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Home My WebLink About3540 CADILLAC AVE - Building Permits� . ' , �, � - ' COSTA MESA BUILDING-SAFETV DEPARTMENT • P.O. BOX 1200 COS7A MESA, CALIFORNIA 92626 For Applicant to Fill in Comple[ely — Use Ink Only BUILDING c ADOflESS �V OWNER � p L�Q��. MA�L �J, ADDRESS Q I G.h CITV � n �_ � . NOL -(otG FI BPANCH ADDRESS ARCHITECT �s 4227 2/28/79 302.87 TL lii�—- - n' / - -.. � �./�— APPLICATION FOR STRUCTURAL PERMIT ECEIVF BV D T EI DATE ISSUED / � � " � � � �•lg ��%2� � PERMIT NO. 8,�' TFACT I �OT OWNER � VALUE FIRE � ADDRESS \� yrp,S � Y.vQ I«'^ C�. ZONE T E I ROUP � APPROVED CONTRACTOR BV DATE ADDFESS � 0.„�;\ TEL. p� �ONyy NO.OF USE OF NEW CITY y� NO. ��.Ir pp�I �� P�'� BUILDING F STATE CITY �'ARDSAPPROVED VARDSAPPROVED LIC. NO. LIC. NO. MAIN BUIL�ING ACCESSORV BUILDING [s,� S12E NO.OFBLDGS. (FROM �TREET) - �. OF lOT � NOW ON LOT ' CS RONT FT. FT. d USE OF � � EXISTING BLDG.''_ 1 �� T FT. y � Separate permits are required for L. SIDE PT. FT. electric, plumbing and heating work. WREAR FT. FT. [.., VSE OF BUIIDING AND WORK TO BE PERFOFMED DISiANCE BET. BET. MAIN & qMAIN BLDGS. ACCESS. BLDGS. "� L , C URP. ��Q AP ROVED'J / a u. � APPROV � � ' � R� W � I hereby ecknowledge that I have reatl this epptieailon antl state ' "—"" � y� that the above Information is corract entl apree to comply with m I 0+ all laws reBuleting buildtng construction, entl I shall not employ � v z any petson In violetlon of the workman's compensation lews of m �. the Stete of Califo/�le. � • � 3 I �ereby certify ffiat I am properiy Iicensed as a contractor untler SQ. FT. �cmi � the Staie of Califof��a Buslness end Protessions Cotle, Dlvision 3, THE AMOUNT SHOWN UNDEF VALUATION IS FOR m Chepiar 9, entl t�ot such Ilc¢nses era In tull force ontl effect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: � am exempt from tna provlslons of the State of Callfornia Business o `, antl Profeasiona Code, Division 3, Cheptar 9. VALUATION ERMIT FEE E m V _%��/' l+�-�^�'Y $�/ I � ��O' PLAN CMECK E �SS � � Sipnatura of � Permittww �iY THX $ LL � I � U (� A t�f h etl Apeni TOTAL PAI D i Lv ' COSTA MESA BUILDING-SAFEZY�EPARTMENT APPLICATION F� R� R� C.�.�� (�43.00 Tl.i o n RlIY t�fl(1 rneTn ne�en rn� � nMnre a�a�a �27� �/ a��'w� PERhiIT.�r+... .._' __.. '___ _.....f...."".. _.._.. _..._..' _ RECEIVED BV PERMIT For Applicant to Fill in Completely — Use Ink Only � BV I�DING A.P. NO. ADORESS C BUILDING / OWNEROR /%/I G ADDRE55 TEfVANT �V I UNITOR MAI LI NG SPACE NO. ADDRE55 TR.NO. LOT BLK. TEL. CITV NO. CONSiRUCT10N NEW ADD ITER REPAIR MOVING DEMOLISH LENDER BRANCH ^r� / OWNER \/ ADDRESS �— � VALUE ARCHITECT TEL. VSE��I,' OFi ENGINEER ADDRESS ZONE TVPE GFOUP APPROVED CONTRACTOR BV DATE ADDRESS TEL. CITV NO. STATE CITV APPROVEDSETBACKS LIC. NO. �IC. NO. SI2E NO.OF BLDGS. (FROM C/L STREET) OF LOT NOW ON LOT OM FT. USE OF EXISTING BLDG. Separate permits are required for �, SIDE FT. electric, plumbing and hea[ing work: REAR Fr. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION DATE /1PPROVED APPROVED I hareby acknowletlpb ihat I heve reatl this applicetion and state °1 thet che above informetion is correct and aBrae to comply with � FOit SPECIAL REOU[REMEN'i''� � all laws re8uleting bui�tlinp conatruction, and I shall not employ � any pe�son in violatl0n of the workman's compensallon laws af d the Staie of Califarnle, m I hereby cartity that I am propetly licensetl as a contractor under S0. FT. a the State of CallfornlB Buzineu antl Protessions Cotle, Division 3, 7HE AMOUNTSHOWM UNDER VALUATION IS FOR m Chapter 9, antl that sUeh licenses ere in fuli torce antl effect, or I THE PURPO6E OF ESTABL6HING A PERMR FEE NLV: e am ezempt from tha provisions ot the State oi Californie Busineu and ProfessionsCotle, Division 3, Chapter 9. VALUATION PERMIT FEE E m SlgnaturBaf PLANCHECK E '^ 0 Permittee $ TAX E f or V Authorizetl Agent Date TOTAL PAID S -. WSo soxEtzoo CIOSDTIA M SAFCALI ORNAIA 9 626 T APPLICATION F��'RI�C�T� PERMIT .� RECEIVEDBV PERMIT NO 48130 For Applicant to Fill in Completely — Use Ink Only BVILDING �( O C�� G A.P.NO. ��Q' ��07. � � ADDRESS V / OWNEROR _'r��M F m� �I-. l�lj/ ADIDRE55 S � TENANT `/ V N� //�.�� UNIT OR ADDRE 5 / � ��` aHt /`O� SPACENO. T�NOG 6_a LOT / b BIK. TEL. n Q CITV Q/� NO�/ q,� NEW ADD LTER REPAIR MOVING DEMOLISH CONSTRUCTION cK� �/ �h � LENDER /— BRANCH JO� �N,P/ /T� � /f OWNE � � � LL ADDRESS O �(,J �- �� . VALUE OR EN INEEFi �(�j i.N C TEII/a/ pQ)/ USE S 7 r o w- ADDRE55 ZONE I�YI � TVPE GROUP APPROVED CONTRACTOR O��IeY " / CY 8r DATE ADDRESS �� p'( �Y QM� . TEL. CITV h � No. ya� � F STATE CITV �. .QPPROVEDSETBACKS LIC. NO. —� LIC. NO. � SIZE `i .3 � NO.OFBLDGS. O (FROMGLSTREE ) � C. OF l0T � � NOW ON LOT RONT F. a USE OF '/ � EXISfING BLDG. /� � N H FSeparate permits are required for L SIDE FT. 0 electric, plumbing and heating work. REAR Fr. F USE OF BUILDING AND WORK TO BE PERFORMED PLqNNING ACTION Q � OATE a� L �Q� APPROVED � APPROVED 3a } � 0�. W � I hereby acknowledge thet I hava reatl this application and state O y� that the above Information is carrect antl aB�ee to comply with 0+ all laws regulatlnB builtling construction, antl I shall not employ Z any person in violation of the workmen's compansation laws of W Me Smta ot California. 3 I hereby cartify that I am properly lieensed as e contractor under SQ. FT. ihe Stata of Calitornia Business antl Professions Cotle, Division 3, THE AMOVNTSHOWN UNDER VALUATION IS FOR Chapter 9, antl that such licenses ere in ful� torca antl effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLv: am exempt from the D�ovizlons ot the $tate ot CalltOrnia Business VALUATION PERMIT FEE E . O O antl Profes5ions Code, Divislon 3, Chapter 9. � �� /jPLAN CHECK E �— Signatura of /��s+�w'' y/' / Q a . Permitte S Y TAX E � 1 ,1=.30 -79 �j� �/ T izetl AOant Date TOTAL PA1 D S 8� S�./ . COSTA MESA BUILDING•SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 • For Applicant to Fill in Completely — Use Ink Only 9UILDING�C�O /��D�L�C ^ v �� ADDRESS � �-� /� ANT R ARcti�-v� c� � � APPLICATION F R I RECEIVE BV P _ A.P. NO. `3�, � BUILDING /J��O ADDRE55 ,� UNIT OR SPNCE NO. � URAL PERMIT - ` �5071 _ io' r'�, �ll..c A✓@- CITV �JT/ J MCJA CA N� /,v `a � O NEW ADD AL� REPAIR MOVING CONS�RUCTION A2CH �Y� r LENDER BRANCH n OWNER �� `Oi ADDRESS VALUE ARCMITECT TEL. U5E rM+• A !� • : OR ENGINEER ADORESS ZONE M TVPE �ZfROUP OCONTilACT R /�IIeCH/� �,'OJe{! ByPROVED OATE ADDRESS 3�QO CA/i/LL/�C �O� /� TEL. %� CITV � IV��/ � NO.�/-QZ% F STATE CITV APPAOVEDSETBACKS UC. NO. LIC. NO. {c� SIZE NO.OF BLOGS. (FROM C/L STREET) L OF LOT NOW ON LOT OM FT. '� EXISTINGBLDG. G7CK9K-l0 Rwc�v/��% h FSeparate permits are required for L SIDE FT. Q electric, plumbing and heating work. REAR FT F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION a Q ��JTC�1��O� /v � APPROVED > „�� - r a 04D FOR SPECIAL REQ m �� I hereby acknowlatlpa that I have reotl this ep0��ation end ttnte y� that tha ebova In/ormallon ia corract antl aprae to comply wIM � all lewe repulatinp Gu(Itlinp eonrtrueHon, entl I shell not amploy ,Z eny oerwn in violation of Me warkman'� eompeneation Inws ot � Ma State af Calitornle. 