HomeMy WebLinkAbout2540 BACK BAY LOOP - Building Permits •
ICity of Costa Mesa
Development Services Department CERTIFICATE OF OCCUPANCY No. — v A...s 3
Building Safety Division
P.O. Box 1200
Costa Mesa,California
The Building located at 2540,2541,2542,2543 Back Bev Loop
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group R-1, B-3 Occupancy.
Use of Building Condominiums
Legal Description 439-121-35
(See reverse side for Metes and Bounds)
Building Permit No B26738 Electrical Permit No. E27550 Plumbing Permit No. P27C40
Mechanical Permit No. 028435 Number of apartments and/or guest rooms
ISSUED TO: Building Official William T. Howard
investments
•
!./bsz i-:urpay Avenue by - :,.• A. 87 _
Lrvino, CA 92714
Date Scdtember 16, 1987
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C.
CMF 1015-46 rev.1/83 White-Owner;Canary-Numerical File:Pink-Bldg.Permit File
•
C � /5 4
}Al, /'Y]U�Q� )Y/2, ��Ap�y..u�jfJft to fill in all spaces except those within heavy border lines and sign all appropriate declarations. r
CITY.Of COJTA MESA CONSTRUCTION h P�,FS MIT —PERMIT NO. TRACT NO. LOT NO. UNIT NO, .g ,
2- [Ain B 2.G7 a 8 /ot//l� LI
/ .! - +•J -
'Applicant's
Ht'sAdMai
Ask. u ADD LI ALTERATION U REPAIR 9559 12131/86 992.48
Applicant's Marlin• Address
16 5 •} O �//S -W• !J TYPE OF CONSTRUCTION 4I-NEW
i ' ail
A P' ❑ CONVERSION DI DEMOLISH ❑ OTH R � t AP.# / q Zona
Owner's Name •• - A ��■,�-J' 1 Phone DESCRIPTION OF WORK/USE OF BLDG. Ce ll atrbt Ad Vvvvvel T-` _ 9/ _ d5
Addresseta�`7 tJ�- Ug ���-1y Avg IE 1 e S Main Building: - Accessory Building:
Arch/Eng. '' �' ~�Mag}��f���-z�^ff-11'ticense�No.
) , 1 TYPE OF PERMIT LI GRADING FOUNDATION fig-STRUCTURAL RAL T Front /p ,5/ p
Address 1.. .P,,11,-..) Ha^~V rA A . . N ❑.TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL ^ d /
-1 gg DI OTHER A Rear Of �f .lN
Contractor's Name ('' O`er- m-za. Phone 3.S O-�Q1 _ ♦ C Right 5N
qq ,l ( PROJECT DESCRIPTION Sr'. F L&S' OCCUPA91fyY falLJs g M. a,/ hi
Address(mailing) Lto14 S��-'1 pck cc. • 'i e C. Dr VIU2 ---' (�Lj+ K , /� 1.---""-------T---T.
G
,/ / / CONSTRUCTION TYPE VALUATION$ •S Left 10 G L R
Cit• y'License No. , 4(:).5 -0 - ZONE GRADING CU.YDS. • ACRES ' '`n
i LICENSED CONTRACTOR DECLARATION ^ lfJ Ping. Ref.# bee - 8�-OI Parking Req./Provided 9, 5(.� E
• I hereby'.affirm that I am licensed under provisions of Charter 9 (commencing Remarks: pc Tr�2 ra f FEE 57ô rib A� Planning Notes: jay T• M
' with'section'7000).of Division 3 of the Business and Professions Code,and w. 4h(a•L / ct/t D
A •' my license is in II force and effect. 'O / f--7p^V/ Ac eked ,Vv _ WO tQl� .J}'E(,,(�L 1 IDCxTT:l�1Tp • T
r \1 iicenspp Cl55 Lice a o. (0 ( L--Pe, _ V /}IVY S,, ,,,, �,,, "� q��"��"/��1 �Q�U/1111a1.L1Y1J S
{� ate; lel��l Signature .�/ �ir"`� •
PLUMBING / ES Al.5a ta,ante) WuOlf.wt.e.(l _
~1 WORKERS' COMPENSATION DECLARATION /
\I I hereby affirm that I have a certificate of consent to self-Insure or cel'tificate Bar Sink Showers ELECTRICAL • FE-= s.
