HomeMy WebLinkAbout2530 BACK BAY LOOP - Building Permits a
City of Costa Mesa
Development Services Department CERTIFICATE OF OCCUPANCY No. 001318
Building Safety Division
P.O.Box 1200
Costa Mesa,California
The Building located at 2530 & 2531 Back Bay Loop
•
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group R-3 Occupancy.
Use of Building Condominiums
Legal Description 439-121-35
( (See reverse side for Metes and Bounds)
Building Permit No B26735 Electrical Permit No. E27547 Plumbing Permit No. P27037
— Mechanical Permit.No. M28432 Number of apartments and/or guest rooms
ISSUED TO: Building Official William T. Howard
- R.J. Investments
17602 Murphy Avenue by '. ..
Irvine, CA 92714 -
\ Date September 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 (e) U.B.C.
CMF 1015-46 rev.1/83 White-Owner;Canary-Numerical File;Pink-Bldg.Permit File
/` -i `.3 / /�Di, ant to !spaces except those within heavy border ne�all appropriate declarations.
GYI S-. owcaA CONSTRUCTION PERMIT PEWIT NO. -7 TRACT NO. LOT NO.
s' . ... r- > f. 0�,�0-/ 3LC /2"/111 / ��+ -+Ef—
Project Anor@ss `.�s � �jy�, �-�A �,y{ . .
'h. ITD36 Ho A�'el/iA AU. � j TYPE OF CONSTRUCTION Vim+ NEW LJ ADD LI ALTERATION ❑ REPAIR
Applicant's Mailing Address _
s a ,�� }�•�� �/' D-'ell
0 CONVERSION 0 DEMOLISH 0 OTHER A.P.# � -La/_ R.K 95b5 12/31/6:j1Zone ,P.4O5P47 TL
Owner's Name •c-).' /•./ ���'-t J y�y�J"�tv �r'hone IG { DESCRIPTION OF WORK/USE OF BLDG. C� •" 11 �+ JVtl
Address I 1L0-2- i :`( Mk:) 1e.V I IJ L . 5 Main Building: C� Accessory Building:
Arch/Eng -:-�V' h:jt•1 f• Q icense No. µ TYPE OF PERMIT ❑ GRADING +�-FDUNDATION LILST RUCTU RAL T Front /n r 51 (�/ �/ 0
Address I5.. .. r�_tC,r�1•.�kle- )01� / ILL t� s��,, ,,� ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL • B Rear /O, /Gl b/ N
'Coniractor•s NamP f_1�WK��'"""PQ}^_.b�c/A4(L{1 Phone ____ 0 OTHER A - I.
N
Address(mailing/ IC-CA 6/Cyfa�_ Cf-rL,(,Q �lt..«'LF •ZrviK�' PROJECT DESCRIPTION 50. FT. OCCUP/11 K Right /(�f G
I IIICONSTRUCTION TYPE VALUATION Sii 3C! Left f
City License No. I0320 / 5 58 �/ h/ R
ZONE GRADING CU.YDS. AC3RES Ping. Ref.# ParkingR
'LICENSED CONTRACTOR DECLARATION �� - '-Di eq./Provided�,p�� E
A
I.hereby affirm that I ani licensed under provi5lon5 of Char[¢r 9 (commencing Remarks: PCt/�f },{fes, / p p /y PlanningNotes: T -
I
N. with section 7000) of Division 3 of the Business and Professions Code,and �C� sa'_ �� P 3 31+�J (/21aJL Q FOR SPECILL }1rn•r TTt1t'nTr�.imC �a 5/ M
`L /� /y7 (yF� eO- �J ( HOLD SLL\.Itsu EQUt•`L,r+L,t 1u T
my license Is in full force and effect. 3A 3110 6 7 ` -9‘ ' "a eo, . /0 €-4-7 —6r /��� ' �^ ^^ _' S
\ bate /2e /Rj 4 Signature - PLUMBING FEES 12Q../2fa-- ant' C 1 l-f�W�
RISERS'COMPENSATION DECLARATION •
Bar Sink Showers
reby affirm that I have a certificate of consent to Self-insure ora incase ELECTRICAL FEES
ON or Workers' Compensation Insurance, or a certified topy thereof (Section
Backflow Preventer Service Sink
3800, Lab. Ca„t ��y- -y.
