law for the • Lavatories, _ '��f_1I following reason (Section 7031,5 Business and Professional Code: Any city or Auto-Wash • it arbage Dispo +I� `��,�,1 :I-Standing Sections county which requires'a permit to construct,alter,improve,demolish or repair p-Trap Laundry Trays • t enerat r'•r any structure, prior to its issuance, also requires the applicant for such permit ^N O 1y5-1$-KW Trash Compactor • to file a signed statement that he/she is licensed pursuant to the provisions of Roof - Drains - � v� �1 � ' 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 • '*erefrom 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 - ' sty of not more than five hundred dollars($500). - ' - ' -a 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 1s not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's> MECHANICAL FEES Reinspection Fee $15 Issue Fee S 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 p��. �' S- Zyfp sale. If, however, the building or improvement is sold within one year of com- ' • Canopy Type II ❑ Zoning Approved By Dete r� pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground l prove for the purpose of sale). , . Building Approved By Date• �s 0 I as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date /// 7/�p tractors to conftruct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating - ❑D-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 thatO•.a C„1 proof p their worker's Compensation insurance should be provided to me. Exhaust System 0 Multiple ❑ System Repair/Alteration l BUILDINGPERMIT $ 7�'.Sa SMTP $ • • PLAN CHECK $ •9r •tf PERMIT ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBO.# Fire Dampers PLUMBING $ ISSUANCE $ Date ' Owner . Heating System& Ducting ' Registers ENE RGV P.C. $ PLAN CHECK- 25%. $ ' I hereby certify-that-I have read this application and state that the above 00-100,000 BTU 0100,000 BTUGRADING $ • information is correct. I agree to comply with all city and county ordinances • ELECTRICAL 1 $ antlslate laws relating to building cons ru So and.hereby authorize repre- MICROFILM S sentatives of th' city._ ter upo �sr- •ove-mentioned property for . PLAN CHECK '50% $ Inspection pure ses.� 6/13/86 MECHANICAL $ 2c 124 Z-'• Signature / � _ _ _ Reinspection Fee $15 Issue Fee • $ 3 PLAN CHECK' 25% $ - -a '� CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor I .1 •CONSTRUCTION AND PLANNING • POOL ' 'A Date Inspector Date Inspector P•R A OVALS Permit# APPROVALS Permit# 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 UF ER 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 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) & Monocoat75. 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 '1 V. ;` HEALTH DEPT. REQUIREMENT ,-Lt 31. Plaster Brown Coat . /7 yR �4/9. FINAL INSPECTION 32. Electrical Power Meter-Final 1' if 80. FOOD CERTIFICAT/TS ISSUED 33. Final Electric Notes//: '' /jp7ob. '34. Final Heating & Air Conditioning -r7 , /. �_ y /35. Final Gas Pipe-Test ' v ( (((///[[[��'-�8` L 001• ._"36. Hood or Canopy `7'/ 37. Final Factory Fireplace �D (I 38. Final Plumbing - foy(sfg7 0IC TD ‘440aroJe{,-DO - 39. Water Service-Final 40. Gas Service-Final -r 41. Solar Domestic-Final H 42. Backflow Preventer ' ` 43a8ackf low Irrigation 442Landscape Irrigation System I / 45.,Sound Attenuation -46'Handicap Regulations 47,3FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50.2Gas Release to Southern California Gas Co • . ' 511,CERTIFICATE OF OCCUPANCY • No. Date . City of Costa Mesa Development Services Department CERTIFICATE OF OCCUPANCY No. G U t '_v i 8 Building Safety Division P.O.Box 1200 Costa Mesa.California The Building located at 2.398 Elds.n Avenue. []nits A ry R has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group R3/M1 Occupancy. Use of Building Condominiums Legal Description 439=262-14 (See reverse side for Metes and Bounds) Building Permit No B24597,B30967 Electrical Permit No. F. 24712 Plumbing Permit No. 0 ),tion Mechanical Permit No. M27601,M27486 Number of apartments and/or guest rooms ISSUED TO: Building Official William T. Howard Robin Rvan 3711 Long Bondi, Blvd. 0419 by _/ Jr- - .771 Loan Reach, CA 90807 Date 8anuary 19, 1988 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;Cary Numerical File;Pink-Bldg.Permit File -. / •�, Applicant to fill in all spaces except those within heavy borderlines and sign all approprl$te declarations. _ _ _ P MIT •NO. ' TRACT NO. - L- T NO. IT O. { Crrr-/ STA rrESA C•NST- UCTIOI• PEWIT a" z � �� AY a- 24 C97 • Wc9cf_3c,�Pahl PLf a 9902 7/22/86 604.53 TL Projec d n - ' • `` iPE OF CONSTRUCTION NEW ❑ ADD ❑ ALTERATION REPAIR • Applicant•; 9 Ad. ess • •r ✓ .. ••�V! f� y / •/ ,- a �- � � -_•vim , - a 0 CONVERSION 0 DEMOLISH ❑ O -ER A.P.# ,�j Zone m 1 Owners Na/irpe �:-a rA �f/ 1p,- • J l D CRIPTION OF WO/grK7/UU��E OF B '�pIG�.7 1 I t� N, LL �`-�� -a�a J VVI Address 1'� - s ' ' '1' l X ' .r 0 I' C•�A Vf1�j(ITlBI. `'- :J Ir. rl4G�- 0 •.8,1., 7r S Main Building: Accessory Building:.• Z Arch/Eng • •YID_ a• E R$- Licen,e No TYPE OF PERMIT ❑ GR DING LJ FOUNDATION V STRUCTURAL T Front a 9 / D ddress Ott tarotilli s• s •/ .-+ ra 0 TENANT ❑ ELECT•ICAC 0 PLUMBING 0 MEC ANIGSAL. ` l_/ g Rear (�/�f �� • N 'k-t5 ❑OTHER .SID - '06« /`4I _ A 4 x ( s :R►y.:;.;�/i:►/19R�� Phone ICI=11.--8(C.5 a�r.�T � 7 C Right5 N 1. Mai I/ P 7 > i_--. 7 PROJECT DESCRIPTION '5Q.,FT: sic-�-w OCCUPA V �� - ' Vr Ad.r€s at g (3V sS lly� �'7JJ K G nnp C• 7C� C^ CON STIVICTION TYPE '; VALUATION $ l fLrr S Left "y City License No. �- \ ZONE /1-Z \ GRADING CU.YDS. ACRES Ping. Ref./ �� -�'�-� Parking Req./Provideda. / (S Q ��!! LICENSED CONTRACTOR DECLARATION t - sr,, . I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: 7sN PLAN C j,/ PlanningNotes: r with section 7000) of Division 3 of the_Business and Professions Code,andk. '�� 'V_ ^r �i•�� p C-'� 01� FOR SPECIAL REUu:rt a"r••. _ M my license is in full for • effect. .,.Y L 062 I. A O Pc/ ,\�/ S License --s IC'•' ' O. 4 `-'(' sn �p Date f' Signature f.