Of Workers'I Compensation Insurance, or a certified,copy thereo Section , -. •
Backflow Preventer - Service Sink _ - - -
\ 3800, Lab:C-) p.!�. • - Automatic Washer 'Transformer ❑ 15-50 KW
Policy No.N D 3559-� -Doi 'company I--zUl,en...Ot.X'. Backflew Irrigation Sewer Cap 0 50+ KW1'
f Construction Pole Sub.
Certified copy:is hereby furnished,,"-- '; •
Certifier]copy is filed with the city B I 'ig Divi ion. . Bathtubs Sewer Connection ,x- _ Cooking Unit Meter 0 u to 100.
Date /'16 3I/St. Applicant •
EXEMPTION F OM WORKERS'COMPEN ATION DECLARATION Clalifl¢rs Solar Collectors, Dishwasher • Meter Clover,10, amps
(This section need not be completed if the permit is for one hundred ($1 - -
less). Dishwasher: _ Solar Piping ,
I certify that in the performance of the work for which tills permit •
_ p 9 Dryers ❑Gas ❑Electf is Sub Panel
is issued,
-
shalt not employ any person in any manner so as to become subject to the Drinking Fountains Solar T k - '
Workers' Compensation Laws of California- Fan Motor ■0-1 HP ❑1%-8- . •
• Date - Signature Floor Drains ' Sw' ming Pool w/SpaF,A,U. I.
•
NOTICE: If,after making this declaration,you should become subject to the .Solar 09-15 HP 016-15+
•
' Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks rinal - • .
comply, with such provisions or this permit shall be deemed revoked. ' Fixtures' - - .Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet •
�'•' •
1 hereby affirm that there is a constrgction lending agency for the performance ` - ,Device Boxes• . Y POI¢ Light • ,
of the work forpwnich •tfµe. permit is psu (Sectio 3097 Civ. C.) - , - ,
Lender's Name futon• (1M1G•.LI. ts"✓I Interceptors Water Heater Outlets'. Range
Lender's Address - T'hh S�" • �`j •4'Q+-t7 Kitchen Sink: Water Service Switches '6 I
OWNER BUILDER DECLARATION / UU - '" _ 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 Dispose Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap •
Laundry Trays ' Generator •S a-5 KW 05.15 KW Trash Com actor
my structure, prior to Its issuance,also regUnes te applicant for such permit P
•
o file a signed statement that he/she is licensed pursuant to the provisions of
• the Contractor's License Law (Chapter 9_(commencing with Section 7000)of Roof Or. s d •
• 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 .. . . -
oeenalty 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 1 ' $15 Issue Fee- $ 3
1
'compensation, will do the work,and the structure'is not intended or offered 1 Reinspection Fee . $15 loos 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/nerself 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 improve Rlent is sold within one year of com- I " Canopy Type I ❑ ' ' Zoning Approved By Date 4
•
platten, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground
Trove for the purpose of sale). - Building Approved By �7� Date �oZ�3�
LJ I,as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration Sy Application Issued By ...1 Date /�-3/-$G
, 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, TU ❑100,000 BTU SUMMARY OF F S
builds or Improves thereon,and who contracts for such projects with . con- - BUILDING PERMIT $ 8355.x7 SMIP $ g•,30
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 em Repair/Alteration
proof oftheir Worker's Compensation Insurance should be provided to me. 75�� PLAN CHECK $ •36•(� PERMIT
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $
Date Owner Heating System& Due ' Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above ❑o-100,000 BT 100,000BTU— GRADING $
Information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ •
and state laws relating to building construction,and hereby authorize repre- - - ,MICROFILM $
• sentatives of this city- to a upo the above-mentioned property for PLAN CHECK 50% $
• Signa •
Inspecture
s. /_ J3i F MECHANICAL . $ TOTAL FEE $ t�
Signature��1 Date y / _ v
Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ a �8
Drivers' License or 55# Sr
CMF 0865-46,rev. 16/84 White - Building; Canary - Applicant: Pl lk -Accounting; Goldenrod - Assessor • 7
r
CONSTRUCTION AND PLANNIA .)L & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
41. Temporary Electrical Service or Pole 52. Pool & Equipment Location
• 12. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
• 4. Electrical Conduit-Undrgrnd. l 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing& Pressure Test
6. Electrical UFER Grnd. EEE!!! 57. APPROVAL TO COVER-GUNITE
7. Footings
f4;171 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 - 31)11v Cv,r, 61. APPROVAL T&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 . ;. ;1• APPROVALS Permit# -
21. Ducts, in Structure' i 70. Underground Hydro
22. Ducts, Ventilating • 11 �,;, 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
5/17/117 G✓ 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing ` 03* G,/" 76. Dry Standpipe
28. Lathing & Siding 1 4q)gi 77. FIXED SYSTEM FINAL
29. Insulation • 431n (.f✓ 78. FIRE PREY. FINAL
- 30. Drywall Nailing ', •tel 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 BUD.LOR srtsciAL UQULREItiAlt