Automatic Washer Transformer 0 15-50 KW
Policy No. %1/(73 -�7`a"Company ���„why- Backflow IrrigationSewer Cap _ ❑ 50+KW
�Iy1 Certified copy is hereby furnished. + 1 7- - - Construction Pole Sub. ,
+� Cerjlfi d Co yis filed with the cityrw.Icg Div ion 1 Bathtubs Sewer Connection L Cooking Unit Meter ❑up to 100 amps
EXEMPT-LH
XE / �1 9Ke Applicant • // (
I EXEMPT ON!ROM WORKERS'COMPENFv ATION OECLARATI N Clarifierst Solar Collectors • Dishwasher Meter Dover 100 a '
(This section need not be Completed if the permit Is for one hundred ($1 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, I ' '
•
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Ta •
Workers' Compensation Laws of California. - . . Fan Motors ■a1 HP ❑1 Ya-8
-7-Date Signature Floor Drains Swi ing Pool vv/Spa
NOTICE: If,after making this declaration, you should become subject to the' _ F.A.U. Inc %.lar ❑9-15 HP 015-15+
Workers' Compensation provisions of the. Labor Code, you must forthwith Floor Sinks sinal - -
comply with such provisions or this permit shall be deemed revoked. FixturesicrOwav¢
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 work for hfswhich thus f5 ,lssyetl ($$¢¢ctlyn 3097 Civ- C.)' •
ofLethe's' Name Ti Ma it I permit irf `�'Cf C. Interceptors Water Heater Outlets .- -
Lender's Address 4 eft Le S' '-.7i^e�•�- - Range
Kitchen Sink Water Service Switches
OWNER BUILDER DECLARATION I - Sign '
I hereby affirm that I,am exempt from the Contractor License Law for the - Lavatories Auto-Wash -- 1\
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-TIa
, any structure, prior to Its issuance, also•requires the applicant for such permit P Lau ndry.Trays - Generator ❑. .KW 05-15 KW. Trash Compactor
'ire a signed statement that he/she is licensed pursuant to the provisions of Roof Dr s - •
,
lontractor's License Law(Chapter 9_(commencing with'Section 7000)of , _ • '
.ion 3 of:the Business and Professions Code) or that he/she is exempt - •
• ,
efrom and the basis for the alleged exemption. Any violation of Section , i _ '
]031.5 by any applicant for a permit subjects the applicant to a civil _ "
enalty of not more than five hundred dollars($500). _ _
U I, as owner of the property or my employees with wages as their sole Reini $ 3 pection.Fee I $15 Issue Fee _ '
compensation, will do the work,and the structure is not Intended or offered - - etL.
') for sale (Section 7044. Business and Professional Code: The Contractor's MECHANICAL Reinspection Fee I $15 Issue Fee $ 3
•
License Law does not apply to an owner of a property who builds or improves _ FEES
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:Li/Wet-nate
employees, provided that such improvements arenotIntended or offered for Boiler .Hood or Type 1 ❑
I sale. If, however, the building or Improvement Is sold within one year of com-, — Canopy Type I D. Zoning Approved By N X lti/ tllate /� 111'f71o/
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground , BuildingApproved B �� /� J/`b b
rove for the purpose of sale). pP By_12.--Z. Date
i � I, as owner of the property,am exclusively contracting with licensed con- Duct-,Structural Refrigeration Syste . Application Issued By( ea ' •@--
_Date 423/-g^(0
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 ❑0-100,00. : ❑100,000 BTU •
builds or improves thereon,and who contracts for such projects with a con-. - SUMMARY OF FEES q
' tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System S Multiple ❑ S ` 'm'Repair/Alteration 0 BUILDING PERMIT $- t S-71' 00 SMIP $ . /•1/
proof of/ their Worker's Compensation insurance should,be provided to me. - PLAN CHECK $,•;r/ �"PER MIT •
' 0 I am exempt under'Section , PLUMBING I. $B.& P.C.for this reason Firepl/Fact.Bit. ICBG# , Fire Dampers ISSUANCE $
Date Owner Heating System& Duc ' Registers • PLAN CHECK 25% $ -• ENERGY P.C. $
•
I hereby certify that I have read this application and state that the above U❑o-100,000 BT 100,000 BTGRADING $
I 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 en r upon the, above-mentioned pro arty for l PLAN CHECK 50% $
inspection pyspq / MECHANICAL $a -TOTAL FEE $ SZ �
S •
ignature I" Date
Drivers' License or$$tat sPe Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ !i 05Th V7 /\
CMF 0865-46,rev.10/84 White - Building; Canary -Applicant Pink -Accounting; Goldenrod - Assessor _ •
/-
•
C NSTRUCTION AND PLANNING PO' &SPA __
�-
APrROVALS Date Inspector Date Inspector
Permit# - APPROVALS ermit#
'. Temporary Electrical Service or Pole 52. Pool & Equipment Location
'!'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
I- 6. Electrical UF ER Grnd. .2-l,if&i /'� 57. APPROVAL TO COVER-GUNITE
i 7. Footings i-PAvs • 41027 58. Electrical Conduit-Undrgrnd.
r -/
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
IS 9. Water Pipe-Undrgrnd. . . 60. Backwash Lines, P-Trap, O:Undrgrnd.
