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Home My WebLink About525 ANTON BLVD - Building Permits�� Applieant to /iii in all sDaees exce0< <�ose wit�in �eavY �orEer Iinas an0 sign all aporopriate Oeclarations. CI7Y oF COSra nnESA ONSTR CT�ON PERMIT Project Address Dyy � Applicant's Mailing Address � � / � Owner's Name ' I ^ � L� one Address %��^�C ��% i e�vc � G�9 9qe�sa i Arch/Eng. -,,,�-;t aL .LicenseNo. D�Dg2 / Adtlress %G�!_/l ' -✓ Z Contractor's Name — �Phone7�� Address Imailingl �l��77i.L/� �m.o A/%!/ia,�/ Ciry License No. _��5�� LICENSED CONTRACTOR DECLA0.ATION 1 hereby a/firm fhat I am li[ensetl untler provislons Of Charter 9(Commencing with section 7000) of Division 3 ot the Businezs antl Professlons Cotle, antl my license is in tull o�ce antl etfect. �� iconso CI s O ic nse Datc/�1p7p?_ Si9nature WORKE0.5' COMPENSFTION ARATION , '�� ereby altirm that I have a ce ' cale o( consent to selt-insure or a certificate � ' Worke�5' CompenSatiOn In u�ance, o� a ce�tifietl copy tne�eot (Section e0o, �b. C}L9�� 3 �D�I/L .1,aLi tV Policy No. f'�— Company� "V ertifiea copy is hereby furnishea. Certifietl copy i flletl with the city B Itlin9 ' sio . L � Dale_(0=�� Applicant �EXEMPTION FROM WORKERS' C ENSATION DECLARATION (Thissetlion neetl nal be complete i ihe permit is for one huntlre� (5300) or less). I Certily that in thG pGrformant th¢ work for which lhis pe�mk is Issuetl, I shall not omploy any persOn in any manner s0 as [o b¢com¢ Subject to th¢ Wo�kers' Compensation Laws of California. Date �ignature NOTICE: If, af[er making this tleclaratlon, you shoultl bemme subject ro tno Worker5' COTp¢nSdtiOn prOvi5ion5 ot N¢ LdbOr Cotle, you must (olttlwith comply witM1 suc� ProviSiOns or [nis permit shall be tle¢mCtl revoketl. CONSTRVCTION LENDING AGENCV I ba�eby a1�I�m thal t�e�e is a consl�uclion lentlin9 agency fot the perfo�mance oi the work fOr whith thi5 p¢rmi[ i5 ISsuetl (Settion 309� Civ. C.) Lenaer's Name Lantler's AGtlress OWNER BUILDEN DECLARATION 1 hereby alfirm that I am exampt from the Contractor's Llcense Law for tno lollowin9 reason (Sattion ]031.5 Buzlnesi antl Prote55ional COUe: Any clty or munly wbich requir05 a pe�mlt lo ConS[ruct, all¢r, improve, tlemolish or r¢pair any SVucture, prior to Its iszuance, also requlres the apP�icant �or such pormit lo ti10 a slgnBtl slatement Ihdt he/The is IicenS¢tl purSudOt 101b¢ Provl5ion5 of the Contractor's License Law (Chapter 9,(commencing wi[n Sectlon ]000) ot Divlsion 3 ot IhR BuSinlss antl Profe551on5 COtlG) or Ihat he/sne i5 ¢xCmpt hereirom anG Ihe basis (or the all¢9¢tl Gxemp[Ion. Any violatiOn ol $ec[Ion ,j131.5 by any applican[ tor a petmll SubjCCtS Ih¢. applicant to a<ivil � �Gndlty ot nol more lhan five huntl�etl tlollars (5500). I, as owner of thC Ptoper[y Or my emO�oYeeS with wag05 as thei� sole COTp805atIOn, will tlo the wOrk, antl Itle iVuttuf¢ IS nOt IntBntled Or OII¢r¢0 lor salc (Section ]044, Business antl Professional Cotle: The ConVactor's Licenso Law tloos not appy to an owne� 01 a property wb0 builtls o� improv¢S tM1oreon, antl who aoes such work Nmselt/herselt or tnrou9h nis or her own emoloyees, provitletl that such improvements are not Intentletl or olleretl for sala. If, howuver, tha oulltlin9 or improvement Iz soltl within one year o/ com- pletlon, tne owner will have tne burtlen ot proving he/she tlid not buila or Im- prove iorthe purposa olsale). ❑ I, as owner Ot the OrOperty, am excWSivety contracting with Iicensetl Con- traCtorS to COnst�ucl the Orojetl ($ection 7044, Business antl Prot¢zsions Cotla: The ConVactOr'S lic¢nse Law tloes not dppty [o an owner OI P�op¢rty who builtls or improves tnereon, ana who contracts for such proje<ts wltn a con- tractor(s I�cense pursuant to t�e ConVactor's License Law). I am aware that prool o� ttleir Worker'S Compensation insurance sboultl Ge O�ovitletl to me. ❑ I am exempt untler Section B. & P. C. for this reason CI Date _ I hereby cE Informatlon antl state la sentatives c Inspectlon p Si9nature _ �rivers' Li 1F OB65- , r Owner _ have reatl this or 55 � a pro G� J `-� V V `1 TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OT R A,p.