35. Final Gas Pipe-Test s/s Van -">b NOT 7...CELJCACC w.An
36. Hood or Canopy _amp AB..ATSW r e
37. Final Factory Fireplace rT``
38. Final Plumbing i�/8'f air gra '�
39. Water Service-Final a-5te,rte/ `1Z-- 2'3 Di/' 1r', raL _ASe N.
40. Gas Service-Final r 1',,,4L 13L Dom. (r• A) •
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation -
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE& BUILDING ?//f7
48. Special Requirements Completed 1/ /41 n^m
49. Electric Release to Edison •
1 I / Y '
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
11.2 ... _. ... . ... L'
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA ' T' UCTION P RMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO.
Project Address
ze� I �7SSD
Applicant's Mailing Address`,l� y r�' TYPE OF CONSTRUCTION [7-NEW ❑ ADD H ALTERATION ❑ REPAIR l
�/rrn�� Phone ❑ CONVERSION ❑ DEMOLISH ❑ OTHER, ,, A.P.# I Zone
Owner's Name • DESCRIPTION OF WORK/USE OF BLDG.
�oNoo�iNiu
Address S Main Building: Accessory Building:
E ' Z
Arch/Eng. - License No. TYPE OF PERMIL/, ❑ GRADING El FOUNDATION ❑ STRUCTURAL - T Front • O
Address / �s�� ❑ TENANT 1951..-ELECTRICAL ❑ PLUMBING 10 MECHANICAL B Rear N
Contractor's Name//��nel r k.2—LES LG Phone 1 1 9_9.7 El OTHER A - I
L',� 5 O /� 1� C Right N
Address(mailing) ——1 6 S. Mbe,/,ek/i st+ 9 .7a7 PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Left - G
O�7/q(� CONSTRUCTION TYPE VALUATION $ $ R
City License No. /6 ZONE - GRADING CU.YDS. ACRES E
LICENSED CONTRACTOR DECLARATION 6 Ping. Ref.# Parking Req./Provided
1 herebyaffirm that I am licensed underprovisions of Charter 9 (commencing cin Q )./�2 yr Q( g Remarks: I� JV Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code, and T
my license is in ful fo� ntl effect. S
License Clas qI�License N33 '
to Signature (�4C PLUMBING FEES
•
z
JRKE RS'COMPENSATION DECLARATION Bar Sink Showers .• •
'- ELECTRICAL FEES
1 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
3800, Lab. C) �u � (iv Automatic Washer Transformer 0 15-50 KW
Policy No. �$t '))'///0 44Company ttN" cUifrrY• Backflow Irrigation Sewer-Cap Construction Pole Sub. 0 50+KW /1r1
Certified copy is hereby furnished. ^
Certif' d c'9p filed with the city B lag.Divi ' n. Bathtubs Sewer Connection Cooking Unit Meter p to 100 amps /0
Daten SeWORKERS' w•
COMPENSATION DE LARATION Clarifiers . Solar Collectors 7" Dishwasher ' Meter ❑over 100 amps 4 50
(This section need not be completed if the permit is for one hundred ($100)or
less). Dishwasher Solar Piping - !� Dryers ❑Gas Electric r/ Sub Panel•
(�O ��
I certify that in the performance of the work for which this permit is issued, I - /A - 7
shall not employ any person in any manner so as to become subject to the Drinking Fountains • Solar Tank Z Fan Motors 00-1 HP ❑1'h-8 C
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/Spa L` F.A.U. - Inc.Solar 09-15 HP 016-15+ (y. Q9
NOTICE: If,after making this declaration, you should become subject to the l••
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal 70 Fixtures /L l O
comply with such provisions or this permit shall be deemed revoked. 7 Microwave
CONSTRUCTION LENDING AGENCY GasService Outlets Water Closet Device Boxes •
hereby affirm that there is a construction lending agency for the performance r v Pole Light
of the work for viS:ch t is p is s u (Section 3097 Civ. C.) Interceptors Water Heater
Lender's Name r JM by✓ llpj Outlets Range • - O(/
Lender's Address ne a/ ft £7L Cf./.17/ S/ LA rer Kitchen Sink Water Service gdSwitches Sign g 0V
OWNER BUILDER DECLARATION c 'IQ x