__ UMBING I FEES • • WORK RS' OMPENSATION DECLARATION • Bar Sink Showers ELECTRICAL FEES ' hereby affirm that I have a certificate of consent to self-Insure or a certificate _ • f Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink. ❑ 15-50 KW s800, Lab. C) / Automatic Washer Transformer Policy No. �t !—r�[ U1 Jc-Company G74-1?-__ -c Irl Backf low Irrigation ,Sewer Cap'. . . iNN.„..N. . Construction Pole Sub. 50+KW • Certified copy is hereby furnished. " "e• cc"i • with the city gkltltinl� Bathtubs • Sewer Connection - Cooking Unit Meter Dim to 100 amps Date '� t Applicant 'Kng \ / - - \ EXEMPTION FROM WORKERS'COMPENSATION DE ARATIAN Clarifiers Solar Collectors - Dishwasher Meter Dover 100 amps (Thissection need not be completed if the permit is for one hundr d($100) or - less). Dishwasher Solar Piping. . Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance-is ti/e work for which this permit is issued, I r _ . ' shall not employ any person ny manner so as to become subject to the Drinking Fountains Solar Tank ' - • Fanr6 \❑0-1 HP 011/2-8 Workers' Compensation of California. W Date - Signature .. 'I!--":„:a6- - - —Floor Drains Swimming Pool w/Spa F.A'U. i c.Solas 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 Fixture& comply with such provisions or this permit shall be deemed revoked. ,w Crowa CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet ~'aryl 1Boxes‘ ' 'tight - • I hereby affirm that there is a construction lending agency for the performance - / •e • -• P „1 of the work for which this permit is issued (Section 3097 Civ. C.) —Interceptors Water He. f ‘ig ,but ''T g1_ 0, ,v Lender's Name ‘i Lender's Address Kitchen Sink - agri ,' _t',•Sj+ y nl� OWNER BUILDER DECLARATION - ' ` I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories following reason (Section 7031.5 Business and Professional Code: Any city or Auto-. h .age or, - tions county which requires a permit to construct,alter,improve,demolish or repair P-Trap ! �• a- any structure, prior to its issuance, also requires the applicant for such permit —_ TLC �� Gener.cTi -e�" ,1 ./� Trash Compactor V/ 41 to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains - liner - i.�% 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 • ' LII, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 ,' •r-4 compensation, will do the work,and the structure is not intended or offered 1 Reinspection' Fee I $15 Issue Fee ' $ for sale (Section 7044, Business and Professional Code: The Contractor's • CHANICAL 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 REDUIREME / employees, provided that such improvements are not intended or offered foryp '�' 15'86 (e sale. If, however, the building or improvement Is sold within one year Of coin- Canopy Type II 0 Zoning Approsed By ,/ ��}s�� l Date 15 v prove thetowner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By 6Yyti �' '`•'• DetO�_,_/. Drove for the purposef tsale). I, s owner tr the property,roject t 7 44, sinesscontracting with licensed con- Duct-Structural Refrigeration System Application,Isstied Ey Dat tractors construct the project (Section apps tos Business and Prof property Code: • The Contractor'smproLicense Law does not era t to an owner ie is hta who Duct-Ventilating ❑0.700,000'BTU 0100,000 BTU ,,� • : SUMMA Y OF FEES buildsto or Improves thereon,and who rapt is forcesuch Law). I as with a tha-. / Pectoris? license orker's o the Coon insurance License beov aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING•PERMIT $ S rt 00 SMIP $i 1`• 33 proof o their Worker's Compensation insurance should be provided to me. $,aL,PLAN•CHECK $ Jr 2O PERMIT ❑ 1 am exempt uneer.Section ' B.& P.C.for this reason Firepl/Fact.BIL !CBO# 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 0100,000 BTL ELECTRICAL $ GRADING $ information is correct. I agree to comply with all city and county ordinances _ and state-la • • . g to,building •nstruc on,and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $' sentatives • this ci to enter upo • above-mentioned property for • / �' inspection p rposes. reMECHANICAL $ TOTAL FEE $' 60V. S 3 Signature v - ' . Date/t-23'IS •„- -- ' Drivers' License or SS# -Accounting; Goldenrod - Assessor ' ,,4 er r r COI)ISTRUCTION AND PLANNING POO. SPA v. .'•6 • Date Inspector Date Inspector •; rAPPFIOVALS Permit# I APPROVALS Permit# .171; 'Temporary Ellectrical Service or Pole , 52. Pool & Equipment Location , z.'Soil Pir -Undrgrnd. . 53. Steel Reinforcement . , ,ectrical Conduit Utility-Undrgrnd. K 54. Forms j K 4tElegtrical Concii t-Undrgrnd. I in 55. Electrical Bonding I• 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd, ZSJ//g( PI* 57. APPROVAL TO COVER-GUNITE f 7. Footings I V K1s 4,0 r !-/ *. 58. Electrical Conduit-Undrgrnd. 8. Foundation ` • - 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water'Pi pe-Undrgrnd. " IiWq� 60. Backwash Lines, P-Trap, 0 Undrgrnd: • 10. Structural Floor System -6661t'1 , 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 :,r 67. Fencing & Access Approval 17. Rough Wiring Sign .....1; 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 21 APPROVALS Permit# 21. Ducts,in Structure N 70. UndergFddbOnyydro , 22. Ducts, Ventilating ' .r- . 71. Product Piping alias ❑Oil 23. Gas Pipe-Rough&!Test r; •,:' - 72. UntlergraindFFllush ;r • 24. Roof Framing i -7 r' 73. Undergrred3orage Tank El Gas 0 Oil . L. ./ . 25. Roof Sheathing. ' / i tnia1 (j� 74. Overheadlhdro • 26. T-Bar Ceiling (Structural) & Monocoat 75.,,Dry Clip4l I 27. Frame and Flashing: ' L7 r 76. Dry Standpipe I 28. Lathing & Siding n Iz0, ' d 77. F(XE(3 SYSTEM FINAL , • II - 29. InsulationL 78. FIRE P)REV. FINAL 30. Drywall Nailing r• , fit lit? pt,- - y HEALTH DEPT/REQUIREMENT / 31.,Plaster Brown Coat if ` I" 79. FINAL INSPECTION /I . 