10. Structural Floor System 36181 6' 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
l
:i • 15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval .
)1 17. Rough Wiring Sign - 68. APPROVED-FOR PLASTERING
ti 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL -
o;
) 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace ' 'ti APPROVALS Permit# _
21. Ducts, in Structure .t 70. Underground Hydro
22. Ducts, Ventilating "i,' t 71. Product Piping 0 Gas 0 Oil •
23. Gas Pipe-Rough & Test F I r' - 72. Underground Flush
24. Roof Framing ' A 73. Undergrnd.Storage Tank 0 Gas 0 Oil
I,
25. Roof Sheathing y; aft/ G./" 74. Overhead Hydro .
26. T-Bar Ceiling (Structural) & Monocoat --0I��1•! 75. Dry Chemical . •
•
27. Frame and Flashing "!'8/8,7 G 76. Dry Standpipe
28. Lathing & Siding 6/4/87 & AI . 77. FIXED SYSTEM FINAL
29. Insulation r•+ g/6/n 6404.1 78. FIRE PREV. FINAL
30. Drywall Nailing 4 a/[�9 A G'i HEALTH DEPT. REQUIREMENT
. 7' �d/
31. Plaster Brown Coat79. FINAL INSPECTION
1 32. Electrical Power Meter-Final°' 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning, HU FOR I¶CML REQUIREMENTS •
35. Final Gas Pipe-Test
%/
35. p NOT it.t+ingle CA0,11R
36. Hood or Canopy "Senbe ail.4 reS4.GA WC Al • U►
37. Final Factory Fireplace S ��\�/
38. Final Plumbing d a `. C`�
39. Water Service-Final 3N ^ at fL 25 31 era/at MAI 9/7/ r?
40. Gas Service-Final Ft tiA L. SAoG ys3o e'wE7 G. N 9 yk
41. Solar Domestic-Final SQ Rho.OG. 3D a -m- 9/ 27
42. Backflow Preventer 6
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations •
47. FINAL STRUCTURE & BUILDING OliGN��bb Cis/48. Special Requirements Completed
49. Electric Release to Edison •-
r
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
\ -� i ♦ A
• - , _ 2 5-30 _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. :"'' 08'166 3/04/87 - 109.20 TL
CITY OF COSTA MESA CONSTRUCTION PERMIT • PERMIT Nr2a //� TRACT NO. • LOT NO. UNIT NO. I
� .,
Project Address• 9-2530 3/ BAG/C Sty Goof " 5 97 - '
TYPE OF CONSTRUCTION lYil NEW U ADD U ALTERATION U REPAIR
•
Applic nl's Mailing Address
Owner's Name Coi✓FS E CONVERSION ❑ DEMOLISH ❑ OTHER. A.P.AP # I Zone. •
'
Phone �N�OM /
DESCRIPTION OF WORK/USE OF BLDG.
Address - S Main Building: ' Accessory Building:
Arch/Eng.- License No. TYPE OF PERMI ❑ GRADING El FOUNDATION El STRUCTURAL . T Front . Z
Address Qn ❑ TENANT OGY ELECTRICAL ❑ PLUMBING El MECHANICAL BB Rear N
Contractor's Name LRISC&e /G Phone � /OTHER C Right N
�, L ,, PROJECT DESCRIPTION SQ. FT. OCCUPANCY
Address(mailing) .2'`J6.S >CMA°V/ �/�-70 S Left G
.ani-7/9i
CONSTRUCTION TYPE. VALUATION$ R
City License No. �d ZONE GRADING CU.YDS. ACRES '
(� LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
y ` I hereby affirm that'I am licensed under provisions of Charter 9 (commencing Remarks: #.8. ,24 3S- . , Planning Notes: M
with section 7000) of Division 3 of the Businessand Professions Code,and
my license is in full/f,rce and effect. T
/...License Class rcD Llcen 3; 3-3 )r- _ - - S
Date•S—S-87 Signature V - -1,1111111/41. - -• PLUMBING • FEES -
C WORKERS'COMPENSATION DECLARATION v• Bar Sink Showers
•hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink -
•
_ 7, Automatic Washer ' Transformer '❑ 15-50 KW
Pol c Lab. 6: /• Ce .