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash iG Garbage Disposal Standing Sections 4 00
following.reason (Section 7031.5 Business and Professional Code: Any city or T
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor
fly structure, prior to Its issuance, also requires the applicant for such permit -
i file a signed statement that he/she is licensed pursuant to the provisions of ROOF Drains •
ne 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 —
'
oenalty of not more than five hundred dollars($500). _
LJ 1, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure is not intended or offered Reinspection Fee $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I FEES
License Law does not apply to an owner of a property who builds or improves - _ S
thereon, and who does such work himself/herself or through his or her own Hood or Type I ❑ DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Zoning Approved By Date
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date fir/
( 1
•
prove for the purpose of sale). - /� �// 1 /
❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By • I n� Date r 1 1
•
tractors to construct the protect (Section 7044,Business and Professions Code: t
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU i SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a con- _
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ _ _ PERMIT
❑ I am exempt under Section B.& P.C.for this reason firepl/Fact.Bit ICBG# Fire Dampers PLUMBING $ - ISSUANCE $ —
Date Owner - Heating System& Ducting Registers ENERGY P.C. $
PLAN CHECK 25% $
I hereby certify that I have read this application and state that the above ❑o-100,000 BTU 0100,000 BTL ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of this city to ente n the above-mentioned property for
inspection pure e _ 2 �/ MECHANICAL $ TOTAL FEE $
r/�LGC.S�Ii/
Signature Date J /
Drivers' License or SS# - Reinspection Fee $15 Issue Fee $ 3 PLANCHECK 25% $ �/5, yd
a .
CMF 0865-46,rev. 10/84 White - Building: Canary -Applicant; Pink -Accounting; Goldenrod - Assessor A
i 1
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 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
I
16. Rough Electric Wiring :67. -Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ' •
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
,• 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas 0 Oil
- 23. Gas Pipe-Rough & Test 72. Underground Flush • f-
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. Insulation78. FIRE PREV. FINAL -6
30. Drywall Nailing • HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79.' FINAL INSPECTION .r + -
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric I-4-91 J C Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test ,
36. Hood or Canopy
37. Final Factory Fireplace „ • •,-
38: Final Plumbing - _j -
/.
39. Water Service-Final - '' !'
40. Gas Service-Final - • ,,
41. Solar Domestic-Final ,
?r . -
4Backflow t-
2. BkflP . Y I • '` -
.•/,I ^ ',
43. Backflow Irrigation • •f• •!
X44 Landscape Irrigation System '�- - . '�,
l. ' 7
'45.`Sound Attenuationi' - %
1
46..Handicap Regulations -
47:'FINAL STRUCTURE & BUILDING ')/...,-/,
481..Special Requirements Completed - f,; ✓.
n:
49. Electric Release to Edison •
50. Gas Release to Southern California Gas Co
1 -
51. CERTIFICATE OF OCCUPANCY
No. Date -
i.
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
-
NCITY Gr COSTA MESA CONST(�RR•_�UCTION PERMIT PERMyY/NO.
��O�� TRACT L T�NUNIT No,
'Project Address 1.5110-1.5110-113 FACT-- �. r�Qy - !_/!' 1l2 .