32,,Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED t , - ie 33. Final Electric Notes:. i 34. Final Heating& Air Conditioning HOLD FOR SPECIAL REQUIRhuIta Ir ' 35. Final Gas Pipe-Test SJ,f". � °"� _ , . r y 1 It 36. Hood or.Canopy /, - ' D/ / ,/ 3 '� e pp 11 37. Final Factory Fireplace 8 I ;6 ^^((�� •fJi'.rte, • ' ` 'a • , l/ 38. Final Plumbing b- s.„ s D' 7 39. Water Service-Final I 40. Gas Service-Final / • D ! 41. Solar Domestic-Final , ., • 42. Backflow Preventer ' 43. Backflow Irrigation - .• 44. Landscape Irrigation System \l 45. Sound Attenuation ! 48. e.. . .ns 4 . FINALSTRUCTUR,E & BUILDING ( jil/g�j -4 -. Special Requirements Completed ��'i. eig- li } 11 49. Electric Release to Edison ' 50: Gas Release to Southern California Gas Co • ' 51. CERTIFICATE OF OCCUPANCY No. - Date . 0 / 17 w . Applican •t those within heavy border lines and sign all appropriate declarations. .tea PERM( O Y• • . NO. LOT NO. UNI L Y OFt A COSTA 7 CONS ' U�BION PERMIT a• / 3 / 'iri ` PI 8817 11/02/87 10,50 TL ct Address //VV w 'cant's Mailing Add,-ssI/ Lo ' ItajMi TYPE OF CONSTRUCTION - I ADD U ALTERATION li REPAI R I nor's Name- i_ Phone/Rid�3�, • ONVERSION ❑ DEM• ❑ OTHER A,P.# (Zone DESC• - - •- - SE OF BLDG. Jdress S Main Building: Accessory Building: • a •ch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL Frontdress ❑ TENANT ,❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear _ • N ntractors Nam �" Phone ❑ OTHER A dress(mailing) 7)7 r / PROJECT DESCRIPT e e _ K Right N • CO• ION TYPE VALUATION$ -�• S Left G y License No. R •NE GRADING CU.YDS. ACRES Ping. Ref:# Parking Req /Provided E CENSED CONTRACTOR DECLARAT //,�{{�� C(_4�-.-/r ,a�t�yJ O ereby affion rm7 that I aDi lision 3 onder provi ns of t er9 (commencing emarksit � a�J / I �/T - - �arming Notes: M h section 7000) of Division 3 of thessions Cotle, antl UUT licenseisin 5U for=a,d ec / 7Sens lass ite 4I" fit Signature ea . —/._ AI PLUMBING FEESRKERS' COMPENSATION DECLARATI•-N Sink I Showersereby affirm that I have a certificate of co•sent to self-insure o a certificate + ELECTRICAL FEES Workers' Compensation Insurance, or certified copy th-r-•f (Section - \ 10, Lab. c Backflow Prevenfer aervlc¢3mk Automatic Washer Transformer 0 15-50 KWiso - -icy No. l V Company i V d Backflow Irrigation. Sewer Cap '❑ 50+KW Construction Pole Sub. Cgrtified opy hereby furnished. efye op I fi d with the city Build.-• . �, • Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date lC Applicant i� EXEMPT! N OM WORKERS'COMP - - i• D CLARATION Clarifiers Solar Collectors Dishwasher Meter (Dover 100 amps (This section need not be completed if the permit. for one hundred($100) or less). ' Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel - I certify that in the performance of the work to 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 00-1 HP 0114-8 Workers' Compensation Laws of California. - 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 forthwith Floor Sinks 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 hereby affirm that there is a construction lending agency for the performance Li ght of the work for which this permit Is issued (Section 3097 Civ. C.) Interceptors Water Heater ' Outlets Range 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-Wash Disposal Garbage 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 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 ' 7'1%5,by any applicant for a permit subjects the applicant to a civil ty of not more than five hundred dollars($500). 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 rrr - 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 ❑ ZoningApproved sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ pP By - Date p , the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date proverove for the purpose of sale). r / ❑ 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 SUM MARY O FEES builds or Improves thereon,and who contracts for such projects with a con- Fn tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration ' BUILDING PERMIT $ ✓• OSMTP $ 'Ca 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.Blt. ICBG# Fire Dampers ISSUANCE $ PLUMBING $ — Date Owner Heating System& Ducting Registers AL PLAN CHECK 25% $ ENERGY P.C. $ - I hereby certify that I have read application and state that the above 00.100,000 BTU 0100,000 BTI, ELECTRICAL $ GRADING $ information is correct. I a•ree to ••ly with all city and county ordinances and state laws rete • o •uiidi,••••nstructlon, and hereby authorize repre- MICROFILM $ inspection of t,' city t• enh pun e above-mentioned prope y r , T PLAN CHECK 50% $ ingnature •uses. MECHANICAL $ TOTAL FEE $ i'�•S1J Driver Signature .. p CMF 0865.46,rev. 10/8' White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor ,• 4; CONSTRUCTION AND,PLANNING POOL &SPA . • APPROVALS 'L-Rermt-# Date Inspector APPROVALS Permit Date ' Inspector I • 1.;Temporary Electrical•Service or Pole 52. Pool & Equipment Location 2.f 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 �� r, 58. Electrical Conduit-Undrgrnd. 8. Foundation • i' 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 WSign 68. APPROVED FOR PLASTERING, - 18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT t. •`�.'- . i ry 20. Rough Factory Fireplace APPROVALS Permit# _ is 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 OjI 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical I - A 27. Frame and Flashing 76. Dry Standpipe •1• : ti 28. Lathing & Siding 77. FIXED SYSTEM FINAL fl i 29. Insulation 78. FIRE PREV. FINAL - 30. Drywall Nailingr • HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION . -'C 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED k - r •r, �q1 33. Final Electric Notes: t S t Y 34. Final Heating & Air Conditioning ‘ r �'' 35. Final Gas Pipe-Test ` �' ,�� '//? . 36.-Hood or Canopy ii,;;�i""�� 3E-Final Factory Fireplace ' „38. Final Plumbing ,1: .