� DESCRIPTION OF WORK/USE OF BLDG. � Te=�rv�� S Main Buildi E TVPE OF PERMIT GRADING FOUNDATION STRUCTV RAL T Ffant ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAI 8 Reer ❑ OTHER %� PROJECT DESCRIPTION Sq. FT.�� 7 OCCUPANCV � C Right K Left CONSTRUCTION TVPE f � VALUATION $ 3 S ZONE GRADING CU. VDS. ACRES Ping. Ref. # Remarks: �(� R 7 Planning Notes: Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Orinking Fountain5 Floo[ Drains Gas Service Interce(Itors KitcFen Sink Roof Drains Reinspection Foe Servite Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping . Solar Tank Swimming Pool w/Spa Outlets Water Closet Water Heater Water Service AULO-W85I1 Laundry Treys $15 Issua Fae �uct - Under Ground Duct - S[ructural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact, Blt. ICBO � Heating System & Ducting ❑0.100,000 BTU 0100,000 Reinspec[ion Fae � $15 10/84 White - Builtling: Canary - ApPlltanq Pink - ACGounting; GoltlenrOtl - Assesso� Hood or Type I � Canopy Tyyi 11 ❑ ietriger on System 7a ,000sru ❑ioo,000 System Repair�Alteretion Fire Dampers Registers I�sue Fee FEES $ 3 $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures Device Boxes Outlets Garbage Disposal Generetor �0-5 KW �5-15 8486 10/2B/B7 Zone Accessory Building: Parking Req./Provided ELECTRICAL, Transformer 15�50 KW / ❑ 50+KW Meter ❑up to 700 amps Meter pover100amps Sub Panel Motors �0-1 HP � 1 X- 8 Ina Solar �9�15 HP �16�15* Microwave Q Pole Light Q Sign Standing Sections Trash Compactor � Reinspaction Fee �$75 � � Issue Fee DEVELOPMENT SERVICES RE�UIREMENTS: Zoning Approved By Buildin9 APProved By Appliwtion luued By G 66o85�TL FEES S 3 Z O N I N G R E Q M T S SUMMARV OF FEES� . BUILDING PERMIT $ �SMIP S PLAN CHECK $ PERMIT PLUMBING $ �SSUANCE S . � PLAN CHECK 25% $ ENEFGV P.C. $ ELECTRICAL $ � GRADING 5 PLAN CHECK 50% $ Z'7 � MICROFILM S Q/ MECHANICAL $ TOTALFEE _ $ _$�� (IZ PLAN CHECK 25% $ CONSTRUf,TION AND PLANNING � Yl' �� : �' ` �.POOL & SPA ' ._ F\PPROVALS Permit# Date Ins�c'or qppROVALS� Permit# Date Inspector . � ; � 11..Temporary Electrical Service or Pole 52. Pool & Equipment Location i 2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement, � 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd: 57. APPROVAL TO COVER-GUNITE 7. Footings � 58. Electrical Conduit-Undrgrnd. � 8. Foundation '� 59. Gas Pipe, O Undrgrnd., Test . � 9. Water%Pipe-Undrgrnd. � � 60. �Backwash Lines, P-Trep, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line�& House Connection � ; 62. Backwash & Receptor-final 72. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final ' 75. Rough Electrical-Conduit 66. Solar System-Final - 16. Rough Electric Wiring � 67. Fencing & Access Approval 17. Rough Wiring Sign �� '� 68. APPROVED FOR PLASTERING 78. Rou9h Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL � - 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ( 20. Rough Factory Fireplace APPROVALS Permit # _ 21. Ducts, in Structure 70. Underground Hydro - 22. Ducts, Ventilating 71. Product Piping OGas OOiI � 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil ' 25. Roof Sheathing 74. Overhead Hydro . , ''' 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe ' �-' I 28. Lathing & Siding � 77. FIXED SYSTEM FINAL • � �� 29. Insulation 78. fIRE PREV, FINAL '� 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 37. Plaster Brown Coat 79. FINAL INSPECTION , '� 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric � Notes: � � , ' 34. Final Heating & Air Conditioning Ii� 35. Final Gas Pipe-Test 'y � 36. Hood or Canopy 37. Final Factory Fireplace . 38. Final Plum6ing ' . � , , i 39: Water Service-Final . . � '' i . 40. Gas Service-Final . 41. Solar pomestic-Final � � � � • � ' 42. Backflow Preventer - ' ' � � ,43. Backflow Irrigation � � ' . � , . � ' . i • r' 44. L•andscape 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 � . i No. Date Aoplicant to fill in all spaces exceo� those within �eavy Gortler lines ana sign all approDriate tleclarations. CITY OF COSTA MESA CONSTRUCTIO}�N/ PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NU. ProjectAddress �2�rw� ��pO'� U 1 �d . 