Policy No. `�'07��07n — Company ( JJ7: Backflow Irrigation Sewer Cap Construction Pole Sub. - 0 50+ KW ..ZCertified copy is hereby furnished. DO
Cert gopy3Jlled with the city Oyu in DI ' -� w Bathtubs - Sewer Connection Cooking Unit Meter �up to 100 amps los 00
ate 'S�'/d/ Applicant (� r^e�eh i -
EXEMPTION FROM WORKERS'COMPENSATIO ECLARATION Clarifiers• Solar Collectors - - 2 Dishwasher - Meter 0over,100amps 021/4
OD
(This section need not be completed if the permit is for one hundred ($100)or
less). 1 Dishwasher Solar Piping xy Dryers ❑Gas %ElectricSub Panel (1
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 • 14 Fan • Motors CI 0-1 HP 01%-8
Workers' Compensation Laws of California. A - - -
Date Signature Floor Drains Swimming Pool w/Spa y F.A.U.
-NOTICE:If,after making this declaration,you should become subject t0 the -
Inc.Solar 09-15 HP 016-15+ a 90
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. �/ Y Microwave •4 �'Q
CONSTRUCTION LENDING AGiNCY yr •
Gas Service Outlets Water Closet Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for the performance - 9
of the work for hith't er 1k slued {Section 3097 Civ. C.) Interceptors Water Heater
• Lender's NameOutlets Range
• I '. /496�
•
Lender`s Address 2 - Ai - ._ / . '4' Kitchen Sink - Water Service ' ' - •
OWNER BUILDER DECLARATION •
�1 Switches Sign A�
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 y 9 P Standing Sections a
county which requires a permit to construct,alter,improve,demolish or repair P---Trap Laundry Trays Generator 00-5 KW❑5.15 KW
any structure, prior to its issuance, also requires the applicant for such permit - - - Trash Compactor •
to file a signed statement that he/she Is licensed pursuant to the provisions of ,
•
'
the Contractor's License Law (Chapter 9(commencing with Section 7000)of .�
)ivision 3 of the Business and Professions Code) or that he/she is exempt - - -.
herefrom and the basis for the alleged exemption. Any violation of Section • '
7031.5 by any applicant for a permit subjects the applicant to a civil - l •
-
enalty of not more than five hundred dollars($500).
I, as owner of theproperty 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: -.
employee), provided that such improvements are not intended or offered for Boiler Hood or Type I 0 ,
'sale. It, 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 i Date
•
prove for the purpose of sale). _ -
❑ I, as owner of the property, am.exciusively contracting with licensed con- Duct-Structural Refrigeration System' Application Issued By CC. Dat •
• tractors to construct the project (Section 7044,Business and Professions Code:
, The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ' 00-100,000 BTU 0100,000 BTU .. SUMMARY OF FEES ••
builds or improves thereon,and who contracts for such protects 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 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. (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 - ❑0.100,000 BTU 0100,000 BT • ELECTRICAL $• GRADING $
information is correct..) agree to comply with all city and county ordinances
and-statePLAN CHECK 50% $ 3C-laws relating to building construction,and hereby authorize recce- MICROFILM $
sentatives of t'Is ity to enter upon the above-mentioned -property for - - I .Q
' Inspection pur• .se a. MECHANICAL $ O/,
Signature './L.:.. //
Reinspection Fee ' $15 Issue Fee • , $ 3 PLAN CHECK 25% $
lle
`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. 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 Grind. 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 _ 6/1')57 ([' i. Fencing &Access Approval - • .
17. Rough Wiring Sign ''KK 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# _ 2
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 Framing73. Undergrnd.Storage Tank 0 Gas 0 Oil i
25. Roof Sheathing 74. Overhead Hydro '" •
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical .
.