3 I hereby <ertlfy Mat I em propelly Iicensed af a contrector untler S�' the Steta oi Calitornle Busineu entl Profeuions Cotle, Dlvisian 3, THE AMOUN' Chapter 9, antl tha[ such Itcanns ere in tull forca antl affxt, or 1 TiE PURPO6E em axampt from the provisiona of the Steta of California Businau VALUATION antl Protezsions Cotla, Dlvision 3, Chapmr 9. � ♦ � Sipnature of //➢,//,^', Pormlitee .AN`f.l.GL�N(� $7/��i— o, � Z g�L AuthoNzatl A;•nx naee _i S °' ; i m 7�.so.., m 7 VN UNDER VALUATION IS FOR m 'ABLISNING A PERMIT FEE ONLV: � PERMIT FEE E � � N n PLAN CHECK y . � o TAX S , j O f U TOTAL PAID E% . I C7 MITCHELL, JOHN F. DA7E 5-30-79 J08 ADDRESS 3b4U Gatl711dC !GENERAL CONTRACTOR wner- r. No. 9- 52-04 LOT TR/ iNSPECTIONS SI �, yoi� .s �TER OUGM PLUMBING PAOP. $WR. LINE MOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROU6N MEPTING �NO �IN CONOITIONING TEMPOR�RV SERVICE OR POLE ' UN�ERGROUNO POwC11 ROUGX WIRING TRENCNES FORMS STEEI PEIMF. y FLOOR SVSiEM � BONO BE�M SiEEL REINFORCE SHEATNING FRRME �NO FL�SNING LATMING - IN OUT PLr15TER, BROWN CORT STRUCTUR�L, FIN1L NEATING. VENT., REFRIG. �N� �.C., FINAL PLUMBING. FINAL �ND GRS TEST n SUBCONTRACTOR PERMIT N0. osure CITY OF COSTA MESA3 a b Project Address Applicant's Maili ddre5 .3 , Owner's Name � �� Atldiess � AM/�� —t Arch/Eng. Address Contractor's Nam� Addresslmailin9l-?�% � Ciry License No. � LICENSED CONTRACTOR DE L T I hereby affirm that I am licensetl untler with sectlon 7000) oJ.�Divis n 3 of [he my li<ense is ip fwl j6r[e a ect. � Dat Signature � ti--�� WORK RS PENSATION DECLARATION � I hereby af(i m that I have a certifitate of consent {�. ' Worker/s' aCyo�mpensation Insurance, or a cer J , ��. �Jf 1 X �I � �Y%�� ,.'_"'.. the city PERMIT Applitant to fill In all ipaces eace0t �nose wlthin heavy bortler IineS antl si9n all aoP�oDriata tleclarations. TYPE OF CONSTRUCTION , ❑ CONVERSION ❑ 1 IIYIR�Ji[S ALTERATION No. TVPEUF PEXMIT ❑ GRADING ❑�UNDATIO STRVCTICI ❑ TENANT ❑ ELECTRICAL ❑ PLUMBIN� ECHANICAL �Phon � ❑ �OTHER WECT DESCRIPTION Sa. FT. oCCUanrvcv CONSTRUCTION TYPE VALUATION $ _ ZONE GRADINGCV.VDS. ACRES— ot Charter 9 (commencing Remarks: antl Profes "�ons e, � �� , �elf ' ure r a certiticate Bar Sink op r of (5 Backflow Preventer Backflow Irrigation � . �� Bathtubs Clarifiers (This section neetl not be completetl i( the permit is to one undretl ($300) ar less) I certify that in the performance oi the work tor which this perm�t is i5suetl I shall not emplOy any pe�son in any manne� so a5 to become SUDject to t�e Workers' Compensation Laws of Calitornia. Date Signa[ure NOTIGE: If, atter making this tleclaration, you Shoultl become subject to the Workers' Compensation provisions of the Labor Cotle, you must forthwith comply with such provisions or this permit shall be tleemetl revoketl. CONSTRUCTION lENO1NG AGENCV . I hereby afBrm that there is a construction lentling agency for the performance of fhu wark for which this permit is issued (SeCtion 309� Civ. C.) �entler's Name Lentler's Atltlress OWNER BUILDER DECLARATION - I hereby affirm lhat I am exempt trom the Contractor's License �aw for the following reason (Sectlon 7031.5 Business antl Professional COGe: Any clty or county wnich requires a permit to construct, alter, improve, tlemolish or repair any sVucture, prlor to its issuance, also requires the applicant for such permit to file a signetl statement that he/she is licensetl pursuant to Ihe provisions of the Contractor's License law (Chap[er 9(commencing with Sectlon 7000) of Division 3 ot tne Business antl Professions Cotle) or that he/she is exempt "'^refrom anG the basis for the allegetl exemption. Any violation of Sectlon 71.5 by any applicant for a permit subjects the applicant to a civil alty of not more than tive huntlretl tlollars (E500). J I, as owner of the property or my employees with wages as their sole compensalion, will tlo the work, antl the structure is not intentletl or.of(eretl for sale (Section 7044, Business antl Protessional Cotle: The Contractor4 License Law tloes nol dpply to an owner of a property who builtls or improvcs �[hereon; an0 wM10 tloes such work himself/herself or through his or her own Iemployees, o�ovitletl that such imo�ovements are not intenaea or otteretl for 5ale. 1f„however, tne builtlin9 or improvement is soltl within one year ot com- pletion, the owner will have the burCen ot proving he/she tlitl not builtl or im- �rova fOr the purpo5e ot sale). I, az owner of the Oroperty, am exclusively contracting with licensetl con- tractors to constru<t the project (Section 7044, Business antl Protessions Cotle: The Contrattor's License Law tloes not apply to an owner o( property who builtls or imoroves thereon. ana who contracts for such oroiects witn a con- tractor(51 I�cense pursuant to ine ConVactor•s License Law). I am aware Iha� proof o( tM1eir Worker's Compensation insu�ance Should be provltletl to me. ❑ I am ezempt untler Section B. S P. C. for thls reason Date Owner 1 hereby certity that reatl this aooi�canon antl Information is correct I a ee to comply with all <ity a dO(i SIdI2 �dWS relati �O U�IdIl1 COI15LfUCIl00� dflG IIf sentatives of this-c y e ter n the above-mer Inspectlon purpose . Sl9nature / =y�-�--- I I P Orivars' Li<ense or 55 # Reins ec[ion Fee 0865-46, rev. 5/88 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor Drinking Foun[ains Floor Dreins Floar Sinks • Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains , _ I Reinspaction Fee � $15 Boiler • Duct'-UnderGround Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Facc Blt. iC60 I He ting System & Du ' 100,000 BTU �1 0, 6'� $15 Shawers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Cbset . Water Heater Water Service Auto-Wash laue Fee Hood or Typel ❑ Canopy Typell ❑ BTU Issue Fee • A.P. # S Main Buildi REPAIR E T Front B Rear A C Right K Left �S Ping. Ref. # Planning Notes: $ 3 FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers �Gas ❑Elec Fan F.A.U. Fixtures Device Baxes Outlets $wi[che5 Garbage Disposal Generetor 00.5 KW C Zone Accessory Building: Parking ReqJProvided ELECTRICAL Transformer ❑ 75-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over100amps Sub Panel Motors �41 HP 01 Yh - 8 Inc. Solar �9-15 HP �16-15+ Microwave Pole Light Range Standing Sections 5 KW Trash Compacmr � Reinspection Fee !$15 � � laue Fee UEVELOPMENT SERVICES REQUIREMENTS: Zoning Appraved By __ Building Approved By APPliotfon laued By _ FEES $ 3 O N I N G R E Q M T S. SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT .�- PIUMeING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM $ MECHANICAL $ � . TOTAL FEE $ PLAN CHECK Z5% $ �J.T� vl tIG�29477-0002?977 TOT 33.9D CATE� 04f05/89 TI17E: 12:42 y� { l �n� �, ,p� CONSTRUCTION AND PLANNING _' ' POOL 'A , Date Inspector � Date Inspector APPROVALS Permit # ' i t APPROVALS Permit # L Temporary Electric8l Service or Pole'. - -� '. 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. �'. '� • '� � 53. Steel Reinforcement 3. Elect�ical ConduiuUiility-Undrgrnd. '1 . 54. Forms - i 4. Elecfrical Conduit-Undrgmd. , � , � 55. Electrical Bonding .. 5. Steel Reinforcement , �✓ �� 56. Rough Plumbing & Pressure Test 6. �Elect'rical UFER Grnd.J, 57. APPROVAL TO COVER-GUNITE `� ,, i -7. �Footings � ,., ;; „ 58. Electrical Conduit-Undrgrnd. � �� . �8��Foundation � �� ' � '� 59. Gas,Pipe, O Undrgrnd., Test ' " i' � �9. �Water� Pipe-Undrgtnd. -'? �.� "' � 60. Backwash Lines, P-Trap, O Undrgrnd. � � 10rStr,uctural Floor System �� ; � � f r� 61. APPROVAL TO DECK ; � 1 t, Property Sewer� Line�& House Connection � 62. BacRwash & Receptor-Final 72.Sewer�Cap -:,-'.! ' � ' '' 63. Heater&VenbFinal �- " � 13..Roof Drains " `�-f. 64. Plumbing System - Final '� '� 14. �Rough Plumbing �!'�� ;� 65. Electrical-Final , -� �15. Rough-Electrical=Coraduit 66. Solar System-Final - : 16., Rough Electric Wi��ing 67. Fencing & Access Approval � - " �,1-7! Rough Wiring Sign ' 68. APPROVED FOR PLASTERING 18; Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough`Heating & Air Conditioning FIRE DEPT. REQUIREMENT t �� 2B. Rough:FactoryFireplace APPROVALS Permit# 27. Ducts, in'Structure 70. Underground Hydro '� �� T� 22. Duets;�Ventilating 71. Product Piping � Gas ❑ Oil � "" � 23. Gas Pipe-Rough & Tesi � 72. Underg'round Flush "� ' . 24.�RoofFraming � 73. Undergrnd.StorageTankOGas ❑Oil,�,� � `�� V , .� 25. Ro,pf'Sheathing 74. Overhead HYdro � ' , _. ` ; 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical „,_, . 27. FrameFandFlashing . 76. DryStandpipe ;� '" �� 28. Lathirig�& Siding 77. FIXED SYSTEM FINAL �' ' 29. Insulatian� 78. FIRE PREV. FINAL 30. Drywall�Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Bfown Coat � 79. FINAL INSPECTION- _ 32. Eleetrica�l Power Meter-Final 80. FOOD CERTIFICATE ISSUED + �•' � 33. Final Electric Notes: � . 34. Final'Heating & Air Conditioning B�_�G G�� 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 `�' -'� • �. i 43.�Backflow Irrigation •- i- (1_r 44. �Landscape Irrigation System '`. 45. Sound Attenuation- � 46.'Flandicap Regulations 47. FINALSTRUCTURE&BUILDING � 48. Special Requirements Completed , � 49. Electric Release to Edison 't._ ; f' . �.� 50. Gas Release to Southem California Gas Co � •� "� -'•; �� 51. CERTIFICATE OF OCCUPANCY aY �;. {, �;'' �.`i No. � Date � � � "?� �_i APPLICATION FOR A BUILDING PERMIT BUILD NG�PERMIT NO. Eiectr�wi m Tract Block Lot Permit No. � Atltl�ress �/SYO l..i/-l.[/��.L/"�� AV CM �� , Q Plumbing c Permit No. � Cross %ORO/�Ji� {,(f Mechanlwl 6 Area Street SV l�.%F�W6�. Pormit No. �- ,./ 'm Owner ��(�j.rN � L✓1 �TC�c` L� MD. I'V— TYCe of Proj c[: ❑ New ❑ Alter L7 Atltli on �(((��,��, AAtlress Zg6� �1T��A+�T� flV �tE 22�} � Repair ❑ Convart ❑ Demo ❑ Otwpan Pmt. r n V � CitY �/v(7 r�.{yL H�ZIP9� Phone � 2� A.P. $uP. DISt./ � Inso. Area O qrcnitect/ 1 /1 �-j ( E Dasigner /iT � Licenze No. Zone SPI. Pmt. No. Atltlress �L� �DI�� V Setbacks P/LFron[ C/LSt. StreetWiGth � VartlS Lett ght ¢a� CItYC�rA �� C� ZIP � Phone�l-OZ%9 � 0�� - ave o . 