1' 3353-1 �- � p L6� E� UUN7t'YL f�UE ANANE TVPEOFCONSTRUCTION " NEW ADD �ALTERF�TION I ApplicanYsMailingAddress y� - i' � F•�-.L � - ❑ CONVERSION ❑ DEMOLISH OTHER Owner's Name Phone DESCRIPTION OF WOR UUSE OF BLDG. '��=� Addreu 7 �T_�fi_� ✓' �ktV'tC' O YLt�_i-il�le REPAIR Arch/Eng. License No. 4-37Z� TYPE O PERMIT ❑ GRAoi G Foor oATION ❑ STRUCTURAL Addre55 . �NANT ❑ ELECTRICAC ❑ PLVMBING ❑ MECHANICAL Coniractor's Namrg��O � CP4G+L'�EY� PL'JIA$d1� onelA''�• %�%S/ld OTHER � -' �� Address (mailing) 52� e. �}uN-rr� A�f�. A�1At1�,ht, -�, PROJECT DESCRIPTION 5�. FT. occUaANCv �� 3dS CONSTRUCTION TYPE y-' VALUATION $ u..�VU � G City Lic¢n5¢ NO. 20NE GRADING CU. VDS. ACRES LICENSED CONTRACTOft DECLARATION . iI hereby affirm that I am licensetl untler provision5 ot Charter 9(commencing Remarks: � 22 with section ]000) of Division 3 of the Business antl Profe55ion5 Cotle, antl C- 'e'Q � my license is in full forc¢ antl eftect '3 � � License Clasz '� � icen o. Date U-7.'1- SSK Signature � ' PLUMBING FEES WORKERS' COMPENSATION DECLARATION � - Baf Sink � Showers � I hereby aHirm that I have a certi(icate oi mnsenl to selt-insure or a certificate ^f Worke�s' Compensation Insurance, or a certifietl coOY th¢reof (SeCtion ' �o Backflow Preventer Service Sink \' 70, Lab. CJ n�a.� icy No.?�k�OOI03S'(/�T.!'�pany_Na}_-t.��de- Backflowirrigation SewerCap �ertifietl copy is hereby fumishetl. - Certifietl ropy is fileC with the city.8 ivi i Bathtubs Sewer Connec[ion � Date �J1 �!-� 'U� Applicant � EXEMPTION FROryM WORKERS' COMPENSATION DECLA ION Cle�ifi¢fi � SOId� COII¢ctO�S (This section neetl not be cOmpletetl if the permit is f0/ One hun0�ed (El 0)br , less). Dishwasher Solar Piping, I certify that in the performance of the work for which this pe�m�t is issued I� � shall not employ any person in any manner so as to become subject to t�e Drinking Fountains Solar Tank ' Workers' Compensation Laws of Calitornia. - Date Signature Floor Drains Swimming Pool w/Spa NOTICE: It, after making [his tleclaration, you shoultl become subject to the Worke�s' Compensation provisions of Ne Labo� Cotle, you mu5t fortbwilh FIOOf SinkS U�i�dl comply with such p�ovi5ions or this pe�mit Shall be tleeme0 revoketl. CONSTi3UCTION LENDING AGENCV GasS¢NiG¢ Out12t5 W2LefCIOSE[ , I M1e�eGy aflirm that there i5 a const�uctlon lentling agency (or tM1e performance ' of th¢ work for .which this permit is i55uetl (Section 309] Civ. C.) InLE�c¢ptOfS Water Heater Lentler's Name Lentler's Atltlress Kitchen Sink � Water Service OWNER BUILDER DECLARATION I hereby af(itm that I am exempt from [he Contracto�'S LicenSe Law (or the Ldv3tO�i¢5 AutO-WaSh followin9 reason (Section ]031.5 Business antl Professional Cotle: Any ciry or . county which requires a permit to construct, alter, improve, tlemolish or repair P-Trap � Laundry TraYs any structure, prior to its issuance, also requires the applicant Por such permit to file a si9netl statement that he/she is licensetl pursuant to the provisions of Roof Drains ' the Conlractor'S LicenSe Law (Chapter 9(commencing witM1 Se[[ion 7000) of f]ivicinn 3 0( the BUSi�¢55 antl PrOf¢SSionS coee� o� Ihat M1C/She i5 e%empt therefrom antl�the basis for tne aueged exempuon. �any vio�auon � aecuw� '031.5 by any applicant tor a pe�mit subject5 the applicant to a civil nalty of nat more than five huntlretl tlollars ($500). � I, as owner ot the property or my employees with wa9es as their sole comoensation, wi11 tlo the work, antl the sVucture is not intentletl or ofieretl for Sale ($e<tion ]044, Business antl Protessional Cotle: The Contractor's license Law tloes not apO�Y to an owner of a property who builAS o� impmves thereon, antl who tloes such work himselt/herseii or throug� his or her own employee5, provitletl that such imprOvemen[5 ate not intentled o� offe�etl for sdle. If, however, the bwltling or improvement i5 Soltl within one yea� of com- pletion, the owner will have the burtlen ot proving ite/she tlitl not builtl o� im- .p�ove tor the pu�po5e of sale). ❑ I, a5 owne� of the p�operty, am exclusively contracting with licensetl con- trattorsto cons[ruct the project (Section 7044, BuSiness antl Profe55ion5 Cotle: The Contractor's License Law tloes nol appry to an owner of oroperty who builtls or imoroves thereon, and wno contracts for such projecfs wich a con- tractor(s