Applicant's Mailing Address l TYPE OF CONSTRUCTION CR NEW ❑ ADD U ALTERATION U REPAIR
/ Z7,
I�v�����g r !n
0I CONVERSION ❑ DEMOLISH Ell OTHER A.P. ,#6 Zone
Owner's Name, P V Phone okr0 /7/ I DESCRIPTION OF WORK/USE OF BLDG.
Address 1-70(02 moa-Li Aol I R1N)1,S CA. 9Z7 I� _ S Main Building: ,.,. C.' Accessory Building: Z
Arch/Eng. I License No. TYPE OF PERMIT ❑ GRADING U FOUNDATION U STRUCTURAL T Front �� G
Address ' Sl1 ❑ TENANT ❑ ELECTRICAL ig PLUMBING ❑ MECHANICAL B Rear I r t II • N
Contractor's Neme�ti?I'.OKttt Yt.-LAV/3/r1L. Phone fO )0-9�6 ❑ OTHER G Right cd:-
M' lZ I'" t N
Address(mailing) 3C13(_ E-• ��ON9A b7 AN A�rCt S'I CA /2S�� PROJECT DESCRIPTION 50. FT. OCCUPANCY K . Jr+ G
Slip �z/ / CONSTRUCTION TYPE VALUATION $ S Left R
City,License No. 1 ( IW - ZONE GRADING CU.YDS. ACRES �r
- Ping. Ref.# - v05 1♦�assrl� Req./P`ovided E
LICENSED CONTRACTOR DECLARATION �{V O n
L I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: j�1f 073 ' Planning Notes: CI1 1 M
Y, with section 7000) of Division 3 of the Business and Professions Code,and r, .Ll/ /J D T
my license is In f II force and effect. ! L
-� 'cense Clas V License No. ✓�� - - S
1 ,te /-27' �) Signature ..+r a.Y> [...+g r— PLUMBING FEES .
WORKERS'COMPENSATION DECLARATI N Bar Sink
' ELECTRICAL FEES
I hereby affirm that I have a certificate of consent to self-insure or a certificate ers '
of Workers' Compensation Insurance, pr a certified copy thereof (Section Backflow Preventer
' :Service Sink
. 3800, Lab.tCi) �1 /},� - II!ltLo]i..11III.
s
Policy No: Mot 79/51 CPS Company Q�YIaA r-/'f�/3-�-�y Backflow Irrigation Pole Sub.
_ onstruction ■ s
��''{I,Certified copy is hereby furnished. • _ •
to Ce rtif7d cetay is�fi,d with the city B Iltling Ivisi on. ///� ,[ s Bathtubs ��s/.y1_ Il,1 ■ 100 arnps
Date /- §)'K/ Applicant -'/y(�7�J,..+,-71),/ .'�'rj �'�'Va "" I
' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers ••• Dover• • st .
• (This section need not be completed if the permit is for one hundred($100)or 'J.
less). Dishwasher • i a� Dryers IDIGasDElectric 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 Motors 00-1 ■
Workers' Compensation Laws bf California.
Date Signature Floor Drains' Inc.Solar 09-15 ■
16-15+
.NOTICE:If,after makingthis.declaration,you should become subject to the
, Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal
comply with such, provisions or this permit shall be deemed revoked. '
Fixtures :CONSTRUCTION LENDING AGENCY ' Gas Service Q Outlets
• I hereby affirm that thereiis a construction lending agency for the performance 3a a�MI • 0 Pole Microwave
_■
of the work for l which this permit is Issued (Section 3097 Civ. C.) Interceptors , I 3. 1�
Lender's Name - • - ■I
Lender's Address ' -" Kitchen Sink. .. . . /r^ i Co . Switches Sign
Ita.l.I OWNER
BUILDER UECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the LavatoriesOD following reason (Section 7031.5 Business and Professional Code: Any city or �'' -
county which requires a permit to construct,alter,improve,demolish or repair P-Trap -
I my structure, prior to Its issuance, also requires the applicant.for such permit I Generator ❑0.5 KW❑5-15 KW Trash Compactor _
to file a signed statement that he/she Is licensed Pursuant to the provisions of Rad Drains •
the Contractor's License Law(Chapter 9(commencing with Sectlon'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). •
U I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15
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 REOUIREMENTS:
• employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 •
' sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date
. pletion;the owner will have the burden of proving he/she did not build or im- Duct-Under Ground
prove for the purpose of sale). Building APProved fay