- i 39. Water Service:Final j i `--, -'•` };:'' .:..,;..-..c...-: r v' i '40. Gas Service-Final L' i%``-.l w'. Jr." -41. Solar Domestic-Final • "'' is V.. ^� 42. Backflow Preventer ` <-y'.f`-.. r"43'•13ackflow Irrigation • 44.-Landscape Irrigation System ,t,' 1< } .s ^. 45. $aund Attenuation +:;' Ir - . 46. Han • dicap Regulations ' `i%<,. s• - ' ,47. FINAL STRUCTURE & BUILDING .14 - - `"'.:F' o;•. ' ii 48."Special Requirements Completed - VIM.? YQ4 ' r 1.- l 49.'Electric Release to Edison - . :J� .r++ " ,• • 50. Gas Release to Southern California Gas Co -- - - ' 51. CERTIFICATE OF OCCUPANCY Er No. Date / . . Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. •_ - - , ` eITY'oF COSTA M�Fy�9 CONST U TION PERMIT PE IT DOD. /`5—n� TRACT NO. LOT NO. UNi�yob 0533 J gyp{qC' H p OP Y "7 f.�'t'� 7/S ' ' 15.00 TL Project Address L 3<7 trrzeiilj CA"J1/Ci• I - - ' y�-•. Applicant's Mailing Addr-ss /C5' /117-1-/r, TYPEJJJOF CONSTRUCTION l.[VEW U ADD U,ALTERATION U REPAIR V /, y ❑ CONVERSION ❑ DEMOLISH ❑ OTHER- • A.P.# - - I Zone_ Owr�r•s Name /L Ph nej/ // i A ' 9_ -5 FCC •DESCRIPTION OF WORK/USE OF BLDG. — Aaress • �( • /j' r J(/!�/ ��---ggg--- • S Main Building: Accessory Building: • , Arch/Eng. License No. _ TYPE OF PERMIT 0 GRADING YJ FOUNDATION ❑ STRUCTURAL • E Front l I Address ��f q p • `�/ Q ❑ TENANT ❑ ELECTRICAL `PLUMBING ❑ MECHANICAL B Rear Contractor's Name L, ' `` Phone 53 -cyr ❑ OTHER . . - . . p/./.� PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right • I Address(mailing) //t q/4/I � K - City License No. O/_9{ 7/ CON ST RUCTION TYPE VALUATION$ S Left • ZONE GRADING CU.YDS. ACRES R LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided _ I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: Planning Notes: ' with section 7000) of Division 3 of the Business and Professions Code, and - - my license.is in ful •rce an. if:.t. • a� i - -' License Class - License N•. _ - Date Signature ' - , M' -• PLUMBING• . • FEES ' WORKERS'COMPENSATION DECLARATION • Bar Sink ,Showers ' ' 1 hereby affirm that I have a certificate of consent t• self-Insure or a certificate ELECTRICAL FEES -- 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 • Sewer Cap - - - Construction Pole Sub.' t 0 50+ KW • .iiiCertified copy is hereby furnished. °Rifled copy is filed withth the city Building Division. Bathtubs " . - ' ' Sewer Connection - . Cooking Unit • Meter ❑up to 100 amps • •Date Applicant - EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors - Dishwasher Meter- Dreier 100 amps (Thissection need not be completed if the permit is for one hundred($100)or • • • less). Dishwasher • Solar PipingDryers OGas 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 f�become sub' t to the Drinking Fountains , 'Solar Tank .. - Fan Motors❑41-HP 01%-8 Dat 7..---2C --dygn Laws af Califo>. �� ' - Date �? D(D Signature G`� Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP ❑16-15+ NOTIC H,after making this declarat n,you should eaou mustject to the - • Workers' Compensation provisions of the Labor CO you 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 ' Lender's Name - Rang , • Lender's Address - - - - Kitchen Sink- -- - Water Service - Switches -' • Sign �� OWNER BUILDER DECLARATION — 1 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 s 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 _ _ - I ' • malty of not more than five hundred dollars($500). I O I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 , Issue Fee $ 3 r 1 compensation, will do the work, and the structure is not Intended or offered I. - - • 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 cam- - Canopy Type II ❑ Zoning Approved By Date pletlon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground • Building Approved By Date • I •' prove for the purpose of sale). - r, 0 I,as owner of:ilia property,am exclusively contracting with licensed-con- Duct-Structural Refrigeration System • Application Issued By P--- S/-V-lie. 7 e. 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 .SU a�pRV FEES ' • 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 thatUI L' ING PERMIT $ �7 ' 0✓ "SMIP • $ /' i proof of their Worker's compensation insurance should be provided to me: Exhaust System;❑ Multiple 0 System Repair/Alteration - - _ / PLAN CHECK $ 'PERMIT ❑-1 am exempt under Section ;- B.& P.C.for this reason Firepl/Fact.Bit. ICBG 4 Fire Dampers -ISSUANCE $ - PLUMBING , $ — / Date Owner Heating System& Ducting Registers _ ' PLAN CHECK 25% $ ENERGY P.C. $ r/ � I hereby certify that I have read this application and state that the above ail❑100,000 BT GRADING $ / %._c 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- - PLAN CHECK 50% $ - MICROFILM $ Rl sentatives of. this"city to enter upon the above-mentioned property for inspection .•A.�` •( - MECHANICAL $ - TOTAL FEE $ 15-0O Signature- ! „ - Date f( ! - Drivers' License 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 NSTRUCTION AND PLANNING POOL&SPA. f =41 APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector N 1. Temporary Electrical-Service or Pole . • 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' 3. Electrical Conduit Utility-Undrgrnd. 54. Forms a 4. Electrical Conduit-Undrgrnd. • 55. Electrical Bonding m 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVE R-GUNITE :., 7. Footings . . ' 58. Electrical Conduit-Undrgrnd. - o 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 0 Oil 23. Gas Pipe-Rough & Test 72. Underground-Flush . 24. Roof Framing . 73. Undergrnd.Storage Tank 0Gas DOil 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 i 38. Final Plumbing - ' 39. Water Service-Final ' 40. Gas Service-Final - 41. Solar Domestic-Final - . 