imense pursuant to the Contractbr's License law). I am aware mat proof o� their Worker's CompensaHon insurance should be provitletl to me. ❑ I am exempt untle� Section B. & P. C. for this reason Dafe Owner 1 hereby cErtify that I have reai information is correct. I agree to antl stat¢ laws �elating to tli sentatives of this t�e te Inipection {� es. Siqnature orivers' License ar 55 $ ite tM1at the above county ortlinances �y authorize repre- netl property for Reinspection Fee � $15 Boiler Duct - Under Ground Duct - Strucmral Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heatin9 System & Ducting ❑0.700,000 BTU �100,000 Reinspec[ion Fea � $15 CMF 0865-46, rev. 10/84 Wnite - Builtlinq; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor Issue Fee Hood or Type I ❑ Canopy Type I I ❑ Refrigeretion System ❑o-ioo,000sru ❑ioo,oao System qepair/Alteration Fire Dampers Registers luue Fee $ 3 $ 3 A.P. # �S Main Buildi T Front B Rear A C Right K Left S Ping, Ref. # Planning Notes: Automatic Washer Construction,Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Eleci Fan F.A.U. Fixtures Device Boxes O utlets Switches Garbage Disposal Generator �0�5 KW C Fee IIF4N �:/luo�i Zone Accessory Building: Z � O . � N I N G R Parking Req./Provided E , n ' M T 5 ELECTRICAL _ Transformer ❑ 75-50 KW ' ❑ 50+KW 5 15 KW $15 Meter LJup ro 100 amps Meter ❑over'100 amps Suli Panel Motors � 0� 1 H P 01'/: - 8 Inc. Solar��9-15 HP 016-15+ Microwave' � Pole Light' Standing Sections ' Trash Compactor i Issue Fee DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By Building Approved By y� -�_�!;_.._-�— SUMMARVOF BUILDING PERMIT $ l3S-Uv PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ $ 3 9 �s ( •'z3 SMIP $ � PERMIT ISSUANCE $ ENERGV P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ � /3ro•73 CONSTRUCTION AND;PLANNING POOL & SPA ' APPROVALS IPerrtiit�# Date Inspector pppROVALS Permit# Date Inspector i� .'-L-Temporary ElectricaYService or Pole 52. Pool & Equipment Location � �.2. Soil Pipe-Undr9rnd. �' � 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 G?nd'.r � 57. APPROVAL TO COVER-GUNITE i.�. 7. Footings .- �.=; � 58. Electrical Conduit-Undrgrnd. 8. Foundation ; -� 59. Gas Pipe, 0�Undrgrnd., Test 9. Water Pipe-Undrgrnd:•� 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System 61. APPROVA�TO DECK � 11. Property Sewer Line &,House Connection ' 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final ' � 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing ' 65. Electrical-Final . � 15. Rough Electrical-Conduit 66. Solar System-Final - 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign , 6S. APPROVED FOfi PLASTERING � 18. Rou h Electrical-T Bar Ceilin �� g 9 69. POOL/SPASYSTEMSFINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT � '' !`=�- 20. Rough Factory Fireplace ' APPROVALS Permit # �. t` 21 . Ducts, in Structure 70. Underground Hydro � ' � 22. Ducts, Ventilating . • 77. Product Piping O Gas ❑ Oil �. '-1'� ' � 23. Gas Pipe-Rough & Test 72. Underground Flush �• . � 24. RoofFraming ' 73. Undergrnd.StorageTank��Gas ❑Oil � 25. Roof Sheathing _ 74. Overhead Hydro . �.y � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemiral . ' 27. Frameand Flashing 76. Dry Standpipe '�' 28. Lathing & Siding 77. FIXED SYSTEM FINAL �. �� i � 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 ISSUEq , , 33. Final Electric Notes> -7 . ' • 34. Final Heating & Air Conditioning � �- e.y� �j �S' 35. Final Gas Pipe-Test l ''"r 36. Hood or Canopy !� n� � , - ' ' (�.� � 37. Final Factory Fireplace � � -" 38: Final Plumbing - � � �� " 39:" Water Service-Final . �'� � � � �, � ' i• ��40. Gas Service-Final �� " _ • ` i i 41. Solar pomesticFinal �-� .�r ; . -� . � 42. Backflow Preventer � �� , _ - � 43. Backflow Irrigation i� _i � �� ' :� .i � 44: ,Landscape Irrigation System ' .;� • � G� �_ ' 45. Sound Attenuation ` ' � �� " � � �' � . 46. Handicap Regulations . �`� �' ;i ''' �' 47. FINAL STRUCTURE & BUILDING ��; � - ` - :�� 8., Special Requirements Completed }, � 'v " � t 49.!Electric Release to Edison � '� r, '� i .� >. 