'e 9 _ . En97neer License No. (�� `� Park ng SPates qu re -- rovi overe 1 p, Atltlress �` m Clt Zip Phone Sbuct No. of No, ot R Y Helght Stories / Family `+' y IICENSED CONTRACTOR'S DECLARATION Park Fees ves Fee � t0 � Requiretl No QT. Reteip[ m I hereby affirm that I am licensetl untler provisions ot Chapter 9 t (commancing with Secxion 7000 ot Division 3 ot xhe Businass antl ZON�9 p��Provetl By: Date _ Professions Cotla, antl my license fs in full forca and effect�. � license Clas License Num�ar � T Date Conhactor Misc. � E Atltlress Proposetl USe of Structure jy CityandZip Phone (� N CONSTRUCTION LENDING AGENCV O °� I hereby affirm [ha2 t�ere is a conshuc2ion lentling agency tor the (� aperformence of the work tor which this permit is issuetl (Sec. 309], Occ. TYpe Cotle ` Civ. C.). Class Const. Year � y Lentler's Name USE/OCCUPA V SIZE SQ. FT. � � Lender's Addrass '� OWNER-BUILDEH DECLARA710N 1 � � I hereby afiirm that I am exempt from the Coniractor's �icense Law s A fp� �.ha following reason: (� � pAA es ownor of the property, or my employees with wa8es as their 2. M� C sOlo cOmpensation, will tlo the wOrk, antl the structure is not �' �t„ intendetl or offered for sale. ' 3. D � �f, as owner of the property, am excl�sively contracting with licensed contractors to consiruct the prolect. . � ❑ I a axempt ntler Sec.� B&PC fo/r!,�y��7 r•n��y�on�� 4• (� a Date��lLOwner..G(/�,r-i!l-�Q/='H�/� // � ^'b.,/, /� � E WORKERS'COMPENSATION DECLARATION �L-� Total Valuatlon � I hereby &ffirm that I have a certificare ot consent to selt-insure, EntrodGhm¢nt Permlt equlratl Yes ❑ No or e certiticete ot Workers' Compensation Insuranca, or a certitied C topy thereof. Gratlinq GmL Gratling r� Policy No Company RepuireC ❑ V ❑ No mt. No. �a ❑ Certifietl copy is hareby furnishetl. Rough Gratling V Q❑ CertiYietl copy ie filed with Orenge County, EMA. qpprovetl by: ' Da[e � Date Applicant 3 CERTIFICATE OF EXEMPTION � FROM WORKERS'COMPENSATIONINSURANCE Z (This section neetl not be completetl if permit is for $100 or lessl. � I certify that in the performance of the work for which this permit is P issued, I shall not employ eny porson in any manner so as to become �p subject o th yyorkers' Compensetion f C lifornia. PERMIT FEE Dat ZZ �� Applicant_.e�� NOTICE O APPLICANT: If, after making this Certificate of StruCtural E Plan C etk § Exemption, yau should become subject to the Work¢rs' Compensaiion provisions of the Labor Cutle, you must forthwith comply with such Electrical y SPecial $ provisions or this permit shall be deemetl revaked. � ' Invest. I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO Plumbin9 $ ,-� - COMP�V WITH ALL COUNTY ORDINANCES AND STATE LAWS RELPjtING TO BUILDINvG COoNSTRUCTION, AND HERE9V AUTH- Mechani I E TONEZA80VEEMENTI�ONEDS fMFOPEflTV�FORyIN PECTION PUOR- pre-Gr Ge PO/$,�/$%�� n� /%� S .�H%V�G(�fA/i i� f�/j � 2� (� InsPe tion Signature of Applican[ o� Agent � Date Pre-Gr tle a Parmit s Rec. No. ISiue WILLe/q�v( R•M/Lt.F_i2 � , Print Applicant's/AgenYs Name All s ces within this box murt be com leted to rocess Plan Issuance � P P Chetk By: Approve0: CMF 0335-4fi (BU-28) rev. 6/80 . � ADG��cant to fill in all spacas witnin heavy bortic� lines ana zi9� all aoDrovriata aeclarations. CITY'OF"COSTA MESA ' j � ce IT�NO. - TRACT NO. ' 'COT� o�. � ��oc. No. , - -- -- - - 9917 12/28/81 - � -- �49� I % � TLJ CONSTRUCTION PERMIT � 2/SS'' Pri11o1- �n- 10 � • -- ��F " '''•'=�_' :' -- " "' "" Project Address C' TVPE OF CONSTRUCTION�. � , � �_ . . _ � . -. � OWnef ' Phone O NEW ❑ AD� �ALTERATION - , - � � - - � -� . ' - '- � AddfCS ' � - • - -� REPAIR ❑ GONVERSION.