42. Backflow Preventer 43. Backflow Irrigation I . - 44. Landscape Irrigation System ' • 45. Sound Attenuation - • 46. Handicap Regulations • ' ' 47. FINAL STRUCTURE & BUILDING s/tI(iZ The- - _ 48. Special Requirements Completed / ( 49. Electric Release to Edison - • , • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY 4 t . No. , . ., Date - -----._ - r I/ 1st.: . r - - - (APPlica;Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF.COSTA MESA cC'ONSTRUUTION PEAMIT( riti''V pE MIT�NO: TRACT - - NO. LOT•NO, UNIT NO. 1 • QQ75 7/24/86 64.25 TL Project Address - 3 c)R /+ Q I— I AP.?an eq"()?Lg"' dT/oI . . _ . -_ _.. .7 p�� I 7-111a-' • TYPE OF1CONSTRUCTION NEW LJ ADD U ALTERATION U REPAIR ' - ' . Applicant's Mailing Address I•Q6OY 14.21 RY<Lli1L1- C.194i1oo L, ❑ CONVERSION ❑ DEM OLISH El OTHER q.p-# I Zone - Owner ' Owner's Name Phone - - -DESCRIPTION OF WORK/USE OF BLDG. Address - S Main Building: Accessory Building:; I •Arch/Eng: License No. TYPE OF PERMIT L GRADING El FOUNDATION ❑ STRUCTURAL T Front p Address CI TENANT .CI ELECTRICAL ELECTRICAL /ii PLUMBING ❑ MECHANICAL B Rear N Contractor's Name 'S 61 OkSovn phone( 10 Mega. ❑ OTHER i _- . . A _ - _ 2 JPROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right I G Address(mailing) /1. l�oy 14'x` �(Q,q iO. Ca gllN)C,• CONSTRUCTION TYPE VALUATION SK Left R City License No. 3 9� ZONE GRADING CU.YDS. ACRES Ping. Ref.# • - Parking Req./Provided E LICENSED CONTRACTOR DECLARATION !I)�_s - - Q • I hereby affirm that I am licensed tinder provisions of Charter 9 (commencing 1' bks: r}�-{-)fes (vs Planning Notes: M , with section 7000) of Division 3 of the Business and Professions Code, anq,.y`I '1 `t`J/u[//vv��,, 1`U • M1•-�P _ ` `��l ' my license is M full ter d ffect. ��/ �� / 1 c / //q'_ q-.. 7J — ig i,,, ,, ft.een-e _ / y. __•/� - T __LL fe '-(s/gJ'v`(V•1(KCG ✓cC.11r^� YJ `-G�^C. ��VE///(t��f/I'/�"��+' • Q- _ License Class Licens- No. Date L Signature la!Awn a Lr .o.♦ ' PLUMBING FEES - -W• ORKERS' COMPENSATION DECLARATION Bar Sink - Showers • I 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 - Automatic Washer ' Transformer•0 15-50 KW , r. 3800• , Lab. C.) (( '' 11 �+ 1 Policy No. Ly 5G\ 41 Company &kilo 4Z 14 Backflow Irrigation L, Sewer Ca 1 - ' - , ❑•50+ KW • - B Certified copy `� - - p . Coristructio nPole Sub. - - is hereby furnished. • � wp • Cert copy i Iled with the city Building Division. y Bathtubs Sewer Connection • / Cooking Unit • • Meter'Duo to 1,00 amps Date Lf�Z yl Applicant 7c —D,551i - - - - - ' _ (`�` EXEMPTION F oM 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 f ' . less). Dishwasher Solar Piping /A.�r Dr ers ❑Gas ❑Electric I certify that in the performance of the work•for which this permit is issued, It/v Y Sub Panel shall not employ any person in any manner so as to become subject to the Drinking Fountains' ;Solar Tank Fan ,Motors 00-1-HP ❑1'/x-.8 \ Workers' Compensation Laws of California. . _ - _ - , . _ 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 c•-......... Workers' Compensation provisions of the Labor Code, you must forthwith _Floor Sinks Urinal • 1 Fixtures'F- ' comply with such provisions or this permit shall be deemed revoked. ! Microwave I • CONSTRUCTION LENDING AGENCY rv,.. iZ Gas Service /T4E7utlets YI' Water Closet 5 /��I Device Boxes Pole Light OI hereby affirm that there is a construction lending agency for the performance JJ q of the work for which this permit is Issued (Section 3097'Civ. C.) St, interceptors Water Heater - '.G Lender's Name �' �� Outlets , •/ Range ' _ Lender's Address r2 Kitchen Sink Water Service Switches'- ' OWNER BUILDER DECLARATION fit. yl,. - - - - �/! -' Sign � ' I hereby affirm that I am exempt from the Contractor's License Law,for the U Lavatories l Auto-Wash 0 Garbo ¢,DiS o5aStanding following reason (Section 7031.5 Business and Professional Code: Any city or !11111 ('7� 9 _ P i Sections , county which iequires a permit to construct,alter,improve,demolish or repair -r• ' - q P-Trap Laundry Trays Generator ❑0.5 KW ❑5-15 KW Trash Com actor any strusigned prior to its hat he/, also requiresicenthe pursuant t for(ovisio s if • ' - _ P V. , to file a statement that he/she is licensed cIng to the prOVl510ns of Roof Drains —. - the Contractor's License Law (Chapter (commencing with S he/she •7000) of :Z '. ,- thee Division '3-of the Business-and-Professionsthe Code) or 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 - ' penalty of not more than five hundred dollarploye 0). , - - ' • - j 1 LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee 1. $15 Issue Fee $ 3 • compensation, will do the work,and the structure is not intended or offered 111 Reinspection Fee 1.$151 Issue Fee 4 $ 3 c 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, t provided that such improvements are not intended or offered for Boiler Hood or Type 1 0 • ' sale. If, however, the building or improvement is sold within one year of com- Canopy Type 11 Zoning ApprovedApproved By Date pletion, the owner will have the burden of proving he/She did not build or im- Duct- Under Ground Building 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 - ' 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). I am aware that Exhaust System ❑ Multiple❑. ' System Repair/Alt• eration . - ' BUILDING PERMIT $ SMIP •- $ ' proof of their Worker's Compensation insurance should'be provided to me. PLAN CHECK S. • PERMIT'. - ❑ I am exempt under Section B • .& P.C.for this reason - Firepl/Fact.Bit. ICBG# Fire Dampers PLUMBING - $ - ��•Q� ISSUANCE $ - Date Owner _ - Heating System& Ducting Registers PLAN CHECK 25% $ �7>1,0Z5' ENERGY'P.C. $ , - - I hereby • certify that I have read this application and state that the above ❑0-100,000 BTU D100,000 BT - : " - GRADING $ Information is correct.) 