Date
LJ 1,as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By a)... Date 77
• 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 $
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT '
❑ I ani exempt under,5ection B. & P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $
•
Date Owner Heating System& Ducting Registers - PLAN CHECK 25% $ 1 ENERGY P.C. $
I hereby certify that I have read this application and state that the atiove ❑O-100,000 BTU ❑100,000BTL—
information is correct. I agree to comply with all city and county ordinances ELECTRICAL
and state laws relating.to building construction,and hereby authorize repro- MICROFILM $
sentativ this ci,S� �(j enter on the above-mentionedproperty for PLAN CHECK 50% $ /�
inspecti pu oses. uugq\ _�-07 MECHANICAL $ TOTAL FEE $ ,�`"L./
Signature n- C Ga Date Reinspection Fee $15' • Issue Fee $ 3 PLAN CHECK -25% $
Drivers' License or SS# '
CMF 0865.46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL&SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 2.n J(, ttt) 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 z-n'- 7 CZD 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing '9 4 ?7 Clir) 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 ❑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 hien 4•4Q
39. Water Service-Final
1(11.n (-CO
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 .1_
51. CERTIFICATE OF OCCUPANCY
•
No Date
Applicant 9 filbirraf(spaces ex hose within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTR CTION PERMIT _ ER'Iyf�jlNOry mac,(/, l \TRACT NO. LOT NO. NO. -
q.� q s/q -y ,, LQ+t°•allle/L__. -L � I� vWV' t•JGS/ ak� 1 - zt i7i7 5�i2�e7 �. /y 2E'�,'ry ' .
Project Address ono-1593 J /.0I- '✓ '`TT,,,L„J / a-J�
�) f / �� 1 ION IL...LiIrjrEW U ADD U ALTERATION REPAIR Applicant's Mailing Addl.- K __ aJ�_. - _ �._. .
j ,� CONVERSION ❑ DEMOLISH ❑ 01-mss q:p-'#, J Zone
Owner's Name ---._-../. - Phone • DESCRIPTION OF WORK/USE OF BLDG. �( -
Address V •
/nr - .. ..__ ' S Main Building: - Accessory Building:
Arch/Eng. - License No. - TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION STRUCTURAL ' T Front - ' _ O
Address - ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL B Rear N
9f/`en) LI AH
TER • A
Contractor's Nam Pone C Right ' • N
Address(mailing) • �/ tiu '..e. PROJECT DESCRIPTION SQ. FT. OCCUPANCY •K - G
9 visa (,e J - CONSTRUCTION TYPE VALUATION $ S Left - R
City License No. ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION rI //�l �J f} Ping. Ref.# Parking Req./Provided E
CI
I hereby.affirm that l'am licensed under provisions of Charter 9 (commencing Remarks: I'i J I,� t. /5 A G 7 2 Planning Notes: - M
with section 7000) of Division 3 of the Business and Professions Code,and -�'_✓//j ,J - -
I� my license is in yII r nd,effect. �l - T
1 ` Ucense /ass v Llcens o. e- L s••/ -
S.
' ,te s'i7/87 Signature UL's*"—r+✓ .-�s� PLUMBING FEES
.ORKERS'COMPENSATION D LARATION
I hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers ELECTRICAL FEES
•of Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink
3800, Lab, - . Automatic Washer - Transformer 0 15.50 KW._ _
Policy inr:',72-1.7 CompanytRM4 s.JIL.1rJ.er..as.A Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW
Certified copy is hereby furnished. _ -- i
�rt I} 5oyy i}filed with city Iltlln Ivision. �1 ye Bathtubs _ -- , Sewer Connection' , ' - • Cooking Unit Meter Dup to 100 amps
Date 9p ,p ( theant y6 /- 11 /7"/ L/ ,
EXEMPTION FROM WORKERS'COMPENSATIONlDECLARATION Clarifiers - ' Solar Collectors . ' ' Dishwasher • Meter Cover 100 amps
(This section need not be completed if the permit is for one hundred ($100)or -,less). l 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 • FanMotors 00.1 HP 01:4--8
Workers' Compensation Laws of California. .
Date Signature Floor Drains 4. 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 . - _ ,
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for the performance '
of the work for which this permit is issued (Section 3097 Civ. C.) Intercept
Interceptors Water Heater Outlets Range
Lender's Name
Lender's Address - Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION - ' '
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Garbage Disposal Standing' Sections
following reason (Section-7031.5 Business and Professional Code: Any city or .
u
county which requires a permit to construct,alter,improve,demolish or repair P-Trap
' ` ,y structure, prior to its issuance, also requires the applicant for such permit ' Generator 00-5 KW 05-15 KW Trash Compactor
:ARay
file a signed statement that he/she Is licensed pursuant to the provisions of - Roof Drains ' -
i.tL
e Contractor's License Law(Chapter 9(commencing with Section 7000) of -
:vision 3 of the Business and Professions Code) or that he/she is exempt - - - .
therefrom and the basis for the alleged exemption. Any violation of Section - -
7031.5 by any applicant for a permit subjects the applicant to a civil - -
LIenalty of not more than five hundred dollars($500). •
I, as owner of the property or my employees with wages as their sole Reinspection.Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure Is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such Improvements are not Intended or offered for Boiler Hood or Type I 0 Zoning Approved By Date
' sale. If, however, the building or improvement is sold within one year of Com- Canopy Type II 0
pletlon, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground - Building Approved By Date
glove for the purpose of sale).
LI I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date
tractors to construct the project (Section 7044,Business and Professions Code: _
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 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 BUI LDING PERMIT $ SMIP $
proof oftheir Worker's Compensation insurance should be provided to me. p zz PLAN CHECK $ PERMIT 7
❑ I am exempt under Section B.a P.C.for this reason Firepl/Fact.Blt.ICBO# Iii. R .ti�� 1 co PLUMBING $ ISSUANCE $ `y ' V Cr
Date - Owner se`s -H(¢�atrn9 System& butting PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above - 1 t]Mh 100,000 BTU ❑1OQ000 BTL !(� ELECTRICAL $ GRADING $
Information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repro- PLAN CHECK 50% $ MICROFILM $
sentatives • this city to enter ufon the above-mentioned pr pe{`ty for
inspection ' poses- y /-' �-wp7 MECHANICAL $ -� TOTAL FEE $ tr./. 01-)
V
•
Signature {l. _ -_a` Date /
Drivers' if ense or 55$ '; Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $ f , OD
CMF 0865-46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor
• CONSTRUCTION AND PLANNINL )L& SPA
' APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE i
. 7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation . 59. Gas Pipe, ❑ Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System • 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap - 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 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 'll91X7 14/7 FIRE DEPT. REQUIREMENT
20:' Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping ElGas ❑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. FinaliHeating& Air Conditioning Y 7L}I!L
35. Final Gas Pipe-Test
36. Hood or Canopy -
37. Finat Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation .
44. .Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
• 47. FINAL STRUCTURE & BUILDING •
48. Special Requirements Completed
49. Electric Release to Edison - -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY ,
No. Date
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. Ofi/7 4/09/85 - 8.00 T�
•
CITY OF COSTA MESA`/ CONJSTRIJ,CTION PERMIT - PERMIT NO. r�/1-� TRACT NO. LOT NO. • UNI6O. • I ' '• -
Protect Address 7 s7 Q I 1 L4,S� ,�, n•trD Yill `�� O "' 2...y -
r D I TYPE OF CONSTRUCTION- / NEW ❑ ADD U ALTERATION LI REPAIR •
Applicant's Mailing Address 0'3 Q L% r r 0 CONVERSION 0 DEMOLISH 0 OTHER
Owner's Name P one 6S 146/6A.P.AP # Zone
e— /� DESCRIPTION OF WORK/USE OF BLDG.
Address i O72— S b p-o& �� �j'F{� S Main Building: Accessory Building:
Arch/Eng. License No. TYPE-OF PERMIT ' 0 GRADING 0 FOUNDATIOONy U STRUCTURAL E Front p
Address 0 TENANT 0 ELECTRICAL 0'PLUMBING trMECHANICAL B Rear N
Contractor's Nam. `a.rA_: • s �s _'hone 3 "Z ❑OTHER _ V'A3 Sit C Right N
PROJECT DESCRIPTION SQ. FT. •J OCCUPANCY
Address(mailing) `3 • ea-- .rY K ' G
CONSTRUCTION TYPE VALUATION B S Left
City License No. • Ln 19) 39 - ' R
LICENSED CONTRACTOR DECLARATION ZONE GRADING CU.YDS. AC RES Ping. Ref. # Parking Req./Provided E
I hereby affirm that I am licensedunder provisions of Charter 9 (commencing Remarks: r Planning Notes: Q
M
with section 7000) of DivisionIsion3 3 of the Business and Professions Code,and • _ ,r
my license is in f force and effect. -5Z8 11( Q/Zvi
License lass '2-O t..r yS4 ° Ckj�-b V'"r I - S
Date =+Z, 3' Signature a �Q 1L11�1((/�i A.r— PLUMBING FEES •
WORKERS'COMPENSATION DECLARATION - Bar Sink Showers ELECTRICAL i FEES
1 I hereby affirm that I have a certificate of consent to self-insure or a certificate
1 Workers' Compensation Insurance, or a certified.copy, thereof (Section Backflow Preventer- Service Sink - '
.800, Lab. C.) Automatic Washer Transformer 0 15-50 KW
rP�olicy No. /- s� 7 Y k Company - "'^">" , Backflow Irrigation Sewer Ca 0 50+KW •
y Certified copy is hereby furnished. p Construction Pole Sub. •
ertified cctP filed with the city euimipg to L/- ' Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date 3'-`4- 35 Applicant /S .l [ �i•V+/s"� '
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 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 ❑1'h-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 ' . - - -
comply with such provisions or this permit shall be deemed revoked. -Urinal Fixtures 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.) •
Lender's Name Interceptors - Water Heater Outlets Range '
Lender's Address Kitchen Sink 7 - 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 ❑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 - 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 ,
lerefrom 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 a
Calty of not more than five hundred dollars($500).
'en -
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 I MECHANICAL FEES -
License Law does not apply to an owner of a property who builds or improves - -
thereon,'and who does such work himself/herself or through his or her own - - 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
grove for the purpose of sale). 1/41
,
U I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By C LVII'-' Date X11
• 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 ❑1(0,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con- - •
tractor(s) license pursuant.to the.Contractor's License Law). I am aware that Exhaust System 0 Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $
proof off their Worker's Compensation Insurance should be provided to me. PLAN CHECK $ PERMIT
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. (CBO# Fire Dampers PLUMBING $ ISSUANCE $
Date Owner - - • Heating System& Ducting ' Registers PLAN CHECK 25% $ ENERGY P.C. $
' I hereby certify hat I have read this application and state that the above J 100,000 BTU ❑100,000BTIJ — - M ELECTRICALGRADING $
information is correct. I.agree to comply with all city and county ordinances rr� CSD $
and state laws relating to building construction,and hereby authorize repre- n _ I/ I PLAN CHECK 50% ,$ MICROFILM S
sentatives of this city Ito t r upon the above-mentioned proper y for
inspection Pur ses.� [gg�PP{g' p MECHANICAL $ 7.00 8.00
Signature c' -/ I�i'[q`Q-.x Date •.3-`Z — -s • •�g TOTAL FEE '$ _
Drivers' License or SS 9F, Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% •$ 1 .00
........
CMF 0865-46,rev.10/84 White - Building; Canary • Applicant; Pink -Accounting; Goldenrod - Assessor ®f 00
CONSTRUCTION AND PLANNING ` POO. .SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole •- 52. Pool & Equipment Location
•
2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement
3. Electrical Conduif,Utility-Undrgrnd. - 54. Forms
4. Electrical Conduit`Undrgrnd. c t, 55. Electrical Bonding t
.
5"Steel Reinforcemeht . 56. Rough Plumbing & Pressure Test
6r,Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation ' 59. Gas Pipe, 0 Undrgrnd.,Test
9:.
Water pe-Undrgrnd 1 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.rSewer 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 PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
J
33. Final Electric Notes: <.
34; Final Heating & Air Conditioning /./y/�--(moo
35.Final Gas Pipe-Test ��
36.-Hood or Canopy
37.final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison50. Gas Release to Southern California Gas Co
I51. CERTIFICATE OF OCCUPANCY
No. Date _