�DEMOLISH. , . . _ _ Arch/En � LicenseN�.' -OOTHER '� . AP� �� ZONINGREGULATIONS. Addf2i� �1 ' ��.4� ._ , D CRIPTI NOF ORK � �- a � �'� ' � ��• _ �A�i� F` i� II� VP ZONE ,BLNG.REF:� �� .. Cantracmr ' - Phone / , TYPEOF PERMIT -- ' " -' � 7p BtnLp iNG . � �../ SETBAC T. PROPERTY LINE AddIC55 � � ❑ GRADING:' ❑ F,OCINOHTION 1� STRUCTURAL I VARD ' ' - -� �� _ -LICENSED-CONTRAC O O CLARA N�� - `� - �` ,. ❑'TENANT ❑ELECTRICAL OPIUMBING�OMECHANICA - `��HT I hereby affirm that I am IlcenseU untler provisions of Charter9�(com- -� : • � mentin9^wIM section-7000)-of -DIvi5lon 3 ot [he Bu5ine55 and ��OTHER� - - - _ Professlons , a C my Iitense is in full tor an ec , REAR VARD (TO P/L) � � Lice se Class • --' en �PROJECT OESCRIPTION . _. __ - . : . ., . - . _ _ _ - ' . 5�: FT. �� PKG. SPACE REQ. PR V D.� _ �Date " Si9nature � •8 � �. �- � �� STREET VJIDTH PARK FEE $ � } -WO KERS'COMP NSATIONDEC A ATIO OCCUPANCY CONSTRVCTIONTVPE � - � ZONINGAPPROVED BV - OAT � � I bereby attirm that I have a tertillcate of consent to seli sure ona VALUATION� ZONE • certlfirate'oYWorkers"Compensati n Insurance,-or- a-cerb ey copy - - _ __ (� thereof (Section 3800, �C_),��C� /� , _ . ... L_`J_ _ ; , GRADING CU. VDS. � ,� ACRES �__ SPECIALCONDITIONS:- � II oalicr No. �CZ3mGanY I.VL�(yD'9 o�r•L .. . .. ..� -� - - -- - - -- rr-- ,. : ' Certl(letl�copyls��hereby�turnishetl.- --- !/ � .'REMARKSi" � .l1 �„k _ ' . ' _ - _ ' _ ' ' ' " ' _ ". . ' ' " " 0 l;�Certlfietl copy Is filetl with the city Builtling Division. , ,, . �. � � , ,{ ' f 1 EXEMPTION FROM WORKERS' COMPENSATION"DECLARATION ' " - �-^' '--- - "'^- ' ' - - ' - � i ..... _�(This 5ection_neetl not be completetl.if the_permit is_(or one huntlretl -- - _ • '- • � .IS100Zorless). ' i � �.� , . ".� . .I _ ' _'__'�" _ "_' " .. _... _ _. ... _.._ ._. . cert fy_that in_t�e performance ot the work for_which this permit is _. Issuetl, 1 shall not emQloy any person In any manner so as to-be<omo : PLUM8ING - .. PLAN CHECK'-- - �ECECTRICAL �' PLAN CHECK �� - subjecLto the Workerz Compensation Laws of Ullfornia._ . _ . - " _ " _. . _ _ _ . Date � Si9nature BATHTVBS SHOWERS � ' . � NOTICE: If after making thls tleclaration, you shoultl become su0ject 'TOILETS�� n:� ; -• URINAL'S' �� ' - " GENERATOR" 0-1 KW_ 1-10 KW �� to the Workers' Compensation provisions of the labor Cotle, you muzf � __ _ _ TRANSFORMER .� . - - forthwith comply with such provisions or this permit shall be tleematl LAVATORIES DOUBLE LAVS "- - -APPLIANCE -� -'�0-50 KW_50'+-KW ' - .revoketl._. _ �.' " ' " " _ __ "_ ' CONSTRVCTION LENDING AGENCV � KIT. SINKS �- � DISHWASFiERS'" '- MOTORS ' - 04 HP-=1d0 HP "-' ' ' 1 hereby aftirm that there Is a wnstruttion lentling agency for the perv SE0.VICE SINKS'�',' �' SUMPS� '�'- - -" -ONC. SOLAR) -30-SO�HP=50 +�Hp - � (ormdnt¢ ot the work for wnlch this permit is issuetl (5¢Ction 3097 C��' �'�' � �FLOOR.SINKS � ; FLOOR DRAINS � � '- �FIXTURES- - OUTLETS SWITCHES " � " - �entler's,Name. Lentler's AGtlress � DRINKING FOUfJYAINS �� - - " '- 'GAS-TUBE SIGNS ^" ' "" -'--- '-- - OWNER BUILOER DECLARATION�i " 'l � " � °' � 1 - - - '- " ` POLE LIGHTS"� " "--- ' '"` " --' ' '"� 1 hereby aHirm tnal'I'am exempt from