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 to enter upon.the above-mentioned property for ' i1 - PLAN CHECK -50% $ inspection purpo s. /� / Signature • - �( Reinspection Fee $15 t Issue Fee--. $ '3PLAN CHECK 25% $ `0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor _ S )7 / CONSTRUCTION AND PLANNING r POOL&SPA APPROVALS Permit# Date Inspector APPROVALS Permit# • Date Inspector 1. Temporary Electrical Service or Pole • - 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. g/i/ti jeC 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. . p/,/fi 47:ii 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 ,*/7/ 1 •/��6/>e 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 P 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 0 /Q•,rSr 36. Hood or Canopy 7• Jq 37. Final Factory Fireplace 38. Final Plumbing /,447 ///3 ' 39. Water Service-Final !��"� , 40. Gas Service-Final ' 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation / 44. Landscape Irrigation System • I 45. Sound Attenuation 46. Handicap Regulations la 47. FINAL STRUCTURE& BUILDING 48. Special Requirements Completed ' - i 49. Electric Release to Edison ,I • 50. Gas Release to Southern California Gas Co - ' i 51. CERTIFICATE OF OCCUPANCY ,No. Date -_ • 3525 3/06/87 10.00 TL - / Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. " • CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. • Project Address 22?g'aElde�,• " c(«` —A.--, ,r ; t �7 �� l Applicants Mailing Address /rep. so. g%.'•:'O I man/ SataAt TYPE OF CONSTRUCTION H NEW U ADD U ALTERATION U REPAIR �J b�� I/l/t ❑ CONVERSION ❑ DEMOLISH ❑ OTHER _• i Owner's Name nF-0 0.f— Phone QS)-£Y tie• 'DESCRIPTION OF WORK/USE OF BLDG. A.P.# Zone Address I/ E� • SI kt c fai .. At ( .C,,•.� � S Main Building: Accessory Building: E Z Arch/Eng. - License No. - TYPE 6F PERMIT El GRADING ❑ FOUNDATION H STRUCTURAL T Front , o • Q TENANT ❑ ELECTRICAL CI PLUMBING MECHANICAL B N Address - �7 �� l� ••.❑ OTHER A Rear I Contractor's Nam¢ Pm 4.!i-✓• Phone `]S7-$S"SS - C Right • N �•.1 PROJECT DESCRIPTION SQ. FT. OCCUPANCY Address(mailing) �I �- S't. tns'•ial it ad / -�rK..,.4u� K G L7 t-sr ,CONSTRUCTION TYPE VALUATION $ S Left R City License No. eee��2 J V 'ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION •' q Ping. Ret.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks 5 D�S 17 5 R aU�9 Planning Notes: - M with section 7000) of Division 3 of the Business and Professions Code,and t-+ T ' my license is in full force ak,• effect. 3y (yg D E s License lass I r icense • g ' Date .1 Signature Ari_!. /r - - PLUMBING .FEES ' WORKE-S' •MPENSATION DELLA: TION - Bar$ink Showers - hereby affirm that I have a certificate •consent to self-Insure or a certificate ELECTRICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section f 3800, Lab. C.) Backflow Preventer Service Sink 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. - Certified copy is filed with the city Building Division. i. 1BathtubsSewer Connection Cooking Unit Meter Dula 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 less). Dishwasher . Solar Piping Dryers ❑Gas ❑Electric an .� 6 I certify that in the performance of t work for which this permit is issued, I - - shall not eymplo any person in any an r so as to become subject to the —~Drinking Fountains Solar Tank Fan ��• 'wl+ hll� g • Workers'-C jnp Ilion Laws of Calif i �•`,.•v Date J//D/rj� Signature Floor Drains Swimming Pool w/Spa F.A.U. \ i6-15+ NOTICE. f,alter making this declar ion,you zf u d- ecome subject to the I\�4 �, �;'• \.—• _ Workers' Compensation provisions the Labor Code, you must forthwith Floor Sinks Urinal ��,� ��4 wry.P.v_ comply with such provisions or his permit shall be deemed revoked. Fl �p:�p\,yQ� Q ��r r )a .43..L� CONSTRUCTION LENDING AGENCY "t r <?'1'I �-V... j Z a• r /./ Gas Service Outlets Water Closet 7 a .� \ ,•\ ,y ale I hereby affirm'thaf there is a construction lending agency for the performance _1 '4;1'4-414-- -C:1/4;r'.1`.4.•A \jr`1 �---t-,4,..----.0a ��, ' of the work for which this permit is issued (Section 3097 CIU-C. Interceptors Water Heater •Y'\ ♦•-t'44.:‘,...1 ...471V! Lender's Name - -, J- -. -� \ 4th S A! �a e1�!♦ ' Lender's Address - • - - Kitchen Sink Water Service Y� �� --tit*�•'�� -�\• y • OWNER BUILDER DECLARATION �. �~ �, �• �5e,C11I�T 1p �� • I hereby affirm that I am exempt from the Contractor's License Law-for the Lavatories Auto-Wash y Y'�\_rl 41..8h_��•♦ �~ Sr• • o coons following reason (Section 7031.5 Business and Professional Code; Any city or �._1�,Z_ which requires a permit to construct,alter,improve,demolish or.repair P-Trap Laundry Trays ..'; 1:i�"'4t "•�l�4. s // any structure, prior to its issuance, also requires the applicant for suchpermit - _ 4 TrazNi(-"ompact Or /1 /Al-- county ' to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains \•�`�'... // !••"� • the Contractor's the-Business ei usLaw nd rofe s ons )ing with Section Is x)of /t `�` n��'•C,f/�tj�/\> ^ Division 3 of and Professions Code) or that he do Is exempt- �•� 1 (Jt` Q — therefrom and the basis for the alleged exemption. Any violation of Section Gl/ �1L ,J 7031.5 by any applicant for a permit subjects the applicant to a civil » - I ! f 00_‘I. ,.p G` f penalty of not more than five hundred dollars($500). I 3 L.O„ v t/` LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee 1 $15 Issue Fee 1N$ 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 MECHANICA W FEES I 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 •od • , Type I II sale. Ifhowever, the building or improvement is sold within one year of com- 1,qq• •- a Zoning Approved By —4Date pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Gro Building Approved By Date prove for the purpose of sale). 0 I, as owner of the property,am exclusively contracting with licensed con- Duct-St I R- .