50. Gas Release to Southern California Gas Co � � 51. CERTIfICATE OF OCCUPANCY . No. Date � � - ' ! -�� t<", - � ,i . _..w . . . _ . , . � _ . � � .. Aop�icant to fi11 in all s0aces exceot those within neavy Doraer Iines antl sign all aDV/avriate aeclarationz. �ITY�� COSTAMESA CONSTRUCTION,PERMIT �' . _'��-�s—��"-z— AJ�"!//f/ �/�, Project A ApplicanYs Mailing Address � 0 � Owner's Name �7 C /� f ��7 'J Phoyne / Adtlress �3�% �i G ' /�GV�S'r�,�dlJ. /[Jlth�� Arch/Eng. ' License'No. Address ///7// /1 ��,� �� Contfactor'cNamr� p �Sfy[�{�� L�//i p�e�� Addresslm �I' 1 � h F ��.�i/JfIQ.i� �i �j�Z City License No. y��.� � L� ' LICENSED CONTRACTOR DECLARATION 1 hereby a(/irm that 1 am li<ensetl untler provi5ions of Charter 9(commencing with section ]000) of DiviSion 3 of Ne Business antl Professions Cotle, an my license is in tull t ce n e/fecL � Licenz Qnass / - e Oale��` �L S9 t � � J WORKERS' COMPENSATION DECL RATIO ' ' � I h¢reby atfirm that I nave a cer[i(itate of con5ent to SE TRu�e o� a certificate ' Workers' Compensation Insurance, or a certified copy thereof (Section i00, Lab. �,)_�DQ/0�� Poli<y No. � ompany y�� Certifietl copy is hereby furnished. Certl '�tl. �c%qy �y a f�i %Q.witb the ci ir�9 D�vi on� Oate_'Y��-�'�J-V'�- APPlica t J _ E%EMPTION FROM WORKERS' COMPENSATION DECLARAT ON (ThiS section neetl not be completetl it the permit is tor one hunOretl ($300) o� less). 1 certi(y t�at in the performance of the wo�k for which thls pe�m�t is issuetl, I shall nof employ any person in any manner 5o as to become subject to the Workers' Compensation Laws of California. �a[e Signa[ure NOTICE: If,after making this tleclaratlon, you shoultl become subject to tbe Workers' ComOenzztion provisions of the Labor.Cotle, you musi tortnwitn comply wiN such provisions or tM1is permit shall be tleemetl rewketl. CONSTRUCTION�LENDING AGENCV f, 1 hereby afilrm that�there is a constructlon lentling a9ency for the pertormance of the work for which th15 permit is issuetl (Section 3097� Civ. CJ Lentl¢�'s Name Lentler's AGtlress OWNER BUILDER DECLARATION � I hereby affirm that I am ezempt irom the Cantractor's License Law for the following reason (Section �031.5 Business antl Professional Cotle:,Any ciry or county whlch requires a permit to construct, alter, improve, tlemolish or repair any structure, prior to Its issuance, also requires the applicani tor sucn permit lo fiie a signetl statement that he/she i5 licensetl pu�suant to the provisions of Ihe ConVacior's License Law (Cnapter 9(commencing with Section•]000) ot Division 3 of the Business antl Professions Code) or that he/she is exempt 'herefrom anG the basis for the allegetl exemptiOn. Any viOlation ot Section j031.5 by any applicant (or a permit subjects the applicant to a civil �enalty of not more than tive huntlretl tlollars ($500). ❑ 1, as owner oi the property or my employees with waqes as their sole compensation, will tlo the work, antl the siructura is not intenGetl or offeretl fo� sale (Section ]044, Business antl Protessional Cotle: The Contractor's License �aw tloes not apply to an owner of a property who builtls or improves thereon, antl who tloes such work nimseli/herself or through his or her own employee5, provitletl that such improvements are not Intentletl or otte�etl for sale. If, however, the bulltlln9 o/ Imp�ovement is soltl wiihin one year of com- pletloq the owner will ttave the burtlen Ot proving he/she tlitl not builtl o� im- prove for the pu�0ose of sale). ❑ I, as owne� of the property, am exclusivety contracting with licensetl con- tracto�s to construct the project (Section ]044, Business antl ProteSzionS Cotle: The Contractor's License I..aw tloes not apply to an owner oi property who builtls or impwves thereon, antl who contracts for such projects witn a con- tractor(s) Imense pursuant to the Contractor's License Law). I am aware tbat proof of thei� Wo�ker'S Compensation insuranc2 shoultl be provi0etl to me. ❑ I am exempt untle�'Section B. & P. C. fo� this reason Date Owner I hereby certify that I�have reatl this application antl state that the above iniormation is correct. I agree to comply with all city antl county ortlinances antl state laws relatin9 to builGinq construction, antl hereby duthorize repre- sentatives of this city to e er upon the above-mentlonetl pro erty