27. Frame and Flashing - 76. Dry Standpipe
28. Lathing& Siding I 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 7-3o$'1 J C Notes:
34. Final Heating & Air Conditioning f
35. Final Gas Pipe-Test
36. Hood or Canopy
37-. Final Factory Fireplace •
38. Final Plumbing
39. Water Service-Final "
,40. Gas Service-Final -
41. Solar Domestic-Final 1 • "
'42. Backflow Preventer •
43. Backflow Irrigation :
- 44. Landscape Irrigation System . - i
• "45: Sound Attenuation ,-
i
• 46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48: Special Requirements Completed •
49.' Electric Release to Edison n ,
50. Gas Release to Southern California Gas Co .
51. CERTIFICATE OF OCCUPANCY -
No. Date
.
5' ZZ zz )
-.LO a �ustL ,-/ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
PERMIT TRACT NO. LOT NO. UNIT NO.
CITY 6F COSTA MESA CRNSTR CTION PERMIT pa�37 300 /25 II - i2
Project Address,�5. t)41 /1C\C �/41 �Q? 1'�i
,Applicant •
's Marlin Address 1 TYPE OF CONSTRUCTION vim,NEW Li ADD U ALTERATION U REPAIR
1 I$�, CI CONVERSION ❑ DEMOLISH ED OTHER A.P.# Zone.
OwneriName •S' IIY t9L *epos Phone L1x' DESCRIPTION OF WORK/USE OF BLDG.
Address /701'2 MVQL 1 A1� Jamie, CA. 92t0' • ,E Main Building: Accessory Building:
• z
Arch/Eng. License No. TYPE OF PERMIT U GRADING•II��IUI FOUNDATION 0 STRUCTURAL T Front G
Address ante()
[[�� /� p�.��" ' ❑ TENANT ❑ ELECTRICAL her PLUMBING ❑ MECHANICAL B Rear f l \\ �i \l N
Contractor's Name L_NIteO Ka- ("I.. mb)a V3°- SI" ❑ OTHER A y 0 I
( C) Phone C Right �� F N
Address(mailing) / F . CMl1NAAtl .QN4141 N1 Cia- 81807 PROJECT DESCRIPTION SQ. FT. OCCUPANCY K /N G
-f / CON ST RUCTION TYPE VALUATIONS $ Left lit VittR
City License No. � � ` � . ZONE •GRADI NG CU.YDS. ACRES s y 1 E
LICENSED CONTRACTOR DECLARATION Ping. Ref.# C Z( !(4, , Parking Req./Provided
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: g g 7 3 5 Planning Notes: .J NI
with.section 7000) of Division 3 of the Business and Professions Code,and • Cr'-' � IC"--- my license is in full(arced effect. �/ niJ r I OF n� J `, T
(�p Ucedse Class —z�y�License No. i.7 r--,ri j`I S
Date t92 t7 Signature OGf/s-' "fl/� /wr1 PLUMBING FEES , /tsq
WORKERS'COMPENSATION DECLARATIO - Bar Sin •
k Showers ELECTRICAL FEES
hereby affirm that I have a certificate of consent to self-insure or a certificate
• if Workers' Compensation Insurance, or a certified copy thereof (Sectlofl•,- •
Backflow Pieventer Service Sink Automatic Washer Transformer-❑ 15.50 KW
NO Polic, Lab. C.) cg76451 c1S Aer d C/5o L.Ty 0 50+ KW -
�,�1 Policy No. Company ' Backflow Irrigation _ Sewer Cap' -• Construction Pole Sub. •
� Certified copy is hereby furnished. /1 yy�� - -
"Certifie copy is tiled with the city it g I ion. -h Bathtubs - 2 Sewer Connection - IA DI/ Cooking Unit �� "Meter ❑up to 100 amps
Date / -�7 -� Applicant ' NN 1
EXEMPTION FROM WORKERS'COMPENSATION DECLARATIO Clarifiers Solar Collectors, - Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100)dr /
less)-' ;j Dishwasher. - ,T Solar Piping OD Dryers ❑Gas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit is Issued I T
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank - Fan Motors❑0-1 HP ❑11A-8
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool wlSpa • F.A.U. Inc.Solar ❑9-15 HP 0161 5*
NOTICE:If,aftermaking this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked. /^ / /�
CONSTRUCTION LENDING AGENCY 2. Gas Service /0 Outlets W 'Water Closet ' �� ,IJ Device Boxes .1 '
I hereby affirm that there is a construction lending agency for the performance ,7D Pole Light
of the work for which this permit Is issued (Section 3097 Civ. C.) Interceptors • , 2, Water Heater L{. (� Outlets' ' Range •'�
Lender's Name - - `mob( . `AUL
Lender's Address - - 2 Kitchen Sink • 2 Water Service Switches - - - ' -
OWNER BUILDER DECLARATION n Sign
' I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories 2 Auto-Wash ^^
following reason (Section 7031.5 Business and Professional Code: Any city or rri.N� Garbage Disposal Standing Sections
county which requires a permit to construct,alter,Improve,demolish or repair P.