-ration System Application Issued By b c1/4/1 Datei •o rcr • tr • actors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who I • Duct-Ven flee ` 0"100,000 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 Syst 0 Mul -- a System Repair/Alteration BUILDING PERMIT $ SMIP $' ' proof of their Worker's Compensation insurance should be provided to me. rr��..rr\� PLAN $ • PERMIT ❑, 1 am exempt under Section B. & P.C.for this reason Firepl/Fact.Blt. IC-• # y311L- Fire Dampers iQ 'v PLUMBINGCHECK $ ISSUANCE • RMIT $ Date - Owner Heating System& Ducting Registers PLAN CHECK 25% $' ENERGY P.C. $ I hereby certify t at I have read this application and state that the above 00-100,000 BTU 0100,000BTL GRADING $ information is cor -ct. I agree to comply with all city and county ordinances ELECTRICAL $ - and state laws 1. ing to bu' =ing construction,and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ sentatives of ta- ity to nter pon the above-mentioned proper[ for. r �^ —` inspection pur.. (... Reinspection Fee I $15 • Issue Fee $ 3 PLAN CHECK 25% $ 3. a CMF 0865-46,rev. 0/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor kfi 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 .r • 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 Conditlonink FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace •, pj4'*7 y,pc APPROVALS Permit# _ 21. Ducts, in Structure Kra 70., Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test ' i- 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 9 Gas ❑Oil 25. Roof Sheathing .-�""``� - 74. Overhead Hydro 26. T-Bar Ceiling (Structural)�iyMonocoat ..751' Dry Chemical 27. Frame and Flashing y - 76. Dry Standpipe IND As 28. Lathing & Siding Er�a 77. 'FIXED SYSTEM FINAL 29. Insulation 7 tf,;.? 78.‘FIRE PREY. FINAL 30. Drywall N4ing �' /; HEALTH DEPT. REQUIREMENT 31. Plaster Brown Codi / _ . 79."FINAL INSPECTION ff 32. Electrical PowerMtsitr-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:3 f/yr � r 0ofiTtY e✓v f /Z'A 34. Final Heating & Air Conditioning / (, - bify�•//A�/" 04.2 p . -# A.xm./ ii YOJs.irra� 35. Final Gas Pipe-Test (/ ire' 36. Hood or Canopy ��0 37. Final Factory Fireplace 1//�f /'fiL�T� 38. Final Plumbing �r�! 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. CITY OF COSTA MESAq (CONS4RUCTION PERMIT PER/My��►)/�NO. TRACT NO. LLO/T NO. �1 UUNN-IT NOO ,2989 2/27/87 23000 TL Project Address a 3 / / �L V(r A� - 4'1?4, Ik�,77 1 �� /+ '` —V • .• • ' Applicant's Mailing Address 3101 c4- FAs • C I •U;•'w 5p•6- 5. A: TYPE OF CONSTRUCTION gNEW LJ ADD LJ ALTERATION Li REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# ' _ . , _ I Zone I Owner's Name _ Phone - DESCRIPTION OF WORK/USE OF BLDG. - Address _ _ S Main Building: Accessory Building: TYPE OF PERMIT ❑ GRADING LJ FOUNDATION LI STRUCTURAL E Front Z Arch/Eng. License No. Imo{ T _ O Address ❑ TENANT ❑ ELECTRICAL' ❑ PLUMBING , MECHANICAL B Rear N Contractor's Namp �li("/E-PUE CO NE-Li 's,� Phone 5 7-4/gar ❑.OTHER C Right - - N Address(mailing) - i 01 -5. FA[AWE"' 5R A- S. /4-• PROJECT DESCRIPTION SQ. FT. OCCUPANCY K G � CONSTRUCTION TYPE VALUATION$ S Left City License No. 37-pi - ZONE GRADING CU.YDS. ACREG R LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E I hereby affirm that 1 am licensed under provisions of Charter 9(commencing Remarks: '3 D 5/3-19:y Planning Notes: • M with section 7000) of Division 3 of the Business and Professions Code,and a•J v' 7 / ' - my license is in full force and effect. • T License Class C-a-O License No 34.y7 i S l� Date ,.2 7"P7 Signature 044-- L tom' . PLUMBING FEES • - • ,` WORKERS'COMPENSATION DECLARATION Bar Sink Showers - ELECTRICAL . FEES hereby affirm that I have a certificate of Consent to self-Insure or a certificate . . ,f Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink t ' ' Automatic Washer Transformer 0 15-50 KW 3800, Lab. C.) _ (� - j Policy No. 73's�s.S3S -te/ Company s I A-`re- r-14 1J ) Backflow Irrigation Sewer Cap ❑ 50+ KW • Construction Pole Sub. entified copy Is hereby furnished. ‘. 1", kertAiecippigy is I with the city Builq.ing Division. Cr,i.... : ; Bathtubs Sewer Connection , Cooking Unit • M• eter ❑up to 100 amps � Date `--. /- Applicant are - • 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). 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❑0.1 HP ❑1 h-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 ❑9-15 HP ❑16-15+ 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. ---,- , MicroWav¢ CONSTRUCTION LENDING AGENCY G• as Service Outlets Water Closet o�. s 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 'i• Lender's Name p _ Outlets 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 sP Standing Sections county which requires a permit to construct,alter,Improve,demolish or repair . .13;-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 .•. . livision 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 /031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars($500). I _ • 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 e' thereon, and who does such work himself/herself or through his or her own -- - - DEVELOPMENT SERVICES REQUIREMENTS: c 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 com- Canopy Type II ❑ 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). - '- //'�1�, �� ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System /Implication Issued By cep 1/ Date tractors to construct the project (Section 7044,Business and Professions Code: ////illl]]]]...� aaS _ The Contractor's License Law does not apply to an owner of property who 1i Duct-Ventilating 00.100,000 BTU 0100,000 BTU ,t v 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 ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ :.SMIP - $ proof oftheir Worker's,Compensation insurance should be provided to me. • CK $ 0 I am exempt under Section B.& P.C.for this reason -. Firepl/Fact,Bit. ICBG# Fire Dampers PLAN PLUMBINGCHECK $ ISSUANCE PERMIT CE $ Date Owner - 7`.s Heating System& Ducting Registers • PLAN CHECK 25% $ ENERGY P.C. $ - I hereby certify that I have read this application and state that the above l PI0.100,000 BTU 0100,000 BTL /y ELECTRICAL $ . GRADING $ information is correct. I agree to comply with all city and county ordinances _ c W and state laws relating to building construction,and hereby authorize repre- - _ PLAN CHECK 50% $ MICROFILM $ ' sentatives of this city to enter upoDDD the bo -mentioned property for inspection purpo s. /r yya 7 l Signature _G?