tor inspection p �6ses. Signature � - Da e/ 8 Orivers' License or 55 � — TVPEOFCONSTRUCTION .L�J,NEW LJ ADD IJ ALTERATION IJ REPAIR ❑ �pNVERSION ❑ DEMOLISH ❑ OTHER DESCRIPT NOFWOR /USEQFBLDUG � S _ TVPEOFPERMIT GRADING ❑ FOUNDATION STRVCTURAL � ❑ TENANT ❑ ELEGTRIGAI � PLUMBING ❑ MECHANICAL . ❑,OTHER PRQIECT DESCRIPTION S�.FT. OCCUPANCv CON STRUCTION TVPE VALUATION $ � . ZONE ' GRADINGCU.VDS. ACRES /"'—t Remarks: ' 2 ,!1 Q' •—��J ' � Sink Preventer Irrigation Clarifiers Dishwasher Drinkin9 Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P-Trap Roof Dreins Reinspection Fee � $15 Boiler Duct - Under Ground Duct - Structurel Duct - Ventilating Exhaust SYstem ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting � ❑4100,000 BTU 0100,000 Reinspection Fee � $15 CMF 0865-46, rev. 10/84 White - Building; Canary - ApPlicanp Pink - Acmunting; Goltlenrotl - Assessor Showers Servite Sink ' ' Sewer Cap Sewer.Connection ' Solar Collecmrs Solar Pipin9 .. Solar Tank Swimming Pool w/Spa Urinal . Water Closet Water Heater Water Service Auto-Wash Laundry Trays Issue Fee Hoodor Typel ❑ CanoPY TYPe 11 ❑ Refrigeration System ❑a�oo,000eTu ❑ioa,000eT System Repair/Alteration Registers i � Issue Fee FEES A.P. # S Main Building: E T Front ARear C Right g �eft Ping. Ref. # � i Planning Notes: Aummatic Washer Construction PoleSub. Cooking Uni[ Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures ,� • DeviceBoxe's' � OuSIELS ;.� -i Switches Garbage Dispoul " Generator 0�65 KW O $� Reinspection Fee FEES DEVELOPMENTSER Zoning APProved By- Building Approved By Aaolintian luued BY_ $ 3 0547 12/�2/87 Zone Accessory Building: Parking Req./Provided 23v00 TL ELECTRICAL . FEES Transformer ❑ 15-50 KW . ❑ 50+KW. . Mete� ❑upto100amps� � Meter ❑over 100 amps Sub Panel Motors DO-1 HP �1'/:-8 InaSolar �9-15 HP �16-15+, Microwave � � Range � Sign Standing Sections �� 5-15 KW Trash Compactor � $15 Issue Fee $ 3 S REQUIREMENTS: Z O N I N G R E Q M T S SUMMARV OF FEES � BUILDING PERMIT ,$ SMIP $ PLAN CHECK $ � PERMIT PLUMBING $ I %� Of7 ISSUANCE $ PLAN CHECK 25h $ H•�� ENERGV P.C. $ ELECTRICAL. $ GRADING , $ PLANCHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE , $ 23' � PLAN CHECK 25% $ CONSTRUf,TION AND PLANNING POOL & SPA I APPROVALS Permit # Date Inspector AppROVALS Permit # Date Ins�ector tYTemporary Electrical�Service or Pole 52. Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. �-%-$a G� 53. Steel Reinforcement � ' ' 3. Electrical Conduit Utility-Undrgrnd. 54. Forms � � 4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test � � 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE � � 7. Footings � 58. Electrical Conduit-Undrgrnd. ' 8. Foundation � � 59. Gas Pipe, � Undrgrnd., Test �i 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 6�3(1;Y ('�rf 62. Backwash & Receptor-Final � _ 12. Sewer Cap 63. Heater & Vent-Final � 13. Roof Drains 6r�3 fjjj LE� 64. Plumbing System - Final . 14. Rough Plumbing 65. Electrical-Final � � 15. Rough Electriral-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 22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil � 23. Gas Pipe-Rough & Test 72. Underground Flush i'i 24. Roof Framing 73. Undergrnd.StorageTank O�Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro �� "� � 26. T-Bar Ceiling �Structuraq & Monocoat 75. Dry Chemical i . 27. Frame and Flashing � 76. Dry Standpipe . �° � -4 � 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 , r i 37,. Final Factory Fireplace :; � ' ' ' � =' - " 38: Final Plumbing ((�g(i (ilE/J �,. �•'• y'%•� ` '� �.,39. Water Service-Final � • • �� . . _ � i �� ,. t'40. Gas Service-Final ' . � � � - i , '.41. Solar pomestioFinal y: . '� ;� � - � � ��'42. Backflow Preventer � % -' y� � � � �� 43. Backflow Irrigation � ' � �` '-' '� � . ��44. Landscape Irriga[ion System � " � 1-� �/ ' i � , , . _ j• 45. Sound Attenuation ' � �•� - � • �' r. ,. 46�., Handirap Regulations � . � `� � }' � ' �, { ' ✓ i - 47.FINALSTRUCTURE�&BUILDING '� � � � �- ' • '' . i' r > >" - 48-. Special Requirements Completed - ,: � ' ' � � 49'. Elearic Release to Edison � ,% �• • 50. Gas Release to Southern California Gas Co � 51. CERTIFICATE OF OCCUPANCY No Date - , . � _ ` _. � �1� . � .. i � .t CITY OF COSTA MESA C N TRU Project Address Appliwnt's Mailing Addreu Ow�er's Na�mer� r � AA(JlC55 Sn_ �—� %� Arch/Eng.f � l�ddress � 8. �% i D Con[ractor's Nam Adtlress Imailingl � CityLicenseNo. �3%!