• any structure, prior to its Issuance, also requires the applicant for such permit Trap Laundry Trays Generator 00-5 KW❑5-15 KW Trash Compactor
to file a signed statement that he/she Ivlicensed pursuant to the provisions of Roof Drains -.
the Contractors License Law(Chapter 9(commencing with Section 7000)of
tivision 3 of the Business and Professions Code) or that he/she is exempt
sorefrom 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 -
penalty of not more than Live hundred dollars($500). • '
U 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 I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL • FEES
• License Law does not apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own Boiler • I Hood or Type I ❑ DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such Improvements are not intended or offered forZoning Approved By bate
•
.sale. If, however, the building or improvement is sold within one year of corn- Canopy Type II ID. , oration, the owner will have the burden of proving he/she did not build or Im- Duct- Under Ground � _ Building Approved By Date
• orove for the purpose of sale). !L7/.�/
I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date CS/L7
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law oes not apply to.an owner of property who Duct-Ventilating - ❑0.100,000 BTU ❑100,000 BTU - -
bullds or Improves thereon,and who contracts for such projects with a con- • SUMMARY OF FEES • -
tractor(s) license pursuant to the Contractor's License Law). I am aware that- Exhaust System 0 Multiple 0 System Repair/Alteration - BUILDING PERMIT $ SMIP $
proof 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.ICBO# 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 ❑0100,000 BTU 0100,000 BTU - 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 $
sentative of this c• to enter upo the above-mentioned property for '
Inspects n p poses. 1 l —277 i MECHANICAL $ TOTAL FEE $ 53.3.CO
Signature W W Date
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
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. r/77 Pr 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 ,� i/i Sri 62. Backwash & Receptor-Final
12. Sewer Cap r`! / /�//� 63. Heater & Vent-Final
13..Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 4-ta' c..go 65. Electrical-Final
15.' Rough Electrical-Conduit 66. Solar System-Final •
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
•
18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro
1 �
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 7-(-xl LFA .
36. Hood or Canopy ` 253/ Fi „
37. Final Factory Fireplace �f' !�'�
38. Final Plumbing •i(scla (a° -
39. Water Service-Final i/M v? L°1
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 -
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
z�30 153 App1IpAterill in all spaces except thole lthin heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CON$_ TFjUCTIONPERMIT I ( Pm IT NO. TR TNO. LOTNO.. IT NO. I, 7714 El : i_j:7a7�� �'I:oG
Project Address D. 0-x531 V.
`r-� • r gar2e9'0.1 `}'`\_T"/Y'PaEI-cai U D
r Applicants Mallin Addre V. al; , i / OP-CONSTRUCTION %NEW ADD U ALTER TION REPAIR l
❑ CONVERSION 0 DEMOLISH ❑ OTHER A•P•.�b Zone
Owner's G 1- .G�r.sp.�, Phone�.y- DESCRIPTION OF WORK/USE OF BLDG. '
Address NaNO/ r Li...., d•`� dnn.-.•.w .a S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT U GRADING U FOUNDATION U STRUCTURAL T Front ZO
Address - •r ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING r. MECHANICAL g N
��-� �� .�� .."9/c...- ❑ OTHER A Rear _ _ . 1
Contractor's Name �. `�"—s�_`'J„ Phone C Right N
PROJECT DESCRIPTION SQ. FT. OCCUPANCY
Address(mailing) 3/ �n, ttt��� -�� CON STRUCTION TYPE VALUATIONS K Left G
City License No. OSS /.L/ •`' R
ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided E
LICENSED CONTRACTOR DECLARATION (^/ 0
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: girt 1 .zt_ A G 73 �f/J" Planning Notes: ` V p M
with section 7000) of Division 3 of the Business and Professions Code, and 'Fig b Ol �u ��VED '��`I � 0� -
' RE T
my license is in f I for nd effect.