�•'- "�-""�- Date �� MECHANICAL $ TOTAL FEE $ � ' Drivers' License or 55 . . Reinspection Fee I $15' Issue Fee • $ 3 PLAN CHECK 25% $ CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor POOL&SPA CONSTRUCTION AND PLANNING • 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 t 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing • 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System:Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical=T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating& Air Conditioning 3/f/a.7f� e FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace ��{{,,� APPROVALS Permit# 21. Ducts, in Structure 7/111 /,8C 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 Min 4/2" - 35. Final Gas Pipe-Test !/ l�J�'� 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 _ -I CIT-Y OF COSTA MESA CONST7RUCTION PERMIT PERMIT Nom. I TRACT NO. LOT NO. UNIT NO. ' ` Project Address /_S" i 6 t eci O7 - •i - Applicant's Mailing Address / /// ni+d?1 Z I r• (�2' TYPE OF CONSTRUCTION w ADD ALTERATIO EPA�R 01 73 7/25/86 i I P.20 TL Owner's Name•./ t�Fi4'C'L/T[ .1 phone ❑ CONVERSION ❑ DE nOL15H 0 OTHER A.P. y • . . I Zone DESCRIPTION OF WORK/USE OF BLDG. ' Address - S Main Building: Accessory Building: Z Arch/Eng. License No. _ TYPE OF PERMIT ❑ GRADING U FOUNDATION ❑STRUCTURAL j E Front - O I 0 TENANT ELECTRICAL 0 PLUMBING ❑ MECHANICAL 8 N Address ,�// p /- _ Rear 1 V'"'7 !�('Pr`/SLC Phone -305 2," ❑ OTHER. CA Right • N Contractor's Name PROJECT DESCRIPTION SQ.FT. OCCUPANCY - G Address(mailing/ K 3 7-70^'g CON STRUCTION TYPE VALUATIONS $ (Left R City License Na. /L'O\ ZONE LICENSED CONTRACTOR DECLARATION • GRADING CU.YDS. ACRES Ping. Ref.# - Parking Req./Provided - E I hereby affirm that I am licensed under provisions Of Charter 9 (commencing Remarks: Planning Notes: . . • M with section 7000) of Division 3 of the Business and Professions Code,and /r� - . my license is in full force and effect. - ,3 5'1 7 1 13 - 2 uGper • 'S License Class _�`L= ,License No, C /Yl �� 'r �^ L I Date_74.03.6 b Signature 1)EC i l •"")'LJiy ---...m"> ' PLUMBING I FEES _ ' WORKERS'COMPENSATION DECLARATION ' Bar Sink • I hereby affirm that I have a certificate of consent to self-insure or a certificate . - Showers ELECTRICAL . FEES Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer I Service Sink 0, Lab. C.) vt pp :±1/' f7'$1 /' s /! Automatic Washer - Transformer ❑ 15-50 KW- ' (icy No. .//in/J :tr.6't% oro' i9/'/: CRl'Jrj.efrl , p1rt9 Backflow Irrigation ❑ 50+ KW ��I Certified copy is hereby furnished. • g Sewer Cap -• Construction Pole Sub. ' • • 3 c/ \ �y}s,ertif�copy is(ilertl.with the city Building pivision. _Bathtubs `_ Sewer Connection Cooking Unit - Meter Zip to 100 amps O cyto .!r ' / Y r' Applicant t'%' iT//LY��C'• 7/) ' 5 iz, ' EXEMPTI N FROM WORKERS'COMPENSATION DECLARATION " Clarifiers Solar Collectors - 3 Dishwasher , , .. .Meter Dover 100 amps Co (This section need not be completed if the permit Is for one hundred ($100)or • less). Dishwasher Solar Piping, • Dryers ❑Gas lectric ,:.5 OO - •� Y "/-1 Sub Panel 1 i certify that in the performance of the work for which this permit is issued,I b shall not employ any person In any manner so as to become subject to the Drinking Fountains Solar Tank .� Fan Motors 001 HP 01%-8 3 ._26)Workers' Compensation Laws of California. • Date Signature Floor Drains —♦ Swimming Pool w/Spa F,A.U. Inc.Solar ❑9-15 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 comply with such provisions or this permit shall be deemed revoked. @ Microwave Q� CONSTRUCTION LENDING AGENCY Gas Service - - Outlets Water Closet Device Boxes Pole I hereby affirm that there is a construction lending agency for the performance Light • of the work for which this permit is issued (Section 3097 Civ. C.) • Interceptors Water Heater /� t) ' Lender's Name - 6o Outlets Range L1 Lender's Address Kitchen Sink Water Service. 2 Switches - - Signi5/ L` OWNER BUILDER DECLARATION -- — I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories ' Auto-Wash , Garbage Disposal Qa.e following reason (Section 7031.5 Business and Professional Code: Any city or 9 sP , Standing Sections �J V 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 Lay/the Contractor's License La (Chapter 9(commencing with Section 7000)of • Division 3 of the Business and Professions Code) or that he/she isexempt' - '•efrom 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 _ ' dty of not more than five hundred dollars($500). U I, as owner of the property or my employees with wages as their soleI 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 - - 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 it ❑ • Zoning Approved By Date Pierian, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground rove for the purpose of sale). • Building Approved By Date 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 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 S PERM{T 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 —111111[11 PLAN CHECK 25% 5 ENERGY P.C. $ ' I hereby certify teat I have read this application ate that the above 00-100,000 BTU 0100,00OBT ` Z GRADING $ information is correct. I agree to comply with all cityty andand county ordinances ELECTRICAL $ S and state laws relating to building construction, and hereby authorize repre- • PLAN CHECK 50% $ MICROFILM $ sentatives of this city to enter upon the above-mentioned property�/{t{or �� inspection purposes. r C / / MECHANICAL $ , r Signature V Lr\ i2/6Uyfr'd .'L Date .4ti o b TOTAL FEE $ - Drivers' License or 5$9f _ - Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ Pink -Accounting; Goldenrod -Assessor