the Contractor's License Law for ��NTERCEPTORS CLARIFIERS 'the'following reason'(SecHon 7031.S�Business antl ProfessionrCotle: SWIMMINGPOOL� �P•TRAP- -� � � ` '- ' - ---' Any city or county which requires a permit to mnstruct„ alter, POlES METERED � SVB� •'1 'improve,-tlemolish-or'repalr any s[ructure, prior to its issuance, also re- ',yyqTER SERV ICE � A'LTERATION -� � PANELS ��" �- MAIN : CSVB . - " , quire5 Ih¢ ap�.liGant fo� such pe�mit to.tile a Sign¢tl Statert�¢nt that h¢� - ��- � is licensetl pursuant to the provisions'o( [he.Cmtractor'S'License law : GAS SERV ICE'- OUTLETS � � SERV ICE '" - -'- -AMP-' '' ' r (Chapter 9'(commentinq .witb Settion 7000) of Division 3 of the � - �- � "8usine55 antl Prdesslons Cotle)'or thaC ne is'exempt theretrom antl tbe� `-y�qTER HEATERS,� - � BTU�OUTPUT �� " " - � '" ""' - ' - n•sis for the allegetl exemptlon. Any ;violation of Section ]031.5 by- "appticant 'for a'.permlt sub7ectr tha applicant to'a civll �penatry' ' SEWER CONNECTIONS � '� �' --- - �� " ' ""- " - ' � ' ' ' - - iot more t�an /ive'nuntlretl tlollars'(§500). • \__,- � ^ - '� 7 _. I, as owner ot the property, or my employees witti wages �as�thelr SOLAR TANK - � COLCECTORS - - - -" " ' - .- "^� �:� -, - sole compensation, will.tlo the work, antl [he structure.ispot intentletl. � 1 or oTferetl for sale. (Sectlon 7044, Business antl ProfeSsions Code: The SOLAR PIPING SYS. '� � ��SSUE FEE� �- ' ' ''"' � Contraclor'S-License Law tloes not apply to an owner_of a propertY ' APPL'ICATION'APPROVEO BY wno bWltls or Improves thereon, antl who tloez such work himsel! or ISSUE FEE � � - �'DATE� p .ttlrough hi5.own.CrtlplOy¢¢5, prOvitl¢tl tM1dt 5uch i�TProveTents are not, intentletl or oifinetl tor sale. If, howeveq the builtling or improvement MECHANICAL PL•AN CHECK SUMMARV-OF FEES �,.; i,� ^ .is Sold within one year of completion, IhE ownev will hav¢ the bu�tlen �j ' ' � ot proving he tlitl not builtl or improve for the purpo5e of Sale). HEATING $YSTEM 0-300,000 BTU PERMIT G+ b � ��SMIP �- E O•Sa � -�-I, as •owner of -the property, am �exclusively conVacting with qND DUCTING ' ' - ' " ' ` - � - - licensetl contractors (o construct the project (Section 1044, Business 100,000+BTV P�ANCHECK y_J� r PERMIT� , , antl'PrOfessions Cotle: -Tha Contractor'S Licens¢ Law tloes not apply to �- - ISSUANCE S an owner of Oroperty wM10 builtls or improves tnereon, antl who con- REFRIGERATION 0-100,000 BTV PLUMBING E ,-�� ,f � r' ' tracts from� zuch-Orojects��with a� contractor(s) licesnetl pursuant-to SVSTEM - ' ' • ' ' - - � - � - - � GRADING -S y the Contractor's Llcense 1.aw). 100,000 + gTU �' PLAN CHECK S� , ,.. . _ �� ❑ 1'am exemp[ under Section ' - - -' B. & P. C. for this gOILERS BTV bR ELECTRICAL E reason-' - - ' ' - PLANCHECK- E - N1ICROFILNI.§ -Date - Owner SVSTEM REPAIR,ALTERATION , . . � � ' I hereby certify tbat I have reatl this a MECHANICAL '§- - ._ TOTAL FEE $ � pplita[ionantlstatethattheabove EXHAUSTSVSTEM MVLTIPLE - LE55liD=' � � informabon is correcL I ee to co ply with all city antl munty �- PLNNCHECK E - VANCEPC $_ '� orAinances an0 state la Ung to t truction, antl hereby thorize ��' �� ' � \ representaUves of thi i to upon ttie above� nti tl ' ' �' property tor ' t' _ � ` , �, Sl9natu�e _ ,� _ _ ' "'_ _ _- _ ' " _ - ' FINAL FEE E • / ' Drivers' Litense or 55 � - '�SSUE FEE , -- - . - . � CMF 0865-46 Wnite-BuilUing; Gnary-Applicant; Pink-A<countin9; GOIEenrotl-Assessor