�/Q No. MIT AVo��ant to fill in ail spaces except thasa witnin neavy Dorder tines an0 sign all avProoriate aaclarations. ` ` /PERMIT NO. TRACT NO. LOT NO.: UNIT NO., �AR K 1 1V� C� . S=3o87Z �0�5C� .S — TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR Q CONVERSION ❑ DEMOLISH ❑ OT�5 R q p # 4 DESCRIPTIONOFWOFiK/USEOFBLDG.��/1/SR II.IL CiT LGT!)IQ� S Main I TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL ' T Front O�TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 8 Rear ❑ OTHER � � %� PROJECT DESCRIPTION 5c�. F7. oCCVanrvCv� — C Aight CONSTRUCTIONTVPE VALUATION$�.QQB�.� S Left 'ZONE �GRADINGCU.YOS. � ' ACRES . PIng.Ref. �LICENSED CONTRACTOR DECLARATION � � 1 hereby affirm tnat 1 am licensetl untler'provision5 of Charter 9(commencing �with section 7000) of Dlvision 3 oi t�e Busin s tl Professlons"Cotle,.antl my license iz in fu fo,rc antl effect. � �� License lass L ._�� ', � Date�� $I9natu�AJ(J _ /L WORKERS'COMPENSATION DECL qTION ' y Ii hereby affirm [nat I'h5ve a cer[ifitate of consent to s f-Insure or a�certlfi te t� A t Workers' Compensa[ion Inzurance, or a certlfietl copy thereof •(Se ion ' �� .800, l.ab. CJ �/` Policy rvo. WC�30257� company�NilFh �GIFIC� �. ' 8 Cer[ifietl mpy is h¢reby furnishetl. '� � '1 Certifietl mpy is tiletl with the city Builtling DiNsion. �. _ , Date Applicant , EXEMPTION FqOM�WORKERS' COMPENSATION DECIARATION (This Section neetl not De complet¢tl if tha permit Is to� ane huntlr¢tl�($300).or � less). : . . '• . I certity tnat in the performance o(�Ihe work for which this perm�t ii isiuetl,�l ; , shall not employ any person In any manner so as to become subject to the� . WOrkers' Compensation LawS of Calilomla. ' Date • � $i9natute - '� NOTICE: If, after making [hi5 tlatla�ation, yau ShOWU becoTe.Subject to th�- Workers' Compensation�provisions of lhe Labor CoCe, you must-forthwith- camply wi[h Such prOvisions o� tbis p¢rmit Shall be tleemed revoketl. CONSTRUCTION LENDING AGENCV ' 1 hereby aftirm that tneie is a constructlon lentling agency for the periormance of the work �for, wnlch this permit is issuetl (Section 3097 Civ. C.) Lender's Name. +-� lentler'S Adtlres5 — OWNER BUILDER �EGLHRATION ' 1 hereby a(firm that I-am exempt from tho Contractor's Lirense Law for tne tollowing reasoq (Section 7031.5 Business antl Professlonal Code: Any city or tounty whicti requires•a pe�mit to const�uCt, alteq Improve; tlemolish or repai� any structure, prior to� il5 isSuanC¢, also reqWres Ihe applicant for�sucn permit to file a signetl staterrient [hat he/she I5 Ilcensetl pu�suant to tlte p�ovi5ion5 of the Contractor's License Law (Chapter 9.(commencing with Section ]000) of 'Division'3 of [M1e Buslness antl Prof¢SSiOns Cotl¢) or that h¢/She is exempt therefrom antl the basis for Ne alle9etl exemptlon. Any violatlon ot Section 7031.5 by any applicant fo� a pe�mlt subjects the applicant fo a civil penalty of not more than five huntlretl tlollars ($500). ❑ I, as owner of tha property or my amployees wltM1 wagos as fheir sole com0ensation, will tlo lha work, antl th¢ Slruc[U/e Is not in[entletl o� offeretl for sale (Section ]044, Business and Pwtessional Cotle: The ContractoPs License Law tloes not apply to an owner of a properry who builAs or improves thereon, antl who tloes Such wOrk hlmself/he�self o� through M1is or her own employees, provitletl that such impiovements are not Intentletl Or ofteretl for sal¢. It, however, the bulltlin9 or ImprOvement I5 soltl within one year of com- pletion, the owne� will have [he burtlen ot proving h¢/She tlitl not builtl Or im- � �rove tor the pu�pose oi sale). I, a5 ownet of the Oroperty, am exGlusively con[�acting with IicenSetl com � t�aG[Ors [o construct Ihe project ISectlon 7044, Business antl Protessions Cotle: � The Contractor's License law does not appry to an owner of pmperty who . builtlz or imoroves thereon, antl who conVacts (or6uch projetts with a con- Iractor(s) license pursuant to the CoM�attor's Lfcense Law). I am aware [hat proOf Ot