License CI ss License No.C-Z 4 S
I" Date4 /$r S'7 Signature �-- -....� � PLUMBING FEES
•
WORKERS'COMPENSATION D LARATION Bar Sink Showers
' I hereby affirm that I have a certif cate of consent to self-insure or a certificate _ ELECTRICAL FEES
1 of Workers' Compensation Insurance, or a certified c pYc thereof - --4—
Backflow Preventer Service Sink
3800, Lab. C Automatic Washer Transformer ❑ 15-50 KW -
Policy No ___y7fr-5 z. 7 CompanySi Backflow Irrigation Sewer Cap Construction Pole Sub... 0 50+KW
Certified copy is hereby furnished.
ertifiie} co is filed with the city gond- ivislon. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date (PTION/ Applicant Sst•.tiG�•w-•S/) Al Lt..;_____
EXEMPTION FROM WORKERS'COMPENSATIONEC ON -r Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps . -
(This section need not be completed if the permit Is foror hundred hundred (2100)or
less). Dishwasher- . Solar Piping Dryers ❑Gas [(Electric. Sub Panel -
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 Drinking Fountains Solar Tank Fan Motors 00-1 HP 01%-8
Workers' Compensation Laws of California. 1Y - _
Date Signature . Floor Drains • Swimming Pool w/Spa F.A.U. Inc.solar 0945 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 ,
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 HeaterOutlets Range Name .
Lender's Address Kitchen Sink Water Service I Switches
OWNER BUILDER DECLARATION Sign • ,
I hereby affirm that I am exempt from the Contractor's License Law for the lavatories Auto-Wash Garbage Disposal
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 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 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 (0-
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 cam- 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
move for the purpose of sale). p
LJ I,as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Datn !T 11
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 $ PERMIT
0 lam exempt under Section - B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $
Date Owner Heating System& Ducting It.,, Registers 11 Ct PLAN CHECK 25% $ ENERGY P.C. $
1 hereby certify that I have read this application and state that the above a"-100,000 BTU 0100,000 BT sf OD ELECTRICAL $ GRADING $
information Is correct. I agree to comply with all city and county ordinances r/V
and state laws relating to building construction,and hereby authorize repro- PLAN CHECK 50% $ MICROFILM $
sentatives of this city to enter upon the above-mentioned pr perty for - t•'
inspection rposes- ,y'� property
MECHANICAL $ — • PD TOTAL FEE S aft.at)
Signature `E OO-s'T+v t✓Y Date 7 �,r�
Drivers' ansa or SS# �_(�. .� Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $' S V
CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL &SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressurer.Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-Gl9NITE
7. Footings 58. Electrical Conduit-Undrgrrrcl.
8. Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, tUndrgrnd.
ti!
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring - 67. Fencing & Access Approval •
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning 4p$-$7 tsfoo 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 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 p(201fl c4 -
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace S
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
.t
.46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed -
49. Electric Release to Edison .5
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. '
0867 4/09/85 6000 IL
CITY OF COSTA MESA CONST
CONSTRUCTION PERMIT — PERMIT NO. TRACT NO. LOT NO. . UNIII {O. �//7 - - - -
Project Address 3530 a�"v� _►+' 1 rC3 • S Li-REPAIR "�
•
y� ///� ' TYPE OF CONSTRUCTION. NEW 'U ADD U ALTERATION
Applicant's Mailing Address 0 rz `�K -(
Owner's Name rY� - Alai •' .. Pone- 4 2--hk(�C ❑ CONVERSION ❑ DEMOLISH ❑ OTHER - A.P.#', I Zone •
..t DESCRIPTION OF WORK/USE OF BLDG.
Address 01 -S rs ' I + I • I - to 2.. - -71--e-- • S Main Building: Accessory Building:
Arch/Eng. - License No.; TYPE OF PERMIT El GRADING ❑ FOUNDATION ❑ STRUCTURAL ' T Front , O
Address ��(( 't--t1 ❑ TENANT ❑ ELECTRICAL ❑�'QPLUMBINGKMECHANICAL B Rear ' ' N
Contractor's Name•s -Q Yo-iii--- P one (QST'),/il, ,CI OTHER h's S- s
PROJECT DESCRIPTION SQ. FT. JJ •
OCCUPANCY C Right N
Address(mailing) (13 6 e - /�Q- ar K - - G
O 1P 13 1 - CONSTRUCTION TYPE VALUATION $ - $ Left ,_
City License No. ZONE GRADI NG CU.YDS. ACRESR
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
Q
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 Businesss and professions Code, and •
7JLTIIJ'_"UT
my license is in full orcgJalrnld effect. .� / a ( n • $
• License Class 11• ---�LICen a,191q� O{�y..'xv--y{t-j`�'7•�
Date `Signature f�. J iffriel /11.17 • PLUMBING FEES
WORKERS'COMPENSATION DECLARATION • Bar Sink Showers
I hereby affirm that I have a certificate of consent to self-Insure or a certificate 1 ELECTRICAL FEES
f Workers' Compensation Insurance, or a Cert copy jh re f (Section _ Backflow Preventer - Service Sink -
800, Lab. C.)- - - Automatic Washer ' Trariiformer 0 15.50 KW
Policy No. P'3��I /`� Company Backflow Irrigation ' • Sewer Cap , I Construction Pole Sub. •
0 50+KW
Certified copy is hereby furnished.
�'•Eertjfie0.Wily_is filed with the city Buildirpp Ann // 0 Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date J S Applicant Q N /a4M` '
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 ❑Gases ' -['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 D0-1 HP 1'h-8
Workers' Compensation Laws of California.
.,Date Signature -- Floor Drains' • Swimming Pool w/Spa F.A.U. J
'NOTICE:If,after making this declaration,you should become subject to the Inc.Solar 09-15 HP ❑18-15+
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. - Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water,Closet Device Boxes '
I hereby affirm that there is'a construction lending agency for the performance - POIeLight
of the work for which this permit is 'Issued (Section 3097 Civ. C.) Interceptors T Wate •
r Heater - Outlets
Lender's Name, ' ` - Range
Lender.'s Address - Kitchen Sink . i _ 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 - - - •
.to file a signed statement that'he/she is licensed pursuant to the provisions of Roof Drains '- . '
the Contractor's License Law(Chapter 9(commencing with Section 7000) of - .
'Division 3 of the Business and Professions Code) or that he/she is exempt - ,
'herefrom and the basis for the alleged exemption. Any violation of Section - - - - t •
'031.5 by any applicant for a permit subjects the,applicant to a civil . . - i
Denalty 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 1 - 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 whobuilds or improves _ _ _ _ _ - _ _ _
thereon, and who does'sucn 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 corn- - 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 Dat
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 JL�VV�-] Dat '
tractors to construct the project (Section 7044,Business and Professions Code: -
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU
builds or Improves thereon,and who contracts for such projects with a-con- -- - ,- - - - -
• SUMMARY OF FEES
tractor(s) license pursuant'to the who
License Law). 1 am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me.
' PLAN CHECK •$ PERMIT
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. (CBO# Fire Dampers; 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 L'—100,000 BTU ❑100,000BTGRADING $
information is correct. I agree to comply-with all city and county ordinances • Y OD ELECTRICAL $ '
and-state laws relating to building construction, and hereby authorize repre- I PLAN CHECK 50% $ MICROFILM $
sentatives of this city.to enter/Jr on the above-mentioned property for ' • •
Inspection purposes, A nn//��//11��I 7,�7 P DS- D MECHANICAL $ 1•Co TOTAL FEE $ S -oo
Signature —�j JT-.NX1C/ 1.� Date 3) `�4i"D ,
Drivers' Licenseroor SS ye Reinspection Fee $15 Issue Fee $®3 �� PLAN CHECK 25% ,$ -O ,
___ _ - GCC(/ _ _ .. - _ _ __
CMF 08 65-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod -Assessor
CONSTRUCTION AND PLANNING .y POOH _SPA
APPROVALS ' Permit# Date Inspector APPROVALS Permit # Date In3pectnr
1. Temporary Electrical Service or Pole 52. Pool &.Equipment Location -
- 2. Soil Pipe-Undrgrnd. ) - . • 53. Steel Reinforcement -
_
3. Electrical ConduitUtility-Undrgrnd. _ 54. Forms •
- '
4. Electrical Conduit-Undrgrnd. ° ° . 55. Electrical Bonding _
5"Steel Reinforcement •. . 56. Rough Plumbing & Pressure Test
6•;Electrical UFER Grrid. 57. APPROVAL TO COVER-GUNITE - -
7.'Footings58. Electrical Conduit-Undrgrnd. •
8..,Founclaiion t 59. Gas Pipe, D Undrgrnd., Test
9: Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
• 10:+StTuctural 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 ❑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
r
32. Electrical Power Meter-Final - 80. FOOD CERTIFICATE ISSUED
33. Final Electric ,Notes: <,
34. Final Heating& Air Conditioning tgy/i.r Cr°
35. Final Gas Pipe-Test -
36:,Hood or Canopy • i
LAI .
37.t--F(nal 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