their Wo�ke�'s CompenSaUOn insurance Shoultl-be pwvitletl to me. ❑ I am exempt untler Section B. & P. C. (or this reason Date Owner I hareby certity that I have reaC lnis appllcati infOrmation is correct. I agre (p comply wi[h.al .antl State laws ielating to 'IBin9 Constr +CNO sentatives of this cit I�e insoectlon purpos! . � $ignature Drivers' License or 5 � .F 0865-46, rev. 30/84 White - Bulltling; Canary Remarks: :� � BaGSink Back(low Preventer Backflow Irrigation , Bathtubs Clarifiers . Dishwdsher Drinking Fountains Floor Drains . Floor Sinks Gas Service , Outlets Interceptors ' � Kitchen Sink-�. - Lavamries � P-Trap Ro rains Reinspec[ion Foo . Boiler ` Duct � Under Ground Duct - Svuctural FEES 'Showers . � Service Sink Sewer Cap Sewer Connection Solar Collectors / Solar T k • S ' min9 Pool w/Spa. — Urinal � Water Clout ' i Water Heater - � � Water Service � � !. � Auto-Wash � ' Laundry Trays � $15 �Isue Fee - ' $ 3 Exhaust System �' �Multiple ❑ Firepl/Fact Blt. ICBO �h I Oai oo,000 Rainspaction Fee I $75 Ilcant; Pink - A<countin9: Goltlenrotl - AsseSsor Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑aioo,000sT' ii Syste epav/Alterati Fire Dampers Registers . Issue Fee FEES � � $ 3 �'L' ' � ig: / �j � �t� , � 7 � +� Jn 5� Automatic Washer ' Construction Pole Sub. Cookin9 Unit Dishwasher � Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlet5 ' Switches Garbage Dispoul Generator ❑ KW C I Reinspection Fee � DEVELOPMENTSE� Zoning Approved By Building Approved By STRvcTu R�E. 8377 10/27/97 1�.�32e7�� TL Z�ne 0 Perk'rngfieq./Pravided - ELECTRICAL - ' Transformer � 15-50 KW � ❑ 50+KW Merer �up ro 100 amps . Meter ❑over 100 amps Sub Panel � � Mororz�0.1 H�ih-8 Inc.Solar 9-15HP�16-15+ Light Standing Sections Trash Compactor � i Z O N 1 N G A E 0 M Issue Fae ' I .§ 3 ' ITS: ' Date ��7'�� SUMMARV OF FEES . BUILDING PERMIT s A7an .So SMIP $ Z3 • . PLAN CHECK $ / d�S pERM1T PlUM81NG $ ISSUANCE $ ,PLAN CHECK 25% $ ENERGY P.C. $ - ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM $ MECHANICAL $ , TOTALFEE $Iat332�7L� . PLAN CHECK 25% $ ' ' i / � CONSTRUCTION ANp pLANNING APPROVALS Permit# . 1. Temporary Electrical $ervice or Pole 2. �Soil Pipe-Undrgrnd. . 3. Electrical Conduit Utility-Undrgmd. 4. Electrical Conduit-Untlrgrnd. 5. Steel Reinforcement 6. Electrical UFER Grnd: 7. Footings , 8. Foundation' , 9. Water Pipe-Undrgrnd. � 10. Structural Floor System 11. Property Sewer Line & House Connection 12. Sewer Cap 13. Roof Drains- 14., Rough Plumbing 15. Rough Electrical-Conquit i6. Rough Electric Wiring 17. Rough Wiring Sign 18. Roug ectrical-T Bar Ceiling 19. Rough Heati g& Air Conditioning 20. Rough Factory Fireplace 21. Ducts, in Structure 22. Ducts,'Ventilating ' 23. Gas Pipe-Rough & Test 24. Roof Freming 25. Roof Sheathing 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing 28. Lathing & Siding � 29. Insulation 30. Drywall Nailing 31. Plaster Brown Coat 32. Electrical Power Meter-Final 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37: Final Factory FireplaCe 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System - - 45. Sound Attenuation 46. Handicap Regulations , 47. FINAL STRUCTURE & BU�LDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No.' Date - Date POOL & SPA Inspector qppROVALS Permit# 52. Pool & Equipment Location 53. Steel Reinforcement � 54. Forms 55. Electrical Bonding � 56.� Rough Plumbing & Pressure Test. 57. APPROVAL TO COVER-GU.NITE , 58. Electrical Conduit-Undigrnd. . 59. Gas Pipe, 0 Undrgrnd.,;Test 60. Backwash Lines, P-Trap,-� Undrgrnd. : 61. APPROVALTODECK � ' 62. Backwash & Recepfor�Final � 63. Heater & Vent-Final 64. Plumbing System - Final • . 65. Electrical-Final � i 66. Solar System-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING . 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT � - APPROVALS Permit# , - Date Inspectoi; .� .. , 8 70. Underground Hydro � 71. Product Piping OGas �OOiI 72. Underground Flush � . ' 73. Undergrnd. Storage Tank � Gas ❑ Oil 74. Overhead Hydro ' 75. Dry Chemical 76. Dry Standpipe - � � .. 77. FIXED SYSTEM FINAL, ' 78. FIRE PREV. FINAL ' • HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION . 80. FOOD CERTIFICATE ISSUED Notes: