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Home My WebLink About711 17th St - Building Permits ((Public))Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OP COSTA+�M�ESA CONSTRUCTION PERMIT PERMIT NO TRACT NO. LOT NO. UNIT NO Project Address �/1]'fes,�t+rT►� /�%� £,t Applicant's Mailing Address Owner's Name Ti2c�:'�Nrf.�i rCil7 _Phone Address Arch/Eng, License No. Address Contractor's NameM L A iZ?1 LrCT21 L Phone 4 7 %- A < Address {mailing)/`I9,4 r X31: }'AJC i .4T liil.Ct]R17rJc;t�n3 9 2�i6 City License No. 3� S LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of C wter 9 (commencing with section 7000) of Division 3 of theM ess and rofessions Code, and my license is in full force and effect. rf License Class �� a Fcense 2 nate x'10' -f Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to seif-Insure or a certificate -)f Workers' Compensation Insurance, or a certified copy thereof (Section 800, Lab. C.) Policy N061C S /0 737d Co eCertified copy is hereby furnished Certi ietl copy sailed with the cit B 'I vision. Date-�O 4 - Applicant J— - EXEMPTION FROM WORKERS' COMPENSATID DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued I shall not employ any person in any manner so as to become subject to tale Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is ,issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 1 31.5 by any applicant for a permit subjects the applicant to a civil s Rnalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/hersolf or through his or her own employees, Provided that such Improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletlon, the owner will have the burden of proving he/she did not build or lm - rove for the purpose of sale). I, asowner of the property, am exclusively contracting with licensed con- tractor sto construct the project(Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and _who contracts for Such projects with a con- tractors) license pursuant to the Contractor's License Law), I am aware that proof of their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section i B. d. P. C. for this reason Cr Date Owner I hereby. certify that I have rea information' rre . agree to and state I ws re ng o buildi sentatives f this it y to ente inspection rpo Signature Drivers' License or SS �F this application and -stale that the above imply withall city and county ordinances constr tion, and hereby authorize repre- cpon h above-mentioned property for Date 9' ; E 33 TYPE OF CONSTRUCTION F1 NEW ADDI I ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P 9P DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING 0 FOUNDATION 0 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ S Left ZONE GRAOING CU.YDS. ACRES Ping. Ref. 0 Remarks: Planning Notes: 5848 1/16/85 Le 5U TL Zane Accessory Building: Z a N I N G R Parking Req./Provided E Q M T is Bar Sink PLUMBING Showers FEES ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter El up to 100 amps Clarifiers Solar Collectors Disfiwasher Meter ❑over 10_0 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan I Motor 1 HP ❑1'h - 8 p0, Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 1:19.15 HP 1116-15+ Floor Sinks Urinal Fixtures Microwave Gas Service, Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches 'Sign Lavatories P -Trap Auto-WashGarbe Laundry Trays Dis a g Disposal Generator ❑0.5 KW 115-15 KW Standing Sections Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee 5 3 ' MECHANICAL FEES Boiler Hood or Type I ❑ Canopy Type 11 ❑ DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date ate —Date— QLP Data Duct - Under Ground Duct - Structural Duct Refrigeration System ❑0-100,000 BTU 11100,000 BTU Duct - Ventilating SUMMARY BUILDING PERMIT $ PLAN CHECK $ $ PLAN CHECK 25% $ ELECTRICAL $ L4ACU PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ OF FEES SMIP' $ PERMITPLUMBING ISSUANCE $ 1 ENERGY P.C. $ GRADING $ () MICROFILM $ TOTAL FEE $� 1 Exhaust'System ❑ Multiple ❑ System Repair/Alteration Firep1lFact. Bit. lCBO Fire Dampers Heating System & Ducting 00.100,000 BTU ❑ 100,000 BT Registers Reinspection Fee 515 Issue Fee $ 3 IF 0865-46, rev. 10/84 White - Building; Canary - Applicant; pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING Date ' APPROVALS Permit # Inspector POOL ,'A APPROVALS Permit # Date Inspector 1, Temporary Electrical Service or Pole 52. Pool &Equipment Location 2. Soil,Pipe-Undrgrnd. 53, Steel Reinforcement 3' Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5.,Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation : 59. Gas Pipe, ❑ Undrgrnd., Test 9,,.Pater Pipe•Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10, Structural Floor System 61. APPROVAL TO DECK I1'.'Property Sewer Line.& House Connection 62. Backwash & Receptor-Final 12 Sewer Cap 63. Heater & Vent-Final 13..,Roof Drains f ` ' 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. Rou.1h Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOLISPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 3p) Drywall Nailing HEALTH DEPT. REQUIREMENT Plaster Brown Coat 79. FINAL INSPECTION 2�Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric a.� Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. 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 5fl. Gas Release to Southern California Gas Co 51. CERTIFICATE OF, OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUS-TION PERM�IIT1 o�ree.,r n n TRAPT Aifl , f17 PIf1 w,iT Project Address ;V W • / ST `+" Applicant's Mailing Address A-1 4A "'i Owner's Name rkc:, ��- - � Phone Address Arch/Eng. License No. Address Contractor's Namrn r S Ce: Phone -27 s -n Address (mailing) City License No. —7-&- Z LICENSED CONTRACTOR DECLARATION I hereby affirm that I bm licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in full fonZeand effect. License Class C � -Z G License Not (nit 2-2-67— Date _2-67Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate -if Workers' Compensation Insurance, or a certified copy thereof (Section 800, Lab. C.) Policy No. Company eCertified copy is hereby furnished. ' Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not he completed it the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner s 5 to become subject to the Work e Com ensatio�y6aws of Calif=' Date ^ � . !_-:3 Signature �xf NOTICE: If, after making this declarati , you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith • comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 ;q'031.5 by any applicant for a permit subjects the applicant to a civil "`:%.Menalty of not more than five hundred dollars ($500). 3'L.� I, as owner of the property or my,employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for We. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above Information is correct, 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city enter upon the above-mentioned property for Inspection � s. t Signature z� Drivers' License or,SS VL TYPE OF CONSTRUCTION LJ NEW Ll ADO LJ ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORKIUSE OF BLDG. S Main Building: E TYPE OF PERMIT 0 GRADINGEl FOUNDATION U STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YOS. ACRES Ping. Aef. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service / Outlets Interceptors Kitchen Sink Lavatories P --Trap Roof Drains Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # �� Heating System & Ducting ❑0-100,000 BTU 111100,00013T Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater fWater Service Auto -Wash Laundry Trays Issue Fee Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System 00-1100,000BTU E-)100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric 9936 3/25/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW 4-1 ❑ 50 + KW Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 05-15 KW Meter LJ up to 100 amps Meter Dover 100 amps Sub Panel Motors ❑0-1 HP 111 4 8 Inc. Solar ❑9-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 10.54 TL FEES Z O N I N G R E G M T S $ 3 Reinspection Fee 1 $15 1 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REOUIREMENTS: Zoning Approved By Building Approved By Application issued By Date Date Dat BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 2596 ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ $ $ $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ $ 3 = CONSTRUCTION AND PLANNING 7Date'Inspector APPROVALS Permit # POOL iPA APPROVALS Permit # Date inspector 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. y' Electrical Conduit Utility-Undrgrnd. .53. Steel Reinforcement 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 - 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, D'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 Plumbingr fJ 65. Electrical -Final 15, Rough Electrical -Conduit 66. Solar System -Final �6. 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydra 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank © Gas E] 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 4 36. Hood or Canopy 37. Finai 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. FINALSTRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date s Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. Do CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address, 711 W. 17th St. Bldg (C) Unit 9 Applicant's Mailing Address 13110 Saticoy St. N. Hollywoo Owner's Name Troy Investment Fund phone 549-2988 Address 4321 Birch SIt. Newport Beach, Ca. Arch/Eng. Marin J.RoQk License No. Address 19S€31 Knott Ave. Suite 216 _ -_„_, Contractor's Name itioi iri Phone 982-1216 Address (mailing) 131 W Saticoy t . N . HO11 ood, Ca. City License No. 33999 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions o Charter'9 (commencing with section 7000) of Division f the Business Professions Code, and my license is in fullfory(ynd of ct. 346251 License Class [[UU c so No. Date '4.118184 Signature WORKERS' COMPENSATION CLARATION I hereby affirm that I have a cer icate of consent to self -insure or a certificate rif Workers' Compensation In urance, or a certified copy, thereof (Section 3800, Lab. C.) Policy No. — r—vY�.7vz- Company Lumbermans Certified copy is hereby furnished. Certifi co y is filed with the city B ding Divisi4h 1 Date Z Applicant l W ii'1 EXEMPTI N FROM WORKERS' COMPENSATION D CLARATION (This section need.not be completed if the permit Is for one hundred (5100) or less). I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be "deemed revoked. CONSTRUCTION LENDING AGENCY; I hereby affirm that there is a,construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's' Name Lender's Address - - OWNER BUILDER DECLARATION i hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, pelor to its issuance, alto requires the applicant for such permit 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 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 fora. permit subjects the •applicant to a civil Penalty of not more than five hundred dollars ($500). L1 I, as owner of the property or my employees with wages as their sole compen$ation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business anti Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, andwho does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burd(an of proving he/she dld not build or.im. prove for the purpose of sale). ❑ 1, as owner of the property, am ekciusively contracting with licensed con- tractors t6 construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does hot apply to an owner of property who builds or improves thereon,.and _who contracts for such projects with a con- tractors) license pursuarit 'to the Contractor's aw License L). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information Is correct, I agre o comply with all city and county ordinances and stat s relating to rl ing construction, and hereby author a repre- sentatl $ of this city t e er uppn the above-mentioned e'ty o.] inspec n pu poses. Signature Date Drivers' L' nse or SS _...1� $ 3 - Reinspection Fee $15 Issue Fee TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Dai” ' Dat ' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Q.P. 2# Zone' ` DESCRIPTION OF WORK/USE OF BLDG. I S Main Building: Accessory Building: SUMMARY OF FEES $ $ $ $ S $ $ 13.00 $ 2.50 SMIP $ PERMIT ISSUANCE $ *� ENERGY P.C. $ GRADING $ MICROFILM $ - TOTAL FEE $ 15.50 i System Repair/Alteration E Fire Dampers Z TYPE OF PERMIT El GRADING FOUNDATION STRUCTURAL T Front O ❑ TENANT 1:1ELECTRICAL ❑ PLUMBING ® MECHANICAL B Issue Fee $ 3 N ❑ p Rear - I ,OTHER C Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY K G CONSTRUCTION TYPE VALUATION $ S Left R ZONE GRADING CU. YDS. ACRES Ping. Ref. °# Parking Req./Provided E Remarks: Planning Notes: ,a M T ' S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW ` Backflow Irrigation Sewer Cap Construction Pole Sub. 1 ❑ 50 + KW Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00-1 HP E11%-8 Floor Drains Swimming Pool w/Spa ' F.A.U. Inc. Solar 09.15 HP El 16-15+ Floor Sinks Urinal Fixtures - Microwave Gas Service Outlets Water Closet _ Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign , Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO '# 1 Heating System & Ducting C]0-100,000 BTU ❑ 100,000 BT r Reinspection Fee I $15 AF 0865- fi, rev. 10/84 r ng; anary - ppllcant: Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Dai” ' Dat Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU 01100,000BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL, PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ S $ $ 13.00 $ 2.50 SMIP $ PERMIT ISSUANCE $ *� ENERGY P.C. $ GRADING $ MICROFILM $ - TOTAL FEE $ 15.50 i System Repair/Alteration Fire Dampers Registers g 6 �� t Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS - Permit # Date inspector POOL.- .PA APPROVALS Permit # Date Inspectn'r 1. Temporary Electrical Service or Pole p 52. Pool &Equipment Location 1 , _ y .2. -Soil Pipe-Undrgrnd. 53, Steel Reinforcement 3: Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. "~ �, 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. -8: Foundation •"~' 59. Gas Pipe, ❑ Undrgrnd., Test +' 9. Water Pipe-Undrgrnd. y :,.•r 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash &Receptor Final ' 12. Sewer Cap 63.- Heater & Vent -Final 13. Roof Drains 64. Plumbing System- Final " r.% 14. Rough Plumbing 65. Electrical -Final ' r 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oi1 23. Gas Pipe,Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Stdrage Tank ❑ 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 PREY. FINAL 30.Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Piaster Brown Coat 79. FINAL INSPECTION + 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: '34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. water Service -Final 40. Gas Service -Final 41. Solar Dornestic-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 fo 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. 00 CITY OF COSTA MESA CONSTRJULTION PERMIT a PE IT / lA'�,/3 TRACT NO. LOT NO. T NO. a Project Address 7 1A/ / 7 T %.- Applicant's Mailing ess 7 o �% O .J Q. Owner's Name O ✓ ►' ' Phone Address Arch/Eng. License No, Address Contractor's Nam Phone? 77 >~7 y6 Address (mailing) City License No. �_`� Z_ LICENSED CONTRACTOR DECLARATION lihereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of. Division 3 of the Business and Professions Code, and my license is In full force and of ect. �O License Class C — License No. 3 o 7 Date I A S Signature WORKERS' COMPENSATION DE ARATION I hereby affirm that I have a:certificate of consent to self -insure or a certificate 41f Workers' Compensation • Insurance, or a certified copy thereof (Section 3800, Lab. C.) - Policy No. Company _ H Certified copy is hereby furnished, Certltied copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that In the performance of the work for which this permit is Issued, I shall not employ any person in any mdn�ner so apo become subject to the Worki5s' Compensation Laws of CalifornTe� Date `lam'r �f < 11ssTr �` -Signature NOTICE: if, after making this declaratiorceyou should become subject to the Workers' Compensation provisions of the ,Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name _ Lender's Address OWNER BUILDER DECLARATION " I hereby affirm that I art} exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to it% issuance, also requires the applicant for such permit to file asigned statement that he/she is licensed pursuant to the provisions of 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 antl the basis for the alleged exemption. Any violation of Section "a,�31.5 by any applicant for a permit subjects the applicant to a civil' .`�'°Enalty oT not more than five huntlretl dollars ($500). Ltl, as owner of the property or my'employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Suction 7044, Business antl Professional Code: The Contractor's License law does not apply to an owner of a property who builds or improves thereon, and who does guch work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. IT, however, the builtling or improvement is soltl within one year of com- pietion, the owner will have the burden of proving he/she did not build or im- prove fpr the purpose of gale). ❑ 1, as owner of the prgperty, am exclusively contracting with licensed con- tractors to construct the broject (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a con- tractor(s) license pursuarjt'to'the Contractor's License Law). 1 am aware that proof of their Worker's Compensation insurance should be provided to me. L7 I am exempt under Section B. & P. C. for this reason Date Owner I hereby Certify that I have read this application and state that the above information is correct. 1 agree to,comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of, this City enter upon the above-mentioned property for inspection pins. Signature Drivers' LiceW or SS =,f FEES Bar Sink Showers ELECTRICAL FEES TYPE OFCONS' RUCTION NEWI-A ADD ALTERATION L1 REPAIR Service Sink Automatic Washer Construction Pole Sub. ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # Zone DESCRIPTION OF WORK/USE OF BLDG. Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher 5 Main Building: Accessory Building: Dryers ❑Gas ❑Electric Sub Panel E Solar Tank IZ Motors ❑0-1 HP 01 A 18 TYPE OF PERMIT GRADING FOUNDATION LJ STRUCTURAL T Front _ Inc. Solar ❑9-15 HP ❑16-15+ O ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 13 Microwave' Gas Service / Outlets N ❑ •OTHER A Rear Water Heater I Range C Right Switches N PROJECT DESCRIPTION SQ. FT. OCCUPANCY Auto -Wash Garbage Disposal ; Standing Sections CONSTRUCTION TYPE VALUATION $ S G Left Roof Drains - R ZONE GRADING CU. YDS. ACRES Ping. Ref.+ Parking Req./Provided E Q Remarks: Planning Notes: M T -- S FEES Bar Sink Showers ELECTRICAL FEES % Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over.100 amps Dishwasher . Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0-1 HP 01 A 18 Floor Drains Swimming Pool vv/Spa F.A.U. Inc. Solar ❑9-15 HP ❑16-15+ Floor Sinks Urinal Fixtures Microwave' Gas Service / Outlets Water Closet Device Boxes Pale Light Interceptors Water Heater Outlets Range Kitchen Sink / Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor Roof Drains - Reinspection Fee I $115 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/,Fact. Bit. ICBO 4 Heating System & Ducting ❑0-100,000 BTU 0100,000 BT' Reinspection Fee 1 $15 AF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee _ $ 3 Reinspection Fee $15 Issue Fee $ 3 4ANICALFEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By —Data_ 1 Date Date Hood or Type I ❑ Canopy Type H ❑ Refrigeration System ❑0.100,000 BTU ❑100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL ' PLAN CHECK 50°x• MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $� $ / $ $ $ $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C.• $ GRADING $ MICROFILM $ TOTAL FEE $ System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 -CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector. POOL SPA APPROVALS Permit # Date Inspector 1. Temporary -Electrical Service or Pole 52• Pool & Equipment Location 2• S44il Pipe-Undrgrnd. 53. Steel Reinforcement 3. Ell trical Conduit Utility-Undrgrnd. 54. Forms 4- Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56.- Rough Plumbing & Pressure Test . 6- Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE i. Footings 58. Electrical Conduit-Undrgrnd. :-8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 1.1- 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` Clew 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 APPROVALS , Permit # 20. Rough Factory Fireplace 21..Ducts, in Structure 70. Underground Hydra 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72• Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 -E inal 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing ! Zsc�s (i+&J 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 fo Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date. ' CITY O9 COSTA MESA CONSTRUCTION PERMIT Project Address 7/1 Lam! 17 r,,11si L'-t+S f1� , 4 r, f/i Applicant's Mailing Address Owner's Nam, tN:.r(�S ! -�Ai1 - _ Phone Address Arch/Eng License No. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. Address _ Contractor's Namel"Q0,i3 1-f lclgc f C. Phone Address (mailing)4%V'�J 6r N T` 57 - City /City License No. !3 :7 CI d -- LICENSED CONTRACTOR DECLARATION Phereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business an Prof es ons Code, and my license is in full farce and effe License Class Licen No. Date,—�J ' Sa Signature - WORKERS' COMPENSATION DECLAR TION I hereby affirm that I have a certificate of consent to self -Insure or a certificate �f Workers' Compensation Insurance, or a certified copy thereof (Section 800, Lab. C.) ro .licy NdLZ S%1 13,%Q y L lr r eCertified copy is hereby furnish Certified copy is filed with the c t In Divis- Date JL 1— APPllcan EXEMPTION FROM WORKERS' COMPENSATI DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith . comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY ' I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section '31.5 by any applicant for 'a permit subjects the applicant to a civil salty of not more than five hundred dollars ($500). ,,I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered forsale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for sale. It, however, the building or Improvement is sold within one year of Com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Cade: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a con- tractor(s) license pursuant'to the Contractoi's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date I hereby. ct information and state )a sent atives c inspection p Signature _ Owner that I have rea thls•application and state that the above I agree t comp#V with all city and county ordinances ati to build g c. r, and hereby authorize repre- clt to an r upon the above-mentioned property for Drivers' License or SS :# (— Date I - / CRI, I 1 / I if IoG - ,. -rt TL PERMIT NO. �(`7I34 TRACT NO. LOT NO.. UNIT NO. c-10 • ��, , r• rr ro:,lV TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF SLOG. A.P. 916 zone 5 Main Building: Accessory Building: TYPE OF PERMIT GRADING 11 FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ -OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE' VALUATION $ ZONE GRADING CU.YDS. ACRES E T Front Z O B A Rear N I C Right N )r; S Left G R Ping. Ref. Parking Req./Provided E Remarks: Planning Notes: 0 M T S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer _ " Construction Pole Sub._ Transformer ❑ 15.50 KW 1 ❑ 50+KW Backflow Irrigation Sewer Cap � Bathtubs Sewer Connection Cooking Unit Meter Dup to 100 amps Clarifiers Solar Collectors Dishwasher Meter [lower 100 amps _ Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panelr Drinking Fountains Solar Tank Fan Motors>O0-1 HP ❑ 1 X - S Floor Drains Swimming Pool w/Spa F.A.U. Inc, Solar El 9-15 HP 1316-15+ Floor Sinks I Urine( Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator 1:30.5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Foe � $15 Issue Fee , $ 3 Reinspection Fee $15 Issue Fee S 3' MECHANICAL FEES 111111111110 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date r Application Issued By , pq5, Data Boiler Hood or Type I ❑ Canopy Type 11 ❑ Duct - Under Ground Duct - Structural Refrigeration System ❑Q100,000 BTU ❑i00,000 BTU Duct - Ventilating BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ $ PLAN CHECK 50% .$ MECHANICAL $ PLAN CHECK 25% $ SUMMARY OF FEES SMIP' $ PERMIT ISSUANCE $ ENERGY P.C. $ � co GRADING $ AsCC) MICROFILM $ f TOTAL FEE (_ $ ` .5 Exhaust'System ElMultiple ❑ System Repair/Alteration Firepl/Fact. Bit. 1CBO # Fire Dampers Heating System & Ducting 1:10-100,000 BTU ❑100,000 BTELECTRICAL Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 'CONSTRUCTION AND PLANNING Date APPROVALS Permit # Inspector POOL 'A APPROVALS Permit # Date Inspecrnr 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._ A 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test p 6. Electrical LIFER Grad. 57. APPROVAL TO COVE R-GUNITE y 7. Footings r 58. Electrical Conduit-Undrgrnd. 8., Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9..Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10.. Structural Floor System 61. APPROVAL TO DECK I 1: Property Sewer Line House Connection f . 62. Backwash & Receptor-Final 12 Sewer Ca 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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑ Oil 23. Gas Pipe•Rough & Test 72, Underground Flush 24. -Roof Framing 73. Undergrnd. Storage Tank ❑ 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 C Notes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42, Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System N 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 M Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address _ 711 W. ' 17th St.: Bldg. (C) 'Unit 10 ' Applicant's Mailing Address 13110 'Safico ST. -N.Hollywood Owner's .Name Troy nvestment Fund Phone 549-2988 Address x.321 Birch St, Newport Beach,Ca. Arch/Eng. _ _ia rin J. Rock License No.' Address —L2981, e_._ Suite Contractor's Name—). riln Phone 982-1216 Address {mailing) _111.00 Sat.'i-cOy St, _N_ Hollywood, Ca. City'License No. LICENSED CpNTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division f the BusinesZe Professions Code, and my Ilcense.is in full force I� a eel License Class' / C—�� LI No. 346251 Date 4 18-/&4L Signature WORKERS' COMPENSATION CLARATI N I hereby affirrn that I have a ce ficate of consent to self -insure or a certificate If Workers' Compensation 1 urance, or a certified copy thereof (Section 300, Lab_ C,) .olicy No. _ WC9824 Company Lumbermans eCertified copy is hereby furnished, - Cert f' C y is filed with the city Buildin Division, l Date �-- Applicant `--� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section heed not be completed if the permitis for one hundred ($100) or less). t , I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature ' NOTICE: If, after making this declaration, you should become subject to the Workers' Corhpensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I ' i hereby affirm that there is a construction lending agency for the performance Of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Narne ' Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section .7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signgd statement that he/she is licensed pursuant to the provisions of the Contractgr's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section '31,5 by any applicant for a permit subjects the applicant to a civil salty of not more than five hundred dollars ($500). _J- I, as owner of the property or' my employees with wages as their sole 'compensation, will do the work, and the structure Is not intended or offered for Sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. I1, however, the building or improvement is sold within one year of com- pletion, the Uwner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as own@r of the property, am exclusively contracting with licensed con- 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 builds or imbroves thereon_ , and who contracts for such proiects with a con- tractors) license pursuant to the Contractor's License Law), I am aware that proof of their Worker's Compensation insurance should be provided to me. L� I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above ' information is correct.' Iagree to comply with all city and county ordinances and state laws relating to buil construction, and hereby author a repre- sentatives is city to e e upon the above-mentioned r erty or Inspection urp I.S. q Signature Dat Drivers' Lice or'SS PERMIT NO._ TRAGI NO. LOT NO. UNiT NO. I/5d 4/24/65 +x.50 ] TYPE OF CONSTRUCTION NEW LJ ADD ALTERATION'. ❑ CONVERSION ❑ DEMOLISH .❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. ' REPAIR A.P. Zone S Main Building: Accessory.Buitding: Z TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL ❑ -OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY— ' CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU -YDS. ACRES T Front O B A Rear _ N l C Right N G K $ Left R, Ping. Ref. Parking Req./Provided E O Remarks: Planning Notes: M T S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink e Automatic Washer Construction Pale Sub. Transformer ❑ 15-50'KW r ❑ 50+ KW - Backf1ow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00-1 HP ❑ 1 h - 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP 1316.15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets ' Water Closet Device Boxes Pole Light Interceptors ' Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ S Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REOUIREMENTS:, Zoning Approved By Date Building Approved By Date Application Issuod By Dat , Boiler Hood or Type j ❑ Canopy Type 11 ❑ Duct - Under Ground Duct - Structural Refrigeration System 00-100,000 BTU 13100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 2596 SUMMAR $ $ $ $ $ $ $ 13-Q0 $ OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ -15.50 50 Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG # Fire Dampers Heating System & Ducting 1 X10-100,000 BTU 0100,000 BTL Registers 6 00 Reinspection Fee $13 Issue Fee $ 3 CMF 0865.46, rey, 10/84 White -Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor �I - CONSTRUCTION AND PLANNING ATPRQVAES Permit # Date Inspector POOL ?A 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 `. A .4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test r ' 6. Electrical UFER Grnd. 57. A ROV6LTO COVER-GUNITEAW 7. Footings � �.'. _y� 99-• Electrical ConduitUndrgrnd. 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test f. 9. Water Pipe Undrgrnd. f �f 60. Backwash Lines, P -Trap, ❑ Undrgrnd. : r 10. Structural Floor System , 61. APPROVAL TO DECK -11. Property Sewer Line & House Con action 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, POOLISPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping El Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31.- Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning y� 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. ,Laridscape irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. _ --- Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA , CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UI�iJT NO } [�'-/ Proiect Address ? r ' Applicant's Mailing Address I TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR Owner's Name- 7t � �`� `rte J w Phone Address Arch/Eng. License No. Address "� Contractor's NameMmaig,- %2L�.�t �'CC_. �_" __Phone /'-6 e Address 4.41 rl� •1,[c*c:S'fy/A�-x�iYk i%i7�6 City License No. LICENSED CONTRACTOR DECLARATION I -hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division he usiness a d Profe ns Code, and my license is in ful force �Od of ect License Class �r Lic No. Date L70Signature WORKERS' COMPENSATION DECLARATIO I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance_, or a certified copy thereof (Section N00, Lab. C.) Alcy No _ = C rzci-C'r,,J 0 Certified copy is hereby furnished - ❑ Cerlifiea copy is f' d with the cit Bu+ dl Isio Date_'1=�� Applicant EXEMPTION FROM WORKERS' COMPENSATION CLARATION (This section need not be completed if the permit Is for one hundred -($100) or less). I certify that In the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you shoula become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name -' Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section -7031.5 Business and ProfeSsional'Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 o the Business and Professions Code) or that he/she is exempt therefrom 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 malty of not more than five hundred dollars ($500). i I,,as: owner of the property or, my employees with wages as_ their sale - .compensation, will do the work, and. the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The. Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. It. however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of Sale). - ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 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 proof off their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner 1 hereby certify that 1 have rea, information ,s t• 1 agree t i and sta relati to build sentativ s of t cit to ente Inspect[ urp Signature Drivers' U, cense or SS # CMF OB65-46, rev. 10/134 J this application and state that the above compiYYYY with all, city and county ordinances I confthuctiun,and hereby authorize repre- up'. 4he above-mentioned property for Date / ^1.0-fer ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A. P. # DESCRIPTION OF WORK/USE OF BLDG. S, Main Building: E TYPE OF PERMIT GRADING, C1 FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ ,OTHER A PROJECT DESCRIPTION SO. FT. OCCUPANCY C Right K' CONSTRUCTION TYPE VALUATION $ S :Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System C3 Multiple ❑ Firep(/Fact. Bit. ICBO # Heating System & Ducting ❑ 0-100;000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 plicant; Pink - Accounting; Goldenrod - Assessor IANICAL Hood or Type I ❑ Canopy Type II ❑ Refrigeration System (__10- 100,000 BTU (D 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES $ 3 FEES $ 3 5813 1/16/85 IL i Zone Accessory Building: . Z O N IIN G R Parking Req./Provided E Q M T S , ELECTRICAL Atitomatic Washer Trarisformer ❑ 15-50 KW Construction Pole Sub. 50 + KW Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures - Device Boxes Outlets Switches Garbage Disposal Generator ❑45 KW EJ 5-15 KW Meter El up to 100 amps Meter Clover 100 amps Sub Panel 'Motors,P!6-1 HP Ell !, - 8 Inc. Solar 09-15 HP El 16-15+ Microwave ' , Pole Light Range Sign Standing Sections Trash Compactor FEES PLUMBING ' Bar Sink Showers Backflow Preventer Service Sink - Backflow Irrigation Sewer Cap' Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains' Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater r Kitchen Sink Water Service Lavatories Auto -Wash P-Trap ' Laundry Trays Roof Drains _ — Reinspection Fee - •$15 Issue Fee Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System C3 Multiple ❑ Firep(/Fact. Bit. ICBO # Heating System & Ducting ❑ 0-100;000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 plicant; Pink - Accounting; Goldenrod - Assessor IANICAL Hood or Type I ❑ Canopy Type II ❑ Refrigeration System (__10- 100,000 BTU (D 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES $ 3 FEES $ 3 5813 1/16/85 IL i Zone Accessory Building: . Z O N IIN G R Parking Req./Provided E Q M T S , ELECTRICAL Atitomatic Washer Trarisformer ❑ 15-50 KW Construction Pole Sub. 50 + KW Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures - Device Boxes Outlets Switches Garbage Disposal Generator ❑45 KW EJ 5-15 KW Meter El up to 100 amps Meter Clover 100 amps Sub Panel 'Motors,P!6-1 HP Ell !, - 8 Inc. Solar 09-15 HP El 16-15+ Microwave ' , Pole Light Range Sign Standing Sections Trash Compactor FEES f , Reinspection Fee $15 Issue Fee , $ 3 DEVELOPMENT SERVICES REQUIREMENTS:, Zoning Approved By Building Approved By Application Issued By Date Date Dat - BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% i MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ C)b $ SD $ '$ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ //'' TOTALFEE $ Lt-Jt� _ — CONSTRUCTION AND PLANNING APPROVALS Permit # Date, Inspector POOL A APPROVALS Permit # Date Inspector -1., Temporary Electrical Service or Pole ^ 52. Pool & Equipment Location :.2, Soil-Pipe-Undrgrnd., �,r� 53. -Steel Reinforcement 3 Electrical Conduit Utility-Undrgrnd. 54. Forms 4 -,Electrical Conduit,Und�grnd. I 55. Electrical Bonding .5j Steel Reinforcem'entJ 56. Rough Plumbing &Pressure Test 4� 6r Electrical UFER Grnd. 57. -APPROVAL TO COVER-GUNITE 7d Footings 58. Electrical Conduit-Undrgrnd. �r 8.,Founlation n� 59. Gas Pipe, ❑ Undrgrnd., Test 9.. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. ! 10 -Structural Floor System .r �, 61. APPROVAL TO DECK 11 .'Property Sewer Lin e& House Connection 62. Backwash &Receptor -Final 12. Sewer Cap 63. Heater &Vent -Final 13. Roof Drains f 64. Plumbing System - Final 14. Rough Plumbing,- 1 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, -in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas -Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank'❑ 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 �tj C� Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflpw Preventer 43. Backflow irrigation 44. Landscape Irrigation System 456 Sound Attenuation 46. Handiczp Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co F51. CERTIFICATE OF OCCUPANCY-. Date ' 1 -t Applicant to fill in,atl spaces except those within heavy border lines and sign all appropriate declarations. PE IT NO. TRACT NO. LOT NO. UNIT NO. CITY OF COSTA•ME9A CONSTRVCTIONPERMIT Project Address -7 r �./ 1 7 Tern , Applicant's Mailing Address/ 7 �r d '! ANG i. / A.P. TYPE OF CONSTRUCTION NEw ADD ALTERATION REPAI R ❑ CONVERSION [:]DEMOLISH ❑ OTHER Owner's Name "' +'' Phone DESCRIPTION OF WORK/USE OF BLDG. Address _ Accessory Building: ' E T Front Arch/Eng. License NO, Address TYPE OF PERMIT GRADING1:1 ❑ TENANT - ❑ ELECTRICAL ❑ -OTHER FOUNDATION STRUCTURAL ❑ PLUMBING ❑ MECHANICAL 7 -% 7 Z.i Contractor's Nam �"+ Phone y Address (mailing) % % �/ ��/ c�J L6\ L E y L - City License No. �� gZ� /� PROJECT DESCRIPTION Sly. FT. OCCUPANCY CON STRUCTION TYPE VALUATION $ ZONE GRADING CU. YDS. ACRES LICENSED CDNTRACTOR DECLARATION N C Remarks: I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and N 5 my license is in fu force antl ffect. �-f License Class 8 "' License No. 0 P1 0. r Date `Z• - l`! � Signature BUILDING PERMIT . PLUMBING . FEES WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of Consent to self -insure or a certificate Bar Sink Showers ` Backflow Preventer Service Sink �f Workers' Compensation Insurance, or a certified copy thereof (Section 100, Lab. C.) t" Backflow Irrigation Sewer Cap olicy No. Combany BCertified copy is hereby furnished. Bathtubs Sewer Connection Certified copy is filed with the city Building Division. Date Applicant „ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' ' Clarifiers Solar Collectors . (This section need not be completed if the permit I$ for one hundred ($100) or less). I certify that in the performance of the work for hich this permit is iSSued,'1 shall not employ any person in any manner to s to become subject to the Worker EompenSatIO ws of Calif Date _� " / hF 9' -Signature Dishwasher Solar Piping Drinking Fountains Solar Tank ' Floor Drains Swimming Pool vv/Spa' NOTICE: If, after making this declarati you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit- shall be deemed revoked. CONSTRUCTION LENDING AGENCY Floor Sinks Urinal _ j Gas Service Outlets Water Closet I hereby affirm that there is a construction tending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name ,. Interceptors Water Heater Kitchen Sink - / Water Service _ Lender's Address - — ` _- DWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law forthe following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit -to file a signed statement that he/she is Licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professlgns Code) or that he/she is exempt therefrom 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 malty of not more than five hundred dollars ($500). J I, as owner of the property or my employees with wages as their sole compensation, will do the work, -and the Structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner ti1 a property who builds or improves thereon, and who does such work himSellyherself or through his or her own employees, provided that such improvements are not intended or offered for sale, If, however, the building or improvement i5 Sold within one year of com- pletion, the owner will have the burden of proving he/She did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractors) license Pursuarit to the Contractor's License Law). I am aware that proof o their Worker's Compensation insurance should be provided to me. Lavatories _ Auto -Wash P—Trap Laundry Trays , Roof Drains -L Reinspection "Fee' $15 Issue Fee $ 3 I EF MECHANICAL FEES Fixtures goiter Hood or Type I ❑ yP Canopy Type I I ❑ Device Boxes Pale Light Duct - Under Ground Duct - Structural Ra6ge Refrigeration System E-10-1100,00OBTU 0100,000BTU Switches Duct - Ventilating Exhaust System Multiple ❑ ; Standing Sections System Repair/Alteration Generator 00.5 KIN 05-15 KW Firepl/Fact. Bit. ICBO # Fire Dampers ❑ 1 am exempt under Section ^ B. & P. C. for this reason Date Owner _ I hereby certify that I have.read this application and state _that the above information is correct, I agree to comply with all city and county ordinances Heating System & Ducting ❑0-100,000 BTU 0100,000 BT Registers , and state laws relating t building construction, and hereby authorize repre. sentatives of this city o enter upon the above-mentioned property for inspection pu s, Signature at �"_/ Drivers' Lice a or SS Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev, 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 9:39 S/2u/u. i �r Reinspection Fee S75 Issue Fee A.P. Zone S Main Building: Accessory Building: ' E T Front Building Approved By Z O A Rear Application Issued By N C Right SUMMARY OF FEES N 5 Left BUILDING PERMIT . S G R Ping. Ref. # Parking Req./Provided PLAN CHECK E Planning Notes: Q M $ �� ISSUANCE S T'' S S i�S ELECTRICAL FEES ELECTRICAL Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW $ Cooking Unit �. Meter El up to 100 amps MICROFILM $ Dishwasher Meter ❑aver 100 amps $ TOTAL FEE Dryers ❑Gas DElectric Sub Panel PLAN CHECK 25% $ Fan r Motors 00-1 HP ❑114 - 8 F.A.U. Inc. Solar L1 9-15 HP 1:116-15+ Fixtures Microwave Device Boxes Pale Light Outlets Ra6ge Switches Sign Garbage Disposal ; Standing Sections Generator 00.5 KIN 05-15 KW I Trash Compactor �r Reinspection Fee S75 Issue Fee S 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By ' Date Building Approved By Date Application Issued By pat ! SUMMARY OF FEES BUILDING PERMIT . S SMIP $ PLAN CHECK S PERMIT PLUMBING $ �� ISSUANCE S PLAN CHECK 25% S i�S ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL • $ TOTAL FEE $ PLAN CHECK 25% $ I• CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL 'A APPROVALS Permit # Date Inspector 1, Temporary Electrical Service or Pole 52.- Pool & Equipment Location j 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3: Electrical Conduit Utility-Undrgrnd. 54. Forms t 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 - 9. Water Pipe-Undrgrnd. ... 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap r- 63. Heater & Vent -Final ' 13. Roof Drains 64. Plumbing System - Final 14; Rough Plumbing- '' `' cio 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 9 69. POOL/SPA SYSTEMS FINAL _ 19.''Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20 Rough Factory Fireplace 21' Ducts, in Structure, 70. Underground Hydro 22. Ducts, Ventilating 71: Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush .24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION - - 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning - 35. Fina[Gas Pipe -Test 4/ 36, Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing q 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 50. Gas Release to Southern California Gas Co E 51. CERTIFICATE OF'OCCUPANCY - Date ; + T0. ---- - Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 711 W 17th St. Bldg. (C) Unit # 12 Applicant's Mailing Address 1 i�l l(1_� OOd C Owner's'Name TrOY Investment Fund phone 5 Address St. NewPort Beach Ca. Arch/Eng, Marin J . ROCK _ License No. Address to 216 Contractor's Nam, mirn Air__ Qmd1tionin? Phone 982'•-1216 Address(Mailing)13110 SatiCay St. N.Hollywood,Ca. City License No. LICENSED CONTRACTOR DECLARATION . I hereby affirm that i am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Busin;sSProfessions Code, and my license Is in fult,.f rce and effe 3462Co 51 License Class/ C L� No. Date 1 RF] R I�R4 Signature WDRKERS' COMPENSATION D CLARATI I hereby affirm that I have a car icate of consent to self-4nsure or a certificate �f Workers' Compensation In urance, or a certified copy thereof (Section "' labWE4824 Lumbermans �licy No. Company L� Certified copy is hereby furnished. ' ❑ Certi �i p c y is filed with the city Building vision. /� i Date �-5 �' _ _. Applicant— EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or lass). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. ' Date - Signature 'NOTICE: it, after making this declaration, you should become subject to the Workers' Compensation provisions of the labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code:' Any city or county which requires a permit to construct, alter, improve, demolish or repair any Structure, prior to its issuance, alto requires the applicant for such permit 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 Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleg@d exemption. Any violation of Section 031.5 by any applicant for --a permit subjects the applicant to a civil malty of not more than five hundred dollars ($500). ' J 1, as owner of the property or my employees with wages as their sole Compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended Or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the Purpose of sale). I, as owner of the property, am eketuslvely Contracting with licensed con- tractors to construct the project (Section 7044, Business and Processions Code: The Contractor's License taw does hot apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) I1Cense pursuant to (he Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section _ B. & P. C. for this reason Date Owner_ 1 hereby certify that I have read this application and state that the above Information is correct. I agree t mply with all city and county ordinances and stale I s relating to buil n construction, and hareby authori repre- sentative of this city to uppn the above-mentlonetl .p rty for inspect - n pu oses. Qr Signator 4' d Date Drivers', L�Ense or SS =hl 1770 4/24/85 jam_ PERMIT NO. TRACT NO. LOT NO. UZi NO. Z TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR • ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. Zone S Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING gMECHANICAL ❑ OTHER PROJECT DESCRIPTION. SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ I ZONE GRADING CU.YDS. ACRES T Front 0 A Rear N C Right N K S Left G R Ping. Ref. # Parking Req./Provided E Remarks: Planning Notes: 0 M T S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink • Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00-1 HP Ell A - 8 Floor Drains Swimming Pool w1Spa F.A-U. Inc. Solar 09-15 HP Ell 6-15+ Floor Sinks Urinal Fixtures. - Microwave - Gas Service Outlets Interceptors Water Closet Water Heater Device Boxes Outlets Pole Light Range Kitchen Sink Lavatories Water Service Auto -Wash Switches Garbage Disposal Sign ; Standing Sections P—Trap Laundry Trays Generator ❑0-5 KW 05-15 KW Trash Compactor Root Drains TI Rai nspection .Fee $15, Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 Boiler. MECHANICAL FEES Hood or Type I El Canopy Type I I El SERVICES Zoning Approved By Building Building Approved By Application Issued By REQUIREMENTS: Date Date Dat Z' Duct - Under Ground Duct - Structural Refrigeration System ❑0100,000 BTU ❑100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY $ $ $ $ $ $ $ $ OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ _ r Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Blt. ICBG Fire Dampers Heating System & DuctingRegisters 1 klo--00,000 BTU ❑100,0009 6 00 1 4100 I, Reinspection Fee$15 Issue Fee $ 3 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING ' APPROVALS -, Permit # Date Inspector POOL ,,A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ?' 5. Steel Reinforcement 56. Rough Plumbing& Pressure Test 6• Electrical UFER Grnd, • -+9� 57. APPROVAL TO COVER-GUNITE t ' 7. Footings 58. Electrical Conduit-Undrgrnd. 8: Foundation ' 59. Gas Pipe, ❑ Undrgrnd., Test ,9. Water Pipe•Undrgrnd.'10 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10: Structural Floor System /; 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap ' 63. Heater & Vent -Final ' A: 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydra 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 60. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating•& Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43. 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 OD 1 51. CERTIFICATE OF OCCUPANCY No. Date ' , A • Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. ,CITY OF COSTA JNAESA CONSTRUCTION PERMIT Project Address"LIULI V, L' u C_ C- v;L+ Applicant's Mailing Address Owner's Name _ r Phone 1Addrgss Arch/Eng. License No. Address Contractor's Name I Phone Address (mailing) r rA City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division If the Bu • ess nd Professions Code, and my license is in full rce antl effe1.{ k� License Class 1 Ice se No. `� 4� Oatc_5__-==S6 Signature WORKERS' COMPENSATION Df=CLAR T N I hereby affirm that 1 have a certitiCate of on ent to self -insure or a certificate . of Workers' Compensation Insurance, or rt' led copy thereof (Section 600, Lab._c' l 1 olicy No. a Corp pa y eCertified copy Is hereby furnish41 Certified copy Is ti ed with the city u di Dr Ilio Date- -Zi Applicant EXEMPTION FROM WORKERS' COMPE Ao`zhich N DE LARATION (This section need not be completed if the p m for one hundred ($100) or less). I certify that in the performance of the work this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California, Date Signature • 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions- or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY , I hereby affirm that there is a construction lending agency for the performance of the work for which tris permit Is Issued (Section 3097 Civ, .C,) Lender's Name 42, 1 n /o Lender's Addresson�Ace:_ It L OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the ContraCtor'S License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or _County which requires a permit to Construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed Statement that he/she is licensed pursuant to the provisions of 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 1031,5 by any applicant for a permit subjects the applicant to a Civil malty of not more than five hundred dollars ($500). J 1, as owner of the property or my employee$ with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sate. If,'however, the building or improvement is sold within one year of com- pletion,'the owner will have the burden of proving he/she did not build or im- 1rove for the purpose of sale).. ,,as owner of the property, am exclusively contracting with licensed con- ' 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 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 proof of their worker's Compensation insurance should be provided to me., 0 1 am exempt under SeCtion S. & P. C. for this reason Date Owner 1 hereby certify that I vE ead t "s application and state that the above Information is co ect I re o co fy with all city and County ordinances and state laws rg tin to W 9 co struction, and hereby authorize repre- sentatives of this cit t an upo the above-mentioned property � Inspection purpose l Signature Date Drivers' License or - I NUI HAGI NU LU I IVU• UNIT N - - 3 1109 I� I C�r i �'� ►2 OF CONSTRUCTION NEW❑ ADO ALTERATION REPAIR • 6922 7/07/86 121.50 TL lJ CONVERSION DEMOLISH OTHER _ .400 q P #- Q C -Lu .� / Zone D S RIPTION OF WORK E LDG. AS Backflow Preventer Service Sink TOO Main Building: _ Accessory Building: _Zi G ADI NG )UNDATION� TRUCTURAL TYPE OF PERMITII77�t Backflow Irrigation Sewer Cap T Front 1 �l � ��F 119;I�-- TENANT -E FCTRICAL L`_TPLUMBING LJ MECHANICAL O B Solar Collectors - ❑ -OTHER Meter ❑over 100 amps A Rear ' PROJECT'DESCRIPT(ON SQ. FT1000 OCCUP N Y C K Right CONSTRUCTION TYPE VALUATION $ Motors 00.1 HP ❑ 11% - 8 S Left Swimming Pool w/Spa ZONE Ar, GRADING CU. YDS, ACRES Inc.Solar ❑9-15 HP 016-15+ Ping, Ref, # Parking Req./Provided Q oC/1✓ / Remarks:riC # 3 L f l --86 S F&c- s2`.33 A �j Microwave Planning Notes: AZ,4tJJje Gas Service Outlets FEES Z O N 1 N G R E O M T S Bar Sink Showers .400 ELECTRICAL FEES Backflow Preventer Service Sink TOO Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW E]50 +'KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection ,. Cooking Unit Meter Quip to 100 amps O Clarifiers Solar Collectors - Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas . ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00.1 HP ❑ 11% - 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave S' Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets, Range Kitchen Sink _ Water Service Switches Sign Lavatories P -Trap Auto -Wash Laundry Trays Garbage Disposal ! Standing Sections Generator 00.5 KW ❑5-15 KW Trash Compactor + Q Roof Drains *' r - f j Reinspection Fee $15 lssue Fee $ 3 Reinspection Fee $15 I$sue Fee $ 3 MECHANICAL FEES DEVEII OPMENT`SERVICES REQUIREMENTS: Zoning Approved By Date--,__ 0 Building Approved By Date � . Application _Issued By Dat Boiler Hood or Type 1 [3- Canopy • Type II C1- Duct - Under Ground Duct - Structural Refrigeration System 00.100,000 BTU 1:1100,000 BTU Duct -Ventilating BUILDING PERMIT $ PLAN,CHECK $ PLUMBING $ PLAN CHECK 25% S ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ SU�MJMARY OF FEES 'J 0' Cd SMIP $ PERMIT • OID ISSUANCE $ ENERGY P.C. S lrlrG GRADING $ Z' /O MICROFILM $ ` TOTAL FEE $ �O , Exhaust System ❑ Multiple 1:1 System Repair/Alteration Firepl/Fact, Bit. ICBO # Fire Dampers Heating System & Ducting ❑ 0- 100,000 BTU ❑ 100,000 BT Registers Reinspection Fee $15 _ Issue Fee $ 3 CMF 0865-46, rev. 10/84 Wh\e -Building: Canary - Applicant: Pink - Accounting; Goldenrod - Assessor - CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL 8 , APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipb-Undrgrnd. 7- ?fla L," 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4.-Electrieal Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings s� ? (� 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11- Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17, Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Tests 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 0. FOOD CERTIFICATE ISSUED 33. Final electric otes: aZ� trt RA(,Fc mon 34, Final Heating & Air Conditioning 35. Final Final Gas Pipe -Test 7 !& 4 36. Wood or Canopy 30BL X,��zmT6AIPjc4lti!!~ 37. Final Factory Fireplace V (r 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 & BUILDINGjfj7 48. Special Requirements Completed 49. Electric Release to Edison 50: Gas Release to Southern California Gas Co 51.. CERTIFICATE OF OCCUPANCY No. Date ' 1 60 r 974,15 -1 C li�, L W- lt-'Ce M&(_j") CITY OF COSTA MESA CONSTRi CTION PERMIT Project Address Applicant's Mailing Address Owner's Name yyPone ��( Address 1�-- \� Lr isl'r ArchlEng. License No. Address Applicant to fill in all spaces except those within heavy border lines and sign ail appropriate declarations. PE MT TRACT NO. LOT NO. UNIT NO. o3.� O/Ai(f—)/,NI/.P- TYPE OF CONSTRUCTION LJ NEW LJ ADD ALTERATION LJ REPAIR Contractor's Name_�hhoonee Address(mailing) City License No. C. :;?r, 3 ^� LICENSED CONTRACTOR DECLARATION I hereby affirm that l am licensed under proviSlonS of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. _t License Class License v C4 Date C'? ' Signature WDRKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a Certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. olicy No. Company ertified copy is hereby furnished. Certified cop s letl with the city a.7'mwa Divisio Date ��'Z' ApplicantSS� r�-^-�'� -? 5 EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit Is -for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 renally of not more than five hundred dollars ($500). 1, as Ir owner of the property or my employees with wages as their sole _ompensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon; and who does such work himseif/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she old not build or im- prove for the purpose of sale), ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- , tractors) license pursuant'to the Contractor's License Law), I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this apl Information is correct. I agree to comply v and state laws relating to building c nstru sentativos of Is city for enter u n tt inspection o s. Signatur Drivers' Li cc a or SS tion and state that the above all city and county ordinances i, and hereby authorize repre- bove-mentioned property for ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P 4A DESCRIPTION OF WORK/USE OF BLDG, G«. S Main Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT 1-1ELECTRICAL 1:1 PLUMBING 2O MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Right K CONSTRUCTIONTYPE VALUATION S Left ZONE GRADING CU. YDS, ACRES Ping. Ref. 9W qom;arks: nit if, -I- t� IrrAwie Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains ' Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting ❑0-100,000BTU ❑100,000BTi Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays EES Issue Fee $ 3 FEES Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System 130-100,00013TU 1:1100,000'BTU System Repair/Alteration Fire Dampers Registers Issue Fee . 1 $ 3 4416 10/02/86 - n Zone Accessory Building: Z O N N G R Parking Req./Provided E O M T S ELECTRICAL FEES Automatic Washer Construction Pale Sub. Cooking Unit Transformer 1115-50 KW ❑ 50 + KW Meter ❑up to 100 amps Dishwasher Dryers ©Gas' ❑Electric Meter Dover 100 amps Sub Panel ' Fan Motors 00-1 HP❑1%-8 F.A.U. Inc. Solar139-15 HP Ell 6-15+ Fixtures Microwave Device Boxes Pale Light Outlets Range Switches Sign Garbage Disposal ; Standing Sections Generator 00-5 KW (35-15 KW Trash Compactor I I Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REOUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By— 75 / Data (/ SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK , $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. S ELECTRICAL $ GRADING $ PLAN CHECK 50% MECHANICAL S $TOTAL MICROFILM FEE $ $ PLAN CHECK 25% $ 11101) ,C) CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & A APPROVALS Permit # Date Inspecror 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. ,Electrical Conduit Utility-Undrgrnd. 54. Forms 4, Electrical Conduit -Undrgrnd. 55. Electrical Bonding 5. Steel •Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduif-Undrgrnd, 8' Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9., Water. Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor Sysiem 61. APPROVAL TO DECK 11. Property Sewer Line & House Connectign 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 fD��V/yi FIRE DEPT. REQUIREMENT APPROVALS. Permit # 20, Rough Factory Fireplace 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 ❑ 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, lnsuiation 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 ry(� 35. Final Gas Pipe -Test 36, Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39, Water Service -Final 40, Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation t 44. 'Landscape irrigation System 45, Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. J! --I PER TRACT NO. LOT NO. UNIT NO. CITY OF C05TA ME5A CONSTM UCTION PERMIT 7 Project Address r r r5 C -1I cL Ct 2— Applicant's Mailing Address Owner's Name Zn.ES'4f-kt/a�Y475S� ZL44_4one Address :74l w' !7 M 5-r. C tel• Archltng, License No. Address � Contractor's Name +<' ;J---a/011—CC Phone SZ' Address .(mailing) ��/�� T Py7, City License No.f,6 vis LICENSED CONTRACTOR DECLARATION I herebyaffirm that I am licensed under provisions of Charter 9 (commencing with section 700 0) of Division 3 of the Business and Professions Code, and my license Isin full for and eff ct. License Class Cv — License No, Date ��Z Z_ Signature WORKERS' COMPENSATION DECLARATION ' I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified Copy thereof (Section 3800, Lab. C.) polity No. Company Certitiedcopy Is raby furnished. Certified c e with the city Bu iv' 0 Date -- Applicant - 1 q - EXEMPTION FROM WORKERS' CO ENSATION DECLARATION (This section need not be Completed if the permit is for one hundred ($100) or less)., I certify that in the performance of the work f Ich this permit is issued, I shall not employ any person In any mann beco bject to the Workar� Cop©nsat n Laws of Californi JJ Date Signature NOTICE: If, after making this dectarati you should become subject to the Workers' Compensation provisions - t e Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a Construction lending agency for thin performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the I following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 enafty of not more than five hundred dollars'($500). 1 I,' as owner of the property or my employees with wages as their sole ampensation, will do the work, and the Structure is not intended or offered far sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletlon, the owner will nave the burden of proving he/she did not build or Im- 1rove for the purpose of sale).. , as owner.of the property, am exclusively contracting with licensed con- tractors t6 Construct the projectlSection 7044, Business and Professions Coda: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner ' I hereby Certify that I have read this application and state that the above Information is correct. I a ree to comply with all city and county ordinances and state laws relatin uilding'construction, and hereby authorize repre- sentatives of this enter u on the above-mentioned property for inspection purpo e Signature Data C brivers' License or SS TL Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Lrtterceptors Kitchen Sink - y1P—Trap Roof Drains Reinspection Foe I I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICSO # Heating System & Ducting [__10-1 00,000 BTU ❑ 100,000 BT Reinspection Fee I +$15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor i PLUMBING _FEES Showers Service Sink ' Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee, MECHANICAL Hood or Type ❑ Canopy Type II ❑ Refrigeration System 00-100,000 BTU 01100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 I' 9937 7/22/86 Zone Accessory Building: Parking Req./Provided ELECTRICAL 23.00 , TL FEES Z O N I N G R E Q M T S Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 50+ KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas ❑Electric TYPE OF CONSTRUCTION NEW ADD ALTERATION LJ REPAIR Motors ❑0.1 HP ❑1'f, - 8 F.A.U. ❑ ❑ ❑ Fixtures Microwave CONVERSION DEMOLISH OTHER Pole Light A.P. # DESCRIPTION0 /UU OF BLDG. Sign Garbage'Disposal Standing Sections Ae 67 2_x1 S Main Building: TYPE OF•PERMIT GRADING FOUNDATION LJ STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL .PLUMBING ❑ MECHANICAL B ❑ OTHER A Rear C Right PROJECT -DESCRIPTION SQ. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATION S S I Left ZONE - GRAOING CU.YOS. ACRES Ping. Ref. # Remarks:" Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Lrtterceptors Kitchen Sink - y1P—Trap Roof Drains Reinspection Foe I I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICSO # Heating System & Ducting [__10-1 00,000 BTU ❑ 100,000 BT Reinspection Fee I +$15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor i PLUMBING _FEES Showers Service Sink ' Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee, MECHANICAL Hood or Type ❑ Canopy Type II ❑ Refrigeration System 00-100,000 BTU 01100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 I' 9937 7/22/86 Zone Accessory Building: Parking Req./Provided ELECTRICAL 23.00 , TL FEES Z O N I N G R E Q M T S Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 50+ KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel r - Fan Motors ❑0.1 HP ❑1'f, - 8 F.A.U. Inc. Solar 09-15 HP 016-15+ Fixtures Microwave Device Boxes Pole Light Outlets , ' Range Switches - Sign Garbage'Disposal Standing Sections Generator ❑0.5 KW 05-15 KW Trash Compactor I Reinspection Fee 1 $15 1 1 Issue Fee : FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued BY Date $ 3 SUMMARY OF FEES BUILDING PERMIT $ SMTP , PLAN CHECK $ PERMIT PLUMBING $ - ISSUANCE PLAN CHECK 25% S ENERGY P.C. ELECTRICAL S GRADING, PLAN CHECK 50% S MICROFILM MECHANICAL $ TOTAL FEE PLAN -CHECK 25% $ $ 3 $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location �J 2. Soil Pipe-Undrgrnd. T_ (,fid 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 COVE R-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing jp-2-?14 L 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 APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas []Oil 25. Roof Sheathing 74. Overhead Hydra 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: 7-U-46 eye. ZF4P�(, C40 ,0;y9 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 x'41. Solar Domestic -Final 42. Backflow Preventer J 43. Backflow Irrigation 44. Landscape Irrigation System ',45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. Zone CITY OF C09TA ESA CONST UCTIO Project Address . I! PERMIT iL! Main Building: Accessory $ujldjng: PERIi01T N % �'''J �? TRACT NO. LOT NO. UNIT NO. c/Z E T Front Z O 13 A Rear N `TYPE OF CONSTRUCTION LJ NEW LJ ADD 0 ALTERATION LJ REPAIR TAppiicant's MailingAddressG%d Z/ Owner's Name r) 43- JEOS 7 - Phone .Address •�_:y Arch/Eng. License No. Address Contractor's Nam Phone 3t� Address (mailing) L City License No. b LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in fu force and effect. CIS 1- Licensfe-�CI ss - ense No. Date �gZ� Signature -rrL WORKERS' COMPENSATION DECLARAT40N I hereby affirm that 1 have a certificate of consent to self, -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section AB00, La G. r31/ •� )licY N!VC /GOZ 7/ig Company - �Certified copy is hereby furnished. C %/moo/ ' I filed with the city ' di g I n, Dates j-br1L Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This Section need not be completed.if the permit Is for one hundred ($100) or less). I certify that In the performance of the work for which this permit is issued I� shall not employ any person In any manner so as to become Subject to the Workers' Compensation laws of California. - Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the labor Code; you must forthwith comply with Such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work ,for which this permit Is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am axompt from the Contractor's License Law41jr the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior'to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of theContractor'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 ,nalty of not more than five hundred dollars (x500). I, as owner of the property or my employees with wages as their Sole imponsation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended Or offered for sale. It, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose Of sale). ❑ I, as owner of the property, am exclusively contracting with licensed Con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. - ❑ 1 am exempt under Section B. & P. C.,for this reason Cr Date Owner I hereby Certify that l have read this application and State that the above Information is Correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentativesof Is city to enter upon the above-mentioned pro arty for Inspection p s Signature Date Drivers' License or SS 9775 7/21/86 25._SQ TL ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. iC 'r s7U�G�fG� A.P. # Zone 5 Main Building: Accessory $ujldjng: TYPE OF PERMIT GRADING FOUNDATION $TRVCTVRAL ❑ TENANT XELECTRICAL ❑ PLUMBING ❑ MECHANICAL ElOTHER PROJECT DESCRIPTION SQ. FT, OCCUPANCY CONSTRUCTION TYPE VALUATION S ZONE GRADING CV,YDS. ACRES E T Front Z O 13 A Rear N C Right N' K S I Left G R Ping. Ref, # Porking Req./Provided E Remarks: Planning Notes: O M T 5 PLUMBING FEES ELECTRICAL FEES Bar Sink Showers . Backflow Preventer Service Sink. Automatic Washer Pale Suh. Transformer ❑ 15-50 KW ❑ 50 + KW ; _ Backflow Irrigation Sewer CapConstruction Bathtubs Sewer Connection Cooking Unit Meter'❑up to 100amps �. ` Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher $olar Piping Dryers ❑Gas ❑Electric• Sub Panel f Drinking Fountains Solar Tank Fan Motors 00.1 HP ❑l A - 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9.15 HP Ell 6 15+ Floor Sinks Urinal f Q Fixtures Microwave Gas Service Outlets Water Closet f' _ � Device Boxes Outlets Pale Light Range Interceptors Water Heater Kitchen Sink Water Service SwitchesSi 9 n Lavatories Auto -Wash 4 Garbage Disposal Standing Sections I �U P—Trap Laundry Trays Generator 00-5 KW 05-15 KUV Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee S 3 MECHANICAL ' FEES' Bailei - Hood or Type I ❑ Canopy Type 11 ❑ ` ; DEVELOPMENT SERVICES REOUIREMENTS: 120ning Approved By *%-Building Approved By Application Issued By Date Date Deal _ Duct Under Ground Duct -Structural Refrigeration System ❑0.100,000 BTU 0100,000 BTU Duct - Ventilating BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK .25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL S PLAN CHECK 25% $ SUMMARY OF FEES SMIP $ PERMIT ISSUANCE " $ ENERGY P.C. S GRADING S MICROFILM $ TOTAL FEE $ _ _ Exhaust System ❑ Multiple ❑ System Repair/Alteration _ FireptlFact. Blt: IC80 # Fire Dampers ` Heating System & Ducting 00.100,000 BTU ❑100,000 BT Registers , Reinspection Fee S15 Issue Fee $ 3 AF 0665-46, rev. 10184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # • I. Date Inspector POOL & SPA 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 f 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58, Electrical Conduit-Undrgrnd. -).x 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13, Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring + f,114 67. Fencing & Access Approval 17. 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping El Gas ❑Oil 23. Gas Pipe -Rough & Test 72, Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 8rown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric �j+Q� �j Notes: 34. Final Heating & Air Conditioning x wood upoptl 35. Final Gas Pipe -Test r X 36. Hood or Canopy 37. Final Factory Fireplace K 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 r 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date 1 .� for sale'(Sectron 7044; Business; and Professional Code: The•Contractor s License Law does not apply to an owner of a property who builds or Improves thereon, and who'doesysuch work himself/herself or through•his or her own I employees, provided that such -improvements arelnbt Intended or offered for r sale. If, however, the building or Improvement Is sold within one;year.of com- pletlon, the owner will have the burden of proving he/she did not build or Im- �ove for the purpose of. sale). I �- ' ; , LJ I, as owner of the property, am excluslvely contracting;withllicensed con. tractors to.con5truct the;project.I Section 7044,.Business, and Professions Code:»' I -The Contractor's License Law ddoes not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law).' I I ❑ I am exempt under Section - B. & P. C. for this reason Date ' Owner' -1 -herebyy •certify- that +,have read this appilcation- and -state that the above - I Informatlon is correct, I agree to comply with all cityland county ordinances I and state laws relating to building construetion,'arld hereby authorize repre- sentativell of )this it 'to t -upon the abovo-mentioned propertym for Inspectlon osas. I Signature �� ! Datey f Drivers' License or'SS I I ) Applicant to till in all spaces except those within heborder lid sign all appropriate declarations. heavy orer an ! ` ' Date Refrigeration System DO-.100,000BTU ❑ 100 a BTU CITY OF COSTA MESA I Duct-'l3nderlGround BUILDING PERMIT -nes i SMTP ! System Repair/Alteration I I Ii PLAN CHECK S: ! - Ducts Ventilating.. { I -, CONSTRUCTION PERMIT + - PERMIT NO Zb�St TRACT NO. $ LO1.NO. BL GRADING , $ ; ;ELECTRICALI i } Fi�epl/Fact. Blt, ICBG # 'PLAN CHECKI $' MICROFILM i $ -1 ;MECHANICAL I HeatingrSystem & Ducting 130-100;000'BTU-0100,000BT TOTAL`FEE+ 1611 .7/07/03 34 20; $; Applicant's Mail(n Address r TYPE OF CONSTRUCTION NEw L 'ADD LJ ALTERATION REPAIR 1 I I I tT., , ' T 1 �� SEVNTIoE►r1� ( { G' CONVERSION ❑ OEMOLISH OTHER. lI I Registers i e $ 3 Project Address ' Owner's,Name R�'�NV SZ EI►+T - - Cyy�� DESCRIPTION OF WORK I r IND EGULATI _phone 2 ,-W '%I *h Y i .. _ t.� _ �- - Address' ;TYPE OF PERMIT- GRADING -.-LI FO pATION STRUCTURAL ; A. P. i ' ' r EZON E Arch/En . I g•' License No. ❑ TENANT 9 ELECTRICAL' 0 -,PLUMBING ❑MECHANICAL PLNG. REF.0.6, ' r. 1 BUILDING, Address " ❑,OTHER- To' LDING. - i Contracto['s Name�«"� S�Myt..tMAN= ^Phone � PROJECT DESCRIPTION SQ. FT. +• r - OCCUPANCY - PR TY LINE REAR YARD (TO P/L) _ Address {mailing) 1 , Sr.' a CONSTRUCTION TYPE 3 ' .VALUATION $ LEFT SIDE YARD I RIGHT SIDE YARD 1 i � License No. ' ZONf: GRADING � C4f.YDS. ACRES i PKG.SPACE REQ. I PROV-IDED � + _ \ LICENSE61CONTRACTOR DECLARATION i Remarks: I STREET WIDTH 1 PARK FEE:$ ( I .hereby` affirm that'6 dm licensed under provlslons of Charter 9 (commencing with section 7000) of Division 3, of the Business and Professions Code, and 7 SPECIAL CONDITIONS: ' I t i.' meffect. y_license is In full orcog,�q ; i V ' +, I License Cl ssr.' Llc se - _ PLUMBING i 1 i I t t Date,. Signature Signature : _ +-` �� WORKERS' COMPENSATION DECLARATION 1 k ! gar Sink I I Sewer Cap I ( ELECTRICAL i -1 herebyafflrm that (-have a Certificate bf.consent t0 -self -insure or a certificate .+ _. - _ BeckflOw'Preventer` Sewer Connection_ `' r""- '' - .. _ - -. Automatic.VYasher I _ _ ?Meter. _©Over_100 am S, •„ _ t 4''- ,Workers' Compensation Insurance,, or a certified copy thereof (Section Construction Pole Panel ,t`-)0, Lab. �C.),y •jc{_ jai ] S. �, �,F, i = t r lacy No. Company Backflow irrigation Solar Collectors e i ,' .Sub F Certified copy Is hereby furnished. i i r i r } er ie c s filed with the ci ulld�pg Ws 6, F i Bathtubs ! Solar Piping [ CookingUnit !, I i I Dishwasher ' i Sub Pole 1 1 'Motors S ❑0-1 HP ❑ 1 %-a + —¢j + , Date Applicant �' r EXEMPTION'FROM WORKERS' COMPENSATIOW DECLARATION ! Clarifiers _ J---- Solar Tank , , _ f. r — dryers ❑Gas ` ❑Electric f.; _ i _ _ fnc.Solar;❑9 15 HP ❑16-15+ �r ! _ _ i Dishwasher I _ _ — — Swimming Pool vv/Spa (This section need not be completed if the permit Is for one hundred ($100), or less):. ? ( i certify4hat In the performance of the work for which thli permit is Issued, I I i Drinking Fodntains Urinal ( t I.;, Fan I ; i ! mcrowave I Shall not employ any person In any manner so as to become subject. to the _ I I F.A.U. 4 I s 'Pole Li ht I 9M Workers',Compensa[idn Laws of California. t i FIOOr I]ralns: i : a W ter Closet, 1 I Date Signature ' -NOTICE- If; after making this declaration, -you should become- subjett-to-the c ��, _ r Floor Sinks I - - I t Fixtures I Waterlieateri --- ; -• , - ;, - , - - �_ . I , 'Range r--- .-••-ti — •.-- *— Workers'. Compensation' provisions of the Labor. Code, you ,must forthwith, comply with:• such provision s;or-thisnper-mit shall be 'deemed; revoked:• j Gas 5ervicei Outlets t d ' Water, Service , I �: i >r ( r : `i 3 Device Boxes ( ! Sign CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a Constructlon•le�nding agency for the,performance. I Interceptors] , -: + ± Outlets ( Standing Sections + ( 1 of the work for which this, permit •,is 'Issued (Section 3097 Civ, C.)• Lender's Norrie, __ -'- .--,- - ='- --- ( G `.. rri 1 t * ; �' I Kitchen!S kf ; I u r °• ' ! I I - Switches t i i Trash Compactor ; I Lender's Address OWNER BUILDER DECLARATION I _ - 1 ; s LaJatpries.• ry f, L 1 Garbage Disposal 1 I hereby,affirm that 1 am exerript'from the, Cohtrar-tor'S'Llcensa Law for the P—Trap r , ti - Generatgr ❑0 5 KW ❑5.15 KW following reason (Section 7031.5 Business and Professlonal'Code; Any city or county which, requires a permit to construct, alter, Improve; demolish or'repalr any structure, prior to Itsassuance,'also requires th6 applicant for such permit; _ �" ; Trarisformer 015 50 KW ! j -� r• - i Roof;Drains l I ^. w ,, ri i ; ' 1 ;� ,T I .to file a slgnetl statement that he/she Is licensed pursuant to the ;provisions of I the Contractor's•Llcense Law (Chapter 9 (commencing',wlth Sectionr7000) of j : ';� ( j . Y '' 1 1 , ' ❑5U + KW 1 i ! r t ; i ;Rain coon Fee 1 t >� , $15' I .Division (3 of- the Business antlC Professions Code} pry that he/st5eis exempt '��refrom-and the, basis for the alkeged ezen,ptlon•'Any.- violation ofISection - - Sh o,hierS •� ; r , -� , _ -" "`- - - ReinspectiontFee ' ' $15 - j Meter Opp to 100'amps i 1 lIssue.Fee f '$ i 1:5 by .any applicant for'.a permit subJects the applicant to a civil -- I Service Sink ' • • �f c 1 Issue Fee_ - 3 r 3_ alty of not more than five hundred dollars ($500): : 1 li I Zoning Approved By i ( Date i I; as 'owner of. the ;property or.my employees with +riages�as their sole I compensation will, do the work, and the structure Is not intended or offered '' -. MECHANICAL 1 Appliration Approved By I I ate I } I ; for sale'(Sectron 7044; Business; and Professional Code: The•Contractor s License Law does not apply to an owner of a property who builds or Improves thereon, and who'doesysuch work himself/herself or through•his or her own I employees, provided that such -improvements arelnbt Intended or offered for r sale. If, however, the building or Improvement Is sold within one;year.of com- pletlon, the owner will have the burden of proving he/she did not build or Im- �ove for the purpose of. sale). I �- ' ; , LJ I, as owner of the property, am excluslvely contracting;withllicensed con. tractors to.con5truct the;project.I Section 7044,.Business, and Professions Code:»' I -The Contractor's License Law ddoes not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law).' I I ❑ I am exempt under Section - B. & P. C. for this reason Date ' Owner' -1 -herebyy •certify- that +,have read this appilcation- and -state that the above - I Informatlon is correct, I agree to comply with all cityland county ordinances I and state laws relating to building construetion,'arld hereby authorize repre- sentativell of )this it 'to t -upon the abovo-mentioned propertym for Inspectlon osas. I Signature �� ! Datey f Drivers' License or'SS I I ) CMF 0865.46 rev. 12/82 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor I Application Issued BY Boiler- -' I ~ 4 _ ! ` ' Date Refrigeration System DO-.100,000BTU ❑ 100 a BTU SUMMARY OF FEES Duct-'l3nderlGround BUILDING PERMIT Duct - Structural I # i i SMTP ! System Repair/Alteration I I Ii PLAN CHECK S: ! _L Ducts Ventilating.. { I -, - --4 r $ IPLAN CHECK- Exhaust: System ❑ Multiple ❑ I GRADING , $ ; ;ELECTRICALI i $; �3.2� _ } Fi�epl/Fact. Blt, ICBG # 'PLAN CHECKI $' MICROFILM i $ -1 ;MECHANICAL I HeatingrSystem & Ducting 130-100;000'BTU-0100,000BT TOTAL`FEE+ 1 `PLAN CHECK' $; LESSi I ADVANCED PC - --! - t i 1 I I I Hood or TypeI ❑ ' Cano i Type I I ❑` I i Reinspection Fee i $15 $' lI I Registers i i I Issue Fee I $ 3 CMF 0865.46 rev. 12/82 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor I Application Issued BY I ! ` ' Date SUMMARY OF FEES BUILDING PERMIT $' i i SMTP ! $ I I Ii PLAN CHECK S: ! F PERMIT, i � 1 1 'PLUMBING $I $ IPLAN CHECK- $, GRADING , $ ; ;ELECTRICALI i $; �3.2� _ ' i ! $ 'PLAN CHECKI $' MICROFILM i $ -1 ;MECHANICAL I $; TOTAL`FEE+ $ I r `PLAN CHECK' $; LESSi I ADVANCED PC l I 4} r I ) 1 I FEE i$) FINAL 1 $' r}''CONSTRUCTION AND;PLAN NG' r -i' }f�, w [ _ .POO L-8 ? APPROVALS Permit #� �~- r!` `� `Date r' < `Inspector APPROVALS 'Permit # Date I'nspe'ctor'_ , . _ ,1 Temporary Electrical Service or F?ole ��: :; c : 52�, Pool &Equipment Location, " E = n i 2! Soil Pipe=Undrgrnd._ j s `. Q i ' . ° v ` '. �' ` ° ' S3: Steel Reinforcement ; - , 3: Electrical Conduit-Utility-Undrgrnd'. " - n ;''�: ' J54, Forms u 4- Electrical Conduit-Undrgrnd: _ l _ i - ", 55. Electrical Bonding ; I - o n 5: SteelReinforcement' ` - - -56.• Rough Plumbin & Pressure Test t 6. Electrical UFER Grnd: ' " = ` 57 APPROVAL TO COVER•GUNITE ; 7. Footings I r :� - 58. Efectricai'Coriduit-Uridrornr!•_ :- 8. Foundation! - 59. Gas Pipe; ©Undrgrnd., Test y y _ 9. Water) ipe-Undrgrnd. , o _ ' F. 60. Backwash Lines, P -Trap, ❑ Undrgrnd.. _ 10. Structural Floor System a r _ ' i_ 61. APPROVAL TO DECK - - 11. Property Sewer Line &House Connection t a 62. Backwasli & Receptor -Final: 12' Sewer Cap, 63. Heater &:Vent -Final = r 13. Roof -Drains j 64. Plumbin S stem : Final 14. 'Rough Plurrlbin a 9 � � _ '65. Electrical -Final •15. Rough Electrical:Conduit'--- - 66. Solar•System-Final 16. 'Rough -Electric Wiring, „ ' = ' i� ` - _}s + ' ; }T,4'_ , _- `_67: -Fencing &Acces's Approval 17. Rough -Wiring Signr . 68. APPROVED FOR'PLASTERING _ ' 18. ;Rough Electrical-T;Bar Ceiling ; I 69., POOL/SPA SYSTEMS FINAL 4 + „ 19: Rough Heating &Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit# 20. Rough.Factory Fireplace , ; } ; I J F 21. bZicts,:in Struetur'e I } X70. Underground Hydro , X22 Ducts, Ventilating r } ; �, i j i ?71.1 Product Piping ❑ Gas ❑ Oil ' 23. ,Gas Pipe -Rough & Test}{al �' 72. Underground Flush ~ i 24. ;Roof Framing �' ! � 1 o I •v ! ; �; - 73. Un'dergrnd. Storage Tank ❑'Gas ❑'Oil' 25.aR66f Sheathing ' > 6" j i� i I _ ,74. Overhead Hydra , , 26. T -Bar Ceilin Structural ti &�Monoco ' f ( 1 at ° i ` ` ` (. ' r i7Fi.; Dry Chemical ' .g r . I r '27. F rak;e'and )`lashing: } i } 76.1 Dry Stan pipe I Lathing;&'Sidi'ng ; r I F,1{ i l I {77.} FIXED SYSTEM -FINAL t I 1 29: 'Insulation _ s ¢ i $' ,� �I +78. FIRE PR EV. FINAL a r fi 30. Drywall F ailing `1 I ie i I j f Notes:! i r t 1 i , 31: Plaster Brown Coat 32. Eiectrical'Power Meter -Final i 33. Final Electric - it_ ~+ 34. Final Heating &Air Conditioning !' 1 l I = , •moi - , 35. Final Gas Pi pe_Test �' 36. Hood Or ,Cane Pv = " } I ,. S n r •` ,v 1 I I y '• , . cc • , -.t - ! } _ -' 37. Final Factory Fireplace• - } t 38, Final Plumbingl I } n t e , } 39. Water S&vice-Final! k , I 1 40. Gas Service•Final 41. Solar Domestic -Final r s y _ _• __ _. +_ T_, -, _ r 42. Backflovlr' Preventer 43. Backflow Irrigation! '- i i "I I,v i _ 44. Landscape Irrigation System 45. Sound Attehuaiio'n 3 i 46. Handicap Regulations 47. FINAL STFIUCTURE & BUILDING 48. Special Requirements Completed i f 49. Electric Release'to Edison; 50. Gas Release io Southern California Gas Co ,.o 51. CERTIFICATE OFIOCCUPANCY ID No . >i i I 1 ' ate - _� _= 1- _- _ ..._ _ - _ _ _ I- -...y• _ .3 .� -•er--sem•• (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.usNG PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 711 W 17TH ST Status: ISSUED Suite: C Applied: 04/11/2005 Vicinity: UNIT C Issued: 04/11/2005 Primary Occ: B Eat<501 Office/ Bar<50 Type of Construction: V Parcel Number: TPN02004 Zoning: Applicant: BATIOFF, JOHN ISSUED BY: Address: 17182 ARMSTRONG AVE Phone: 949-260-1900 IRVINE, CA .; Zip: 92614 ' Owner: MESA BUSINESS CENTER ASSOCIATION Address X711 W 17TH ST Phone: 949-672-9035 COSTA MESA, CA s' Zip: 92627 Contractor: 'DRI COMMERCIAL ' Address:, 17182 ARMSTRONG AVE Phone: 949-260-1900 IRVINE; CA Zip: 92694; License: 818623 Arch Eng: Address: Address: Phone: Phone: Zip: License: License: _ SCOPE OF PERMIT TEAR OFF EXISTING BUILT-UP ROOFING & INSTALL NEW BUILT-UP ROOF SYSTEM (UNIT C) - 192 SQ. FEE SUMMARY Plan Check: $0.00 Calc Valuation: 540,000.00 Permit: $543.25 -- Claim Valuation: $40,000.00 SMIP Res: $0.00 SMTP Com: $8.40 Other: $0.00 _ Inspection: $0.00 Total: $551•.65 -- PLANNING & ZONING SETBACKS � MAIN STRUCTURE 'Front 0- 0 Rear �0- 0 Left 0- 0 Right 0- 0 ACCESSORY �Front.- -0- 0 Rear 0-0 Left 0-0 Right-. '0-0 , PARKING Existing:. '"0' Required: .0 Pro osed: 0 NOTES: .. - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 46-46 tarool PECLARATiONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1'13 I have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. % My workers' compensation Insurance carrier and policy number are: G{ Carrier: ) 47-0�152&2 LA Al T�( L4 DC= �t�kpi 0. Policy Number: W 477 � I (a(�, (nis section need not be completed if the permit is valued Al one hundred dollars (,8100) or fess.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of C lifomia, and ag a that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith Go" with these pr r 'rcanf Sig ature: Vx n- p� ate' -ill '-L1J ARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE f5 UNLAWFUL AND SHALL SUBJECT AN EMPLOYER40 C�R#MINAI- PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (S100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR iN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am lice`d under,,provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic, a 71 (p 1 Class a Gontt5-Signature: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code), Lender's Name: Lender's Address. Signature: Date: OWNER-BUILDER DECLARATIONS. i hereby affirm that under penalty of perjury that 1 am EXEMPT FROM T14E CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): [] I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). C1 I am exempt under sec. Business and Professions Code for this reason: Signature: Date: owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Varificalion of O Wnership by (type of document, i.e. - property tax bill or deed}; DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required 10 descend, will be made in connection with work authorized by this petmh, and that no building structure, scalloiding, latsework, or demolition or dismantling thereof, wilt be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). d As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to the and ceriity a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .................................................................................................................................................................................................................................................................................................................................................................................... 2 hoes or will the applicant Or present or tuture building Occupant meed to file a registration form for acutely hazardous materials? ©Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic teat of compressed gas at standard temperature and pressure). ................................................................................................................................................................................................................................................................ ................... ... ............................................... --............................ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .........................................................................................................................................................................................."......................,.............................................................11111111........................... 4 It an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ..............................................................."................................... -----............................................ ,............................. ,.........,......-..............................................,""I.......................... 5 Does or w01 the appiicant or present or future building occupant requiro for the work which Is the subject of this a plication a ermit for such construction or modification Isom the South Coast Air Guality Management District or from any other air pollution control district or agency? a Yes g No (Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). :..............................". i.............. h •..............................................................................--- ------------...............................................................................I.................I.........1 .....................111.. 11.......................11. -- ------....1.11............1..... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If all permit from Lha South Coast Air 0Uality Management District or, clhar air pollution control district or agency is required far the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No .g attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si ur Of Legal O er(s) Date AnFUar Authorized Ap tcent_,ate�c.=,.�, COGS L INSPECTION TYPE INTMALS CODE P INSPECTION TYPE IP(TITibL,$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign __ 222 Final Sile 204 Final Demolition 250 Final Building/Occupancy Applicant to 1111 In all spaces except those within heavy border lines and sign all appropriate declarations, s Duct -Ventilating _ CITY OF COSTA MESA] "`/3 O ! PERMIT NO RACT NO. LOT NO. BLDG. NO. $s Exhaust System CJ Multiple ❑ CONSTRUCTION PERMIT — 11096 1 6, 2 D 01 t6 5/10/84 I5-Vi 71. 50% Project Address 711 W. 17th Street = TYPE OF CONSTRUCTION LJ NEW LJ ADD bd ALTERATION Li REPAIR $ TOTAL FEE 25% S Applicant's Mailing Address 2418 MacArthur .Blvd. , C. I MLI CONVERSION "❑ DEMOLISH ❑ OTHER A. P. 4—Q _ 5 � Zone and state laws relating to building construction, and hereby authorize repro- sentatives of this city, lienter upon the above-mentioned property for Inspection rposes. Signature Date 2 Drivers' ase or SS =PReinspection PLAN CHECK MECHANICAL r PLAN CHECK 'Troy 'InveS-tment dPhone Alterations- $26 Issue Fee $ 3 Owner's Name f_ -749-298 :DESCRIPTIONOFWORK)wXterlOr 5 Main Building: Accessory Building: Z 4321 Birch. Street, Newport Beach E O Address TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front N Arch/Eng. Wm : L . Pereira A $ S O�icense No. ❑TENANT ❑ELECTRICAL ❑PLUMBING ❑MECHANICAL B Rear i / Address 2418 MacArthur Blvd.,.Corona . Corona del' M r ❑,OTHER A N Contractor's Name Phone PROJECT DESCRIPTION SQ. FT.C OCCUPANCY Right � _ G R Address (mailing) CONSTRUCTION TYPE VALUATION $ 800- 0O g Left E City License No. ZONE GRADING CU. YDS. ACRES Ping, Ref. 7 Park, Fees $ Q \ LICENSED CONTRACTOR D11LARATION Remarks: P.C. #20-84S Parking Req./Provided I t hereby affirm that I am licensed under provisions of Charter 9 (commencing R f� with section 7000) of Division 3 of the Business and Professions Code, and Use of Building: E my license is In full force and effect. M License Class License No. PLUMBING FEES Planning Notes E Date Signature Bar sink Showers N WORKERS' COMPENSATION DECLARATION \ I hereby affirm that I have a certificate of consent to self-insure or a certificate Backflow Preventer Service Sink — S \, of Workers' Compensation Insurance, or a certified copy thereof (Section 00, Lab. C. 2420001683 Argonaut Backflow Irrigation Sewer dap ELECTRICAL FEES icy No. Company Certifled copy is hereby furnished. L� Bathtubs Sewer Connection Automatic Washer Transformer El15-50KW Certifled copy Is filed with the city Building Division. 1-150+ KW Date Applicant Clarifiers Solar Collectors Construction Pole Sub. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Dishwasher Solar Piping Cooking Unit Meter ©up to 100 amps (This section need not be completed if the'permlt is for one hundred ($100) or less). I certify that In the performance of the work for which this permit is Issued I to to tke Fountains Drinkin 9 ns Solar Tank Dishwasher Meter ❑over 100 amps, shall not employ any person In any m nner so as come subject workers' o p s ion Laws of Calif n a. Floor Drains Swimming Poo! w/Spa Dryers ❑Gas ❑Electric Sub Panel Date Signature NOTIC : I j fter making this declar I you should become'subject to the- Floor Sinks - Urinal Fan Motors 00:11 HP Ell 1/2 B Workers' Compensation provisions the Labor Code, you must forthwith comply ,with such provisions or this permit shall be deemed revoked. Gas Service. Outlets Water Closet F.A.U. Inc. Solar ❑&15 HP ❑16-15+ CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance Interceptors Water Heater Fixtures i Microwave of the work for which this permit Is Issued (Section 3097 Civ. C.) Lender's Name kitchen Sink Water Service Device Boxes Pole Light Lender's Address OWNER BUILDER DECLARATION Lavatories -• Outlets Range I hereby affirm that I am exempt from the Contractor's License Law for the Professional' Any P—Trap; Switches 'Sign'. following reason (Section 7031'.5,Business and Code: city or B county which requires a permit to construct, alter, Improve, demolish m repair t _ - 'any structure, prior to its Issuance,:also requires the•applicant for such permit Roof Drains _ Garbage Disposal Standing Sections to file a:slgned statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Generator ❑0-5 KW ❑5.15 KW Trash Compactor Division 3 of the Business and Professions Coda)-or that he/she is exempt T 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 Reinspection Fee'' � � 5 ' Issue Fee $ 3 f t than flue hundred dollars 500. �{ty o no more t ($ ) , Reinspection Fee $25 Issue Fee $ 3 as owner of the+ property or my employees with wages as their sole ,pensation will do the work, and the structure Is not Intended or offered �. MECHANICAL FEES' for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to.an owner of a property who builds or ImprovesBoiler Hood T ❑ PUBLIC SERVICES REQUIREMENTS- himself/herself through har or ype I I Ut thereon, and who ,does such work or his or own employees, provided that such Improvements are not Intended or offered for however, the building or improvement Is sold within of corn- - Duct -Under Ground Canopy Type I I El Zoning Approved By Building Approved By Date Date sale. If, one year pletion, the owner will have the burden of proving he/she d{d not build or Im- rove for the purpose of sale). Duct -Structural Refrigeration System '.Application Issued By « at � I, as owner of the property, am exclusively contracting'wlth.ilcensad con- ".traCtors.tb construct the project -(Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such protects with a'con• tractors) license pursuant to�tha Contractor's License Law). ❑ 1 am exempt under SectionB. & P. C. for this reason s Duct -Ventilating _ NIT ❑0-100,000 BTU ❑100,000 BTU _ - /cJ !1 $MIF - - - BUILDING PEI PLAN CHECK „ PLUMBING PLAN CHECK ; ELECTRICAL $s Exhaust System CJ Multiple ❑ System Repair/Alteration ISSUANCE 25% Firepl/Fact. Bit. ICBG ENERGY P.0 $$ Date owner I her certify that I` have read' s application avid state that the above ' Information Is correct. I agree to comply with all city and county ordinances 50% Heating System & Ducting ❑o-100,000 BTU �100,000BTL MICROFILM $ TOTAL FEE 25% S g and state laws relating to building construction, and hereby authorize repro- sentatives of this city, lienter upon the above-mentioned property for Inspection rposes. Signature Date 2 Drivers' ase or SS =PReinspection PLAN CHECK MECHANICAL r PLAN CHECK Fae $26 Issue Fee $ 3 CMF 0865-46 rev. 12/83 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor i$ , i s SUMMARY F FEES NIT $ /cJ !1 $MIF $s PERMIT $ ISSUANCE 25% S ENERGY P.0 $$ GRADING 50% $ MICROFILM $ TOTAL FEE 25% S i$ , i s : -CONSTRUCTION-AND.PLANNING APPROVALS „ Permit # Date - Inspector POOL,&5' -,_ 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. I 54. Forms • 44. Electrical Conduit-Undrgrnd. 55.' Electrical Bonding", 5. Steel Reinforcement 56. hough Plum bing;& Pressure Test 6:. Electrical UFER Grnd., 57. APPROVAL TO COVER-GUNITEM r. - 7. Footings ands. ��, 58. Electrical Conduit.Undrgrnd. , 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. _ 60. Backwash Lines, P -Trap, ❑ Undrgrnd.: - 10, Structural Floor System 61. APPROVAL TOrDECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final r 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 i 69. POOL/SPA SYSTEMS FINAL - 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 4 APPROVALS Permit le ' 20. .Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping PGas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush I 24, Roof Framing ' 73. Undergrnd. Storage Tank ❑ Gas ;❑ Oil 1 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 f t # 29. Insulation 7B. FIRE PREV, FINAL 30. Drywall Nailing I HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79., FINAL INSPECTION ; 32. Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED i 33. Final Electric Notes: 34. Final Heating & Air Conditioning ! �i� �,i�jr,t} Cd,O(i✓CT t�G , 35. Final Gas Pipe -Test ' 36. Hood'or Canopy • ' I I r ! - 37. Final•Factory Fireplace 38. Final Plumbing i 39. Water. Service -Final ' 40. Gas Service -Final 41. Solar Domestic -Final - - 42. Backflow/Preventer 43. Backflow Irrigation 44. ,Landscape lrrige'tion System 45. Sound Attenuation 46, Handicap Regulations } ° 47. FINAL STRUCTURE & BUILDING I 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ' 51, CERTIFICATE OF OCCUPANCY No. Date j ' 6 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.usING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 711 W 17TH ST Status: ISSUED Suite: D Applied: 12/0512001 Vicinity: Issued: 12/0512001 Parcel Number: 93983048 Zoning: Applicant: MIKE ROGERa . - ISSUED BY: Address: Phorie: 949-548-1645--` Zip: Owner: MESA BUSINESS ASSOCIATION Address W-17TH•ST `•� �� i �� ' ��\\ /711 /�'� �'� A = `_ Phone: 949-672-9035 �-.�� \� COSTA MESA, CA `� - =%"� Zip: 92649 Contractor: �P.ETRONELIA-ROOFING Address:- 2626 -NEWPORT 13L Phone: "(949) 548-1645 COSTAMESA, CA Zip:_, 92627 License:de 460707 Arch- :�- r. •- 4",�,�.'�. ' ,. En g• a Address: _��-=i! -- Address:. .Phone:- Phone: `Zip: " 1 f License: r 'License: -SCOPE OF PERMIT_ r T/OFF AND REROOF 17500SF UNITS CONDO.WIBUILT,UP, ROOFINGfASTM-D5957. i ,12 FEE SUMMARY j,'/ ` Plan Check:- $0.00 "` '; �,, ,� _ `; Calc Valuation: -+ :$35,000.00, Permit: $492.75; _ �_ _ �� ! ` Claim Valuation: $35,000-00 SMTP Res:' $3.50 �.SMIP Com: $0.00 - $0.00 .Other: Inspection: '.$0.00 � `vTotal: $496:25 PLANNING & ZONING SETBACKS' \ MAIN STRUCTURE;F,ront. , 0-1,0' f Rear 0- 0 Left 0-0 - Right i ACCESSORY Front 0- 0 Rear 0- 0 Left 0 0 . Right 0 0 j= PARKING Existing-, 0 Re' uired: ' 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. " I INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-562$ 2"6-0 (6-W) 7 WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued, ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and po y nurp`ber are: L4 L Carrier: S r Emma.. r / ,1> T my. rulD Policy Number: 17 Z g (This sec ;ort meed not be completed illitho permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is Issued, I shell not employ any person in any manner so as to become subject to the workers' 'compensation laws of California, and agree that If I should become subject to the workers', compensation provisions of Section 3700 of the tabor Code, I shall forthwith comply with theselpro�ions.' j Applicant Signature: v V�-� / Date: WARNING: FAILURE TO SECURE WORKERS' COMPEN ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINk PE TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (S10D,000), IN ADDITION TO THE COST OF OOMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7 0) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Uc. q /" Class q G - Contractor's Signature: Date: / CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. 11, however, the building or improvement Is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ i am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. • property lax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division o1 Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 o1 the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greeter than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ....................................................................................................................................................................................................................................................................................................................................... ...................................... . 2 Does ar wig the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materlals equal to or greater then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................................................................................................................................................................................................................................................................................................................................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costs Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materiels with the Fire Department. .............................................................. .......................................................................................... .......................... ..................... ................................. --•-----......................................... 4 if an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ................................................ ........................................................ ........................................................................ I •--................................................... ................................... ........................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ll Yes l� No (Section 95850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits). ..._ _ ................._....................__..._.................................................... ................. .............................................................. --._.................................................................... ........_._....._.................................... _... _........... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (If 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ....................................................................................•.............................................................................................................................................................................................................................................................................................. 7 If a permit from the South Coast Air QualityManagement District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by Califomla Health and Safety Code Section 42303 been made? ❑ Yes ❑ No w ..............._.—_..._............................ m .._... --.................................�_......................... .............................. ....................._............._ 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury [hat I have read this application and state that the information given Is correct. I agree to comply with all state laws and City ordinances relating t0 building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this pen -nil until final inspection. 5ignatu Legal Owner(s) D to /Z /as�%l And/Or Autho'pfed Applicant Date 000E 0. INSPECMNTYPE 2AM j( $ 000Et INSPECTiONTYPE 2AM INTITIA 1616 Fixed System Final Fire Prevention 209 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 20'0 Final Re -Roof 2_-7!n92_- 210 Final Electrical 201 Final Block/Retalning Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final BuildinglOccupancy .34892] COSTA MESA BUILDING -SAFETY DEPARTME P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill y"in Completely BUILDING %'ir _ ADDRESS 1 D 1'��+7T- OWNER MAI L Z ADDRESS w w TEL. IL U CITY 1131j�'NNAInh.NO Z Q CONSTRUCTION I— Z Q _U J IL a Q O H Z O H U U) Z ADDRESS CONTRACTOR ADDRESS LENDER CITY EL m STATE J BRANCH J SIZE Q W !n J ADDRESS ARCHITECT OR ENGINEEF co J Q U � ZQ IL THE AMOUNT SHOWN UNDER VAL TION IS FOR IL Lu THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. v W Z JO N . OF NEW BLDG, o +! MS STORIE; _TZ J Er HOOF I W W COVERING O Z� Signature - 11 W cnEr $/�/ %��D �O I— Z Q _U J IL a Q O H Z O H U U) Z ADDRESS CONTRACTOR ADDRESS USE OF BUILDING AND WORK TO BE PERFORMED 'rPAia APPLICATION FOR BUILDING PERMIT RE I V 13Y DZE�CE ED DATE ISSUE PERMI�L A.P. No.11{,-1(■O—o°{-� O BUILDING ADDRESS�� I OWNE FIRE •_ZONE APPROVED W �� =_ ,IME R�� r' 'WR ZONE � NO. OF USE OF NEW r A/ J �'T 7 1 1 PLANS ;L BUILDING 13 L b 495� YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM C/L STREE l)y n z 5 3 qC) TEL. CITY t NO. STATE CITY LIC. NO. LIC. NO. SIZE NO. OF BLDGS. OF LOT GODNOW ON LOT USE OF THE AMOUNT SHOWN UNDER VAL TION IS FOR EXISTING BLDG. THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. v SIZE OF Y A N . OF NEW BLDG, o +! MS STORIE; EXTERIOR WALL HOOF I COVERING COVERING USE OF BUILDING AND WORK TO BE PERFORMED 'rPAia APPLICATION FOR BUILDING PERMIT RE I V 13Y DZE�CE ED DATE ISSUE PERMI�L A.P. No.11{,-1(■O—o°{-� O BUILDING ADDRESS�� I OWNE FIRE •_ZONE APPROVED W �� =_ ,IME R�� r' 'WR ZONE � NO. OF USE OF NEW r A/ J �'T 7 1 1 PLANS ;L BUILDING 13 L b 495� YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM C/L STREE l)y n z 5 3 qC) REAR FT. F.T. DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. VAR. * DATE C.U.P. * APPROVED APPROVEov nn rc At I hereby acknowledge that I have read this application and state pEC QIHf6 that the above information Is correct and agree to comply with all laws regulating building construction, and I shall not employ any person In violation of the workman's compensation laws of42 the State of California. m I hereby certify that I am properly licensed as a contractor under SQ. FT. TAX o the State of California Business end Professions Code, Division 3, THE AMOUNT SHOWN UNDER VAL TION IS FOR Chapter 9, and that Such licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. v am exempt from the provisions of the State of California Business VALUATION and Professions Code, Division 3, Chapter 9. Cc m ` PERMIT FEE $ Signature - 11 a� m Permittee $/�/ %��D PLAN CHECK $ o Authorized Agent TOTAL FEE $ Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. G. NO. CONSTRUCTION PERMIT Mpg, 'Project 2�n7 8/Q1 TL Address _ - fG TYPE OF CONSTRUCTION .15-00 Owner Phone = C12 Z NEW ❑ ADD ❑ ALTERATION Address ❑ REPAIR ❑ CONVERSION ❑DEMOLISH ❑ OTHER ZONING REGULATIONS Arch/Eng. License No. DESCRIPTION OF WORK A.P. - Address ZONE PLNG, REF. 5ye Contractor Ph6ne TYPE OF PERMIT BUILDING - TToo %g1UVL ❑1NG Address ❑GRADING ❑ SET ACK PROPERTY LINE FOUND Tr1y0N S L I E YARD LICENSED CONTRACTOR DECLARATION I hereby affirm that- I am licensed under of Charter 9 (com- �PLU f IJ�MECH ICA S1DFE YARD provisions mencing with section 7000) of Division 3 of the Business andTERProfessions *TENANTAEELECTRICA I HT Code, antl my license Is In full force and effect.1ECT REAR YARD (TO P/L) DESCRIPTION License Class Licanso No, SQ. SQ. F7.' PKC. SPACE REQ. PROVIDED, Data Signature WORKERS' COMPENSATION DECLARATION - OCCUPANCY CONSTRUCTION TYPE STREET WIDTH PARK FCE 5 1 hereby affirm that I have a Certificate of consent to self -insure or a VALUATION ZONE ZONING APPROVED BY DATE Certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.). GRADING CU. YO$. ACRES SPECIAL CONDITIONS: Policy No. CoMpany - i,. copy is hereby furnisped. - REMARKS: trtified copy is filed with the city Building Division. '� r^_LMPTIOIV FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred , ($100) or less). I certify that in the Performance of the work for which this permit is Issued, I shall not employ any person in any manner s0 as t0 become PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK subject to the Workers Compensation Laws of California. - Date Signature BATHTUBS SHOWERS NOTICE: It after making this deClaration, you should become subject _ TOILETS URINALS GENERATOR 0-1 KW 1.10 KW to the Workers' Compensation provisions of the Labor Code, you must TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS APPLIANCE 10.50 KW 50 + KW revoked. _ - CONSTRUCTION LENDING AGENCY KIT. SINKS DISHWASHERS - MOTORS 0-1 HP 1.10 HP I hereby affirm that there Is a construction lending agency for theper- SERVICE SINKS SUMPS - (INC. SOLAR) 10-50 HP 50 + HP formance of the work for which this permit is Issued (Section 3097 Civ. C.). FLOOR SINKS FLOOR DRAINS FIXTURES OUTLETS SWITCHES Lender's Name Lender's Address ___ _ _ __ DRINKING FOUNTAINS GAS TUBE SIGNS OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License law for INTERCEPTORS CLARIFIERS POLE LIGHTS the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL - P TRAP Any city or county which requires a permit to COnstruCt, alter, POLES METERED sue improve, demolish or repair'any structure, prior to Its Issuance,also're- WATER SERVICE - ALTERATION PANELS MAIN SUB quires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law GAS SERV ICE OUTLETS r SERVICE RMP Chapter 9 (commencing with Section 7000) of Division 3 of the Chapter and Professions Code) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT, basis for the alleged exemption. Any violation of Section 7031.5 by arf•"applicant for a permit subjdcts the applicant to a civil penalty SEWER CONNECTIONS '.^$t more than five hundred dollars ($500). "-"�as owner of the property, or my employees with wages as their sFs._1_11 ompensation, will do the work, and the structure Is not Intended.. SOLAR TANK COLLECTORS+ Or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. _ ISSUE FEE - Contractor's License Law does not apply to an owner of a property. , who bullds or improves thereon, and who does such work himself or ISSUE FEE - APPLICATION APPROVED BY DATE - through his own employees, provided that Such improvements are not intended or offered for sale. If, however, the building or Improvement Is sold within one year of Completion, the owner will have the burden MECHANICAL PLAN CHECK SUMMARY OF FEES of proving he did not build or improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTU BUILDING ' -I, as owner of the property, am exclusively •Contracting with the 7044, AND DUCTING PERMIT 5 SMIP $ Iicensetl contractors to construct project (Section Business 100,000 + BTU PLAN CHECK S PERMIT and Professions Code: The Contractor's License Law does not apply to ISSUANCE E ' an owner of property who build4 or Improves tnereon, and who Con- REFRIGERATION 0-100,000 BTU PLUMBING $ tracts 'from such projects with a contractor(s) Ilcesnod pursuant to SYSTEM GRADING 5 the Contractor's License Law). 100,000 +BTU PLAN CHECK $ ❑ i am exempt under Section- B. d. P. C. for this S L BOILERS BTU ELECTRICAL $ reason SYSTEM REPAIR. , PLAN CHECK 5 MICROFILM S Date Owner .._ TOTAL FEE S I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE .MECHANICAL 5�[� LESS AD. Information is correct. I agree t0 comply with all city and County PLAN CHECK S VANCE PC 5 ordinances and state laws relating to construction, and hereby authorize representatives of this city to enter upon the above mentioned property for pet o urpo 4. .� C_rJlLAI �� Af- Signature cJ O FINAL F6E $ Drivers' License or SS� ISSUE FEE -- � ^'- CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # 11 Date . Inspector . 1 � _ 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location - 2. Soil PipemUndrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bondin 5. Steel ein orce 47. Rough Plumbing & Pressure Test + 6. Electrical UFER Grn 46. APPROVAL TO COVER -GUN ITE 7. Footingt 49. Electrical Conduit-Undr rn B. Foundation 50. Gas Pipe, ❑ Undr rn, Test 9. Water Pipe-Undrgrn 51. Backwash Lines P-TraQ, ❑ Undrqrn 10. Structural Floor System 52. APPROVAL TO DECK 11. Property Sewer Line & House Connection 53. Backwash & Receptor -Final 12. Street,Sewer Connection 54. Heater & Vent -Final 13. Rough Plumbing 55, Plumbioa System - Final 14. Rough Electric -Conduit 56. Electrical -Final 15. Rou`h Electric -Wiring 57. Solar System -Final 16. Rough Heating & Air Conditioning M. Fencing & Access Approval 17. Ducts in Structure 59. APPROVED FOR PLASTERING 18. Ducts, Ventilating 60. POOL/SPA SYSTEMS FINAL 19. Gas Pipe -Rough &Test 20, Roof Framing _ 21. Roof Sheathing NOTES: 22. Frame and Flashing- 23. Insulation 24. Lathing & Siding 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter -Final 2B. Final Electric 29. Final Heating & Air Conditioning 30. 31. Final Gas Pipe -Test Final Plumbing 1 32. Water Service -Final 33. Gas Service -Final 34, Solar Domestic -Final 35. Landscape Sprinkling System 36. Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42, CERTIFICATE OF OCCUPANCY No _ Date 7\7 kr - PROJECT ADDRESS: 711 W 17TH ST OWNER'S NAME: ROBERT S. NACKOWSKI ADDRESS: 711 W 17TH ST D-1 COSTA MESA CA -92627 ARCH/ENGINEER: (71 fii) 8 4 0— 8 0 8 0 ADDRESS: UNIT: D-1 REG.NO.: UNIT: PERMITTEE: ROBERT S. NACKOWSKI (714)840-8080 ADDRESS: 711 W 17TH ST D-1 COSTA MESA CA 92627 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. CITY LIC.: STATE LIC.: CLASS: Date: Signature: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certiticale of Consent to self -insure or a certificate of Workers' Compensation Insurance. or a certified copy thereof (Section 3BOO. Lab, C), POLICY NO.: EXP, DATE: COMPANY: ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division Jale: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This segfion need not be completed it the permit is for one hundred (5100) or less), I Certdy that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date: 71 dL" 17 199L signature: NOTICE: If. after making this declaration, you should became Wbjecl to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued {Section 3097. Civ. Cj. LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to fife a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State 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 70.31,5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S5O0). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale (Section 7D44, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himsenlherself or through his or her own employees. provided that such Improvements are not Intended or offered for sale. It, however the building or improvemenl is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale), I. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractors) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided 10 me. I am exempt under Section: B P 70 4 4 ""- o r . 8P. G.or this reason: NO EMPLOYEES Date: 3" 1 L_ Owner: _— I do hereby certify that I am aware of and understand the requirements of California,Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant willlwill not (circle one► need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Date: Applicant, I hereby certify that I have read this application and State that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes Date: —.,�."""�ry1 17 Driver's License or Social Security 164145 White—Budding; Green—Code Enforcement: Canary—Applicant; Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 05661 PERMIT NO: B 056611 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: 5—N PERMIT TYPE; STR PURPOSE: DEM JOB DESCRIPTION DEMO A WALL & SHELVING/PREPARE FOR T.I. SQ FT: CLAIM VALUE; 1,000,00 CALL—VALUE: 1,000,00 GROUP OCC: B-2 / COMMENTS: THIS IS NOT A BUILDING PERMIT! Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGrHT: FT IN PARKING RE • PROV: PARCEL; 42409111 ZNE: REF NO: PLANNING NOTES> > �E * �t � �t * iF iF * iE 9F it• it � iF it• iF iF �E iE iE �E iE * iE yF � � * * * �t * �E * * � �t � �t �t �t * * * iE * it• � �F �F iF * iF i4 � it• * yF �E * * �t �t �t * �E i4 iF iF 1F iE iF � it• iE it• it iF D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N .T S ZONING APPROVED BY DATE: BUILDING APPROVED BY DATE: ' APPLICATION ISSUED BY: I DATE; �*iF*****it•*�iF*iFiFdMiFiFiFjFik � 9E it if 9F ib�F-)tiE i4iF iF�l•*1FiE***�1•��1•**�t�t�t***��t�***��t�t1F�E*****��}�}�}*�} �3t*iEiFiFiFiFiFit�iE*�E�t�}*it•�*9F9F��*iFiE*iE*9F��t LEGALIZATION:N F E E S U M M AiF Y STRUCTURAL'SEGMENT:Y r• , BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 25.00 SMIP/NON—RES PLAN ,50 ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 25.50 0,00 0,00 25,50 25.50 .00 REVENUE DIVISION TOTALS--> COLLECTED: 25,50 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 25.00 .50 iE��tiFiFiEiEiEyF*�*�****•It�t�t�t*iF��t�tiF9F9FiE�iEiEiEiFiF*iE**iE***it•��iF?tF*�iF�iFitiFiE*iF�tiF1FiE�iF**�E�itiFiF**�tiFiEiEit I N D I V I D. .0 -A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST NO FEES WERE SELECTED FOR THIS PERMIT DATE: 03,'171'92 '11;72" r34,40l CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspictor POOL ' ("A APPROVALS Permit # Date Inspector 1, Temporary Electrical Service or.Pole 52. Pool & Equipment Location 2, Soil.Pipe-Undrgrnd._ ; 3, 53. Steel Reinforcement 3. Ejectr;ca4 Conduit 4tj;sty-Undrgrnd. 54. - Forms S 4, Eledt-rical Condi3Q--U6drgrnd. r 55. Electrical Bonding _ ' 5. Sieei.eiraforcement2 56. Rough Plumbing &Pressure Test , 6. Elec- 57. APPROVAL TO COVER•GUNiT' 7.'Footing5 5$. Electrical Conduit-Undrgrnd. ' 8. -foundation E ~ i 59. Gas Pipe, ❑ Undrgrnd., Test 9': Water Pipe-Undrgrnd. 60, Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13, Roof Drains c 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 Electricai•T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT • _ r •- x PPROVALS' = -Permit # _ 20. -Rough Factory �freplace 21. Ducts, in,5tructijre. ... 1_: •.70. Underground;Hy r0 t 22, Ducts, VentilatingI 'r '- ti. _ r `•` ` "71. Produef'Piping ❑"Gals ❑*Oil , 23.:Gas'PipecRaugh & est �; - _ �z - 72. Undergrout�c� Flush=, 24. 'Rocf Framing _ , - " * X73. F Undergrnd: Storar'Tca hk O Gas 0 Oil 25.' Roof Sheathing ' 74.'' Overhead Hydro,_, X26: T -Bar Ceiling (Structural) &'Monocoat r; .: }'" -A 75.sDry Chemical _ = 27.'Frame and Flashing, �.r f 76. Dry Standp 28. Lathing'-& Siding r -L -:* r -" 1 F� .w w 77-7FIXED SYST'EM:�INAL" �9. Insulation F . ' i `+' r : 7By1 IRE PREY. FINAL �1 x .r30. DrywaH:Nailing �'� t �• - - HEALTH�DEPT^REQUIREMENT 31. Plaster Srow Coat' n r. �,79.`°FINAL INSPECTION T L32:. Electrical Power A ""e*Final . X, � ' LL80.=1FOOD CERTIFICATE ISSUED . 33. Final Elctricr , , = !' h Notes: .34.- Final Heating,& A ,'Conditioni,09&* 35.' -'Final Gas Pipe -Test` VC i -r 36. Hood or'Canopy a, n 37. -Final Fe&ory Fireplace t - •`a _1 + I ' ' 1 Y '• ', ir, `38. Final PI u- nbing- 39. Water Service -Final ;410. Gas Service Final I i` - 41. Solar Domestic -Final i ,r A r, 42. Backflow Preventer 43. Backflow Irrigations = `, .44. Landscape Irrigation System,- „' 1, - �.} ; g ti , 45. -Sound Attenuation �•J' 46. Handicap Regulations J _ 47. FINAL STRUCTURE & BUl-LDING 1- sm - 48. FINAL PLANNING. -49. ;Electric Release to Edison 50. Gas -Release to Southern California Gas Co I F 51. CERTIFICATE OF OCCUPANCY No. Date ,' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA/ CONSTRU TION PERMIT Project Address Applicant's Mailing Address 220R Owner's Name ` 7, Phones 2 ,Address Arch/Eng. License No. Address Contractor's Nam Ph0n1_1SSh 7 Address (mailing) 2/2n e7VT City License No. OZ/24/ / 7 LICENSED CONTRACTOR DECLARATION I hereby affirm that i am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full for an effect, License Cl z2 )nse No. �RdS Date YIYZSignature - ' WORK RS' COMPENSATION DECLARATIO hereby affirm that i have a certificate of consent to Mlf-insure or a certificate Workers' Compensation insurance, or a certified copy thereof (Section oC, N rtY 76 o. 1'7 6 L i� R'C7 Company Y•�n7'� /��V ❑ Certified copy is hereby furnished. ertiftq y with the city tli 2ivisl pr Dale ' Applicant EXEMP ON FROM WORKERS' COMPENSATION DECL ATI N (This section need not be completed if the permit is for one undr ($100) or less). I certify that In the performance of the work for which this permit is Issued, I Shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION. LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for .which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that.1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License taw (Chapter 9 (commencing with Section 7000) of _ Division 3 of the Business and Professions Code) or that he/she is exempt '•erefrom and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a permit subjects the applicant to a civil natty of not more than five hundred dollars ($500). LJ I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sate., If, however, the building or improvement is sold within one year of com- pletion, the Owner will have the burden of proving he/she did not build or [m- Eove for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s1 license pursuant to the Contractar'S License Law). 1 am aware that proof off their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and State that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this to enter upon the above-mentioned prop rty r inspection pur / y y OF Signature zr.[_✓`�/t�t..�— J• r Dai. Drivers' License or SS :P PERMIT NO. TRACT IVO. LOT NO, UNIT Nt)_ I 7� ��, �► fDs _ r �r.nc3al d}i� Ti l TYPE OFCONSTRUCTI N LJ NEW LJ ADD EX ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTr- A.P. # zone DESCRIPTION OF WORKIUSE OF BLDG. / • S Main Building: Accessory Building: E TYPE OF PERMIT LJ GRADING 0 FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTFZICA. ❑ PLUMBING El MECHANICAL R Rear ❑ OTHER Z C Right PROJECT DESCRIPTION SQ. FT.. _ OCCUPANCY _ K CONSTRUCTION TYPE VIV VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Parking Req./Provided Rimarks: ADD Jl_fr, w, -L ��p (R F (,.. To 4#, C((y� Planning Notes: Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—T rap Roof Drains PLUMBING FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Reinspection Fee $15 I I Issue Fee $ 3 MECHANICAL FEES 1 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0.100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type 1 ❑ Canopy Type II ❑ Refrigeration System Do-100,00OBTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee I $ 3 ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F. A. U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW 05.15 KW Reinspection Fee 1 $15 Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter Dover 100 amps Sub Panel Motors ❑0-1 HP ❑l h- 8 Inc.Solar 09-15 HP 016.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor Issue Fee FEES Z O N I N G R E O M T S, DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By 417 fate_ ti Application Issued By Oate SUMMA Y OF FEES BUILDING PERMIT $ �', O O SMIP $ PLAN CHECK $ f PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ 'Z 0 jD GRADING $ PLAN CHECK 50% $ __ Q'_ 5P MICROFILM $ MECHANICAL - $ TOTAL FEE $ '-p PLAN CHECK 25% $ -7 V CONSTRUCTION AND PLANNING APPROVALS Permit # + Date Inspector POOL & SPA APPROVALS Permit # Date Inspector Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Ungrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test '6. Electrical UFER Grnd. - 57. APPROVAL TO COVER-GUNITE 7, Footings 58. Electrical Conduit-Undrgrnd. B. Foundation : r .�r 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65, Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring �r 67. Fencing & Access Approval - 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 7 69. POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Uncle rgrnd. Storage Tank ❑ 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 7B. '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. Finan Electric !�-�l n Notes: ,3A 1011 3 �'G 34. Final Heating & Air Conditioning �LC 35. Final Gas Pipe -Test 36. Hood or Canopy ' 37. Final Factory Fireplace 36, Final Plumbing f 39. Water Service -Final t. ' 40. Gas Service -Final a r. ` 41. Solar Domestic -Final • 42, Backflow Preventer 43. Backflow Irrigation f 44, Landscape Irrigation System 45, Sound Attenuation •46: Handicap Regulations ; 47. FINAL STRUCTURE & BUILDING 0 - 48. Special Requirements Completed , 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date L+ .i 1 CITY OF COSTA MESA CONSTRUCTION PERMIT 1.34093 � Q �� Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. Project Adl 7 1 3 - W- 1 7th �q t rP e Apprficant's Mailing Address 2418 142a C lir t " r Sl ir_ -- - C. D Owner's Name T-r-ohone 5 4- 29 B Address 4"121 •Ai rr_h St�N wp V j3eaCh - Arch/Eng. Wm - F. - P a r e i r;3 a c s C3 atanse No. Address 941 R Mne Arthur R1-trej F C r)-il del Ma Contractor's Name Phone Address (mailing) City License No. LICENSED CONTRACTOR ECLARA710N I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Date Signature WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -Insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section )0, tab. C. Nonce No. 2420001683 Company Argonaut 8 Certified copy is hereby furnished. Cer f' tl c P is flied with the cityuil ling Dl s n, Date Applicant EXEM TIO FROM WORKERS' C FENSATION DECLARATION (This section need not be completed If he permit is for One hundred ($100) or less). 1 certify that in the performance Of the work for which this permit Is issued I shall not employ any person In any manner so as to become subject to tke Workers' Compensation Laws of California. Date Signature NOTICE: If,lafter making this declaration, you should become subject to the Workers' Compensation provisions Of the tabor Code,,you must forthwith comply -with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is 'issued (Section 3097 Civ. C.) Lender's Name - Lender's Address OWNER BUILDER DECLARATION I hereby affirm that i am exempt from the Contractor's License Law for the following reason (Section 7031.5 Businfass and Professional Code; Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit .to file a signed statement that he/she is licensed pursuant to the'provisions Of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the 'Business and Professions Code) of that he/she is exempt -refrom and the basis for the alleged exemption, Any violation of Section 1.5 by any applicant for a permit subjects the applicant to a civil alty of not more than five hundred dollars (5500). U 1, as, owner of the property or -my employees with wages as their sole compensation will d0 the work, and the structure IS not Intended or offered for sale (Section 7044, Business and Professional Code: The. Contractor's License Law does not apply to an owner of a property who builds Or Improves thereon, and who does such work himgeif/herself or through his or her own employees, provided that Such improvements are not Intendedoroffered for sale. If, however, the building or improvement Is sold within One year.of com- pletion, the owner will have the burden of proving he/she did not build or Im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- t ctorsto construct the project (Section 7044, Business and Professions CO y9: The Contractor's License taw does not apply to an owner of property o builds or Improves thereon, and who contracts for such projects with a co - tractor(s) license pursuant to the Contractor's License Law). El 1 am exempt under Section B. & P. C. for this reason Date q Owner t hereby certlf that I have re his application and state that the above Information is correct. I agree to comply with all city and county ordinances and state laws relating to building con%tri loo, and hereby authorize repre- sentatives of this city t nter upon the above-mentioned property for inspection PPTPOses. Signature Date Drivers' Lice se or'SS l* P RMlT NO. TRACT NO. LOT NO, BLD 11019 fir 1 & 2 D TVPEOFCONSTRUCTION NEW ADCO) ALTERATInN REPAIR (y . ElCONVERSION 0 DEMOLISH 1:1 pTHER DESCRIPTION OF WORK_ gy ar1oz—Ali e�-atiens 0107 5/i0/94 _ O 1 04 p5 Zone _ A.P. 91647-4 0-11 S Main Building: Accessory Building: Y TYPE OF PERMIT Li GRADING El FOUNDATION W STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ 75,26 nn ZONE GRADING CU.VDS. ACRES E T Front 0 N BRear A. N C Right s G S Left R E 'Ping. Ref. # Z Park.Fees $ Q U Remarks: _ A 4S Parking Req./Provided Use of Building: R E PLUMBING FEES Planning Notes:n HOLD SPECIAL _ A M N Bar Sink Showers Backflow Preventer Backflow Irrigation Service Sink Sewer Cap ELECTRICAL T S FEES Bathtubs Sewer Connection Automatic Washer Construction Pole Sub. Transformer ❑ 15-50.KW ❑ 50+'KW . Clarifiers Solar Collectors Dishwasher ' Solar Piping - Cooking Unit Meter ❑up to 100 amps Drinking Fountains Solar Tank Dishwasher Meter ID over 100 amps. Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel Floor Sinks Gas Service Outlets Urinal Water Closet Fan, F,A,U, `• Motors 1:10-1 HP ❑1'16 - B �lnc.Solar El 9-1'5 HP 16 -15+ Interceptors Water Heater Fixtures "Microwave Kitchen Sink Water Service Device Boxes Pole Light Lavatories s ,. Outlets `J Range P -Trap Switches Sign Roof Drains Garbage Disposal'i _ Standing Sections Generator 00.5 KW 05-15 KW r Trash Compactor Reinspection Fee $25 Issue Fee $ 3 . Reirispection Fee,Issue Fee $'3 MECHANICAL FEES PUBLIC"SERVICES REQUIRE NTS: y � '-• � � .� m Y"C_ Zoning' Approved By ate Building Approved By f r Data 6 Application Issued By ' -� 100K � Hood or Type I ❑ Boller I .- Canopy . Type ll ❑ Duct - Under GrounU Duct - Structural' l Duct, ventilating Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU �f ' 4SUN)MARY OF FEES BUI LDING PERMIT $ .3 �oj��Q-- SMIP $ PLAN CHECK'- „ $ }- PERMIT / PLUMBING „$t r ISSUANCE $ _ ' - ENERGY P.C. $ PLAN CHECK 2596 , $' '� GRADING $ - ,ELECTRICAL '' $!' PLAN CHECK 50% $ t ' MICROFILM $ MECHANICAL $ - TOTAL FEE $ 3G 6 "z PLAN CHECK 25% $ Exhaust System ❑ Multiple ❑, System Repair/Alteration r FirepUFact. Bit. ICBG # Heating System &Ducting ❑0-100,000 BTU 1:1100,000 BTU • Reinspection Fee I 525 Issue Fee $ 3 CMF 0865-46 rev. 12/83 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod -Assessor F.CONSTRUCTION -AND PLANNING -APPRMVALS Permit # Date Inspector POOL € APPROVALS Perm ii # - Date Inspector 1, Tgnporary Electrical Service or Pole 52. Pool & Equipment Location- =�2: Soil Pipe-Undrgrnd. 53.- Steel Reinforcement' 3. Electrical Conduit Utility-Undrgrnd. 54., Forms ` 4. Electrical Conduit-Undrgrnd. 55:- Electrical Bonding ` 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58.' Electrical Conduit=Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test.- est.=9. 9.Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd• X10. 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. POCIUSPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT.. APPROVALSPermit ' , 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. 6as Pipe -Rough & Test 72. Underground Flush c - ' 24. Roof Framing 73. Undergrnd. Storage Tank'❑ Gas ❑'Oii- + `. 25. Roof Sheathing 74. Overhead Hydro ; 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing Q 76. Dry Standpipe 28. Lathing &Siding 1S �r✓ , 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_y 8 _ 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 X40. Gas 5e'rvice-Final 41. Solar Domestic -Final •tCr� CON �R'II/ .� !IY`-' 42. Backflow PreventerNJ , 43. Back9ow Irrigation _ 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING'- ` 48. Special Requirements Completed 49, Electric Release to Edison T ' 1 f 50. Gas Release to Southern California Gas Co X151. CERTIFICATE OF OCCUPANCY do. pate Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA NSA TION P K 1 1 Project Address ~ Applicant's Mai lin A dress Owner's Name V�!i�. i- Phone Address Arch/Eng. `' License No. Address Contractor's Nam E 11V A 'One 2z; Address (mailing) City License No ~ _r LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in fu ornd effect. -- Lice" Class a/� 2. License No 62+ A -/ Date Signatur WORKERS' COMPENSATION DE LARATION I hereby affirm that I have a certificate of consent to Self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) - Policy No. Company BCertified copy is hereby furnished. Certified copy is filed with the city Building Division, a' Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION {This section need not be completed if the permit is for one hundred (5100) or } less). I certify that In the performance of the work for which this Permit is issued I shall not employ any person in any manner so as to become subject to tire' WornCom pen do Laws of Califo Date 4 ��u Signature 'NOTICE: It, after making this declarat , you should become subject to the Workers' Compensation provisions of he Labor Code, you must forthwith comply with such- provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Clv. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisionsof 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 clvli enalty of not more than five hundred dollars ($$00). 1, as owner of the properly or my employees with wages as their sole :ompensation, will do the work, and the structure is not intended or offered or sale (Section 7044, BuSineSs and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herSelt or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletlon, the owner will have the burden of proving he/She did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, BuslneSS and Professions Code_ The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuarit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date L Owner I hereby certify that 1 have read thisapplication and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to e0ter upon the above-mentioned property for inspection our s. Signature Date i Drivers' LiceVe or SS nt; Pink - Accounting; Goldenrod - Assessor CMF 0865-46, rev. 10/84 Wh g`I i4 l/ C:lr 9940 �"; 10.50 TL ❑ ❑ ❑ OTHER PLUMBING FEES Bar Sink CONVERSION DEMOLISH A.P. 91, Zone DESCRIPTION OF WORK /USE OF BLDG. Sewer Cap, Bathtubs Sewer Connection Clarifiers Solar Collectors 5 Main Building: Accessory Building: Solar Tank Floor Drains E Floor Sinks Urinal Z TYPE OF PERMIT GRADING LJ FOUNDATION STRUCTURAL T Front Kitchen Sink O ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B P—Trap Laundry Trays N ❑ OTHER A Rear 1 C Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY— K G CONSTRUCTION TYPE VALUATION $ g Left I R ZONE GRADING CU.YDS. ACRES Ping. Ref. # Parking Req./Provided @ Remarks: Planning Notes: M Is T Reinspection Fee • 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple 11, Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0.100,000.BTu ❑ 100,000 BTL Reinspection Fee 1 $15 Issue Fee Hood or Type I ❑ Canopy Type 11 ❑ ' Refrigeration System ❑0-100,000 BTU ❑100,000 BT System Repair/Alteration Fire Dampers Registers Issue Fee ELECTRICAL I FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas DElectric Fan F.A.U. Fixtures _ Device Boxes Outlets Switches Garbage Disposal .Generator 00-5 Kw 05.15 KW Transformer ❑ 15-50 KW El 50 50 + Kw Meter ❑up to 100 amps Meter Dover 100 amps Sub Panel Motors ❑0-1 HP ❑1 h - B Inc. Solar 09-15 HP 016.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor $ 3 PLUMBING FEES Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap, Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains Reinspection Fee • 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple 11, Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0.100,000.BTu ❑ 100,000 BTL Reinspection Fee 1 $15 Issue Fee Hood or Type I ❑ Canopy Type 11 ❑ ' Refrigeration System ❑0-100,000 BTU ❑100,000 BT System Repair/Alteration Fire Dampers Registers Issue Fee ELECTRICAL I FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas DElectric Fan F.A.U. Fixtures _ Device Boxes Outlets Switches Garbage Disposal .Generator 00-5 Kw 05.15 KW Transformer ❑ 15-50 KW El 50 50 + Kw Meter ❑up to 100 amps Meter Dover 100 amps Sub Panel Motors ❑0-1 HP ❑1 h - B Inc. Solar 09-15 HP 016.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor $ 3 Reinspection Fee 1 $15 1 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By nate SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK ' 25% $. S ENERGY P.G. ' $ ELECTRICAL $ 1 GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ Q� PLAN CHECK 25% $ $ 3 CONSTRUCTION AND PLANNING APPFIOVALS Permit # !'^ Date Inspector w^ POOL &S. , - APPROVALS Permit # Date Inspector p 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. SoilPipe-Undrgrnd. %3 ^t 53. Steel Reinforcement ,✓� 3!Elee rical Conduit Utility-Undrgrnd. N -54. Forms 4` Electrical Condu�i°11n�rV grnd. Y n + 55. Electrical Bonding , n S.+Steel!Reinforcemerit . Ok .56. Rough Plumbing & Pressure Test ,6•p Electrical UFEFI•Gd. y f 57. APPROVAL TO COVER-GUNITE .7, Footings '' e ► ti �� 58. Electrical Conduit-Undrgrnd. 8. Foundation y. 'n 59. Gas Pipe, ❑ Undrgrnd., Test fis 9. Water Pipe-Und�grn , r j 60. Backwash Lines, P-Trap, ❑ Undrgrnd. r* 10 jSQr'uctural Floor Sysiem + 61. APPROVAL TO DECK 1 Property Sewer Line,& House Connection C 62. Backwash & Receptor-Final 12,'Sewer Cap 63. Heater & Vent-Final 18' Rgof Drains .� 64. Plumbing.System - Final i 1,4, Rough Plumbing 65. Electrical-Final ` 15. Rough Electrical-Conduit M 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/SPASYSTEMS FINAL ' 19. Rough Heating & Air Conditioning -- FIRE DEPT. REQUIREMENT APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating, 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe-Rough & Test 72, Underground Flush 24• Roof Framing 73. Undergrnd. Storage Tank ❑ Gas O 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 3�, Final Gas Pipe-Test 36. Hood or Canopy 37.' Final Factory Fireplace 38. Final Plumbing o ' 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42, Backflow Preventer 43. Backflow Irrigation 44, Landscape Irriqation System _ 45. Sound Attenuation 1 46. Handicap Regulations F 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed ' 49, Electric Release to Edison t 50. Gas Release to Southern California Gas Co + 51. CERTIFICATE OF OCCUPANCY No. Date , Applicant to fill in all spaces except those within heary border tines and sign all appropriate declarations. CITY Or COSTA MESA /Z ;%-%j ucTI%,p PERMIT PERMIT NO. _ _ TRACT NO. LOT NO, UNIT NO. ProJect Address ! w 7��'' 7— Applicant's Mailing Addresst7��r/��'� Owner's Name FA Qom% Phon,� -d !MK Address 7// (-r! • %7�1i` _ r`s �� _.,..._ Arch/Eng. License No. Address Contractor's Name -- +� Phone Address (mailing) City Ljcense No. LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of DivlSIOn 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. Company - 8 Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less), ' I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so s toGome subject to tyre Worker m ns tI Laws of CaliforrR l Data Signature — NOTICE: If, after ma <ing this declaration, you should beco iect to the Workers' Compensation provisions of the Labor Code, you thwith corriply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING- AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097_ Civ. C._) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Caw for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair anystructure, 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 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 Mrialty of not more than five hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their sole Cornpensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply town owner of a property who builds or improves thereon, and who does such work hlmself/herself or through his or her own employees, provided that such improvements are not intended or offered for salt, If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- �4ve for the purpose of sale), LJ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuarit'to the .Contractoi's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason DateOwner I hereby certify hat I ave read this application and state t t t!&, above Information is correct. 1 agree to comply with all city and cou ty inanCes anct state laws relating to building construction, and hereby authorize repre- sentatives of t city _t o` en r upon the above-mentioned pr ort jpsJ Inspection pure s, /'} !P/ (�{tfif[ Signature fi Dat¢el Drivers' License or SS :AL 3544 7/06/84 E 3a if] 1 TYPE OF CONSTRUCTION LI NEW LJ ADD LJ ALTERATION LJ REPAIR Cl CONVERSION ❑ DEMOLISH ❑ OTHER y A.P. Zone DESCRIPTION OF WORK/USE OF BLDG.- $ Main Building: Accessory Building: E Z TY E OF PERMIT GRADING FOUNDATION STRUCTURAL T Front O TENANT ElELECTRICAL 1:1PLUMBING ❑ MECHANICAL A Rear - N -OTHER C Right - N PROJECT DESCRIPTION SQ. FT. OCCUPANCY 'CONSTRUCTION TYPE VALUATION $ 5 G Left , R ZONE GRADING CU. YDS. ACRES Ping. Ref. # Parking Req./Provided E Remarks: Planning Notes: Q M T ' S. PLUMBING FEES ' Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors =� Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa u 1 Floor Sinks ' Urinal Gas Service Outlets Water Closet 2 Interceptors Water Heater Kitchen Sink Water Service Lavatories P—Trap BUILDING PERMIT Roof Drains SMIP Reinspection .Fee . $15 Issue Fee Boiler Hood or Type I ❑ Duct - Under Ground Canopy Type 11 ❑ Duct - Structural Refrigeration System Duct - Ventilating 1:10-100,000 BTU 0100,000 BTU Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact, Bit. ICBG + Heating System & Ducting 130-100,000 BTU [3100,()0013T Reinspection Fee I $15 CMV 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee 1 $3 FEES ' $ 3 ELECTRICAL FEES Automatic Washer Construction Pale Sub. Transformer ❑ 15-50 KW ❑ 50+ KW I Cooking Unit Meter Kup to 100 amps a Dishwasher Meter Dover 100 amps Dryers ❑Gas ❑Electric Sub Panel - Fan Motors 1 HP ❑ 1 i4 - 8 24 F.A.U. Inc. Solar 09-15 HP ❑16-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal Standing Sections Generator 00.5 KW 05-15 KW Trash Compactor ' Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ JrQ� ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ E-LECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ _ MECHANICAL $ TOTAL FEE $ _ K,� PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit # = Date Inspector POOL .- .PA APPROVALS Permit # Date Inspector _1. Temporary Electrical Service or Pole rig 52. Pool & Equipment Location ; 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement f ; 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. •Fo6ndation 59. Gas Pipe, ❑ Undrgrnd•, Test i 9:. Water.`Pipe-Undrgrnd, 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11`. Property Sewer Line & House Connection „` t 62. Backwash &Receptor-Final 12: Sewer Cap 63. Heater & Vent-Final 13.,-Roof-Drains64. y, Plumbing System Final 14. Rough Plumbing 65. Electrical-Final , 15. Rough Electrical-Conduit 66. Solar System-Final 76.' 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 Hating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts; in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23., Gas Pipe-Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 $t 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 4 7 ,8 Notes: ZXZ ZZY 34. Final Heating & Air Conditioning 1 �7 35. Final Gas Pipe-Test " 36. Hood or Canopy ' 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System ' 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date CITY OF COSTA MESA CONSTRUCTION PERMIT Proiect Address — 7& Gf�/f ApOicant's Mailing Address Owner's Nam Phone Address Arch/Eng, ice No Address Ap Contractor's Nam Phone Address (mailing)— City License No. { LICENSED CONTRACTOR DECLARATION (,hereby affirm that I am licensed under provisions of Charter 9 (commenting with section 7000) of division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No, Date Signature WORKERS' COMPENSATION DECLARATION ' I hereby affirm that i have a certificate of consent to Self insure or a certificate 4 Workers' Compensation Insurance, or a cert ied copy thereof (Section ,800, Lab. #'Certified icy No,Certified copy is her0by furnished.copy i5 filed with the city Building Diylston- Date Applicant.6�g" -EXEMPTION FROM WORKERS' COMPENSATION D CLARATION (This section need net be completed if the permit is for one hundred ($100) or less). I certify that In the performance of the work for which thIS permit is issued, 1 shah not employ any person in any manners s to -h bject to the ' Workers' Compensation Laws of California. Date — Signature 'NOTICE: 11, alter making this deClarallon, you should become subject to the Workers' Compensation provisions of the Labor Code, you must fortnwlth comply with such prgvislons or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for Vh h this e i is issu d (Section 097 Cly. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I Am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to Construct, alter, improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for Such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 . 031.5 by any applicant for a permit subjects the applicant to a civil malty of not more than five hundred dollars ($500)-, 1, as owner of the property or my employees with wages as their sole Compensation, will do the work, and the structure Isnot Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not Apply to an owner of a property Who builds or Improves thereon, and who doeg such work himself/herself Or through his or her own employees, provided that such improvements are not Intended'or offered for safe. If fiowever, the building or Improvement is sold within one Year of com- , pletlon, the owner will have the burden of proving he/she did not build or Im- rove for the purpose of sale). 1, as owner Of the property, am exclusively Contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's LicehSe Law does not apply to an owner of'property who builds or improves theroon, and who contracts for such projects with a con- tractor($) license pursuant to the Contractor's License Law)- I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner ---- I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and county ordinances and state laws relating tQbuilding construction; and hereby authorize repre- sentatives Of this c o en tete above-mentioned property for inspection purposes. Sigriat ureDate Drivers' License or SS CMS= 01365-46, ray. 10/84 plicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. 603+ 5%23%86 - '-- -- 8.00 TL _. T Q. 0 TRACT NO. A -& LOT NO. UNIT NO, D- / TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION U REPAIR CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORKIUSE OF BLDG. A.P. 90 Zone S Main Building: Accessory Building: - TYPE OF PERMIT GRADING 0 FOUNDATION STRUCTURAL_ - ❑ TENANT ❑ ELECTRICAL KPLUMBING ❑ MECHANICAL 13 PROJECT DESCRIPTION SQ. FT- OCCUPANCY CONSTRUCTION TYPE VALUATION $ • ZONE • GRADING CU.YDS. ACRES E T Front Z O A Bear N OTHER C Right - N S Left G R Ping. Ref. qI` Parking Req./Provided E Remarks: Planning Notes: O M T- S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW 0 50 + KIN Backflow irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit, . Meter ❑up to 100 amps Clarifiers r Solar Collectors - Dishwasher Meter Dover 100 amps - Dishwasher Solar Piping Dryers DGas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00-1 HP 0 !r 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc, Solar 09-15 HP 016.15+ Floor Sinks Urinal Gas Service Outlets 2 Water Closet Fixtures r Device Boxes Microwave Pole Light Interceptors Water Heater Kitchen Sink Water Service Outlets Switches Range Sign Lavatories Auto -Wash Garbage Disposal ! Standing Sections P—Trap Laundry Trays Generator 00.5 KW 05.15 KW Trash Compactor Roof Drains Reinspection Fee S15 Issue Fee_ S 3 Reinspection Fee $15 Issue Fee $ 3 r. MECHANICAL FEES Boiler Hood or Type I ❑ Canopy Type I I ❑ ' Duct -Under Ground DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By _ Date Date pat Duct - Structural Refrigeration System 00.100,000 BTU 1-1100,00OBTU Duct - Ventilating ,SUMMARY BUILDING PERMIT $ PLAN CHECK I $ PLUMBING $ CHECK 25% $ I ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL , S PLAN CHECK 25% $ OF FEES SMIP $ PERMIT 77ood ISSUANCE $ l0 ENERGY P.C. $ GRADING $ MICROFILM $ s TOTAL FEE $ Exhaust System ❑ Multiple 0 System Repair/Alteration Firepl/Fact. Bit. ICBOI# Fire Dampers Heating System & Ducting I ❑0-100,000-bTU'❑'100,0006T RegistersPLAN Reinspeclion Fee $15 Issue Fee $ 3 y • Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING Date APPROVALS Permit # Inspector POOL 'PA APPROVALS Permit # Date Inspector 1. Tempary Electrical Service or Pale 52, Pool &Equipment Location 2. Soil PipeU drgrnd. 53. Steel Reinforcement f 3. Electrical conduit Utility-Undrgrnd. 54. Fel ms � 4.10ect ica Contduit Undrgrnd. 55. Egctrical Bonding 5Ateel,Reinforcement' N 56. Rough Plumbing & Pressure -Test 6.�EIecth�'aJ(UP,E16rnd. 'Ile 57. APPROVAL TO COVER-GUNITE 7. Footings 71 : 58. Elec^rical Conduit-Undrgrnd, r� B. Foundations 59. G;s$ipe, ❑ Undrgrnd., Test 9 !WaterlPipe-U drgrnd. Jr4. 60. Backwash Lines, P Trap, ❑ Undrgrnd. 10.tructurai Floor System '� �17� a� 61. APPROVAL TO DECK 11.'Property�Sewerline & House Connection � ; ►t ti "� 62. Vckwash & Receptor -Final 12. Sewer, Cap 4 63. Heater & Vent -Final 13. Roof•Dra ns".. 64. Plumbing System - Final 14, Rougl�Plumbing 65. ElectricakFinal 15, Rough Electrical Conduit �J 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68, APPROVED FOR PLASTERING 18. Rough ElectricahT Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditirning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 1' 21. Ducts, in Structure 70. Underground Hydro 2%jDucts, Ventilating a 71. Product Piping ❑ Gas ❑ Oil 23TGas Pipe -Rough & Test rp 72. Underground Flush 24400f Framing 73. Undergrnd, Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing r�� 74. Overhead Hydro 26. T -Bar Ceiling {Structural] & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30f/Drywall Nailing HEALTH DEPT. REQUIREMENT 31.+Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe, -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer �a3. Backflow Irrigation ,;44. Landscape Irrigation System -L45. Sound Attenuation E46. Handicap Regulations �:47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison c50. Gas Release to Southern California Gas Co c51. CERTIFICATE OF OCCUPANCY No. Date CP CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 1 r _ ARplicant's Mailing Address 13].].Q_Sa. Owner's NameTr-Gy--,I(Sve",, Phone 549-7ARR Address 4321 Rirch St. Neswr nrt Reach, ra Arch/Eng. M11rin .l•. Rock License No. Address M81—Knnrr-_Ave__ Suite -916 Contractor's NameDi cn Air Conrii ti nni na _ - Phone 982--l91.6 Address (mailing) 111 1 f1 Ca ti i-ny rt N�Ca_ City License No.�14Qz5_ LICENSED CONTRACTOR DECLARATION I hereby affirm that l am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of a Business an ofesslons Code, and my license Is In full force and affec Ucense �17s$0-� - so o, nate �I Signature WORKERS' COMPENSATION DEC RATION I hereby affirm that 1 have a cortlfl a of consent to solf-Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. WrA824 Company-1.11B1k]Ertn,1nS 8 Certified copy is hereby furnished. Certigl,VS is filed with the city Buildip� Oil ?op(C� Date _ ___ Applicant, �}7 ftl EXEMPTION FROM WORKERS' COMPENSATION D CLARATtON (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued I shall not employ any person In any manner so as to become subject to tare Workers' Compensation Laws of California. Date Signature .NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the tabor Code, you must forthwith Comply with such provisions or this permit shall be -deemed revoked. CONSTRUCTION LENDING - AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ, C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code,. Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 ienalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law docs 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 employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- Irove for the purpose of sale).. , a$ owner of the property, am exclusively contracting with licensed con- 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 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 proof 0f their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. PERMIT NO. TRACT NO. I LOT NO. I UNIT Nr) Date Owner I herebyy certify that I have read this application and state that the above informatkon Is correct. I agree to mply with all city and county ordinances and state laws relating to build' construction, and hereby author )repre- sentatives of s city' to en r upon the above-montlonetl pro rty Inspection rpo s IS Signature Date Drivers' Liceallf or S!iA If IF 0865.46, rev. 10/84 white - Building; Canary - Applicant; Pink - TYPE OF CONSTRUCTION LJ NEW LJ ADD 1J ALTERATION LJ REPAIR ❑ CONVERSION '❑ DEMOLISH ❑ OTHER - A P 916 DESCRIPTION OF WORK/USE OF BLDG. Date Building Approved By S Main Building: Date E TYPE OF PERMIT LJ GRADING 0 FOUNDATION C3 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING_ ® MECHANICAL B BUILDING PERMIT ❑ •OTHER A Rear PLAN CHECK C Right PROJECT DESCRIPTION SQ. FT, OCCUPANCY K $ CON STRUCTION TYPE VALUATION $ S I Left ZONE GRADING CU.YDS. ACRES Ping. Ref. Remarks: Planning Notes: 1 PLUMBING I FEES I ar Sink ackflow Preventer ackf low Irrigation athtubs Dishwasher Drinking Fountains Floor Drains ; Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO + Heating System & Ducting 1 0-100,000 BTU ❑ 100,000 BT Reinspection Fee $15 Accounting; Goldenrod - Assessor Showers Service Sink -- Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays I issue Fee I $ 3J ECHANICAL FEES Hood or Type 1 ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000 BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee I $ 3 1771 4/24/85 M 5e 50 TI. Zone Accessory Building:. Z O N I N G R Parking Req./Provided E Q M T S ELECTRICAL Automatic Washer Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas ©Electric Fen F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW 175-15 KW Transformer ❑ 15-50 KW ❑ 50+ KW Meter ©up to 100 amps Meter Dover 100 amps Sub Pane( Motors 00.1 HP 0114- B I nc. Sotar 09-15 HP 1:116-15+ Microwave PoleLight Range Sign Standing Sections Trash Compactor FEES I I Reinspection Fee I $15 I I Issue Fee I $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat Z SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ 9 S(1 CONS+RUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL u oPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location f' 2. -Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement �. 3. Electrical Conduit Utility-Undrgrnd. 54. Forms F' 4, Electrical Conduit-Undrgrnd. 55. Electrical Bonding ?0 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ��;.7 6. Electrical UFER Grnd. f 57. APPROVAL TO COVER-GUNITE ! f 7, Footings i 58. Electrical Conduit-Undrgrnd. - 8: Foundation 1 S 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. y 10. Structural Floor System _ 61. APPROVAL TO DECK 11. Property Sewer Line & House Con6ection 62. Backwash & Receptor -Final 12. Sewer Cap � 63. Heater & Vent -Final ,+ ti 13. Roof Drains 3 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 Electricai-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL •30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, .Landscape Irrigation System i 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 150. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY Nn. Date _ r Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY QF COSTA r4F.SA CONSTRUCTION PERMIT Project Address C,.).S' 1~ Applicant'%Mailing Address r'smX O�h7S PhoneOwte Address Arch/Eng. License No. Address Contractor's NameAl-_LYCS L? c?2! Phon 7^ t sr&C Address imailing/Y Is City License No. -? 3 Z LICENSED CONTRACTOR DECLARATION t hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division ='icense ss and Pr es ns Code, and my license is in fu force and effe �_ License Class f Date `? 1 Signatur WORKERS' COMPENSATION DECLARATI 1 hereby affirm that I have a certificate of con ent to self -insure or a certificate of Workers' Compensation insurance, or a Certified copy thereof (Section 3800. Lac') �p(!cy 44 , L% S-210 f-7 70 Co T Certified copy is hereby furnished . Cert 'fie copy is led with the city'B Ision. Date •� `� Applicant r EXEMPTION FROM WORKERS' COMPEN ATION D ARATION (This section need not be completed if the permit IS f One hundred ($100) or less). i certify that In the performance of the work for which this permit is issued, i shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is •issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5'Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she i$ licensed pursuant to the provisions of the Contractor's License taw (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant. to a civil penalty of not more than five hundred dollars ($500). I, as. owner of the property or, my employees with wages as their sole ompensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 ye emploes, provided that such Improvements are- not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving ho/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply t0 an owner of property who builds or Improves -thereon, and _who contracts for such projects with a con- tractors) license pursuarit•to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. I am exempt under Section B. & P. C. for tnis reason Date Owner I hereby certify that I have read this'a Information is correct. I ree to comply and slate laws r o Tiding cons sentali les of is ci to ter upo Inspection purs. Signature Drivers' License or SS in and state that the above city and county ordinances and hereby authorize repre- ve-mentioned property for r Data �- t[�`-+r.5 r PERMIT NO.TRACT 3 NO. LOT NO. UNIT NO. 1 TYPE OF CONSTRUCTION J NEW LJ ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. d(k Zone S Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES T Front O B A Rear N I C Right N S Left R Ping, Ref. # Parking Req./Provided E Remarks: Planning Notes: Q M • T 5 PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pale Sub. Transformer ❑ 15.50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Floor Drains Solar Tank Swimming Pool w/Spa Fan F.A.U. Motors 1 HP ❑ 1 r4 - B p� Inc, Solar ❑9-15 HP 1316.15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays ._ Generator ❑0.5 KW 05.15 KW Trash Compactor Roof Drains I Reinspection Fee !$15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Approved By Date Application Issued By Data • Boiler Hood or Type 1 El Canopy Type I I El Duct - Under Ground Duct - Structural Refrigeration System ❑0-100,000 BTU 0100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP •$ •$ PERMITPLUMBING $ ISSUANCE $ $ ENERGY P,C. $ $ -Lr� GRADING $ $ + C MICROFILM $ $ TOTAL FEE ,$ $ Exhaust,System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBD # Fire Dampers Heating System & Ducting El 0-100,000 BTU ❑100,000BTL Registers - I Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rov. 10/84 Wnite - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor �. CQNSTRUCTION AND PLANNING f APPROVALS Permit # Date Inspector POOL & APPROVALS Permit Date InspPctar i 1. Temporary Electrical Service or Pole ! 52. Pool &Equipment Location 2, Soil.Pipe-Undrgrnd:, 53. Steel Reinforcement 4b3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4, Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5; Steel-Reinforcemerit 56, Rough Plumbing & Pressure Test 6: Electrical UFER,Grhd. 57. APPROVAL TO COVER-GUNITE 7. Footings _ 58. Electrical Conduit-Undrgrnd. 8. Foundation n J 59. Gas Pipe, © Undrgrnd., Test ' 9.,Water Pipe-Undrgrnd. .. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10.- Structural Floor System _ 61. APPROVAL TO DECK 11..1"Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final i 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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping © Gas ❑ Gil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 1x I Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. 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 F51. CERTIFICATE OF OCCUPANCY No, Date CITY bF COSTA MESA CONSTRUCTION PERMIT Project Address 'esL 2ZZA 1%ih c �%PP,4 Applicants Mailing Address 2/��/ Owner's Name Phone X21 Lf+/fs Address Arch/Eng. License No, Address Contractor's Name Phone/- %G Address (mailing)— City mailing) City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter.9 (commencing with section 7000) Of Division 3 of the Business and Professions Code, and my license Is In oc�}yffect. License Cass` Lice Date_AW-9Y Signature WORKERS' COMPENSATION DE ARATION I hereby aft lrim that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.j 352 r✓ )e Policy No, Company Cer B C." if''I tl copy is fleedbwith rthe hci[y Builtll Iv�'+si n e C) Dateopy Applicant��1 �1S GJe"� EXEMPT ON FROM WDRKERS' COMPENSATION DECLARATION (This section need not be completed it the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued I shall not employ any person in any manner so as to become subject to tie Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Cly. C.) Lender's Name' Lender'S'Address _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the fallowing reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a, signed statement that he/she Is licensed pursuant to the provisions of 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 17031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). .fl I, as owner of the property or myemployeeswith wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself orthrough his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractOr(s) llcense pursuarlt'tD the Contra Ltor'S License Law). l am aware that proof o their Worker's Compensation insurance should be provided to me. L� i am exempt under Section B. & P. C. for this reason Date Owner I- herebycertify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating+to building Instruction, and hereby authorize repre- sentatives of this, city to enter on the above-mentioned property for inspection p uses. / // p - Signature Ile .L - _ _ Date O 11 Drivers' Llcinse or SS dp CMF 0865.46, rev. 10/84 to fill in all spaces except those within heavy border lines and sign all appropriate diclarations.._.�- (,MIT 1x0 _ TRACT NO: LOT NO. I ANIt N6. -ko O 4716 6111'/85 ? i - TYPE OF CONSTRUCTION La NEW LJ Aoo L.I'ALTERATION LJ REPAIR Automatic Washer Construction Pole Sub. Cooking Unit ELECTRICAL Transformer ❑ 15-50 KW ❑ 50 + KW Meter Cup to 100 amps ❑ El DEMOLISH El - CONVERSION OTHER A.P. # Zone DESCRIPTION OF WORK/USE OF BLDG. - j Dryers ❑Gas ❑Electric Sub Panel ' S Main Building: Accessory Building: TYPE OF PERMIT GRADING ❑ FOUNOATION 0 STRUCTURALT E Front Z O ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Microwave N ❑ -OTHER A Rear I PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N G CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU. VDS. ACRES Ping. Ref- # Parking Req -/Provided R E Remarks: / O Planning Notes: Generator 00-5 KW ❑5.15 M ' T S Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct . Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting El 0-100,000 BTU 1:1100,000 BT Reinspection Fee 1 $15 ry - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service A uto-Wash Laundry Trays Issue Fee MECHANICAL Hood or Type ❑ Canopy Type 11 ❑ 1 Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers !i Issue Fee `-7 FEES Automatic Washer Construction Pole Sub. Cooking Unit ELECTRICAL Transformer ❑ 15-50 KW ❑ 50 + KW Meter Cup to 100 amps FEES �- • t Dishwasher Meter Dover 100amps [ yS - j Dryers ❑Gas ❑Electric Sub Panel Fan Motors 00-1 HP ❑ 1 34 - S j F,A;U. Inc.SOlar'09-15 HP 1__116-15+ Fixtures Microwave _ Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal ; Standing Sections Generator 00-5 KW ❑5.15 KW Trash Compactor $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Oate Dat BUILDING PERMIT $ PLAN CHECK S PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ SUMMAR OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ (, 2�_ MICROFILM $ -7 TOTAL FEE $ $ 3 CO N,0 AND PLANNING IAPPnOVALS Permit # d Date Inspector POOL & .,rA APPROVALS Permit # 52. Poof & Equipment Location Date Inspector 1. Tdmporary Electrical Service or Pole 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. 1 ' 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B. Foundation - 59. Gas Pipe, ❑ Undrgrnd., Test .9. Water Pipe-Undrgrnd.tJ 60. Backwash Lines, P -Trap, ❑ Undrgrnd. Structural Floor System 61. APPROVAL TO DECK _ 11. Property Sewer Line &H Ouse Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 114. 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 APPROVALS Permit # 20. Rough Factory Fireplace , . 21. Ducts, in Structure / 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing "P 73. Undergrnd, Storage Tank ❑ 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 J 77. FIXED SYSTEM FINAL 29. Insulation f 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final j 80. FOOD CEFITIFICATE ISSUED 33. Final Electric l Notes: 34'. Final, Heating & Air Conditioning 35.' Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final -40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. ,Landscape Irrigation System ; 45. Sound' Attenuation 46, Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48. Speciaf Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Date: - — Signature: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of Consent to sett -insure or a certificate of Workers' Compensation Insurance, or a certilied copy thereof (Section 3800, Lab. C). POLICY NO.: 1300158-92 EXP• DATE: 0 3/ 01 / 9 3 COMPANY: STATE FUND Certified copy is hereby furnished_/Applicant: rtified copy is filed with the City Building Division. Date: � S 19 ,. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need riot be completed i1 the permit is lot one hundred (5100) or less). I cenily that in the performance of the work for which this permit is issued, I shall not employ any person in any rnanner so as to become subject to the Workers' Compensation Laws o: California. Date: Signature: NOTICE: It, after making this detaaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ, C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm trial I am exempt from (he Contractors' State License Law for the following reason (Section 7031,5 Business and Professional Code: Any city of county which requires a permit to construct. alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for suO permil to Ile a signed Statement Ihat helshe is licensed pursuant 10 the provisions o1 the Contractors' Slate License Law (Chapter 9 (commencing with Section 7000) of Division 3 o1 the Business and Professions Code) or that helshe is exempt therelrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). I, as owner of the property or m1' employees with wages as their sole compensation, will do the work, and the structure is not intended of offered lot sale (Section 7044, Busufess and Prolessional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himselllherself or through his or her own employees, provided that such improvements are not intended or offered for sale. Ii, however the building or Zis sold within one year of completion, the Owner will have the burden of proving helshe did not build or improve for the purpose Of sale). .. / 1, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does riot apply to an owner of property who builds or improves thereon and who contracts lot such projects with a conlractor(s) license pursuant to the Contractors' 5tate License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. n I am exempt under Section: B. 8 P. C. for this reason: �/+ Date: �h�la Z S 1 9ZOwner: 1 do hereby certify that I am aware of and understand the requirements of Cehfomia Health and Safety Code Sections 25505, 25533, and 25534 and that I or any luture building occupant vAnWn not (circle one) need to comply wifh said state codes and the requirements for a permit for construction or modification from the Air Ouality Management District. Residential construction applications are exempt from these provisions. Date: _ Applicant I hereby certify that I have read this apprrcatidn and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this dry to enter upon the above-mentioned property lot inspection purposes. // Date: ti'7r2 (f�n 7 /%9Z ! .Signawre:(vl`— Driver's License or Social Security P: ifi4o-c6 White—Building: Green—Code Enforcement: Canary—Appliranr; Pink—Revenue; Goidenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B •-05669 PERMIT NO: B 056699 PLAN CHECK NO: 00771-92 A GOVT; N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE; ALT JOB DESCRIPTION ; 2000SF CATERING KITCHEN IMPROVEMENT SQ FT: 4,000 CLAIM VALUE: 15,000.00 CALC-VALUE; 15,160,00 GROUP OCC: B-2• COMMENTS: X Z O N I N GS E R T E B Q A U C I K R S E M E N T S rr+"! REQUIREMENTS ------------ MAIN BUILDING------------E{Q��Q S9�i�f--BUXLDIN��----- FRNT: FT IN REAR: FT IN FR T. IN REAR: FT IN LEFT; FT IN RGHT: FT IN LEFT: FT- IN RGHT: FT' IN PLANNINGKING RN(7TES> INTERIOR:II3R; ALT.ERAYNFORA939830-48 ZNE: MG REF O 2-18 CATERMGBUSINESS/SANDWICH SHOP > IN AN EXISTING INDUSTRIAL,CONDOMINIUM COMPLEX. P 6 F, D E V E -L~,O P*M� E N T S E R V I C E S R E Q U I R E M E -N!-T --S% ZONING APPROVED BY 4 DATE: 'ZS - t BUILDING APPROVED BY-* : DATE: �►. APPLICATION ISSUED BY; DATE: �F�F�F�F�iETt*****��1•lt�1•gf**iE�F#E��*�**ltFif�F�F�F��FiF�F�F�F*�F�F��****�(•;*;*;****��#Eif#E�F*�*iF�**iE;*ltTtiEiF#E LEGALIZATION:N F E E S U M M A R Y STRWTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRICS^•MECHANIC FIRE SMIP/RES GRADING PERMIT 171.00 ; �• SMIP /NON -RES PLAN 27.79 J 3.18 ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 174.18 0,00 /11,27.79 201,97 201.97 .00 REVENUE DIVISION TOTALS--> COLLECTED t, 174.18 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 171.00 3.18 �E�FiE�****�**�iF��MFT4�F�F�F�F�F�F�F��F�F�#E��1.1111***}Elf'If'if*#E*****iEiF'If'�FiE�1•�F***��***�Fgf*�F�F��FiE*�iE*�T4#E�F IND IVIDUAL ' F'E-.E, B R E A K D 0 W N TYPE QTY D E S C R I P T I O NL �. _ UNIT COST TOTAL COST SFC 2000 STO-INT, ALTER TYPE V' -AVER 6.94 13 880.00 SFC 2000 EQU--ALT COMM. AIR COND %�� -AVER .64 1,280,00 END.' OF,- FEES r !• �,✓ ti .i PROJECT ADDRESS: 711 W 17TH ST UNIT: D 1 OVER'S NAME: FREDA DAVIS ADDRESS: 5932 PADUA , H.B. 840-4396 ARCHIENGINEER: FRANCIS PHAT UNG REG.NO.: C 1 85 8 5 T' UI91 ADDRESS: 5932 PAD UA H. B. CA 92647 PERMITTEE: FREDA DAVIS (714)840-4396 ADDRESS: 5932 PEDUA DR HUNTINGTON BEACH CA 92646 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. CITY LIC.: STATE LIC.: CLASS: Date: - — Signature: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of Consent to sett -insure or a certificate of Workers' Compensation Insurance, or a certilied copy thereof (Section 3800, Lab. C). POLICY NO.: 1300158-92 EXP• DATE: 0 3/ 01 / 9 3 COMPANY: STATE FUND Certified copy is hereby furnished_/Applicant: rtified copy is filed with the City Building Division. Date: � S 19 ,. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need riot be completed i1 the permit is lot one hundred (5100) or less). I cenily that in the performance of the work for which this permit is issued, I shall not employ any person in any rnanner so as to become subject to the Workers' Compensation Laws o: California. Date: Signature: NOTICE: It, after making this detaaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ, C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm trial I am exempt from (he Contractors' State License Law for the following reason (Section 7031,5 Business and Professional Code: Any city of county which requires a permit to construct. alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for suO permil to Ile a signed Statement Ihat helshe is licensed pursuant 10 the provisions o1 the Contractors' Slate License Law (Chapter 9 (commencing with Section 7000) of Division 3 o1 the Business and Professions Code) or that helshe is exempt therelrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). I, as owner of the property or m1' employees with wages as their sole compensation, will do the work, and the structure is not intended of offered lot sale (Section 7044, Busufess and Prolessional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himselllherself or through his or her own employees, provided that such improvements are not intended or offered for sale. Ii, however the building or Zis sold within one year of completion, the Owner will have the burden of proving helshe did not build or improve for the purpose Of sale). .. / 1, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does riot apply to an owner of property who builds or improves thereon and who contracts lot such projects with a conlractor(s) license pursuant to the Contractors' 5tate License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. n I am exempt under Section: B. 8 P. C. for this reason: �/+ Date: �h�la Z S 1 9ZOwner: 1 do hereby certify that I am aware of and understand the requirements of Cehfomia Health and Safety Code Sections 25505, 25533, and 25534 and that I or any luture building occupant vAnWn not (circle one) need to comply wifh said state codes and the requirements for a permit for construction or modification from the Air Ouality Management District. Residential construction applications are exempt from these provisions. Date: _ Applicant I hereby certify that I have read this apprrcatidn and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this dry to enter upon the above-mentioned property lot inspection purposes. // Date: ti'7r2 (f�n 7 /%9Z ! .Signawre:(vl`— Driver's License or Social Security P: ifi4o-c6 White—Building: Green—Code Enforcement: Canary—Appliranr; Pink—Revenue; Goidenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B •-05669 PERMIT NO: B 056699 PLAN CHECK NO: 00771-92 A GOVT; N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE; ALT JOB DESCRIPTION ; 2000SF CATERING KITCHEN IMPROVEMENT SQ FT: 4,000 CLAIM VALUE: 15,000.00 CALC-VALUE; 15,160,00 GROUP OCC: B-2• COMMENTS: X Z O N I N GS E R T E B Q A U C I K R S E M E N T S rr+"! REQUIREMENTS ------------ MAIN BUILDING------------E{Q��Q S9�i�f--BUXLDIN��----- FRNT: FT IN REAR: FT IN FR T. IN REAR: FT IN LEFT; FT IN RGHT: FT IN LEFT: FT- IN RGHT: FT' IN PLANNINGKING RN(7TES> INTERIOR:II3R; ALT.ERAYNFORA939830-48 ZNE: MG REF O 2-18 CATERMGBUSINESS/SANDWICH SHOP > IN AN EXISTING INDUSTRIAL,CONDOMINIUM COMPLEX. P 6 F, D E V E -L~,O P*M� E N T S E R V I C E S R E Q U I R E M E -N!-T --S% ZONING APPROVED BY 4 DATE: 'ZS - t BUILDING APPROVED BY-* : DATE: �►. APPLICATION ISSUED BY; DATE: �F�F�F�F�iETt*****��1•lt�1•gf**iE�F#E��*�**ltFif�F�F�F��FiF�F�F�F*�F�F��****�(•;*;*;****��#Eif#E�F*�*iF�**iE;*ltTtiEiF#E LEGALIZATION:N F E E S U M M A R Y STRWTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRICS^•MECHANIC FIRE SMIP/RES GRADING PERMIT 171.00 ; �• SMIP /NON -RES PLAN 27.79 J 3.18 ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 174.18 0,00 /11,27.79 201,97 201.97 .00 REVENUE DIVISION TOTALS--> COLLECTED t, 174.18 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 171.00 3.18 �E�FiE�****�**�iF��MFT4�F�F�F�F�F�F�F��F�F�#E��1.1111***}Elf'If'if*#E*****iEiF'If'�FiE�1•�F***��***�Fgf*�F�F��FiE*�iE*�T4#E�F IND IVIDUAL ' F'E-.E, B R E A K D 0 W N TYPE QTY D E S C R I P T I O NL �. _ UNIT COST TOTAL COST SFC 2000 STO-INT, ALTER TYPE V' -AVER 6.94 13 880.00 SFC 2000 EQU--ALT COMM. AIR COND %�� -AVER .64 1,280,00 END.' OF,- FEES r !• �,✓ ti .i fRUCT;QN AND PLANNING POOLSPA "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- CondtPit•Undrgrnd. - 55. Electrical Bonding 5, Steel f einfarcai�ent - 56. Rough Plumbing & Pressure Test 6. Electrical LfFER Grr,d. 57. APPROVAL TO COVER•GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9, Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line ,& House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains i 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 Electric I -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT 'APPROVALS -Permit # 20. -Rough Factory Fireplace 1 21. Ducts, irl-Structure t - - 70. Underground. Hydro 22, Ducts, Ventilating _ x 71. Product Piping ❑ 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..D�y Chemical _ 27. Frame and Flashing I- i� � 76. dJry Standpipe 77, :FIXED SYSTEM FINAL 28. Lathing -& Siding _ I/A "h 29. Insulation `. 78. FIRE PREV. FINAL 30. Drywall-Nailing12 f HEALTH_DEPT. REQUIREMENT 31. Plaster Brown Coat . 79. F I NA L I NSRtCT ION .132. Electrical Power Meier -.Final 80. FOOD CERTIFICATE ISSUED ;33. Final Electric '34, Final Heating & Air Conditioning i Notes: w35. Final Gas Piple-Test`_- (- 36. Hood of Canopy 37. Final Factory Fireplace , -7 ' 38. -Final Plumbing `t •39. -Water Sdrvice Final 40. Gas Service -Final 41. Solar Domestic -Final r T♦ r • 42. Backflow Preventer ,' • $ r 43. Backflow Irrigation ' ' r 44. Landscape Irrigation System ", r 0 ;, J -45. Sound Attenuation ` 46. Handicap Regulations ' F r 47. FINAL STRUCTURE &BUILDING .- � .' r fly 7��• _ _ _ 9. Electric Release to Ed' on 50. Gas ReleSse to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 711 W 17TH ST UNIT: DI OWNER'S NAME: FREDA DAVIS - r ADDRESS: 5932 PADUA , H. B. ARCHIENGINEER; 840-4396 FRANCIS PHAT UNG C qaa 5REG.NO.: ADDRESS: 5932 PADUA PERMITTEE: H. B. CA 92647 REI, VROOMAN PLUMBING (714)969-6714 ADDRESS: 914 OLIVE HUNTINGTON BEACH CA 9264$ LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am Licensed under provisions at Chapter 4 (commencing with Section 7D00) of Division 3 0l the Business arm Professions Code, and my license is in full farce and effect. r CITY LIC.: 051798 STATE LIC.: 5 8 4 5 18 //CLASS: C 3 6 Date: _7__X ~ . Signature: — WORKERS' COMPENSATION DECLARATION: I nerebp affirm that I have a certificate at consent to sell•hsure ora certificate of workers' Compensation Insurance, or a certified copy thereat (Section 3800. Lab. C). POLICY NO.: EXP, DATE: COMPANY: ❑ Cenified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. Date: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need riot be completed it Ne perrnd Ls'tor one hundred (S100) or iess). I Certdy that in the performance of the work for which this perrait is issued, I shall not employ arty person in arty manner so as to becume subject to the Workers" Compensation Laws of California. / h� �f� '•• ' 30- 9 Date: 3 - � � - Signature: NOTICE: tf, after making this declaration, yW should become subject to the Workers' Compersatiori provisions Of the Labor Code. you must tonhwith comply with such provisions of Ilti4 permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby allirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 9097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed pursudnt to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 70DO) of Division 3 of the Business and Professions Code) or trial 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 riot more than live hundred dollars (5500). ❑ I, as owner of the property or my employees with wages as [heir spite compensation, will do the work, and the structure is not intended or offered for safe (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work hims0rherself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or improvement is sold within one year of Completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). 13I, as owner o1 the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business and Prolessions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor($) license pursuant to the Contractors' Stale License Law). I am aware that proof of their Worker's Compensation insurance shou$d be provided to me. ❑ I am exempt under Section: B. & P. C. for this reason: Date: Domer: I do hereby certify that I am aware of and understand [he requirements of CaMomia Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant wiluwie not (circle one) need to compoith wsaid state codes and the requirements for a permit for construction or modification from the Air uahty Management District, Residential construction applications are exempt from these provisions. Dale: Applicant. I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and county ordinpnceS and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. Date: _� — 3� --� L _ Signature: Driver's License m Social Security 0: 1641.46 White—Builaino; Green --Code Enforcement: Canary—ADDlicant; Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT PERMIT NO: P 056748 PLAN CHECK NO: N CONSTRUCTION TYPE: PERMIT TYPE: PLU JOB DESCRIPTION : 2000SF CATERING KITCHEN IMPROVEMENT CLAIM VALUE; CALC-VALUE: PERM NO: P 05674 GOVT: N SUPP: N PURPOSE: ALT SQ FT: GROUP OCC: B-2 / COMMENTS: REF B56699 Z 0 N I N G R E Q U I R E M E N T S S E T B A C K S - -- MAIN BUILDING --------- --------- ACCESSORY BUILDING --------- - FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV; PARCEL: 93983048 ZNE; REF NO: PLANNING NOTES> > **************�itit************its***��*********'*.*�t•�*************it********�***fit** D E V E L O P M E N T S E R V"I C E S�' R E Q U I R E M E N T S i ZONING APPROVED BY DATE: BUILDING APPROVED BY ; DATE: APPLICATION ISSUED BY: DATE, --- Zu 7 ********************* it -Nit *iEit****** W N it wit it it F **************fit•**************************9t***#t**1t1t�F1t�F****ltltlt*it**ltlt**it******itTt-* LEGALIZATION:N F E E SY M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTR C MECHANIC FIRE SMIP/RES GRADING PERMIT TOTAL COST 18.00 1 WASH BASIN - 2.00 2.00 25% - SMIP/NON-RES WATER CLOSET (TOILET) PLAN 2.00 PLU I WATER HEATER AND/ORVENT ISSUE FEE 2.00 3.00 1 GAS PIPING SYS OF` 1 TO 4 OUTLETS BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 18.00 3.00 0.00 21.00 21.00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 21,00 OVER/SHORT: 00 BLDG AMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 21.00 I N D I V I D U A,L F E E B R E A K D 0 W N -- TYPE QTY D E S C R I P T I.O N UNIT COST TOTAL COST PLU 1 WASH BASIN - 2.00 2.00 PLU 1 WATER CLOSET (TOILET) 2.00 2.00 PLU I WATER HEATER AND/ORVENT 2.00 2.00 PLU 1 GAS PIPING SYS OF` 1 TO 4 OUTLETS 2.00 2.00 PLU 4 SINKS, FLOOR 2.00 8.00 PLU 1 SINKS, SERVICE / MOP 2,40 2.00 END OF FEES CONSTRUCTION AND PLANNING iAPPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector' 1, Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe•Undrgrnd. [�/�C� 1 �r�� 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Condtift-Undrgrnd. 55. Electrical Bonding 5, Steel Reinforcement 56, Rough Plumbing & Pressure Test 6• Electrical LIFER Grnd. 57. APPROVAL TO COVER•GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe Undrgrnd. 60. Backwash Lines, P•Trap, ❑ Undrgrnd, r 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 Plurnt: ing S NCS rl 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning _ FIRE DEPT. REQUIREMENT r 'APPROVALS. -,-Permit # - 20. Rough Factory Fireplace 21. Ducts, in Structute _ 70. Underground Hydro 22. Ducts, Ventilpting 71. Product'.Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing - " 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74• "Overhead Hydro ` 26. T•Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frgme 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 + •80.1 -FOOD CERTIFICATE ISSUED 33. -Final Electric W,4greI( {lEr oCr-C!� 34. Final Heating & Air Conditioning 35._FinaI Gas Pipe-TestIN Z C9e�i 36. Hood or Canopy 37. -Final Factory Fireplace 38. Final Plumbing 39. Water Sarvice,Finai 40. Gas Service -Final 41, Solar Domestic•Finat-. 42: Backflow Preventer ' t s 43. Backflow Irrigation - 44. Landscape Irrigation System 45. Sound Attenuation - t 46. Handicap Regulations , 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF.O000PANCY No. Date - PROJECT ADDRESS: 711 W 17TH ST OWNER'S NAME: FREDA DAVIS ADDRESS: 5932 PADUA , H, B. UNIT: D 1 840-4396 ARCH/ENGINEER: FRANCIS PRAT UNG REG.NO.: C 18 58 5 ADDRESS: 5932 PADUA UNIT: H.B. CA 92647 PERMITIEE: LEE'S REFRIGERATION (714)828-0719 ADDRESS: 7691 CODY DR STANTON CA 90680 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and of S. CITY Lc,: 0 5 5 / 9 7 0 STATE LIC,: 16 8 8 3 SS: 0 Date: / Signature: WORKERS' COMPENSATION DECLARATIDN: I hereby affirm t i I have a certificate of consent to se 1 -insure or a cert' to al Workers' Compensation Insurance. or a certified copy thereof (Sec0oh 3800, Lab. C). POLICY No.: EXP. BATE: COMPANY: ❑ Certified copy is hereby furnished. [N Certified copy is I3 t the city Building Division. Date — Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hued 00) or less). I certify that in the pedarmance of the work tar this permit is " I shall note lay an n in y manner s s to become subj¢ci to the Workers' Compensation Laws CaGlomia. Date: Signature NO CE: It, after making this declaration, you shoalme subject to the Workers mpensatiort provisio of he Labor Code. you must forthwith comply with such provisions or this permit sha0 be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the pertarma e f the work for which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city at county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of Inc Contractors' State License Law (Chapter 9 (commencing with Section 7000) a1 Division 3 o1 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 apoficant to a Civil penalty of not more than five hundred dollars (5500). I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for safe (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who build$ or improves thereon, and who does such work himselflherself or through his or her own employees, provided that such improvements are not intended or offered for sale. It, however the building or improvement is sold wilhin one year of completion, the owner will have the burden of proving he/she did nol build or improve for the purpose of sale). 1, as owner of the progeny. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' State License taw does not apply to an owner of properly who builds or improves thereon and who contracts for such projects with a contractor($) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance stmtd be provided to me. ❑ I am exempt under Section: B, & P. C. for this reason: Date: — Owner: I do hereby certify that I am aware of and understand the regrdrements of Cabfomia Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant willtwill not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Atr uabty Management District. Residential construction applications are exempt from these provisions. Date: Applicant: — I hereby cerhly that I have read this appfication pd state Gat the above information is ordinances and stale laws relating to building Lvg6iruction and her rite represent property for inspection purposes. [!J Date: / ` .. �` Signa Driver's License or Social Security M. to comply 11011 city and co Icy to enter apo a above -menti ned $641-46 White—Buikiinq; Green --Code Enforcement: C,anarr—ADolicant; Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: M 057032 PLAN CHECK NO: N CONSTRUCTION TYPE: PERMIT TYPE: MEC JOB DESCRIPTION : 2000SF CATERING KITCHEN IMPROVEMENT CLAIM VALUE: CALL—VALUE: PERM NO: V 5li PURPOSE; ALT SQ FT: GROUP OCC: B-2 / COMMENTS: RE:#B56699 �I-iETEi(-�Fi6iFiE�I-�I-��irt*�*i(-i(-***-ME*-ME�iEi(-TETE**�**TE**iFiF-ilk-lkiE*��-MEiFiF*iF�***irt*-ME�iFlf+E*if*?'(•*�iE*-ME*iFikiFi(-i(-*i(- Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------- MAIN BUILDING ---------- ---------- ACCESSORY BUILDING--------- FRNT: FT IN REAR; FT IN FRNT: FT IN REAR; FT IN LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL; 93983048 ZNE: REF NO: PLANNING NOTES> > i(- i(- 3F iF � �I- �I- �I- � in }E in * iF i(- iF if it * iE iI- iI- iF iE * it iF iF iE �- � � iE iE iE iE iE,iE -�F -�F -�F -�F iF iF iE iE -ME �F � }E iE -ME iE iE iE 1i� iF �f- iF iE �e �L- iE �E TF iE 3E iE �F � �F iF •1� �F iF iE iE iE D E V E L O P M E N T S E RL -V I C E S R E Q U I R E M E N T S ZONING APPROVED BY �� DATE; ILDING APPROVED BY : r. DATE: APPLICATION ISSUED BY: DATE; L �I- * if * * it it T{ iF it it i(- iF if• �I- TE �I- iF �I- � TI- {'4 � i(• }E !f• iF * * � iE Tr!- iE i{-iE * IE Tr!- Tr!- * Tr!- i(- 9t- Tr!- # * * iE �L--k� TI- � * #(iF �I- �I- � dF iIf• * iIf• * T( iE � T{- * � � ic• �L- iE -k� Tr!- jE � iF LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 455% SMIP/NON—RES PLAN ISSUE FEE 15,00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 45,00 15.00 0.00 60.00 60.00 .00 REVENUE DIVISION TOTALS--> COLLECTED; 60,00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN --CHECK 60.00 � � iE in it it it * � * 9E iE ic- ic- * 9E LF iE ii' iE iE iE iE 3E iE it -rt ik iF it- ic- � if• * iE• * * * * >f � � � l{• THF THF � � iF it it• * in N• TE * i(- it If �F I{ iE in ih * if * * in iE iE it 9E if iE iE I{ I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST MEC 1 REPAIR/ALT COOLING UNIT/SYS W/CNTLS 9,00 9,00 MEC 2 REFRIGERATION SYSTEM <= 100 K BTU/H 9.00 18.00 MEC 2 INST/REL BOIL/COMPR 0.0 — 3.0 HP 9.00 18.00 END OF FEES CATS: 01/'.; 'I'•' ` i,. CONSTRUCTION AND PLANNING. APPROVALS Permit # Date Inspector POOL 6 SPA 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, f=orms 4, Electrical Conduit-Undrgrnd. 55, Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd, 57. APPROVAL TO COVER-GUNITE 7, Footings 58. Electrical Conduit-Undrgrnd. 8, Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd, 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House'Connection 62, Backwash & Receptor -Final 12, Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing + 65. Electrical -Final 15, Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring _ 67. Fencing & Access Approval 17, Rough Wiring Sign - 68. APPROVED FOR PLASTERING 16. Rough Electrical -T Bar Ceiling 69. POOLJSPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit #_ 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72, Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74, Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77, FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes, 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 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. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS:IS 711 W 17TH ST OWNER ADORE E: FREDA DAVIS DpRESS: 5932 P AD UA , H. B. UNIT: D1 ARCN7ENGINEER: 840-4396 FRANCIS PHAT UNG REG.NO.: C 1 8 5 ADD Ell: 5932 PADUA T` PERMITTEE: H. B. CA 92647 ADDRESS: FR EDA DAVIS (714)840-4396 5932 PEDUA DR HUNTINGTON BEACH CA 92646 LICENSED CONTRACTOR OECLARATIOW I hereby affirm that I am licensed under provisions of Chapter 9 {commencing with Section 70001 of Division 3 of the Business and Professions Code, and my license is in full farce and effect. CITY LIC.: STATE UC.: CLASS: Date: �_ - Signature: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-inSure or a certificate of Workers' Compensation Insurance. or a certified copy thereat iSection 3800, Lab. C). POLICYNO 1300158-92 EXP- DATE: 03/01/93 COMPANY: STATE FUND ❑ Certified copy is hereby 7tum17ed. Ce ified copy is /(tail with the city Budding Division. Date: iS'9z APpiicanu EXEMPTION FROM WORKERS' COMPENSAITON DECLARATION: (This section nerd not be completed if the permit is lar one hundred {5100) or I I certify that in the pertamance of the work for which this permit is issued. J shall not employ any person in any manner so as to become Subject to the Workers' Compensation Laws of Calitomia. Date: Signature: NOTICE: If, after making this declaration, you Should become Subject to the Workers' Compensation provisions of the Labor Code. you must lomhwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued {Section 3097, Gv. C). `-7 LENDER: - t ADDRESS: OWNER BUILDER DECLARATION; I hereby affirm that I am exempt Irom Ine Contractors' State License Law for the following reason (Section 7031,5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its itsuance, also requires the applicant for such permit to file a Signed statement that he7she Is licensed pursuant to the provisions o1 the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that hriShe is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant tar a permit subjects the applicant to a civil penally of not more than five hundred dollars (5500), toI. as owner of the prpperty or my em layees with wages as their sole compensation, will do the work. and the slructure is not intended or offered for sale (Section 7044. Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himsell1herself or through his on her own employees, provided that such improvements are not intended or offered for sale. 11, however the building or improvement is sold with} one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the prapVtam exclusively contracting with licensed contractors to construct the project (Section 7044, Business Eland Prolessions Code: The Contractors' State Lkense Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractors) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: 8, d P. C. for this reason: Dose: 'i��1Qi[ C-i�t 5 % q 9 Z --Owner: C4Jti� I do hereby certify that I am aware of and understand the requirements o1 California Hearth and Safety Code Sections 25505, 25533, a4 25534 and that 1 or any future building occupant wiiMI not (circle one) need to comply with said state codes and the requirements for a permit for construction or moddieation from the An Duality Management District. Residential construction applications are exempt from these provisions Date: Applicant: I hereby cenily that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and State taws relating to building ruction and hereby authorize representatives of this city to enter upon the above-mentioned property tar inspection purposes, Date: 2=.S-- I 'gnature: tel` r�� C — Driver's License of Social Security r: 1641-46 Whine—Bruldinq: Gfekn—Code Enforcemenn: Canary—Applicant: Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: E 056700 PLAN CHECK NO: N CONSTRUCTION TYPE: PERMIT TYPE: ELE JOB DESCRIPTION ; 2000SF CATERING KITCHEN IMPROVEMENT CLAIM VALUE: CALC—VALUE: PERM NO: E 05670 GOVT: N SUPP; N PURPOSE: ALT SQ FT: GROUP OCC; B-2 / COMMENTS: TEMP POWER RE:#B56699 Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------- MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING RE& PROV; PARCEL; 93983048 ZNE; REF NO: PLANNING NOOTES> > D E V E L O P M E N T S;` E. ;R V I C E S R E Q U I R E M E N T S a Y ZONING APPROVED BY DATE; BUILDING APPROVED BY DATE: APPLICATION ISSUED BY: f DATE?? '� L it if if iE �E i6 i6 �4 �F if if if• � �k � it if if �F iE iE � �f � � * TF TF i6 iE � If �F if iE * �f * �f iF iF * * �4 TF �E iF iE �k � �k � iE � �F �F �F if if iE if * �F i6 �F if if * i6 �F �F �F * if TF TF TF i6 LEGALIZATION:N F.E�E+' S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING' ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 15.00 501 SMIP/NON—RES PLAN ISSUE FEE 15.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 15,00 15.00 0.00 30.00 30.00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 30.00 OVER/SHORT•00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 30,00 iF �F i6 i6 �E iF �F �f 1E if �F �F iE If ♦14 �F TF TF TF TF �F i6 iF �4 �f �f if �4 1E i6 i6 i6 if * if if if !E i6 �E i6 �F �F TF if �F iE iE �E �E i6 i6 �E �F �F �F it �F i6 �E * i6 if �f �f �f * �f iF if * �4 �E iE iF iF iF �E �f I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 1 TEMP SERV PWR POLE W/OUTLETS EA. 15.00 15.00 END OF FEES CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL &SPA APPROVALS Permit # Date Inspector 1 .Temporary Electrical Service or Pole 52. Pool & Equipment Location 2, Soil Pipe•Undrgrnd.- 53. Steel Reinforcement 3. Etectrical Corlduit.Utiiity-Undrgrnd. 54. Forms 4, Electricar Condtfit-Undrgrnd. 55. Electrical Bonding "5.'5teel Reinforcer2ent 56, Rough Plumbing & Pressure Test 6. ElectricafiLIFER Grid. 57. APPROVAL TO COVER-GUNITE 7. Footings T 56. Electrical Conduit-Undrgrnd. B. Foundation 59, Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60, Backwash Lines, P -Trap, J Undrgrnd, 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line &House Connection 62, Backwash g, 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 ElectricV4liring �Ri�- �-qZ 17, Rough Wiring Sign 67, Fencing & Access Approval 66. APPROVED FOR PLASTERING 1$. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT _ PPROVALS Permit # 20. Rough Factory Fireplace 1. 21. -Ducts, in Structure = 70. Underground Hydro - 22. Ducts, Ventilating 71. Product'Piping O'Gas ❑ Oil 23. Gas Pipe`Flough 8+ Test .72. Underground Flush f 24. Roof Framing • ' - `7 Undergrnd. Storage Tank 0 Gas O Oil 25. Roof Sheathing ' 74Overhead Hydro ' 26. T -Bar Ceiling (Structural) &-Moriocoat '• 75. -Dry Chemical 27: Frame and Ftashipg 76. Dry Standpipe 2$. Lathing•& Siding _ 77. FIXED SYSTEM,FINAL 29. Insulation 78. FIRE PREY. FINAL , 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat '. .7 INAL INSPECTION ` 32.. Electrical Power Meter -Final OD CERTIFICATE ISSUED 33. Final Electric s: 34. Final Heating& Air Conditioning' 35.'Final Gas Pipe-Testq.36. Hood or;Canopy + 37. Final Factory Fireplace 38. Final Plumbing < 39. Water Service -Final 40. Gas Service -Final r t 41. Solar Domestic -Final. - 42. Backflow Preventer , I 43. Backflow Irrigation 1 44. Landscape Irrigation System s j. +45. Sound Attenuation .l r- 46..Handicap Regulations - 47. FINAL STRUCTURE & BUILDING - 48.' FINAL PLANNING - 49. Electric Release to Edison 50. Gas Release to Southern Califorpia Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 711 W 17TH ST UNIT: D1 OWNER'S NAME: FREDA DAVIS ADDRESS: 5932 PAD UA , H. B. 840-4396 ARCHIENGINEER: FRANCIS PHAT UNG REG.ND,: C 18 5 8 5 ADDRESS: 5932 PADUA UNIT: H,B. CA 92647 PERMITTEE: R.J. ELECTRIC (714)744-5881 ADDRESS: 1216 W. BARKLEY AVENUE ORANGE CA 92668 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 o the Business and Professions Code. and my license is in full force and effect. CITY LIC.: 0 3 3 STATE LIC.: 4 4 0 6 2 0 CLASS: C 10 tri+ at'a1 e: Signature: — WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a cenifirate of Workers' Compensation { or aj e p . thereof (Section 3800. Lab. POLICY NO.: •• �� `�� EXP. DATE: 0 / 0 1 / 9 2 COMPANY: FREMONT �r ❑ certifi c y is her by lumished. ff Ceniiied copy is filed 'm the city Building Division, Date: Applicant: EXEMPTIDN FROM WORXERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred (5100) or less). I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date: Signature: NOTICE: If. after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. ! - CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ. Q. +` LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 70,77.5 Business and Prolessional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to ils issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Prolessions Code) or that helshe is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (M). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himselflhersell or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or improvement is said within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Prolessions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' State License Law), I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ t am exempt under Section: B. 8 P. C. for this reason: Date: owner: I do hereby certify that I am aware of and understand the requirements of California Health and Solely Code Sections 25505, 25533, and 25534 and that I or any future building occupant will/will not (circle one) need to comply with said state codes and the requirements for a permit Ior construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and stat aws relating to building construction and hereby authwLze representatives of this city to enter upon the above-mentioned property !or insp lion pDeposes. Dai Signature: Driver's License or Social Security a: 1641-46 White—Buildina: Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO; E OS6891 PERMIT NO; E 056895 PLAN CHECK NO; N GOVT; N SUP CONSTRUCTION TYPE: PERMIT TYPE; ELE PURPOSE: ALT JOB DESCRIPTION : 2000SF CATERING KITCHEN IMPROVEMENT SQ FT: CLAIM VALUE: 9,300.00 CALL—VALUE: GROUP OCC; B-2 / COMMENTS; REF: B56699 >f-►E�*�c•�c•��+E+Eac��•��*��•�•��+�-►E*�•��•�� +E�•->E�•+E**��•�*��c•�c•�c•***x*�-��-►E��-�**->E�ac•�*��•�� Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ------------ ---------- ACCESSORY BUILDING--------- FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN PARKING REQ: PROV; PARCEL: 93983048 ZNE; REF NO; PLANNING N TES> * 3E �E 1'(• #E -IF * i[• �E iE yF #E �E -IF iF iE iE 1'T• if ♦t4 if if iF 1'E iE 1'T• iE iE if ?ft iF -1F �E 1t'#E if if if ?ft iE iE #E ?ft if ?ft if iF iF yF #E 1'(• iE ii• iF iF iF * #f �E �E �E iF iF i[• 9r �E -IE iF iF iE yF �¢ ?ft �i- �(• #E ?ft if iF D E V E L O P M E N T S -E-R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE; BUILDING APPROVED BY DATE; APPLICATION ISSUED BY; DATE, r �� it dE �E iE #E it iE �E iE �E �f• iE iE it iE 3E iE 1E iE iE iF iE ic• �E i{• �f. iF �E #4 �E iE �E #F -IF * -1F �E iE �4 ?tt 1'T• �4 �E iF if �E iF iF i[• i[• �E �E it it #E it iF �E �E �E iE iE -IF +e iE �E �E �E +e iE it 9[• iE iE �(• �E ?tt +e iE ?tt ?tt ?tt #! iE yF �E iE iE iE iF iF it iE 1'E iE iE iE it iF � �E �E iE -IF iE �(• �E +e �E �E +e }E iE LEGALIZATION;N F E E'S U M M A R Y STRUCTURAL SEGMENT;N r PERMIT BLDG PMT PLUMBING ELE52 RIC MECHANIC FIRE SMIP/RES GRADING X02 SMIP/NON—RES PLAN ISSUE FEE 15.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 52,25 15,00 0,00 67,25 67,25 .00 REVENUE DIVISION TOTALS--> COLLECTED; 67.25 OVER/SHORT; ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN --CHECK 67.25 iE iE * �E * * �E �E 1'(• i[• �E i[• #E it #E 9[• � iE iE -lf �E iE it it it it iF iE iE -lf �E iF it it iF -lf �E �E iE it it iF iF iF �E �E �E �E cit• -IF iF iE * -1F 9F iE iE +e +e �E �E �E 1'(• 1F it• iE �E 3(yF ?E iE ?tt iE �4 �f• 1'T• -1F �4 iE I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 6 FIXTURES LIGHTING 1 ST 20 EA. .75 4.50 ELE 15 RECEPT/OGTLET 1 ST 20 EA, .75 11.25 ELE 6 RECEPT/SWITCH 1 ST 20 EA, .75 4.50 ELE 2 NON—RES APPLIANCE NOT OVER 1,0 HP 3,00 6.00 ELE 1 SUB—PANEL 11.00 11,00 ELE 2 MOTOR/POWR APPARATUS 1.1 — 10.0 HP 7,50 15.00 END OF FEES 01 CONSTRUCTION ANO PLAIy kNG APPROVALS Permit # + Date inspector POOL a+ SPA APPROVALS Permit # Date ' Ins ector i.' Temporary Electrical Service oG Pole 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd. 53, Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms r 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 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. .i 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 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 16. Rough Electric Wiring 144Z l-� 77 17. Rough Wiring Sign 18. Rough Electrical -T Bar Ceiling 1�-z� 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structuee 70. Underground Hydro 22. Ducts, Ventilating -71. Product Piping ❑ Gas 00il 23. Gas Pipe -Rough & Test 72. Underground Flush 24.. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 33. Final Electric 34. Final Heating & Air Conditioning!! Vic k 80. F OD CERTIFICATE ISSUED 35. Final Gas Pipe -Test 36. Hood or Canopy + r i 37. Final Factory Fireplace 38. Final Plumbing 39, Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46, Handicap Regulations 47. FINAL. STRUCTURE & BUILDING ' 48. FINAL PLANNING 49. Electric Release to Edison -50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date l Ucen C Llce O. Oat Signature WORKERSCOMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -insure or a certificate A Workers' Compensation insurance, or a certified copy thereof (Section 3800, Lab. C. s Policy No. ��F623 -96 Company" Q,Wertilled copy I$ hereby furnished_ Rr Certifop it ¢.with the city ISIO Date tx-Applicant EX MPT ON FROM WORKERS' COMPENSATION DECL ATI (This section need not be completed if the permit is for one ndr ($100) or toss). I certify that in the performance of the work for which this permit Is issued I $hall not employ any person In any manner so as to become subject to the _ Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions Or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for ':which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that,l am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code_ : Any city or county which requires a permit to Construct, alter, improve, demol]sh or repair any structure, prior to its issuance, also requires the applicant for such permit to fife 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 Oivision 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars (5500). 1, as owner of the property or my employees with wages as their Sole compensation, will do the work, and the structure Is not Intended or offered for Sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletlon, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed Con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law doe% not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the COntraCtor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. a P. C. for this reason Date Owner I hereby certify that 1 have read this application and state that the above Information is correct. 1 agree [o comply with all city antl county ortl[nances and state laws relating to building Construction, and hereby authorize repre- sentatives of the 'ty to a er upon the eve-mentioned%rope y s inspection p 7 Signature a Drivers' License or SS 4 Bar Sink Backflbw Preventer Backflow Irrigation Bathtubs Dishwasher Drinking f=ountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P --Trap Roof Drains Reinspection Fen 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. )CBO # Heating System & Ducting E-10-11 00,000 BTU ❑ 100,000 BT Reinspection Fee I $15 CMF 0865-46, rev. 10/84 white . Building; Canary - Applicant; Pink - Accounting; Goldenrod • Assessor 6234 3/07/11' eElElElElE11 Zone Accessory Building: i Parking Req./Provided wa— fpr 1'irh i (1•'111, 95, I IZ TL PLUMBING FEES i ou/11+ "toumd ELECTRICAL FEES - Applicant to fill in all spaces except those within heavy border lines and sign ail apprAifate declarations. r(TY OF COSTA MESA. CO NSTR CTI PERMIT PERMIT NO. 2 2 6 G• TRACT fVOiw t cY LOT NIP 4 UNI i NO. i Lam' Project Address C J v�}f Building Approved By Dishwasher Meter ❑over 100 amps Solar Piping Date Dryers ❑Gas ❑Electric Sub Panel _ .Applicant's Mailing Address ��d2 v S C q2;r TYPE OF CONSTRUCTION NEW ADO ALTERATFON REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OTF,LF-P Fan A.P. 906 `' 1 Owner's Name Phone $J�6 J/2 DESCRIPTION OF WORK/USE OF'BLOG. a° iz� Inc. Solar ❑9.15 HP 13 16-15+ Urinal Address _ Fixtures S Main Building: _ Device Boxes Outlets E Water Service Arch/Eng. — License No. TYPE OF PERMIT 0 GRADING 0 FOUNDATION STRUCTURALT ElELECTRICAL 1:1PLUMBING 1:1MECHANICAL B Front PERMIT ISSUANCE $ ENERGY P.C. S GRADING S MICROFILM S Address❑ TE=NANT ❑ OTHER Laundry Trays Rear Nam c PhonesSy�6 7 Right Contractor's - Address (mailing) PROJECT DESCRIPTION SQ. FT. 2 OCCUPANCY V/VI 26-00�� C Left ' $. CON 5TRUCTION TYPE VALUATION $ S $ o_ 0�2 �7 7 City License No. _ ZONE GRADING CU.YDS. ACRES -' Ping. Ref. 914 LICENSED CONTRACTOR OECLARATION PLAN CHECK 25% $ 1 hereby affirm that 1 am licensed udder provisions of Charter 4 (commencing Remarks: / a-4 �� a V Planning Notes: with section 7000) of Division 3 of the Business and Professions Code, and my license Is Irl full f c_ aftd effect. pcl*v� • ` —4- 4• „ Pr+� � �Z� is es v. 1 w Q Ucen C Llce O. Oat Signature WORKERSCOMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -insure or a certificate A Workers' Compensation insurance, or a certified copy thereof (Section 3800, Lab. C. s Policy No. ��F623 -96 Company" Q,Wertilled copy I$ hereby furnished_ Rr Certifop it ¢.with the city ISIO Date tx-Applicant EX MPT ON FROM WORKERS' COMPENSATION DECL ATI (This section need not be completed if the permit is for one ndr ($100) or toss). I certify that in the performance of the work for which this permit Is issued I $hall not employ any person In any manner so as to become subject to the _ Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions Or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for ':which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that,l am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code_ : Any city or county which requires a permit to Construct, alter, improve, demol]sh or repair any structure, prior to its issuance, also requires the applicant for such permit to fife 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 Oivision 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars (5500). 1, as owner of the property or my employees with wages as their Sole compensation, will do the work, and the structure Is not Intended or offered for Sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletlon, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed Con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law doe% not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the COntraCtor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. a P. C. for this reason Date Owner I hereby certify that 1 have read this application and state that the above Information is correct. 1 agree [o comply with all city antl county ortl[nances and state laws relating to building Construction, and hereby authorize repre- sentatives of the 'ty to a er upon the eve-mentioned%rope y s inspection p 7 Signature a Drivers' License or SS 4 Bar Sink Backflbw Preventer Backflow Irrigation Bathtubs Dishwasher Drinking f=ountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P --Trap Roof Drains Reinspection Fen 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. )CBO # Heating System & Ducting E-10-11 00,000 BTU ❑ 100,000 BT Reinspection Fee I $15 CMF 0865-46, rev. 10/84 white . Building; Canary - Applicant; Pink - Accounting; Goldenrod • Assessor 6234 3/07/11' eElElElElE11 Zone Accessory Building: i Parking Req./Provided wa— fpr 1'irh i (1•'111, 95, I IZ TL PLUMBING FEES i ou/11+ "toumd ELECTRICAL FEES Showers 2 p Service Sink Canopy Type 11 ❑ Automatic Washer 11 Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Sewer Cap Sewer Connection Lam' Cooking Unit Meter El up to 100 amps Solar Collectors Building Approved By Dishwasher Meter ❑over 100 amps Solar Piping Date Dryers ❑Gas ❑Electric Sub Panel Solar Tank Fan Motors 1:10-1 HP E11%-8 Swimming Pool w/Spa F,A.U. Inc. Solar ❑9.15 HP 13 16-15+ Urinal BUILDING PERMIT Fixtures Microwave Water Closet Water Heater $ ••S� Device Boxes Outlets Pole Light Range Water Service Switches Sign Auto -Wash PERMIT ISSUANCE $ ENERGY P.C. S GRADING S MICROFILM S Garbage Disposal Standing Sections Laundry Trays _ Generator 00.5 KW 115-15 KW Trash Compactor II Issue Fee S 3 -I MECHANICAL FEES Reinspcti eon Fee $15 1 1 Issue Fee 1 $•3 Z O N I N G R E Q M T S Hood or Type I ❑ DEVELOPMENT SERVICES REQUIREMENT y `3 ,Q� Canopy Type 11 ❑ Zoning Approved ByI Lam' Date �++-+ Building Approved By Date Refrigeration System Application Issued By ❑0-100,000 BTU 0100,000BTU BUILDING PERMIT $ SUMM RY OF FEES �tZQ SMIP $ ••S� System Repair/Alteration PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% $ $ S $ $ •� O • SP _ PERMIT ISSUANCE $ ENERGY P.C. S GRADING S MICROFILM S Fire Dampers Registers MECHANICAL $. TOTAL FEE $ o_ Issue Fee I $ 3 PLAN CHECK 25% $ (CONSTRUCTION AND PLANNING APPROVALS ' Permit'-# r r Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. -Temporary Electrical Service or Pale 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd, 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms ti 4, Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' 5. Steel Reinforcement 56. Rough Plumbing & Pressdre Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER=GUNITE 7. Footings t 1 i� `- s J 58. Electrical Conduit•Undrgrnd.- 8. Foundatidrr Jr^(r �• 59. Gas Pipe, ❑ Undrgrnd' Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd• 10. Structural Ffoor 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 -Fina! 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 t f 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro ✓ w 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil,) 23. Gas Pipe -Rough & Test 72. Underground Flush '3r r 24. Roof Framing I 73. , Undergrnd. Storage Tank'❑ Gas ❑ Oil 25, Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 3 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL' 1 '� 29. Insulation 78. FIRE PREV. FINAL 30. Drywatl Nailing HEALTH DEPTI EOUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED t, 33. Final Electric Notes:^ 3 83ler %Yo ant loo�»-L, G.•svn 34. Final Heating & Air Conditioning ' 35. Final Gas Pipe -Test 36:'. Hood or Canopy ' ,wK,,,Final Factory Fireplace I ' 38."Final Plumbing 39. Water Service -Final 40. Gas Service -Final .'141, Solar Domestic -Final 42.,Backflow Presenter 43. Backflow Irrigation �44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations r `. 47. FINAL STRUCTURE & BUILDING r 48/Special Requirements Compteted r, 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ' St. -CERTIFICATE OF OCCUPANCY No. Date , I ` Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY &F COSTA MESA CONST UCTION PERMIT Project Address �/ Applicant's Mail' Address 220 %,��,,{{ Owner's Name ~' Phon1fd_7 � 2 Address Arch/Eng. --- License No. Address Contractor's Nam G/r7/ /- Phone5r6 /967 Address (mailing) Reo City License No.Q!5_12 417 7 LICENSED CONTRACTOR DECLARATION I hereby affirm th$t I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full f ce a effect, tacense C ss LI a No. Dale Signature ' WORK RS' COMPENSATION DECLARATION I hereby affirm that I nave a certificate of consent to s Ins a or a certificate �f Workers' Comp�enssation Insurance, or a certified �/vcopy ��.thereof (Section 3800, Lab. C PoIicy No. 8a2,_� P6 Compant� �t__. �s % /O— zn11 . Certified copy is hereby furnished. Certlll I d with the city B �1 visi Date Applicant EXEMPTI N FfIGM WORKERS' COMPENSATION DELLTf (This section need not be completed if the permit Is for one oreri'soissued 100) or less). I certify that in the performance of the work for which this perms i shall not employ 8ny person in any manner so as to become subject to the Workers' Compensation i_aws of California. Date Signature NOTICE: If, after Making this declaration, you should become subject to the Workers' Compenf,ation provisions of the tabor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Of the work for which this permit is issued (Section 3097 Civ. C.) l.rnder's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that i am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, PrI0r to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is 11Censed pursuant to the provisions of 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 7031.5 by any applicant for a permit Subjects the applicant to a civil enalty of not more than five hundred dollars (3500). 1, as owner of the property or my employees with wages a$ their solo compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for We If, however, the building or improvement is sold within one year of com- pletion, the Owner will have the burden of proving he/she did not build Or im- ve for the purpose of sale). rO I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project(Section 7044, Business and Professions Code: The Contractor's License Low does not apply to an owner Of property who builds or Improvgs thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me, ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and stale that the above Information is correct. I agree to comply with all city and county ordinances and state laws relating to building cons ruction, and hereby authorize repre- sentatives O 1 it y enter upo the above-mentioned property for Inspection es. Signature to Drivers' License or SS mp PI LNIX NO. TRACT NO. LOT NO. UI�T N; , TYPE OF CONSTRUCTION NEW ADD ALTERATION�i/7��REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTU9A DESCRIPTION OF WORK/USE OF BLDG.24 A.P. �f. Zone S Main Building: Accessory I 'NA ES A TYPE OF PERMIT GRADING El FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER �._L PROJECT DESCRIPTION SQ. FT. nCCUPANr_.y__ CONSTRUCTION TYPE VALUATIONS ZONE GRADING CU,YDS. ACRES E T Front Z O B A Rear N C Right N K 3 Left - G R Ping, Ref. Parking Req,/Provided E Remarks: 1� Planning Notes: M T S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Pole Sub, Transformer ❑ 15-50 KW E)50 + KW _ Backflow Irrigation Sewer CapConstruction Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps Dishwasher I Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains SoJar Tank Fan Motors ❑Q-1 HP 01 Y, - 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 HP C]16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets oOWater Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections P—Trap Laundry Trays Generator 00.5 KW 05.15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee S 3 Reinspection Fee $15 Issue Fee S Boiler Duct - Under Ground MECHANICAL FEES Hood or Type t El Canopy Type I I ❑ SERVICES Zoning Zoning Approved By Building Approved 8 Application Issued By REQUIREMENTS: Date Datta Dat Duct - Structural Refrigeration System ❑0-100,000 BTU 0100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% S RY F F $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ $ GRADING S 5 MICROFILM $, S of?Z"rlo, TOTAL FEE $ Q $ -3i• Exhaust System Cl Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO Fire Dampers Heating System & Ducting ❑0.100,000BTU ❑1100,000BT Registers 13 3z Reinspection Fee 515 Issue Fee CMF 0865-46, rev. 10184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor ,CONSTRUCTION AND'PLANNING, 11 �r POOL &SPA _V ,' / /APPROVALS Permit #� Date Inspector APPROVALS Permit # Date Inspector ,; 1." Temporary Electrical _Service or Pole 52. Pool & Equipment Location t 2. Soil Pipe-Undrgrnd.`i 53. Steel Reinforcement t.Lt 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding + 5. Steel Reinforcement j 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. /' 57. APPROVAL TO COVER-GUNITE 7.�Foarcings -'� ��' 58. Electrical Conduit-Undrgrnd. r 1$!. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test ` 9tiWater?Pipe-Undrgkndi J 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap _ f 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 -1,6. Rough Electric Wiring 67. Fencing & Access Approval 1t7.. Roughliring Sign 68. APPROVED >=0R PLASTERING " j8./Rough,Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL i9. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # f � 20. Rough Factory Fireplace ,zv 21. Ducts, in Structure E 70. Underground Hydro ) {, 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oiler 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 si 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: l i. 34. Final Heating & Air Conditioning D� I 35. Final Gas Pipe -Test 36. Hood or Canopy 37. -Final Factory Fireplace ' • E 38: Final Plumbing _ 39. Water Service -Final 40. Gas Service -Final ; I •7r ''41. Solar Domestic -Final 42. Backflow Preventer =43. Backflow Irrigation , Irrigation System ('44'!�Landscape { +, 55 Sound Attenuation ; + 48. Handicap Regulations 411'''FINAL' STRUCTURE & BUILDING I. 48.,Special Requirements Completed L 49 Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date { k I CITY QF COSTA MESA CONSTRUCTION PERMIT Project Address�r— Applicant's Mailing Address Owner's Name 1 - 1"t LA7'-f —-P. 17.yr Phone Address Arch/Eng. License No. Address rt._, Contractor's Name/110,0- I IS 'Et re 06? /t Phoneme' � f�� Address Imailing)AV6CAem—rf City License No. - M.7 J �^ LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions ofZr 9 (c mencing with section 7000) of Division 3 h Iness and Pr�ssio ode, and my license is in ful force and off ct. License Class License 7 Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent t0 self -insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section 800, Lab. C.) Policy No. &C-iZ10 y.7 C pa rL LI'"C 8 Certified copy is hereby furnished. Certifiedop csled with the cit ng Divisio Date—/ i@ Applicant EXEMPTION FROM WORKERS' COMPENSATI N DECLARATION (This section need not be completed if the permit Is for one hundred (5100) or less) I certify that in the performance of the work for which this permit is Issued I shall not employ any person in any manner so as to become subject to the Workers' Compensation laws of California. Date Signature 'NOTICE: It, after making this declaration, you Should become Subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY _ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097 Cly. C.) Lender's Name Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve• demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant t0 the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of -Division 3 of the Business and Professions Code) or that he/she is exempt therefrom.and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil , enalty of not more than five hundred dollars ($500). I, as owner of the property or my empiOyeeS with wages as their sole compensation, will do the work, and the structure Is not Intended Or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for Safe. If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- i tractors t6 construct the project (SeCUun 7044, Business and PmfeSSions Code: The Contractor's License law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuarit'to the Contractor's License Law). I am aware that proof of their worker's Compensation Insurance should be provided to me. ❑ 1'am exempt under Section B. & P. C. for this reason Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. PERMIT NO.� TRACT NO. LOT NO. UNIT —> Date Owner DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat l(� I hereby certify that 1 have read' this ap -catlon and state that the above information Is correct gre¢ to co pl t all city and county ordinances and state g buildin d ction, and hereby authorize repre- sentative of this cit to ente up the above-mentioned property for inspectio urp / __HMECHANICAL $ 3 Signature Date Drivers' License or SS TYPE OF CONSTRUCTION NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSiON ❑ DEMOLISH ❑ OTHER A.P. DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT LJ GRADING El FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION 5 S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Interceptors Kitchen Sink Lavatories P—Trap Roof Drains PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal Outlets Water Closet Water Heater Water Service Auto -Wash Laundry Trays Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting ❑ 0-100,000 BTU ❑ 100.000 BTS Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor /( MECHANICAL FEES Issue Fee $ 3 f FEES Hood or Type 1 ❑ Canopy Type 11 ❑ Refrigeration System E10-100,000BTU 11100,000 BTU System Repair/ Alteration Fire Dampers Registers Issue Fee Automatic Washer 5845 1/16/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW ❑5.15 KW Transformer ❑ 15-50 KW ❑ 50+ KW Meter El up to 100 amps Meter ❑over 100 amps Sub Panel Motor2!LD-1 HP❑i% - S Inc. Solar 09-15 HP El 16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor h-50 TL FEES Z O N I N G R E Q M T S I I Reinspection Fee 1 $15 1 1 Issue Fee , 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat l(� SUMMARY OF FEES BUILDING PERMIT S SMIP S PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE S PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $--��- GRADING $ PLAN CHECK 50% $ 9bo MICROFILM S $ TOTAL FEE $ PLAN CHECK 25% $ __HMECHANICAL $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Dat Inspector POOL L. -SPA APPROVALS Permit # Date Inspector 1: Temporary Electrical Service or Pole .� 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd � �� ,, w 53. Steel Reinforcement .3. -'Electrical Conduit Utility-Undrgrnd. 54. Forms 4` Electrical Conduit-Undrgrnd. i �� 55. Electrical Bonding 5. Steel.Reinforcem;ent 56. Rough Plumbing & Pressure Test 6. Electrical UFER.Grnd. 57. APPROVAL TO COVER-GUNITE ' 7.'Footings 58. Electrical Conduit-Undrgrnd. B..Foundation- 59. Gas Pipe, ❑ Undrgrnd., Test w 9. -Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10t Structural Floor Sysjem 61. APPROVAL TO DECK I i..s'Property Sewer Line &!-louse Connection� 62. Backwash &Receptor -Final 12. Sewer Cap t, 63. Heater & Vent -Final 13. Roof Drains , • 64. Plumbing System - Final 14, Rough Plumbing t i 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25, Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceilifig (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30:•Drywall Nailing HEALTH DEPT. REQUIREMENT 31t. Plaster Brown Coat 79. FINAL INSPECTION 32.E Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38- Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System t , 45. Sound Attenuation 46, Handicap Regulations 47. F INAL 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 morz'a �s EL-Cct-r Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Projp' t •Address L 4/ 6L Applicant's Mailing AqSLess Owner's Name Phone , 77 Q Address ArchlEng. License No. Address — Contractor$ Name- % Ort 19,2 aa S _Phone _ 22::6,Z) Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION Thereby affirm that t am licensed under provisions of Charter 9 (commencing with section 70001 of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License N 3 S3 -Date ignature WORKERS' COMPENSATION DEC RATION I hereby affirm that I have a certificate of consent to self -insure or a certificate ,f Workers' Compensation Insurance, or. a certified copy thereof (Section .800, Lab. C.) Policy No. Company Certified Copy is hereby furnished, Certified copy is filed with the city B Ing Division� Date Applicant EXEMPTION FROM WORKERS' CO ENSATION DECLARATION (This section need hot be completed i the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensgtion Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name — Lender's Address ' OWNER BUILC)ER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the fallowing reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to Construct, alter, Improve, demolish or repair any structure, prier 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 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 '031.5 by any 4pplicant for a permit subjects the applicant to a civil /penalty of not more than five hundred dollars ($500). '❑ 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as -owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and who contracts for such projects with a con- tractors) license pursuant to'the Contractor's License taw). I am aware that proof o! their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances ancIL state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter u the above-mentioned property for inspection pure Signature Dale 6G G' Drivers' �Licen or SS CMF 0865-46, rev. 10/84 Wh �a% I�NO,, 00 TRACT NO. LOT NO. UNIT NO, 5484 6/25/85 Sp 10 ;1 TYPE OF CONSTRUCTION NEW ADD ALTERATION ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF. BLDG. REPAIR A.P.# Zone S Main Building: Accessory Building: TYPE OF PERMIT GRADING 0 FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ •OTHER - PROJECT DESCRIPTION SQ- FT. OCCUPANCY CONSTRUCTION TYPE VALUATIONS ZONE GRADING CU.YDS. ACRES _ E T Front Z O B A Rear - N I C Right N S. Left G R Ping. Ref. # Parking Req./Provided E Remarks:61 �bO Planning Notes: O M i T S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. - Transformer ❑ 15-50 KW El 50 + KW Backflow Irrigation Sewer Ca 9 R Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Ciarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors El 0-1 HP ❑ 1 4 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP ❑16 15+ Floor Sinks ; Urina) 'Fixtures Microwave �C1 Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ! Standing Sections P --Trap Laundry Trays Generator ❑0.5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee $75 Issue Fee $ 3 i Reinspection Fee s15 Issue Fee $ 3 MECHANICAL Boiler Duct - Under Ground Hood or Type I ❑ Canopy Type I I ❑ FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved BY Building Approved By Application Issued By Date Date Date _a! / aIrIlpi Duct - Structural Refrigeration System ❑0•i00,000 BTU ❑100,000 BTU Duct- Ventilating - _ BUILDING PERMIT $ PLAN CHECK $ PLUMBING S PLAN CHECK 25% $ ELECTRICAL S PLAN CHECK 50% $ MECHANICAL S PLAN CHECK 25%' $ SUMMARY OF FEES SMTP $ PERMIT ISSUANCE $ ENERGY P.C. $ if �d GRADING $ ' 7b - MICROFILM $ TOTAL FEE $ Exhaust System C1Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO'# Heating System & Ducting . El &100,000 BTU'❑100,000BT EFireampers ters Reinspection Fee r $15 Issue Fee $ 3 Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING A?PROVALS Permit # Date Inspector POOL r'A APPROVALS Permit # Date Inspector 1ji .ETemporary Electrical Service or Pole i 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. I 53. Steel Reinforcement ; 3. Efectricaf Conduit Utility-Undrgrnd.' 54. Forms 4. Electrical Conduit-Undrgrhd, 55, Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test "6. Electrical UFER Grnd.57. r APPROVAL TO COVER-GUNITE 7. Footings ' 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer -Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13, Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16, Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18, Rough Electrical,T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19: Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil .23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil -25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 2B. 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 6 a s? (I Notes: 34. Final Heating & Air Conditioning I 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. ,Landscape Irrigation System 45. Sound Attenuation 46, Handicap Regulations l 47. FINAL STRUCTURE & BUILDING 148: Special Requirements Completed 149. Electric Release to Edison s i0. Gas Release to Southern California Gas Co 1'1y. CERTIFICATE OF OCCUPANCY ` ! Date " I CITY OF COSTAMESA CONSTRUCTION PERMIT Project Address 71.1 W. 17th St. Bldg. (D) [Unit-2- AOpticant's Mail -09 Address 131 10 Sa ti r03r St , N . Nnl 1 ornnri Owner's Name hone 549-99$$ Address [31 13i-rr h St =_ NPWnnrt Beach [ a _ Arch/Eng, McL1=iI3, .I-Rnrk License No. Address 19911 Knorr Ave- Silite 916 Contractor's Name_11LlC Air f'.nnrli t -i nni no Phone 4871 1 h71 F, Address (mailinga—(LLQ—Saticoy,—$_t.._N_- linil ywnod f ri City License No. ---3CLC LICENSED CONTRACTOR DECLARATION 1 hereby affirm that 1 am licensed under pro"Islons of arter 9 (commencing with section 7000) of Division 3 f the Business a ofessions Code, and my license is in full force and of Ct. Llcenso Class —n nse o.___3462.51_ 2 S 1 Date / 1 R RLe - _- signatu WORKERS' COMPENSATION DE RATION _I hereby affirm that I have a cert] ate of consent to self -Insure or a certificate of Workers' Compensation Insu nce, or a certified copy thereof (Section '800, Lab. C.) rOilcy No. - --la'fG9924 ° Company T IrMlae rm ane BCertified copy is hereby furnished. Certi i o is filed with the city Buil g Division. LL S V Date Applicant, TIL�C tZ ._-/ � I EXEMPT( N FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (5100) or -,J Iess). 1 certify that in the PQrformance of the work for which this permit is Issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that thfaro is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name -_ Londer's Address OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which require% a permit to construct, alter, improve, demolish or repair any structure, prior tp its Issuance, also requires the applicant for such permit to file a signed staternent that he/she is licensed pursuant to the provisions of 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 1031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). _ J I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 nis or her own employeas, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of Com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). 1, asowner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and who contracts for such projects with a con- tractor(s) 11cense pursuarit'to the Contractor's License Law). I am aware that proof of their Workffr's Compensation insurance should be provided to me. ❑ 1 am exempt under section B. 6 P. C. for this reason Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. I TRACT NO. I LOT NO. I UNH Date —T Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and stat lacing Ilding construction, and hereby allthorizo repre- sentatly s of cit o nter upon the above-mentioned ro rty f r inspect) [fR Slgna[ur OateT Drivers (cense r CJ 1772 L/24/85 TYPE OF CONSTRUCTION U NEW Ll ADD LI ALTERATION LJ REPAIR El CONVERSION CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # Zone DESCRIPTION OF WORK/USE OF BLDG. S Main Building: - Accessory Building: E TYPE OF PERMIT El GRADING 17 FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 1..24 MECHANICAL_ A Rear El -OTHER ght PROJECT DESCRIPTION SQ. FT. OCCUPANCY C K Left CONSTRUCTION TYPE VALUATION $ S Lett ZONE GRADING CU. YDS. ACRES Ping. Ref. # Perking Req./Provided Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee • 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepi/Fact. Bit. ICBO # Heating System & Ducting 1 R10-100,000 BTU ❑ 100,000 BT r Reinspection Fee - 1 $15 CMF 0865-46, rev. 10/84 white - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays - issue Fee 1 $ .3 IANICAL Hood or Type I ❑ Canopy Type II ❑ Refrigeration System 1:10-100,000 BTU 0100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES LO $ 3 ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers OGas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 05-15 KW Transformer ❑ 15-50 KW D 50+KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors El 0-1 HP ❑ 11% - 8 Inc,Solar 09-115 HP ❑16-15+ Microwave Pole Light Range Sign, Standing Sections Trash Compactor 15060 FEES Z O N I N G R E O M T S I I Reinspection Fee 1 $15 1 1 Issue Fee I $ 3 , 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date_ SUMMARY OF FEES BUILDING PERMIT $ — SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ - 13 00 _ TOTAL FEE $ 15 50 PLAN CHECK 25% • $ x_,_50 -CONSTRUCTION AND PLANNING APPROVALS • Permit # Date Inspector POOL jPA APPROVALS Permit #_ Date Inspector IV Temporary Electrical Service or Pale 52. Pool & Equipment Location ;I F 2..Soii Pipe-Undrgrnd. 53. Steel Reinforcement"µ. ✓3. Electrical Conduit Utility-Undrgrnd. 54. Forms r.?, res 4. Electrical Conduit-Undrgrnd. 55, Electrical Bonding i ' 1.✓ 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. _ ,y; 57. APPROVAL TO COVER-GUNITE J :, 7. Footings 58. Electrical Conduit-Undrgrnd. • 8: Foundation J 59. Gas Pipe, ❑ Undrgrnd., Test s 9. Water Pipe Undrgrnd. „ 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System r- �l 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor-Final , 12. Sewer Cap i 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 78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30.. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32.- Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 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 e1ty of COSTA MESA CONSTRUCTION P MI I Project Address r J Applicants Mail i ddress !-�! ?_, l"`�GL Uf�li VI f__ Owner's Name Phone Address Arch/Eng. License No. Address ' �/ Contractor's Nam , Phone �/ P Address (mailing► City License No. LICENSED CONTRACTOR OECLARATIISN I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the f3usiness and Professions Code, and my license is in full rc nd effect. Licens Class License No. b2 0 Date ^ Signature OJ WORKERS' COMPENSATION DE RATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section `3800, Lab. C.) Policy No. Company BCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I„ $hall not employ any person in any manlier s as to 'become subject to the WorkeCom ns f ion Laws o (' Califor ' Date ^ Signature NOTICE: If, a er ma Ing this declarati you Should become subject to the Workers' Compensation provisions of a Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is,a construction lending agency for the performance of the work for which this permit ii ,issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires apermit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit -to file a signed statement.that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 ((Commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil )enalty of not more than five hundred dollars ($500). L7 I, as owner of the property or my @mpioyees-with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvem@nts are not intended or offered for sale. if, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractors) license pursuart'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. L� I am exempt under Section B. & P. C. for this reason Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 30� P MIT NO. TRACT NO. LOT NO. UN! Ci. Date Owner • I hereby certify that I- have read this application and state that the above , information is correct. Iagree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for inspection our s. �f T - Signature Date Drivers' Lice a or 55 i TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER APP. * DESCRIPTION OF WORK/USE OF BLDG - S Main Building: E TYPE OF PERMIT GRADING ❑ FOUNDATION El STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ 5 Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service I Outlets Interceptors Kitchen Sink Lavatories _ P—Trap Roof Drains Reinspection Fee , ! $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating [ Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating -System & Ducting ❑0-100,000 BTU 0100,000BT Reinspection Fee 1 $15 -- -- ----.. -7 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal '- Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU ❑ 100,000 BT System Repair/Alteration Fire Dampers Registers FEES 7741 9941 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑F-lectric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 05-15 KW $ 3 Reinspection Fee $15 FEES Issue Fee 1 $ 3 Transformer ❑ 15-50 KW ❑ 50+ KW ,Meter ❑up to 100 amps Meter El over 100 amps Sub Panel Motors 00-1 HP E)1%- 8 Inc. Solar ❑9-15 HP E] 16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By G ES SMIP PERMIT ISSUANCE ENERGY P.0 GRADING MICROFILM TOTALFEE 10,50 TL Z O N I N G R E Q M T S FEES $ 3 k SUMMARY OF BUILDING PERMIT $ PLAN CHECK PLUMBING $ $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ ' PLAN CHECK 25% , $ ES SMIP PERMIT ISSUANCE ENERGY P.0 GRADING MICROFILM TOTALFEE 10,50 TL Z O N I N G R E Q M T S FEES $ 3 k fCONSTRUC71ON AND PLANNING " APPROVALS Permit # 7-7 ' Date' - Inspector- �i POOL & .sPA _ APPROVALS - Permit # - Date Inspector -1. Temporary Electrical Service or Pole r 52. Pool'& Equipment Location 2. So,Pipe-Undrgrnd. �f'+ y 53. Steel Reinforcement�- � �� tip.+' s+ • (Electrrical Conduit,tJtiliity..Und4kn _ 54. Forms _4f�Electrical Conduit-�Undrgrnd. 55. Electrical. Bonding r 5.�Steel ,Reinforceme t 4 56. Rough Plumbing & Pressure Tesi �D 6!'Elec#rival UFER G nd. A '57. APPRO=VAL TO COVE R GUNITE 7. Foot^ngs �' 58.. Electrical) Conduit-Undrgrnd. 8 Foundation 59. Gas Pipe, ❑ Undrgrnd., Test - .'9.- Wath Pipe-Undr&nd. i 60. Backwash Lines, P -Trap, ❑ Undrgrnd. n k� 10i+ t uctural Floor System i 61. APPROVAL TO DECK 11`Property Sewer Line & House Cofire ction w � $2. Backwash &Receptor -Final 12 ,Sewer Cap 63. Heater & Vent -Final v� 13 JRoof Drains Lj i/� 64. Plumbing System - Final ' 14./,Rough Plumbing 65. Electrical -Final vrZ 15. Rough Electrical -Conduit 66. Solar System -Final - 16. Rough Electric Wiring 67. Fencing & Access Approval 0.1 Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling i 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26, T -Bar Ceiling {Structural} & Monocoat 75. Dry Chemical 1 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29.' Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31.' Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 180. FOOD CERTIFICATE ISSUED 33. Final Electric Notes'., 34. Final Heating &•Air Conditioning E - 35. Final Gas Pipe -Test' , 36. Hood"or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final + 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations ' 47. FINAL STRUCTURE &-BUILDING 48. Special Requirements Completed 49. Electric Release to Edison: • i 50. Gas Release to Southern California Gas Co } + 51. CERTIFIC kTEOF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT IVO. LOT NO. UNITNO, Protect Address n 2- • Applicant's Mailing Address // C 56-7—le- .0 ��-rf��. Owner's Name a /V tw T nem Addresslee-11 s,7 � Arch/Eng �ta` License No! Address IC VGrf' Z!/ Contractor's Nam 44hone lZ, Address (ma€€ing) �� Q <0A177 G City License No. LICENSED CONTRACTOR DECLARATION I h@rebyaffirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professio e, and my license is in�I fors -moi elle / License las �Y Licen e Date WORKERS' CDM ENSATION OEC RATION € h@reby affirm that I have a Certlt€cat of consent to self -insure or a cerliflCate Of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab.J �n I_ Policy No. �4 1 5-,WeCompany '—r► t Uig A, n S BCertified copy is ereby furnished. Certi Ie cow` is tiled with the city BuildingtDivision. Date J Applicant _ nLL _ c, EXEMPTI N FROM WORKERS' COMPENSATION OECLA ATION (This section need not be completed if the permit is for one hundred ($100) or loss) I C"tify that in the performance of the work for which this permrt is issued, l shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name lander's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's Llcense taw for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair anystructure, 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 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 ,er%alty of not more than five hundred dollars ($500). Ll I, as owner of the property or my empioyeeS with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License taw 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 eMp)oyees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/She did not build or Im- Kove for the purpose of sale). W 1, asowner of the property, am exClusivoly contracting with licensed Con- trbctors t6 construct the project {Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who bkiiIds or Improves thereon, and who contracts for such projects with a con- tractors) license pursuant 'to the Contractor's License taw). I am aware that Proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section - - B, & P. C. for this reason Date Owner I hereby Certify that I have read information Is correct. f agree to c and state laws relating to bulldinc sentati"es this city_t9,,ent r Inspetti0 pur oses- Signature Drivers' Lic se of SS :P pplication and state that the above with all city and county ordinances uct Ion, and hereby authorize repre- the above-mentioned ProrM tty _fqr TYPE OF CONSTRUCTION- LJ NEW LI ADD LJ ALTERATION I__) REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 916 DESCRIPTION OF WORK/USE OF BLDG. -- S Main Building: E TYPE OF PERMIT GRADING ElFOUNDATION El STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ O-FHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ $ Left ZONE GRADING CU. VDS. ACRES Ping. Ref. # Remarks: (n f Qjf�f} % Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains ' Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct -Ventilating 5,..fpl Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. iCBO # Heating System & Ducting ❑ o -i oo,000 B TU ❑ 100,000 BT Reinspection Fee I $15 CMF 0665-46, rev. 10/B4 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 5b37 6/25/85 Zone Accessory Building: Parking Req./Provided ye25 PLUMBING FEES ELECTRICAL FEES Showers Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Sewer Cap Sewer Connection MECHANICAL FEES Cooking Unit Meter ❑up to 100 amps Solar Collectors Dishwasher Meter Dover 100 amps Solar Piping Solar Tank Date Date Dat z Dryers ❑Gas ❑Electric Fan Sub Panel Motors ❑0.1 HP E-11% - S Swimming Pool w/Spa F.A.U. inc. Solar 119.15 HP 1318.15+ Urinal SM1P $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ ZS Fixtures Microwave Water Closet Device Boxes Pole Light Water Heater Registers Outlets Range Water Service Switches Sign Auto -Wash Laundry Trays Garbage Disposal Generator 00.5 KW 05-15 KW ; Standing Sections Trash Compactor Z O N I N G R E Q M T S Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Hood or Type I ' ElDEVELOPMENT Canopy Type 11 ❑ SERVICES Zoning Approved By Building Approved By Application Issued By REOUIREMENTS: Date Date Dat z Refrigeration System E]0.100,000BTU 0100,000 BTU scc BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ 5 $ $ $ SM1P $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ ZS System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 1/ CONSTRUCTION AND PLANNING APPROVALS Permit # Date l Inspector POOL a SPA APPROVALS Permit # Date Inspector I., Temporar-y Electrical Service or Pole' 52. Pool & Equipment Location 2. Soil•Pipe-Undrgrnd, �• , 53. Steel Reinforcement 3. Electrlcal QonduitlUlility-Undrgrnd. 54. Forms , 4. Electrical Conduit-Undrgrnd. �.' F 1 55. Electrical Bonding .r' 5. Steel tiReinfoGcgrrfent 56. Rough Plumbing & Pressure Test '' '• 6. Electrical 'VFER;Grrid. ; 57. APPROVAL TO COVER-GUNITE �l 7. Footings ,� 58. Electrical Conduit-Undrgrnd. 8. Foundation t 59. Gas Pipe, ❑ Undrgrnd., Test " 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, C] Undrgrnd. ! ' 10. Str`ucfural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line ,.& House Connection 62. Backwash & Receptor -Final 12. Sew" 6r,C0 63. Heater & Vent -Final 13. Rdof Drajns `a' 64. Plumbing System - Final 14. Rough f iumbing 65. Electrical -Final 15. Rough Electrical -Conduit c 66. Solar System -Final J 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 20. -Rough Factory Fireplace FIRE DEPT. REQUIREMENT APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydra 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas []Oil 25, Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ,51. CERTIFICATE OF OCCUPANCY No, Date Applicant to fill in all spaces except th a within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT P MI - L 1/NO. TRACT NO. LOT NO. UNIT NO. d•�� Prcy.at A&ress TM c �� rO r A+pplicant's MailinAddress TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR g Owner's Name2-(_IUVWSrftr1T 't QPhone:&_f Address A52I 15I Rc k[ ,f?:[. WeW f' IKr BEACT�_ Arch/Eng. R.L. SoeA AW —License No. Address I Ylcc2QL-AKE E 68'k, Contractor's Nam Phone Address (mailing) City License No. LICENSED CONTRACTOR D L RAT I hereby affirm that tam license under v ons of Charter 9 (commencing with section 7000) of Division oft a Busl ass and Professions Code, and my license is in full force and of ect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a Certificate of Workers' Compensation Insurance, or a certified. copy thereof (Section 3800, Lab. C.) Policy No. Company • eCertified copy is hereby furnished. Certified co y € lied with the cityu€Iding Orion. Date Applicant ��1', �•'� P_Z_ E EXM ION FROM WORKERS' CO4IPENSATION DECLARATION ' (Thissection need not be completed €tr4he permit is for one hundred (5100) or less). I certify that in the performance of the work for which this permit is Issued I shall not employ any person In any manner so to become subject to tyre Workers' a s ofti`Laws of Cal into. Date G Signature =_'� NOT.IC : If, after making this di Ion, you Should become subject to the Workers' Compensation provisions f the Labor Code, you must forthwith comply with' such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there iia construction lending agency for the porformance of the work for which this permit Is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he%she is licensed'pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit. subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or Offered for sale (Section 7044, Business and Professional Code: The Contractor's License taw does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not Intended or offered for Sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contract$ for Such projects with a con- tractor(s1 license pursuant'to'the 'Contra ctor's License Law). I am aware that proof o their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I. hereby certify that I have lea it applicatiOn and state that the above information is correct. I agree t0 comply with all city and county ordinances and state law$ relating to building construction, and hereby authorize repre- sentatives of this City toer upon the above-mentioned property for inspection P oses. ur/ rte Signate Date Drivers' LI se or 55 v ❑ CONVERSION ❑ DEMOLISH ❑ OTH DESCRIPTION OF WORK/USE OF BLDG. TYPE OF PERMIT EJ GRADING 0 FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ IOTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY -Z CONSTRUCTION TYPE �'�� —VALUATIONS UCCO ZONE GRADING CU. VOS. _'ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap' Roof Drains. Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO + Heating System & Ducting E36-1 00,000 BTU Ell 00,000 BT' Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor e► 2 PLUMBING 1 Showers Service Sink Sewer Cep - Sewer Connection Solar Collectors Solar Piping Solar Tarik Swimming Pool w/Spa Urinal ' - Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type I ' ❑ Canopy Type 11 ❑ Refrigeration System 00.100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEI $ 3 FEES $ 3 L625 6/13/95' 07oG, A.P. # 7— O ✓r — Zone SUMMARY QE FEES S Main Building: Accessary Building: PLAN CHECK $ E T Front $ ISSUANCE Z. O B A Rear ELECTRICAL $ N I C Right MICROFILM MECHANICAL N 5I Left $ G R" Ping.'Ref. # Parking Req./Provide+ 3L?0 E Planning Notes: M T S ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter Clover 100 amps - - Dryers ❑Gas ❑Electric Sub Panel FanMotors , 00-11HP ❑1l5 - B F.A.U. Inc. Solar 09.15 HP ❑16.15+r Fixtures Microwave Device Boxes Outlets Pole Light Range Switches Sign Garbage Disposal ; Standing Sections Generator 00.5 KW 05.15 KW Trash Compactor , f Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By ' $ $ $ s SUMMARY QE FEES BUILDING PERMIT $ �(�� SM1P PLAN CHECK $ PERMIT ' PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.0 ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL S TOTAL FEE PLAN CHECK 25% $ $ $ $ s CgNSTRUCTION AND -PLANNING , JPPROVALS Permit # Date Inspector POOL & SPA 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 15. 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 9. Water Pipe-Undrgrnd. 60, Backwash Lines, P -Trap, ❑ Undrgrnd. 10. -Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof. Drains 64. Plumbing System - Final 14, Rough Plumbing 65, Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17, Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank [--)Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoot 7�Y� 75. Dry Chemical '27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. 'Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 36. 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 GIs Co 51. CERTIFICATE OF OCCUPANCY No. - Date ' koDRIss Gp BatoING: '111 W 17TH ST UNIT: D2/ gIyNERs NAME til: fOAOWYI• HAN S ON , MARK- 711 ARK- 711 W 17TH ST #D2 COSTA MESA,CA 92626 957-9304 APPL . UNLM ADDRE54: ,utc ff,GR,mm,,R JULIE CHAMBERLAIN LNGND.: C22332 iulaL OR ENa's AODREss: 2647 WESTMINSTER DR UNL- C A 92627 C.M. CONTRACTORS NAME. CONTRACTORS MAILING ADDRESS INC. N0. UNIT: LICENSED CONTRACTORS DECLARATION: I Im ahoy rdlirm under penally of perjury that I son Toerned under provisions of Chapter 9 (commenpng wilh Section 7000) d Dirison 3 of the Business and Prdessions Code, and my lke se is in full lace end e/bd. CITY LIC. NO.: LIC. cuss: LIC. NO.: EXP: Date: I Corergdon OWNER BUILDER DECLARATION: I hereby sthm+ under penary d perjury that I am exempt from the Contractors Lioense Law for the following noun (Section 70315 mss Bus and ProfessionsCade: Any city or county which requires a permit to construct, after, improve. demolish. or repair any structure. prior to its issusnoe, also requires the applicant for such permit to fila a signed swarnord that he or she is licensed pursuant to the provision of the Contractors License Law (Chapter 9 (commencing with Sefton 7000) of Division 3 of the Business and Professions Code] or that he or ndm is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant la a permit subjects the apptiard to a civil penalty of not more than five hundred dollars ISSWD. Q I, as owner of IM property arty emyloyeea MIN wages se their sob compensation, will do the work, and the structure is n0l intended or offered for sale (Section 7044, Businees and Professions Code: The Collnadors License Law does not apply to an 'owner of properly who builds or improves thereon. and who does such work himself or bersel or through his or her own employees, provided thin such improvements are not intended or offered for eels, H, howevw, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving he or she did not build or improve for the purpose of sale). I. as owner of the properly, am exclusively oordrwing with krensed conbaclon to mytruci IM project (Section 7044, Business and Prolessione Cade: The Contractor License Law does nor appy to an owner of property who builds or Improves thereon and who omiram for such ptojeda with a corarador(s) Iomrsedpumuyd to the Cont License Law). I am exempt under Section: B, h P. P7 far p Tfor-d orysmiction or moddc�i0n [ran the Aieragenmend District. Remderdid aarSYntdon mppirelione ora aremq Inas phase prawglory. Oete: Appikort: WORKER'S COMPENSATION DECLARATION: I hereby affirm under peaky of perjury one of the hilowmi; asderetions: I have and will mavdsir a rxrldrete d oorswd to selviniture for waken' mrtrpeesaton. as provided for by section 3700 of the Labor I Code. for the performance, Of the work for which this Perna is issued. r Q I have and will meimm wrorksm' oo mpermat6n "vsuren0e. as required by Sadie+ 3700 of the Labe Code, for the pafdmance of the work for which this permit is sued. My workers' cornpenation insurance wrier and policy number ere: Carver: • P06W Number. This section red not be a'mplersd I the perm is for afro kodned donors 1$1001 or lsss.) I comfy that in the perforrTtar" of the work for whin this permit is issued. i $hep nol employ arty person in any mmwer so as to became srnbjed to the waken' mnpenswion Tawe d California, and That I I shadd bacons subjed to the workers` compensation provisory of Section 3700 or the Labor Code, 1 shall forthwith com* with those Provisions. Data: APplicsrd: Warning: FrYun to Oscura workers' ConWdr=don sorrels Is unh n'A ane shell subloct m employer to cd t nW penaMOR ane dv9 lines res to one hundred thousand dollars IS101% OWA In addldon to the Cwt of connponeallorq doges es provldsd roll In seclfon 7106 of the Labor Cada, Intimal, and arforney s fees, CONSTRUCTION LENDING AGENCY: I hereby affirm unger penally of perjury that there is a construction lending agency for the performance of the work for which the permit is issued (Sedion 3097, Civ, C), LENDER'S NAME: LENDER'S ADDRESS: I certify That I have read this application and state that the abrrye intonmetion is coned. I agree to comply with all dry and county ordinances end state taws mtating to building construction and hereby eudlwrize repeearuativen d this city to order upon the sbove•mentoned Properly for inspectionPurp"a"ROBERT MORALICE Date: a- 12.-7A (5151e6.WP) WhOa_Buid'ng 6 Safely; GnserFlp; Canary-ApplcaM: Pink4lavenue; Goldenrod -Assessor CITY OF COSTA MESA — BUILDING PERMIT (�v PERM NO:_E 086933 PERMIT NO: E 086933 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V IHR PERMIT TYPE: ELE PURPOSE: ALT JOB DESCRIPTION : RELOCATE STAIRWAY,,UPGRADE H.C. RESTROOM SQ FT: CLAIM VALUE: CALC--VALUE: GROUP OCC: B / COMMENTS: REF:B-86410 ��jk*��irt�(-*�**��*�En1EiEiP��k'IE�F�E�E�En1En1En1En1EnlEjk�E�E��En1En1En1E��E�EiE�E��E�***��rEjk*jk�*�?fdEdE'11-'1I-♦F1E*♦FiEiE�*iEiE•;E�EiE� Z O N I N G R E Q U I R E M E N T S S E T S A C K S ------------- MAIN BUILDING ----------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 00000000 ZNE: REF NO: PLANNING NOTES> � * elk � elk �(-'!� � �(- dE dE 91- dE 91- jk * # iE �E � �(- i(• �(- iE• * * dE � iE iE iE iE• �(- dE * � * in it iE iF �(- �1E � elk * �1E elk iE• dE'JE dE'JE �E fI- 3E'!� �E'1I-'1I- iE �(- � �(- � �1E �(-'!� � iF � �t it- �1E �t 9E '11- iE D E V E L O P M E N T S E RV I C E S R E Q U I R E M E N T S ZONING APPROVED BY a DATE: BUILDING APPROVED BY * DATE: APPLICATION ISSUED BY: DATE: LEGALIZATION:N F E E,'S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 169,25 50% SMIP/NON—RES PLAN ISSUE FEE 22-,00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS-----> 169.25 22,00 0,00 191.25 191.25 .00 r REVENUE DIVISION TOTALS--> COLLECTED: 191.25 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 191.25 n iE•iEiEiEiEirt*�t��?f��E'1I-iEiEiEiEf{iEiE34?f�*��a! 3F'1I-iFihirtirtirt�E'11-��******#11-'11-iEfl-�EiEit-iEiEii�iF��1E�iEiE�t��iFit-1E�t�*��*iE I N D I V I D U A L F E E B R E A K D O W N A TYPE QTY D E S C R I P T I O N= UNIT COST TOTAL COST P , ELE 20 FIXTURES, LIGHTING 1;'ST 20 EA. 1.00 20,00 ELE 21 FIXTURES, LIGHTING ADDITIONAL EA. ,65 13.65 ELE 20 RECEPT/OUTLET 1,ST 20 EA, 1.00 20.00 ELE 43 RECEPT/OUTLET ADDITIONAL EA. .65 27,95 ELE 20 RECEPT/SWITCH 14,ST 20 EA. 1,00 20,00 ELE 16 RECEPT/SWITCH •P,DDITIONAL EA. .65 10.40 ELE 2 NON—RES APPLIANCE NO'T-,OVER 1.0 HP 4.25 8,50 ELE 3 SUB --PANEL ) r . 16.25 02-12-1998/01-67 PAA 193 5 END OF FEES RCPTN:91-0819584 PERMIT :086933 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector. POOL cdSPA .) 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 S. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8, Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof grains 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, POO USPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22.. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd, Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling {Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power Meter -Final 33, Final Electric jj L�1� {{EE ^ FOOD CERTIFICATE ISSUED/ o s: ��%%CC 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Pactory 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 , r 46. Handicap Regulations 3• Y" 47, FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50, Gas Release to Southern California Gas Co t 51. CERTIFICATE OF OCCUPANCY No. Date ` J ADDRFSS of BMLDM: 711 W 17TH ST OMRIERSIIAMEIF10101 N: HANSON, MARK W 17TH ST #D2 COSTA MESA,CA 92626 957-9304 APPL. MAILDID ADDRM' ARCIInooltBi30OfA. JULIE CHAMBERLAIN AIICILoRENa'sAL711Rm 2647 WESTMINSTER DR C. M. ownUCTOR11 NME' CONTRACTORS MALIlIG ADDRM, UNIT: D2/3 S -P LItw: C22332 UW.. CA 92627 Lir. No: YNR: LICENSED CONTRACTORS DECLARATION: I hereby affirm under penalty of perjury that I am licensed under provisions Of Chapter 9 (oommenncig with Section 7DOO) d Division 3 Of the Business and Professions Code. and my lipase is in Id fame and effect. CITY LIC. NO.: LIC. CUSS; LIC. NO.: EXP Date: ._. Condrartor. OWNER BUILDER DECLARATION: I hereby/ affirm under penalty of perjury that I an exempt from the Contractors Lim nse Lew for the following reason (Suction 7031.5 Business and Professions Code: Any city or county which requires a permit to mtatnrd, alter, improve, demolish, or repair any structure, prim to hs issuance, also requires the applicerd for such permit to Rb a signed statement that he or She is lioensed pursuant 10 the provisions of the Contradors License Lew (Chapter 9 (commencing with Section 7100) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant lir a permit subjects the applicant 10 a aril penalty of not more than five hundred dollars (0001). 1, as owner of the properly or my employees with wages as their sole compermtion, will do the work, and the structure is not intended or offered For We (Section 7044, Business and Professions Cade: The Contractors License Law does no apply to an owner of property who builds or improves thereon. and rano does such work himeg or herself or through his or her own employees. provided that such improvements are not imerded or offered for sale. 6, however, the building or inprmvernart is Sold within One year of completion. the � f owmhewn the ilder will hthe burden d prDvu g he or she did not build wPwe imofor the purpose d sale). !� 1, as owner of the property, am exausrrely contreding with licensed contractors to oordl ua the Ptmjed (Section 7014, Business and P Code: The Contractors License Lew does no apply to an owner of property rano builds or improves thereon and who such projects with a mrtractor(s) licensed pursued to the Cat L.owl" Lew). an exemSection: B. & P.C.. for n: r a: — t r Cl Owns. der tertdy that I am aware of and understand the regcdnmsrss Of Catfmnia Haan and Safety Code Sections 25505, 25573, and that I or any future building o0wpe ll will f will not (reale aro) need to comply with said stets codes and the rsenmemerm for et forocrstnxbon or modification from IhsA: y anaganem District. Residential Omuslruaion Appiratiorsars mempt from Ihme bate: Applicant: WORKER'S COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the trtlowing dederatus: I here and wig meimen a coakale of oo tom to soir-insure for workers' mxnpansetion, as provided For by Section 3700 of the Labor Code, la the performance of the work for which this permit is issued. I haw and will maintain workers' oompenseticn insurance, as required by Section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. My workans' oompensation insurance ramie and policy number are: Cartier: Pricy Number: (This sedion need not be completed 7 the pwmtot is for one hundred dollars [$1001 or I®.7 I canny that in the performance of the work for which this pemmil is issued. I shalt not employ any person in any manner so as to become abject to the workers' compensation laws of California, and agree that 9 1 should became subject to she wmrkana' compensation provisions of Section 3700 of the Labor Code, I shag forthwith comply with time pvvisicu Date: Applicant: Warning: fagun m secure wipers' comprtsatian coverage la unfartld, and shelf subject an empf"sr to cffnnfnsf prwltisa and drfl 11nss rip to crw hundred thotfsatn doflas (SIC4000k M eddfdan 10 trove coat of eorrpansatfen, demep se As prvvfdsd for In Section 3706 of dw Labor Code, Interest and afforrwl''s fess. CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that then is e construction lending agency for the performance of the work for whidr the permit is issued (Section 3097, Civ. C). LENDER'S NAME LENDER'S ADDRESS: I certify [het I hew trod this apptieatimn and state Chet the above infamnation is oorrea. I agree to corrPly with a9 city and omaty o diwnose and state taws relating to WWnp construction and hereby suckme representatives of this city to eater upon the above-mentioned property farnaQed'onp`rp0's''ROBERT MORALICE Date: 2 — + (5151�O.WP) Whir sty', Gr—,file; ; Pink-Flevenuue; Ootlenrod-Asseasor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 086934 PERMIT NO: M 086934 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V IHR PERMIT TYPE: MEC PURPOSE: ALT JOB DESCRIPTION RELOCATE STAIRWAY, UPGRADE H.C. RESTROOM SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: B I COMMENTS: REF:B-86410 iF �E * iE �c �E iE � ii jE � jE jE ifr * * -)fr i4 * -IE i'E iE iE iE )tr * �c'lE iE * * � t � )fr'IF iE iE iE iE iE iE itr itr iE -)1r qtr )tr )tr dE �4 d4 iE d4'IE'IE'IE �c'lE'lE'lE -F; # jE )fr i4 * jE iE i4 iE iE iE � � iE �E iE �E Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ----------- ---------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ• PROV: PARCEL: 00000000 ZNE: REF NO: PLANNING N TES> s z � # * * iE is iE * iE is )tr iE iF iF iF �E iE -IE iE iE �{ dE � �F �E iE iE iE * iE )fr * � * iE � iE iE it: !E iE sE iE Ii iE * * * * iE iE iE jE iE iE iE iE iE # jE sE �E � � iE sE dE jE iE iE qtr )tr �E iF iF iF ?E * � iF D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: rB_UILDING APPROVED BY A DATE: _ APPLICATION ISSUED BY: 3 DATE: 3t�E�t*�t*�E►f►f�E►f►fWit LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEvMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 45.00 25% SMIP/NON—RES PLAN ISSUE FEE 22.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 45,00 22.00 0.00 67.00 67,00 r00 REVENUE DIVISION TOTALS--> COLLECTED: 67,00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK •.67.00 sEiiiE9EjEjE*jE9E*iEi<i4*-1fr�F**}FiEiEiEiEiE*�iF*�*iFiFiE#iE�iEitiE�4iE)triEiE�E�EiF�EiFiEiE*iEiEiF**�*�***�**iF****iEjEiFitifr3434}'r I N D I V I D U A L -I: F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST MEC 2 INST FORC—AIR/GRAY-FURN <= 100 K BTU 13.25 26,50 MEC 1 GAS PIPING SYS 1 — A\ OUTLETS 5.50 5.50 MEC 2 VENTILATION FAN CONN TO SINGLE DUCT 6.50 13.00 END OF FEES 82-12-1498/81:86 Ph/167.89 - t RCPT8:91-8819683 PERMIT=086934 CONSTRUCTION AND PLANNING !APPROVALS Permit # Date �' Inspector POOL & SPA APPROVALS Permit # Date inspector ITemporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54, Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test ' 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 56. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, Q Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60, Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64, Plumbing System - Final 14, Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67, Fencing & Access Approval 17, Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Etectricat•T Bar Ceiling 69. POOUSPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning pQ, O'[6 N FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas © Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24- hoof Framing 73. Undergrnd. Storage Tank ❑ Gas 00R 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling f Structura0 & Monocoat 75. Dry Chemical 27. Frame and Flashing 76, Dry Standpipe 28, Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78, FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 60. FOOD CERTIFICATE ISSUED 33, Final Electric NoteA-Jg W RvjG_H OK (�L �\ �J!Y 34. Final Heating & Air Conditioning (( I V 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Weter 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. FINAL PLANNING 49. Electric Release to Edison --- - '} 50. Gas Release to Southern California Gas Ca 51. CgRTIFICATE OF OCCUPANCY No Date ADDRESS OF BWLWa0: 711 W 17TH ST waT: MMMSNAMElF10IDlfIt HANSON, MARK ,_.,,=ms:711 W 17TH ST #D2 COSTA MESA,CA, 92626 957-9304 APPL. HELM AODRE9S: I ARCRITECTOREMMIl:JULIE CHAMBERLAIN ur-No.: C22332 ARCILORENO'1ADDRESS: 2647 WESTMI19STER DR UNIT: C.M. CA 92627 CONTRACTORS NAME: CONTRACTOR'S MAIiM ADORES& LIC. NO_ UNIT: LICENSED CONTRACTORS DECLARATION; I hereby affnn uridm penalty of perjury that I am licensed under Provisons of Chapter 9 (eemmendrq with Swoon 7000) d Division 3 of the Broinase and Professions Code. and my Icmase is in he force and effect. CRY LIC. NO.: LIC. CLASS: ` LIC. NO.: EXP: Dais: Contntdor: OWNER BUILDER DECLARATION: I hereby affirm under penalty of perjury that I an exempt Iran The Contractors License Law for the ldlowing reason (Sedion 70914 Business and Profesaom (,oda: Any city or onunry which requires a permit to mrssauct, alter, improve, demolish, or repair any Stnrlun. Prior lo its isauartce. also MgoinIS the appinant for such permit to fib lei a SOM eerneru that he or she I ficensed pursuart to the prwmons d the Coraredom License Law [Chapter 9 (commarrana with Sedition 7000) of Division 3 of ft iusiness and Prolassions Cade] or that he or she is exempt thereftm and the basis for the a0sged exemption. Ani violation of Section 7091.5 by any applicant for a permit subjects the applicant to a did penalty d not mon than five Modred doltite [S600D. I, as owner d the property ol my empbyesa wish wages as their sale compensation, will do the work, and tie ebucture is not intended or offered far sale (Section 7041. Bmness and Prolaasi We Cods: The Contractors License Law does not apply to on owner of property wM buddy or improves thereon. and who does such work himself or Meal or through he or her own employees, provided that such imtwwarnam are not intended ordfrad for sale. If, hoverer, the building or improvemrd is sold within oro year of completion. the X owner -builder will have the burden of Pnirinp he Or Sha did not build or improve for the purpose of C] I, as owner of the property. am esdusively cootnadig with fiormed contact= to oorhaacb the project (Section 7041. Business end Professions Code: The Cowradore License Law does not apply to an owner of property who buildsoe improves thereon and who contracts lor such projects with a oonIM010r(e) licensed pursuard to IM Contract= Liceme Law[. fAzi 1 eon exempt under Section: B. a P,C., for th n: r D Owns do ereby tertay the I am aware d and undentad the requrirermtrds d California Heath and Safety Coda Sediom 25505, 25513. aha 2 .and that 1 or arty future buildirvg cocuPars will 1 will nra (drek oma) need to Ownpy wish said state codes and the requmenhents for perms for ronstnnaion w nhuddhcatim frim lM A:�iy la'ar agar,hera acrid. fsesiderrw corhatreaion ai m.e exempt halm tress provisions. Dere: APpGram: WORKER'S COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the Following dedend'ons: E] I have and will maintain a certificated consent to selfdfisure lor workers' compensation, as provided for by Section 3700of the Labor Cade, for the perfomhwra of the work for which This Puma in issued. I have and willmaintain workers' cornpensaion insurant e, as required by Section 3700 d the Lebo Coda, loriM perlarmance d tM wort for which this perms is issued. My workme' compensation insurance terrier and policy number era: Cartier: Polly Number. .his sectkc nand nor be ccmrplefed T Ow perms is !a one hundred dollars 111001 or fees.) I candy that in the performance d the wart lax which this permit is issued. I shell not employ any person in any me veer e0 m to become su*d to the workers' Compensation laws of California, and agree that 4 1 should become subject to tM worlmro' comprm dio n provisions d Section 3700 of IM Labor Code, I shall forthwith comply with those provickmhs. Dde: APPtrant: WernkW; F'affure to secure workars' compensadon coverage Is unhwhd, and shall slbJaet an employer to edinlrnl porkies and Civil renes up to ons hundred theusard dollars (110gflOpI le addldon to Ma cost of cnmpermllort damaDas as provldad for In 9aodon 3706 of Me Labor Code, Intens[, and attomsy's laax CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that then is a construction larding agency for the periomarm of the wok ler which thiw permit is issued (Segion 3097, Civ. CJ. LENDER'S NAME: LENDER'S ADDRESS: I codify Ihd I have read Dios application and ride that the above cdormdion is coned. t apse to oompy with all coy and County ordinances and nude laws rending to building construction aid hmaby authorize aprearhtaiivm of this cry to mala upon the above-mentioned prop" rw unspedon "!`pose$' ROBERT MORAL I C E I: Data: 2-/Z-96; 1St 5 ides WPI Wha dine A afaty: OreenFle: Canarvalmirar - Pink -Revenue: Goldenrod -Assessor CITY OF COSTA MESA - BUILDING PERMIT PERM NO: P 086935 PERMIT NO: P 086935 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V IHR PERMIT TYPE: PLU PURPOSE: ALT JOB DESCRIPTION : RELOCATE STAIRWAY, UPGRADE H.C. RESTROOM SQ FT: CLAIM VALUE: CALC-VALUE: GROUP OCC: B / COMMENTS: REF:B-86410 ��i#**��itf34�i##��##�itf�if�?L�*��F��i4iKi4��FiK*14i'FiK94?fi4�i4*}F}F��F�EitiQ�-Ki�iF#iClt?f**->fill--)E1E-)f)E)EiEdE*iE#EjE*�E�E�E Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RIGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 00000000 ZNE: REF NO: PLANNING NOTES> PLAN ISSUE FEE 22.00 > BUILDING -DIV-> PERMIT ISSUE PL;pN-CHECK TOTAL PAID DUE iE iF * )E iE iE iE iE iE iE * iE iF � iF * iE -lF ?f air- ill- * it• �F iE dE -k dE �E 1E �E �E ill- � * * * * * ?f ?f * ?f 1E �E �E �F dE 3E ->F 3F * jE ifs iE * iE jE � * iE iE iE jE -1r iE 3E iE je iE iE �F dE dE dE � * * iE D E V E L O P M E N T S E R V I C E S •-R E Q U I R E M£ N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY APPLICATION ISSUED BY: DATE: DATE: n * * * * * �F iE * iE iF iE iF * if i4 if iE iE iE iF if #E iF iF iE iE � jE• -If iE 3E -?f; � � iE iE LEGALIZATION:N F E E S U M M A R Y STRUCTURAL 3EGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 61.25 251 SMIP/NON-RES PLAN ISSUE FEE 22.00 BUILDING -DIV-> PERMIT ISSUE PL;pN-CHECK TOTAL PAID DUE TOTALS ---- > 61.25 22,00 , 0.00 83.25 83.25 .00 REVENUE DIVISION TOTALS--> COLLECTED: 83.25 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 83.25 iE iE iE iE )F * iE iE � iE )E iE iE dE �E iE * * � � iE #E 3� �F dE #E ?f in iE iF iE iE iE iE iE{iE iE iE iF fF iE iE iE jE iE iE -lE iE fF iE iE iF iE �E iE �F iE dE if iF 3E iE �E iE iE iF iE iE iE it it ik'1E iE iE 3� dE iE irk I N D I V I D U A LT( F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLU 1 DISHWASHER 8.75 8.75 PLU 1 SINK, KITCHEN - 8,75 8.75 PLU 3 WASH BASIN 8.75 26.25 PLU 2 WATER CLOSET (TOILET) 8.75 17.50 END OF FEES _ 82-12-1999/01:07 Pr/$83.25 h' PERPI I TFrB869355 CONSTRUCTION AND PLANNING APPROVALS Permit # Date n - Inspectgr. j POOL IPA '' APPROVALS Permit # Date Inspector i 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57, APPROVAL TO COVER-GUNITE 7. Footings 58, Electrical Conduit-Undrgrnd. 8. Foundation 59, Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe•Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10, Structural Floor System 61. APPROVAL TO. DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13, Roof Drains 64. Plumbing System : Final 14. Rough Plumbing G[��p• 65. Electrical -Final 66. Solar System -Final 15. Rough Electrical -Conduit 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68, APPROVED FOR PLASTERING 18, Rough Electrical -T Bar Ceiling 69, POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24• Roof Framing 73. Undergrnd. Storage Tank [:]Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75, Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29, Insulation 78, FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric 34. Final Heating & Air Conditioning Notes: a_t.$ 35, Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow irrigation 44, Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING r 46. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ADDRESS OF BUILDING: 7 1 1 W 17TH ST MNEFrsHUE IFwow. HANSON MARK ADDREss: 711 W 17TH ST #D2 COSTA MESA,CA 92626 957-9304 APPL. MWLIW3 AMES&- ARCRIrECTOREMINEER:JULIE CHAMBERLAIN ARCN.oil uwsADDRESS: 2647 WESTMINSTER DR C.M. Cdli1GCTOFiS UAM CONTRACTOR'S MR= ADDREM UNIT: D 2 / 3 mw C22332 UNIT: CA 92627 Lx NO: UNIT: LICENSED CONTRACTORS DECLARATION: i hereby etfrm under penalty or Perjury 00 1 am licensed under provisla of Chapter B (oommencing with Sector 7000) of Division 3 or The Busvwa and Professors Code, and rrry Goerme in in lull force and of oc, Crry UC. NO.: LIC. CLASS: UC, NO,: EXP ; Date: Cmtraa0r. OWNER BUILDER DECLARATION: 1 hereby affirm ods penalty of perjury that f am axo mpt from the c4"twors I Law for dee Iojo reagon (Sedion 7031.5 Business and PudessiOM COde: Any Cty Or Garry which require a permit 10 0onstruct, ,Ref. Improve. demalah. or repair any skvdure, prior to is uutanhca, abo requ it the appkwd to each perm ID fAe a *Vied steemefd the he or she I lipans. panne, to the praiia of the Caufradws Lyse Lar [Chapter 9 (mmeehmq with Sectoh 7000► of Division 3 of the Amnesa and Prafessans Code] or the he or she is exempt IhseEom and the hem for the akged exemption. Any violation of Section 7(131.5 by entr applicant for a permit subjects the applicant to a elvb penaby at not more than Iva hundred dOBare PwD. ❑ 1, as owner of the property or my employees wih ream as their note mmpermtim, will do the wok and the strWvre is nit Wended or offered for sale (Section 71)", So' -e s and Profeaskm Code: The CaRredws Lioerse Law does not apply loan 6ww of property rho (weds or impwes thwea , and who does such work hiarseB or h omel or trough his or her ors empNlese, provided than ouch "prwernarm ere not iaeided or offered Io, oris. I, however. the buildmD or impitwsnea u sold w &dn ore yes of completion, the V ~w-b.Wor ed have the burden d proving to or she did not build or impeova for the purpose d cele). ljL_, 1. as owner d contracting pup", am exclusively with GM oeed axtra ee�hid p l 10 owhDr aled (Ssfion 7W, &nines, and Prdassioi Code: The Contractors Chores Law does not apply W an ,mer of props" who bolds or frnprwm thereon and who cored, for such with a owasctar(s) rrarrssd pesusa to the Cont License Law) I am exempt under SSeclim: B. B P.C.. (a Date: — S - "/ U Owns: I do hereby certily the 1 am aware of and understand the rwrdiamern of CeWoia' I- on and Sooty Crile Sections 25505. 251,73, and 2swd, and the I or any future bu*ft ommpea,�y anwwilwill/ wnit (t9cla'a e) need m end comply with said state codethe roqum-nerde lot erwulldi e pnd for co0n or woddiceb tion on the A,egemera Dotrhx. Reidwr W u>omuuciom eppieetkne afe ekemlrl ham theca prOvamm. Data: APprCent: WORKER'S COMPENSATION DECLARATION: I hereby offs m under penalty of perhay one of the k4owng dodaretam: ❑ 1 have and oil meitan a cendeat s of are -r to seltinava lor woikrs' oenp ronin, a provided for by Secim 3700 of the Labor Code, for fns performance of the work for which this pend is issued. I haw and will mei tw n waters' compese0un Insurance. as reiyu>bsd by Section 9700 of De Labor Code. for the Performance d the work torwhich Dia permit is usual. My workars' ampmseon ins r orriw and porwy mwnbw -s: canner: Policy Number, Ti's section need nil be Cannon d I the permf w Ar ore Isaiisd dof5n IS1001 orle,sj I coney that in Ow prformence d the oak for which this pemm Is issued, I stied not employ any pam n any roamer eo as to become subject to the wxrtrere' campersation Laws of Catdamia. and arse the 0 1 Sneed bowme nApd to the rakm,' mnpo sdion previsiorw of Section 3703 of the Labor Code. f shall forthwith comply w9h thcee pwisim Date: AppGrm: Warning: Fadww t0 "M" Wo+frera' =npensaffon corers* la u nbwA4 end ahr7/ tr ibfi cf an to ployr ro a4rlfn l Peru &= and CIV/1 fir" ry to one Modred Owusanhd deflans (ftg(l,000l In o"Clan to rite cost of cornponsatbn dsrnogsn as prorfdsd for In Section 97M of Me Labor Coder Interest and efforney's fees, CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of porhay that there he a connruwlon Iendbq arrc7 Im the performance of the work for which this panni n i,susd (Section 3087. Civ, c). LENDER'S NAME: LENDER'S ADORES& I cw* that I have read this appficaben and Rate that pe above Wormation is rwrrsd. I agree to comply whh a0 nm7 and owmty ordinarieee and surae Laws relating b bu ildiq consgunion and hereby authorize mprnsnlaiim of this dry to enter upon the above-meaioned Property for inspection purposes. OB ERT MORAL I C E Print _ / Dale: ! r� Signature of OwnerfAgwWAppicwvContrwtor (5151-4e.WP) Whhe-Builft a Safety: Green -File: Conry-Applicard; Pink -Revenue: Goldenrod -Assessor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: B 086410 PLAN CHECK NO: 05260-97 A CONSTRUCTION TYPE: V IHR PERMIT TYPE: STR �J-�' - a-0 2 - PERM NO: B 086410 GOVT: N SUPP: N PURPOSE: ALT JOB DESCRIPTION RELOCATE STAIRWAY, UPGRADE H.C. RESTROOM SQ FT: 3,000 CLAIM VALUE: 30,000.00 CALL—VALUE: 40,380.00 GROUP OCC: B / COMMENTS: RELOCATE WALLS FOR MISC OFFICE TI TO COMBINE UNITS D2 & D3 iNiN#E#EdkiNdkdkdkdkdkdkiN#EiNiN#Eck#E♦EiNiNiN��♦E♦E♦E♦E♦Ei6'�*****jE#Ei6i6i6iNdkiN#EiN#E��if�if**i6 i6iNdk#E♦E��E�Ei(�i(i6i6�E Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------- MAIN, BUILDING ------------ --------- ACCESSORY BUILDING---------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 00000000 ZNE: MG REF NO: PLANNING NOTES> INTERIOR ALTERATION TO COMBINE TWO SUITES FOR AN AUTHOR. '16'16 96 96 96 96 96 96 96 96 96 9E 96 9E 9E 96 96 96 96 9E � 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 * * 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 * * 9E 96 96 9E 96 96 96 96 96 96 96 96 96 D E V E L O PiM E N T S E R V I C E S R E Q U I R E M E N T.S ZONING APPROVED BY DATE: [ G}� BUILDING APPROVED BY ��; DATE: APPLICATION ISSUED'BYE: _ DATE: 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 i6 96 96 96'16 96� ��96 96 96 9E i6 96 96 96 96 96 96 96 LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 493.75 PLAN 80.24 •' 8,48 ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS-----> 502.23 0.00 80.24 582.47 582,47 .00 REVENUE DIVISION TOTALS--> COLtECTED: 502.23 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 493,75 ! 8.48 96 96 9E 9E 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 9E 9E 9E 9E 996 9696 96 96 9E 96 96 96 96 96 96 96 9696 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 9E 96 96 96 96 96 96 96 96 96 96 96 96 96 9E I N D I V I D U A L,; F E E B R E A K D O W N TYPE QTY D E S C R I P T I O"N UNIT COST TOTAL COST f SFC 3000 OFF—INT, ALTER TYPE V-1 HOUR —AVER 12.74 38,220.00 SFC 3000 EQU—ALT COMM, AIR COND —AVER ,72 2,160,00 END OF FEES A r l � ' i r i C.10 A MESA _-,0 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL _..iPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location -2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement i 3,_Electrical Copouit Utility-Undrgrnd. 54. Forms - 4. Electrical•Conduit•Undrgrnd. 55, Electrical Bonding �5. Stilet Reinforcement 56. Rough Plumbing & Pressure Test .6: Electrical LIFER Grnd. X, - 57. APPROVAL TO COVER•GUNITE 7. Footings " 58. Electrical Conduit -Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10, Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap - 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing ,, 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 1B. Rough Electrical•T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating &,Air Conditioning 1 1 - - -y Y FIRE DEPT: REOUIREMENT T'7 . � 1 J• Y APPROVALS Peemit # 20. Rough Factory Fireplace �'_ �_ 21. Ducts, in Structure • _ 70. Underground Hydro 22. Ducts, Verttilitind 71. Product -Piping ❑.Gas ❑ Oil 23. Gas Ripe Rough &,;Test 72. Underground Flush 24, Roof Framing _- 73', ,Undergrnd. Storajje Tank ❑ Gas ❑ Oil 25.-Roof•Shebthing - 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Mohocoat 27. Frame and Flashing 0 A 75. Dry Che_r�iCal 76. Dry Standpipe r_ 73,. FIXED'SYSTEM-FINAL ' 28. Lathing & Siding } = `+ - 29. Insulation , .r 78. FIRE PREY. FINAL 30. Drywall Nailing - :'HEALTH DEPT. �EQUIREMENT 31. Plaster 8r6wn�Coat 79. FINAL INSPECTIDN . 32. Electrical Power Meter -Final 33. Final. Electric. 80' FOOD CERTIFICATE I'zSUED r Notes: 34. Final, Heating-& Air Conditioning •C 35. -.Fina[ Gas Pipe -Tess' ;, 7 36. Hood or Canopy 71- 37. Final Factory Fireplace 38. -Final Plumbing -- 39. Water Service -Final - 40. Gas Service -Final--` 41, Solar Domestic -Final 42. Backflow•Preventer. - 43. Backflow Irrigation ;44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap'Regulations - .47, FINAL STRUCTURE & BUILDING - O 48. FINAL PLANNING' 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co -; 51. CERTIFICATE OF OCCUPANCY No. Date CITY. 0,F COSTAyMESA CONSTRUCTION PERMIT ProjettAciclress 1" 17714S,l 6�, /HiC"rJt Applicant's Mailing Address Owner's Name r 2c^� XJ vee —Phone Address Arch/Eng. License No, Address Contractor's Namdn ()kllZ EC. t7R+C Phone Address (mailing) 0F1Cy*65— 1.3 A r-5 i3tc>re.�ti fr�l t�.J 9��/G City License No. .. *3 LICENSED CONTRACTOR DECLARATION - I hereby affirm that I am licensed under provisions of Charter 9 ( mmen cin9 with section 7000) of Division 3 of the sin ss and Pro essi Code, and my license is in f { d eff c . License Class _ License Date - �- _ Signature WORKERS' COMPENSATION DECLARATION ' I hereby affirm that I have a certificate of consent to self -insure or a certificate sf workers' Compensation Insurance, or a certified copy thereof (Section 300, Lab- C) Cr n Policy N42jj� �� I� 7vy i2.G0r� BCertified copy is hereby furnishe . Certified ccopy Uted with the cit Build- vision. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION)6ECLARATION (This section need not be completed if the p(krmIt.is?l5r one hundred ($100) or - less). I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with Such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name, Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for Such permit to file asigned statement that he/she Is licensed pursuant to the provisions of 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 '031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). .© I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale), 1, as owner of the property, am exclusively contracting with licensed con- tractors W construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or.improves thereon, and _who contracts for such projects with a con- tractor(s) license pursuarit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ i am exempt under Section B. 8& P; C. for this reason Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations, PERMIT NO. TRACT NO. LOT NO. UN NO, Date ' Owner — I hereby certify that I have read th information is correc . _ TM to con and State laws g building sentatives of is to enter p Inspectlon p Signature ` Drivers' License or SS =r IF 0865-46, rev. 10/84 White application and state that the above Y wdi0aII city and county ordinances tr n, and hereby authorize repre- above-mentioned property for Date o_ S� 1 ,. TYPE OF CONSTRUCTION Ll NEW ADD ALTERATION r REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. IS Main Building: E TYPE OF PERMIT GRADING ❑ FOUNDATION C1 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE ---,VALUATION$ S I Left ZONE GRADING CU.YDS. ACRES Ping. Ref. Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas SerJice* Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground' Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact• Bit. ICBO �k Heating System & ducting ❑ 0-100,000 BTU ❑ 100,000 BT Reinspection Fee I $15 licant; Pink - Accounting; Goidenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee r IANICAL Hood or Type I • ❑ Canopy Type 11 Refrigeration System ❑0-100,000 BTU 0100,000 BTU 'System Repair/Alteration Fire Dampers Registers Issue Fee FEES 5B47 I/16/B5 Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F,A.U. Fixtures Device Boxes O utlets Switches Garbage Disposal Generator 1:10-5 KW 1:15-15 KW zone Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter Dover 100 amps Sub Panel Motors 90.1 HP ❑ 1 4 • B Inc. Solar 09-15 HP ❑ 16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 4sEW0 TL Z O N N - G R E O M T S FEES $ 3 Reinspection Fee $15 Issue -Fee $ 3 FEES i I DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date !!'' Date BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ �Q� $ 0 $ $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ �S�L $ 3 ` -POO CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector L __ SPA APPROVALS Permit # Date Inspectnr 1. Temporary Electrical Service or Pope i - 1 52. Pool & Equipment Location 2. Soil,Pipe-Undrgrn .}, 7, 53. Steel Reinforcement .13 -,Electrical Conduit:Utility-Undr I d. r a r 1 54. Forms 4aElecirical Conduit Undrgrnd. r 55. Electrical Bonding 5 ,SteelReinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER`Grnd. 57. APPROVAL TO COVER-GUNITE 7,.^Footings 58. Electrical Conduit-Undrgrnd. y 8" Foundation "� " 59. Gas Pipe, ❑ Undrgrnd., Test i1 9. Water Pipe Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10:'Structural Floor System ' 61. APPROVAL TO DECK lit" Property Sewer Line-& House Connection 62. Backwash & Receptor -Final s 127sewer Cap 63. Heater-& Vent -Final , 13. Roof Drains , ; is 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final s 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26, T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30r Drywall Nailing HEALTH DEPT. REQUIREMENT 31Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical power Meter -Final BD- FOOD CERTIFICATE ISSUED 33. Final Electric 12 tC (2.,4 Notes: 34. Final Heating & Air Conditioning 35. Final Gas Npe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer s 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison' .50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - No. Date - Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF gOSTA MESA CONSTRUCTION PERMIT 1f I� Nr PERMiT_UO. TRACT NO. LOT NO. IT NO. . Project Address !i� 61 1 Z7y!9Z: CQiMA M ESA • Applicaht's Mailing Address Owner's N'a'me Phone Address.�� Arch/Eng. L• -Li nse No. Address Contractor's Nam' hone Address (mailinglGrJ LI.- W Dhaj( I LJC .S/lJt �7f` City License No: 21m n LICENSED CONTRACTOR DECLARATION ' I hereby. affirm that I am licensed under provisions of Charter 9 (commenting with section 7000) of Division 3 of the Business and Professions Code, and my license is in �ll force and effect. License it No Date Clas Signature WORKERS' COMPENSATION DEC ATION I hereby affirm that 1 have a certificate of consent to self -insure or a certificate Of Workers' Compensation insurance,- or a Certified copy thereof (Section 3800, Lab. C.) ,7Q .SELE:7i ~ rolicy No. /� ��"-37v Company r - eCertified copy Ii hereby furnished. Datee/ Ie�coP,y,ls,filetl wApplicant ppl can'ty B74d t EXEMPTION FROM WORKERS'COMPVASATION DECLARATION (This section need not be -completed -if the permit is for one hundred ($100) or less). I certify, •that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to tke Workers' Compensation Laws of California.. Date. Signature 'NOTICE: If, after making this declaration, you should. become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there ii a construction lending agency for the performance' of the work for which this permit is issued (Section 3097 Civ. CJ Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor'S.LJcense Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or.repair any structure, prior to Its'lssuance,�also requires the applicant for such permit 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 Division 3 of the Business and Professions Code) Or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Subjects the applicant to a civil enalty of not more than five hundred dollars ($500). . I, as' owner of the property or my employees with wages as their sole .compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion o, the owner will have the burden of proving he/she did not build or im- rve for the purpose of sale). I, as owner of the property, am exciusivety contracting with licensed con- 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 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 proof of their Worker's Compensation insurance should be provided to me. ❑ Tam exempt under Section B. & P. C. for this reason Date Owner I hereby certify that 1. have read this application and state that the above Information is correct, I agree to comply with all city and county ordinances and state laws relating to building Const ction, and hereby authorize repre- sentatives of t c t to ante a e above-mentioned property for inspeCtlon Signature Date Drivers' LicepW or SS :r TYPE OF CONSTRUCTION U NEW LJ ADD LJ ALTERATION LI REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TYPE,OF PERMIT GRADING FOUNDATION STRUCTURAL r# ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER ' PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE -VALUATION $ ZONE GRADINGCU.YDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service •.Outlets Interceptors `. Kitchen Sink ' Lavatories P—Trap Roof Drains i Reinspection Fee _ 1 $15 Boiler Duct - Under Ground ' Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting 00.140,000 BTU 0 100,000 Showers Service Sink Y Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal . - Water Closet Water Heater Water Service Auto -Wash Laundry Trays I Issue Fee MECHANICAL Hood or Type I ❑ Canopy Type II ❑ Refrigeration System ❑0.100,000 BTU El 100,000 BTU ❑ System Repair/Alteration Fire Dampers. Registers 3T - Reinspection Fee I $15 'I I issue Fee CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink-- Accounting; Goldenrod - Assessor FEES A.P. # S Main Building: E T Front B Rear A C Right K S Left Ping. Ref. # Planning Notes: 3735 12/10/84 Zone Accessory Building: /� Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. ! Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures - Device Boxes Outlets Switches Garbage Disposal Generator ❑O.5 KW 05.15 KW Transformer -❑ 15-50 KW ❑ 50 + KIN Meter Oup to 100 amps Meter El over 100 amps Sub Panel Panel :��jA Motors ❑0.1 HP C11 'A -8 Inc. Solar ❑9-15 HP 016 15+ c 7-& 30 TL Pole Light Range Sign Standing Sections Trash Compactor r Z O N 1 N G R E Q M T $ 3 � Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved Sy Building Approved By Application Issued By—Date. REQUIREMENTS:, Date Date BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ l 1� $ a.fo $ $ -- SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ 730 $ 3 {POOL ,CONSTRUCTION AND PLANNING ,APPROVALS Permit # Date Inspector & _. A APPROVALS . Permit # Date Inspecrnr 1. Temporary Electrical Service or Pole 52. Pool &Equipment Location 2: Soil Pipe-Undrgrnd. 53. Steel Reinforcement :',•Electrical Conduit Utility-Undrgrnd. 54. Forms 4. -Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. .Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Gr6d. 57. APPROVAL TO COVE R-GUNITE 7. Footings i 58. Electrical Conduit-Undrgrnd. 8- Foundation - 59. Gas Pipe, ❑ Undrgrnd., Test 9. 'Water Pipe,Undrgrnd.60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10, Structural Floor System 61. APPROVAL TO DECK 11. Property'Sewer Line & House Connection 62. Backwash & Receptor -Final 12.i,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 APPROVALS Permit # ` 20. Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas O Oil 23. Gas Pipe -Rough & Test 72, Underground Flush 24. Roof Framing - 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydra 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76, Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric !J C(+ Notes: 34. Final Heating & Air Conditioning 1 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace - 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final _ 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations , 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date 1411 M Applicant to till In all spaces except those within heavy border lines and sign all appropriate declaration$" CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. Project Address _ 711 W. 17_th St Bldg -_(p) Una_t 4 Applicant's Mailing Address 13110 Saticoy St.'N.Hollywood. Troy-Investment^'549-2988 Owner's Name Fund - _ ----Phone* Phone Address 4321 Birch St. Newport Beach, Ca. �^ Arch/Eng. Marin J. Rock License No. Address 12881 Knott Ave. Saute 216 Contractor's Name Duco Air Conditining Phone 982--1216 Address (mailing)- 13110 Saticoy St. N.Hol.lywood, Ca. City License No. ,3,2925 - LICENSED CONTRACTOR DFCLARATIO14 I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and ofessions Code, and My license is in full force and effect License Class — e $ p. 346251 Date_ 4-4 1 L/8 L�L Signature WORKERS' COMPENSATION DE RATION I hereby affirm that I have a certifilEate of consent to self -insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section 800, Lab. C.) Policy No. WC 824 company Lumbermans BCertified copy is hereby furnished. 7 Certi f d tP, is filed with the city Buil C9.Division. n Date LL Applicant t� EXEMPTION FRAM WORKERS' COMPENSATION OECLA ATIDN (This section need not be completed if the permit Is for one hundred ($100) or less)" I certify that in the performance of the work for which this permit Is Issued I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date _ Signature 'NOTICE: $f, after making this declaration, you should become subject to the Workers' Compensation provisions of the labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction tending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lander's Address OWNER BUILDER t]ECLARATION I hereby affirm that I am exempt from the Contractor's License Law for trio following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for Such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of thfi Business and Professions Code) or that he/she is exempt therefrom 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 .4enalty of not mgre than five hundred dollars ($500). IJ 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License law doe4 not apply to an owner of a property who builds or improves thereon, and whb does Such work himself/hertalf or through his or her own employees, prOvl(jed that such Improvement$ are not intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner wilt have the burden of proving he/she did not build or Im- rove for the purbose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Profession$ Code: The Contractor's License taw does not apply to an owner of property who bullds 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 proof of their Worker's Compensation insurance should be provided to me, 0 I am exempt under Section I B. & P. C. for this reason Date Owner I hereby certify that I have rea Information is correct. I agree to and state qlalatipg to builowsentativescity to e e InspectionSignature Drivers' LSS this application and state that the above omply with all city and county ordinances construction, and hereby authorize repre- upon the above-mentioned prypertYSQL TYPE OF CONSTRUCTION L_I NEW LJ ADD U ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P 46 DESCRIPTION OF WORK/USE OF SLOG. S Main Buildi E TYPE OF PERMIT GRADING 17 FOUNDATIONI STRUCTURAL T Front ❑ TENANT El ELECTRICAL 1:3PLUMBING E} MECHANICAL A Rear ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Right Left CONSTRUCTION TYPE VALUATION S ZONE GRADING CU.YDS. ACRES Ping, Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural puct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact, Bit, ICBO Heating System & ducting 1 X100,000 BTU 0100,000 BT Reinspection Fee f $15 CMF 0865-46, rev. 10/84 White - Building; Canary"- Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Issue Fee MECHANICAL Hood or Type I ❑ Canopy Type 11 ❑ i Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES 1.774 4/24/85 zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW 05-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter Uup to 100 amps Meter Dover 100 amps Sub Panel Motors 00-1 HP ❑1 h - 8 Inc. Solar 09.15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 15,,50 TL Z O N 1 N . G R E Q M T S FEES $ 3 " Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By - --- pat Z SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ _ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ 1 3- 00 TOTAL FEE $ 15-50 PLAN CHECK 25% $ _ 2-50 $ 3 CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POOL __..iPA 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 ;i ' 6• Electrical USER Grnd. ,' f 57. APPROVAL TO COVER-GUNITE fL-� 7. Footings 58. Electrical Conduit-Undrgrnd. 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. �, 60. Backwash Lines, P -Trap, ❑ Undrgrnd. •10• Structural Floor System '- f 61. APPROVAL TO DECK -11. Property Sewer Line & House Con4ction 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 -Fina! ' 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Stdrage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32.- Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbirig 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 CITY OF COSTA MESA CONSTRUCTION PE MIT Project Address Applicant's Mailing Address Owner's Name Phone — Address _ Arch/Eng. License No. Address Contractor's Nam o Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7600) of Division 3 of the Business and Professions Code, and my licenseis in fu11 prce and effect. License Class r — License No,.39 Date��-=� Signatur WORKERS' COMPtrNSATION CWCLARAT10N I hereby affirm that I have a certificate of consent to self4nsure or a certificate ,fWorkers' Compensation Insurance, or a certified copy thereof (Section .800, Lab. C.) Policy No. Company eCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Date_ ._._ - Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit Is for one hundred ($100) or less). 1 certify that in the performance of the work for which this permit is Issued, I shalt not employ any person In any manner so as to become subject to the - Workers' Cam ens ws of California. Date Signature NOTICE: If, atter making this declarati , you Should become subject to the Workers' Compensation provision$ of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 CIv. C.) Lender's Name - - Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason ($ectlon 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 '031.5 by any applicant for a permit subjects the applicant to a civil ,enalty of not more than five hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their sole Corn will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: Tho Contractor's License Law does hot 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 employyees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within one year of Com- pletion, the Owner will have the burden of proving he/she did not build or irrm- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who Contracts for such projects with a,Con. tractor(s) llcense pursuarit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C, for this reason Date Owner I hereby certify that t have read this application and state that the above Information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for s Inspectionpur s- S Signature Date Drivers' Liceh6re or SS = CMF 0865-46, rev. 10/84 Whit I Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service f Outlets Interceptors Kitchen Sink Lavatories P --Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO + Heating System & Ducting 00100,000 BTU ❑ 100,000 BT Reinspection Fee ,1 $15 Cant: Pink -'Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee I $ 3 I �T FEES Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑0100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 ELECTRICAL Automatic Washer Construction Pale Sub. Cooking Unit• Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 005 KW El 5-15 KW Transformer I) 15-50 KW ❑ 50 + KW Meter LJup to 100amps Meter ❑over 100 amps Sub Panel Motors 001 HP 011 ''A - 8 Inc. Solar 09.15 HP E:116-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES I I Reinspection Fee 1 $15 1 1 Issue Fee I $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved ByDate Application Issued By 7 Dat 3 10-50 TL plicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. $ SMIP P MIT NO TRACT NO. LOT NO. UNIT N PLUMBING $ O CONSTRUCTION $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL TYPE OFF C1 NEW LJADD LJ ALTERATION LJ P±PAIR GRADING $ PLAN CHECK 50°% ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. Zone MECHANICAL DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: E Z TYPE OF PERMIT GRADING 0 FOUNDATION LJ STRUCTURAL. T Front O ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B N ❑ A Rear I -OTHER C Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY K G CON STRUCTiON TYPE VALUATION $ S Left R ZONE GRADING CU.YDS. ACRES _ Ping, Ref. # Parking Req./Provided E Remarks: Planning Notes: M T S PLUMBING FEES Date Owner I hereby certify that t have read this application and state that the above Information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for s Inspectionpur s- S Signature Date Drivers' Liceh6re or SS = CMF 0865-46, rev. 10/84 Whit I Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service f Outlets Interceptors Kitchen Sink Lavatories P --Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO + Heating System & Ducting 00100,000 BTU ❑ 100,000 BT Reinspection Fee ,1 $15 Cant: Pink -'Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee I $ 3 I �T FEES Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑0100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 ELECTRICAL Automatic Washer Construction Pale Sub. Cooking Unit• Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 005 KW El 5-15 KW Transformer I) 15-50 KW ❑ 50 + KW Meter LJup to 100amps Meter ❑over 100 amps Sub Panel Motors 001 HP 011 ''A - 8 Inc. Solar 09.15 HP E:116-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES I I Reinspection Fee 1 $15 1 1 Issue Fee I $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved ByDate Application Issued By 7 Dat PLAN CHECK 25% $ SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50°% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ _/D,S- PLAN CHECK 25% $ CONSTRUCTION AND PLANNING t Date _ . APPROVALS Permit # I ns tor ec p� POOH SPA APPROVALS Permit # Date In"spector 1. Temporary Electrical Service or Pole ', 52. Pool_& Equipment Location 2, Soil Pipe-Undrgrnd, t t 53. Steel ReinforcementJ._ y 'EI coital Conduit•Utility-Undig,r rid. , r iv 54. Forms L4. Electrical ConduitfLndrgrnd. 55. Electrical Bonding 5. S cilReinforcemenf �� a 56. Rough Plumbing & Pressure Test ` �_ 6. 'Electtrical UFER�Grnd. ��•- `V 57. APPROVAL TO COVER•GUNITEel 71"Footings � r 58. Electrical Conduit-Undrgrnd. �! 8�.• Foundation ;� �. 59. Gas Pipe, ❑ Undrgrnd., Test 1 9 ;Wate� Pipe Undrgd. 60. Backwash Lines, P -Trap, 0 Undrgrnd, n 10. S.ird'cturai Floor Sy?tem 61. APPROVAL TO DECK 1'1.?Property Sewer Lirie & House Connection } 62. Backwash &Receptor -Final 12. Sewer Cap 1, 63. Heater & Vent -Final 13.o -Roof Drainsre 64. Plumbing System • Final r 14,,.Rough Plumbing - 65. Electrical-Finallei '15.., Rough Electrical -Conduit F 4F6. Solar System -Final 16, Rough Electric Wiring 67. Fencing & Access Approval -17. Rough Wiring Sign 68, APPROVED FOR PLASTERING JV Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydra 22. Ducts, Ventilating 71. Product Piping []Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas D Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic•Final _ 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irfigation System 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co 51, CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. �K �PtjRMjT,N � ACT Nq. LOT NO. UNIT CITY OF COSTA MESA CON TRUCTION PERMIT ��f//--�✓✓{{ B� r �► Project Address _ AeY/ Applicant's Mailing Address Owner's Name7ROV Phone 6 Address Arch/Eng, License No.4 Address 1&57L' Contractor's Nam hone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Chartei 9 (commencing with sactlan 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. , License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate .f Workers' Compensation Insurance, or a certifi d copy thereof (Section 3800, Lab. C./L'' /JI�/ Policy No. a�Nfle/c/!!/�1�% Company Certified copy Is hereby furnished. Certifietl copy Is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION OECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature •NOTICE. 11, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there I$ a construction lending agency for the performance of the work for __WJiJch thi ermit Is issued Section 097 Civ. C.) Lender's Name Lender's AddressJ OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than live hundred dollars (5500). 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License taw 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 employeos, provided that such Improvements are not intended or offered for Sala. If, however, the building or Improvement is sold within one year of com- pletlon,'the owner will, have the burden of proving he/she did not build or im- prove for the, purpose of sale). ❑ 1, as'ownar of 'tne property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License law). 1 am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I,am exempt under Section B. & P, C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to ildingSonstruuction, and hereby authorize repre- sentatives of this cit entgr otir,ya above-mentioned property for inspection pUrpOse s. r/ Signature Drivers' License or SS zip TV.eF ,,OF CONSTRUCTION IJ NEW LJ ADD U ALTERATION REPAIR 1 1 - I I , ZkCONVERSION ❑ OEMOLISH ❑ OTHER MECHANICAL FEES A p =4#1 DESCRIPTION OF WORK/USE OF BLDG. Hood or Type ! ❑ Canopy Type 11 El Duct - Under Ground Duct - Structural + Refrigeration System E1&100,000BTU 0100,000 BTU S Main Buildi SUMMARY OF FEES �y BUILDING PERMIT $ SMIP $ `L PLAN CHECK $ PERMITPLUMBING $ O ISSUANCE $ ENERGY P.C- S PLAN CHECK 25% S , ELECTRICAL $ GRAOiNG S i MICROFILM S PLAN CHECK 5Q% $ � MECHANICAL S TOTAL FEE $ PLAN CHECK 25% $ Exhaust System ❑ Multiple ❑ E TYPE OF PERMIT LJ GRADINGQ��/FOUNDATION STRUCTURAL T Front 1-1 TENANT ❑ ELECTRICALS,[' *PLUMBING 1-1MECHANICALB ❑ -OTHER \ A Rear $15 Issue Fee $ 3 C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY CON STRUCTION TYPE VALUATION $ 5 Left ZONE GRADING CU.YDS. ACRES Ping, Ref, # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains PLUMBING Showers Service Sink r Sewer Cap , Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spe Urinal 2. Water Closet Water Heater Water Service Auto -Wash L•aundry Trays b FEES 35 5%2 %Bb BAG YL Zone Accessory Building: Z O, N I N G R Parking Req./Provided _ _ E Q M T S ELECTRICAL Automatic Washer Construction P61eSub, Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures 00 Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW 05.15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors 00-1 HP ❑lis -B Inc. Solar ❑9-15 HP ❑16.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES —1' Reinspection Foo 1 $15 Issue Fee - $ 3 1 1 - I I , Reinspection Fee $15 Issue Fee $ 3 + MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Data Building Approved By . pate Application Issued By _ Date Bailor Hood or Type ! ❑ Canopy Type 11 El Duct - Under Ground Duct - Structural + Refrigeration System E1&100,000BTU 0100,000 BTU Duct - Ventilating SUMMARY OF FEES �y BUILDING PERMIT $ SMIP $ `L PLAN CHECK $ PERMITPLUMBING $ O ISSUANCE $ ENERGY P.C- S PLAN CHECK 25% S , ELECTRICAL $ GRAOiNG S i MICROFILM S PLAN CHECK 5Q% $ � MECHANICAL S TOTAL FEE $ PLAN CHECK 25% $ Exhaust System ❑ Multiple ❑ System Repair/Alteration FirepllFact. Blt. ICBO # Fire Dampers Heating System & Ducting ❑0-100,606BTU 0100,000BT Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865.46, rev, 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING Date APPROVALS Permit # Inspector POOL jPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 1 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53, Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms !l1 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE r 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd, v 10. Structural Floor System � 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection JK 62. Backwash & Receptor -Final N 12. Sewer Cap A-4 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing , J 65. Electrical -Final 15. Rough Electrical -Conduit V 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 Cei lin 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditip"h ing FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace • 21. Ducts, in Structure Ile 70. Underground Hydro 22,:�Ducts, Ventilating Ri 71. Product Piping ❑ Gas ❑ Oil 23'irGas Pipe -Rough & Test I e.73. Underground Flush 24?Roof Framing : t 73. Undergrrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing +r 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75, Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 26. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30JDrywall Nailing HEALTH DEPT. REQUIREMENT 31,lPlaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 46. Special Requirements Completed 49. Electric Release to Edison 50, Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except.those within heavy border lines andsign all appropriate declarations. CITY OF COSTA MESA C ff TRUCTt0N PERMIT PERMIT NO T 7 O LOT NO. U NO Project Address �1 • 'AlLL�N �'� Applicant's Mailing!Adclmss 'A�_ �t��ty. u�ir Owner's Name Ph6ne Address 17 5'r D �f S>f� /• 64 'nol(girn T Arch/Eng. License No. Address Contractor's Nam fL1 C H PhoneGCS� Address (mailing) City License No. LICENSED CONTRACTOR D CLARATI N I neeeby affirm that,I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in f force and effect, 3 Liceny ass Lf ns o - Date Signature WORS' COMPENSATIDN DECLARATION . j here affirm that i have a certificate of consent to self -insure or a certificate -•:'� Workers' Compensation Insurance, or a certified copy thereof (Section Lab. C.) ; "policy No. Company BCertified copy iS,hereby furnished. ` Certified copy�€S filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION' (This section need not be completed if the permit is for one hundred ($100) or less). '•• -' I certify that in th@.performance of the work for which this permit is issued,l shall not employ any person in any ner a t become object to tie Worker mpe s tion Lawj�of Cay a . + Date 5fgnature NOTI : If, a er rhaking this declaration, you should become subject to the Workers' Compensgtion provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name -- Lender's Address OWNER BUILDER DECLARATION I hereby affirm that l:am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requirei-a permit to construct, alter, improve, demolish or repair any structure, prior to,its issuance, also requires the applicant for such permit to fife a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License taw (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 131.5 by any appi€cant for a permit subjects the applicant to a civil malty of not more than five hundred dollars ($500). L� i, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that Such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a Con- tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance Should be provided to me. ❑ 1 am exempt under Section B. & P. . for this reason Date w I here y certify that I'have read this application and state that the above Information is correct. I agree to comply with all city and county ordinances and state laws g Ing constru tion, and hereby authorize per y repre- Sentatlyes of this y to a er don t above-mentioned pro erty or inspection porde Signature Drivers' f_icense.arrS,� 7722 3/25/6: - 7;e7" X32_43 CMF 0 s TYPE OF CONSTRUCTION NEW ADD ALTERATION ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCR€ TION OF WORK/USE OF BLDG. R Pr REPAIR A.P.# Zone _ S Main Building: Accessory Building: TYPE OF P RM17 LJ GRADING U FOUNDATION LJ STRUCTURAL ❑ TENANT [3ELECTRICAL 1:1 PLUMBING ❑ MECHANICAL ❑ OTHER' T Front O B A Rear N C Right N PROJECT DESCRIPTION SQ. F OCCUPANCY CONSTRUCTION TYPE VALUATION S .ZONE GRADING CU.YDS. ACRES K Left G R Ping, Ref, # Parking Req./Provided E Remarks: !�.� ( r3S t!v is �`� Planning ` O M s PLUMBING FEES ELECTRICAL FEES Bar Sink Showers ., Backfldw Preventer Service Sink Automatic Washer Construction Pale Sub. Transformer El 15.50 KW ClH 50 + KW i Backflow Irrigation Sewer Cap Batlifubs Sewer Connection Cooking Unit . Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors Ell 0-1 HP 01 Floor Drains Swimming.Poof vv/Spa F.A.U. Inc. solar 09.15 HP 016-15+ Floor Sinks Urinal `\ `` . I#A Fixtures !fit Microwave 7� Gas Seri ice Oistlets ti Water Closet Device Boxes Pale Light ' Interceptors Water Heater Outlets Range10C Kitchen Sink Water Service Switches Sign 7 Lavatories Auto -Wash Garbage Disposal Standing Sections P—Trap Laundry Trays Generator ❑O.5 KW ❑5-15 KW Trash Compactor r Roof. Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee MECHANICAL —FEES SERVICES REQUIREMENTS: Q 2 - 2S • � V Zoning Approved By Date Building Approved By Date�'-r Application Issued By Dat Boiler Hood or Type 1 ElDEVELOPMENT Canopy Type I I El Duct -Under Ground Duct - Structural Refrigeration System 00-100,000 BTU ❑100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMA �Oyi�FEES S _ yj_l�}_j,L SMIP $ PERMIT S ISSUANCE S $ P.C. $ $ GRADING $ $ MICROFILM 5 5 TOTAL FEE $ s77-75- * S *7 Exhaust System El Multiple El System Repair/Alteration Firepl/Fact. Blt, ICBG R Fire Dampers Heating System & Ducting 1:1111100,000 BTU ❑100,000BT RegistersENERGY Reinspection Fee $15 Issue Fee $ 3 CMF 0865.46, rev. 10/1;4 ' White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor ! ' 01" ._ (I CONSTRUCTION AND PLANNING `%Z POOL & SPA %PROVALS Permit # � Date I�speclor „r APPROVALS Permit # Date Inspector "It-(Temporary Electrical Service or Pole 52. Pool & Equipment Location, F• 2. Soil Pipe-Undrgrnd. t 53, Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding S 5. Steel Reinforcement 56. Rough Plumbing & Pressure)Test 6• Electrical UFER Grnd, 57. APPROVAL TO COVER-GUNITE . f _ ar 7. Footings f 58. Electrical Conduit-Undrgrnd. 8. Fouhaation ! 59. Gas Pipe, ❑ Undrgrnd., Test. 9, Water Pipe-Undrgrnd, f ' 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor Systerii , 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 - Fina! 14, Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval J 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING`r I" r 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �r 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREM£NThl APPROVALS Permit# c� i r y Ll 20. Rough Factory Fireplace rc, 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oii 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank_l] Gas ❑ Oi_I• 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe r� 28. Lathing & Siding 77. FIXED SYSTEM FINAL .r 29. Insulation 78. FIRE PREV. FINAL ),1 30. Drywall Nailing 3 f gg HEALTH DEPT. REQUIREMENT ' S 31. Plaster Brown Coat 79. FINAL INSPECTION I i1 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED r ' 33, Final Electric �/� Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test �� f ,u vitls 36. Hood or Canopy `� V h 37• Final Factory Fireplace + r 38rFinal Plumbing 39. Water Service-Final 40. Gas Service-Final Solar Domestic-Fina! `�• f141. r it/ 742. Backflow•Preventer `' f Backfjovii Irrigation- .r , ;k44_ Landscape Irrigation System i j y(L' i s r�-45'eSoundAttenuation -,'4'6.1' Handicap Regulations ' 47 FINAL STRUCTURE & BUILDING 49� Special.Requirements Completed r 49. Electric Release to Edison .A ✓r! - 50. Gas Release to Southern California Gas Co r' 51. CERTIFICATE OF OCCUPANCY No. Date _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONS TR ACTION P RMIT PERMIT NO TRACT NO LOT NO. UN O Project Address '� Applicant's Mailing Address -VJ Owner's Name Phone Address Arch/Eng. License No. Address Contractor's Name �/_ Phone.Z.Z7__-2,S/( Address (mailing) 4�7 e t 5:_h J City License No. _?�.;1 _ LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full orce and effect. Ur f cense Class �+ License NO,_?d ��PS Date �� a C Signature WORKERS' COMPENSATION D RATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section •800, Lab. C.) - lolicy No. Company BCertified copy is hereby furnished. _ Certified copy is filed with the city Building Division, Date - -_ Applicant EXEMPTION FROM WORKERS' COMPENSATION OECLARATION (This section need not be completed if the permit is for one hundred (5100) or ^ less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the - Worker ' Com en tibn Laws of Callfor Date - Signature 'NOTICE: If, after making this decuu-a n, o should become subject to the Workers' Compensation provisions of he Labor Code, you must forthwith comply with such provisions Or this permit shail be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency'for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name _. Lender's Address _ OWNER BUILDER IJECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 3malty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered forsale (Section 7444, Business and Professional Code. The Contractor's License Law does not apply to an owner Of a property.who builds or improves thereon, and who does such work hlmseH/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. 11, however, the building or Improvement is sold within one year of com- pletion , the owner will have the burden of proving he/she did not build or im- rove forr the Purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractor(s) license putsuarit't0 the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner f hereby certify that I have read this apPlicatjon and state that the above Information Is correct- I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city o enter upon the above-mentioned Property for Inspection purS. s y 3fl Signature Date 'I Drivers' Licen or SS TYPE OF CONS1rRUCTION LJ NEW LJ ADD LJ ALTERATION M REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 4A DESCRIPTION OF WORK/USE OF SLOG. $ Main Building: E TYPE OF PERMIT LJ GRADING C1 FOUNDATION 0 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Hear ❑ ,OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATIONS S Left ZONE GRADING CU.YDS. ACRES - Ping. Ref. Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service ` Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting ❑D-lo0,000BTU 1_-)100,o0oBT Reinspection Fee 1 $15 CMF 0865.46, rev. 10/84 White - Building; Canary - ppllcant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type ❑ Canopy Typell ❑ Refrigeration System Do-100,000BTU ❑ 100.000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES $ 3 FEES $ 3 Automatic Washer Construction Pole•Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. P Fixtures 9944 _ Zone Accessory Building: Parking Req,/Provided ELECTRICAL 4 4Transformer ❑ 15-50 KW 1-150+KW Device Boxes Outlets Switches Garbage Disposal Generator ❑D-5 KW []5.15 KW Meter LJup to 100 amps i Meter Dover 100 imps Sub Panel Motors 00-1 HP 011A - B Inc. Solar 09-15 HP 1116-15+ Microwave -. Pole Light Range Sign Standing Sections Trash Compactor .. "_ 10.30 TL FEES Z O N I N G R E Q M T S { I Reinspection Fee I $15 1 I Issue Fee I $ 3 1 I DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued BY— Date PLAN CHECK 25% $ $ $ SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% S Z . S^ ENERGY P.C. ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ $ $ CONSTRUCTION AND PLANNING- • .. Date _ APPROVALS Permit #� Inspector POOL , ,PA - APPROVALS Permit # Date Inspector 1. Temporary Electrical Service orPole r 52. Pool & Equipment Location F 2. Soil,Pipe-Undrgrnd. ny 53. Steel Reinforcement 3. Elecfrical Cond it:Uiiliity-Undrgrnd. 54. Forms 4' Electrical Conddit-6n`dr1grnd. - 55. Electrical Bonding `? 5' Steel' Reinforcement "� 56. Rough Plumbing & Pressure Test ,6-ttlectrical UFER Gynd. a 57. APPROVAL TO COVER-GUNITE J.Footings A ✓� 58. Electrical Conduit-Undrgrnd. B! Fourodation 59. Gas Pipe, 0 Undrgrnd., Test ,^! 9. Water Pipe-{Jnd{rnd, 60. Backwash Lines, P-Trap, ❑Undrgrnd. 10,a Structural Floor System 61. APPROVAL TO DECK 11Property Sewer LiA & House Connection ., A n t l 62. Backwash & Receptor-Final 14 12' Sewer Cap 63. Heater & Vent-Final 13" Roof Drains t (i 64. Plumbing System - Final 1,4'.. Rough Plumbing✓ [.ECJ 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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping i7 Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 1 73, Undergrnd. Storage Tank []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. Piaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final -Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41, Solar Domestic-Final _ 42. Backflow Preventer 43. Backflow Irrigation 44. ,Landscape Irriqation 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 i 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. :1tY OF COSTA MESA . CiON TRUCTION PERMIT Project Address r(!j f 71t Applicant's Mailing Address E Owner's NamPhone Name Address ( t Arch/Eng. Lit rise NO. h C1SZ,I.t Address59 - L • N QA Contractor's Name f3l b Phone Address (mailing) City License No. _ LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class *License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby, affirm that I have a certificate of consent to self -insure or a certificate f Workers' Com ensation Insurance, or A certified copy thereof (Section )00, Lab. C.) r_, + Tlf :1 cy No. l0 Company _� � - --+- �• nCertified copy is hereby furnished. Certified copy Is filed with the city Building Division. Date Applicant _ _ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed it the permit is for one hundred ($100) or less). '_�_ I certify that in the performance of the work for which this permit Is issued, I shall not employ any person In any manngr so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY _ I hereby affirm trial there is a constructionlending agency for i e performance of the work for which h s perrrtit �� ;ss ed 097 tion 097 Civ. C.) Lender's Name _.� 1�J1� iltTY�t Lender's Address �� 11 13vu--in in sr _11 Rr- OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7033.5 Business and Professional Code, Any City or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its Issuance, also roquires'the applicant for Such permit to (lie a signed statement that he/she is Ilcgn$ed pursuant to the provlSions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profess+onS Code) or that he/she is exempt •horefrom and the basis for the alleged exemption. Any violation of Section '131.5 by any applicant for a permit SubjeCts the applicant to a Civil jatty of not more than five hundred dollars ($500)`. LJ I, as owner of the property or my erhployee5 with wagas as their sole compensation, will do the work, and the,Structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to An owner Of'a property who builds or improves thereon, and who does such work him$elf/horsolf or through his or her own employees, provided that such improvements are not'Intended or offered for sale. If,however, the building or improvement Is sold within one year of com- pletion,.the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, a$ owner of the property, am exclusively contracting with licensed con- 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 builds or Improve$ thereon, and who contracts for such projects with a con- traCtor($) license pursuarit to Ina Contractor's Licen$e Law). I Am aware that proof of their Worker's Compensation insurance should be provided to me. Cl i am exempt under Section B. & P. C. for this reason Date Owner' I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to but ding constructlon, and hereby authorize repre- sentatives of this city �uptbove-mentioned property for inspection purposes.Signaturepate Drivers' License or SS 9F + rev MI7 NO l TIZACT LOT NO. UNIT NO. 6036 5/23/86 TYii�E,,OFCONSTRUCTION NEW ADD FALTERATION REPAIR CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. yP Zone. _ S Main Building: Accessory Building: TYPE OF PERMIT GRADING �--y FOUNDATION STRUCTURAL LJ TENANT '❑ ELECTRICAL 9PLUMBING ❑ MECHANICAL - C3 -OTHER' `' PROJECT DESCRIPTION Sq. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION 5 ZONE GRADING CU.YDS. ACRES T Front O A Rear - N C Right N g Left R Ping. Ref.+ Parking Req./Provided E Remarks: t51 Planning Notes: G M T' S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Prtoventer Service Sink Automatic Washr' Construction Pole Sub. Transformer ❑ 15-50 KW 1 ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers _ -Solar Collectors Dishwasher Meter Dover 100amps - Dishwasher Solar Piping, Dryers ❑Gas -❑Electric Sub Panel Drinking Fountains Solar Tank Fan ,A b Motors ❑0-1 HP ❑1'fr 8 Floor Drains Swimming Pool w/Spa F.A.U•Inc. So lar ❑9.15 HP 01615+ Floor Sinks- Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light interceptors Water Heater Kitchen Sink . Water Service Outlets Switches Range Sign Lavatories Auto Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays ' Generator 1:0-5 KW 1:5-15 KW Trash Compactor Roof Drains + Reinspegion Fee 515 Issue Fee- S 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REGUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By— Boiler Hood or Type 1 ❑ Canopy Type If ❑ � Duct - Under Ground Duct - Structural Refrigeration System 00-100,000 8TU ❑ 100,000 BTU Duct - Ventilating SUMMARY OF FEES ' BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT NG $ D r ISSUANCE S PLAN CHECK 25% $ Q ENERGY P.C. S + ELECTRICGRAp)NG S AL $ PLAN CHECK 50% $ MICROFILM S MECHANICAL S TOTAL FEE S PLAN CHECK ,25% $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO,ab Fire DampersPLUMBi Heating System &Ducting ❑0-100,000BTU❑100,000BTU Registers Reinspection Fee $15 issue Fee S 3 GMF 0865-46, rev. 10184 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING ' APPROVALS Permit # Date Inspector POOL A 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 / A 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE i 7. Footings 5B. Electrical Conduit•Undrgrnd, erg 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pi a-Undr rnd. P 9 60. Backwash Lines, P-Trap, ❑ Undrgrnd. +' r_ 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line &House Connection l'+ 62. Backwash & Receptor-Final UPJ 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 1B. Rough Electrical-T Bar Ceiline All 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditi" FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace . A 21. Ducts, in Structure trt 70. Underground Hydro 22,)Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23!, Gas Pipe-Rough & Test R) 72.1 Underground Flush 24�)Roof Framing 73. Undergrnd, Storage Tank ❑ Gas ❑ Oil 25yRoof Sheathing( 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Nlonocoat 75. Dry Chemical 27. Frame and Flashing v 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 3&Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing e-,40 -ire 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 4Z Backflow Irrigation 44' Landscape Irrigation System 46: Sound Attenuation 46; Handicap Regulations 47: FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 1. 5:1= CERTIFICATE OF OCCUPANCY No Date -n cri Y OF COSTA MESA CONSTRUCTION PERMIT Project Address __LL1 W. 17th St.Sldj;. {D Unit 5 P.pplicant's Mailing Addre,,, 1'3110 Saticoy St. N . Hollywood, Owner's Name _Troy Investment Fund Phone -549-2988 Address 4391 Birch St_ Newport Rr-aCh, Ca- Arch/Eng. Marin .1- Rn —License No. Address —12881— V_o t t— Ave Suit@ 2 16 Contrector's Name_ nuCn Air C'.nnd i ti nni ng Phone 992-1216 Address (mailing) 13119 Saticoy City License No. _ _39925 — LICENSED CONTRACTOR DECLARATION I hereby affirm that I arh licensed under provisions of Charter 9 (commencing with section 7000) Of Division 3 the Business an rofessions Code, and my license is in full force and eff License Class C- 0 ns p, 346251_ Date ' 4 Sign a"' WORKERS' COMPENSATION D LARATION I hereby affirm that I have a cert icato of consent to self -insure or a certificate Of Workers' Compensation insurance, or a certified copy thereof (Section 800, Lab. C.) ?olicy No. a0994 Company Tj1MhaX1Iianc eCertified copy is hereby furnished. Certifl is filed with the city Bu Date— Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any Pgrson in any manner so as to become subject to the Workers' Compensation Laws of California. Date , —Signature 'NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with' such provisions or this permit shall be deemed revoked. CONSTRUCTION LENt]ING AGENCY I horeby affirm that there Is a construction lending agency for trio performance of the work for whl¢h this permit Is Issued (Section 3097 Civ. C.) Lander's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's license Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that ho/she Is exempt therefrom and the Basi$ for the alleged exemption. Any violation of Section ,7031.5 by any applicant for a permit subjects the, applicant to a civil -xwenalty of not more tharr five hundred dollars ($500). as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the b4ilding or Improvement is Sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and who contracts for Such projects with a con- tractors) license pursuant•to the Contractor's License Law). 1 am aware that proof of their Worker% Compensation insurance should be provided to me. I] I am exempt under Section B. & P. C. for this reason Date —_ Owner T I hereby certify that I have roe his application and state that the above information is correct. I agree t c mply with all city antl county ordinances and State Ielating to but in construction, and hereby all thori repr - sentative f t is city to ter upon the above-men tlonedl=rty rJ Inspects n pur SP1ir Signatu 7� Drivers' nse or SS CMF 0865-46, rev. 10/84 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. I LOT NO. I UNIT Nf]_ C r 0atw Q TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ,❑ OTHER q p # DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING FOUNDATION D STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL BRear ❑OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CV.YDS. ACRES Ping. Rei. # Remarks: I Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ® 0-100,000 BTU ❑ I oo,000 BT Reinspection Fee I S15 ite - Building; Canary - Appl€cant; Pink - Accounting; Goldenrod - Assessor PLUMBING I FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee 1 S .3 MECHANICAL I FEES Hood or Type t ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,00013TU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee I $ 3 1775 4/24/65 Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW ❑5.15 KW Transformer ❑ 15.50 KW ❑ 50+KW 15o60 no Meter nup to 100 amps Meter ❑over 100 amps Sub Panel Motors C30-1 HP ❑ 1 h - 8 Inc. Solar 09.15 HP 1:116.15+ Microwave - Pole Light Range Sign Standing Sections Trash Compactor Z O N I N G R E a M T S I I Reinspection Fee 1 $15 1 1 Issue Fee I S 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE S PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL S 13 Cl(i TOTAL FEE $ 15-50 PLAN CHECK 25% $ _ - 2.50 T CONSTRUCTION AND PLANNING ` APPROVALS . Permit # Date r Inspector POOL - ,PA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool& Equipment Location .f 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement ;r 3. Electrical Conduit Utility-Undrgrnd. 54. Forms , 4, Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5, Steel Reinforcement i .• 56. Rough Plumbing & Pressure Test _ -•6. Electrical UFER Grnd. �. _ 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduif-Undrgrnd. f 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. �� 60. Backwash Lines, P -Trap, ❑ Undrgrnd. f 10. Structural Floor System .4 61. APPROVAL TO DECK 11. Property Sewer Line & House ConnIction 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72, Underground Flush .24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30.. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32.- Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. .Landscape Irrigation System 45. Sound Attenuation 46, Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison , 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border line$ and sign all appropriate declarations. Clf OY COSTA MESA CONSTRUCTION PER"MIT PERMIT NO, TRACT NO. LOT NO. UNIT NCL_ . Project Address t i _ Applicant's Mailing Address TYPE OF CONSTRUCTION LJ NEW U ADD LJ ALTERATION LJ REPAIR Owner's Name w ^+� i,li r Phone Address Arch/Eng, License No, Address _ Contractor's Nam - Phone"? Addressfmailingj�7 �- �n��"AJ1i� sY�3L+'�3r,�r•�a 0rJ"I /6 City License No. - LICENSEE) CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Chartar (commencing with section 7000) of Oivislon 3 of th Iness and ofe ons Code, and my license is in f II force and effe ` license Class Lice s No Dat, J SLC r- - Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to Self-insuro or a certificate of Workers' Compensation Insurance, or_a certified copy thereof (Section 1800, Lab. C.) Policy No1%.,r S/Cyy% � C �ZY H Certified copy is hereby furnished- Cer�i+ied copy_is filed with the cit uil !vision. Date----�{ /y %�r Applicant EXEMPTIDN FROM WORKERS' COMP NSATION ECLARATION (This section need not be completed if the permit is or one hundred ($100), or less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers' Compensation Laws of California.; Date" Slgnaturo NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with Such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that t am exempt from the Contractor's License Law for the following reason (Sectign 7031.5 Business and Professional Code: Any city or county which requires 4 permit to construct, alter improve, demolish or repair any structure, prior to its Issuance, also requires lite applicant for such permit 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 Division -3 of the BusiheSS and Professions Code) or that he/she is exempt therefrom and the basig for the alleged exemption. Any violation of Section 7031.5 by any applic8nt for a permit subjects the applicant to a civil )enalty of not more than five hundred dollars ($500). ❑ f, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided th4t such improvements are not intended or offered for sale. 1f, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors td construct the project(Section 7044, Business and Professions Code: The Contractor's License law loos not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a con- tractor(s) license puisudrit*to the Contractor's License Law). I am aware that proof off their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date — Owner I hereby certify that $'have read this al Information is correc agree to co ly and state la 9 t building nstr sentatives tai sty enter pan inspectlo Pur Signature Drivers' License or SS ation and state that the above 1 all city and county ordinances 6n, and hereby authorlZe repre- above-mentloned property for Date /—/0 — of ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT El GRADING FOUNDATION 71 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 13 A Rear El -OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ S 1 Left ZONE GRADING CU.YDS- ACRES Ping. Rei. # Remarks: Planning Notes: Bar Sink Backflow Preveater Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Interceptors Kitchen Sink Lavatories PLUMBING FEES Showers » Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Outlets P—Trap Roof Drains Reinspection Fee _ $15 Boiler Duct - Under Ground Duct - Structural Ouct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO Heating System & Ducting 00.100,000 BTU ❑100,000BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Bullding; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Urinal Water Closet Water Heater r Water Service 'A uto-Wash Laundry Trays r. Issue Fee ECHANICAL Hood or Type I ❑ Canopy Type II ❑ Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee I, 5962 1/16/65 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers C]Gas ❑Electric Fan F,A,U. Fixtures Device Boxes 0uttets Switches Garbage Disposal Generator 110-5 KW ❑5-15 KW Transformer ❑ 15-50 KW ❑ 50 + KW Meter 0 u to 100 amps Meter El over 100 amps Sub Panel Motors -1 HP 01Y,8 1nc.Solar 09-15 HP ❑16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor $ 3 Reinspection Fee $15 Issue Fee ' FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By _ r Building Approved By [ Application Issued By _. SUM OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% 5 ENERGY P.C. ELECTRICAL $ ._� -� GRADING PLAN CHECK 50% $ 1�0'0 MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ ' $ 3 Lo'p9 TL FEES $ 3 to to t $ $ $ Z O N I N G R E O M T S CONSTRUCTION AND PLANNING .APPROVALS Permit # Date Inspector POOL 6, SPA APPROVALS Permit # Date lnsp@Cfnr I . 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 1 6:f Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7.,-Foofings < <' 58. Electrical Conduit-Undrgrnd. .t $.Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9,SWater Pipe-Undrgrnd.=i 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10,`Structural Floor System '' 61. APPROVAL TO DECK 11 ,'Property Sewer Line '& House Connection ., -Final 62. Backwash -& Receptor 12. Sewer Cap ' 63. Heater & Vent -Final 13. Roof Drains '10 ✓ 64. Plumbing System - Final 14. Rough Plumbind.' :. 65. Electrical -Final 1 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 L: 30r Drywall Nailing HEALTH DEPT. REQUIREMENT 31'. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric �,Z �( (moi Nntes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy -37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43. Backfiow 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 OWNER QUICK SAND _ DATE 12-8-75 JOB ADDRESS 711 West 17th Street, A-1 BUILDING PERMIT NO. 40949 DESCRIPTION of WORK Interior Alterations GENERAL CONTRACTOR Owner/Bldr. �v' AP No. 1 16-260-24 LOT i�ISPECTI0k5 SOIL Wk. -4 (ROUGHPLUMBINGOP.SWR. LINE [:]HOUSE CON. RINKLING SYSTEM ISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND E] POWER 0 ROUGH WIRI G TRENCHES FORMS STEEL REINF. FLOOR SYSTEM BOND BEAM STEEL REINFORCE SHEATHING FRAME AMD FLASHING LATHING - IN ❑ OUT ❑ PLASTER, BROWN COAT STRUCTURAL, FINAL HEATING. VENT.. REFRIG. AND A.C., FINAL PLII•'RING. FINAL AND GAS TEST ❑ _, Et AC, FINAL BUt-ING, FINAL TRACT FIRE ZONE VALUE $5,000. Si nature Date TYPE V GROUP J SUBCONTRACTOR Datl Plumbina OWNER BAY Ready Mix DATE 2-4-61 . JOB ADDRESS BUILDING PERMIT NO. 186138 GENERAL CONTRACTOR owner-gIcIr, VALUE $ CP4.00 AP No. 116-260-10 LOT TRACT FIRE ZONE DESCRIPTION OF WORK gi:L,p . Rjdg . Tr" 'SECTIONS Signature DATE GROUP J TYPE TTI ZONE M-] S� SUBCONTRACTOR PERMITS ISSUED Gas DATE NUMBER Water Rough Com. Refrig. ❑ Air Cond. ❑ Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line ❑ House Con. ❑ St. Swr. ❑ Sprinkling System Construction Pole Underground ❑ Power Rough Wiring Trenches ❑ Forms ❑ Steet em . ❑ Floor System Bond Beam ❑ Steel Reinforce ❑ Sheathing Frame and Flashing Lathing — In ❑ Out ❑ P1a-*-r, brown coat R( ❑ Air Cond. ❑ Final Hea.,.ng, Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final Building, Final OCCUPANCY 9M 7.r1 --Id OWNER BAY READY NIX APR i 8 ossa DATE 12--30-59 JOB ADDRESS 711 . 17th St. BUILDING PERMIT NO. 11183 GENERAL CONTRACTOR MSS Maintenance VALUE $ 600.00 AP. No. 116-260-10 LOT TRACT FIRE ZONE DESCRIPTION OF WORK install under d. IN^DECTIONS I DATE I~GROUP J TYPE 4 ZONE M-; Tank i rKruunu auu U.lr. WaLer Unaerground Gas — — SUBCONTRACTOR PERMITS 15SUED DATE NUMBER Overhead Water and Gas Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole Underground Power Rough Wiring Trenches Forms Steel Floor System Steel Reinforce Chimney Re -Rod Bond Beam Sheathing Fr--- o and Flashing Li .g, In Out Plaster, brown coat Plumbing Fixtures, Final Electric Fixtures, Final Building, Final OCCUPANCY APR i Form 210-5M-11-59 5-B P Jr ' 11183 1, as owner of the property, am exclusively contracting with licensed con- ' SUMMARY OF FEES ;% � SMIP $ 00 11 00,000 BTU ❑100,000 BTU $ PERMIT tractors td construct the project ISaction 7044,.Buslness and Professions Code:— ' Applicant CITY OF COSTA MESA /J �J Q / CONSTRUCTION PERMIT tf fill in all spaces.except those within heavy border lines and sign all appropriate declarations. t -_ 003 5/ f 0/ 84: y PE.HMIT NO. TRACT NO. -- 11096. LOT NO. BLDG. 1 & 2 A Exhaust System ElMultiple 1-1System Project Address _ 7 1 1 W . • 17th Street Applicant's Mailing Address Owner's Name Troy Investment FilndPhone 549-298 TYPE OF CONSTRUCTION , M .❑ CONVERSION ❑ DEMOLISH DESCRIPTION NEW I D 9 X ALTERATION REPAIR ❑ OTHER EXt rior Aterati�ns- tractors} license pursuant to.the Contractor's License Law). A.P. # Zone S Main Building: Accessory Building: ❑ I,am exempt untler Section & P. C. for this reason Address 4321 Birch Street, Newport BeachE Arch/Eng, W 9-eense No. Address 2418• MacArthur Blvd.. Corona _del J4a Contractor's Name Phone Address(mailing) City License No, TYPE OF PERMIT LJ GRADING FOUNDATION X35TRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL r El OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION$ 800.00 ZONE GRADING CU.YDS. ACRES T Front t B! A Rear S1{ C Right Date ' Owner S Left Ping, Ref, # Park. Fees $ Remarks: P.C. 20-84S Parking Req./Provided 1\ S LICENSED CONTRACTOR DECL ATION I hereby affirm that -1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and ,,,formation is correct. I agree to c mplyy with all city and county ordinances and state laws relating building constructEon, and hereby authorize repro- I Use of Building: I my license is in full force and effect, Llcense Class License No, PLUMBING FEES ; Planning Notes: PLAN CHECK Inspectlon purp a r)ate Signature )RKERS' COMPENSATION DECLARATION Bar Sink Showers MECHANICAL Signature pate Backflow Preventer Service Sink Issue Fee $ 3 PLAN CHECK Drivers' Llcen or SS ,ereby affirm that I have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Irrigation Sewer Cap ELECTRICAL CMF 0865-46 rev. 12/83 White - Building; Canary - Applicant; Pink - Accounting; 3800, tab, C.) _ Policy No, 52420001683Companv Argonaut Certified copy is hereby furnished, Bathtubs Sewer Connection Automatic Washer Transformer El15-50'KW Certified copy is filed with the city Build Ing Division. Date Applicant Construction Pole Sub. E] 50-,+'K' KW Clarifiers Solar Collectors EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit Is for one hundred ($100) or Dishwasher Solar Piping 9 Cooking Unit Meter ❑up to 100 amps Drinking Fountains - Solar Tank Dishwasher Meter Dover 100 amps less), I certify that in the performance of the work for which this permit is Issued E shall not employ any personIn any anner 5o a become subject to tke Work q s Ion Laws of Call n a. Date Signature14 NOTI : If,i fter making this decla atl n, you should become subject to the Workers' Compensation provisions the Labor Code, you must forthwith comply with such provisions or this permit shall_ be deemed. revoked, CONSTRUCTION LENDING AGENCY Floor Drains • Swimming Pool w/Spa Dryers ❑Gas ' ❑Electric Sub Panel Floor Sinks Urinal '- Fan Motors El 0-1 HP Ell %z - B Gas Service Outlets . Water Closet F.A.U. 1nc.Solar ❑9-15 HP Ell 6-15+ Interceptors - Wates Heater _ Fixtures Microwave I hereby affirm that there Is a construction lending agency for the performance. of the work for which this permit is issued (Section 3097 Clv. C.) Lender's Name Kitchen,Sink Water Service Device Boxes Pole Light Lender's Address -' OWNER BUILDER DECLARATION Lavatories Outlets Range I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair : any structure, prior to its Issuance, -also requires the applicant for such permit , +o file a signed statement that he/she Is licensed pursuant to the provisions of p—The P Switches Sign Roof"Drains Garbage Disposal Standing Sections ; Generator'00-5 KW 05-115 KW Trash Compactor •e Contractor's License Law (Chapter 9 (commencing with Section 7000) of V3 of the' Business and Professions Cade) or that he/she Is exempt V,erefrom and the basis for the alleged exemption. Any. violation of Section Reinspection Fee'*, $25 Issue Fee $ 3 ' •7031:5 by, any applicant for;.a permit subjects the applicant to a civil` `penalty of not more than five hundred dollars ($500), 1 LJ 1, as owner of the'proper y or'�my employees with wages as their sole compensation will do the work, and the.structure Is not Intended or offered for sale (Secflon• 7044, Business and Professional Code -.F The, Contractor's License Law does not apply to an owner of a property who builds or improves thereon„ and who does such work hlmself/herself •or through his or her own employees, provided that such Improvements are' not'lntended or offered for sake, if however, the bulldln or Improvement Is sold within one year'�of com- pletion, the,owner;wfu have the burden of proving he/she did not buiId or Im- rove for the purpose of sale) Reinspection Fee $25 Issue Fee MECHANICAL FEES PUBLIC SERVICES REQUIREMENTS: Zoning Approved By ate— _ �} _ Building'Approved By nate,... Application Isiued By - /ice - �� .., -Data- Boiler Hood or Type I ❑ - Canopy Type It ❑ Duct Under Ground _ Duct - Structural Refrigeration System ' , 1, as owner of the property, am exclusively contracting with licensed con- ' SUMMARY OF FEES ;% � SMIP $ 00 11 00,000 BTU ❑100,000 BTU $ PERMIT tractors td construct the project ISaction 7044,.Buslness and Professions Code:— ' Duct Ventilating - { ISSUANCE $ I The Contractor's License Law does not apply tD an Dwner of property who builds or Improves thereon, and who contracts for such proiacts with a con- ENERGY P.C. Exhaust System ElMultiple 1-1System Repair/Alteration $ BUILDING PE tractors} license pursuant to.the Contractor's License Law). 50% $ $ MICROFILM. TOTAL FEE $ $ PLAN CHECK ❑ I,am exempt untler Section & P. C. for this reason Firepl/Fact. Bit. ICBG # ± PLUMBING Date ' Owner Heating System & Ducting ' PLAN CHECK 1 hereb)(Cert fy that I have read is application and state that the above 00.100,000 BTU,❑100,000 BT' ELECTRICAL ,,,formation is correct. I agree to c mplyy with all city and county ordinances and state laws relating building constructEon, and hereby authorize repro- I I sentatives of t s city to orf upon the above-mentioned propertyfor ; PLAN CHECK Inspectlon purp a MECHANICAL Signature pate Reinspection Fee $25 Issue Fee $ 3 PLAN CHECK Drivers' Llcen or SS CMF 0865-46 rev. 12/83 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor ' 154Qf�TI, Z O N I N G R E Q U I R E MM dIT $ SUMMARY OF FEES ;% � SMIP $ _ $ PERMIT ' ISSUANCE $ I 25% ; $ ENERGY P.C. $ $ GRADING $ 50% $ $ MICROFILM. TOTAL FEE $ $ r � 2 25% $ F/ "_ 'CONSTRUCT_IOl�1 AND PLANNING - Date APPROVALS Permit # Inspector POG SPA- APPROVALS Permit #' Date :Inspector - ., . 1: Temporary Electrical Service or Pole 52. Pool & Equipment Location - • - _i.1So11 Pipe- Undrgrnd. 53. Steel Reinforcement - - 3.. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding. 5Steel Reinforcement ~56. Rough Plumbing'& Pressure Test: =� _ 6.' Electrical LIFER Grnd. 57. APPROVAL TO COVER:GUNIT.E 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd:, Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. - 10. Structural Floor System - 61. APPROVAL TO:DECK- 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap fi3. Heater & Vent -Final ; 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final - 15. Rough Electrical -Conduit 66. Solar System=Final- 1 16. Rough Electric Wiring «17. 67. Fencing & Access Approval 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. REOUIREMENT APPROVALS Permit.# 20. -Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro f �- 22. Ducts, Ventilating 71., Product Piping ❑ Gas,. boil 23. Gas Pipe -Rough & Test 72., Underground Flush l i 24. Roof Framing _ 73. ` Undergrnd. Storage Tank ❑ 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.E FINArL INSPECTION T '32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final'Heating & Air Conditioning 35. Final Gas Pipe -Test # I 36. Hdod'or Canopy 37. Final Factory Fireplace 38. Final-Plumbirig'_ r ' 39. Water Service -Final ; 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation i x 44. Landscape Irrigation System 45. Sound Atterivation - •' i I 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 1 �! l 49. Electric Release to Edison i 1 + _r• t = I ' E • tr 50. Gas Release to Southern California Gas Co ' • 51. CERTIFICATE OF OCCUPANCY No. Date E J- - ' - •- - �+ _ __ - ... -' COSTA MESA BWLDING•SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 t' a6 A 1 cI i 1079 40000" TU, For Applicant to Fill in Completely — Use ink Only APPLICATIONIPb'R STRUCTURAL PERMIT I BY D TE RECEIV ,4.P, NO. o2 y — �'� �. bNGDDRESS E. ♦ jfryADDRESSPEOWNER Q � 1 0 / h �� MAIL//R �T�of/ Il�t M1j ADIDRIESS %/ W �7��TEL.IYWITY V NO. JEBUIL TRACT /inn C5A LOT �p CONSTRUCTION N W AD AR REPAIR LENDER BRANCH OWNER T AAAA ADDRESS VALUE S 5 ARCHITECT TEL. OR FNGINFER N FIRE ADDRESS ZONE TYPE GROUP CONTRACTOR %j djVWr,1 APPROVED BY DATE ADDRESS C,-,64 V A, t) Nb ((VV EL CITY R of % o. 0�� ZONE NO. OF LANS .2- USE OF NEW Lil j)C.%- BUILOING STATE CITY LIC. NO. 76 y LIC. NO. YARDS APPROVED MAIN BUILDING YARDS APPROVED ACCESSORY BUILDING SIZENO. OF BLDG.S. (FROM C/LSTREET) OF LOT NOW ON LOT RO FT. FT, USE OF EXISTING BLDG. + Sf F7. FT Separate permits are required for L. SIDE FT. FT. REAR FT. FT. electric, plumbing and heating work. USE OF BUILDING AND WORK TO HE PERFORMED DISTANCE BET. BET. MAIN & 1 MAIN SLOGS. ACCESS. SLOGS. � ry Pie a f -&l VAR. 46 C.U.P.+ DAT£ APPROVED S Gft (:4♦ f!IAlI ,06C Q APPROVED u)k1 .3/.Zi 175 R GL I hereby acknowledge that I have read this application and nate that the above information Is correct and agree to comply with all laws regulating building construction, and I shalt not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Profe Ions Code, Division 3, Chapter 9, and that such licenses are in 11 force an fact, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY am exempt from the provisions of eS to of Calf r a Business and Professio s ode, Division 3, r 9. VALUATION PERMST FEE S PLAN CHECK $ Signature of Permittee $ p TAX S - Authorized g nt TOTAL PAID $ F 17 COSTA MESA BUILDING -SAFETY DEPARTMENT P.Q. BOX 1200 COSTA MESA, CALIFORNIA 92626 FIILL oDD r ANNf pGG plicant/jtlo Fill in Completely — Use Ink Only ADDRESS II k[J�I S -r OWNER MAIL ]3,� i�J✓QC`N S%/ ADDRESS TEL CITY /ll�u/ r JC9Cff N0. Zed CONSTRUCTION LENDER BRANCH ADDRESS IN ARCHITECT TEL. ADDRESS CONTRACTOR t ADDRESS TEL. CITY NO, ~ STATE CITY % LIC. NO. LlC. NO. GLU SIZE NO. OF BLDGS. 9. OF LOT NOW ON LOT Q USE OF EXISTING BLDG. 4 Separate permits are required for G electric, plumbing and heating work. W USE OF BUILDING AND WORK TO BE PERFORMED '1'ak JAW J pl: W o. Q I hereby acknowledge that I have read this application and state 1:4 that the above information is correct and agree to comply with G. all laws regulating building construction, and 1 shall not employ Z any person in violation of the workman's compensation laws of W the State of California. 3 I hereby certify that I em properly licensed as a contractor under the State of California Business and Professions Coda, Division 3, Chapter 9, and that such licenses are in full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3 haptar 9. Signatura of ✓ Permlttea i Authorize gent 32 3/ i 6%Ts 5.50 TL APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY DATE RECEIVED Ir DATE ISSUED /)� �+)�� A. P. N A�'� d e5 PERMIT NO. BUILDING 7/ r r -2 r.. -271 - ADDRESS ADDRESS (�(J ` y 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: TRACT LOT BLOCK WREPAIR ,O m PLAN CHECK $ c 5 a OWNER VALUE Q�. S FIRE V ZONE TYPE GROUP APPROVED BY DATE [(FROM ONE NO. OF USE OF NE�d �� (<w PLANS ?j BUILDING YARDS APPROVED YARDS APP OVED MAIN BUILDING ACCESSORY UILDING C/L STAZEET► 111 ,A rvk- -REAR VT. 1 i .1 FT. DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. SLDGS. VAR .+ DATE C.U.P. yip APPROVED � APPROVED/7,s n TOTALPAID $ m i e SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR m THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: b N VALUATION PERMIT FEE $ ,O m PLAN CHECK $ c 5 a TAX S TOTALPAID $ Applicant to fill in all spaces except those heavy border lines and sign allpa propriate declarations. CJ -TY OI`'COSTA MESA CONSTRl1CTlON PERMiT PERMIT NO. TRACT NO. LOT NO. UNIT NO Project Address �� (� f �%T S r [ryr�� i L M Applicant's Mailing Address Owner's Name _7 aO ��♦% � f $r-1 I Phone — Address 43 24 111a C S N IZ POP_ Arch/Eng. License No. Address Contractor'sName MP,fLRZ1S j;. L 12 5- T R TL Phone!r'y-Y77-t.b Address (mailing) �� V,' WK'�a N'1 S�` t� ��^cSlt4)r�Jr_TCry� n City License No. LICENSED CONTRACTOR DE LARATiON I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in f I force and effect. Licensee Class i c se o 3`TS ] ) 7 Date `?!_- Signature WORKERS' COMPENSATION DECAL RATION thereby affirm that I have a certificate of consent'to self -insure or a certificate 'f WorkersCompensation Insurance, or a certified copy thereof (Section 3900, Lab. C.) 1 _ Policy No 6J C- S )*9a Company — � 1- �r BCertified copy is hereby furni�Cert'f', ed copy Ipstiled with theion.Date `1 d�..i ApplicJ EXEMPTION FROM WORKERS' COMPENSATION D LARATION (This section need not be completed if the permit is for rte hundred•($100) or tess). I certify that in the performance of the work for which this permit is issued, I shall notemployany person in any to beta e sub' t to the Workers' Co pen att''0 Laws of Cali o is Date '�� " X � Signature NOTICE: If, after making this declaration, you should bjLcome subject to the - Workers' Compensation provisions of the Labor Code, you must forthwith comply with • such provisions or this permit .shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1. j 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is -issued (Section 3097 Civ. C.) Lender's Name Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 'the Contractor's License Law (Chapter 4 (commencing with Section 7000) of. Division • 3 of the Business and Professions Code) or that he/she is exempt O',ierefrom and the' basis for the alleged exemption. Any violation of Section , ;f031 5 by any, applicant for a permit subjects the "applicant to a civil � . 0• cna(ly of not more than five hundred dollars ($500). © 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. It, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). - ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant'to the Contractor's License taw). 1 am aware that proof of their Worker's Compensation insurance should be provided to me. i� I am exempt under Section S. & P. C. for this reason Cf Date ' Owner I hereby- certify that•1 have read, this appli information iscorrect. I'agree to comply wit and state law to build construct sentatives o this it to ent r pon the inspection p ps I + Signature Drivers' License or SS :9* tion and state that the above - all city and county ordinances n, and hereby authorize repre- pave-mentioned property for ` Date i 5808 I/Ib/85 IF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor TYPE OF CONSTRUCTION NEW El ADD ALTERATION' U REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG, A.P. Zone S Main Building: Accessory Building: TYPE OF PERMIT GRADING 0 FOUNDATION [_1 STRUCTURAL ❑. TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL tip OTHER ,-PROJECT DESCRIPTION SQ. F7. OCCUPANCY (-CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS, .ACRES E T Front Z . O 13 A Rear N I C Right N S I Left G R Ping. Ref. # Parking Req./Provided E Remarks: Planning Notes: Q M T S PLUMBING FEES Bar Sink Showers ° ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer El 15-50 KW El 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors i Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank _ Fan Motors 0-1 HP ❑ 1 A - B / Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP E] 16-15+ Floor Sinks Urinal Fixtures - Microwave " Gas Service Outlets Water Closet Device Boxes Pole'Light Interceptors Water Heater' Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P -Trap Laundry Trays Generator ©0.5 KW 05-15 KW Trasli Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 issue Fee $ 3 MECHANICAL FEES SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved'By Date Application Issued By _ _Data:::1 ; � Boiler Hood dr Type ( El Canopy Type I I ElZoning Duct -Under Ground Duct -Structural Refrigeration System ❑o-100,000 BTU 01100,000BTU Duct - Ventilating BUILDING PERMIT '$ PIAN CHECK $ $ PLAN CHECK 25% :$ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ SUMMARY OF FEES SMIP $ PERMITPLUMBING ISSUANCE $ ENERGY P.C. $ L) GRADING 1$ 5D MICROFILM $ TOTAL FEE $ (J r'I 'SU Exhaust System ❑ Multiple ❑ System Repair/Alteration Firep1lFact. Bit. ICBO+ Fire Dampers Heating System & Ducting ❑ 0-100,000 BTU C] 100,000 BT Registers peinspection Fee $15 Issue Fee $ 3 IF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor .+' {CONSTRUCTION,AND PLANNING - Date ` APPROVALS Permit # Inspector POO_. -SPA APPROVALS Permit # Date Inspector F 1. Temporary Electrical Service or Pole -+ ;; 52. Pool & Equipment Location 2. Soil, Pipe-Undrgrnd. '' 53. Steel Reinforcement 3 -'Electrical Conduit Utility-Undrgrnd. 54. Forms + 4.rElectricaI Conduit-Undrgrnd, 55. Electrical Bonding 5. 'Steel Reinforcement �w, 56. Rough Plumbing & Pressure Test + .6. Electrical UFER Grndn 57. APPROVAL TO COVER-GUNITE 7.. Footings 58. Electrical Conduit-Undrgrnd. } 8.' Foundation' 59. Gas Pipe, ❑ Undrgrnd., Test "+ 9, •Water Pipe-Undrgrnd. 60. Backwash Lines, P Trap, ❑Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor Final 12. Sewer Cap 63. Heater & Vent -Final 11, 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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro .22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System % ' 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date' ? Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PE IT NO. TRACT NO. LOT NO. UNIT NO. 1L I7 "9 i� �� . . r.ri /„ I Al _ l Project Address �AA 'Applicant's Mailing'Adciress 15'7AMA, Owner's Name s$t�Y_r� T—iriltlC�honeI Ce-6wol Address t . Arch/Eng. License No. Address ' Contractor's Name Phone 4 (— Address (mailing)' u Tlkw( f -j .City License No. 7 sing _LICENSED CONTRACTOR DECLARATION t hereby affirm that 1 am licensed under provisions of Charter 9 (commencing With Section 7000) of Division 3 0f the EWsiness and Professions Code, and my license is in full f t and of Licen Cl a s is j Date 7 Signature WORKERS' COMPENSATION DECLARATION ' hereby affirm that I have a certificate of consent to 5e -inre or a certificate ` Workers' Compensation Insurance, or a certified copy thereof (Section 300, Lab. C.) ,•-, _ Policy No. Company eCertified copy is hereby furnished. Certified copy is f(lerl with the city Building Division. Date. _ Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). •- I certify that In the performance of th rk r which this permit is-5sued, I shall not employ any person in any an e o a o me ub to the Worker Co p nsa Laws o! Cali or pate Signature -NOTICE: If, after making this declaration, you should became bjec to the Workers' Compensation provisions Of the Labor Code, you ust forthwith comply with such provisions or this permit $hall be tl erred revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there i$ a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name _ Lender's Address OWNER BUILDER DECLARATION I hereby affirm that 14m exempt from the Contractorts License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000) of r)ivlsion 3 of the Business and Professions Code) or that he/she is exempt erefrom and the basis for the alleged exemption. Any violation of Section ;31.5 by any applicant for a -permit subjects the applicant to a civil 5 -malty of not more then live hundred dollars ($500). U I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden Of proving he/she did not build or im- rove for the purpose df sale). 1, as owner of the property, am exclusively contracting with licensed Con- 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 builds or improves lh@reon, and who contracts for such projects with a con- tractor(s) llcense pursUant'to the Contractor's License L.aw). I am aware that proof o/ their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I -have rea- information r r l ogre and state I i t la g t uiId-r sentatives of t is ty en r inspectio p / I I Drivers' License or SS -p _J J this application and state that the above comply w h all city and county ordinances InLst,u io nd hereby authorize repre- on t e-mentionepro{garty f Oate�J" 9248 2/11/86 TYPE OF CONSTRUCTION L._1 NEWADD LJ ALTERATION LJ REPAIR Reinspection Fee $15 Issue Fee $ 3 FEES C1CONVERSION ❑ DEMOLISH OTHER q p # ., , Zone C DESCRIPTION) F WORK/USE OF BLDG. A�Q1�� or 6C— Y. Jk']l} S Main Building: Accessory Building: jA $ 3 TYPE OF PE�RADING FOUNDATION STRUCTURAL T .Front Q TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL — E]OTHER, A Rear _ N PROJECT DESCRIPTION SQ. FT. OCCUPANCY �•,,� C Right N G CON STRUCTION TYPE VALUATIONS d� S Lett - R ZONE GRADING CU.YDS. ACRE Ping. Ref. # Parking Req./Provided E O Remarks: �^ Planning Notes: M T S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink - ' Automatic Washer 'Tfansformer 0 15-50 KW" ❑ 50,+ KW Backflow Irrigation Sewer Cap Construction Pole Sub. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter over 100 amps Dishwasher Solar Piping Dryers ❑Gas ©Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑t}1 HP Ell h - B Floor Drains Swimming Pool w/Spa F.A.U. 1nc.Solar 09-15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink' Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator El 0-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting ❑0.100,000BTU ❑100,000BT 1 ' Reinspection Fee I , $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee Hood or Type ❑ Canopy Typell ❑ Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIRE Zoning Approved Ely Date :M42 Building Approved By Date 2--'6:M42 Application Application Issued By Date S MMARY OF FEES BUILDING PERMIT $ CP Z_ SMIP $ •�a PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE S PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 5D% $ MICROFILM $ r MECHANICAL $ TOTAL FEE PLAN CHECK ) 25% $ I $ 3 '� 1 CONSTRUCTION AND PLANNING i iAPPROVALS Permit # Date Inspector POO IPA APPROVALS Permit # Date Inspector j 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel_ Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. i 57. APPROVAL TO COVER-GUNITE 7G. Footings 58. Electrical Conduit-Undrgrnd, S. Foundation' r 59. Gas Pipe, ❑ Undrgrnd., Test y , 9., Water Pipe -Un drgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd, r, 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 Drain's 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 Bat Ceiling 69. PQOVSPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20..•Rough Factory Fireplace 21'.:Ducts, in Structure 70. Underground Hydro -22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. 'Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling jStructural) & Monocoat 75. Dry Chemical 27 Frame and Flashing 76. Dry Standpipe 2B. Lathing &,Siding 77. FIXED SYSTEM FINAL 29. Insulation 7B. FIRE PREV. FINAL 30. Drywall Nailing _ HEALTH DEPT. REQUIREMENT 31: Plaster Brown Coat„ r 79. FINAL INSPECTION 32. Electrical Power Meter -Fina! 80. FOOD CERTIFICATE ISSUED 33. Final'Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas,Pipe-Test 36. Hood -or Canopy 37. Final Factory Fireplace 38. Final Plumbing.. 39. Water Service -Final t 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 4B. Special Requirements Completed 49. Electric Release to Edison. 50. Gas Release to'Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. pate - 1 now 40949 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 PAID Oc--75CMSnOQ 321,1 :� �53.3Q Ln co` i m NN m_ ka v U) 0 LL E U AP CA ION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only REI E Y DATE RECEIVED DA:LE IS UED BUILDING I I�� L 1 �� ADDRESS J' � _7( 111 Q / // 'PERMIT NO. W —2 t o OWNER A.P. NO. +1 I ADIDRESS 7/� r" • I r�� I ADDRESS 1 .� TEL: � NuPolCT MESA9/� Cy 60 CITY -NO. "zq TRACT LOT / BLOCK CONSTRUCTION NEW ADD I ALTE R R IFAUtOVtNG LENDER BRANCH owNER (IGC 5 ADDRESS VALUE ARCHITECT L. yy� l� 5 VST c rz OR ENGINEER FIRE ADDRESS ZONE TYPE GROUP APPROVE r) �n :CONTRACTOR Ll.2J�lU BY DATE ADDRESS A( w-e�— I $tµ TEL ZONE NO. OF / USE OF NEW PLANS I BUILDING r CITY Q_C - NO. ` AZ I M STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO, MAINJBUILDING ACCESSORY BUILDING W SIZE ! NO. OF SLDC}S. (FROM C/ STREET) Or OF LOT �OX %U NOW ON LOT FRONT• .F FT. Q USE OF 5.4-+J� n LA15n N EXISTING HLpG. J C� f � F FT [/] Separate permits are required for p� L. 3ID FT. FT. electric, plumbing and heating work. Vy REA FT. FT, E. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE SET. BET. MAIN & MAIN BLOW. ACCESS. SLOGS. j�7.y(�y%Z �Bj►!�%f ESSd/LC `- t lcS.Itrs VAR. * DATE Q ! 4/ Uv�.ViY/0/J C.U.P. # APPROVED /L COLLEGT�f� APPROVEDC,�•_-7 }, ICDATEaT .a Ge; {s7 0 I hereby acknowledge that I have read this application and state pe; that the above information is correct and agree to comply with a+ all laws regulating building construction, and I shall not employ W any person in violation of the workman's compensation laws of the State of CaiifOTnla. I hereby certify that I am properly licensed as a contractor under SO. FT. the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ �7 and Professions Code, Division 3, Chapter 9. ` f PLAN CHECK S v. SiJ Signature of ' I U Permittee_ S TAX a Authorized Agent . TOTAL PAID a C� Ln co` i m NN m_ ka v U) 0 LL E U 1= 1. 1 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. LOT NO. UNI N Y OF CDSTASA CONSTRUCL10 PERMIT R dd ress 1 Applicant's Mailin ddress Owner's Name Lif &D Phone Address Arch/Eng, License No. Address Contractor's Nam �Pah/one% Address (mailing) -,?r�amuU City License No. 757-2 f LICENSED CONTRACTOR DECLARATION i hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in ful t rce and effect. license Class License No. &A :k --A-40!1 Date. — Signature WORKERS' COMPENSATION D LARATION hereby affirm that I have a certificate of Consent to self -insure or a certificate ,f Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. Company_ �' Certified copy is hereby furnished. ". Certified copy is filed with the city Building Division. i Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred (5100) or. Ies4)• certify that in the performance of the work for which this permit is Issued,,l. shalt not employ any person in any manner so as to become subject to the Worker Comp!ry�afion Laws of Calif 'a. Date �L�—Y7 --- Signatur 'NOTICE: If, after making this decla on, you sh0uld become subject to the Workers' Compensation provisions the Labor Code. you must forthwith cornply with such provisions or this permit shalt be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm tnat there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address _ OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file asigned statement that he/she Is licensed pursuant to the provisions of 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 nalty of not more than five hundred dollars ($500). I, as owner of the property or -my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 erriployees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 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 Proof of their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Date owner I hereby certify that I have read this application and state that the above Informatinn is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this cit to enter upon the above-mentioned property for inspection Dur es. Signature Date Drivers' LI c se dr SS 9F CMF 0865.46, rev. 10/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES TYPE OF CONSTRUCTION 0 NEW ADD =ALTERATION U REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER OESCRIPTiON OF WORK/US F BL G. 4E C TYPE OF PERMIT LJ GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICALPLU BIN El MECHANICAL El OTHER e PROJECT DESCRIPTION SQ. FT- OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU. V DS. ACRES A.P. qj[, Zone S Main Building: Accessory Building: E T Front Z O B A Rear N I C Right N gI Left G R Ping.-,ffief, # Parking Req.IProvided E Remarks: Planning Notes: 0 M Meter ❑aver 100 amps Dishwasher T S CMF 0865.46, rev. 10/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑aver 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00-1 HP❑1l:-8 Floor Drains Swimming Pool vv/Spa F.A.U. Inc. Solar 09-15 HP El 16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet z Device Boxes Pale Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Q Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee $15 r Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Hood or Type ype I ❑ Canopy Type 11 ❑ DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date ate Dat Duct - Under Ground Duct - Structural Refrigeration System ❑0.100,000 BTU 0100,000BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING$ PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT q_ -0O ISSUANCE $ $ �� 5D ENERGY P.C. $ $ GRADING 1 $ $ MICROFILM $� $ TOTAL FEE $ 10.SD $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firep1lFact. Bit, ICBG # Fire Dampers Heating System & Ducting ❑0.100,000 BTU 0100,u00BT Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865.46, rev. 10/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor N57RUCTION AND PLANNING , PPROVALS Permit # Date - Inspe� r POOL 6 SPA APPROVALS Permit # Date Inspector 7 . Temporary Electrical Service or Pow 52. Pool & Equipment Location i, Soil Pipe-Undrgrnd. rte, 53. Steel-Reinforcement70 •`r j FA, EI • ical Cond ji� ility-Undrgrnd. � 54. Forms 4 Elec5ical Conrluii I M 1 J 55. Electrical Bonding y,p? i 5.1f teelReinforcemenc 56. Rough Plumbing & Pressure Test 'Electrical UFER,Gnd. } I 57. APPROVAL TO COVER-GUNITE 7. Footings ' "' � ,n �-.� : � 58. Electrical Conduit-Undrgrnd. l u - r4 .$. Fe dation UK? 59. Gas Pipe, ❑ Undrgrnd., Test . .Anter, Pipe-Undrgr a 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 1.0. Structural Floor System 61. APPROVAL TO DECK 1Property, Sewer Liin"er& House Chnnection 62. Backwash & Receptor -Final ,'1ft,Sewer Cap 1 } +7i. ,� 63. Heater & Vent -Final 13 R-'oogf Drains q rZ 64. Plumbing System - Final 141 Rough Plumbin 65. Electrical -Final ry 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 -7 Bar Ceiling 69. POOL(SPASYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22., Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test " 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25, Roof Sheathing 74. Overhead Hydro 26. 7 -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27.;Frame and Flashing 76. Dry Standpipe 2B. j Lathing & Siding 77. FIXED SYSTEM FINAL 29. i Insulation 78. FIRE PREV. FINAL 30.'.Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPEC710N 32. 'Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test L 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound' Aitenuation 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' ; f Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT ND- LOT NO. I inliT nir. Project Address 711 W. 17th ST. BLDG. (A) Unit 1 Applicant's Mailing Address 13.110 Saticoy St. N.H011ywo_od Owner's Name Troy Investment Fund Phone 549-2988 Address 4321 Birch St. Newport, Beach, Ca, Arch/Eng. , Marin, J. Rock _ —License No. Address 12881 Knott Ave. Stuie 216 _ Contractor's Name Duco Air Conditioning h,,,, -982-1216 Address (mailing) 13110 Saticoy St. N.H011ywood, Ca. City License No. —33925 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of'Charter 9 (commencing with sectlon 7000) of Division 3 of the Business and Prof es 'ons Code, and my license is in full fosLA and effe 2j 1 License Class C— LU nse ZE— Date Signature WORKERS' COMPENSATION DEC RATION .I hereby affirm that 1 have a certifi to of consent to self -insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) 4Lumberinans Policy No. WC982. Company _ H Certified copy is hereby furnished. Gertit7i d py is filed with the city Bui ing Divi ( J Date—q, , 1Z� Applicant du exp EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall. not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked, _ CONSTRUCTION LENDING AGENCY ' I hereby affirm that there is aiconstruction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address ' OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit -to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 031.5 by any applicant for a permit subjects the applicant' to a civil ` enalty of not more than five hundred dollars ($500). 1, as owner of the property .or my employees with wages as their sole compensation, will do the work, and the -structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale, If, however, the building or improvement is sold within one year of com- p1et10n, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale), ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professlons Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuarit*to'the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason TYPE OF CDNSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ -REPAIR Bar Sink ❑ ❑ ❑ Backflow Preventer Service Sink CONVERSION DEMOLISH OTHER Sewer Cap' A.P. # DESCRIPTION OF WORK/USE OF BLDG. _ Solar Collectors Dishwasher Solar Piping Drinking Fountains S Main Building: Swimming Pool w/Spa Floor Sinks E Gas Service Outlets, TYPE OF PERMIT GRADING FOUNDATION EISTRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL 13 P—Trap ❑ BOTHER Roof Drains A Rear PROJECT DESCRIPTION. SQ. FT. 'OCCUPANCY C K Right CONSTRUCTION TYPE VALUATION $ $ Left ZONE GRADING CU,YOS. ACRES Ping. Ref. # Remarks: Planning Notes: -Reinspection Fee , 1 $15 1 1 ' Issue Fee Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. I CBO # Date Owner read is application and state that the above information is correct. I ato ply with all city and county ordinances I .hereby certify that J h�builcli PLUMBING Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap' Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets, Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains -Reinspection Fee , 1 $15 1 1 ' Issue Fee Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. I CBO # Date Owner read is application and state that the above information is correct. I ato ply with all city and county ordinances I .hereby certify that J h�builcli 1 Heating System & Ducting Malo0,000BTU ❑.100,000BT ' Cooking Unit Meter Dup to 100 amps and.state la relating to 9 onstructinn,,and hereby aKor - repre-sentatives l is city' tot Pon the above-mentlonedtyinspection r sem 'Meter ❑over 100 amps Reinspection Fee $15 Signature Date Drivers' Lic se or;ss IF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type I ❑ Canopy Type II ❑ Refrigeration System 120-100,0()OBTU ❑ 100,000 BT System Repair/Alteration Fire Dampers Registers I Issue Fee FEES 1734 4/24/85 16o5Q TL Zone Accessory Building: Z O N { N G R Parking Req./Provided E Q M T S ELECTRICAL I FEES Automatic Washer Construction Pole Sub. 'Transformer ❑ 15-50 KW --_ ❑ 50 + KW Cooking Unit Meter Dup to 100 amps Dishwasher 'Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors ❑0-1 HP ❑ 1 )4 - 8 F•A,U. Inc. Solar ❑9-15 HP El 16-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal ; Standing Sections Generator ❑075 KW El 5-15 KW Trash Compactor $ 3 FEES Reinspection Fee $15 1 1 Issue Fee DEVELOPME=NT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By ( X YULE $ 3 �$ 3_[ PLAN CHECK 25% $ 2,_5 SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ 13'.00 TOTAL FEE $ 15-60 �$ 3_[ PLAN CHECK 25% $ 2,_5 CONSTRUCTION AND PLANNING r APPROVALS - Permit # Date Inspector POO, ...SPA APPROVALS Permit #� pate Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd, 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd.- 54. Forms i 4. Electrical Conduit-Undrgrnd. 55, Electrical Bonding { 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57, APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. f P ti 8: Foundation 59, Gas Pipe, ❑ Undrgrnd., Test f ` 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, ❑ Undrgrnd. ' 10. Structural Floor System r 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash &Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13.: Roof Drains ti 64. Plumbing System - Final ' 14.1 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 18Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19: Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oii 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat '75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 2B. Lathing & Siding' 77. FIXED SYSTEM FINAL 29, Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION, 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43, Backflow Irrigation 44. .Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49, Electric Release to Edison 50. Gas Release io Southern California Gas Co > 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations, CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 711 W. 17th S t . Bldg : (A) Unit 3 Applicant's Mailing Address 13110 Satkf,oy Stt,.- N.HollYWood Owner's Namc - Phone - 5492$$ Address 4321 Birch St. NPtanort Beach, Ca. Arch/Eng. Mari n_.3-- Rnrlt License No, Address -..2 Contractor's Name uca Air Cond tinning Phone 9$2-1216 Address (mailingl 13 City License No. —33.925 T LICENSED CONTRACTOR DECLARATION I hereby affirm that I ahs licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full I rc,@and effec 46251 License Class L(] nse o, Date41118//94 Signature WORKERS' COMPENSATION DEC RATION I hereby affirm that I have a certific of consent to self -insure or a certificate of Workers' Compensation Insura ce, or a certified copy thereof (Section '1800, Lab. C.) mbe]rmanS rolicy No. WC9824 -- Company 1•+u- eCertified copy is hereby furnished. - Certife oy' Is filed with the city �}}riding DiYv�I s'yy4g�n � Date Applicant—V rfl Nrtz:? EXEMPT ON FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for One hundred ($100) Or less). ' I certify -that in the performance of the work for which this permit is issued, f shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION ! hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or county which requires ) permit to construct, aNer, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for Such permit to file a signed statement.thal he/she is licensed pursuant to the provisions Of 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 aenalty Of not more than five hundred dollars ($500). "12 I, as owner of the' property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for Sale (Section 7044 Business and Professional Code: The Contractor's License Law does not appiy to an owner of a property who builds or improves thereon, and,who does such work himself/herself or through his or her own empioyees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletlon, the owner will nave the burden of proving he/She did not build or im- 1rove for thee purpose of sale), , as owner of the property, am exclusively contracting with licensed con- tractors to construct th@ project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such, projects with a con- tractor(s) license pursuent•to'the Contractor's License Law). 1 am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under $action B. & P. C. for this reason - Date Owner I hereby certify that I have read this Information -is correct. I agree 1 0 COMP?. and state la s relating to byt��iltling co s sentatives this city • to%hter up n inspection Signature Drivers' Li c se or'SS CMF 0865-46, rev. 10/84 White - Building ration and State that the above i all city and county ardinance on, and hereby authori.0e rep? aboye-mentioned _ppoerty r 1736 4/24/65 � 't 5460 TL TYPE OF CONSTRUCTION LI NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORKIUSE OF BLDG. A.P. 90 Zone S Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 0 MECHANICAL ❑ %OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION S ZONE GRADING CU, YDS. ACRES E T Front Z O B A Rear N I C Right N K S Left G R Ping. Ref. # Parking Req./Provided E- Remarks: Planning Notes: M T S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub- Transformer ❑ 15-50 KW - ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter Cup to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan, Motors ❑0-1 HP ❑ 1'h - B Floor Drains Swimming Pool w)Spa F.A,U. Inc. Solar El 9-15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Lavatories Water Service Auto -Wash Switches Garbage Disposal Sign ; Standing Sections P—Trap Laundry Trays Generator 00-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee $15 i Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 - Boiler MECHANICAL Hood or Type 1 ❑ Canopy Type I1 ❑ FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By— y REQUIREMENTS:' Date Date Dat Duct . Under Ground Duct - Structural Refrigeration System 00.100,000 BTU D100,000BTU Duct - Ventilating Du BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 2596 ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY $ $ S $ $ $ $ $25-2.�n— OF FEES SMIP, $ PERMIT ISSUANCE $ ' ENERGY P.C. $ GRADING , $ MICROFILM $ ' 13.00 TOTAL FEE $ 15'50 Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers 1 Heating System & Ducting &A 00,000 BTU 0100,000 BT 6 Registers O - Reinspection Fee $15 Issue Fee $ 3 Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING r APPROVALS - Permit # Date Inspector POOL, ,;PA APPROVALS Permit # Date Inspector 1, Temporary Electrical Service or Pole 52. Pool & Equipment Location j i 2• .Soil Pipe-Undrgrnd, 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54• Forms ' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding E, i 5. Steel Reinforcement _ 56. Rough Plumbing & Pressure Test r . - 6• Electrical UFER Grnd. �� ' 57, APPROVAL TO COVER-GUNITE 7, Footings 58. Electrical Conduit-Undrgrnd. 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pi a-Undr rnd. R 9 60. Backwash Lines, P -Trap, ❑Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House lCon 4 ction 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.E Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL , 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. -Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74, Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 2B. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 7B. 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 t� 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irriqation System 45. Sound Attenuation 46, Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No. Date –_ —Applicant to-ffll•in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONST13UC IO PERMIT PER} IT NO.� O TRACT NO. LOT NO, U:. N Project � •ss �J Applicant's Nailing Address TYPE OF CONSTRUCTION Li NEW LJ ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P + Owner's Name O IA-,',fPhone DESCRIPTION OF WORK USE QF BLDG. Address Arch/Eng. License No. Address t Contractor's Name. ��i �t � o ws P�,0 a Phone ;77719 Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in fu1 force and effect *7License Class License No. `3d 1 Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certifled copy thereof (Section 1800, Lab. C.) rY- Policy No. Company �• BCertified copy Is hereby furnished. Certified copy is filed with the city Building Division. r Date Applicant EXEMPTION FROM wORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less), 1 certifythatin the performance of the work for which this permit is issued 1 shall not employ any person in any manner so as to become subject to the Work-�.E)rpA`n Laws of Califo Date _G/ _—Signature NOTICE: If, after making this declara - you should become subject to the Workers' Compensation provisions of he Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER 13UILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the_ applicant to a civil )enalty of not more than five hundred dollars ($500), 0 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sake- If, however, the building or Improvement is sold within one year of com- pletion, -the owner will have the burden of proving he/she did not build or im. prove for the purpose of sale). ❑ % as owner of the property, am exclusively contracting with licensed con- tractors to construct the projectSection 7044, Business and Professions Code: The Contractor's License Law oes not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above Information is correct. I agree to comply with all city and'county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of thAes, o enter upon the above-mentioned property for inspection Our o Signature Date Drivers' Lie s l S MainBuilding: TYPE OF PERMIT GRADING FOUNDATION E STRUCTURAL T Front El TENANT El ELECTRICAL .�P 1L–Ul�gBIN �❑ MpcECHANICAL B Rear ❑ ,OTHER !�!` TLA 1 L.J _. ......._, A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K' CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YOS. ACRES Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventef Backflaw Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 1-10-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 AF 0865-46, rev. 10/84 White - Building; Ca ary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type I ❑ Canopy Typell ❑ Refrigeration System E_1&100,000BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automatic Washer C6nstruction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas ❑Electric 9506 3185/65 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Fan r F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 05.15 KW Meter LJup to 100amps Meter ❑over 100 amps Sub Panel Motors 110.1 HP ❑ 1 i4 8 Inc. Solar 09-15 HP Ell 6-15+ Microwave - Pole Light Range Sign Standing Sections Trash Compactor 10050 FEES Z O N I N G R E O M T S Reinspection Fee Mi $15 1 1 Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By - REQUIREMENTS: Date Date Dat BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL. PLAN CHECK 25% SUMMARY OF FEES $ $ —q— $ $ S $ $ $ $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING S MICROFILM $ TOTAL FEE $ os� $ 3 AND PLANNING CONSTRUCTION AND PLANNING APPROVALS Permit # Date L --r Inspector L1 POOL t -..,PA APPROVALS Permit # Date Inspector Temporary Electrical Service or Pole 52. Pool & Equipment Location 7 2. Soil. Pipe-Undrgrnd. t 53. Steel Reinforcement i �� 3� Electrical Conduivlltility-Undrgrnd. - 54- Forms 4. Elect cal Conduit-Unbr` rnd. .9 , „ 55. Electrical Bonding tip, e 5. Steel�'ReinforcemenM j j 56. Rough Plumbing & Pressure Test w6 6' Erectrical UFER'Gr�d! i/ d+ Yt 57. APPROVAL TO COVER-GUNITE 7;,Footings Vl '1 58. Electrical Conduit-Undrgrnd. IFou-t'dation t �� 59. Gas Pipe, ❑ Undrgrnd., Test I'e 9. Water. Pipe-Undrgrnd. + ? 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 14'tStructural Floor System 61. APPROVAL TO DECK 11.h Property Sewer Line & House Co�nriection y 62. Backwash & Receptor -Final 12f'S?r Cap J '{ 63. Heater & Vent -Final 13 f Roof Drains f► I 64. Plumbing System - Final 14. Rough Plumbing?i r i5, C, V9 65. Electrical -Final r:1 15. Rough Electrical -Conduit F � 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts,. Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gasp Pipe -Test 660 36. Hood or Canopy 37. Final Factory Fireplace 38. Ficial Plumbing GjlQ 39, Water ter,vice-Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backf low, Preventer 43. Backflow Irrigation 44. Landscape Irriqation 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 _ r CONSTRUCTION Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMITPERMIT NO.+ TRACT NO. LOT NO. UNIT NO. Project Address -O., / 7''- S; 1 O '3 Applicant's Mailing Address Owner's Name -r �' L/U i11£�Tf�1?rPhone Address 4 P,; PCM S 'I- n3 ` 3;, -_AG.!•! Arch/Eng. License No. Address pry_Lfer_ Contractor's Namei P..My/U� S ,eGr2tL one�-�c Address (mai IingAJt%.1 &-,5X �j7 At c,1%,.tC_it�1-.1- J23ig City License No. LICENSED CONTRACTOR DECLARATION I herebyaffirmthat I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class �'� O ics;r►Se .34 "5 i 17 Oate] )C^TS Signature _ _ c_ /1'A1, ��. WORKERS' COMPENSATION DECLARATION I hereby affirm thgt I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 800, Lab. C.) _ r'olicy No.&C4 fG"a7 �Q Company Z=IT 8 Certified copy is hereby furnished. Cerjifie I copy Is filed with the cit ui1 Divis n. ��— Date J-) )-9-4Z Applicant EXEMPTION FROM WORKERS' COMPENSATION DECL RATION (This section need not be completed if the permit is for one hundred ($100) or less). 1 certify that in the performance of the work for which this 0.0.0.q��ermIt )s Issued, I Shall not employ any person in any 1So-JNo becorrf@ subjecytp the Workers' Compensation Laws of Callf rnla. [[ �I �1 ( j Workers' Compensation provisions of the Labor Code, you `must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY. I hereby affirm thbt there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ, C.). Lender's Name Lender's Address OWNER BUILDI~R DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, after, improve, demolish or repair 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 the Contractor's License Law (Chapter 9 (commencing with Section 7008) 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 1031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). ❑ I, as owner bf the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License taw does not apply to an owner of a property who builds or improves thereon, and who does such work himsolf/horself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im. Eve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractorsto construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a con- tractor(sl license pursuant to the Contractor's License Law). I am aware that proof off their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt 14nder Section B. & P, C. for this reason Date - Owner — I hereby certify that I have read this Information is correc I agree to c m and state la o building o sentatives f this c ty o enter o - inspection or o;e Signature Drivers' License pr SS qp application and state that the above P with all city and county ordinances nStruction, and hereby authorize repre- p th-81,above-mentioned property for Date f - Iy 35 T5810 1/16/85 Accessory_Building: Parking Req./Provided 4.50 TL Zone z O N I N G R E Q M T S PLUMBING FEES TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION MREPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Showers A.P. # DESCRIPTION OF WORK/USE OF BLDG. Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW S Main Building: Sewer Connection E Meter ❑up to 100 amps TYPEEtOFPERMITrr--tt GRADINGrr--tt FOUNDATI�Or--Ntt STRUCTURAL T Front 0 TENANT LJ ELECTRICAL LJ PLUMBING iJ MECHANICAL 13 Solar Piping ❑ OTHER Dryers ❑Gas ❑Electric A Rear Solar Tank C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY F.A.U. CONSTRUCTION TYPE VALUATION S S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: T5810 1/16/85 Accessory_Building: Parking Req./Provided 4.50 TL Zone z O N I N G R E Q M T S CMF 0865-46, rev, lO/84 White - Building: Canary - Applicant: Pink - Accounting; Goldenrod - Assessor PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap ' r Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps .- Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 1 HP 01 h - 8 I Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09- 15 HP ❑16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors - _ Water Heater Outlets Range Kitchen Sink Lavatories Water Service Auto -Wash Switches Garbage Disposal Sign Standing Sections P -Trap Laundry Trays - Generator 130.5 KW 1:15.15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee 5 3 Reinspection Fee $15 Issue Fee $ 3 Boiler Duct - Under Ground MECHANICAL Hood or Type I ❑ Canopy Type 11 ❑ FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date DatA Duct - Structural Refrigeration System ❑0100,000 BTU 010D,000BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMITPLUMBING $ ISSUANCE $ $ ENERGY P.C. $ S _ 4ob GRADING $ $ MICROFILM $ $ TOTA'L FEE $ L-4 1_-() $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firep1lFact. 61t. ICBO # Fire Dampers Heating System & Ducting 00.100,000 BTU El 100,000 BTU Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev, lO/84 White - Building: Canary - Applicant: Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit Date -� inspector POOL ` -?A .APPROVALS Permit # Date Inspector 1, Temporary Electrical Service or Pole „ 52. Pool & Equipment Location 5oil!`Pipe-Undrgrnd. -+,`� 53. Steel Reinforcement 3r Oect'rical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. + 55. Electrical Bonding 5.�$teel Reinforcement4. �> 56. Rough Plumbing & Pressure Test Ci 6.. Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE �t 71.' Footing; 58. Electrical Conduit-Undrgrnd. } 8. *Foundation �► 59. Gas Pipe, ❑ Undrgrnd., Test 9. _Water Pipe-Undrgrnd; ��; �� 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10.,•Structural Floor System-, 61. APPROVAL TO DECK 11,+ Property Sewer Line & House Connection 1 62. Backwash & Receptor -Final 12.,Sewer Cap f r t I. 63. -Heater & Vent -Final 13. Roof Drains Y, I 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 APPROVALS Permit 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil .23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank O 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 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 q1 CC Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service•Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Dndscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ; 51. CERTIFICATE OF OCCUPANCY No. Date _ Applicant to fill in all spaces within heavy noraer lines and sign all appropriate declarations. CITY OF COSTA MESA PE MIT NO. TRACT NO. LOT NO. BLDG. NO. le CONSTRUCTION PERMIT l3r''f X07" M 954 D T 1550 7/27/81 58065 Project Address7& 17 6 """ -- 4 — TYPE OF CONSTRUCTION ❑ NEW ❑ ADD ❑ ALTERATION ❑ REPAIR ❑ CONVERSION ❑DEMOLISH ❑ OTHER - - ZONING REGULATIONS Owner S Phone ` Addrew 1�!t 9 7_ Arch/Eng. License No. DESCRIPTION OF WORK A.P. �0D � ,ZONE PLNG. gRUEF. TYPE OF PERMIT SBUILUING ET AC T. AROPEI Yi1L NE ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL { YARDEFrT A_� ❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHANICA 55i(pE Y r +� / t! Addr@ss Contractor S(,�r� C�/�f,' Phone -L Ad LICENSED CONTRACTOR D LARATI 1 hereby that I licensed of Charter 9 affirm am under provisions (com- menCfng L with section 71300) of Division 3 of the Business and ❑ OTHER i2tGHT ! - I Professions Code and y license Is In full force and effect. REAR YARD (TO PJ, v C3 s ne % %41 b License C{ass PROJECT DESCRIPTION PKG. SPACE REQ. f PRO�DED /�(7 Date - Signature ZFZeG44Y6rr SQ. FT' , STREET WIpTI f P RK FEE S WORKERS' COMPENSATION OECLARATION OCCUPANCY C NSTR41CTION TYPE ZONING APPRO E11BY GATE I hereby affirm that 1 have a Certificate of consent to self -Insure ora VALUATED ONE s` certificate of Workers' Compensation insurance, or a Certified copy thereof Se i n 00, b. C.). .-. r ( ?�C fi GRADING CU. YDS. ACRES SPECIAL CONDI ONS: POlicy No. Company � .n 'artlfied copy is hereby, F—Gf AIAO AI REMARKS: entified copy is filed with the City Building Division. LnEMPTION FROM WORKERS' COMPENSATION DECLARATION (This Lection need not be completed if the permit is for one hundred _ (E100) or le 1. I certify that in the performance of the work for .which this permit is Issued, I shalt not employ any person in any manner so as to become PLUMBING PLAN CHECK ELECTRICAL PLAN CHEC subject to the Workers' Compensation. Laws of California. BATHTUBS SHOWERS LJQ SQ- FT DateSignature TOILETS URINALS GENERATOR _ KW 1.10 KW NOTICE: If after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must TRANSFORM R forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS APPLIANCE - 10-50 KWT50 + K revoked. _ KIT. SINKS DISHWASHERS MOTO '0-1 HP r 1 CONSYRUCTION LENDING AGENCY I hereby affirm that there IS a construction lending agencyy for the per- SERVICE SINKS SUMPS (1N S LAR) 10-50 H P - formance of the rk for which this permit is Issued (SOCtlon 3097 1 FLOOR SINKS FLOOR DRAINS FIXT' R S OUT TS &CHES C1 V. C,). �Jp% /} Lender's Name 'I Lender's Address ----- �___ _ __ _ DRINKING FOUNTAINS - - G USE SIGNS ' OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License taw for INTERCEPTORS CLARIFIERS E LIGHTS SWIMMING POOL P TRAP - the.fohowing reason (Section 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, POLES M T ED SUB WATER SERVICE ALTERATION PANELS I SUB improve, demolish or repair any Structure, prior to its issuance, also re- quires the applicant for such permit to file a signed Statement that he is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE OUTLETS SERVICE AMP {Chapter 9 (Commencing with Section 7000) of Division 3 of the HEATERS BTU OUTPUT 1 J ' Business and Professions Code) Or that he IS exempt therefrom and theWATER basis for the alleged exemption. Any violation of Section 7031.5 by SEWER CONNECTIONS Gul- - abpliCant for a permit subjects the applicant to a civil penalty 3t more than five hundred tlollars ($500). 'SOLAR TANK COLLECTORS- as owner of the Property, or my emplOyeeS with wages as their 'COmpensation, swe will do the work, and the structure is not intended _ SOLAR PIPING SYS. DIM Or offered for sale. (Section 7044, Business and Professions Cade: The Contrdctor's License Law does not apply to an owner of a property ISSUE FEE IG TION APPROVED BY APPLDATE U7 who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not MECHANICAL PLAN CHECK SUMMARY OF FEES Intended or offered for sale. If, however, the building or improvement Is said within one.year of completion, the owner will have the burden Of proving he did not build or improve for the Purpose Of sale). r o BUILDING-`r7. El 1. as owner of - the property, am exclusively contracting with EATING }.{EATING SYSTEM 0-1(10,000 BTU AND DUCTING E SMIP, S V licensed contractors to construct the project (Suction 7044, Business 100,000 + BTU PLAN CHECK S ��• If PERMIT and-Professlons Code: The Contractor's License Law does not apply to ISSUANCE $ an owner of property who buildS or imprOVOS thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING S tracts' from such projects with a contraCtor(s) licesned pursuant to SYSTEM - - GRADING S the Contractor's License Law). 100,000 + BTU PLAN CHECK 5 ❑ I am exempt under Section S. & P. C. for this BOILERS BTU ELECTRICAL 3 S reason _ - _ - - - -- - - _. PLAN CHECK S - MICROFILM S - Date _ _ - _ - Owner—LTS SYSTEM REPAIR, AATION TOTAL FEE S MECHANICAL' J ' I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE $ LESS AD- information is correct. 1 agree to comply with all City and county . PLAN CHECK y _ VANCE PC S Ordinances and Stale laws relating to construction, and hereby authorize _ representatives 54 thchi to a ter pon the above mentioned property for ec is p po Signature u Date FINAL FEE $ Drivers' License or SS =r ISSUE FEE CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location Soil ipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrh 46. Electrical Bonding 5. tee em orce 47. Rough Plumbing & Pressure Teit 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE 7. Footings 49. Electrical Conduit- Undr rn 8. Foundation 50. Gas Pipe, ❑ Undr rn, Test 9. Water Pipe-Undrgrn 51. Backwash Lines P -Trap,© Und&rn 10. Structural floor System 52. -APPROVAL TO DECK 11. Property Sewer Line & House Connection 53. Backwash & Receptor -Final 12. Street Sewer Connection 54. Heater & Vent -Final 13. Rough Plumbing 14. Rough Electric -Conduit •56. Electrical -Final 15. Rough Electric -Wiring 57, Solar System -Final 16. Rough Heating & Air Conditioning b8. Fencing & Access Approval 17. Ducts in Structure 59. APPROVED FOR PLASTERING 18. Ducts, Ventilating 60. POOL/SPA SYSTEMS FINAL 19. Gas Pipe -Rough & Test 20. Roof Framing 21. Roof Sheathing NOTES: 22. Frame and Flashing 23. Insulation 24. Lathing & Siding 25, Drywall Nailing 26. Plaster Brown Coat 27, Electrical Power Meter -Final 28. Final Electric 29. Final Heating & Air Conditioning, 30. Final Gas Pipe -Test 31. Final Plumbing 32. Water Service -Final 33. Gas Service -Final, 34. Solar Domestic -Final 35. Landscape Sprinkling 5 stem 36. Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison . 41. Gas Release to Southern California Gas Co. _ 42. CERTIFICATE OF OCCUPANCY No Date 61OWNER SFILIZIR ,JOB ADDRESS 711-C GENERAL CONTRACTOR LSBACK DATE 1/16/73 W. 17th St. BUILDING PERMIT NO. 34891 Owner Bldr. DESCRIPTION of WORK Ind. Bld,5. Ar. 11 -2 0-09,1@07 INS,,'CTIONS TRACT Si nature FIRE Date ZONE VALUE $ GROUP TYPE 16,2ti0.0O ZONE M-1 SOIL Al S, /-73 SUBCONTRACTOR PERMITS ISSUED GAS Date Number Signature WATER Plom-biacs .41 ROUGH PLUMBING PROP. SWR, LINE HOUSE CON. ❑ &7 SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER E] ROUGH WIRING TRENCHES ❑ FORMS ❑ STEEL REINF.L� D' tiptip av Vent FLOOR SYSTEM @- BOND BEAM El STEEL REIN mfia2Er SHEATHING FRAME AND FLASHING Q O O' LATHING - IN OUT PLA -F -R, BROWN COAT ST URAL, FINAL HEAT iNG. VENT., REFRIG. AND A.C., FINAL c - w 566.r - PLUMBING, FINAL AND GAS TEST ELECTRIC, FINAL BUILDING. FINAL �� +' OWNER - SFUJ.;M/RAIL5RACK DATE 1 -16 -73 - JOB ADDRESS 711 W. 17th Rt. A-2 BUILDING PERMIT NO. 34889 G"ERAL CONTRACTOR Owner. Bldr. DESCRIPTION of WORK Ind.dS . _ ►° o. T TRACT FIRE ZONE VALUE $ 161,260.00 . INSPECTIONS Si nature Dare TYPE III GROUP F-2 ZONE M-1 SOIL SUBCONTRACTOR PgRMITS ISSRED GAS 1 Dote Number Signature WATER I Plumbing ROUGH PLUMBING I PROP, SWR. LINE [�] HOUSE CON. ❑ I SPRINKLING SYSTEM i MISCELLANEOUS 4 ROUGH HEATING AND AIR CONDITIONING II TEMPORARY SERVICE OR POLE I UNDERGROUND ❑ POWER ❑ ROUGH WIRING Heating and Vent, TRENCHES FORMS STEEL REINF, FLOOR SYSTEM ' BOND BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING -- IN OUT :. P'' Fr��-A, BROWN COAT 5��.,.F+°TURAL, FINAL Electror HEATING, VENT., REFRIG. AND A.C.. FINAL PLUMBING. FINAL AND GAS TEST ELECTRIC, FINAL BUILDING. FINAL OWNER - SpILLERNU SBACK DATE 1-16-73 JOB ADDRESS 711 W. 17th St. A-3 BUILDING PERMIT NO. 34889 Cr"ERAL CONTRACTOR Owner Bldr. DESCRIPTION of WORK T-nd. Bldg. r oL16-260-09-10 LOT TRACT FIRE ZONE VALUES 161,2870.007 INSPECTIONS Si nature I Date TYPE III GROUP F-2 ZONE M-1 SOIL SUBCONTRACTOR PE MTS ISSYED GAS Date Number Signature WATER Piumbin ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON, SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND [] POWER ❑ ROUGH WIRING Hooting and Vent. TRENCHES FOR7S-117STEEL REINF. FLOOR SYSTEM BOND BEAM L3 STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING — IN F1 OUT P' ER, BROWN COAT S! _SURAL, FINAL HEATING, VENT.. REFrRIG. AND A.C., FINAL PLUMBING, FINAL ANO GAS TEST ELECTRIC, FINAL BUILDING, FINAL OWNER � SpTf R RAILSBACK DATE 1-16-73 JOB ADDRESS 711 W. 17th St. A-4 BUILDING PERMIT NO. 3 F9 C-"'ERAL CONTRACTOR Owner. Hldr. DESCRIPTION of WORK Tnd. Bldg. .011 -2 0-09-10LOT TRACT FIRE ZONE VALUE$ 161,2dO.00 INSPECTIONS Si nature I Date I TYPE III GROUP F-2 ZONE M-1 SOIL GAS SUBCONTRACTOR - PERMITS ISSYED Date Number Signature WATER Plumbing - ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER ROUGH WIRING Heatina and Vent. TRENCHES 0 FORMS Lj STEEL REINF. FLOOR SYSTEM BOND BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING — IN OUT P ER, BROWN COAT 51. _TURAL, FINAL Electrmc HEATING, VENT., REFR10. AND A.C., FINAL — PLUMBING, FINAL AND GAS TEST 964 ELECTRIC, FINAL BUILDING, FINAL �' OWNER SpnMRIRAILSBACK JOB ADDRESS G"ERAL COI k o7l-1-6-- 2+ INSPECTIONS W. 17th St. A-' OR Owm r Blcir . 1CLOT TRACT SOIL GAS WATER ROUGH PLUMBING PROP. SWR. LINE [ HOUSE CON. ❑ SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ❑ ROUGH WIRING TRENCHES Lj FORMS 0 STEEL REINF, ❑ FLOOR SYSTEM BONO BEAM ❑ STEEL REINFORCE ❑ SHEATHING FRAME AND FLASHING LATHING -- IN OUT PF ER, BROWN COAT S' .TURAL, FINAL HEATING. VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST ❑ ELECTRIC, FINAL BUILDING, FINAL DATE 1-16-73 BUILDING PERMIT NO. DESCRIPTION of WORK Ind. Bldg. FIRE ZONE VALUE TYPE III GROUP SUBCONTRACTOR Plumbina .00 zor OWNER 'SPILUR%RAZLMCK DATE 1-16-73 JOB ADDRESS 711 W. 17th St. A-9 BUILDING PERMIT N0, 34689 G"ERAL CONTRACTOR Owner. Bldr. DESCRIPTION of WORK Ind. Bldg,. oll6-260-0 -10LOT TRACT FIRE ZONE VALUE $ 161,235. INSPECTIONS Si nature Data TYPE III GROUP F-2 7 SOIL GAS SUBCONTRACTOR Date WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE F-1 HOUSE CON. I] SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGRDUNO POWER ROUGH WIRING Heatina and Vent. TRENCHES FORMS U STEEL REINF. FLOOR SYSTEM BOND BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING -- IN M OUT P! ER, BROWN COAT S1 .SURAL, FINAL Electric HEATING. VENT.. REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST - ELECTRIC, FINAL BUILDING, FINAL OWNER • SPILLEER/RAiLSBACK DATE 1-16-73 JOB ADDRESS 711 W. 17th St. BUILDING PERMIT NO. 34889 C ''ERAL CONTRACTOR Owner. Bldr. DESCRIPTION of WORK Ind. Bldg. ,o. 116 -26o -02-100T TRACT FIRE ZONE VALUE $ 161,280.00 - INSPECTIONS Signature I Date 11 TYPE III GROUP F-2 ZONE M-1 SOIL SUBCONTRACTOR PERMITS ISS D GAS I date I Number I Sienature WATER ROUGH PLUMBING PROP. SWR, LINE ❑ HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER ROUGH WIRING Hoatina and Vent. TRENCHES FORMS STEEL REINF. FLOOR SYSTEM BOND BEAM 0 STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING — IN ❑ OUT [71 P ER, BROWN COAT S'. _TURAL. FINAL HEATING. VENT.. REFRIG. AND A.C.. FINAL .2 -�J7 ELECTRIC, FINAL BUILDING, FINAL OWNER - SPIELER/RAILSBACK -- - -- - - ---DATE 1-16-73 JOB ADDRESS Ill W. 17th St. A-8 BUILDING PERMIT NO. 3+889 (r--"ERAL CONTRACTOR Owner. Bldr. DESCRIPTION pf WORK Ind. Bldg. 40•l16 -26o -o9 -10-0T TRACT FIRE ZONE VALUE $ 161.280.00 INSPECTIONS Si nature I Date TYPE TTT GROUP ZONE —1 SOIL GAS SUBCONTRACTOR PERMITS ISS ED Date Number Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE [] HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND Cl POWER C) ROUGH WIRING Heating and Vent. TRENCHES 7 FORMS STEEL REINF. FLOOR SYSTEM ' BOND BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING — IN 7 OUT P PER, BROWN COAT S. _TUBAL, FINAL Eloctroc- HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING. FINAL AND GAS TEST ELECTRIC, FINAL ' BUILDING, FINAL ___. {: OWNER KRANE, JANE DATE 5-1a=74 " JOB ADDRESS 711 W. 17th St. Suite A-9 BUILDING PERMIT NO. 38383 C 'RAL CONTRACTOR Owner-Bldr. DESCRIPTION of WORK xnter.Alt.for Food Preparation Ar io.116-260-09 LOT TRACT FIRE ZONE VALUE $L. 000.00 INSPECTIONS Signature Dote TYPE y GROUP F2 ZONE SOIL SUBCONTRACTOR PERMITS ISSUED GAS Date Number Signature WATER Plumbin ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER ❑ ROUGH WIRING Heating and Vent. TRENCHES ED FORMS [-] STEEL REJNF. FLOOR SYSTEM BOND BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING LA- NG — IN OUT PL _R, BROWN COAT STRUCTURAL, FINAL. Electric HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST 71 ELECTRIC, FINAL onn mein c ni MY I OWNER •SPILL'ER/RAILSBACK DATE 1-16-73 JOB ADDRESS 11 W. 17th St. A-9 BUILDING PERMIT NO. 34889 r-"ERAL CONTRACTOR Owner. Bldr. DESCRIPTION of WORK Ind. Bldg. �o- 6- 60-0 - AOT TRACT FIRE ZONE VALUE $161,280.00 INSPECTIONS Si nature Date TYPE TTT GROUP ZONE — SOIL GAS SUBCONTRACTOR - PERMITS ISSVED Date Number Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND (D POWER E] ROUGH WIRING I Heatina and Vent. TRENCHES FORMS STEEL REINF. FLOOR SYSTEM ' BONO BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING — IN n OUT f 'ER, BROWN COAT S. _.:TURAL, FINAL E Petrien HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST ELECTRIC, FINAL BUILDING, FINAL OWNER • SPIL'LER/RAILSEACK DATE 1-16-73 JOB ADDRESS 711 W. 17th St. A-10 BUILDING PERMIT NO. 34M9- r"ERAL CONTRACTOR Ownerbldr. DESCRIPTION_ of WORK Ind. Bldg. 4o•116-260-09-10LOT TRACT FIRE ZONE VALUE E 1 1,2 0.00. INSPECTIONS SI nature I Date TYPE III GROUP F-2 ZONE M-1 Soil cns SUBCONTRACTOR - PERMITS S5 D Dare Number Signature_ WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND E3 POWER E3 ROUGH WIRING Hootino and Vent. TRENCHES ED FORMS STEEL REINF. FLOOR SYSTEM BOND BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING — IN 0 OUT F -ER, BROWN COAT S. ,:TURAL, FINAL HEATING, VENT., REFRIG, AND A.C., FINAL PLUMBING, FINAL AND GAS TEST ELECTRIC, FINAL BUILDING, FINAL - OWNER - SPILLERYRAILSBACK DATE 1-16-73 JOB ADDRESS 711 W. 17th St. r "ERAL CONTRACTOR OWne JD-116-260-09-10LOT INSPECTIONS SOIL GAS WATER ROUGH PLUMBING PROP. SWR. LINE Q HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER ROUGH WIRING TRENCHES FORMS C3 STEEL REINF. FLOOR SYSTEM BOND BEAM STEEL REINFORCE _ SHEATHING FRAME AND FLASHING LATHING — IN 0 OUT F 'ER, BROWN COAT 5. -.:TUBAL, FINAL HEATING, VENT., REFRIO. AND A.C., FINAL PLUMBING. FINAL AND GAS TEST 0_ _ ELECTRIC, FINAL BUILDING, FINAL A -U TRACT Sianafure BUILDING PERMIT NO. DESCRIPTION of WORK Ind. Bldg. FIRE ZONE VALUES 161 280.00 TYPE TTT GROUP -2 ZO SUBCONTRACTOR I FERMI Date I I Plumbina OWNER • SPrLMR/RAILSSACK DATE 1-16-73 JOB ADDRESS 711 W. 17th St. A-12 _ _ BUILDING PERMIT NO. 34889 r-"ERAL CONTRACTOR owner/Bldr,. DESCRIPTION of WORK Ind. Bldg. to. 1A__phn_nq�.j hOT TRACT FIRE ZONE VALUE $ 161r280.00 - INSPECTIONS 1T2 0.00 - INSPECTIONS $OIL GAS WATER ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER ROUGH WIRING TRENCHES FORMS STEEL REINF. FLOOR SYSTEM BOND BEAM STEEL REINFORCE_ _ SHEATHING FRAME AND FLASHING LATHING - IN F -I OUT n I TER, BROWN COAT S ,CTURAL, FINAL HEATING. VENT„ REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST ELECTRIC, FINAL BUILDING, FINAL SUBCONTRACTOR 0 UwNERAroen tK g. Lnc. DATE 3-6-76 JOB ADDRESS _ 71 LW. 17th qt _ BUILDING PERMIT NO. GENERAL CONTRACTOR /Bldr. DESCRIPTION of WORK Tnstal I Paint 0,116-2 0-21 LOT TRACT FIRE ZONE VALUE $ 5nn, eO INSPECTIONS Si nature I Date ITYPE GROUP ZONE mr SOIL SUBCONTRACTOR PgRMITS ISSVEP GAS Date Number Si nature WATER Plumbing ROUGH PLVMBING PROP, SWP. LINE I] HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE I INV UNDERGROUND 0 POWER ROUGH WIRING Heatin and Vent, TRENCHES FORMS STEEL RE1NF. FLOOR SYSTEM BONG BEAM STEEL REINFORCE SHEATHING FRAME ANO FLASHING LATHING — IN n OUT P- 'TER, 13ROWN COAT _TUBAL, FINAL Electric HEATING, VENT., REFRIG. AND A.C.. FINAL PLUMBING, FINAL AND GAS TEST ELECTRIC, FINAL BUILDING, FINAL UVWfNCK - SPILLER_RAILSBACK_- -- .. .. ,. DATE 10-31-73 �. M13 ADDRESS 711 West 17th Street BUILDING PERMIT NO. 3744 GENERAL CONTRACTOR Harbor Plumbing DESCRIPTION of WORK 31 ' of gas pipe V", "to. LOT I1«:aEC710N5 TRACT EIRE Signature Date ZONE VALUE S TYPE GROUP 400.00 ZONE ,Solt SUBCONTRACTOR PERMITS ISS ED `s AS Date Number Signature IWATER Plumbing (ROUGH PLUMBING PROP, SWR. LINE ❑ HOUSE CON. Q SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER ROUGH WIRING Hooting and Vent. TRENCHES M FORMS STEEL REINF. FLOOR SYSTEM BOND BEAM STEEL REINFORCE SHEATHING FRAME AHP FLASHING LATHING --- IN OUT PLASTER, BROWN COAT TUBAL, FINAL _5 HL.,. ING, VENT., AEF 11 A D App„ FINAL PLUrnBING. FINAL AND GA ELECTRIC, FINAL BUILDING, FINAL c—rl el OFMI112PUrUTc VTtI`ICR Ur.LJ-plAraK% LLAV4�Wu Lav \ wo VAIt it -U-7 f,3 JOB ADDRESS '(11 west 1'(Ln bmreeL BUILDING PERMIT N0. 3(b�iS GENERAL CONTRACTOR Herz Masonry DESCRIPTION of WORK Retaining waIl ll -2 0-09 &LOT TRACT FIRE ZONE VALUE hCTIONS Si nature Date TYPE III GROUP J ZONE M-1 'SOIL SUBCONTRACTOR - PERMITS ISS ED GAS Date Number Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE [-]HOUSE CON. E] ` SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER ROUGH WIRING Heating and Vent. TRENCHES L3 FORMS Lj STEEL REiNF. FLOOR SYSTEM BOND BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING - LATHING — IN OUT PLAI-TER, BROWN COAT S(URAL, FINAL Electric HE— ANG, VENT., REFRIG, AND A.C., FINAL PLUMBING, FINAL AND GAS TEST ELECTRIC, FINAL BUILDING, FINAL OWNER TROY INVESTMENT FUND DATE 1217-79 !OB ADDRESS_ 7, W 17th Straet BUILDING PERMIT NO. GFNERAL CONTRACTORDESCRIPTION n4 WORK A 3-L—A')A—An-1—n LO RACT FIRE ZONE VALUE $ asn_nn INSPECTIONS Sr nature I Date I TYPE GROUP ZONE SOIL _ GAS _ SUBCONTRACTOR PC MTS S Oate Number 5i nature WATER Plumbing ROUGH PLUMBING PROP. 5WA, LINE I HOUSE CON, SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPOAARY SERVICE OR POLE UNDERGROUND POWER ROUGH WIRING Heatin and Vent. TRENCHES {FORMS STEEL REINF, FLOOR SYSTEM BOND BEAM 1 STEEL REINFORCE SHEATHING FILE FRAME AND FLASHING LATHING - IN 1.? OUT PI qR, BROWN GOAT S. ,'URAL, FINAL HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING. FINAL AND GAS TEST_____ ELECTRIC. FINAL ER SpiLLER RAILSBACK CO. DATE 10-8-73 JOB ADDRE55 711 W. 1-fth St. BUILDING PERMIT NO. 37394 GFtiERAL CONTRACTOR hertz Masonry DESCRIPTION of WORK 5 Retaining Wall A . 116-260-0 &liwI TRACT FIRE ZONE VALUE $ 17,000.00 INSPECTIONS Si nature Date GROUP J TYPE III ZONE Ml SOIL SUBCONTRACTOR PERMITS ISS ED GAS Date Number Signature WATER Plumbin ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. ❑ SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ROUGH WIRING A Heating and Vent. TRENCHES ❑ FORMS yTEEL REINF. Q r FLOOR SYSTEM BOND BEAM F1 STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING -- IN OUT PL' -R, BROWN COAT SElectrac T. . URAL, FINAL HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST ELECTRIC, FINAL RIIII nlNf FIN61 ER TROY INVESTMENTS DATE 4-16-79 OB ADDRESS 711 West. 17th Street ' BUILDING PERMIT NO. 47832 ,UkkINJILRAL CONTRACTOR TrIdjiStXinl Enternr4,PAESCRIPTION of WORK JIM Ctorago Tank LOT TRACT FIRE ZONE VALUE; :INSPECTIONS Signature Date _ TYPE V GROUP J ZONE MG -~Z MITS ISSUED SUBCONTRACTOR T PER - pato Number Signature 'SOIL IG AS WATER Plumbing OUGH PLUMBING PROP, SWR. LINE HOUSE CDN. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ROUGH WIRING Hooting and Vent. TRENCHES FORMS STEEL REINF, FLOOR SYSTEM BOND BEAM STEEL REINFORCE SHEATHING FRAME ANO FLASHING LATHING — IN 1-1 OUT PI '�R, BROWN COAT S-. :URAL, FINAL HEATING, VENT., REFRIG, AND A.C., FINAL PLUMBING, FINAL AND GAS TEST ELECTRIC. FINAL BUILDING, FINAL OWNER SPIiUR JOB ADDRESS 711 GEtiFRA� CONTRACTi A 16-26o-0 RAILSBACK DATE 1/16/73 W. 1 Lt St. A BUILDING PERMIT NO. R OwnerBldx. DESCRIPTION of WORK Ind. Bldg. LOT TRACT FIRE ZONE VALUES 161,260. INSPECTIONS Si nature I Dare IGROLIP F-2 TYPE III ZONE — SOIL! GAS SUBCONTRACTOR PERMITS ISSUED Date Number Signature WATER pl ROUGH PLUMBING PROP. SWR. LINE [4-H6y9E'-CON. 6 Q SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE i UNDERGROUND F] POWER O ' ROUGH WIRING HeoVpq and Vent. . TRENCHES FORMS STEEL REINF, c - FLOOR SYSTEM P92 42 o BOND BEAM STEEL REIN P -j9] ' SHEATHING FRAME ANO FLASHING i J9 LATHING IN OUT PI �R, PROWN COAT 5, 'URAL FINAL HEATING VENT , REFRIG. AND A.C., FINAL14-21t7-1 - �Ji^ - PLUMBING, FINAL AND GAS TEST F //4 - ELECT Ir. IZ BUILDING, FINAL 3 EA DATE JOB ADDRESS 711-$ W. 17th St. /-/� BUILDING PERMIT 0. } GENERAL CONTRACTOR Owner IRldr_ DESCRIPTION of WORK Tnd_ ,Bldg_,,,__ AF LOT TRACT FIRE ZONE VALUES INST- ECTION5 5i nature Date GROUP TYPE ZONE SOIL H SUBCONTRACTOR PERMITS ISSUED GAS Dote I Number 5i noture WATER PI ROUGH PLUMBING _ Q PROP. SWR. LINED HOUSE CON. d► 'I SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER El ROUGH WIRING _z 3 Heating and Vent. TRENCHES ❑ FORMS ❑ STEEL REINF. 0 FLOOR SYSTEM BOND BEAM 0 STEEL RE16etftE SHEATHING FRAME AND FLASHING LATHING -- IN D OUT PLY --:R, BROWN COAT ST URAL, FINA HEATING, VENT., REFRIG, AND A.C., FINAL PLUMBING, FINAL AND Otis i ELECTRIC, FINAL%3 BUILDING. FINAL EYYli C' P7. — l-4 "-OWNER' DATE --JOB ADDRESS 11-D W 17th St. BUILDING PERMIT NO. GENERAL CONTRACTOR OwnerB-1-dr DESCRIPTION of WORK Ind. B A OT TRACT FIRE ZONE VALUE $ 161 280.00 INa, cCTIONS Si nature Date GROUP —2 TYPE III ZONE M-1 SOIL SUBCONTRACTOR PERMITS ISS ED GAS Date Number Signature WATER PI ROUGH PLUMBING /� _ PROP. SWR. LINE Q HOUSE CON. _ SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER D ! ROUGH WIRING Houtina and Vent. TRENCHES FORtAS Q S EEL INF, / FLOOR SYSTEM BOND BEAM L REINFORCE —lu FRAME AND FLASHING LATHING — IN F1 OUT PLATER, BROWN COAT ST URAL, FINALact— HEA; MG, VENT., REFRIG. ANO A.C., FINAL PLUMBING, FINAL ANP GAS TEST ELECTRIC, FINAL ` — BUILDING, FINAL OWNER ��y Vn=CK DATE 12/16/80 JOB ADDRESS 711 W. 17th Street, E6 _ BUILDING PERMIT NO. 51027 GENERAL CONTRACTOR A.F.S.E. DESCRIPTION of WORK Dry ChEmical System A 1. 424--091-04 LOT TRACT FIRE ZONE VALUE $ 1,500.00 Ih_. ECTIONS Si nature Date TYPE GROUP ZONE GAIL GAS SUBCONTRACTOR PERMITS ISSYED Date Number Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. 0 SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER ROUGH WIRING Houtinia and Vent. S; TRENCHES FORMS STEEL REINF. { FLOOR SYSTEM h BOND BEAM D STEEL REINFORCE SHEATHING �r1i FRAME AND FLASHING In LATHING — IN OUT PLACTER, GROWN COAT r -I — a 51 URAL, FINAL Electric HEA.,r4G. VENT., REFRIG. AND A.C., FINAL PLUMBING. FINAL AND GAS TEST ELECTRIC. FINAL OWNER Bay Ready M x.Inc _ DATE 1/18/54 JOB ADDRESS 711 W •!7t}'.S'treeti BUILDING PERMIT NO. 62 GENERAL CONTRACTOR O%Tner VALUE $ 1000.00 L 116-026-10 81-OCK TRACT Office Bid , GROUP G TYPE V ZONE M1 FIRE DISTRICT 64 INSPECTION$ DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Footing Trench 1,J Foundation Forms and Grade to Garage Rough Framing Plumbing, Rough to Slab _/ /- Plumbing, Rough Complete Temporary Pole-� Wiring, Rough�� Heating, Rough Heating, .� e -- Heating, Final Sewer Septic Tank or Cesspool —f Pl;.a.ering Plumbing, Final, Fixtures Complete Plumbing, Final Gas Test 11j Wiring, Final 1J Occupancyy Form 210 C H IM 12-68 1 Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. �Y OVICOSTA�MfESA ' CONSTRUCTION PERMIT "A-7] � l� ; PE ,NO. �� TRACT NO. LOT NO, UNIT NO, I Project -Address / / I f,+++ J 'ZTN S7 . [ o Applicant's Mailing Address Owner's Address P Arch/Eng. �7 ' �/�-• _P� S License No,' �1 Address a� ��!/�T��+� %LJU: /Ucl1JO��y .SC��1 Contractor's Nam Dr Phone%%_ -6291_ J Address (mailing) �a� L6,00[l $lUn. /les"e,--ya'- _ City License No. a 3�'p ' tiLICENSED CONTRAC-rOA DECLARATION ' I-hereby'affirm that I am licensed under provisions of Charter 9 (commencing With section 7000) of Division 3 of the Business and Professions Code, and niy license is in ull force and effect, License Class0 No.' i Date - - Signature WORKERS' COMPENSATION DE RATION ereby affirm that I have a certiticate of consent [o self -insure or a certificate "` Workers' Compensation Insurance, or a certified, copy thereof (Section -"° 900, Lab. C.'')-�� » - -._ "policy No. �,tv� �O X370 Company 5ellVT Certified copy is hereby furnished. B Certified c0 pis filed with the city visio Oate �� _ Applicant EXEMPTION FROM WORKERS' COMP SATION DECLARATION (This Section need not be completed if the permit is for one hundred ($100) or less): I certify that in the performance of the work for which this permit is issued, I shall -'not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. ' Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers_' Compensation provisions of the Labor Code, you must forthwith Comply with Such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby afflrri that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name ' Lender's -Address OWNER BUILDER DECLARATION I hereby, affirm that I am exempt from the, Contractor's License Law for the following reason (Section "7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair . any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 '4herefrom and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subjects the applicant to a civil ,,a�•e,nalty of not mare than five hundred dollars ($500). L 1, as owner of the property or my employees with wages as their Sole compensation, will do the work, and the structure IS not Intended or offered for sale (Section r7044. Business and Professional Cotle;= The, Contractor's License Law does not apply to an owner of a property who builds or improve$ thereon, and who •does such work himself/herself or through his or her own employees, provided that such improvements are not intended Or offered for sale. If, however, the building or improvement is sold within one year of com- pletioh, the Owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractorsto construct the project (Section 7044, Business and Professions Code: ) The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con. tractors) license pursuant•to the•Contractoi's License Law). I am aware that proof of their Worker's Compensation insurance should be provided t0 me, ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner ' I hereby certify that I have read this application and state that the above - information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of thi icy to enter pon the above-mentioned property for inspection r� / Si nature Date Reinspection :F.ee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepi/Fact Bit. ICBO # Heating,System & Ducting ❑ 4100,000 BTU ❑ 100;000 BTL V Drivers' Lic se or SS I I Reinspection Fee CMF 0865-46, rev. 10184 ary - Applicant; Pink - Accounting; Goldenrod - Assessor FEES Issue Fes $ 3 iANICAL FEES Hood or Type I El Canopy Type II El Refrigeration System ❑4100,000 BTU ❑100,000.BTU System Repair/Alteration Fire Dampers Registers $15 Issue Fee $ 3 =� Automatic WasliJ Construction Pole Sub. ~� Cooking Unit , Dishwasher , Dryers ❑Gas I ❑Electric Fan Ll F,A,U. + Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW ❑5 15 K 1 374] ' 12!]4/-84 . " ' . Zone Accessory- Building: Parking Req./Provided,- I ELECTRICAL tTransformer ❑ 15-50 KW EJ 504 5d KW Meter EJ up to 100 amps Meter Dover 100 amps Sub Panel -Motors ❑4i HP 1-111A - B Inc, Solar 09-15 HP E116-15+'Micravvave Pole Light Range Sign ! Standing Sections W Trash Compactor Reinspection Fee $15Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat PLUMBING ' TYPE OF CONSTRUCTION ,7 NEW" LJ ADD ❑ C'O10 ERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. ' ALTERATION LJ REPAI R ` A.P. �y IS Backflow Irrigation Main Building: TYPE OF PERMIT El GRADING El FOUNDATION ❑ TENANT ❑ ELECTRICAL —1 PLUMBING ❑ -OTHER STRUCTURAL ❑ MECHANICAL T B A Front Rear PROJECT DESCRIPTION Sq. FT, OCCUPANCY CON STRUCTION TYPE VALUATION S ZONE GRADING CU.YDS• ACRES C S Right Left Ping. fief, # Remarks- 3 Urinal Planning Notes: ' I 1 Water Heater Reinspection :F.ee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepi/Fact Bit. ICBO # Heating,System & Ducting ❑ 4100,000 BTU ❑ 100;000 BTL V Drivers' Lic se or SS I I Reinspection Fee CMF 0865-46, rev. 10184 ary - Applicant; Pink - Accounting; Goldenrod - Assessor FEES Issue Fes $ 3 iANICAL FEES Hood or Type I El Canopy Type II El Refrigeration System ❑4100,000 BTU ❑100,000.BTU System Repair/Alteration Fire Dampers Registers $15 Issue Fee $ 3 =� Automatic WasliJ Construction Pole Sub. ~� Cooking Unit , Dishwasher , Dryers ❑Gas I ❑Electric Fan Ll F,A,U. + Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW ❑5 15 K 1 374] ' 12!]4/-84 . " ' . Zone Accessory- Building: Parking Req./Provided,- I ELECTRICAL tTransformer ❑ 15-50 KW EJ 504 5d KW Meter EJ up to 100 amps Meter Dover 100 amps Sub Panel -Motors ❑4i HP 1-111A - B Inc, Solar 09-15 HP E116-15+'Micravvave Pole Light Range Sign ! Standing Sections W Trash Compactor Reinspection Fee $15Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat PLUMBING Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains' Swimming Pool w/Spa I Floor Sinks Urinal Gas Service Ou'tlets Water Closet interceptors Water Heater Kitchen Sink Water Service Lavatories i Auto -Wash P—Trap Laundry Trays Roof Drains - PLAN CHECK Reinspection :F.ee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepi/Fact Bit. ICBO # Heating,System & Ducting ❑ 4100,000 BTU ❑ 100;000 BTL V Drivers' Lic se or SS I I Reinspection Fee CMF 0865-46, rev. 10184 ary - Applicant; Pink - Accounting; Goldenrod - Assessor FEES Issue Fes $ 3 iANICAL FEES Hood or Type I El Canopy Type II El Refrigeration System ❑4100,000 BTU ❑100,000.BTU System Repair/Alteration Fire Dampers Registers $15 Issue Fee $ 3 =� Automatic WasliJ Construction Pole Sub. ~� Cooking Unit , Dishwasher , Dryers ❑Gas I ❑Electric Fan Ll F,A,U. + Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW ❑5 15 K 1 374] ' 12!]4/-84 . " ' . Zone Accessory- Building: Parking Req./Provided,- I ELECTRICAL tTransformer ❑ 15-50 KW EJ 504 5d KW Meter EJ up to 100 amps Meter Dover 100 amps Sub Panel -Motors ❑4i HP 1-111A - B Inc, Solar 09-15 HP E116-15+'Micravvave Pole Light Range Sign ! Standing Sections W Trash Compactor Reinspection Fee $15Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat SUMMARY OF FEES BUILDING PERMIT ' $ ' SMIP' $ PLAN CHECK $ PERMIT ' PLUMBING 'S `ISSUANCE I $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL�_rL7o$ I1 ��[-�L� MICROFILM ' PLAN CHECK 5 $ $ MECHANICAL $ TOTAL FEE S PLAN CHECK 25% $ CONSTRUCTION AND PLANNING Date APPROVALS Permit # Inspector POOL SPA APPROVALS Permit # Date Inspecror 1 ._.Temporary Electrical Service or Pole 52. Pool & Equipment Location a *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, ❑ Undrgrnd., Test r 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, ❑ Undrgrnd. 10: Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12"Sewer'Cap 63. Heater & Vent -Final .13. Roof Drains 64. Plumbing System - Final 14. -,Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16., Rough Electric Wiring 67, Fencing & Access Approval 17.. Rough Wiring Sign 68. APPROVED FOR PLASTERING 1.8.1Rough* Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping IJ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 76. 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 C Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test �L 36. Hood or Canopy , 37. Final Factory Fireplace ?� 38. Final Plumbing r 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System f 45. Sound Attenuation 46. Handicap Regulations ' 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY NO. Date Applicant to fill In all spaces except those within heavy'border lines and sign all appropriate declarations. CITY OF COSTA MESA�� jCONS�TjRUCTION PERMIT t AI&ess f�4/ . Y Ilcant's Mailing Address Owner's Name - Phone ARidress Arch/Eng. License No. Address Contractor's Nam .Mf2&6X_1-!Z 464 7 / Phone , � _ ._y,21_71; Address (mailing) ��Q,_ 7+Si- aF/V f�R7 I✓,� a City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full for and effect, rf License Class License No. 3G �Zd Date Signature WORKERS' COMPENSATION D I..ARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 9800, Lab. C.) ,olicy No. Company _ Certified copy is hereby furnished, LJ Certified copy is filed with the city Building Division. Date Applicant - EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). 1 certify that in the performance of the work for which this permtt is Issued, I %hall not employ any person In any manners as to become subject to the . Worker y.Copen do laws of Califpcn� Date Jr oW__e Signatures 41 - 'NOTICE: If, after making this declare n, you $houttl become subject to the Workers' Compensation provisions o the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ, C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exernpt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to Construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business anti 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 subject$ the applicant to a civil -natty of not more than five hundred dollars ($500). i I, as owner of the property or my employees with wages as their sole ompensalion, will do the work, and the structure is not Intended or Of, for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner wilt have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuarit'to'the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and .state that the above information is correct. Iagree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for inspection pure se$ rta��Z/�fis Signature Drivers' Lidfftse or SS -'jlIl 9908 3/85/8 10- 5u TL 67 TYPE OF CONSTRUCTION LJ NEW qX ADD LJ ALTERATION V ❑ CONVERSION ❑ DEMOLISH U6THER DESCRIPTION OF WO �i /USE F BLD S� l REPAIR ' A.P. zone 5 Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL PQP UM 1NG ❑ MECHANICAL ❑ -OTHER �s .txi"iA-� E T Front Z O A Rear N C Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YOS. ACRES 5 G Left R Ping. Ref. # Parking Req./Provided E Remarks; Planning Notes: 0 M T S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES r Backflow Preventer Service Sink Automatic Washer Construction Pale Sub- Transformer ❑ 15-50 KW ❑ 50+KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter (Dover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Floor Drains Solar Tank Swimming Pool wlSpa Fan , F.A.U. Motors ❑0-11 HP ❑1 iS - 8 Inc. Solar ❑9-15 HP El 16 )5+ Floor Sinks Urinal Fixtures Microwave Gas Service ` Outlets Water Closet Device Boxes Pole Light Interceptors Kitchen Sink Water Heater Water Service 2 Outlets Switches Range Sign Lavatories Auto -Wash Garbage Disposal 1----- ' Standing Sections P—Trap Laundry Trays Generator 110-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Rainspaction Fee $15 Issue Fee $ 3 Boiler MECHANICAL Hood or Type I ❑ Canopy Type I I El FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date Dat Z Duct -Under Ground Duct - Structural Refrigeration System 00-100,00OBTU 0100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY $ $ $ $ _ $ $ $ $ OF FEES SMIP $ PERMITPLUMBING ISSUANCE $ ��`5(D ENERGY P.C. $ ^� GRADING $ MICROFILM $ TOTAL FEE $� Exhaust System ❑ Multiple ❑ System Repair/Alteration Firep1lFact. Bit. 1CB0 # Fire Dampers Heating System &Ducting 00-100,000 BTU ❑100,0001 Registers Reinspection Fee $15 Issue Fee $ 3 IF 0865-46, rev. 10/84 White . Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor STRUCTION AND PLANNING ROVALS Permit # Date InspectorAPPROVALS POOL Z A Permit # Date Inspector 1 ' 7eri!porary Electrical Service o� Pofe A 52. Pool &"Equipment Location * ^ '2. Soil Pipe-Undrgrnd. + } 53. Steel Reinforcement V Electrical Condyli utility-Undrgrnd ij 54. Forms-` 4.tEIectricaf Conduit U� drgrnd. �� 55. Electrical Bonding J ,5., Steel Reinforcement 56. Rough Plumbing & Pressure Test P �I ytt Electrical UFEFiiG'rnd. �� - 57. APPROVAL TO COVE f 7 Footings �f�'A 58. Electrical Conduit-Undrgrnd, 8 ;Foundation. 59. Gas Pipe, ❑ Undrgrnd., Test nl 9. Water Pipe-Undrgrnd. Y 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10:I-Structural Floor System _ 61. APPROVAL TO DECK 11aPrfperty Sewer Li & House Cori lection 62. Backwash & Receptor-Final 12,;Sewer Cap V n 63. Heater &Vent Finalbor } 1 Roof Drains l� .64. Plumbing System - Final es 14�Rough Plumbing t��f�� Leo 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 Elecirical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Un Lvrground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74, Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27.. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32.. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing ("f/2 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 1, Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PEAMIT NO. TRACT NO. LOT NO, UNIT N6 Project Address' .--7-11—W._ 17th St Bldg -(A) Uil i t 5 O + Applicant's Mailing Address' - TYPE OF CONSTRUCTION NEW ADD ALTERATIONtRE17AIunad E]CONVERSION ElDEMOLISH ElOTHER A P: # Owner's Name i Tt Qy InVestmenr Ftlnd -PhoneSGA-99 8 DESCRIPTION OF WORK/USE OF BLDG. Address. S Main Building: Arch/Eng. Marin .T Rnrir License No., TYPE OF PERMIT GRADING 0 FOUNOA1rION ❑ STRUCTURAL! T Front Address 1�8�?1 Knntt Air _ Suite 216_. ❑ TENANT ❑ ELECTRICAL PLUMBING MECHANICAL B Rear Contractor's Name Duca sir Condi ti nninpPhone I 982-1216 ❑ 'OTHER' C PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right Address Imailing} K CONSTRUCTION TYPE VALUATION $ S Left' City License No. 33925 _ ZONE GRADING CU. YDS. ACRES L-iCENSED CONTRACTOR DECLARATION Ping. Ref. + I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning,Notes: with section 7000) of Division 3 of a Business and Profess' s Code, and my license is in full fOrR and effect A46251 j License Class L(� Li se Date .4/ 18/84 Signature WORKERS' COMPENSATION DEC ATION I hereby affirm that 1 have a certificat of consent to self -insure or a certificate of Workers' Compensation Insuran , or a certified copy thereof (Section 3800, Lab_ C.) Policy No. WC9824 Company Llambermans H Certified copy is hereby furnishe Certifi o y is filed with the c' kldin ivision, n Date Applican Lkf AQ�C EXEMPTI N FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). ' I certify that in the performance of the work for which this permit is issued, I shall -not employ any person in any manner so as to become subject to the Workers'. Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall ' be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she -is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). 1, 'as' owner of the property 'or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code:_ The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove,for the purpose of sale). i ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractors} license pursuarit.to'the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to'me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this a lication and state that the above information is c rrect. I agree to comp Ith all city and county ordinances and state la lating to b Ing co tr ction,-and hereby authors a repre- sentatives th city to or n he above-mentioned erty for inspeCtio pur i Signature Date 3 Drivers' Lit a oriSS 1738 W24 u� ' Zone Accessory,Building: - Z O N N G _ R Parking Req./Provided E Q M T S CMF 0865-46, rev, 10/84 ,- Applicant; Pink - Accounting; Goldenrod - Assessor - PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backfiow Irrigation Sewer Cap Bathtubs Sewer Connection i Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps _ dishwasher Solar Piping Dryers OGas ©Electric Sub Pane! Drinking Fountains Solar Tank Fan Motors ❑0-1 HP ❑1 /: - 8 Floor Drains Swimming Pool vv/Spa F.A.U. Inc. Solar 09-15 HP 016-15+ Floor Sinks Urinal. Fixtures- Microwave Gas Service Outlets .Water Closet' Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches . Sign Lavatories Auto -Wadi Garbage Disposal ; Standing Sections P—Trap* Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor Roof Grains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee • $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date ' Application Issued By ODD at. Boiler Hood or Type I ❑ Canopy Type I f L] Duct - Under Ground Duct - Structural Refrigeration System 00-100,000BTU E1100,000BTU Duct - Ventilating SUMMARY BUILDING PERMIT $ PLAN CHECK $ $ PLAN CHECK 25%,$ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ OF FEES SMIP $ PERMITPLUMBING ISSUANCE $ , ENERGY P.C. $ ' GRADING $ MICROFILM $ 13.00 TOTALFEE $ 15'50 r 2.50 Exhaust System ❑ Multiple ❑ System Repair/Alteration Firep1lFact. Blt. ICBO+ Fire Dampers 1 Heating System & Ducting ®0-100,000 BTU ❑100,000 BT Registers 6 F. 00 4 -M Reinspection Fee $15 Issue Fee '. $ 3 CMF 0865-46, rev, 10/84 ,- Applicant; Pink - Accounting; Goldenrod - Assessor - CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA -APPROVALS Permit # Date Inspector 1 .-Temporary Electrical Service or Pole 52. Pool & Equipment Location 2, -Soil Pipe-Undrgrnd. 53. Steel Reinforcement r .. 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding t 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test -6. Electrical UFER Grnd, f Ar 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduif-Undrgrnd. 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System "''' 61. APPROVAL TO DECK 11. Property Sewer Line & House Conni~ction 62. Backwash & Receptor-Final , 12. Sewer Cap f` 1 63. Heater & Vent-Final 13, Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final. l 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 APPROVALS Permit # 20. Rough Factory Fireplace 21., Ducts, in Structure 70. Underground Hydro 22. • Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 Nates, 34. Final Heating & Air Conditioning l'o-I 35, Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39, Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42, Backflow Preventer' 43, Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & -BUILDING I - 48. Special Requirements Completed ' 49. Electric Release to Edison o X50. Gas Release to Southern California Gas Co ;1. CERTIFICATE OF10CCUPANCY Date _ Ad • CITY OF COSTA MESA CONSTRUCTION PERMIT Ppeject Address ZLI LAt, %i►w 5! . LAN -1,2,0,M 5 Applicant.) Mailing Address Owner' Name / �C y �►`) l'iSSA1 i�� Phone Address Arch/Eng. License No. Address ..��77 � Contractor's Name MAI; kg Ze- r `l_-4 i It Phone��L_L.:.SZ_RYP -i— Address (mailingix% � in✓i�Nl n,LCCm11Jf. ;,CAS 921 G( City License No.�� LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provision$ of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full4fyrce and effect. ��J 3% License Class i se No.� Date 1 /C -'3.$r Signatur It zi 1 _ WORKERS' COMPENSATION DEC ATION\ ~� I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section )800, Lab��( / ..� Policy Nwl __ ID�� /(Z ;jany Certified copy I$ hereby furnishetl.Certified cop Is flied with the cityg Divis on, Date I=1Q-"� Applicant�� EXEMPTION FROM WORKERS' COMPENSATION DE LARATION (This section need not be completed if the permit is for o e hundred ($100) or less). I certify that in the performance of th or w ich this rmit is ued I shall not' employ any person in any anne so as to beco a subje t6 t N e Workers' Co ens 6 Laws of Calif is Date r Signature 'NOTICE: If, after making this declaration, you shouldcome subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's "Address _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file asigned statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter g (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 ��enelty of not more than five hundred dollars ($500). I, as owner of the property or -my employees with wages as their solo compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletlon, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuarit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me, ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information Is correct. I agree to comply with all city and county ordinances and state law lati tiding co structlo and hereby authorize repre- sentatives oT this y to ester upo i the a ve-mentioned property f r inspection pu ses. Signature Date t�r Drivers' License or SS Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERfT NO. TRACT NO, LOT NO. UNIT NO. TYPE OF CONSTRUCTION El NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p' DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TYPE OF PERMIT GRADING FOUNDATION ❑ STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SCI. FT. OCCUPANCY C Right K' CONSTRUCTION TYPE VALUATION S S Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—T rap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground, Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays FEES Issue Fee S 3 MECHANICAL FEES Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0 100,000 BTU E1100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee I $ 3 5812 I/I6/65mono 4450 TL Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator El 0-5 KW El 5-15 KW Transformer ❑ 15.50 KW ❑ 50+KW Meter ❑up to 100 amps, Meter ❑over 100 amps Sub Panel Motors 1 HP Ell i4 - B Inc. Solar ❑9.15 HP 01&15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES Z O N I N G R= E 0 M T S I I Reinspection Fee 1 $15 I 1 Issue Fee .1 $ 3 1 1 DEVELOPMENT SERVICES REOUIREMENTS: Zoning Approved By Building Approved By Application Issued By— SUMMARY OF, FEES BUILDING PERMIT S SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.0 ELECTRICAL $ �'.00 GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ s PONSTRUCTION AND PLANNING V Date jjj APPROVALS Permit # �f Inspector POOL a SPA I APPROVALS Permit # Date Inspec-n!, 1 . Telriporary Electrical Service or Pole '� 52. Pool & Equipment Location �2. Soil Pipe-Undrgrnd,, � > V 53. Steel Reinforcement 1 3�Electrical.Cond iu t UtiliLy-Undrgrnd. 54. Forms Ugrnd, '4. -"Electrical Conduit-ndr 6L� t 55. Electrical Bonding 5!Steel _reinforcement 5- to -� i 56. Rough Plumbing & Pressure Test B.� Electrical UFER.G_r"nd, r 57. APPROVAL TO COVE R-GUNITE 41 7yFooti"ngs 58. Electrical Conduit-Undrgrnd. a 8," Foundation r 59. Gas Pipe, ElUndrgrnd., Test �dt '9. -Water Pipe-Undrgrnd. 60. Backwash Lines, -Trap, ElUndrgrnd. 10; -Structural Floor System 4'� r 61. APPROVAL TO DECK 11.^Property Sewer Line.& House Co' nection t "� 62, Backwash & Receptor -Final 12 ;Sewer Cap V 1 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing " f' ' 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas D Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank D Gas D 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 Nates: 34. Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39, Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. 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 l��o. Date - CITY OF COSTA �fMESA CONSTRUCTION PERMIT Project / Address 11 • 17T//�TSi'r 3S 7-A III C,&4 Applicant's Mailing Address Owner's Name ,r a .Ziou,lu T mr.-jT Phone Address Arch/Eng, License No. Address Contractor's Name_! zlzis h Z,9e-M )C_ Pe o'97742?d Address (mailing)A 4At6enEA 1 Q16,t ^10670-3 92 1 )� City License No. 3- % n LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class `i�en o DateSignatures WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section 800; Lab.-) ^ �� rolicy No. �^ S 10 SU 71) Company BCertified copy is hereby furnished Certi !d co_ py, is filed with the cit Buildi g Ivi "on. Date ` fO Applicant EXEMPTION FROM WORKERS' COMPENSATION DEC ARATION (This section need not be completed if the permit Is for on hundred ($100) of less). I certify that in the performance of the ch this per it is Is ed, 1 shall not employ any person in any anner o as t ' beco bject t the Workers' Com'eens 'Laws of Califo nia. Date hie NOTICE: If, a ter making thiss cleCldeclaration, ou should Dec me subject to the Workers' Compensation provisions of the Labor Code, yob must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ, C•) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for Such permit to file a signed statement that he/she Is licensed pursuant to the provisions of theContractor's License law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or thathe/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section ':431,5 by any applicant for a permit subjects the applicant to a civil •�="Snalty of not more than five hundred dollars ($500). g I, as •owner of the ,property or my employees with wages as their sole compensation will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 builds or -improves thereon, and _who contracts for -such projects with a con- tractors) license pursuant'to the Contractor'S License Law). I am aware that proof of. their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason 3plicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. PERMIT NO. ' TRACT NO. LOT NO. UNIT NO. .�'t-1I� TYPE DF CONSTRUCTION NEW LJ ADO LJ ALTERATION U REPAIR ❑ CONVERSION El DEMOLISH El OTHER A.P. # DESCRIPTION OF WORK/USE OF 8LDG. S Main Building: E TYPE OF PERMIT GRADING El FOUNDATION ElSTRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ •OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K • CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU. YDS. ACRES Ping, Ref, # Remarks: Planning Notes: Zone Accessory Building: Parking Req./Provided hoK TL Z O N 1 N G R E 4 M T S Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepi/Fact. Bit. ICBO # Date Owner Heating System JL r) I hereby certify that I have read this application and state that the above 00-100,000BTU ❑160,000BT information is correc ree to co Ur1S,--A_ with all. City and county ordinances and state laws *latg oidling coruction, d hereby authorize repre- entativesof tto enter upthe ab v .mentioned property for inspection purp "- Signature}C Datej—w—-_ Reinspection Fee DriversLicense or SS =p 4F 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor ►\ $15 Issue Fee � $ 3 PLUMBING FEES ELECTRICAL FEES Ta -M in Showers Backflow Preventer Service Sink $15 Issue Fee Automatic Washer Construction Pole Sub. Transformer 0 15-56 KW ❑ 50 + KW Backflow Irrigation Sewer Cap, '' Bathtubs Sewer Connection DEVELOPMENT SERVICES REQUIREMENTS: Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Cover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Date Date ' Fan Motors 100-1 HP El 11/. -13 Floor Drains Swimming Pool w/Spa BUILDING PERMIT PLAN CHECK F.A.U. Inc. Solar ❑9-15 HP ❑16-15+ Floor Sinks + Urinal Fixtures Microwave Gas Service Outlets ' Interceptors Water Closet Water Heater PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% Device Boxes Outlets Pole Light Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays __[ Generator ❑D-5 KW [--15-15 KW Trash Compactor i F1 Roof -Drains : PLAN CHECK 25% $ Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepi/Fact. Bit. ICBO # Date Owner Heating System JL r) I hereby certify that I have read this application and state that the above 00-100,000BTU ❑160,000BT information is correc ree to co Ur1S,--A_ with all. City and county ordinances and state laws *latg oidling coruction, d hereby authorize repre- entativesof tto enter upthe ab v .mentioned property for inspection purp "- Signature}C Datej—w—-_ Reinspection Fee DriversLicense or SS =p 4F 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor ►\ $15 Issue Fee � $ 3 Reinspection Fee $15 Issue Fee $ 3 �ANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Hood Type 1 ❑ or Canopy Type I1 ❑ Zoning Approved By Date Building Approved By Application Issued By Date Date ' Refrigeration System ❑0.100,000 BTU ❑ 100,000 BTU BUILDING PERMIT PLAN CHECK SUMMARY OF FEES S $ SMIP PERMIT $ System Repair/Atteration Fire Dampers PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% $ $ $ -4 .00 $ ts O ISSUANCE $ , ENERGY P.C. $ GRADING $ MICROFILM $ Registers MECHANICAL $ TOTAL FEE $ L-4 • So Issue Fee $ 3 : PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL ?A APPROVALS Permit # Date Inspector 1 . Temporary Electrical Service or Pole ' 52. Pool &Equipment Location 1 `2. Soil Pipe-Undrgrnd.� 53, Steel Reinforcement 3%Electrical Conduit Utility-Undrgrnd. 54. Forms -4-+Electrical Conduit-Undrgrnd. i 55. Electrical Bonding 5' Steel'Reinforcement, 56. Rough Plumbing & Pressure Test + 6 Electrical UFER Grnd. } r 57..APPROVAL TO COVER-GUNITE ].:Footings 0:' 58. Electrical•Conduit-Undrgrnd, 8.. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test r. 9. Water- Pipe-Undrgrnd.��► 1 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10,`•Struetural Floor System 61. APPROVAL TO DECK 11., Property Sewer -Line.& House Con6ef tion n 62. Backwash & Receptor -Final 12. Sewer Cap , 1 j 63, Heater & Vent -Final i 13. Roof Drains I `� 64. Plumbing System -Final 14. Rough Plumbing ' i 65. Electrical -Final 15, Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring i 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 APPROVALS Permit # 20, Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test i 72. Underground Flush 24, 'Roof Framing 73. Undergrnd. Storage Tank ❑ 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 1 HEALTH DEPT. REQUIREMENT V. Plaster Brown Coat 79. FINAL INSPECTION 3TElectrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric o2 C Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer r 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 e Applicant to fill in all spaces except those within heavy border lines anti sign all appropriate declarations. CITY OF COSTA MESA CONSTiUC,TION ER IT 11 PERMIT NO. I TRACT NO. LOT NO. UNlT NG. ProrOjeLt i4ddress Applicant's Mailing ddress A7e1�lU Owner's Name IrJlV 1A--_ruAAL--phone Address Arch/Eng. License No. Address Contractor's Nam Phone %%_ Address (mailing) 0421A) X1010 V, A. City License No. �a2 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect. r1 License Glass License No30�'3d Date " «1� Signature WORKERS' COMPENSATION DE LARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) i Policy No. Company 8 Certified copy is hereby furnished. Certified copy is filed with the city Building Division. 1 Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($1 GO) or less). t 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 Workerti�Coensa 'on Laws of Califor Date 'l1�m �� 4t!:.__ Signature NOTICE: If, after making this declare , you should become subject to the Workers' Compensation provisions of he Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lendor's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file asigned statement that he/she is licensed pursuant to the provisions of 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 1031.5 by any applicant for a permit subjects the appticant to a civil .enalty of not more than five hundred dollars ($500). -0 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. It, however, the building or improvement Is sold within one year of Com - pletion, the owner will have the burden of proving he/she did not build or im- rove forr the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed Con- 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 builds or improves thereon, and _who contracts for suen projects with a con- tractor(S) license pursuaKt.to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason 1S o FEES ELECTRICAL FEES TYPE OF CONSTRUCTION NEW UADD #1ALTERATION U REPAIR Service Sink ❑ ❑ ❑ Automatic Washer Construction Pole Sub_ CONVERSION DEMOLISH OTHER A.P. # DESCRIPTION OF WO K/US F BL G. r Sewer Connection Fes+ 5 Main $uildi t Y E Dishwasher - TYPE OF PERMIT LJ GRADING L1 FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICA`nL "� PLII/jjpp,��IIBING ❑ MECHANICAL B Rear El -OTHER Il Sx �� A Fan C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K F,A,U. CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks: Planning Nates: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service ! Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact, Bit, ICBO # Date Owner Heating System &Ducting I hereby certify that I have read this application and state that the above ❑&100,000 BTU ❑100,000 BT information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city o enter upon the above-mentioned property for inspection pur s Signature Dat Drivers' LJeVA or SS :ht Reinspection Fee GMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 9907 3/25/65 Zone Accessory Building: Parking Req,/Provided, 10o5il 1'L Z O N I N G R E Q M T S IMBING FEES ELECTRICAL FEES Showers Service Sink 2 no Automatic Washer Construction Pole Sub_ Transformer ❑ 15-50 KW ❑ 50 + KW Sewer Cap Sewer Connection Cooking Unit Meter ❑up to 100 amps Solar Collectors Dishwasher - Meter ❑over 100 amps Solar Piping Dryers ❑Gas ❑Electric Sub Panel Solar Tank Fan Motors ❑0-1 HP Ell y - 8 Swimming Pool w/Spa F,A,U. Inc.Soiaf ❑9-15 HP 016-15+ Urinal Fixtures -Microwave Water Closet Zco Device Boxes Pole Light Water Heater Outlets Range Water Service Switches Sign Auto -Wash Garbage Disposal Standing Sections Laundry Trays Generator 00-5 KW 1:15.15 KW Trash Compactor Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 -IANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By _ r . pat Z Hood or Type ❑ Canopy Type It ❑ Refrigeration System 00-100,000 BTU 0100,000BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICA(_ PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ OC) ISSUANCE $ $ M ENERGY P.C. $ $ GRADING $ $ MICROFILM $ $ TOTAL FEE $ $ System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 :CONSTRUCTION AND PLANNING ,. Date APPROVALS Permit # Inspector POOL JPA APPROVALS Permit # Date - Inspector t a 1. Temporary, Electrical Service or P61e l 52.- pool & Equipment Location 2. Soi1,Pipe-Undrgrnd. 1 �= 53. Steel ReinforcementCIO , 3' Electrical Con uit'ilti;ity_Undr °rod. 54. Forms �1 Electrical Condu t Undigrnd. 55. Electrical Bonding r 5. SCBE l'Reinforcenient 56. hough Plumbing &Pressure Test E �6. Electrical UFER,grnd. - 57. APPROVAL TO COVER-GUNITE a` 7., Footings (., eel 58. Electrical Conduit-Undrgrnd, 8!'.Fudation G''S 59. Gas Pipe, ❑ Undrgrnd., Test n -e 9. Water Pipe-Undrgrnd. s� ; 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 16 '§t--uctural Floor System 61. APPROVAL TO DECK 114Property Sewer Line &House Conri; ction i 62. Backwash & Receptor -Final s -12' Sewer Cap t/ 63. Heater & Vent -Final u' 1r3Roo# Drains 64. Plumbing System - Final 1, )'Rough Plumbind!f Cf 65. Electrical -Final rj 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 i FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. UWerground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation- . 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. •Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43, 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.000UPANCY_ No. Date ' CI Applicant to fill In all spaces 9Kcept those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT No- TRACT NO. LOT NO. UNIT ales_ Project Address 711 14 Applicant's Mailing Address —1.3110 Ra ti ray St. N. HQUYLJ001 Owner's Name T.r-OV InVi_ncz hone 541-298 Address rlJ21 Hi'rCp Sr LNewport KParns ra. Arch/Eng. —31r License No. Address 1_2.881 Knott -AV -. Sftit-a 91A Contractor's Nam Phone -C),92-1 2l h Address lmaiiingl-]31.1110 Cat- Qqy Ct U 1-Tn11y_wa0d Ca City License No. 339.2.5 LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Prot ions Code, and my license is in full fgiye and effect, License Class C--L[I Cens� N 6251 Date4/18/84 Sl9natur WORKERS' COMPENSATION O LARATION l hereby affirm that 1 have a cert! Cate of consent to self4n5ure or a certificate :f Workers' Compensation Insurance,, or a certified copy thereof (Section 3800, Lab. C.)-' Policy No. WC9824 Company Lumbermans Certified copy is hereby furnished. Certs i d c py is filed with the city 4uildinIvisjq�i. Date Applicant _ C..�L)y EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). t certify that in the performance of the work for which this permit is I$$ued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to tate Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION • LENDING AGENCY I hereby affirm that there is a con struCtion'lending agency for the performance. of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name,... --- Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am.exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to conUruct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profetsions Code) or that he/she is exempt herofrom 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 p�enalty of not more than five hundred dollars ($500). , L.l I, -as' owner of the property or n,y employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale' (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improve$ thereon, and who does Such work hirnself/herself or through his or her own employees, provided that such improvements dre not intended or offered for Sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for tne�purpose of sale). I, a$ owner of the property, am exclusively contracting with licensed con- tractors to construct the projectiSectiOn 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for Such projects with a Con- tractors) hcense pursuant'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me, ❑ 1 am exempt under Section- B. d. P. C. for this reason Date IOwner - I hereby certify that I have read t information is correct. I agree to co and stale la elating to Ui1,11109 sentatives f if" ity yr�en��i Inspectio s (/�y Si nature pplication and state that the above with all city and county ordinances -uctlon, and hereby authorize e re - the above-me�tloned propArty7or Da TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR FEES ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. qIE DESCRIPTION OF WORKIUSE OF BLDG. Service Sink Automatic Washer Construction Pole Sub. S Main Builds Sewer Cap E TYPE OF PERMIT C1 GRADING 17 FOUNDATION C1 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL Dishwasher El OTHER A Rear C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K •f' Fan CONSTRUCTION TYPE VALUATION 5 $ I Left ZONE GRADING CU. YDS. ACRES Ping, Ref, # Remarks: Planning Notes: ar Sink ackflow Preventer ackflow Irrigation athtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 1 CW 00,000 8TU 0100,000 BTI. 9 Drivers' Lic se or SS Reinspection Fee $15 AF 0865-46, rev. 10/84 White . Building; Canary :Applicant; Pink - Accounting; Goldenrod : Assessor -1737 4/24/85 Zone Accessory. Building: Parking RecidProvided 15a 50 - TL - Z O N I N G R E Q M T S PLUMBING FEES L + ELECTRICAL FEES Showers Service Sink Automatic Washer Construction Pole Sub. Transformer '❑ 15-50 KW ❑ 50 + KW Sewer Cap Sewer Connection Cooking Unit Meter El up to 100 amps Solar Collectors Dishwasher Meter ❑over 100 amps Solar Piping ; Dryers ❑Gas ❑Electric Sub Panel Solar Tank •f' Fan Motors 00-1 HP 0136- 8 Swimming Pool w/Spa F.A.U. Inc. Solar 09.15 HP 016-15+ Urinal Fixtures - Microwave Water Closet Water Heater Water Service Device Boxes Outlets Switches Pale Light Range Sign Auto -Wash Garbage Disposal ; Standing Sections Laundry Trays Generator 00.5 KW 05-15 KW Trash Compactor Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 IECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat Hood or Type I ❑ Canopy Type I I 0 Refrigeration System 00-100,000 BTU 0100,0008TU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY $ $ $ $ $ $ $ 13.00 $ OF FEES SMIP $ PERMIT •ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTALFEE $ 15.50 2s 50 System Repair/Alteration Fire Dampers 6 Registers 6 00 Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS - Permit# Date Inspector POG SPA APPROVALS Permit# Date Insppctnr 1.' Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement r, 3. Electrical Conduit Utility-Undrgrnd. 54. Forms .' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ,5. Steel Reinforcement 56. Rough Plumbing & Pressure Test t { 6. Electrical LIFER Grnd. %�" 57. APPROVAL TO COVER-GUNITE t' 7. ,Footings •; 58. Electrical Conduit-Undrgrnd. 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. ` 10. Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Conrrection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 1 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. POOVSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21 • Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71 • Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ 0il 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding' 77. FIXED SYSTEM FINAL 29. Insulation 78, FIRE PREV, FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79• FINAL INSPECTION 32; Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. 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 - 050. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY Date + iNo. OWNER JOHN J. COTE, JR. DATE 11-14-79 . JOB ADDRESS 711 W 17th Street Uni t A-6 BUILDING PERMIT NO. 49174 GENERAL CONTRACTOR DESCRIPTION of WORK Nontlect wallSign 424-041-03 LOT TRACT FIRE ZONE VALUEb 00.00 IK CTIONS Si nature I Date TYPE GROUP ZONE MIS SOIL SUBCONTRACTOR PERMITS ISS D GAS Date I Number I Signature WATER Plumbing ROUGH PLUMBING PROP, SWR, LINE HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND r'-1 POWER L.__I ROUGH WIRING Heating and Vent, TRENCHES FORMS 0 STEEL REINF, FLOOR SYSTEM BOND BEAM (^ STEEL REINFORCE I—I SHEATHING FILE - FRAME AND FLASHING LATHING — IN —1 OUT PLASTER. BROWN COAT SF,'" URAL, FINAL ;r s;Electric___ VENT„ REFRIG. AND A.C., FINAL PLUMBING. FINAL AND GAS TEST ELECTRIC. FINAL Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. Project Address 711 o ens /n rTt Applicant's Mailing Address + Owner's Name l ;i !" hiN+j Phone Address Arch/Eng. License No. Address �} Contractor's NamttL' aAR iS F_zge Te irc Phone V77` 1,t Address (mailing 234 City License No. _ ? LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in fu!force and effect. License Class '�� e se N /e� ,573zr— Date 1=10 "JtS Signatu WORKERS' COMPENSATION DE RATI I hereby affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section )0, Lab. C.) ilicy No.AllenS O-7 C Certified copy Is hereby furnishe Certitied copy, Is 'led with te cit iM.nISion, Date Applicant EXEMPTION FROM WORKERS' COMPENSATION p CLARATION (This section need not be completed if the permit Is for one hundred ($100) or e lcertify that in the performance of theCe or which this i ermlt i slued, I shall not employ any person in any o a to beta a subj t t0 the riorkers'Com ensati Laws of Callfo Date Signature NOTICE: If, after making this declaration, you should b ome subject to the Workers' Compensation provisions of the Labor Code, Ou must forthwith comply with ' such provisions or this permit shall be deemed revoked. CONSTRUCTION .LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance~ of the work for which this permit is issued (Section 3097 Clv. C,) Lender's Name ' Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the folio wing reason (Section 7031'.5 Business and Professional Code: Any city or county which requires a permit t0 construct, alter, improve, demolish or repair . any structure, prior to its issuance, also requires the applicantJor Such permit 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 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 31.5 by any applicant for a permit subjects the applicant to a civil iatty of not more than five hundred dollars ($500). J I, as owner of the property or my employees with wages as their sole compensatlon, will do the work, and the structure is not intended or offered for Sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale), ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's LicenseLaw does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof oftheir Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have real information is correct. I agree to and state laWw o buildir sentativ., cito enter Inspection o Signature Drivers' Lic his application and state that the above mply wall clty and county ordinances :onstru t. n, and hereby authorize repre- pon thg1bove-mentioned property for Date—� TYPE OF CONSTRUCTION LJ NEW lJ ADD LJ ALTERATION LI REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 46 DESCRIPTION OF WORK/USE OF BLDG. - S Main Building: E TYPE OF PERMIT U GRADING1:1 FOUNDATION 0 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K Left CONSTRUCTION TYPE VALUATION $ $ ZONE GRADING CU.YDS. ACRES Ping. Ref, # Remarks: Planning Notes: Bar Sink Backflow Preventer Backfiow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service. Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct- Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Sit. ICBO # Heating System & Ducting ❑0-100,000 BTU El 100,000 BT' Reinspection Fee CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 5813 ' 1/16/85 b,60 TL Zone Accessory Building: Parking Req./Provided Z O N 1 N G R E Q M T r S PLUMBING FEES Showers ELECTRICAL FEES Service Sink Automatic Washer Pale Sub. Transformer ❑ 15.50 KW El 50 + KW Sewer CapConstruction Sewer Connection Cooking Unit Meter ❑up to 100 amps Solar Collectors Dishwasher Meter ❑over 100 amps Solar Piping Dryers ❑Gas ElElectric Sub Panel Solar Tank Fan Motors 1 HP Ellm, -a Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP 1:116-15+ Urinal Fixtures Microwave Water. Closet Device Boxes Pole Light Water Heater Outlets Range Water Service Switches Sign Auto -Wash Garbage Disposal ; Standing Sections Laundry Trays Generator ❑0-5 KW 05-15 KW Trash Compactor Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By _ Date Hood or Type I ' ❑ Canopy Type 11 ❑ Refrigeration System F 00400,000 BTU 16100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PIAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ $ L• oo � GRADING $ $ Go MICROFILM $ $ TOTAL FEE $ 5o $ System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL ?A APPROVALS Permit # Date lnspPrmr 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location '2. Soil Pipe-Undrgrnd 53. Steel Reinforcement 3. -Electrical Conduit Utility-Undrgrnd. h 54. Forms 4:'Ele6trical Cond `it t{ndrgrnd. 55. Electrical Bonding 5.'Steel•Reinforcement .+ `r 56. Rough Plumbing &Pressure Test ry fi:• Electrical UFER,G nd. 57. APPROVAL TO COVER-GUNITE 7.`Footings 58. Electrical Conduit-Undrgrnd. r 8 Foundation 59. Gas'Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. -N. r> 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 4 10. Structural Floor System 61, APPROVAL TO DECK 11'.'Property Sewer Line'& House Connection fit. Backwash & Receptor -Final 12: -Sewer Cap j 'r 63. Heater & Vent -Final 13. Roof Drains i 64. Plumbing System - Final .J J 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. POOLISPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72, Underground Flush 24, Roof Framing 73. Undergrnd, Storage Tank ❑ 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 3-InPlaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Of Nates: 34. Final Heating & Air Conditioning 35. Final Gar Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 49. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Cc 51. CEFiTI_FICATE OF OCCUPANCY Nn. Date - _ ' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERI T P MIT NO. TRACT NO. LOT NO. UNI)i N Project Address / W l! Applicant's Mailing actress TYPE OF CDNSTRLICTION NEW ADO ALTERATION REPAI R Owner's Name Phone Address Arch/Eng. License No. Address Contractor's Nam Phone 7-77.2 Z. q Address (mailing) City License No. V15'.2 f LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the BLrsiness and Professions Code, and my license is in full rce and fect. License Class License Date Qom/ �%Signature WORKERS' COMPENSATION DEC RATION I hereby affirm that I have a certificate of consent to self -insure or a certificate -� Workers' Compensation Insurance, or d certified copy thereof (Section 10, Lab. C.) .icy No. Company HCertified copy is hereby furnished. r Certified copy is filed with the city Building Division. Dale Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the 13(3rmlt Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued, (- shall not employ any person in any manner s as to become subject to the Workers Co en t' Laws of Califo Date 7 �% _k Signature NOTICE: If, after making this declara i n, you should become subject to the Workers' Compensation provisions 0 the Labor Code, you must forthwith comply with such provisions or this p@rmlt $hall be deemed revoked: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction Ignding agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from th@ Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file it signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (c(3mmencing with Section 7000) of Division 3 of the Business and Profession$ Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section '31.5 by any applicant for a permit subjects the applicant to a civil ally of not more than five hundred dollars ($500). ,•'I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rpva Tor the purpose of sale). I, as owner of the property, am exclusively contracting with llcen$ed con- tractors t6 construct the project (Section 7()44, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuariCto the Contractor's License Law). 1 am aware that proof of their Worker's Compensation inturance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this apblicatlon and state that the above information is correct. I agree to comply with all city and county ordinances and State laws relating to building construction, and hereby authorize repre- sentatives of this cit to enter upon the above-mentioned property for inspection pu�pgses. Signature � V . Date Drivers' Lic se or SS " CONVERSION " DEMOLISH " U1HER PLUMBING A.I. *6 DESCRIPTION OF WO K/U OF BLDG. Bar Sink Showers Backflow Preventer Service Sink $15 1 1 Issue Fee Automatic Washer Construction Pole Sub. S Main Building: TYPE OF PERMIT LJ GRADING FOUNDATION LJ STRUCTURAL Sewer Connection E T Front ❑ TENANT ❑ ELECTRICA��J PLUMBING ❑ MECHANICAL Clarifiers B El OTHER Ar %� �� Meter El over 100 amps A Rear Dryers ❑Gas ©Electric C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Motors 00-1 HP 01116 - B CONSTRUCTION TYPE VALUATIONS Swimming Pool vv/Spa Urinal S Left ZONE GRADING CU.YDS. ACRES Gas Service i Outlets Ping, Ref. # I Remarks: Device Boxes Planning Notes: 9905 3/25/85 Zone Accessary Building: Parking Req./Provided 11109-0 Z O N I N G R E Q M T S Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 00.100,000 BTU 0100,000 BT Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - 7pPllcant: Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink $15 1 1 Issue Fee Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW El 50 + KW Backflow irrigation Sewer Cap Bathtubs Sewer Connection T Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter El over 100 amps Dishwasher Solar Piping Dryers ❑Gas ©Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00-1 HP 01116 - B Floor Drains Floor Sinks Swimming Pool vv/Spa Urinal F.A.U. Fixtures Inc. Solar 09-15 HP 016-15+ Microwave Gas Service i Outlets Water Closet Z co Device Boxes Pole Light Interceptors Water Heater Outlets Range _ Kitchen Sink Water Service Switches Sign. Lavatories Auto -Wash Garbage Disposal 9 sp ,Standing Sections P -Trap Laundry Trays Generator ❑O.5 KW 05-15 KW 1 Trash Compactor Roof Drains Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 00.100,000 BTU 0100,000 BT Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - 7pPllcant: Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 Reinspection Fee $15 1 1 Issue Fee $ 3 �ANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By— T Date Date Dat Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTU ❑100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ S "t _0n $1) S S S $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date u.i Inspector l�1 POOL °A -- APPROVALS' Permit # Date Inspector 1. Temporary Eleetric�ji Service or Pole ;, .52. Pool & Equipment Location r 2. Soiipe-Undrgrnd. i R, 53. Steel Reinforcement Electrical Concluit,utility-Undryind! �� 54. Forms 4 Eiectriwal Condujt-L1ndrgrnd. 55. Electrical Bonding ,5? Steel Reinforcemerfi 56. Rough. Plumbing & Pressure Test N r� fie"El,ectrical UFERaG-Phd �' � 57. APPROVAL TO COVER-GUNITE f -�7t. Fo? ings I i� 58. Electrical Conduit-Undrgrnd. . l� 8. F=oundation+a �� 59. Gas Pipe, ❑ Undrgrnd., Test f�J 9'. Weer Pipe Undrgr fid. w 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 1P�5guctural Floor System t �T 61. APPROVAL TO DECK 1111 Property Sewer Line& House qp lection 62. Backwash & Receptor -Final __."_Sewer Cap 63. Heater & Vent -Final 1f3. Roof Drains (t 64. Plumbing System - Final l' 1V Rough Plumbind" tjI zy� 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16, Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Firing Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil .23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical -27. Frame and Flashing 76. Dry Standpipe 2B. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 7B. FIRE PREV. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. , UT T. Project Address _LLU- W. _1_7-th 5t . Bldg . (A) Unit • 6 Applicant's Mailing Address 13110 Saiicciy St. N.Hollyw d Owner's Name Troy Investment Fund Phone 549-298 Address 432.1 Eirch St- NpLmnrt Reach -,Cg_ '- --- -- Arch/Eng, MAri n - J . Rork License No. Address X881 Knott Ave_ Suite 216 Contractor's Name DiiCo AJr Conei•it-inni 4hone-9-8.2---IU6 Address (mailing) —I'll IQ qAt-i coy St- N-Ho1lywood, Ca, City -License No. 33.25 1'1 LICENSED CONTRACTOR DECLARATION co I'hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and Qmy license is in full fore♦und effec _} license Classr C Ica e 346251 ' V Date 4 / 19/ 84 __ SignaturDLARATION WORKERS' COMPENSATION 1 hereby affirm that I have a cerof consent to self -insure or a certificate of Workers' Compensation insurance, or a certified copy thereof (Section Lab. c.) Policy No. Company WC9824 Lumbermans Policy Certified copy is hereby furnished. Certifie o is filed with the city Buioing Ivision Date Applicant V u� EXEMP' FROM WORKERS' COMPENSATION DEC L RATION (This section need not be completed if the permit Is for one hundred ($100) or less). I certify,that in the performance of the work for which this permit is issued I shall -not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENOING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name - Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption, Any violation of Section , 7031.5 by any applicant for a permit subjects the applicant -to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and. Professional Code: The Contractor's 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 employees, provided that Such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- Erove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant 'to [he Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P, C. for this reason Date Owner I hereby certify that i have read this informati4e.r ct. I agree to com and stateing to b din c sentativecity to to r inspectio Signatur Drivers' 55 :ation and state that the above i all city and county ordinances on, and hereby authorize repre- above-mentioned propOrty-for LJ I TYPE OF CONSTRUCTION NEW LJ ADD LJ ALTERATION U REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG.' TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL ❑ TOTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADINGCU.YDS. ACRES Remarks: PLUMBING FEES A.P. S Main Building: E T Front B Rear A C R ight K S I Left Ping. Ref. # Planning Notes: 1739 4/24/55 j5o50 Zone Accessory Building: Z O N N G R Parking Req./Provided E Q M T S TL Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps' Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00.1 HP 01 r5 - B Floor Drains Swimming Pool w/Spa F.A.U" Inc.Solar ❑9-15 HP ❑16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections P—Trap Laundry Trays Generator ❑0-5 KW 05-15 KW Trash Compactor Roof Drains I Reinspection Fee$15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Hood or Type 1 ❑ Canopy Type 11 ❑ DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Date Dat Duct - Under Ground Duct - Structural Refrigeration System ❑0 100,000 BTU_ 0100,000 BTU , Duct - Ventilating SUMMARY BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% , $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ 13.00 TOTALFEE $ 1-5•50 2.50 Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG # Fire Dampers 1 Heating System & Ducting ®0.100,000 BTU 0100,000 BT Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspecror 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 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding .' P 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 9. Water Pipe-Undrgrnd. 60: Backwash Lines, P -Trap, ❑ Undrgrnd. f 10. Structural Floor System 'f' 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12, Sewer Cap i 63. Heater & Vent -Final 13. Roof Drains64. 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 APPROVALS Permit # 20.- Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts,,Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY, FINAL 30.. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. -Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 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 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 a 72 r• COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RECEIVE BY D TE R=CEfV D DAZE ISSUEp BUILDING i f✓ /T/ /i/ �/ r ' ADORES f) /_/� A.P. ^U✓ � 1 O P T 1 OWNER a s MAIL IN /)� � ) �7 k- �C%( 7l l / ADDRESS ADDRESS K/ l L ` WW TEL.TRACT r-7 —LO� 0. Ll CITY �L f NO. BLOCK ZZ a CONSTRUCTION NEW ADD A OI-- C LENDEREn am J D J U] BRANCH �+ 124,5e&tavttE(r�k OWNER J a Lu M J ADDRESS ` VALUE drU m J a ARCHITECT y USE U U) NEL. a FIRE LU CC ADDRESS ZONE T PE GROUP 0. Lu APPROVED LU Z CONTRACTOR BY DATE J Q M Z J tr ADDRESS f W lL TEL. ZO E NO. OF USE OF NEW O Z CITY NO. PLANS BUILDING .rT. _ZF LU O STATE CITY YARDS APPROVED YARDS APPROVED U} ir LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NQ. OF SLOGS, (FRDM C/L STREET) OF LOT NOW ON LOTRONT FT. FT. USE OF k (/ SH_(a� L EXISTING BLDG. T FT SIZE OF NO. OF Z NEW BLDG. ROOMS STORIES L. SIDE FT. VEXTERIOR WALL�j IIP ROOF ,�ee� COVERING COVERING 4�P kj Pd REAR FT. FT. J USE OF BU DING AND WOR TO BE WE6 DISTANCE BET. BET, MAIN & CL CL 0920C 1111111 MAIN BLDGS. ACCESS. BLOCS. O k! %t( A L�(I(!C al y Q e r G URP. qW APPROVED APPROVED [C_ z 0 Wo VI hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with STA TF - all laws regulating building construction, and I shall not employ D any person in violation of the workman's compensation laws of the State of California. co z I hereby certify that I am properly licensed as a contractor under SQ, FT. _ O the State of California Business and Professions Code, Oivisicn 3, THE AMOUNT SHOWN UNDER V IS FOR Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m am exempt from the provisions of the State of California Business VALUATION and Professions Cry❑ pivislon 3, Chapter 9, PERMIT FEE $ N' 7 Signature of - Permittee $�/poor` PLAN CHECK $ m o Authorized Agent u TOTAL FEE $ PROJlei-'ADDRESS: UNIT: 711 W 17TH ST A-7 CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 05772 OWNER'S NAME: ADDRESS: STREAM CONDOS SAME PERMIT NO; E 057723 PLAN CHECK NO: N GOVT; N SUPP: N ' CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH ARCHIENGINEER: REG.NO.: ADDRESS: UNIT: JOB DESCRIPTION ; ELECTRICAL WIRING SQ FT: CLAIM VALUE: CALC—VALUE ; GROUP OCC; / PERMITTEE: ADDRESS: NOOK ELECTRIC (714 631--8777 711 W. 17TH STREET J-4 COMMENTS: NO STRUCTURAL PERMIT ON FILE ('`('� `j' j,�E � 6 j IATAOM �Thesreby of s ing Section LICENSED CONTRACTOR' affirm that I am homed under provisions C a mm with Z O N I N G R E Q U I R E M E N T S 7000) of Division 3 of the Business and Professions Code. and my license is in full force and efle S E T B A C K S CITY LIC.: STATE LIC.: CLASS: 030877 52774 C-10 Date:_,`— �?� signature: ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- WORKERS' COMPENSATION DECLARATION: I hereby alfum that I have ace case 6 t o e or a certilirate of workers' FRNT ; FT IN R EAR : FT IN FRNT : FT IN R EAR ; FT IN Compensation Insurance. or a certified copy thereof (Secton M. Lab. LEFT • FT IN RGHT • FT IN LEFT • FT IN RGHT: FT IN POLICY NO.: 0662629-92 EXP. DATE: COMPANY: STPT� FYND-j r 4 Certified copy Is ere turns ed. Certified py is filed with th ' i[y in ivision. PARKING RE8. PROV: PARCEL: 00000000 ZNE: AEF NO: ``3X{ PLANNING N TES > > pplicant: EXEMPTION FROM WORKERS' COMPENSATION DE : (T ' nerd not be camplefed if the perndr is for one hundred (S1OD) or less). D E V E L O P M E N T S- E- R V I C E S R E Q U I R E M E N T S I certify that in the performance of the work tar which this pe issued, I shall not employ any person in any manner so as to become subject to the woxers' Compensabon Laws of California. ZONING APPROVED BY DATE • Date: Signature: NOTICE: It, after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor BUILDING APPROVED BY ' - DATE: Code. you must lonhwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AQENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y ; d DATE • Lp \� L which this permit is issued (Section 3097. Civ. C). *?�?�?�il��ifit•i[•*1E 1E 1E*�FTE�F *�F�Fifif�F*ifiE* *1F LENDER: ADDRESS: LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' Slate License Law lot the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMTP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, after, improve, demolish, or PERMIT 24 50 repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statemerlt.that helshe is licensed pursuant to the provisions of the Contractors' State License taw (Chapter 9 (commencing with Section 7000) of Division 3 of the Business � 0 % SM I P / NON—RES and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars (5500). ISSUE FEE 15 .00 1, asowner of the property or my employees with wages as their sWe compensation, will do the worn, and the Contractors' Law BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE Clstructure is not intended or oflered lot sale (Section 7044. Business and Professional Code: The State License TOTALS — — — — > 24.50 15.0 0 0.00 39.50 39.50 does not apply to an owner of a property who builds or improves thereon, and who does such work himselllhersell or through ,00 his or her own employees, provided that such improvements are not intended or offered for sale. It, however the building or improvement is sold within one year of camptetion, the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 39.50 OVER /SHORT: • 00 for the purpose at sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP /TOT GRADING PLAN—CHECK 1, as owner of the property, am exclusively contraclino with licensed contractors to construct the project (Section 7D44, Business ❑ Professions Code; State Law does of who builds or improves thereon 39.50 and The Contractors' License not apply loan Amer property and who contracts for such protects with a contractors) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. I N D I V I D U A L F E E B R E A K D O W N ❑ I am exempt under Section: $. d P. C. for this reason: TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST Ouse: _ Owner: I do hereby certify that I am aware of and understand the requirements of Cahtomia.Health and Safety Code Sections 25505, 25533, and 'th tot ELE 6 FIXTURES LIGHTING 1 ST 20 ELE 10 REC E PT / OOTL ET 1 ST 20 EA. .75 4,50 EA 7.50 25534 and that I or any luluro building occupant wilVwill not (aide one) need to comp said s e codes and the requirements a permit for construction or modification from the Air Duality Management District. Re enslal co ruction applications are exempt trom ELE 2 R EC EPT /SWITCH 1 ST 20 , .75 EA, .75 1.50 these provisions. ELE 1 SUB—PANEL 11 .00 11.00 Dale: Applicant: f hereby certify that I have read this application and to that the al ordinances and state laws relating to building cat ton and hereby property fo inspection purposes, Date: L - Driver's License or Social Spcurily M: END OF FEES I agree to comply with an city and county this city to enter upon the abov mentioned + CTEo Cit.' i 7,.' 16.4"6 White—Building: Green—Code Enfo Bmenn: Canary—Appfican4 Pink—Revenue: Goldenrod—Assessor << CONSTRUCTION AND PLANNING APPROVALS Permit # Qate Inspector POOL A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. t 53. Steel Reinforcement 3. Electrical Conduit.Utility-Undrgrnd. - ' 54, Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5,• Steel Reinforcemern 56. Hough Plumbing & Pressure Test 6., Electrical UFER Grnd. 57. APPROVAL TO COVER•GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B�•Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9.'Water Pipe•Undrgrod. 60. Backwash Lines, P•Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO D6CK 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, Sol; r System -Final 16, Rough Electric Wiring 67, Fe ting & Acces's Approval 17. Rough Wiring Sign- 68. APF ROVED FOR PLASTERING 18, Rough Electrical -T Bar Ceiling 69. POO /SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIR • DEPT. REQUIREMENT APPROVAL _ Permit # 7 - T. 20. Rough Factory Fireplace t7. _ .. 21. Ducts, in catruqure' :' 70. Undergro'u 'dHydro 22. Ducts, Ventilating - ti •a ;1. Product Pipin§ ❑ Gas ❑ Oil 23. Gas Pipe•Rough & Tbst i y �� ,x 72, Undergrdund Flush = ~ 24. Roof Fraining , s �- Z3. l7ndergrnd:=Storageii}nk ©Gas ©OiT , 1 25. Root Sheathing 3 4, Overhead 14ydro 26. T -Bar Ceiling (Structural) & Mprocoat J 3 r + 75. Dry Chemical 27. =Frame and Flashing 76. Dry Stand r: 28. Lathing & Siding - .- - 77. .FIXED SYSTEM FINAL C . 29. Insulatioli • 78. FIRE PREY. FINAL T- r } 30. Drywall Nailing t HEALTH DEPT. REQUIREMENT 31. Plaster Brown -Coat (.79. FINAL INSPECTION' , - 32. Electrical Power Meter -Final y 80. FOOD CERTIFICA7`E ISSUED �3. Final- Electric % Notes: 34. Final Heating & Air Cond[tioning 35. Final Gas Pipe -Test • l �� '" - _" 36. Hood or Canopy_ 4 37. Final -Factory Fireplace r - ' > 38. Final, Plumbing 39. Water Service -Final - - '' 40. Gas Service -Final 41. Solar Domestic -Final ' 42, Backflow Preventer ' S 43, Backflow IrriVtion • 0: 44. Landscape Irrigatiort System r• 45. Sound Aitenuation ,46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING ' 49. Electric Release to Edison Y t - T 11 r 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY' No. Date ? r „- 0 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF CO$TA�fM�ESA CONSTRUCTION PER PERMIT NO. TRACT NO. LOT NO, UNIT NO. Proiect Address '7// /?T04 S")' iln i,' 1 -7 1 Q-7 1-7, Applicant's Mailing Address TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION U REPAIR SOY_t iLC i r ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # Owner's Name ?� �.'_�' r.T Phone DESCRIPTION OF WORK/USE OF BLDG. Address S Main Building: E Arch/Eng. -License No. TYPE OF PERMIT GRADING U FOUNDATION STRUCTURALT Front Address __ ___ _ ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear Contractor's Name J: I r )CC Phone 927 -68 -SO El OTHER g r7 -S-7,111 N 7D� 793PROJECT DESCRIPTIONht g SQ. FT. OCCUPANCY C Ri Address lmailin I/%yE'S QQ?r CONST RUCTION K TYPE VALUATIONS S I Left City License No. ZONE GRADING CU.YDS. ACRES Ping. Ret. LICENSED CONTRACTOR DECLARATION N # I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class C -f 10 4=sis s ho Date �Signature WORKERS' COMPENSATION DEC RATION 1 hereby affirm that I have a certificate of consent to sell -insure or a certificate of Workers' Compensation insurance, or a certified copy thereof (Section 100, Lab. C.) alley No. 4� t C -A0 9 :3 2-0 Co T !x CSC I 8 Certified copy is hereby furnished. J7-A, Certifiedcopy i filed with the city di �visio ates-%� - - Applicant aG� EXEMPTION FROM WORK4RS' COMPENSATION DELL ATION (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that In the performance of the work f SCh this permit Is sued 1 shall not employ any person in any so as to becoVr�he subj to tate Workers' Co ens. Laws of Call ni Date Signature NOTI E: If, after making thi$ declaration, yo hould ecome subject to the Workers' Compensation provisions of the Labor Cod you must forthwith comply with such provisiohs or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) lander'S Name Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business 4nd Profession$ Code) or that he/She Is exempt therefrom 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 natty of not more than five hundred dollars ($500). _ J 1, as owner of the property or my' employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code. The Contractor's License Law does not apply to an owner of a property who builds or improve$ thereon, and who does such work himself/herself or through his or her own employees, provided that Suth improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of Com- pletlon, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale), ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Processions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant tq the-Contractor'i License Law). I am aware that Proof of their Worker's Compensation Insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this Information Is correct. 1 agrge to comp! and state laws reMti uilding con Sentatives of rill j y to n[er upo inspection p r oras. Signature Drivers' License or SS pplication and state that the above with all city and county ordinances ,uction and hereby authorize repre- the a ve-mentioned property for Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool wlSpa Urinal Outlets Water Closet Water Heater Water Service Auto -Wash Laundry Trays $15 Issue Fee Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust'System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting C1 0-100,000 BTU E] 100,000 BT Reinspection Fee 1 $15 AF 0865-46, rev, 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor IANICAL Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System 04100,000 BTU ❑ 100,000 BT System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ©Electric 58IlI (/16/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+ KW Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 1:10.5 KW (35-15 KW Meter Liup to 100 amps Meter Dover 100 amps Sub Panel Motors )al HP❑1%-S Inc. Solar 119.15 HP 016.15+ Microwave Pale Light Range Sign Standing Sections Trash Compactor 6950 TL FEES Z O N I N G R E Q M T S $ 3 �—LReinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Date Date I r BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ S $ CF • C>a $ $ S _-- SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE S $ 3 r CONSTRUCTION AND PLANNING Date APPROVALS Permit :#' -' � L ' Inspector POOL 'A APPROVALS Permit # Date Inspgcrnr 1.'Temporary Electrical Service or Pole ^ 52. Pool & Equipment Location 'r2. Soil,Pipe-Undrgrnd._ ! 53. Steel 'Reinforcement 3.; Electrical Conduit Utility-Undrgrnd. ; 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5.- Steel Reinforcement l ' 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. .; 57. APPROVAL TO COVER-GUNITE 7. Footings I 58. Electrical Conduit-Undrgrnd. L 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. �� 60. Backwash Lines, P -Trap, ❑ Undrgrnd. ' 10:: Structural Floor System `_ 61. APPROVAL TO DECK 11.,Property Sewer Line& House Corinection 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76, Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30,'Drywall Nailing HEALTH DEPT. REQUIREMENT 31`. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF OOSTq SACQNST y4Trl N PERMIT 1,-,f11� -Address 115 Ldc JO I 6 Applicant's Malll A dress / S Owner's Name Q I� �Phone Address Arch/Eng. License No. Address Contractor's Nam S l M eN-/1 ` . ' Phone 717 Address Imailing] _ ,�r%S/ l�%iU��/.Il/ VDR�l� Z4&,W City License Na. LICENSED CONTRACTOR DECLARATION I hereby affirm thbt I am licensed under provisions of Charter 9 (commencing With section 7000) of Division 3 of the Business and Professlons Code, and my license is In tut fore d effect. Lltens Class License No. 3L3 �a Date `� y Signature WORKERS' COMPENSATION DEC ARATION hereby affirm that I have a certificate of consent to self -insure or a certificate workers' Compensation Insurance, or a certified copy thereof (Section 00, Lab. C.) Policy No. Company eCertified copy is hereby furnished. CertiIled copy is filed with the city Building Division. / Date. _ Applicant EXEMPTION FRAM WORKERS' COMPENSATION DECLARATION J (This section need not be completed if the permit is for one hundred (5100) or, tess). I Certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner o as to become subject to the Worke ' C e Laws of Calif a. Date Slgnatur, NOTICE: lf, after making this decla on, you should become subject to the Workers' Compensation provisions f the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there I% a Construction lending agency for the performance of the work for which this permit is issued (Section 3097 Cly. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repdir 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 the Contractor's License Law (Chapter 9(Commencing with Section 7000) of Otvlsion 3 of th@ Business and Professions Code) or that he/she is exempt erefrom and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a permit subjects the applicant .to a civil :salty of not mgre than five hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered forsale (Section 7044, Business and Professional Code: The Contrattor's License Law doe% not apply to an owner of a property who builds or improves thereon, and whq does such work himself/herself or through his or her own employees, proviged that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the own@r will have the burden of proving he/she did not build or im- prove for the purbose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not appty to an owner of properly who builds or improves thereon, and who contracts for such projects with a con. tractor(s1 llcense pursuariCto the'Contractor's License Law). I am aware that proof C, their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section 9, & P. C. for this reason Date - - Owner I hereby certify that I have read this application and State that the above Information I$ correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for inspection purpcye Signature Date Drivers' Licerne ar SS :VE Reinspection Fee I S15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG + Heating System & Ducting E] 0-100,000 BTU 0100,000BT Reinspection Fee 1 $15 CMF 0865.46, rev. 10/84 white - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor issue Fee Hood or Type 1 ❑ Canopy Type II ❑ Refrigeration System ❑0-100,000 BTU E-11100,000 System Repair/Alteration Fire Dampers Registers Issue Fee 5 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat 9910 3/25/65 I0o60 TL TYPE OF CONSTRUCTION 11 NEW LJ ADD K ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. Zone DESCRIPTION OF WORK/U EF [33l + BLDG. S Main Building: Accessory Building: C J)m lin C� avu-IC t tn+ —E Z TYPE OF PERMIT GRADING LJ FOUNDATION U STRUCTURAL T Front O ❑ TENANT ❑ ELECTRICALS �� U IN.lG El�MECHANICAL H N ❑ OTHER CJlL1lCJ��^(J 'A Rear I C Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY CDN STRUCTION TYPE VALUATION $ S G Left R ZONE GRADING CU.YDS. ACRES Ping. Ref. qh Parking Req./Provided E Q Remarks: Planning Notes: M T S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink �- Automatic Washer Transformer ❑ 15.50 KW Backflow Irrigation Sewer Cap Construction Pole,Sub. ❑ 50 + KW Bathtubs Sewer Connection Cooking Unit Meter ©up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors El 0-1 HP C31 f, B Floor Drains Swimming Pool w)Spa F:A.U, Inc. Solar El 9-15 HP ❑16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes / Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator 00.5 KW 05-15 KW i Trash Compactor Roof Drains Reinspection Fee I S15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG + Heating System & Ducting E] 0-100,000 BTU 0100,000BT Reinspection Fee 1 $15 CMF 0865.46, rev. 10/84 white - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor issue Fee Hood or Type 1 ❑ Canopy Type II ❑ Refrigeration System ❑0-100,000 BTU E-11100,000 System Repair/Alteration Fire Dampers Registers Issue Fee 5 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat SUMMARY OF FEES _ BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ._ I Sn ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ _ID PLAN CHECK 25% $ S 3 V`t'ONSTRUCTION AND PLANNING 11PROVALS Permit # Date Insp c or POG SPA APPROVALS Permit # Date Inspector I. Temporary Electrical Service or Pole f_ 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. �� +� i`7 53. Steel Reinforcement EleYttrical Conduit Utility-Undrgrnd. 54. Forms ` .4 Elegtrical Condult=Undrgrnd. • yr 55. Electrical Bonding 5? Steel' Reinforcemrr��i e �ih r. 56. Rough Plumhing & Pressure Test 6• Electrical LIFER Gfnd. +�p ? 57. APPROVAL TO COVER-GUNITE 4 7'08otings _ ,; ; ' 58. Electrical Conduit-Undrgrnd. • '. 8 Foundation ^t 9:4 Water Pipe-Undrgrnd. ' i ' 59. Gas Pipe, ❑ Undrgrnd., Test 60. Backwash Lines, P -Trap, ❑ Undrgrnd. ' 10*S�uctural Floor System v 61. APPROVAL TO DE=CK i 1 Paoperty Sewer Line & House Connection 1 62, Backwash & Receptor -Final r12,Sewer Cap ` 1' G ; 63. Heater & Vent -Final i 1,3! Roof Drains ' l 64. Plumbing System - Final 14+Rough Plumbingf 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. ,'Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test j -s }f 7 e Z j� 36. Hood or Canopy 37. Final Factory Fireplace _ 38. Final Plumbing lj ZS 6r " 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 _ 0 Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. PFRMIT Nn I TRACT NO. I LOT NO. t1NIT Nn CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 711 W. 17th St. Bldg. (A) Unit 7 Applicant's Mailing Address 13110 Saticoy St. N .Hollywood twner'sName Troy Investment Fund phone 549 2988 Address A Z.1 Birch St._ -Newport Beach, Ca. Arch/Eng. - M;irin J. Rock License No. Address 128.8,E -Knott Ave._ _Suite_ 216 Contractor's Name Dueo Air Conditioning Phone 982-1216 Address (mailing) S ticoy St. N. Holl ood Ca. City'License No. LICENSED CONTRACTOR DECLARATION I hereby affirm tnat 1 am licensed andfir provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Profess ns Code, and my license Is in full force and effect. License Class se346991 Date 41,8184 ___ Signature WORKERS' COMPENSATION DEC RATION hereby affirm that I have a certifi a of consent to self -insure or a cerlifitate Workers' Compensation Insura cc, or a certified copy thereof (Section E00, Lab. C.) - Policy No. WC9824 Company Lumbermans eCertified copy is hereby furnished. Cer f py Is filed with the city gu,itdl g Ivis1A-- C, Date Applicant � f' EXEMPT110M FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit is for one hundred ($100) or less). I. certify that In the performance of thq work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to,the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, You must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt frorn the Contractor's License taw for the following reason (Section 7031.5 Business and Professional Code: Any city or courtly which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 1031.5 by any applicant for a permit Subjects the applicant to a civil penalty of not more than five hundred dollars ($500). LJ I, as owner of the property or nay employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business anq Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not Intended Or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove Tor the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Sectign 7044, Business and Professions Code: The Contractor's License Law does rlot apply to an owner of property who builds or Improves thereon, and who contract$ for such projects with a con- _ tractors) license pursuant'to the -Contractor's License taw). I am aware that proof of their Worker's Compensation insurance should be provided to me. 0 i am exempt under Section B. & P. C. for this reason Date Owner — I hereby certify that I have read this Information IS Correct. I agree to com and -state laws relatingbuilding c sent atives of city to a r. 1 inspection rpos s. Signature Drivers' Licen or SS cation and State that the above h all City and county ordinances ion, and hereby authoriye repre- above-mentioned pr erty,^r 1740 4/24/65 Zone Accessary Building: Parking Req,/Provided 15so0 T!_' Z O N 1 N G R E a M T 5 PLUMBING FEES ELECTRICAL FEES Bar SinkShowers TYPE OF CONSTRUCTION L1 NEW 0 ADD LJ ALTERATION LJ REPAIR IIIIIIIII ❑ CONVEASION ❑ DEMOLISH ❑ OTHER r A.P. DESCRIPTION OF WORK/USE OF BLDG. Sewer Connection Cooking Unit ' Meter ❑up to 100 amps Clarifiers S Main Building: Dishwasher Meter Dover 100 amps E Solar Piping TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL B Motors ❑0-1 HP El 1'A - 8 ❑ OTHER Swimming Pool vv/Spa A Rear ©g -i5 HP ❑1615+ Floor Sinks Gas Service Outlets Interceptors Urinal Water Closet Water Heater Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K K Water Service CONSTRUCTION TYPE VALUATION $ &I Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks: P—Trap Planning Notes: 1740 4/24/65 Zone Accessary Building: Parking Req,/Provided 15so0 T!_' Z O N 1 N G R E a M T 5 CMF 0865.46, rev. 20184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES ELECTRICAL FEES Bar SinkShowers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW 0 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit ' Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps Dishvoasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0-1 HP El 1'A - 8 Floor Drains Swimming Pool vv/Spa F.A•U.Inc.Soiar ©g -i5 HP ❑1615+ Floor Sinks Gas Service Outlets Interceptors Urinal Water Closet Water Heater r Fixtures Device Boxes Outlets Microwave Pale Light Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator ❑0-5 KW ❑5.15 KW Trash Corn pactor Roof Drains Reinspection Fee $15 Issue Fee 5 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date ' A_p_pliWion Issued By _ Dat Boiler Hood or Type I ❑ Canopy Type II El Duct Under Ground Duct - Structural Refrigeration System ❑0-100,000 BTU ❑100,000 BTUSUMMARY Duct - Ventilating BUILDING PERMIT 5 PLAN CHECK $ $ CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $}�,n�— PLAN CHECK 25% s OF FEES SMIP $ PERMITPLUMBING ISSUANCE $ ENERGY P.C. S GRADING $ MICROFILM $ TOTALFEE $ Exhaust System ❑ Multiple ❑ System Repair/A Iteration Fic,PLAN FirepllFact. Bit. ICBG # Fire Dampers Heating System & Ducting 1 Dtl100,000 BTU ❑100,00087 6 Registers Reinspection Fee 515 Issue Fee 5 3 CMF 0865.46, rev. 20184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor _ CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POC,- .,i SPA 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 ,f 6- Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE t , 7. Footings 1 58. Electrical Conduit-Undrgrnd. 8: Foundation 59. Gas Pipe, 0 Undrgrnd., Test i 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. { 10. Structural Floor System '`�i 61.• APPROVAL TO DECK 11. Property Sewer Line & House Connection r 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 1 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72, Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ 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 PREY, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46, Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49. Electric Release to Edison 50, Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date 3V 596 COSTA MESA BUfLDING•SAPETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 l PAIu 32 5 is.tis -FR 11-75cric:' 57.56 0,PJICATION FOR BUILDING PERMIT For Applicant to Fill in Completely REC PATE RECEIVEd I55 aDORESS 7// W, / 7 THST, 5v/ 7'L� ¢ ?ITE r 5 .IC P 1T O OWNER SFd¢%S g 1_A71Sv%2E J`/VT£�'N.iTiti�G: A.P. NO, O MAIL BUILDING ADDRESS ADDRESS TE L. NC CITY NO. TRACT L T BLOCK CONSTRUCTION WD AjUR I REPAIR LENDER BRANCH OWNE �- ADDRESS S r / VALUE L-, $ ARCHITECT TEL. OR ENGINEER FIRE ADDRESS ZONE TYPE GROUP APPROVED C CONTRACTOR jG_N_'/_>Gr EiVG1I►��'QI/YG BY DATE ADDRESS [ZFr-/ A: 1_406.4,V AVS, TEL. ZO E NO. OF USE OF NE CITY �Q$� /Vj - tT 2� G NO. �LS.3O PLANS BUILDING STATE ZQ �' CITY yGS3 YARDS APPROVED YARDS APPROVED LIC. Li C. ND. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF BLOCS, (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. USE OF 1'� EXISTING BLDG, i�WRAIr'7}oUSF 110ma opplecdoz SIZE OF NO. OF NEW BLDG. ROOMS STORIES L. SIDE F EXTERIOR WALL ROOF COVERING COVERING REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET, MAIN & MAIN $LOGS, ACCESS, SLOGS. 1�0 fL,er,* 1?-oe Nf VA. C.URP, DATE APPROVED 4FPRD V E I hereby acknowledge that I have read this application and state that the above information Is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of .� the State of California. I hereby certify that I am properly licansed as a contractor under SO. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Dlvisicn 3, Chapter 9, and that such licenses are in full force and affect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. am exempt from the provisions of the State of California Businoss VALUATION and Professions Code, Division 3, Chapter 9. PERMIT FEE $ Signature of / Permittee �.,/ c _ $!6 iLtJ1 PLAN CHECK $ Authorized Agent TOTAL FEE $ CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address / W r%f Sl 2s —7 APi EgA Applicant's Mailing Address Owner's Name r `%� ,��+.12 S r /f 1L�e I� Phone Address ArchlEng. License No. Address Contractor's Nam? Phoneg! "68 Address Imailing p« rJT zp r.r 2 !(� City License No. 722 — ---- -- LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and professions Code, and my license is in full force and effect. .y�7 License Class i 0 is s N .LS �! 7 T—les— �_ ' Date � Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to salf-Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 1 00, tab. C.) 4, : Acy No. &?C_:Sr! o ! 3 i0 CoZjg C •0 nnn Certified copy is hereby furnished. Certified copy i filed with the City B. Date�><"�a �S Applicant EXEMPTION FROM WORKERS' COMPENSATI N DEC ARATION (This section need not be completed If the permit is for One hundred ($100) or less). I certify that In the performance of the Ich this pe�rutlgp,.�.d, I shall not employ any person In any anner p as o becoo the Workers' GompensatigrtI " of Calif Hiss. Date ~.; r.—=�D' 3 Signature 'NOTICE: If, after making this declaration, you should b come subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance ofthe work for which this permit Is Issued (Section 3097 Civ. C.) L.ender's Name Lender's Address .. OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Cdntraclor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant far such permit 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 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 malty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole empensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for We. If, however, the building or improvement Is sold within one year of com- pletion , the owner will have the burden of proving he/she did not build or Im- rove forr the purpose of sale). ' I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Cotle: The Contractor's License Craw does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a con- tractorfs) license pursuarit'to the Contraitor's License Law). I am aware that Proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this'iappllcation and State that the above information is corre 1 agree to co ply with all city and county ordinances and state la ng building onstructl , and hereby authorize repre- sentatives O thl Illy enter u On thove-mentioned property for Inspection p r os l Signatures Date Drivers' License or SS �P except these within heavy tborder lines and sign all appropriate declarations. TRACT NO. LOT NO. UNIT NO. A _ rr TYPE OF CONSTRUCTION LJ NEW LJ ADD Li ALTERATION u REPAIR FEES ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.[. DESCRIPTION OF WORKIUSE OF BLDG. Showers S Main Building: Backflow Preventer Service Sink E Transformer ❑ 15-50 KW [3 50 + KW TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Clarifiers ❑ -OTHER A Rear Dishwasher Solar Piping C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CON STRUCTiON TYPE VALUATIONS S Left ZONE G RAIDING CU. YOS. ACRES Ping. Ref. dk Remarks: Floor Sinks Planning Notes: - T 5615 1/16/85 Zone Accessory Building: Parking Req./Provided 4933 TL Z O N I N G R E Q M T S Reinspection Fee Boiler 515 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO /k Heating System & Ducting ❑0.100,000 BTU [3 100,000 BT Reinspection Fee 1 $15 GMF 0865-46, rev. 10/84 white - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee IANICAL Hood or Type I ❑ Canopy Type II ❑ Refrigeration System 00.100,000 BTU 1:1100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee S 31 FEES Reinspection Fee $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW [3 50 + KW Backflow Irri Irrigation Sewer Ca 9 q ' Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors b-1 HP ❑ 1 h - 8too Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 HP ❑1&15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light t Interceptors Water Heater 0uttets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal 'Standing Sections P—Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee Boiler 515 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO /k Heating System & Ducting ❑0.100,000 BTU [3 100,000 BT Reinspection Fee 1 $15 GMF 0865-46, rev. 10/84 white - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee IANICAL Hood or Type I ❑ Canopy Type II ❑ Refrigeration System 00.100,000 BTU 1:1100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee S 31 FEES Reinspection Fee $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By S 3 ate ate SUMMARY OF FEES BUILDING PERMIT S SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% S ENERGY P.C. ELECTRICAL �$ OO GRADING, PLAN CHECK 50% $ r�C7_ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% •$ $ 3 S 3 ate ate i CONSTRUCTION AND PLANNING APPROVALS Permit # Date J Inspector POOL la , APPROVALS Permit # Date Inspecrnr 1. Temporary Electrical Service or Poie 52. Pool & Equipment Location 2, Soil Pipe Undrgrnd.. " F i 53. Steel Reinforcement EIectrical Conduit Utiliiy 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 4 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9:: Watef Pipe-Undrgrnd. 1, 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. -Structural Floor System ' 61. APPROVAL TO DECK 11 •LProperty Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap .f � 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas D OII 23. Gas Pipe -Rough & Test 72. Underground Flush 24. rRoof Framing 73, Undergrnd, Storage Tank D Gas D 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 Re Drywall Nailing HEALTH DEPT. REQUIREMENT 31'. Plaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric `/ Nntes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System fir' 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49. Electric Release to Edison ; 56. Gas Release to Southern California Gako 51. CERTIFICATE OF OCCUPANCY �Jn. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. -�-I P RMIT NO TRACT NO. LOT NO. UNI CITYU�cZSTA MESA C /NSSUR CTIO�[1 PEPMIT Project Address f -J Applicant's Mailin A ress t Owner's Name Phone Address Arch/Eng. License No. Address Contractor's Nam Phone 7 772 7 V Address (mailingl City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license IS in fuk force affect. License Class License No. Date_ Signature WORKERS' COMPENSATION DEC RATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) policy No. Company eCertified copy is hereby furnished. Certified copy is filed with the City Building Division. Date Applicant , EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit is for one hundred ($100) or less). r I certify that In the performance of the work for which this permit is issued t . shall not employ any person In any manner so s to become subject to tke Worker�Cor7Wlrn`sa% Laws of Califor Date ��YY ]S1r�tC Signature 'NOTICE: If, atter making this dcclar n, you should become subject to the Workers' Compensation provisions o the Labor Code, you must forthwith comply with Such provisions or t Is permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I horeby affirm that there Is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its•Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provision$ of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). !, as owner of the property or my employees with wages as their sole "'compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License taw does not apply to an owner of a property who build$ or improves thereon, and who does Such work himself/herself or through his or her own employees, provided that such Improvements are not Intended or offered for $ale. If, however, the building or Improvement Is sold within one year of com- pletion, lite owner will have the burden of proving he/she did not build or im- rove for the purpose of sale), 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and who contracts for such projects with a con- tractors license pursuarit'to the Contractor3 License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason .a � "G' TYPE OF CONSTRUCTION El NEW ADD ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p 911k DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING 13 FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU. YDS. ACRES Ping, Ref. Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service 1f Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 S15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO * Date Owner Heating System & Ducting I hereby certify that I have road this application and state that the above El 0-100.000 BTU El 100,000 BT Information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned propertyfor Inspection a Signature Date �� Reinspection fee Drivers' Lice or SS CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type ❑ Canopy Typel) ❑ Refrigeration System 00-1100,000BTU 0100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee 9911 3/25/55 Zone Accessory Building: Parking Req./Provided 1005,j . TL Z O N I N G R E Q M T S FEES ELECTRICAL FEES 2 Automatic Washer_ Construction Pole Sub. Transformer ❑ 15.50 KW © 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas DElectric Sub Panel Fan Motors 1:10-1 HP Ell %, - 8 F.A.U. Inc. Solar 09-15 HP ❑16-15+ Fixtures Microwave z CIO Device Boxes Pole Light Outlets Range 2Z Switches Sign Garbage Disposal ; Standing Sections Generator 00-5 KW 05.15 KW -Trash Compactor S 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By —Datfi=V _ BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ OC ISSUANCE $ $ 1 ENERGY P.C. $ $ GRADING S $ MICROFILM $ $ TOTALFEE $ $ 10 --so $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & „eA APPROVALS Permit # Date Inspector �1. Temporary Electrical Service or Polp 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd. � 53. Steel Reinforcement .'3'Elerc6ical Condttit(Utility Undrgrnrdl v 54. Forms } 4� Elec�ical Gondol-Undrgrnd. 55. lElectrical Bonding ,J 5: Reinforce 0 56. Rough Plumbing & Pressure Test i'�40 -6' E�ecj�ical UFER%f,d. ` �� r s 57. APPROVAL TO COVER-GUNITE � '7") 7� f Notings ,. rP i`h = 58. Electrical Conduit Undrgrnd. 8 �F 'urdation .!� rI v ,", 59. Gas Pipe,•❑ Undrgrnd., Test ;9'W^ e Pipe-Undrgrn i r �i 60. Backwash Lines, P -Trap, ❑ Undrgrnd, {� 0Nt uctural Floor System R 61. APPROVAL TO DECK -11: `Piroperty Sewer Linn & House Co"4 P ction f 62. Backwash & Receptor -Final , i 12:,Se' 'Cap ' 63. Heater & Vent -Final + 1Roo Drains 64. Plumbing System - Final , 3 14. RaU_' Plumbing :' [f Lrt/� 65. Electrical -Final r 15. Rough -Electrical -Conduit 66. Solar System -Final i6. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18, Rough Eiectricat-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19.,Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT rt • - APPROVALS Permit # 20. Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydra 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Uru4erground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oii 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28, Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNWN Project Address ! ! Applicant's Mailing Address 13110 SatiCa:y 5t, N.Hollywood Owners Name - .TXJDy TnyeStttlent Fund Phone 549=2988 Address 4121 Birch St- N wnort. Rearb, Ca_ Arch/Eng-Marin -1 - Rork —License No. Address —1.288-1—Knott _ Ave '3111 to 21h Contractor's Nam hone .9.89— 12 1 �+ Address (mailing)—} 0 Saticoy St_ N_ City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I aryl licensed under previsions of Charter 9 (Commencing with section 7000) of Division 3 of the Business androfesslons Code, and my license is in full for@and effect. ticense Class C ` Li n o, 346251 Date__Z4_1S4Svim Signature WORKERS' COMPENSA710N DEC�GR ATION I hereby affirm that I have a certifiof consent to sell -insure or a certificate of Workers' Compensation Insura , or a certified' copy thereof (Section 1800, Lab. C.) policy No. 4C9824 Company' Lumbermans eCertified copy is hereby furnished. Certif- �i�i is filed with the city Buil D"yision Date `•'�� Applicant EXEMPTI FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit Is issued I Shall not employ any Porson in any manner so as to become subject to tf e' Workers' Compensation Laws of California. Date , —Signature 'NOTICE: It, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that therq is a construction lending agency for the performance of the ,work for which this permit Is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION i hereby affirm that I am exempt from the Contractor's License Law for the following reason (SeClldn 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 4 (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 applicbnt for a permit subjects the applicant to a civil ienalty of not more than five hundred dollars ($500). 3 I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not abply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own employees, provided thOit such Improvements are not Intended or offered for sale, If, however, the bgilding or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 builds or lmpfoves.theteon, and who Contracts for such projects with a con- tractor(s) license pursuant'to the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & p. C. for this reason Date — Owner I hereby certify that 1 have rea- Information is correct. I agree to and state laws relating to buildir sentatives of s -clty to en inspectionelMWel. gol Signature Drivers' Lice or SS J this application and state that the above comply with all city and county ordinances %guconstruction, and hereby authorI re e- pon the above-mentloned�gr e_taz TYPE OF CONSTRUCTION IJ NEW " ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 46 DESCRIPTION OF WORKIUSE OF BLDG. S Main Building: E TYPE OF PERMIT U GRADING El FOUNDATION ID STRUCTURAL T Front ' ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL 13 A Rear 1:1 OTHER PROJECT DESCRIPTION SQ. FT.C Right OCCUPANCY CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks; Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains' Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspeciion -Fee - $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # 1 Heating System & Ducting 40-100,000 BTU ❑ 100,000 BT Reinspection Fee CMF 0865-46, rev. 10184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service A uto-Wash Laundry Trays Issue Fee Hood or Type ❑ Canopy Type 11 ❑ } FEES Refrigeration System ' 1:10-100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers i Issue Fee 1 $ 3 17+1 4/24/B5 zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ©Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW 05.15 KW Transformer ❑ 15.50 KW ❑ 50 + KW Meter ❑up to 100 amps Meter ❑fiver 100 amps Sub Panel Motors ❑0.1 HP 01 h - 8 Inc. Solar 09-15 HP 016.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor Reinspection Fee $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Applieation Issued By -- $ 15,,50 TL FEES $ 3 Z O N 1 N G R E O M T S SUMMARY OF FEES BUILDING,, PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.C. ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ 13.00 TOTALFEE PLAN CHECK 25% $ 2.50 $ 15,,50 TL FEES $ 3 Z O N 1 N G R E O M T S CONSTRUCTION AND PLANNING APPROVALS . Permit # Date inspector POOL & . A APPROVALS Permit # Date Inspectn.r 1. Temporary Electrical Service or Pole 52, Pool & Equipment Location .l . 2, -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test'' 6. Electrical LIFER Grnd. ' �,' 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduif-Undrgrnd, 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test - 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62, Backwash & Receptor-Final 12. Sewer Cap J 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas O Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24, Roof Framing • 73. Undergrnd. Storage Tank O 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 & Sidir19 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. 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 • r CITY OF CPSTAkESA CONSTRT10. 1. MIT Project AddressZJ i Applicant's Mai lin ddress eftax-ou &A Owner's Name k% hone Address Arch/Eng, License No. Address Contractor's Nam hone Address (mailing) L ' City License No. LICENSED CONTRACTOR DECLARATION t hertoy affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and My license is In fu Or effect. L-ICense Class di License N43.-3-0'2-0 _7_ Date .Z-:24& M Signatur WORKERS' COMPENSATION D ARATION I hereby affirm that I have a certifi ate of consent to self -insure or a certificate of Workers' Compensation insurance, or a certified copy thereof (Section '800, Lab. C.) I r olicy No. Company _ Certified copy is hereby furnished. Certified copy is filed with the city Building Division, Date_ Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - (This section need not be completed if the permit Is for one hundred (5100) or less). I certify that in the performance of the work for which this permit is issued,'( Shall not employ any personIn any manner s as to become subject to the Worker ' Comp ns Io ws of Caiif 1a. Date Signature NOT( E: If, after makmg this dociarittiln, you should become subject to the Workers' Compensation provisions o the labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I her@by affirm that there is a Construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address - - - - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code. Any city or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor'$ License taw (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 3n4ity of not more than five hundred dollars ($500). 1, as owner of the property or my'employees with wages as their sole Compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale, If, however, the building or improvement is sold within one year of com- pletion, trio owner will have the burden of proving fie/she did not build or im- ro4e far the purpose of sale), 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and who contracts for Such projects with a con- tractors) 11cense pursuant'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. P RAP /O TRACT NO. LOT NO. UA NO. T Datt, Owner I hereby certify that I have read this application and state that the above Information Is correct. Iagree to comply with all City and county ordinances and "State laws relating to building construction, and hereby authorize repre- sentatives Of this city to enter upon the above-mentioned property for inspection p r es. SignatureDate + ALW Drivers' Licata or 55 VE CMF 0865-46, rev. 10/84 W TYPE OF CONSTRUCT)ON LJ NEw LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF SLOG. I $15 Issue Fee A.P. # S Main Buildi TYPE OF PERMIT GRADING El FOUNDATION 0 STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER E T B A Front Rear PROJECT DESCRIPTION SQ. FT. OCCUPANCY _^___ CONSTRUCTION TYPE VALUATION S ZONE GRADING CU. YDS. ACRES C K g Right I Left Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO + Heating System & Ducting ❑0-100,000 BTU ❑ 100,000 BT' Reinspection Fee I $15 Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING ' I FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee $ 3 MECHANICAL FEES Hood or Type I ❑ Canopy Type 11 ❑ T7 Refrigeration System E10-100,000BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 9513 2/25/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 110-5 KW 115-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100 amps Meter Dover 100 amps Sub Panel Motors ❑ 0-1 HP Ell % - B Inc. Solar 09-15 HP 1116.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 18e30, TL FEES Z O N I N G R E O M T S Reinspection Fee I $15 Issue Fee $ 3 DEVELOPMENT SERVICES REOUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Det SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING 5 ISSUANCE $ --_-� PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50%. $ MICROFILM $ MECHANICAL S TOTAL FEE $ /] PLAN CHECK 25% $ Is i-- CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL , ,'A APPROVALS Permit # Date Inspectnr 'I• 1. Temporary Electrical Service or P81e 52. Pool & Equipment Location •2. Soy) Pipe Undrgrnd. 10 loe 1 53" Steel Reinforcement y fir Electrical Conduit Utility-Undrgrnd. 54• Forms 4 Electrical Conduit-Uridwrnd. ZJ �� « r r, r 55_ Electrical Borxlir�g U 5:- St of Reinforcement n 56. Rough Plumbing & Pressure Test i - S'� ctrical UFERIGr'rid. �- 57. APPROVAL TO COVER-GUNITE N 7. Foot Pgs � "r 58." Electrical Conduit-Undrgrnd. `'t1 8.- Foundation CIA 59. Gas Pipe, ❑ Undrgrnd., Test V�Wate Pipe -Una gyr%d. �< ;a 60. Backwash Lines, P -Trap, ❑Undrgrnd. 0:, Structural Floor System fit, APPROVAL TO DECK ii,,Property Sewer Lid',& House Connection sf n E 62. Backwash &Receptor -Final r iSe}nrer Cap tj" ^? ; 63. Heater & Vent -Final b .t 13., Roof Drains 64. Plumbing System - Final J' 14. Rough Plumbing'✓ Y �(� 65. Electrical -Final 15.. Rough Electrical -Conduit 66. Solar System Final Rough Electric Wiring 67. Fencing & Access Approval r 17: Rough Wiring Sign 68. APPROVED FOR PLASTERING 18: Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL X19. -Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS ' Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas 0 Oil -23, Gas Pipe -Rough & Test n 72. Underground Flush '24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical -27, Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe -Test -6-a7 e- CA -3 36. Hood or Canopy - 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final' 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations, Ir CITY OF COSTA�MfES�A CONSTRUCTION PERMIT �t III PERMIT NO. TRACT NO. LOT NO. UNIT NO. 'Project Address � %✓ � % �ysi ��i-%7� �J�f1T' Applicant's Mailing Address Owner's Name 77? -!_6,t 7--J LIE -r7 ,L11C1-1 i _ Phone Address Arch/Eng. License No, Address Contractor's Namp1mails r hone 3 L 1-9 0 Address (ma iling)fN-1 �.4. ./2LCr, � iyy%i_ Z,_/_� City License N_o- LICENSED CONTRACTOR OECLARATION I hereby affirm that I aM licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my llcense.is in full orce and effect. — License Class icense No.T:r-S -7/7 Data Signature WORKERS' COMPENSATION DEC ATION ' "hereby affirm that I have a certificate of consent to self -insure or a certificate f Workers' Compensation Insurance, or a certified copy thereof (Section 380D, Lab. C.) Policy No. 1212L ric9 'i 7O CWny�G BCertifled copy is hereby furnishetl. Cer ified co y is filetl with the cityon. Date�1� -� - ..� Applicant EXEMPTION FROM WORKERS' COMPENSATION D CLARATION (This section need not be completed if the permit is for 6ne hundred (5100) or lass). I certify that• in [he performance oft a wo hich this p rmlt is d, I shall not employ any Parson in any mann so a [o beco subje t t the Workers' ompensa Laws of Calif r ia. Date Signature 'NOTIC : If, after making this declaration, yo Should Come subiect to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with 'such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that therQ Is a construction lending agency for the performance of lho work for which this permit is issued (Section 3097 Civ. C.) Lender's Name _ Lander's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Sectlgn 7031.5 Business and Professional Code: Any city or county which requires d permit to construct, alter, Improve, demolish or repair any Structure, prior to its issuance, also requires the applicant for such permit to file a signed Statemeht that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of )Ivlsion 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 1D31.5 by any. apPlicent for a permit subjects the applicant to a civil analty of not more than fivo hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, willdothe work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor'$ Llconse 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 employees, provided that such Improvement$ aro not Intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pietion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of Sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and who contracts for such projects with a con- tractors) license pursuant -to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should De provided to me, ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby, certify that I'have read this application antl state that the above Information I reef agree to co ply with all city and county ordinances and state la s re 9 building G IT -11h and hereby authorize repre- sentatives o this J t enter ,up n the ve-mentioned property for inspection pu os — Signature /, .�- Date Drivers' License or SS :ip -t-1 1 -i 1 1 0 -ID TYPE OF CONSTRUCTION LJ NEW LJ ADD 11 ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. ql6 DESCRIPTION OF WORK/USE OF BLDG. ' IS Main Building: E TYPE OF PERMIT GRADING 0 FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ -OTHERA PROJECT DESCRIPTION SO. FT. OCCUPANCY C Right K Left CONSTRUCTION TYPE VALUATION S $ ZONE GRADING CU. YDS. ACRES Ping. Ref, Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee Boiler Outlets I $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 13 0-100,000 BTU ID 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. ID/84 'White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING I FEES Showers Service Sink Sewer Cep Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee $ 3 IANICAL FEES Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System 00.100,000 BTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric 5817 1/16/05 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW 05.15 KIN Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors;0.1 HP ❑ 1 A - 8 Inc. Solar 139.15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor Reinspection Fee 1 $15 1 1 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By - r - bG TL FEES $ 3 to to t MECHANICAL $ TOTAL FEE $ $ 3 PLAN CHECK 25% $ Z O N I N G R E Q M T S SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.C. ELECTRICAL $ GRADING PLAN CHECK 50% It • SO MICROFILM r - bG TL FEES $ 3 to to t MECHANICAL $ TOTAL FEE $ $ 3 PLAN CHECK 25% $ Z O N I N G R E Q M T S + CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector PO(._ & SPA APPROVALS Permit # Date Inspector 1 . Temporary Electrical Service or Po1e f 52. Pool & Equipment Location 2. Soil „P,ipe Undrgrnd., dolt i. 53. Steel Reinforcement 3 EEle'trical Conduit Utility-Undrgrnd- 54. Forms 4. ;Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement- =� 56. Rough Plumbing & Pressure Test `t ,�• Electrical UFER.Grnd. 57, APPROVAL TO COVE R-GUNITE 7., Footings 58. Electrical Conduit-Undrgrnd. 8,,Fouhdation , F 4 e 59. Gas Pipe, Q Undrgrnd., Test ,v 9; Water Pipe-Undrgrnd. ;. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. '10 'Structural Floor System " 61. APPROVAL TO DECK 11 .'Property Sewer Line & House Connection ' + 62. Backwash &Receptor -Final 12. Sewer Cap ;. Y, 63. Heater & Vent -Final 1Roof 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 APPROVALS Permit # 20. Rough Factory Fireplace 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 ❑ 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 PREY, FINAL 30,,..Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Finai 80. FOOD CERTIFICATE ISSUED 33. Final Electric Lj'0 1Votes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Presenter 43. Backflow Irrigation 44. Landscape Irrigation System }r 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 as Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT ;O. Project Address Applicant's Mailing address d TYPE OF CONSTRUCTION NEw ADO ALTERATION REPAIR Owner's Name Troy Investment Fund Phone 54.9-2988 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P., DESCRIPTION OF WORK/USE OF BLDG. Address S Main Building: Arch/Eng. Marin J, Rork —License No. TYPE OF PERMIT GRADING El FOUNDATION 0 STRUCTURAL T Front Address 12881 Knott Ave_ Suite 216 ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL B Rear Contractor's Name T)lirn Air_ Cnnriiti_vnning.Phone-982-1216 ❑OTHER C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY Address(eNg)_. 1n Safir�r St. N-1in113,yLnn�_CA` CONSTRUCTION TYPE VALUATIONS S Left City Licensnse No_ 3392 ZONE GRADING CU. YDS. ACRES Ping. RCf. # LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (Commencing Remarks: Planning Notes: with section 7000) of Division 3 of the Business andcions Code, and my license Is in full force and e.(1Lct. License Class C—r LU L1Ce .7 34625 [Date 411R_..r3;4—_ Signature WORKERS' COMPENSATION DEC RATION 1 hereby affirm that I have a certlfic of Consent to self -insure or a certificate F Workers' Compensation Ins ura ce, or a certified copy thereof (Section alio, Lab. c.) WC9824 Lumbermans Policy No. Company eCertified copy is hereby furnished. Certif'e is filedwith the city Byyf�ing-Q[visic Date Applicant Y� *,C -C7 EXEMPT ON FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit is for one hundred ($100) or less). I certify that in the Performance of the work for which this permit is issued I shall -not employ any person in any manner so as to become subject to tyre Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION, LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3497 Civ. C.) Lender's Name Lender's Address OWNER BUILDE=R DtCt-ARATION I hereby, affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code; Any city or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 V' refrom and the basis for the alleged exemption. Any violation of Section .?<�31.5 by any applicant for a permit subjects the applicant to a civil ,:'I" natty of not more than five hundred dollars ($500). 0 I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the bullding or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- tractors t6 construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who .builds or improves thereon, and who contracts for such projects with a con- tractors) 11cense pursuarit.to the -Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to ❑ '1 am exempt under Section B. & P. C. for this reason Oate Owner _ I hereby certify -that I have read th information r enact. I agree to con and state la s Blatin to bu din c sentatives t 9 9 9 is city to tej Nd inspection ur cnc Signature Drivers' Lic se or SS AF 0865-46, rev. 10/84 Ppfication. and state that the above with all city and county ordinances uction,and hereby authorize repre- the above-mentioned p per)(for if Da71 it Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 I Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple D Firepl/Fact. Bit. ICBO # Heating System & Ducting 1 K10.100,000BTU ❑100,000BT Reinspection Fee White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor $15 PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal Water Closet -Water Heater Water Service Auto -Wash Laundry Trays FEES Issue Fee I $ 3 FEES Hood or Type 1 ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000 BTU 0100,000 System Repair/Alteration Fire Dampers Registers 4 Issue Fee 1 $ 3 1743 4/24/85 Accessory Building:. Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.'U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW ❑5.15 KW Zone -I Transformer ❑ 15-50 KW 1 ❑ 50 + KW Meter Uup to 100 amps Meter Dover 100 amps Sub Panel Motors ❑Qi HP Ell 56-8 Inc. Solar 09-15 HP 016-15+ Microwave - Pole Light Range Sign Standing Sections Trash Compactor 15.58 TL Z O N I N G R E a M T S FEES 6 I I Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Data SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. S ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE $ 15. SO PLAN CHECK 25% $ - 2 SCI ` CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POC SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location r ;.' 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electricol Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding t j - 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test r' 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE .•''' 7. Footings 58. Electrical Conduit-Undrgrnd, r 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final r ' 12. Sewer Cap f 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. POOLISPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20."•Rough Factory Fireplace 21.;Ductsjn Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas D Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30.. Drywall Nailing HEALTH DEPT. REQUIREMENT 31`. Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Dornestic-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 Z . a U F -Z Z Q vCO am J 0 J V) Q W C13 J J CO _ Q UN Z Q W CC CL Ly W Z J C) M Z J W W 0_ ZF- w0 �O 3 838.3 CO%TA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626 For Applicant to Fill in Completely BUILDING. ADDRESS OWNER MAIL ADDRESS S_ V ` CITY CZ-jk-491-� NVV CONSTRUCTION LENDER 1 BRANCH ADDRESS ARCHITECT 5&,L) (SS - OA ENGINEER ` 3 1 +y''� ADDRESS -#I TEL NO. TE L. N O- USE OF BUILDING AND WORK TO BE PERFORMED I hereby acknowledge that I have read this application and state that the Obove information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workmen's compensation laws of the State of California. I hereby Certify that I am properly licensed as a contractor under the State of Califor is Business and Professions Code, Dtvisicn 3, Chapter 9, and that uch licenses are in full force and effect, or I am exempt from th provisions of the State of California Business and ProfessiO Cad Division 3, Chapter 9. Signature of Permittee - L CL71�_ Authorized Agenik 1 f f 'l. SVj07�r ILH) V15r 1l::liy:IL'.511 APPLICAyTION FOR BUILDING PERMIT RECEIV SBLYT�PFCEIV D DATE ISSUED /4t7A,P, ADDRESSS��L��Q �`J BUILDING t7 1ADDRESS I 1_. �� ML-�R%>CT !" Inc JR4 LOT/ �t BLOCK NEW AD P TEL. �- CITY-� NO. STATE �` _ CITY r LIC, NO. LIC. NO. SIZE NO. OF SLOGS. OF LOT NOW ON LOT USE OF EXISTING BLDG. SIZE OF NO. OF NEW BLDG. ROOMS STORIES EXTERIOR WALL ROOF COVERING COVERING USE OF BUILDING AND WORK TO BE PERFORMED I hereby acknowledge that I have read this application and state that the Obove information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workmen's compensation laws of the State of California. I hereby Certify that I am properly licensed as a contractor under the State of Califor is Business and Professions Code, Dtvisicn 3, Chapter 9, and that uch licenses are in full force and effect, or I am exempt from th provisions of the State of California Business and ProfessiO Cad Division 3, Chapter 9. Signature of Permittee - L CL71�_ Authorized Agenik 1 f f 'l. SVj07�r ILH) V15r 1l::liy:IL'.511 APPLICAyTION FOR BUILDING PERMIT RECEIV SBLYT�PFCEIV D DATE ISSUED /4t7A,P, ~}A NO. L>��[� PERMS ,3 �`J BUILDING t7 1ADDRESS I 1_. �� ML-�R%>CT !" Inc JR4 LOT/ �t BLOCK NEW AD P OWNER v Q $ %%O!� SE E�Q A tIOLUE V U FIRE _y ZONE TYPE GROUP APPROVED BY if, %Q DATE J ZON NO. OF USE OF NEW ,�� PLANS BUILDING YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM C/L STREET) REAR FT. FT. DISTANCE BET. BET, MAIN & MAIN SLOGS. ACCESS. BLDGS. VAR. # DATE C.U.P. APPROVED APPROV EDj . jl T DATES TA THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. VALUATION Q O� PERMIT FEE $ S PLAN CHECK $ �� TOTAL FEE $ m 0 Go n 7 m E `o LL f A (714) 754-5273 • Fax (714) 754-4856 • www,ci.costa-mesafL-?CTRICAL PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 711 W 17TH ST Suite No A009 Vicinity: INSIDE BLDG Parcel Nunmber: 93983004 Applicant: CHRISTENSEN, SCOTT Address: 2035 WAVERLY DR ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool 1 Spa . Lighting Fixis Recept Outlets Switches Non Res App1 Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1 hp Motors to 10hp Motors to 50hp Motors to 100hp Motors over 1 00h Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole ISSUED BY: Status: ISSUED Applied: 08/15/2005 Issued: 08/15/2005 EX19ED Own SCOPE OF PERMIT `. - tHANGE-OUT OF AN ELECTRICAL SERVICE FROM 100A TO 200A FOR THE COPY MAN IN UNIT A9. NO OTHER WORK AUTHORIZED WITH THIS PERMIT. .. Phone: 714-235-2601 ANAHEIM, CA Zip 92802 Owner: MULLIN, MICHAEL W TR Address 711 W 17TH ST NO A-9 4uantity Quantity Phone: S23.50 COSTA MESA, CA -Temp Dist System I Lighting $0.00 0 , $0.00 Contractor:-'. MAKO ELECTRIC $0.00 Address:' 2035 WAVERLY DR Standing Section $0.00 Phone: 714-235-2601 $0.00 ANAHEIM, CA Zip: 92802 $0.00 0 License: 836183 ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool 1 Spa . Lighting Fixis Recept Outlets Switches Non Res App1 Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1 hp Motors to 10hp Motors to 50hp Motors to 100hp Motors over 1 00h Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole ISSUED BY: Status: ISSUED Applied: 08/15/2005 Issued: 08/15/2005 EX19ED Own SCOPE OF PERMIT `. - tHANGE-OUT OF AN ELECTRICAL SERVICE FROM 100A TO 200A FOR THE COPY MAN IN UNIT A9. NO OTHER WORK AUTHORIZED WITH THIS PERMIT. .. NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaaa-sa (a=) FEE SUMMARY 4uantity Quantity S23.50 -Temp Dist System I Lighting $0.00 0 , $0.00 Busway 1100 h $0.00 0 $0.00 Standing Section $0.00 0 $0.00 0 Misc Electrical Equipment $0.00 0 $0.00 0 Transformers up to 1 kvalkw" $0.00 0, $0.00 0 ..............::up to 10 kvalkw $0.00 0 60.00 0 .................up to 50 kvalkw $0.00 0. $0.00 0 .................up to 100 kva/kw $0.00 0 $0.00 0 .............:....over 100 kvalkw $0.00 0 50.00 0 Low Voltage Equipment $0.00 0 $0.00 0 Low Volt Wiring System I Ckt $0.00-." 0 $30.50 1 Misc. Conduit $0.00 ; 0 $0.00 0 Misc. Conductor.. ,- $0.00 ,0 50.00 .0 Circus (den orride) ' $0.00 0 ' $0.00 0 Circus -(meth ride or lights) $0.00. 0 .$0.00 0 Christmas Tree Stand $0.00-1. .. 0 $0.00. 0 Fireworks Stand $0.00 0 $0.00 6 Other Electrical Fee 50.00" $0.00 0a $0.00 •0.„ In4esttgation'Fee $0.00 0 Plan Check Fee.,' $0.00 $0.00 0 :, Reinspection Fee $0.00 $0.00 0 r $0.00 0' w ,."TOTAL CALCULATED FEES $54.00 $0.00 0 COMMENTS/ SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaaa-sa (a=) 1 "I WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' Compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. ❑ I have and will maintain workers' compensation insurance, as required by swtlon 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed It the permit is valued at one hundred dollars ($100) or less.) } I Certify that In the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the workers' ` compensation laws of CallforpV. and aglAo 1hat If I should become subject to the workers' compensation provisions of Section 3700 a{ the labor Code. I shall forthwith Comply with these prostate Applican/ t'SIgnaturo: rDat �lT df WARNING: FAILURE TO SECU E WORKERS' OOMPENSATM OOVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CPoMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND OOLLARE ($100,000) IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I em licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, end my license is in full force and effect: Liar# 3 Class• — 10 Contractor's'Sign`eruae .�.- _ _ Daite:--y _At— CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's flame: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any dry or county which requires a permit to construct, atter, Improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to tile a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 700)) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of properly who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's license No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ i hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-slx (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Tltle 6, California Administrative Code), ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division, Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 W ill the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a v(lumo of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure), 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time hes on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ......... ......... ...................—_................—......--- -- - _........ _........... —............. _... ............................................................. 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ........ ................ ............................ _................................_................................_................................................................................................................... ...................... .................. ................... .._........... _.- 4 It an RMPP Is prasently required, has Secdon 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No -- ..............----_..................._—..._..........._.........—....................... -._........................................................ .............................................................---...............__........... —............ —......... ..... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a pllcation a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? I] Yes Il No (Section 65650.2 of the California Goverment Code requires that the requested information be furnished on applications for non-residential building permits). ......................—.h"- ............. - ........... __._...... .— ..................... _...........................................................................1.............................................-.......................... --- ......... ...__ ...w _ 6 Will any part vt the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes Cl No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). - -- ..............—..__..._— _............ ...........-._..-.............. .... -_-.................. �..........................................................-- ..... - 7 If a permit from the South Coast Air Quality Management District or other air poltuUon control district or agency is required for the work which Is the subject of this application, have all of the disclosures prescribed by California Health and Safety Cade Section 42303 been made? ❑ Yes ❑ No 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of podury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and slate that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. �_s pre f LegalOwners)Andq Auft ted Applitent fQRE_L INSPECTION TYPE 2AN IfIIQ16L@ CODE 1 INSPECTION TYPE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Ae-Roof 210 Final Electrical 201 Final Block/Rotalning Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupency Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. G1TY OF COSTA MESA CONSTRUCTION PERMIT PERM)T NO. TRACT NO. LOT U. UNjT NO Projact Address �/�ItO / 71J�(e�i e7MM / 1 ACia Applicant's Mailing Address _.. Owner's Name luw_ pi`'tJ_,1 f�a Phone Address Arch/Eng, License No. Address . -- Contractor's NamP.4W all J t2.LgC'1-A ' Phoneg27"657c AddressImaiIing),�q 9'lSAAY,4"I� S% Qt:sC,r-twySC� �JZ�JC City License No. 2L!0_ LICENSEO CONTRACTOR DECLARATION I herebyiaffirm that I ant 0censed•under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. �.22 Ucense Class ' / 0 Icen e N Dateii,t�-� S, Signature ` WORKERS' COMPENSATION DECLARATION . I hereby affirm that I have a certificate of consent to setf-insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, lab. C.) Policy No. BCertified copy is herepy I rnishetl Certlfied copy is filed with the citQuild&Di€on. Date `f c ' �� — APPI€cant "��•- EXEMPTION FROM WORKERS' COMPENSATION D CLARATION (This section need not be completed if the -permit Is for ne hu Bred ($100) or less). 1 certify that in the piprformance of thMf. h this 'mit i sued, I shall -not employ an person In any /beco a su je to the Workers' Compens OLawsofCa . Date ` Signature NOTICE: If, after making this declaration, you should qecome subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance ofthe work for which this permit is issued (Section 3097 Civ. C.) Under's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair .any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License law (Chapter 9 (commencing witn 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 analty of not more than five hundred dollars ($500). I, as owner of the Property or my employees with wages as their sole Compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of Com- pletion, the owner will nave the burden of proving he/she did not build or im- rOvo for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors t0 construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and _who contract$ for Such projects with a con- tractor(s) license pursuant'to'the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Stiction B. 8. P. C. for this reason Date — Owner I hereby certify that .1 have read this application and state that the above information is correct. I agree to Comply witjt ail city an" county ordinances and state laUth a o I d'" nstruc�ipn, and herepy authorize repre- sentatives ocity to enteru on thE/above-mentioned property for inspection Signature Drivers' License o SS Reinspection Fee 1 $15 Boiler Duct • Under Ground Duct • Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑4100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee ! $ 3 Hood or. Type 1 ❑ Canopy Type II ❑ Refrigeration System ❑Q100,000 BTU 0100,000BTU System Repair/Alteration Fire Hampers Registers Issue Fee 5B16 1 / 1 6Ilio Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. . Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 05.15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100 amps Meter Dover 100 amps Sub Panel MotorseW0-1 HP ❑ 1 f, - 8 inc. Solar 09-15 HP C1 16.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 4011� T1. FEES Z O N I N G R E O M T S FEES PLUMBING I FEES Bar Sink Showers Backflow Preventer Service Sink TYPE OF CONSTRUCTIO LJ NEW LJ ADD LJ ALTERATION LJ REPAIR Bathtubs ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Clarifiers Solar Collectors Dishwasher Solar Piping A.P. 416 DESCRIPTION OF WORKIUSE OF BLDG. Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets S Main Buildi Water Heater Kitchen Sink Water Service Lavatories P—Trap TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B ❑ .OTHE R Rear PROJECT DESCRIPTION SQ. FT_ OCCUPANCY C Right CON STRUCTION TYPE VALUATION S $ I Left ZONE GRADING CU.YDS. ACRES Ping. Ref, # Remarks: Planning Notes: Reinspection Fee 1 $15 Boiler Duct • Under Ground Duct • Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑4100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee ! $ 3 Hood or. Type 1 ❑ Canopy Type II ❑ Refrigeration System ❑Q100,000 BTU 0100,000BTU System Repair/Alteration Fire Hampers Registers Issue Fee 5B16 1 / 1 6Ilio Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. . Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 05.15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100 amps Meter Dover 100 amps Sub Panel MotorseW0-1 HP ❑ 1 f, - 8 inc. Solar 09-15 HP C1 16.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 4011� T1. FEES Z O N I N G R E O M T S FEES PLUMBING I FEES Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories P—Trap Auto -Wash Laundry Trays Roof Drains Reinspection Fee 1 $15 Boiler Duct • Under Ground Duct • Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑4100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee ! $ 3 Hood or. Type 1 ❑ Canopy Type II ❑ Refrigeration System ❑Q100,000 BTU 0100,000BTU System Repair/Alteration Fire Hampers Registers Issue Fee 5B16 1 / 1 6Ilio Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. . Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 05.15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100 amps Meter Dover 100 amps Sub Panel MotorseW0-1 HP ❑ 1 f, - 8 inc. Solar 09-15 HP C1 16.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 4011� T1. FEES Z O N I N G R E O M T S FEES Reinspection Fee 1 $15 1 1 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date + Building Approved By Date Application Issued By— „Data SUMMARY OF FEES BUILDING PERMIT $ SMIP $ + PLAN CHECK $ PERMIT PLUMBING S ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL .$ L4.00 GRADING $ PLAN CHECK 50% $ _ SO MICROFILM $ MECHANICAL $ TOTAL FEE $ 4"50 PLAN CHECK 25% $ $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Dat J Inspector POOL & SPA APPROVALS Permit #, - Date Inspector 1. Temporary Electrical Service or Pale 52. Pool & Equipment Location 2. Soil►Pipe-Undrgrndl ry 53. Steel Reinforcement 3., Electrical Conduit Utility-Undrgrnd. 54. Forms 4. -,Electrical Conduii-UnBrgrnd. 55. Electrical Bonding 5.`SteeReinforcement l 56. Rough Plumbing & Pressure Test 6. Electrical uFER Grnd. r, 57. APPROVAL TO COVER-GUNITE 71%Footings •. �8. 58. Electrical Conduit-Undrgrnd. 1 rFoundation a 59. Gas Pipe, ❑ Undrgrnd., Test 9?;Water Pipe Undrgrnd. 60, Backwash Lines, P -Trap, ❑ Undrgrnd, .10r,Structural Floor System r 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24•, Roof Framing 73. Undergrnd, Storage Tank ❑ 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 PREY. FINAL 30.• Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric �� Notes: 34. Final Heating & Air- Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy 37• Final Factory Fireplace 38. Final Plumbing 39" Water Service -Final 40" Gas Service -Final 41. Solar Domestic -Final 42. Backfiow'Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 1 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed, 49. Electric Release to Edison, 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines andsign all appropriate declarations, . PER IT NO. TRACT NO. LOT NO. UNIT N &fy pF TSTA MESA CO UNCTION PER' I V1 b AN. Projett Address Applicant's Maili Address 'd41 60-LIZA2 Owner's Name �%✓L/--��'W3rePhone Address r If s Arch/Eng. License No. Address Contractor's Nam Phone %% Address (mailing) City License No. -J S"ei-i LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in tuiWQrce d ffect. rf lacen Class r— ; ' (cense No3o �►z� r Date Signature r7 7f WORKERS' COMPENSATION DE ARATION I hereby affirm that I have a certlfi to of consent to self4nsure or a certificate f Workers' Compensation insurance, or a certified copy thereof (Section ,800, Lab. C.) Policy No. Company BCertified copy is hereby furnished, r Certified copy Is filed with the city Building Division. r �- Date Applicant EXEMPTION FROM WDRKERS' COMPENSATION DECLARATION (This section need not be completed if the permit IS for one hundred ($100) or less). I certify that in the performance of the work for which thfs permrt is Issued, I ' $hall not employ any person In any manner s as to become subject to the, Workprs:Co(n� nsati�ws of Calif c Date ��1�Signature 'NOTICE: If, after making this declar n, y u should become subject to the Workers' Compensation provisions the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY I herebyaffirm that there is a Construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ, C.) Lender's Name Lend@r'S Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any City or County which requires a permit to construct, alter improve, demolish or repair any Structure, prior to its Issuance, also requires the applicant for such permit to file a Signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 1031.5 by any applicant for a permit subjects the applicant to a civil innalty of not more than five hundred dollar$ ($500). 1, as owner of the property or my employees with wages as their sole Compensation, will do the work, and the structure is not intended or offered for tale (Section 7044, Business and Professional Code: The Contractor's Licegse Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletion, tho owner will.have the burden of proving he/she did not build or Im- rOve for the purpose of sale). t, as owner of the property, am exclusively Contracting with licensed con- tractors to Construct the project (Section 7044, Business and Prefes$ions Code: The Contractor's License Law does not apply to an owner of property who buildsor improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant'to the *Contractor's License Law). I aril aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentionad property for _ inspection pur s.(d•�'r� Signature -_ — Date,11—/40'—^ Drivers' Lice" or SS ;F TYPE OF CIDNSTRUCTION I I NEW LJ ADD ALTERATION LJ REPAIR ❑ CONVERSION -❑ DEMOLISH ❑ OTHER A.P. DESCRIPTION OF WQ RK/US F BLDG. 1 T � �1 m S Main Building: E TYPE OF PERMIT LJ GRADING LJ FOUNDATION El STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ -OTHER A C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CONSTRUCTION TYPF - - VALUATION $ $ Left ZONE GRADING CU.YOS. ACRES Ping. Ref. 46 Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee I S15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO * Heating System & Ducting 00.100,000 BTU 0100,0WEIT Reinspection Fee 1 $15 CMF 0865-46, rev. 10184 White - Building; Canary - App))cant; Pink - Accounting; Goldenrod - Assessor 9912 3/25/85 Accessory Building: Parking Req./Provided I095.1 Tl, Zone PLUMBING Showers FEES ELECTRICAL FEES Service Sink DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By -- Date Building Approved By Date Application Issued By r j ate seki� Automatic Washer Construction P0)e Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Sewer Cap Sewer Connection Refrigeration System 0()- 100,(100 BTU ❑100,000STU Cooking Unit Meter Cup to 100 amps Solar Collectors Dishwasher Meter Cover 100 amps Solar Piping Fire Dampers Dryers ❑Gas ❑Electric Sub Panel Solar Tank Fen Motors E3 0-1 HP ❑ 1 A - 8 Swimming Pool wlSpa F,A.U. Inc. Solar []9.15 HP 016.15+ Urinal Issue Fee $ 3 Fixtures Device Boxes Microwave Pole Light Water Closet Water Heater Outlets Range Water Service Switches Sign Auto -Wash Garbage Disposal 1 ; Standing Sections Laundry Trays Generator ❑0.5 KW 05.15 KW Trash Compactor Z 0 N N G R E O M T S Issue Fee S 3 Reinspection Fee $15 1 1 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By -- Date Building Approved By Date Application Issued By r j ate seki� Hood or Type I El Canopy Type I I El Refrigeration System 0()- 100,(100 BTU ❑100,000STU SUMMARY OF FEES ^^ BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% S Z/ s' ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ /Is PLAN CHECK 25% $ System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 _,- _ - '� CONSTRUCTION AND PLANNING APPROVALS Permit # Date 1 Inspect or POO -.,x SPA APPROVALS Permit # Date InspectaT [ 1: Temporary Electrical Service or Ne 52. Pool & Equipment Location v 2. Soil Pipe-Undrgrnd. �� 53. Steel Reinforcement A_ Electrical Condujt Utility -1-14 rnd.. 54. Forms �. 4' Electrical Condtt3t=IjAlgrnd- k4 55. Electrical Bonding r 5` Sto Reinforce6eKt 56. Rough Plumbing & Pressure Test 17 ft �6' electrical UFER'GJnd. T �� 57• APPROVAL TO COVER-GUNITE 58. Electrical Conduit-Undrgrnd. I z 8: Fou*dation C� �,}. 59. Gas Pipe, D Undrgrnd., Test r � 9. Vi�ater Pipe -Un cl�gr .. v t, 60- Backwash Lines, P -Trap, D Undrgrnd. 10^ Sfructural Floor System I 61. APPROVAL TO DECK 11r.Pr,'operty Sewer Line House Con,ection # 62. Backwash &Receptor -Final V 12'. Sewer Cap !"o 63. Heater & Vent -Final l 1' f- . 13..F pPf Drains �7 `J 64. Plumbing System - Final 14. Rough Plumbi�,� g '�� - �`f (,rte 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 •mow APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping D Gas ❑ Oil 23. Gas Pipe Rough &Test 72• Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas 0 Oil 25. Roof Sheathing 74, Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31•- Plaster Brown Coat 79. FINAL INSPECTION 32, Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33• Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test (Y] LED 36. Hood or Canopy 37. Final Factory Fireplace 38, Final' Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Sellar 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 N 11 10 ..;0 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. MONV CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. — TRACT NO. LOT NO. UNIT N>:1. Project Address Applicant's Mailing Agdress 11 i 1 1 i1 - Sa ti Cay__S-t„ N 1 Il l ywnnrl Owner's Name T o3t—InveS.tmPiir 1±t117d Phone5�4 8 Address 4321_B1•seh_,S�wportBeas� Ca. Arch/Eng. License No. Address 129U__Knntt Ave--Suite-216 Contractor's Name Di Pro Air C.nnditionin 'hone. 982-1216 Address (mailingi__L3J_0_(;aticn3/ St City License No - 3 1,42i LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 mmencing with section 7000} of Division 3 of the Business and profess n Code, and my license is in full for e�pp eife 46251 License Class UU i se N Date 4119 J R4 Signal re WORKERS' COMPENSATION D LA RATION I hereby affirm that I have a certi ate of consent to self -insure or a certificate •f Workers' Compensation Ins ante, or a certified copy thereof (Section Policy No. Company lio, Lab. c.) PoWC9824 Lumbermans H Certified copy is hereby furnished. i ion Cert'f- c y is filed with the city Buildinoiv._ & J Date tot Applicant— r +(�y EXEMPTIDN*FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (5100) or less) I certify that in the p@rformance of the work for which this permit is Issued, 1 shall not employ any person In any manner so as to become subject to the Workers'. Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION. LENDING AGENCY _ I hereby affirm that there Is a construction tending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER 13UILDER DECLARATION ' 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any City or county which require% a permit to construct, alter, improve, demolish or repair any structure, prior t4 its issuance, also requires the applicant for such permit to file asigned statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) of that he/She is exempt therefrom and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). l� I, as owner of the property or my employees with wages as their sole compensation, will dq the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does Such work himself/hersolf or through his or her own employees, provided that Such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- rovefor the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s) license purguant to tho•Contractor's License Law). I am aware that proof of their Work@r's Compensation insurance should be provided to, me. ❑ 1 am exempt under Section S. & P. C. for this reason Date Owner I hereby certify that I have rea Information is correct. I'agree t and state relating to but it sentative of his, city to ter Inspecti pur , Signature Drivers' Li nso or�SS his application and state that the above mply with all city and county ordinances construction, and hereby authorize rep pon the above-mentioned -p r_ perty jro r IN TYPE OF CONSTRUCTION LJ NEW L1 ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT El GRADING El FOUNDATION 0 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING Q MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION 5 gt Left ZONE GRADING CU. YDS. ACRES Ping. Ref. 0 Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—.Trap_ Roof Drains Reinspection Fee $15 Boiler , Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust system ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # _ Heating System & Ducting 1 P0.100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Tral FEES 1 %2 4/24/55 Zone Accessary Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction PO)e Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan, F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 135.15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter Clover 100 amps Sub Panel Motors 00-11 HP❑1'h-8 Inc. Solar ❑9-15 HP C] 16.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 15 o E0 TI` FEES 2 O N I N G R E Q M T S Issue Fee $ 3 Reinspection Fee $15 ]'Issue Fee $ 3 iANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Zo9 A pproved By Building Approved By Application Issued By Date Date Data Hood or Type ! El Canopy Type 11 ❑ Refrigeration System ❑f}100,000 BTU ❑100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ $ $ 13.00 $ 2.50 SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFI LM $ TOTAL FEE S 15 .50 ' System Repair/Alteration Fire Dampers Registers 6 00 4 00 Issue Fee $ 3 Iu CONSTRUCTION AND PLANNING f APPROVALS . Permit # Date Inspector POOL ;PA 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 fr 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test i 6• Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. r 1 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. -Water Pipe-Undrgrnd. r 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Conr ection 62. Backwash & Receptor -Final 12. Sewer Cap ; - 63. Heater & Vent -Final 13. Roof Drains 64, Plumbing System - Final F' 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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22.Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32.- Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning ��✓ 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed ; 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co E 51. CERTIFICATE OF OCCUPANCY No. Date (714) 754-5273 • Fax (714) 754-4856 - www.ci.costa-mesa.ca.us NG PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 711 W 17TH ST Suite: A Vicinity: UNIT A Primary Occ: B Eat<50/ Office/ Bar<50 Type of Construction: V Parcel Number: TPN02004 Zoning: Applicant: BATIOFF, JOHN Permit: $543.25 Address: 17182 ARMSTRONG AVE SMIP Com: $8.40 Other: $0.00 Phone: 949-260-1900 IRVINE, CA ' " Zip: 92614 Owner: MESA BUSINESS CENTER ASSOCIATION Address 711 W 17TH ST Phone: 949-672-9035 COSTA MESA, CA, Zip: 92627 Contractor: DRI COMMERCIAL Address: 17182 ARMSTRONG AVE Phone: 949-260-1900 IRVINE, CA Zip: 92614 License: 818623 Arch : Address: Eng: Address: ISSUED BY: Status: ISSUED Applied: 04/11/2005 Issued: 04/11/2005 Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING BUILT-UP ROOFING & INSTALL NEW BUILT-UP ROOF SYSTEM (UNIT A) - 192 SQ. Plan Check: $0.00 Permit: $543.25 SMIP Res: $0.00 SMIP Com: $8.40 Other: $0.00 Inspection: $0.00 Total: $551:65 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0- 0 ' PARKING Existing: 0 NOTES: FEE SUMMARY Calc Valuation: Claim Valuation PLANNING R ZONING Rear 0-0 Left 0-0 Right 0-0 Rear 0-0 Left 0-0 Right Required: 0 Proposed: 0 640,000.00 540,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomla statutes and related regulations. (Ord. No. 92-28, § 1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days, or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 446.46 (6M) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensatbon insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation` insurance carrier and policy number are: n 1 / > Gamer: iklM [�/ i C A�-[ -{ Q. QP tv� � r� [� Policy Nt`umber: V_"G _2 7171q ]& (PaL j) (This section need not be compWed it the permit is valued of one hundred dollars (S too) or less.) ❑ 1 certify that in the performance o1 the work for which this permil 15 Issued, I shell not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree the It I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisia SappTi'c�iani sr_alura: �i•r.,Date ;.-� WARNING; FAILURE TO SECURE WORI(ERS' COMPENSATION COVERAGE 15 UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR OODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I em titan a (uear provisions of Chaplet 9 (commencing with Section 7000) of Division 3 of the Business and P Ifisstons Code, and my license is in full force and effect. UC. u Class r L Cantnsetor§ Sjpnat~ uta=w�" Date: e-1-11 c2y CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued. (Sec. 3097, Civil Code), Lender's Name: Lander's Address: Signature: Date: OWNER-BUILDEIT DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance, 81SO requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption, Any violation of Section 7031.5 by any applicant for a permit subjects the applicAnt to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their Soto compensation, WILL 00 THE WORK, and the structure is not intended of offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ I am exempt Under sec. Business and Professions Code for this reason: Signature: _ Data: Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownarship by (type of document, 1.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition Or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit 10 do such work from the divlslon. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or luture building occupant need to file and eertily a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ NO (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does Or will thA app'cant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 Of the California Health end Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). : ...................... __..........•........._.._..._._..._.._..— _.._....-..................... _................ _............................................................................... _.... ......... ...................... _ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes U No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materiels with the Fire Department. ..................._...................................................................................................................................................,,...................................................................................... ................................................................................_._....... a.......It an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes [I No :.............................-..__.........................................._...-----.................._.........................__..................................................,..,,,....,.............................................................................-----------.........................-........--- 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 8 No (Section 65850.2 of the California Government Code requires that tho requested information be iumishod on applications for non-residential building pormits). _ ...- ...................... -- ..._ .__—,_..._.... —-..................._.............."I'll".., .... ..._—......... ----..............-----_.......-- 6 Will any part Of the facility to be constructed under this permit be within 1000 fee t from the outer boundarigs of a school? ❑Yes ©No (it yes', the faGifhty must meet the requirement of Sections 25534 and 42303 of the Celilomla Health and Safety Code), ........ ...._...................... -----_................_...............---•--......---------------------•--------..........................._._..........------.........................................................................---•---•----..................................................---------...-.........._......_.. .. 7 !f a permit from the South Coast Air Quality Management District or Other air pollution control district or agency is required for the work which is the subject of this appacation, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No _................................_ _................................._._.........-._...............'o.n............................................••....................... .......................................................... _.................._-._--------- .._.............. ..�................. 8 {If yes', attach cortiticate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of podury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating 10 building construction, and authorize representatives of the City of Costa Mesa 10 enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection, Ig ature Of L I ner(s) Dat r[d/2r?,ytho zed Ncan1• CODE f. ftpJ&J[QtL= QAg IIi1 TIAL5 CODE INSPECTION TYPE )NITTIAy9 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 FInu1 Plumbing 200 Final Re-Roof 210 Final Electrical 2Di Final Block)Relaining Wall 212 Final Flra PToveriftn 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4855 • www.cl,costa-mora.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT ,lob Address: 711 W 17TH ST Suite No A002 Vicinity: Parcel Number: 93983011 Applicant: MATT THORESON Address: 9911 LARSON AVE Repair lAlt Absorbtion Unit $0.00 0 Phone: 714-530-2440 -,Repair/ Alt Refrigeration Unit GARDEN GROVE, CA, Zip: 92644 $0.00 0 .,° .. .. ' Ventiliation•System $0.00 Owner: HUGHES; RODERICK E TR Evaporative Cooler - Address: 2015 YACHT MISCHIEF $0.001, 0 Commercial Incinerator $0.00 Phone: .$0.00:>=. 0', NEWPORT BEACH, CA,-, . - Zip: 92660-6713 Contractor: A AMES PLUMBING, HEAT, AC Address: 9911 LARSON AVErt Status: ISSUED Applied: 111172005 Issued: 11/172005 ISSUED BY: Phone:. 714-530-2440 GARDEN GROVE, CA Zip: 92644 License: -250307 ' SCOPE OF PERMIT, CHANGE OUT 2 A/C•UNITS; LIKE FOR LIKE, LOCATED ON,COMMERCIAL BUILDING'S ROOFTOP.. '. ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt CoolingfHeat Inst 1 Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factoy Fireplace Hood wlMech Exhaust VAV Box Vent Fan I Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Furnace Floor or Suspend Heater FEE SUMMARY Quantity Quantity $23.50 • - Repair lAlt Absorbtion Unit $0.00 0 50.00` 0 � "; = -,Repair/ Alt Refrigeration Unit $0.00 0 $0.00 0 .,° .. .. ' Ventiliation•System $0.00 0" $27.40 > 27- Evaporative Cooler - $0.00 0 ; $0.001, 0 Commercial Incinerator $0.00 0. ' .$0.00:>=. 0', _ Domestic Incinerator J : $0.00 0 $0-00 0' "` - Compressors /Absorption Systems ix i.,:= " ~' n '3 $0.00_-0 To hp 1500k BTU - $0.00 0 $0.00 0 15 To 30 hp 11,000 k BTU $0.00 0 ' $0.00''` 0 30 To 50.hp 1 1,750 k BTU , $0.00 0 $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 $0.00 0 Boilers $0.00 0 Up to 3 hp $0.00 0 $0.00 0 : , , 3 To,15 hp $0.00 0 $0.00 0 15 to 30 hp - $0.00 0 $0.00;,-_0 .R;- : 30 to 50 hp" _ $0.00 0 S0,001 01 Over 50 hp $0.00 0 $0.00 , 0, Other Mechanical Fee $0.00 0. ,Investigation,Fee.- -- --, - • $0.00 Plan Check Fee-- $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $50.90 -COMMENTS ! SPECIAL CONDITIONS. NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: to order for the work authorized under this permit to be considered legal, such work must compty with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2"846 (6M) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: J ❑ 1 have and will maintain a certificate of consent to self-Insure for workom' compensation; as+provfded for by section 3700 of the Labor Code, for the performance of the _--work, for which this permit is issued. ❑ l.have and will maintainssu workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued.——My-workers' c�`1p_ensatlon Insurance caMeIr and policy number are: Carrfer•.�i I�t-�r�-f--Y1/1rrll Policy_ Number-. G -(Tld section creed not be completed if the permits valued at one hundred dollars (S 100) or lass.) ❑ I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith compty with these provisions pplicartt Signature: _--:- _ C% 1 WARNMN .FAILURE TO SECURE WORKERS' ODMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPf_OYER TO CRIMINAL PENAL ES AND CML FINES up TO ONE HUNDRED THOUSAND DOL ARE (5700,000), IN ADDmoN TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37M OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm-that.l.am.licens_ed under prov l'�rtp o1 C aiter 9 (commencing with Section 7000) of Divlslon.3,of-the.Business anS) P fe s€ons o a d my license is In full -forcea d tfectJ LI�c. # %fit)- (/ !� �ClassA J vContractors'.Slgnature:-- �,; � _ _ - Date:. -r CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter. Improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL 00 THE WORK, and the sinrcture Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner tD verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: verification of Ownership by (type of document, i.e. • properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certity that no excevadon five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, end that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Tille 8, California Administrative Code), ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industria! Safety, es noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certity a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which hes at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ...................._......................... ......... .................................................,,..,,......."................ .............................._.................................... ... ........................................................................................_......................_.............................................. 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight o1 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........w............................... ».»...... ......................................... ... ......................... ........... ..................».......................... __.......................................................................... _.-_._...—................ .-............................................ 3 Does or will theapppllcant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes 11No Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required, has Section 25534 of the California Health and Safety Code been fully tempi€ed with? ❑Yes ❑ No _._.__...--...._....._— .............................». ..................». _ ».... ..».. W.............................-._.....-....__...------...........__.._...................-...................-...-.................-.,. 5 Does or will the applicant or present or future building occupant require far the work which is the subject of this a plication a ermit for such construction or modification from the South Coast Air Ouatity Management District or from any other air pollution control district or agency? LJ Yes H No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residantial building permits). ---.........---..... _........ ..................................-----..__............ --............ ---..........w-................» 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (if 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the Cal€fomla Health and Safety Code). _ ..._.._................---------------------- - --- ................ ......... - ..... - - - ---..... _—.._... _........ _.................... -_.......... 7 If a permit from the South Coast Air Oualiry Management District or other a€r pollution control district or agency is required for the work which is the subject of this application, hove all of the disclosures prescribed by California Haalth and Safety Code Section 42303 been made? ❑ Yes ❑ No _................---....».tta »erti.................»...............................................propri .».....11_.......... _...... _.-.._.-_.-........---- -....._..-....................-- 8 (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certity that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certity under penalty of perjury that I have read this application and state that the information given Is correct. I agree to compty with sit state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. i agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. 5lgnatureOf t( AndfQr Akthcdzad Appllcant__ Date _ CODE 0. INSPECTION TYPE y �� y l)dIE "MtAL3-, -� CODE 1NSPEcnoNJUEI ' i C`Q� 1616 Fixed System Final Fire Prevention `'�- 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Fina! Site 204 Final Demolition 250 Final BuildinglOocupanGy 499 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O, BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely BUILDING ADDRESS OWNER L� MAIL Z ADDRESS W W TEL. fl U CITY NO. zZ Q CONSTRUCTION O LENDER am J Z) BRANCH J to Q LU ADDRESS m J CO ARCHITECT TEL. J Q OR ENGINEER No. U � a W CC ADDRESS 0- LU LU Z CONTRACTOR CO Z J Ir ADDRESS LU W 13 = TEL. Z CITY NO. LV O STATE CITY In CC LIC. NO, LIC. NO. SIZE NO'OF BLDGS. OF LOT NOW ON LOT USE OF EXISTING BLDG. SIZE OF NO. OF Z NEW BLDG. ROOMS STORIES VEXTERIOR WALL ROOF _ COVERING 1COVERING J USE OF BUILDING AND WORK TO BE PERFORMED CL Q O NIAID,1 Z O VI hereby acknowledge that I have read this appllcation and state that the above information is correct and agree to comply with IY all laws regulating building construction, and I shall not employ L_ any parson in violation of the workman's compensation laws of CA the State of California, Z W!1 6-73� '0 U00 71.17 ** * 28$-58 P C TION FOR BUILDING PERMIT RE IV DATE RECEIVED DATE IS UED ER IT NO. A.P. NO. BUILDING ADDRESS / /1 —D r, / -r /. U �t TRACT LOT BLOCK OWNER VALUE FIRE E ZONE TY GR UP APPROVED / 1 Y /1 DAT ~ �I ZONE NO. OF USE OF NEW BET. MAIN & PLANS BUILDING YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM C/LSTREET) VALUATION REAR FT. FT. DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. [APPROVED VAR.* DATE C.U.P. THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m APPROVED � o I hereby certify that I am properly licensed as a contractor antler SO. FT. the State of California Business and Professions Code, Division 3, THE AMOUNTSHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses ere In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m am exempt from the provisions of the State of California Business VALUATION and Professions Code, Division 3, Chapter 9. p a] �' `~ PERMIT FEE S O D Signatura of m Permittee 5 PLAN CHECK S E `o Authorized Agent U. TOTAL FEE S cAi FOEtNIA -..._ ��--'-�•----=�'�� ' COSTA vi rjj FOR OFFICE USE ONLY +� d' "'LC`T� — - t - - Receipt No. Permit�No, TO i ui;din j'�il_ /7 ea ved' y Date R c'd. Date Issued + CoAa Mesa, California ' ^ f �� _ Nearest Cross St. e -B jdi6_ g s Owner Costa Mesa, California � 141 ail Address + Neiest i Tel Cr s St. ; City ' No. Zoe 4 Na. of Type I Group�j Architect or Lie. i Engineer No.b Plans roved 1 Address �} City Lie. Contractor �L{�/It ''. No. t Address Legal Lot Description No. 1 I Blank 0 17raat�'� (Attach Metes and Bounds) ore, No. of Bldgs Size of Lot s Now on Lot CQ RECrn S - - ame: Fire Stops, , O Use of No. of Existing Bldg.t-amities j No. of f Roams "• G� "" ' "' "_ - -- z j b Setback Line from Rear Yard Center of Street © Sidc'Yard DESCR{I_MON OF WORK New ! Alteration I Addition I I herebv acknowledge that T have read this Aand state that the above is correct and agreeth. . Repair I I Moving I { pemolish ! Building No. of T - _Size/_C_ Rooms �.- Stories Exterior Wall I Roof Geve_rin9 %'J�C, '{ ^b COversng S j�J_Fra A-PPROVAI SIlse of NewBuilding �+ r undation LocationInspector arms, Materials, nder-Pinning ame: Fire Stops, Bracing, Bolts th. Int. I herebv acknowledge that T have read this Aand state that the above is correct and agreeth. Extwith all City Ordinances and State Laws building construction.Signature of aster, Ini. Permittee aster, Ext. Reinforced Authorized Agt.asonry aluation ��} errr�it ent, nd Beam Plan Check $ Total Fee $ ' t S FINAL , Date auNd pue a4va 44atia Street PLOT PLAN Show location and distances from property line and between building& ssaam pue awP� i. i 1r f ' r 1 r 1 • ti i 1 1 iPfr� r 3ug 9 JAN 1 n-73�w 00 7L19 '0* :� 208.50 COSTA MESA BUILDING•SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 /,PP/1,40N FOR BUILDING PERMIT For Applicant to Fill in Completely IS D RE EI O Y DAT RECE!,;t LDINGJ ADDRESS 'e (/ OWNER A.P. NO, !BUILDING MAILADDRESS ADDRESSW —G TEL'TRACT CITY NO.Z BLOCK W IL U Q En CONSTRUCTION NEW ADD ALTER REPAIR r)gMntrHOI~—LENDER a apJ OWNER< Z) to BRANCH J ADDRESSARCHITECT TEL. OR ENGINEER No. Q V Q w tr CL LLl S FIRE ZONE TY GROUP ADDRESS APPROVED W Z J CONTRACTOR BYf4 DATE m Z :i Ir 117 W 0 T Z ADDRESS TEL CITY TE ZONE NO. OF PLANS USE OF NEW BUILDING STATE CITY YARDS APPROVED YARDS APPROVED O W [f7 I= LIG. NO. LIC, NO. MAIN BUILDING ACCESSORY BUILDING — D O SIZE NO. OF BLOGS. (FROM CIL STREET) OF LOT NOW ON LOT —FRONT FT. FT. USE OF EXISTING BLDG. FT F- SIZE OF NO. OF Z NEW BLDG. ROOMS STORIES L. SIDE FT FT. tai EXTERIOR WALL COVERING ROOF COVERING REAR FT. FT. J CL CL USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. MAIN BLOGS. BET. MAIN & ACCESS. BLDGS. Q VAR,+ DATE O C.U.P. # APPROVED F' APPROVED AV nA-T-E Z O UI =11 ccall Vj hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with laws regulating building construction. and I shall not employ any person in violation of the workman's compensation laws of the State of California. z 1 hereby certify that I am properly licensed as a contractor under SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or i THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. VALUATION {. PERMIT FEE S / 4:5 r✓ .l. Signature of Permittee S PLAN CHECK S TOTAL FEE $ Authorized Agent JAS? 16 -73PF4� OQ 71-18 �x,4'.r LO8.5U COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 PL ION FOR BUILDING PERMIT For Applicant to Fill in Completely REC I V Y PATE RECEIV@D p TE ISSiiED BUILDING c / , J ADDRESS h (/ �— FERMI OWNER �,L �� `[r A.P. NO. Z MAIL ADDRESS BUILDING J/ %3 e / ADDRESS W W CL U TEL. CITY NO, TRACT LOT BLOCK Z Z Q CONSTRUCTION W A D AREPAIR LENDER CL CO ' J Z) JN BRANCH OWNER LLE" M J ADDRESS VALUE ARCHITECT TEL. OR ENGINEER N 0. M J Q U U) W CC USE $ FIRE ZONE YPE GROUP ADDRESS APPROVED BY DATE b Ly W ZCONTRACTOR J d MZ J IZ WW 0 = Z1-- ADDRESS ZONE NO. OF PLANS USE OF NEW BUILDING TEL. CITY NO. STATE CITY YARDS APPROVED YARDS APPROVED 0 W (n cc LIG. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING 0 SIZE=NOW O.OF BLDGS. IF ROM C/L STREET) OF LOT ON LOT FRONT FT. FT. USE OF EXISTING BLDG. R. SIDE FT. FT. SIZE OF NO. OF Z NEW SLOG. ROOMS STORIES L. SIDE FT. FT. UEXTERIOR WALL COVERING ROOF COVERING REAR FT. FT. _ J Q USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. MAIN BLOGS. BET. MAIN & ACCESS. BLDGS. Q VAR. DATE O C.U.P. + APPROVED D J�% 8/— APPROVED vy 13Y DATF0 z VI =11 cc cc �j ZI hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of any the State of California, hereby certify that I om properly licensed as a contractor under c SQ. FT, THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Divisicn 3, ; Chapter 9, and that such licenses are in full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. THE PURPOSE OF ESTABLISHING A PERMfT FEE ONLY. It tt VALUATION r PERMIT FEE S 24 17 0 PLAN CHECK $ Signature of Permittee 5 a E TOTAL FEE $ Authorized Agent c LL 3.489. I. C COSTA MESA BUILDING -SAFETY DEPA NT P.O. BOX 1200 COSTA MESA, CALIFORNI 626 For Applicant fo Fill in Completely RE BUILDIAOORENG I -) i r'�i 003771 PPLICATION FOR BUILDING PERMIT IVE BY I DAYE REC IVE D DATE IS ED� PER to gP OWNER % A.P. NO. -SGV BUILDING MAIL Z ADDRESS �1p ADDRESS? C LU W TEL. ATJpT Mt-� CL L) CITY NO. TRACT Z IN AD Z Q CONSTRUCTIONLTFR O(7 LENDER tl In J a BRANCH J OWNER M U ADDRESS m ARCHITECT JQ OR ENGINEER ` TEL U (n Q LU IY ADDRESS dL� J Z CONTRACTOR CO Z J CC ADDRESS W Uj TEL. Z = Z_ CITY NO. � LO STATE CITY (n EL LIC. NO. LIC. NO. a O SIZE NO. OF SLOGS. OF LOT (.0 00 ]� (0 O NOW ON LOT Q USE OF EXISTING BLDIy. SIZE OF T NO. OF Z NEW BLDG. ROOMS STORIES UEXTERIOR WALL ROOF _ COVERING I COVERING J USE O UIL4ING AN WORK TO BE PERFORMED d ' Q 0 H N Z 0 t~.? I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and 1 shell not employ any person in violation of the workman's compensation laws of N the State of California. Z I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, anq that such licenses are In full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. Signature _ Permittee Authorized Agent FIRE ZONE APPROVED 1'7T" • S 7-S I �� COTLI BLOCK K MOVING Cf VALVE $ YPE GROUP DATE ZONENO.OF USE OF NEW jN��S-T A� PLANS ';1' BU YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM C/L STREET) .1b JV DISTANCE BET MAIN BLDGS. VAR.:O C.U.P. + 04 FT. BET. MAIN & ACCESS. BLDGS. DATE APPROVED r SQ. FT. r G THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: I11 VALUATION PERMIT FEE S r N 7 -lqn 0PLAN CHECK $ / E TOTAL FEE $ 0 LL COUNTY -OF ORANGE Application for Building Permit BUMDING DEPT.-� 636 No. Broadway AND FORA Permit No...r_........................ Santa Ana, California Certificate of Use and Occupancy Phone: KY 2.6211 P y Date ............ 9 OWNER'S NAME...... ......7 T "`j `i1. C5;�O MAILING ADDRESS ------•��•---�1...... 1` T�. ��••---._...ST ............................. CITY...,G?..5.. .......1....^lP cr�_ Name----------- ----- .__ ------_-_------- ------------- ---- ............. --------------- Name ....... C.?21 (Architect or Engineer) ntractor) Address------- ------------ ----- ------...---............................................ Address ............................ ---------- ----- ----- - ---- City------------------------------------ ----------------------------------------------------- City ......................................... ........... .......... .................................. State State Lic. No....................................... Phone ...................................... Lic. No.... ... ................................. •. Phone ...................................... PROPOSEDUSE: -------------- --»-----------------••--•»........................................................................... ZT 2. YOB .......1. ...T T (House No.) (Aa (Toon or School District) NAME OF AND DIRECTION FROM NEAREST CROSS STREET.._. r o'.. .................1S1 t__.� _.....•...._.... 3. LEGAL DESCRIPTION: Lot ...__.�...�...9 ....... • ._Block .............................•_ . Tract ... lYe_Q.�..7 ---•--•----- ----------------- (Metes and Bounds Description—Use reverse aide of form) 4. CORNER LOT (v)' INTERIOR LOT ( } THROUGH LOT ( ) SLOPE OF LOT ( ) S. SIZE OF BLDG.:Z� . ._AREA:.2. a.__ -...._.-_SIZE OF LOT---------- --••--••-•••-••-- ....... AREA:.---..... .................. G. HEIGHT OF BLDG.: .......................................... CEILING HEIGHT ......... .......................... NO. OF STORIES .......... - .................. 7. NO. FAMILIES------ ............Size of Smallest Bedroom: ................................. ....... Size of Kitchen___. S. EXTERIOR WALL CON STRUCTION%1- 0'cw/--- ----------------INTERIOR WALL COVERING ......... ........................ ..._ (Frame, Stucco, Etc.) _ (Plaster•Drywall, Etc.) ROOFING COVERING ....... -d�..•..........................•-------..........._ 9. STATE HOW MANY BUILDINGS NOW ON LOT AND GIVE USE OF EACH .......... 7__F _fF .......................................... -.F.r.:.t.e `c Y y`� -----••.............................................................: - --------•--.................... ... 10. SETBACKS: Front Yard From Center Line of Street------------ ----0 0_..........._.......__............__._._-_____.._...___...•_.............___...._._..........._... Nearest Side Yard.... .......... Rear Yard_._..2: .......Distance in Feet Between Bldgs. on Same Lot....... �J.. �................. (Property Line) (Property Line) 11. A COMPLETE PLOT • PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. r 12. (a) Footing: Width ..... . ........................... Depth in Ground.... ! .?::: ______________Width of Wall......... C?-.................. b Size of Studs:l..%-. :5��.. Spacing ZZe2o .......`•CC Material of Eloor__.!�C...t- (c) Size of Floor joists: ...... ........ ................ Spacing ..................... .................. d Size of Rafters: --- 2-7._t� ..............................Spacin -CC 13. VALUATION OF PROPOSED WOK: Including all Ia+ lr, plumbing, electrical wiring, heating, fire, sprinklers, painting and sewage disposal $--------..................... ... ---- ....... r 14. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE,' COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO. Signed:.._�:._.....�-•-•--.�•;.. MansFiled: .............. ................................ . ................... ..... By: ----•--•...................•----•---------...•••-•••-•i..•--- .............._................- (Authorized Agent) FOR DEPARTMENTAL USE ONLY FEES: ��ING BY GROUP...�— i .... APPLICATION.. _ HEALTH ............................ Bldg. Permit - $---3•-•---- PlanCheek - $----•----- `-S •`-..... --- TYPE....... ........ --............. --- - �ZONING FIRE Total $ - �DIST. • MAR SHAL....._...... 1 P -L �- PLANS AND Receipt No. --• • ---••-•--•- SPEC'S......... ••.....•• STATE - ------------------ Paid to - SHEET NO.�............. CORRECTIONS ENGINEER Date �1.. ..�' _VERIFIED- - INSi:ow Is D ATE ... ...... I .......................... v i 'APPLICATION FOR A BUILDING F MIT CMF 0335-46 (BU -28) rev. 6/80 k BUILDING PERMIT NO. t al Tract Block Lot PN ermlNo. ermil Building Plumbing " Address 711 W. 17th Street f tf 1 o Permit No, Goss Mechanical Area Street Permit No. Ownar Equalean/Wally Wallick Ty pa of Project: ❑ New ❑ Alter ❑ Addition Address Above Repair ❑ Convert ❑ Demo ❑ Occupancy Pmt. 17 Sup. Dist./ City Zip Phone P. Insp. Area Architect/ Designer License No. Zona 5pf. Amt. No, Setbacks P/L Front C/L St. Street Width Address Yards Left Right e.:r -City - - ""Lt0 Pnone ova Proj. e Right. Engineer Ucense No. rk ng 5 s equ re Provide vera Address Struct No, Of No. of City ZIP Phone Height Stories Family LICENSED CONTRACTOR'S DECLARATION Park Fees Yes C.T. Fee Receipt I hereby affirm that I em licensed under provisions of Chapter 9 Required No Zoning ApproBy: Dale (commencing with Section 7000 of Division 3 of the Business and Professions Code, and my license Is in full force and effect). License Class_, License Number Date Contractor Misc. Proposed Use of Structure Address Cltyand Zip - _Phone CONSTRUCTION LENDING, AGENCY I hereby affirm that there is a construction lending agency for the Oct:- TyP Code performance of the work for which this permit is issued {Sac. 3097, Class Con t. Year Civ. C.). USEIOCC PANCY SIZE 50- FT. Lender's Name Lender's Address OWNER -BUILDER DECLARATION I hereby affirm that t am exempt from the Contractor's License taw 1. for the following reason: ❑ I, as owner of the property, or my amployeas with wages as their 2. sole compensation, will do the work, and the structure is not 3. Intended or offered for sale, © I, as owner of the property, am exclusively contracting with licensod contractors to construct the project. ❑ 1 am exempt under Sec, , B&PC for this reason 4. Oats Owner WORKERS' COMPENSATION DECLARATION Total Valuation Encroachment Permit Required ❑ Y s ❑ No I hereby alflrm that l have a cartiticate of convent to "if -insure, or a cart F..cata of Workers' Compensation Insurance, or a certified copy thereof. Policy No Company Grading Pmt,ailing 0 Yes ❑ P t. No. ❑ Certified copy Is hereby furnished. Required No Rough Grading Approved by: Data ❑ Certified copy Is filed with prangs County, EMA. Date Applicant CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This suction need not be complotod if permit is for $100 or less). I certify that in the Performance of the work for which this permit is Issued, I shell not employ any person in any manner so as to become sDuabtieseciVrsCorn pensJ iVptCrv gefr�1�S 12 llvi 8PAPlicant PERMIT FEES NOTICE TO APPLICANT: If, after making this Certificate of Structural S Plan Check S Exemption, you should become subject to the Workers' Compensation Electrical $ 5Pecial provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Invest. I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THATTH ABOVE INFORMATION IS CDRRECT. I AGREE TO Plumbing E COMPLY W H ALL COUNTY RDINANCE5 AND STATE LAWS Mechanical S RELATING O BUILQING CON RUCTION, AND HEREBY AUTH- ORJZE RE RESENT TIVES O H15 COUNTY TO ENTER UPON T 'E ABO E MEN ZONED P PERTY FOR INSPECTION PUR- Pre -Grade P SES. ' pp 12-11-00 Inspection $ Pre -Grade Rec. No. $ Permit Issue $ Si natu ApplicaWt-6FAgenT Date Joht Williams Print Applicant's/Agent's Name All spans within this box must be tomp(eted to prooess Plan Check By: Issuance approved: CMF 0335-46 (BU -28) rev. 6/80 k Fovm, ' JAR 1 b -73C!!'. :�;;r Cc 750 2$8.5 COSTA MESA BUILDING -S FETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 PLIATION FOR BUILDING Pf RMIT For Applicant to Fill in Completely RE;IV EI E BY DATE RECEIVEp p TE f f f� �J, /f y Utor I" /F�E =ED C (/ 3 I I z-s ADIDRINDES/I /'j i1J PE IT N OWNER 1 4, tr� L A.P. NO. MAIL BUILDING /j j// ADDRESS p (fV y�1 2 ADDRESS Z CL U TEL' CITY NO. TRACT LOT BLOCK ZZ Q CONSTRUCTION NEW AD R REPAIR dLENDER J Q BRANCHn JN OWNER 1'l.L�- Cc J ADDRESS V LUE tp T ARCHITECTEL. S L0� J Q V OR ENGINEER N 0. Q FIRE W Cr ADDRESS ZONE YPE GROUP CL UU APPROVED W Z CONTRACTORBY DATE J Q CII Z J = ADDRESS W LLI TEL ZONE NO. OF USE OF NEW O = CITY NO. PLANS BUILDING Z� LU O STATE CITY YARDS APPROVED YARDS APPROVED (n Cr LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING Q Q (FROM C/L STREET) SIZE NO. OF BLDG$. OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG, R. SIDE FT, FT SIZE OF NO. OF z NEW BLDG. ROOMS STORIES L. SIDE FT. FT. UEXTERIOR WALL ROOF _ COVERING COVERING REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & CL CL MAIN BLDGS. ACCESS. SLOGS. Q VAR. # DATE O C.U.P. + APPROVED /flf i1 A APPROVED z 0 hereby acknowledge that I have read this application and state VI that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. z I hereby certify that I am properly licensed as a contractor under SO. FT. 4 the State of California Business and Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY, m am exempt from the provisions of the State of California Business VALUATION and Professions Code, Division 3, Chapter 9. m PERMIT FEE S . 7 Signature of m Permittee $ PLAN CHECK $ E `o Authorized Agent TOTAL FEE $ LL 3488,9 �� /► -COSTA OOT BOX00 E12UCODIMESA, CALIFORNIACALI O 6 RNIIA 9 26 P For Applicant to Fill in Completely BUILDING ADDRESS f r� I 71 —Q, 1 7 iZI OWNER MAIL ADDRESS TEL CITY\tR�L]�DD�?�T �✓CJ� NO.1 ODNSTRUCTION BRANCH ADDRESS ARCHITECT ti _ TE ADDRESS CONTRACTOR ADDRESS USE OF BUILDING AND WORK TO BE PERFORMED I hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California, I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I em exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. Signature (� Permittee cam.[_ sl ■ice, e Authorized Agent \ on3769': 155.5� APPLICATION FOR BUILDING PERMIT REGI VfjD BY ��/� DAT R CEIVED '/_ TEL. CITY PERMIT NO, NO. STATE 'I /O BLOCK. CITY LIC. NO. LIC. NO. SITEn� el /if /}.i VALUEUSE a �Q FIRE ZONE TYPE GROUP / NO. OF SLGS OF LOT �+CJ Q NOW ON LOOT USE OF IF ROMC/LEET) -fBONT- I ST FT. FT. R. SIDE A("FT. ra" n FT EXISTING SLOG. REAR 3dL FT.064;117 FT. DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. SIZE OF NO. OF NEW BLDG. l� O ROOMS STORIE! EXTERIOR WALL �+ PERMIT FEE $ ROOF TOTAL FEE $ COVFRING COVERING USE OF BUILDING AND WORK TO BE PERFORMED I hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California, I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I em exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. Signature (� Permittee cam.[_ sl ■ice, e Authorized Agent \ on3769': 155.5� APPLICATION FOR BUILDING PERMIT REGI VfjD BY ��/� DAT R CEIVED '/_ DATE ISSUED . /� —3� A,P, NO, lb�+Zb✓"! '� %O PERMIT NO, BUILDING ADDRE S 711'-A W l , N/T$ ]-/.a) ( - MCStq 'I /O BLOCK. NEW A DIALTERIFIEPA MOVING OWNER el /if /}.i VALUEUSE a �Q FIRE ZONE TYPE GROUP / APPROVED BY DATE ZONE NO.OF USE OF NEW IA), `U..T PLANS BUILDING LL3 YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING IF ROMC/LEET) -fBONT- I ST FT. FT. R. SIDE A("FT. ra" n FT L SIDE 16 7 FT FT. REAR 3dL FT.064;117 FT. DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. VAR.# DATE C.U.P. * APPROVED APPROVE 8DATF / Cnik gpE z TAX SO. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION /// S /� / / a �+ PERMIT FEE $ PLAN CHECK $ �a TOTAL FEE $ 'LTJ Flo 7_.�c9p.C.HOOK'3117 S=EE RECEIVED ESA BUILDINCSAFETY DEPARTMENT�[FE8 COSTA MRSA, CALIFORNIA i ��FINANCCE DEPT. Par Applicant to fill In Completely APPLICATION F6R PE"If•-OSTA MESA TYPE OR PRINT BUILDING IL For Office Use Only BUILDING 171 ! 1.1% I17 / f7 �� Hira.irraaa r r i -- v - RECEIPT NO. PER MIT NO, COSTA MESA, CALIFORNIA 18628 /�}7 a Rea it REC�fi1V�D PY DATE REC IVYD _ DA E B [/3//�!V/ (/'\y OWNER .E/ MAIL O `7 �Q IIII�� 7// / 9 / ADDREBUILDISS ADDRESS , � J FIRE �% i . clrY . o . Z ' � .S 0TELrvo. ZONE ZONH TYPE APPROV, /�/ GROUP ARCHIT$CT TEL. OR ENGINEER NO. BY s DATE ZONING ADDRESS ZON NO. OF USE OF NEW S p� ` PLANS BUILDINGLEGAL 6� �f �' Y Y � _ [ �. GONTRACTOR� r �� r rl X' a�`'*DESCRIPTION a F • — ADDRESS Sc� A. P. NO. CITY NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE TEL. SO' TO SIDE & REAR P. L. LIC. NO, NO. EAVES ALLOWED (U. B. C. REOUIREMENT) SIZE ` No, of BLDGS. �✓� OF LOT X v NOW ON LOT YARDS APPROVED YARDS APPROVED USEOF EXISTIP40BLDG. MAIN BUILDING ( FROM C/L STREET) ACCESSORY BUILDING _ 3i1 �- BBTBACK LINE FROM FRONT FT T CENTER OF STREET REAR YARD /d fFT. SIDE YARD LEFT RIGHT R. SIDE FT. DESCRIPTION OF WORK L. SIDE Fr. FT. G3a t NEW ALTERATION ADDITION REAR FT. FT, DISTANCE BET. BET. MAIN & —nlDEMOLISH REPAIR MOVING MAIN BLDGS. ACCESS, BLDGS. BUILDING x F NO. OF �� VAR. # DATE ' SIZE r� ROOMS STORIES C. U. P. # APPROVED EXTERIOR WALL ROOF -i' `1 �l / J COVERING l� CCO COVERING �LJ (ri BYPROVfiD�' DATE USE OP BUILDING AND WORK TO BE PERFORMED SO. FT. 1 HEREgy ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS COR CT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDI ANCEB AN S TE LAWS REGULATING BUILDING CONSTRUqPiqyj VALUATION SIGNATURE OF PERMIT FEE $ PERMVrrE EC - d 4/y' ✓ AUTHORIZED AGENT ,1 TOTAL FEE • rTr a. CO§TA• MESA BUILDING -SAFETY DEPARTMENT P,0,'BOX 317 COSTA MESA. CALIFORNIA fOR APPLICANT TO f/tt X COMPLETELY TYPE OR PRINT '""' r EE RECEIVED 0 —_3n —!5- '? c` FINANCE DEPT. pv APPL' ICAT�OtV SOR PERMl7 c211III 171,11KIG LSV ■FtiV it\V BUILDING', ADDRESS fOR OFFICE USE My COSTA MESA. CALIFORNIA RECEIPT NO. l PERMIT NO. OWNER E G F� . I RECE� HDR 2X ✓••( D IS E�p' MAIL % ADORES$ ` TEL BUILDING I CITY NO. ADDRESS ! ARCHITECT OR ENGINEER LIC. NO. COSTA M SA CALIFORNIA FIRE ZONE pTYPE GROUP APPROVED Gl/ 17 ADDRESS STATE CONTRACTOR LIC. NO. BY �r DATE B(0 !! ate' ZONING [1ADDRESS LEGAL I LOT I I ! ZONE .r i NO, OP l USE OF NEW 3ESCRIPTION NO. BLOCK I I FLANS jl BU ILDIN ACV f APPROVED A.P. NO. BY DATE YARDS EV$S 1 { SIZE !t r NO. OF CLDGS. OF LOT CJ I Now ON LOT REQUIRED ALLOWED (CENTER LINE B I . • �� USE OF El'TIN BLDG FRONT FT. ,� SETBACK LINE FROM CENTER OF STREET /}I� AR YARD ��' /� f R. SIDE L/ FT. 1N. 1 SIDE YARD I LEFT Q T I RIGHT /P L. SIDE D FT. ��7` IN. DESCRIPTION OF WORK REAR IN MEW• ALTERATION I ADDITION 'REPAIR II MOVING; I DEMOLISH BUILDING NO.OF SIZE STORIES EXTERIOR WALL kROOMS {ROOF COVERING S COVERING USE OF BUILDIN AND W K TO BE PERFORMED /8do40 I HERIS13Y A NOWLHDG6 7H I HAVE READ THIS APPLICATION THE AMOUNT BHOWN UNDER VALUATION IS FOR THE AND STATE AT T.E ABOV 15 CORRECT AND AGREE TO COM• PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH A CITY ORDINA CHS AND STATE LAWS REGULATINO BUiLDuaa CONSTRUCTION. VALUATION SIGNATURE OF,�`.�//� PERMITTEE rp / � �/ PERMIT FEE $ 7 •-- $ C/f�/J vJD PLAN CHECK,I `r AUTHORIZED AGENT !=;"Iml TOTAL FEES / 39430 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 52626 For Applicant to Fill in Completely GUILDING ADDRESSCO, i OWNER �v MAIL ADDRESS TE L. CITY NO, CONSTRUCTION LENDER BRANCH ADDRESS ARCHITECT TEL. OR ENGINEER N USE OF NEWZerp�,jN)L ADDRESS r CONTRACTOR _g/9 ADDRESS v J CITY / NO. STATE CITY LIC. NO. 7u Q 7 LIC, NO. SIZE NO. OF BLDGS. OF LOT NOW ON LOT USE OF EXISTING BLDG. SIZE OF NO. OF NEW BLDG. ROOMS STORIES EXTERIOR WALL ROOF COVERING COVERING USE OF E]UILDING A D WORK TO BE PERFORMEDt B s r� i I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that 1 am properly licensed as a contractor under the State of California Business and Professions Code, Divisicn 3, Chapter 9, and that such licenses are in full force and effect, or I am exempt from the provisions of the State of California Business end Professions Code, Division 3, Chapter 9. Signature o Permittee Authorized Agent PAIL /A/PLkATIDN FOR BUILDING PERMIT R Vd.ny DATE RECEIVED 1 I DATE ISSUED fe A. P. NO. 11ry'• G(�L�" V 1 _ 1 * S BUILDING ADDRESS ` TRACT f LOT(0( BLOCK w --=M_ rf-- FIRE' �y ZONE TYPE f GROUP APPROV tL��DATE r1 BY (r VALUATION �J to PER MIT FEE $ +C1� 7 Z ENO. OF USE OF NEWZerp�,jN)L PLAN CHECK PLANS BUILDING YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING {FROM C/L STREETj Sao FAnm,r r r --Im_ CT Ma 4— REAR FT. `T� FT. DISTANCE BET. BET. MAIN & MAIN SLOGS. ACCESS. BLDGS. VAR,+ DATE C.U.P. #I* APPROVED APPAOVEO , } ( DATE 1 �" STAiE `-- A00e- p SQ, FT, THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: o C VALUATION �J to PER MIT FEE $ +C1� 7 PLAN CHECK 5`ZJ LL t� TOTAL FEE $ —3 PAru ,AR-8-76C1i<<.00 382* *****5.50 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT RECE DATE RECEIVED TE r T/" For Applicant to Fill in Completely — Use Ink Only BUILDING ADDRESS OWNER _ �iY f A.P. N0./ �� ! 0- �� PER T MAIL ADDRESS / / rRJ/) rf BUILDING I ADDRESS TEL. CITY �` S' �.9 /�%�–sFJ NO. Pr ,,�,�^ TRA T�A25A OT BLOCK CONSTRUCTION NEW ADD ALTER _ " (J LENDER BRANCH OWNER ADDRESS — S �A%/�! C'+C,�V UE A ARCHITECT TEL. OR ENGINEER N FIRE 1 ADDRESS �1 ZONE TYPE 4 GROUP APPROVED CONTRACTOR BY DATE i ADDRESS 7// 2 j� TEL. CITY NO. Z NEj NO. OF PLANS USE OF NEW BUILDING STATE CITY YAROS APPRO DARDS APPRO LIC. NO. LIC, NO. MAIN BUIL ESSORY Q SIZE NO. OF BLDGS. (FROM CJL5 } OF LOT �— NOW ON LOT RONT T. -US9 OF EXISTING BLDG, R. SID FT. Separate permits are required for L SIDE ' electric, plumbing and heating work. REAR US9 OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLOGS. ACCESS. BLDGS. 1 } / VAR.+ DATE �/N / Gc C.U.P. + APPROVED APPROVED L i I hdreby acknowledge that I have read this application and state to n that the above Information is correct and agree to comply with ail laws regulating building construction, and I shall not employ m any person In violation of the workman's compensation laws of m the State of California. m I hereby certify that I em properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force end effect, or I am exempt from the provisions of the State of California Business and Professions Code, vision 3, Chapter 9. SO. FT. a m v THE AMOUNT SHOWN UNDER VALUATION 1S FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. VALUATION PERMIT FEE $ DO • PLAN CHECK $ w.rM Signature of Permittee //// -�'- S �e o VU rt a L a TAMC $ s 8 TOTAL PAPE) 5 ` O Authorized Agent .7- 36296 ! - Y�PAID rx ,t, ! 1i COSTA MESA BUILDING -SAFETY DEPARTMENT {j� ?7-73cr'= ai)1 o3,s .aa P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 IIIIIIIII PP Far Applicant to Fill in Completely 1 TION FOR BUILDING PERMIT Z . LU LU U �Z Z_Q O t; Cl- _j J J U] Qw CO J J Q U cn ZIrUJIr a W Z Jp m Z J Ir W LU a Z r_ w0 (n cc Z)O BUILDING ADDRE OWNER MAIL ADDRESS 11C�3�c CITY V�0,_ 11r,n 4, � V -L NO. Cp�I�- I BRANCH ADDRESS ARCHITECT ADDRESS �tt CONTRACTORla Iii f TE NC RE V �Y 13-7-7-7-5 ED PATE ISSUED G A, P. NO. PERMIT NO. w L D BUILDING ADDRESS TEL TRACT 17fF_ C, LOT6 BLOCK NOZ4?_ STAT OWNER CITY LIC. NO. VALUE AODRES 1 -70 - QTEL BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. VAR.:O TEL CITY Y APPROVED NOZ4?_ STAT CITY LIC. NO. LIC. NO. SIZE NO. OF BLDGS. OF LOT I NOW ON LOT USE OF EXISTING BLDG. SIZE OF NO. OF NEW BLDG. ROOMS STORIES EXTERIOR WALL ROOF COVERING COVERING USE OF BUILDING AND WORK TO BE PERFORMED 0 r 1hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State Of California. I hereby c@rtify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I am exempt from the provisions Of the State of C fOrnia Business and Professi o , Division 3, C r 9. Signature of Permittee Authorixeq A t Y FIRE ZONET PE GROU AYPROBy VED �/ 1 DATE ._ FZONf NO.OF USE OF NEW�� PLANS B YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING {FROM C/L STREET) REAR FT. I / J FT, DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. VAR.:O DATE C.U.P. yy APPROVED APPROVED � RY � �✓v,.. nA7F �.J �3 i SO. FT. o THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. VALUATION el PERMIT FEE $ � in $ V %� PLAN CHECK .$ E LL TOTAL FEE $ , r� . 3 7394 0CT—8-73PAfDOO 296# ****98.69 Cris, P Cv44+( COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 P I ATION FOR BUILDING PERMIT For Applicant to Fill in Completely RE ED Y D TE RECEIVED DATE ISSUED BUILDING // i. } , b I ADDRESS (r(J S 6 `2 �� PER!U OWNER P,ZZ6M. A.P. NO. MAIL �/1 /f ADDRES 4/&'1J �j;A �' BUILDING �� ADDRESS (/C! JprTRACT a LU U LU CITY ��aff��j` NO.G' —//�/ TEL LOT BLOCK ZZ Q CONSTRUCTION NEW I ADD ALTER REP , O I— LENDER BRANCH (d� n.m.�G ,! OWNER AIV, _jO J to Q 11J CO Jj ADDRESS — V LUE ARCHITECT TEL. OR ENGINEER N co Q 5 S U Q FIRE � 0 W M ADDRESS ZONE YPE GROUP CL 11A APPROVE LU Z CONTRACTOR "7Z OWe BY DATE 'l J O ADDRES &V J TEL as% NO. IQ � ZONE J / NO, OF USE OF NEW PLeNS BUILDING LU LU Zh CITY �R STATE CITY �/ YARDS APPROVED YARDS APPROVED O (n T_ LIC. NO LIC. NO. QEF MAIN BUILDING ACCESSORY BUILDING U O(FROM SIZE NO. OF BLDGS. C/L STREET) (fes OF LOT NOW ON LOT FRONT FT` T! USE OF LDG. I FT F_ NO. OF Z ROOMS STORIES L. SIRE FT, UALL ROOF _ E;�04 COVERING REAR FT. FT. J ILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & IZ a MAIN BLDGS. ACCESS. BLDGS. Q O 4,10174 j( Q/ ' •,s VAR. DATE C.U.P. qW APPROVED / A �� I&A/ APPROVED � )MY) '#. lei , ^ v / J Z O hereby acknowledge that I have read this application and state UI that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of TAX JW the State of California. 1 hereby certify that I am properly licensed as"9 contractor under SQ. FT. the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION and Professions Code, Division 3, Chapter 9. PERMIT FEE S PLAN CHECK S Signature o Permittee r 7��r $ // 67 Authorized Aant TOTAL FEE S _ P Cv44+( 14:,.3 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORIyIA 92626 For Applicant to Fill in Completely BUILDING, f ADDRESSQ W OWNER r ` MAIL Z ADDRESS W W TEL. tl L) CITY NO. I— Z Z Q CONSTRUCTION O f~fY LENDER am J 0 BRANCH J U] m W ADDRESS ARCHITECT OR ENGINEER DATE RECEIVED TEL. ADDRESS PERMIT I�: NG ADDRESS CONTRACTOR '7i��F C/Mdi11L ADDRESS ,t7 ADD AR CITY C &57'p ��SC] TE L. NO. G(liGl STATE LIC. NO. `3 r/ m CITY LIC. NO. SIZE OF LOT the State of California Business and Professions Code, Divisicn 3, NO. OF SLOGS. NOW ON LOT USE OF EXISTING BLDG. THE PURPOSE OF ESTABLISHING A PERMIT FEE O Y: a am exempt from the provisions of the State of California Business SIZE OF NEW BLDG. NO. OF ROOMS STORIES EXTERIOR WALL COVERING ROOF COVERING USE OF BUILDING ANDWORKTO BE PERFORMED Signatureof //H� /f/ jQ �} ?CT 31-73PA3° 5.50 Et -5.00 i 252+ APPLICATION FOR BUILDING PERMIT V DATE RECEIVED DATE A.P.O. PERMIT I�: NG ADDRESS TRACT [BU T BLOCK ADD AR any person in violation of the workman's compensation taws of the State of California. r/ m hereby certify that I am properly licensed as a contractor under VALUE FIRE ZONE APPROVED ZONE NO. OF PLANS YARDS APPROVED MAIN BUILDING (FROM C/L STREET) DISTANCE I MAIN BLDG VAR. y1!+ C.U.P.q APPROVED FT. DATE USE OF NEW BUILDING YARDS PPROVED ACCES RY BUILDIN FT BET. MAIN & ACCESS. BLOGS. DATE APPROVED I hereby acknowledge that I have read this application and state that the above information Is correct and agree to comply with all laws regulating building construction, and I shall not employ f any person in violation of the workman's compensation taws of the State of California. r/ m hereby certify that I am properly licensed as a contractor under SQ. FT. o the State of California Business and Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect, or -1 THE PURPOSE OF ESTABLISHING A PERMIT FEE O Y: a am exempt from the provisions of the State of California Business VALUATION Ir and Professions Cnue, Division 9, Chapter 9. 00 co PERMIT FEE $ n Signatureof //H� /f/ jQ �} Permittee(./(i E PLAN CHECK $ E (ev U. o` Authorized Agent LL TOTAL FEE $ Z . aU HZ Z Q am J J fn Q W m J M J Q C)(A Z Q Lu Cr d W Lu Z J Q CO Z i Ir W W 0= Z �- —O LU U) DO Z Q V a a a 0 H fn Z _2 V H Z '40V ?9-73P 001159:: >r1 [FSS' 37628 COSTA MESA BUILDING -SAFETY DEPARTMENT ' P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 FA t m O i Ir to n 7 m E o` LL PP I TION FOR BUILDING PERMIT For Applicant F' n Co plewly RE I ,6YDATE RECEIVED p C� BUILDING L� ADDRESS / OWN �r+- (,+�[? -� A.P. NO MAIL BUILDING t� f ADDRESS JISSUED ADDRESS jr�f TEL. CITY NO. TRAGI LOT CONSTRUCTION N E W A ALTER LENDER BRANCH OWNER ADDRESS VALUE /�S! SrI $ O ARCHITECT TEL, OR ENGINEER NO. FIRE ADDRESS ZONE YPE GROUP APPROVED CONTRACTOR A BY DAT ADDRESS 'f ONE NO. OF USE OF N CITY" O Z{. NOLrj{�1 �� PLANS BUILDING STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF BLDGS. {FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. d r" USE OF PAL- EXISTING BLDG. F . FT S SiZE OF NO. OF NEW BLDG. ROOMS STORIES L SIDE FT. f� EXTERIOR WALL ROOF '_++ COVERING COVERING REAR F.T. f� USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. (y VA. OL DATE b e _ l C URP + APPROVED APPROVE 10 6__ I hereby acknowledge that I have read this application and state $1( that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. SO. FT. I hereby certify that I am properly licensed as a contractor under THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Divisicn 3, Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. am exempt from the provisions of the State of California Business end Professions Cnde, iv' ion 3, Chapter 9. VALUATION PERMIT FEE $ Signature of l Permittee r $/ PLAN CHECK $ ' Authorized Agent / TOTAL FEE $ FA t m O i Ir to n 7 m E o` LL Appileant to MINI" all spaces except those within heavy border tines and sign all appropriate declarations. CITY OF COSTA MESA CONSTR UCTIQN PERMIT PERMIT Ivo. , TRACT ND. LOT NO. UA N0, Project Address 711 W_ ] 7th St Bldg .(a) 11n> i 11 Applicant's Mailing Address 11110 Sadroy-St.--N-Hally-wand Owner's Name. Troy Investment Fund Phone Address 4321 Birch St.'Newpart 'Reach. Ca- Arch/Eng, Marin T. Rnrk -License No. Address _U8.81 Knott Ave Suite 216 Contractor's Name Duco Air Conditiioni%one 982-1216 Address (mailing) 13110 'Sati.coy St. N.Hollywood, Ca, City License No, 33925 LICENSED CONTRACTOR DECLARATION ' I hereby affirm that I am licensed under provisions of Charter 9 (commencing t� with section 7000) of Division 3 o e Business and :?Isicins Code, and my license is In findlow and effe 3 License Class / Lice O 46251 Date 4.,t'L` 84 Signature , WORKERS' COMPENSATION DE RATION ^t I hereby affirm that I have a certif' to of consent to self -Insure or a certificate of Workers' Compensation Insur nce, or a certified copy thereof (Section Lab. c.) WC9824 Lumber Policy No. Company mans e Certified copy is hereby furnished. Certified copy is filed with the city 8uilpig�D} ionQ �U Date Applicant C ) CIJ f� _ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issuetl, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. - Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the -Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit - to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provid6d that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 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 proof of their Worker's Compensation insurance should be provided to me. 0'1 am exempt under Section I B. & P, C. for this reason Date Owner I hereby certify that I have read this, application and ! information is correct. I agree to c ply with all city an and State 1 s relating to buildin c nstruction, and her sentative o this ci e u on the above-meKl[ inspettio pu, Signature Drivers' LI 'se or SS AF 0865.46, rev, 10/84 e - ui mg; tat that the above d u't, ordinances y authorize repre- Da ed/gyp offer fDate 0 TYPE OF CONSTRUCTION U NEW LJ'AOo LJ ALTERATION LJ REPAIR ❑ CONVERSION- ❑ DEMOLISH ❑ OTHER A.P. DESCRIPTION OF WORK/USE OF BLDG. - 7Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL Tt ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING q MECHANICAL B Rear ❑ ,OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU. YDS. ACRES-7—Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains , 1 .Reinspection Fee S15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 1 0-100,000 BTU Ell 00,000 BT' I Reinspection Fee 1 $15 pp cant; Pink - Accounting; Goldenrod - Assessor MBING Showers Service Sink' - - Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal Water Closet Water.Heater Water Service Auto -Wash Laundry Trays Issue Fee MECHANICAL Hood or Type I ❑ Canopy ' Type 11 ❑ ' Refrigeration System ❑o-100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers ' Issue Fee FEES Automatic Washer Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW ❑5-15 K 1744 4/24/85 I Zone 'Accessory Building: Parking Req,/Provided I I 1 ELECTRICAL Transformer ❑ 15-50 KW' ❑ 50+KW Meter ❑up to 1 00amps Meter ❑over 100 amps Sub Panel Motors E10-1 HP 011V: - 8 Inc. Solar El 9-15 HP E] 16-15+ Microwave 'Pole Light Range Sign Standing Sections W Trash Compactor $ 3 FEES Reinspection Fee S15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By — $ 3 15abO TL Z O N I N G R E a M T S FEES PLAN CHECK 2596 $ SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ ' PLAN CHECK 25% S ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50°/. $ MICROFILM $ MECHANICAL $ 13,00 TOTALFEE $ 15.50 ' PLAN CHECK 2596 $ CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POOL & SPA APPROVALS Permit # Date -Inspecrnr ,1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement %i 3. Electrical Conduit Utility-Undrgrnd. 54. Forms �• 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement �. 56. Rough Plumbing & Pressure Test 6• � Electrical UFER Grnd. f'r f- 57. APPROVAL TO COVE R-GUNITE 7. Footings s 58. Electrical Conduit-Undrgrnd, s• 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test , 9. Water Pipe-Undrgrnd. -j 60. Backwash Lines, P -Trap, EJ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12, Sewer Cap r 63. Heater & Vent -Final + 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final f 15. Rough Electrical -Conduit 66. Solar System -Final 16.' Rough Electric Wiring 67. Fencing & Access Approval 17.1 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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas' ❑ Oil 23..Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank C] Gas ❑ Oil 25. Root Sheathing 74. Overhead Hydro 26. T -Bar Ceiling {Structurals & 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-Firial 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes. 34. Final Heating & Air -Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUI LDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Cn 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. LOT NO. UNIT NG. CITY OF COSTAp �MESA CONSTRUCTION PERMIT `Project Address _ / /1 Id OT" "S7 n6 r 74 m rf Applicant's Mailing Address Owner's Name n24 >,,-,rcj j -► A ---Phone Address Arch/Eng. License No. Address �}., Contractor's Name %•L� i� I J' 124- )2 C IAI C • Phone T774ft Address (mailing) 4�S .11 r -5, L r -J lv3ig City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of th slness and Professions odes and rry license is in ull'for / License Class - - MW6!Pr149 License o. DateSignature WORKERS' COMPENSATION DECLARATION I hereby affirm that k have a certificate of consent to self -Insure or a certificate of workers' Compensation Insurance, or a certified copy thereof (Section -3800, Lab. C.)_ Policy No.,('JC .2 10 /2-70 Company iZL a t7 H Certified copy is hereby furnished. Certified co y' led with the city ui1 i Divi ion• �!� Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARAT[ON (This section need not be completed if the permit is for on hundred (5100) or less)rt. 1 ceify that in the performance of the work for which this permit is Issued, I shall not employ any person in any r so a ! ec me subject to the Workers' Compensation s of Calif nia. Date Signature - , NOTICE. If, of r making this declarati0 s ou become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDINGAGENCY 1 hereby affirm that there is a construction lending agency for the performance - of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name' Lender's Address . OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that'he/she is licensed pursuant to the provisions of 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 nenalty of not more than five hundred dollars ($500). I, as owner of the property or 'my employees with wagestas their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. if. however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/She did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant 'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P; C. for this reason Date Owner Ihereby_ certify that I have read this application and State that the above information is carr 1'agree to comply with all city and county ordinances and state 1 in o building pstruct'o ,and hereby authorize repre- sentatives f this ty , o enter •un the ave -mentioned property for inspection hkase \ Signature Date Drivers' License of 55 b/BS li.wo T4 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor TYPE OF CONSTRUCTION 7 NEW 7ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORKIUSE OF BLDG. - A.P. Zone $ Main Building: Accessory Building: TYPE OF PERMIT GRADING 1:1 FOUNDATION FOUNDATION ❑ ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ LOTHER E T F Zront O B A Rear N I C Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES g G Left - - - R Ping. Ref. + Parking Req./Provided E Remarks: Planning Notes: M T S PLUMBING FEES ELECTRICAL - FEES Sar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer Cl 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection, Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors ' Dishwasher Meter Clover 100_amps Dishwasher Solar Piping Dryers ❑Gas DElectric Sub Panel Drinking Fountains Solar Tank ti Fan Motors ' 0-1 HP❑1'/=-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09.15 HP 1:116-15+ Floor Sinks Urinal - Fixtures Microwave Gas Service Outlets Water Closet Device Boxes 'Pole Light Interceptors Water Heater Outlets Range Kitchen Sink _ Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap -Laundry Trays Generator ❑0-5 KW 1:15-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ $ Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES,REO.UIREMENTS:' Zoning Approved By Date Buitding Approved By Date Application Issued By Data j Boiler Hood or Type I ❑ Canopy Type I I El Duct -Under Ground Duct - Structural , Refrigeration System ❑0-100,000 BTU ❑ 100,0.00 BTU Duct - Ventilating BUILDING PERMIT PILAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PIAN CHECK 25% SUMMARY $ $ $ $ $ $ $ $ OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ 00 GRADING. $ MICROFILM $ ++ TOTALFEE $ 1 ++ Exhaust System ❑ Multiple ❑ System Repair/Alteration FirepllFact.Bit. ICBO# R Fire Dampers Heating System & Ducting ❑0,100,000BTU ❑100,000BT Registers - - ' Reinspection Fee $15 Issue Fee ! $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor _ +'CONSTRUCTION AND PLANNING }APPROVALS Permit # Date � Inspector POOL & SPA APPROVALS Permit # Date Inspector I 1 . Temporary Electrical Service or Pole i 52. Pool & Equipment Location 2. Soil'P.ipe-Undrgrnd. r' 53. Steel Reinforcement_ 3,' -,,Electrical Conduit Utiiiiy-Undr nd, �;� r 54. Forms 4.; Electrical Conduit-Undrgrnd.+ +! %, 55. Electrical Bonding 5 .�SteeLReinforcement+ 1 '' 56. Rough Plumbing & Pressure Test g g 6. Electrical UFER.,G nd.+� 57. APPROVAL TO COVER-GUNITE 7n' Fooii ngst i 'A L � �� 58. Electrical Conduit-Undrgrnd. 8.% -Foundation - i 59. Gas Pipe, ❑ Undrgrnd., Test 9., Water Pipe Undrgrnd. 60. Backwash Lines, P;Trap, ❑ Undrgrnd. 10. -Structural Floor System 61. APPROVAL TO DECK 11- Pro p6rty Sewer Line'& House nection , 62. Backwash & Receptor -Final ,12-; Sewer Cap ,� J 63. Heater & Vent -Final i 13. Roof Drains ", ; r 64. Plumbing System - Final r r 14. Rough Plumbing) ,t 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23.'Gas Pipe -Rough & Test 72. Underground Flush 24.. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 7 77. FIXED SYSTEM FINAL 29. Insulation 78, FIRE PREV. FINAL 30..Drywall Nailing HEALTH DEPT. REQUIREMENT 31'. Plaster Brown Coat 79. FINAL INSPECTION 32'.El,ectrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric '� �j C0__ Notes: 34. Final Heating & Air Conditioning 35. Final Gas -Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer r 43. Backflow Irrigation 44. Landscape Irrigation System' , 45. Sound Attenuation 46. Handicap Regolations 47. FINAL STRUCTURE & BUILDING , 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 1 51. CERTIFICATE OF OCCUPANCY ��4 { Date i Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSJR UCTIO PERMIT PERMIT g // Ury TRACT NO. LOT NO. NO// Project Address Applicant's Mailing Address , Owner's Name - Phone Address Arch/Eng, License No. Address Contractor's Nam 0 one Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) Of Division 3 of the Business and Professions Code, and my license isin f force and effect. 7 �� Ucense Class I leense N-3-1�— oat Signa FC YORKERS' COMPENSATION LA ATION hereby affirm that I hbve a cert) tate of consent to sell -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab, C.) Policy No. Company ❑ Certified copy is hereby furnished. _• ❑ Certified copy is filed with the city Building Division, Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or, less). 1 certify that in the performance of the work f r which this permit is Issued I shall not employ any berson in any marine o as to become subject to the Wor s' Go e t Laws of Call a, Date Slgnature NOT cE: if, 5fter making this decia t .. n, you should become subject to the Workers' Compensation provisions 0 the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ, C.) Lender's Name _ Lender's Address OWNER BUILDER ORCLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's LicenW 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 ba%Is for the alleged exemption. Any violation of Section 7031,5 by any applicant for a permit subjects the applicant to a civil malty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who build$ or improves thereon, and who does such work hlmself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion , the owner will have the burden of proving he/she did not build or im- rove forr the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and professions Code: The Contractor's Liconse Law does not apply to an owner of property who builds OF improves thereon, and _who contracts for such projects with a COn- tractor(s) license qursl,ant•to The Contractor's License Law). I am aware tnat proof of their Worker's Compensation Insurance should be provided to me, ❑ I am exempt under Section B, & P. C. for this reason Date Owner 1 hereby certify that I have read this application anu state that the above Information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this ci to enter upon the above-mentioned property for inspection purpo s. Signature Date + r Drivers' Licens or SS le TYPE OF CONSTRUCTION LJ NEW LJ ADD ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ — _ _ - __ _— A.P.+ DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT 71 GRADING El FOUNDATION 1:1STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ -OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref, # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service # Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO -# Heating System & Ducting ❑ 0.100,000 BTU 13100,000 ST Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Appllcant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000 BTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas []Electric 9914 3/25/85 Zona Accessory Building: Parking Req./Provided ELECTRICAL _�4 Transformer El 15-50 KW ❑ 50+ KW Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW ❑5-15 KW $ 3 Meter ❑up to 100 amps Meter Dover 100 amps Sub Panel Motors ❑0-1 HP ❑1'h 8 Inc. Solar 09-15 HP El 16,15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor ' 1 Reinspection Fee $15 1 Issue Fee FEES DEVELOPMENT SERVICES REOUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By 1 Date 10o5a TL Z O N I N G R E O M T S FEES $ 3 SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ —l_� S� _ ENERGY P.C. ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ $ 3 10o5a TL Z O N I N G R E O M T S FEES $ 3 CONSTRUCTION AND PLANNING , APPROVALS Permit # Date Inspector �I POOL & SPA APPROVALS Permit- # Date Inspector 1: Temporary Electrical Service or Pole 52.. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � f f 53. Steel Reinforcement �a -'Elef trical CondMit;Utility-Undrgrnd 1V 54. Forms v� 4 Elec�ical Condtil fUfd•rgrnd. if; 55. Electrical Bonding 5: SeelrReinforce� n1 Ll( 56., Rough Plumbing & Pressure Test yL 64 Electrical UFE!�,Crnd' �- 57.- APPROVAL TO COVER-GUNITE 3 lr F,00tings r} '� `� L-_' 58. Electrical Conduit-Undrgrnd. 8 s f=oundation �:0 { (r r. cf 59. Gas Pipe, ❑ Undrgrnd., Test _ n� 9.�%jr Pipe-Und g -A. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 16` !Iucturaf Floor Sy's'temI 61. APPROVAL TO DECK 1181 roperty Sewer Liwr House Cohr;ection e 'P.,4 62. Backwash &Receptor -Final 1 S-irver Cap V. /1 63. Heater & Vent -Final ~� 13. Roof Drains juI P,t 64. Plumbing System - Final t 14, Rough Plumbing%! CleQ 65. Electricat-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 I 9. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydra 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas, Pipe -Rough & Test 72. Underground Flush T 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydra 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-"fest 36. Hood or Canopy - 37. Final Factory Fireplace 38. Final Plumbing . �J•/F 39. Water Service -Final 40. Gas Service - Final 41. Solar Domestic -Final 42. Backflow Preventer 43, Backflow Irrigation 44. Landscape Irriggtion 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 CITY OF COSTA MESA J BUILDING DIVISION y 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 - Fax (714) 754-4856 • www.ci.costa-mesa;ca.us r 4 FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: BC07-00018 PERMIT TYPE: B_COMBO Sub Type: COM—ALT STATUS: ISSUED DATE ISSUED: 08/0612007 ISSUED BY: JOB ADDRESS: 711 C012 W 17TH ST CM Suite/Unit C012 APN: 93983036 4 Zoning: Vicinity: INTERIOR, UNIT C0012.2.. Primary Oa: 16 Const Type: v -N SO. FT:, 3182 Valuation: $79,550.00 4• SCOPE OF WORK: 3,182 SF INTERIOR T.:I. FOR "ALCOM MARINE ELECTRONICS" IN UNIT C0012. WORK TO INCLUDE NEW INTERIUR NON-LOADBEARING WALLS, DOORS,•MILLWORK, EL, PL WORK ON FIRST FLOOR AND MEZZANINE (CREATE NEW BREAK ROOM ON MEZZ). OWNER FOSTER, JOHN D TR Phone: APPLICANT: MACDONALD. PETER Phone: 949-706-9038 CONTRACTOR: TENANT WORKS_, INC Phone: 949-706-9038 Cell: ARCHIT CT: ENGINEER: Address: 711 W 17TH ST City/State/Zip: COSTA MESA, CA Address: City/State/zZip: - _ License No Address: 1280 BISONUnit: City/State: NEWPORT BEACH, CA License No. License No. Unit: Unit: 738903 SUITE 139-481 ZipCode 92660 PHONE: PHONE: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulation's. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE f, cnarr srre QATE 11111MA OM IxstEcnor! rr.M DATE If MALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 0 /0 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final 8uildinglOCcupancy PP COMBINTATION PERMIT FEE SUMMARY Building Plan Check: $138.74 Building Fees: $853.75 Electrical Fees: $0.00 Mechanical Fees: $0.00 Plumbing Fees: $0.00 SMIP Residential: $0.00 SMTP Commercial:, $16.71 TOTAL FEES: $1,009.20 "Refer to fee receipts for all fees paid for project Unit: Unit: 738903 SUITE 139-481 ZipCode 92660 PHONE: PHONE: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulation's. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE f, cnarr srre QATE 11111MA OM IxstEcnor! rr.M DATE If MALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 0 /0 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final 8uildinglOCcupancy PP WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -'insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Owner ID verified by drive, .ase. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property lax bill or deed): DIViSiON OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend• will be made in connection with work authorized 'by this permit, and that no building structure, scaffolding, falsework, or demolition Carrier: or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp (Tnwsectdtneednorbewrrrpreteddthepermilisvaruedatone hundreddofars(5140)orress,) 2, Art 2, Sec. 341, Title 8, Califomia Administrative Code). Policy Number: Vi certify t tin o an of the work for which this permit is issued, I shall of e y rs In ny manner so as to become subject to the work sa ti of ajifornia, and agree that if I should become a nsation provisions of Section 3700 of the Lab 11 w t c y with these provision U Apph nt's W gnature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR iN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed Lwder provisions of Chapter 9 (commencing with Section70 ) the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to rile my license is ' f r a e a registration form for acutely hazardous materials? ❑ Yes ❑ No Lic. # ass # �ection 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely Cwtractor's Si Lure 7 oale7 hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ 1 hereby affirm that there is a construction lending agency for the 3. floes or will the applicant or present or future building occupant need to performance of the work for which this permit is issued, (Sec. 3097, Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Lenders Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Srrnaiure !?are 4. If an RMPP is presently required, has Section 25534 of the California OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec, 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to rile a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).): ❑ As owner -builder, l will not employ anyone to do work which would require a permit from the Division of industrial Safety, as noted above, unless such person has a permit to do such work from the division, Applicant's Signature Date Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I. Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? []Yes ❑ No (Section 25505 of the California Health and Safely Code requires, with some exceptions, that a Business Pian be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard temperature and pressure). ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature 305746 (3147) Date Health and Safety Code been fully complied with? ❑Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes". the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code), 7. If a permit from the South Coast Air Ouality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If fires", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: t certify that under penalty of perjury the information given above is correct. i agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury t t e read this application and state that the information ' en i e to comply with all state laws and city ordinances rel ng g ru tion, and authorize representatives of the City 01 ost o on the above-described property for inspection rpo e o cup or allow occupancy of any building Applicant to fill in all spaces except those within heavy'border lines and. sign all appropriate declarations. CITY OF COSTA SA CO T ,ljL'TICOfV PE MlT Project Address' �}- �j4I Applicant's Mailing Address X,�Ak Y-�. Owner's Name Phone Address _ �— Arch/Eng. _ License No. Address Contractor's Nam Phone 7Y Address (mailing) AJ City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in fu) rce d effect. LicenseClass License No.fl Date Signator WORKERS' COMPENSATION D LARATION 'hereby affirm that I have a certifi ate of consent to self -insure or a certificate it Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. _ Company 8 Certified copy is hereby furnished. - Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this pereh4t is Issued, I. shall not employ any person in any manner so to become subject to the Work e ' Cam en ti Laws of Cali a. Date Signator NOTICE: 1f, after ma Zing this decl n, yo should become subject to the a Workers' Compensation provision4 the Labor Code, you must forthwith comply with' such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License taw (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 7031.5 by any applicant for a Permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such worl< himself/herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who builds or improves thereon, and _Who contracts for such projects with a con. tractor(s) license pursuarit to the Contractor's License Law). L am aware that proof of their worker's Compensation insurance should be provided to me, ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this cit to enter upon the above-mentioned property or inspection ,pees. Signatur Date Drivers' L nse or SS =r TYPE OF CONSTRUCTION NEW 0 ADD ALTERATION EJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P, # DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING FOUNDATION Ll STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ •OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Reinspection Fee 1 $15 I ! Issue Fee I S 3 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑ 0-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - BUllding; Canary - Applicant; Pink - Accounting; Goldenrod - ASSeSSor MECHANICAL Hood or Type I ❑ Canopy Type II. ❑ Refrigeration System E-10-1100,00OBTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 9915 3/25/65 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas DElectric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑O.5 KW 05.15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100 amps Meter El over 100 amps Sub Panel Motors ❑0-1 HP 0 %: - B Inc.Solar El 9-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES PLUMBING FEES Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Bathtubs Sewer Cap Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P -Trap Laundry Trays Roof Drains Reinspection Fee 1 $15 I ! Issue Fee I S 3 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑ 0-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - BUllding; Canary - Applicant; Pink - Accounting; Goldenrod - ASSeSSor MECHANICAL Hood or Type I ❑ Canopy Type II. ❑ Refrigeration System E-10-1100,00OBTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 9915 3/25/65 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas DElectric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑O.5 KW 05.15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100 amps Meter El over 100 amps Sub Panel Motors ❑0-1 HP 0 %: - B Inc.Solar El 9-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES Reinspection Fee 1 $15 1 1 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By I Building Approved By Application Issued By , 1 1 SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.C. ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ $ 3 IOo5C1 7L, Z O N I N G R E O M T S FEES S 3 a t�- CONSTRUCTION AND PLANNING ! APPROVALS Permit # "I Date Inspector POS_ & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or P+ 52, Pool & Equipment Location t 2: Soil Pipe-Undrgrnd.' M�7j' .�I` 53. Steel Reinforcement - �r A, i t t• Elaefrical Cond�r't lltility-Undlgr nd. - 54. Forms ,r 4-Electscai Cos+dc-lJnigrncl. C�� 55. Electrical: Bonding �� I 5"i SteeItReinforcemeAe.;_ r J 56. Rough. Plumbing & Pressure Test +:t A ti6•"E16ctrical UFERrGr d. � IP, 57. APPROVAL TO COVER-GUNITE ` Q 4!1Fogtings 58, Electrical Conduit Undrgrnd. Fou ftlation r� J 59. Gas Pipe, C3Undrgrnd., Test �r 6�1W--�:Qr. Pipe-UndrgUj A if s 60. Backwash Lines, P:Trap, ❑ Undrgrnd. 10. Structural Floor Sys. c, 61. APP 1,110roperty Sewer Li�House C Pne ction 62. Backwash & Receptor -Final I2 -Sewer Cap ' 1 r� V 63. Heater & Vent -Final t I 13 Roof Drains 64. Plumbing System - Final 1<1Rough Plumbingv i% Lf,9 65. Electrical -Final "fes 15.. Rough ElectriA-Conduit 66. Solar System -Final %16. Rough Electric Wiring 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts; in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping EJ Gas ❑Oil , 23. Gas Pipe -Rough & Test 72. Underground Flush - 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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. lnsulation 78, FIRE PREV, FINAL 30., Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32, Electrical Power Meter -Final ' 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test - 36. Hood or Canopy 37. Final Factory Fireplace - 38. Final Plumbing 39, Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final - - 42. Backflow Preventer 43. Backflow Irrigation r , 44. Landscape Irrigation System r , 45. Sound Attenuation r i 46. Handicap Regulations ' 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed l 49. Electric Release to Edison - - - 50, Gas Release to Southern California Gas Co i 51. CERTIFICATE OF OCCUPANCY. No, Date ' r , AIF_ F Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 711 W. 17th St Bldg. (A) Unit 12 Applicant's Mailing Address 13110 _Saticoy St. N.Hollywood Owner's Name TroyInvestment�Fund�hone 549-2988 Address 4371BirchSt. Newport Beach, Ca. Arch/En gNtn ri n .T T. Rock —License No. Address _1a8l Knott Ave Suite 216 _ Contractor's Name_DUCC) Air ConditioningPhone 982-1216 Address imailingl11110 Saticav S -t- N.Hol„l ood,Ca. City License No. 33925.__ _ LICENSED CONTRACTOR DECLARATION I herebyaffirm that I am licensed under provisions of Charter 9 (commencing with sect !on 7000) of Division 3 of the Business and Professions Code, and my license,is in full T(fe and effect. 46251 License Class LU L sa oate 411_R�A4 Slgnatur WORKERS' COMPENSATION OEC RATION I hereby affirm that I have a certifl a of consent to self -Insure or a certificate if Workers' Compensation lnsur ce, or a certified copy thereof (Section 3800. Lab- C_) C9824 L _ uibemans Policy No. Company BCertified copy is hereby furnished Certi i y is filed with the city Build Di&y�.ion, Date _� Applicant f a i..C7 EXEMPT N FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (5100) or less). I certify that in the performance of the work for which this permit is issued I shall not employ any person In any manner so as to become subject to the Workers'. Compensation Laws of California., Date Signature 'NOTICE: 11, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ, C,) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole Compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employyees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). 0 1, as owner of the property, am exclusively contracting with licensed Con- tractors to construct the project (Section 7044, Business and Professions Coda: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a Con- tractors) 1)cense pursuartit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner — 1 hereby certify. that I have read this information K orrect. 1 agree to comp and state lalating to building S-oq f ! s cit y�p/�hter�p�r Inspection do s�� Signature Drivers' Lice Or SS 99, ration and state that the above i all city and county ordinances on, and hereby aulhojjlze r pre- above-mentlOnegl',py6perfor rtnwii I iwgj I r "M,, I riV, I LV i -rV V. UI I N TYPE�l `{lOF CONST RUCTION NEW ADD ALTERATION 1REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. q, DESCRIPTION OF WORK/LSE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T FrOnt ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL B Rear ❑,OTHER, A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CON STRUCTION TYPE VALUATION $ S left ZONE GRADING CU, YDS. ACRES Ping. Ref. + Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service ,Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains i - PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal ' Water Closet Water Heater Water Service Auto -Wash Laundry Trays FEES Reinspection Fee I $15 ] I Issue Fee 1 1 $ 3 I MECHANICAL I FEES i Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting 1 QO-100,000 BTU ❑ 100,000 BT Reinspection Fee I $15 AF 0865-46, rev. 10/84 White -�_Bullding; Canary - Applicant; Pink - AcCi5unting; Goldenrod - Assessor Hood or Type ❑ Canopy , Type I I ❑ Refrigeration System ❑0-100,000 BTU ❑100,000 BTU System Repair/AIteration Fire Dampers Registers Issue Fee $ 3 1765 4/24/65 Zona Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW ❑S-15 KW Reinspection Fee I $15 Transformer ❑ 15-50 KW 50+KIN Meter L1 up to 100 amps Meter ❑aver 100 amps Sub Panel Motors ❑0-1 HP ❑1% - B lnc.Solar 09-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections i Trash Compactor Issue Fee 15050 FEES $ 3 Z O N N G R E Q M T S DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Det Z SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. t $ ELECTRICAL $ GRADING $ ` PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ —1-3 On - TOTAL FEE $ 15.50 PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS • Permit # c Date Inspector POG_ �, SPA APPROVALS Permit # Date Inspector _ 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location r r � 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement i 3. Electrical Conduit Utility-Undrgrnd. 54. Forms ' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding f .5. Steel Reinforcement : 56. Rough Plumbing & Pressure Test ��l! 6. Electrical UFER Grnd. j .% i 57. APPROVAL TO COVER-GUNITE 7. Footings 1 58. Electrical Conduit-Undrgrnd. ;8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. v 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System y- 61'. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap�: 63. Heater & Vent-Final t :- 13. Roof Drains f 64. Plumbing System - Final 14, Rough Plumbing i 65. Electrical-Final 15. Rough Electricat-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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22., Ducts, Ventilating 71, Product Piping ❑ Gas D Oil 23. 'Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36, Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41, Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed- 49, Electric Release to Edison r 50. Gas Release to Southern California Gas Co I 51. CERTIFICATE OF OCCUPANCY No. Date _ I +�Ole`Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. my license is in fu1 rce ngeffect. 7, -'5' -/License Cl U Li se N Date) i Signature CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO, TRACT NO. LOT NOi U(V, NO, Bar'Sink ' WOR RS' OMPE14SATION DEC RATION I Hereby affirm that I have a certifit of consent to self4nsure ora certificate Project Address 64J 1 57 6 7— Backflow Preventer 3556 12/W/Oci Backflow Irrigation Applicant's Mailing Address l 3/� d 5 % �✓ �Y / /T TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑OTHER Dishwasher Drinking Fountains Owner's Name hohe57 Z C DESCRIPTION OF WORK/USE OF BLDG. ' A.P. 0 Zone S Main Building: Accessory Building: comply with such provisions or this permit shall be deemed revoked. Address Arch/Eng. License No. 3 ! 1". TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front Urinal - / CJ L ZO b 1:1TENANT ❑ ELECTRICAL ElPLUMBINGJia MECHANICAL B Rear OWNER BUILDER DECLARATION I hereby 'affirm that I am exempt from the Contractor's License Law for the, following reason (Section 7031.5 Business and Professional Code: Any city or - county which requires a permit to construct, alter, improve, demolish or repair any structure; prior to its issuance, also requires the.applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (Commencing with Section 7000) of Dl vision 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 N31.5 by _any applicant for a permit subjects the applicant to a civil natty of not more than five hundred dollars ($500). I, as owner of the property or 'my employees with wages as their sole compensation, will do the work, and•the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply l0 an owner of a property who builds or improves Address ❑ -OTHER A - 4't ` { Contractor's Nam hon Z.f arbage Disposal C Right Laundry Trays I' / /- PROJECT DESCRIPTION SQ. FT. OCCUPANCY K rH�eating xt,o-100,000 BTU ❑100,006BTi Address Imailing) r-,� CONSTRUCTION TYPE_.VALUATIONS S Left ' IM, P City License Nb. _ ZONE GRADINGCU.YDS. ACRES = Ping. Ref. # Parking Req./Provided I LICENSED CONTRACTOR DECLARATION F ' I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: with section 7000) of Division 3 of the Business and Professions Code, and my license is in fu1 rce ngeffect. 7, -'5' -/License Cl U Li se N Date) i Signature PLUMBING FEES ELECTRICAL Automatic Washer - - Transformer ❑ 15-50 KW Construction Pole Sub, ❑ 50 + KW Bar'Sink ' WOR RS' OMPE14SATION DEC RATION I Hereby affirm that I have a certifit of consent to self4nsure ora certificate t Workers' Compensation Insure or a certifi¢d copy thereof (Section Backflow Preventer ` 100, Lab.fp rolicy No F Company seO eCertifletl copy is hereby furnished. Certifi py IS filed with the city 8ui ping Oivlsiogl. Date Applicant Ti1C, EXEMPTI N FROM WORKERS' COMPENSATION OE LARATION (This section need'not be completed If the permit Is for one hundred ($100) or less). I Certify that in the performance of the work for which this permit is Issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Backflow Irrigation Bathtubs . Clarifiers Dishwasher Drinking Fountains Floor Drains Date Signature 'NOTICE: If, after making this declaration, you Should become subject to the Workers' Compensation provisions, of the Labor Code, you must forthwith _ Floor Sinks comply with such provisions or this permit shall be deemed revoked. Gas Service CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance r of the work' for which this permit Is Issued (Section 3097. Civ. C.)t Londer's 'Name Urinal - Interceptors Lender's Addloss_ Kitchen Sink _ OWNER BUILDER DECLARATION I hereby 'affirm that I am exempt from the Contractor's License Law for the, following reason (Section 7031.5 Business and Professional Code: Any city or - county which requires a permit to construct, alter, improve, demolish or repair any structure; prior to its issuance, also requires the.applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (Commencing with Section 7000) of Dl vision 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 N31.5 by _any applicant for a permit subjects the applicant to a civil natty of not more than five hundred dollars ($500). I, as owner of the property or 'my employees with wages as their sole compensation, will do the work, and•the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply l0 an owner of a property who builds or improves Lavatories P—Trap _ RODE Drains - 4't ` { 'Reinspection Fee arbage Disposal S15 threon, and who does such work himself/herself or through his or her own e, em ployees, provided that such'Improve merits are not Intended or offered for PLUMBING FEES ELECTRICAL Automatic Washer - - Transformer ❑ 15-50 KW Construction Pole Sub, ❑ 50 + KW Showers Service Sink Sewer Cap Sewer Connection Cooking Unit Meter ❑up to 100 amps Solar Collectors Dishwasher Meter ❑over 100 amps Solar Piping Dryers ❑Gas ❑Electric Sub Panel Solar Tank Fan Motors ❑0-1 HP ❑1)4 . S Swimming Pool vv/Spa F.A.U. Inc.Solar 119.15 HP 016.15+ Urinal - Fixtures Microwave Outlets Water Closet ! - Device Boxes Pole Light Water Heater Water Servicesof - utlets itches Range Sign /Auto -Wash ,1 arbage Disposal ; Standing Sections ' Laundry Trays I' Generator [3 0-5 KW 05.15 KW Trash Compactor S15 threon, and who does such work himself/herself or through his or her own e, em ployees, provided that such'Improve merits are not Intended or offered for Boiler - sale. If, however, the bullding or improvement is sold within one-year of com- _ pletion, the dwner,wlll have the burden of proving he/she did not build or im- , Duct - Under Ground I rove for the purpose of Sale). I,'a owner of the property, am exclusively Contracting with'Iicen'sed Con- $15 Issue Fee :$ 3 , Duct - Structural trattOrs to construct the project(section 7044, Business and Professions Code: not apply to an owner of who REQUIREMENTS:; - Date Date I Dat Z !Duct Ventilating The Contractor's License Law oeS property builds or Improves thereon, and who' contracts for such projects with a con- + SUMMARY OF FEES :^ BUILDING PERMIT $ SMIP ,$ PLAN CHECK S I PERMIT PLUMBING S ISSUANCE $ PLAN CHECK 25% ;S ENERGY P.C. '$ EL'•ECTRICA•L $ GRADING $ ' PLAN CHECK 0% $ MICROFILM sS MECHANICAL TOTAL FEE I$ PLAN CHECK 25% $ __ 7r. ( ::I, l 1 I 13 - _ tractor(s) license pursuarit'to'the Contractor's License Law). I am aware that of their Worker's Compensation insurance should be provided to me. Exhaust System ❑ Multiple ❑ proof ❑ I am exempt under Section B. & P. C. for this reason Firepl/Fact. Bit. ICBG c# Date Owner System & Ducting 'I hereby certify. that I have read-th 'application and state that the -above -� 7 Z rH�eating xt,o-100,000 BTU ❑100,006BTi information is,correct. I agree to co p with all city and county ordinances ' and state Laws relating to building o tructlon, and hereby authorize repre- + r 1 Isentatives this cltytent p the above-mentioned prop or F inspect p poses. I Dat Signature Reinspection Fee $1-6 Drivers' Llc se or SS yjF CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee l Hood or Type I , ❑ Canopy Type 11 ❑ r Refrigeration System [--10-100,000BTU 1:1100,000 BTI) System Repair/Alteration Fire Dampers Registers t . Issue Fee Illela JL Z O N ( N G R E O M _ T S FEES _I S 3 , Reinspection Fee $15 Issue Fee :$ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS:; - Date Date I Dat Z + SUMMARY OF FEES :^ BUILDING PERMIT $ SMIP ,$ PLAN CHECK S I PERMIT PLUMBING S ISSUANCE $ PLAN CHECK 25% ;S ENERGY P.C. '$ EL'•ECTRICA•L $ GRADING $ ' PLAN CHECK 0% $ MICROFILM sS MECHANICAL TOTAL FEE I$ PLAN CHECK 25% $ __ 7r. ( ::I, l 1 I 13 S 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL ?A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil iPipe.Undrgrnd. 53. Steel Reinforcement '. 3..Electrical Conduit'Utility-Undrgrnd. 54. Forms , 4. Electrical ConduitlUridrgrnd, 55. Electrical Bonding , 5. Steel Reinforcement' 56. Rough Plumbing & Pressure Test 6. •Electrical'UKER Grnd. 57. APPROVAL TO COVER-GUNITE J. Footings 58. Electrical Conduit-Undrgrnd. ..a 8. Foundation 1, - 59. Gas Pipe, ❑ Undrgrnd., Test i 9. Water Pipe-Undrgrnd: 60. Backwash Lines, P -Trap, ❑ Undrgrnd. ; 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final '12. Sewer'Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final + 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydra 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25, Roof Sheathing 74. Overhead Hydro 26, T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe,.- tandpipe..;28. 28.Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL' INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final ` 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preven ter 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 5% CERTIFICATE OF OCCUPANCY No. Date , Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA ; CULyp I Hut, �I ^LION PER VII PERMIT NO. TRACT NO. LOT NO. Uf�(IT N0. w /• l /G.a "Project Address 111. Applicant's MailingAddress�_ Owner's Name 7�s+C Y TO"i LCiT i Rc. ! Phone — Address Arch/Eng. _ .. ,_. ___— License No. Address Contractor's Nam r_ S -C 1 hone Address (mailing)A�Fi-i-r �/ ,IjLOC,�1/..►�i4rJ 973% City License No. LICENSEO CONTRACTOR OECLARATION I hereby affirm that I am licensed under provisions of Charter 4 (commencing with section 7000) of Division 3 e B mess and Professions Code, and my license is in full forfe and elf t. Ll cense Class L O icense o• -%.s f Date -AVS Signature WORKERS' COMPENSATION DECLARATION hereby affirm that I have a Certificate of consent to If -insure or a certificate ,f Workers' Compensation Insurance, or a Certified copy thereof (Section 3800, Lab. C.) Polity No.JG. C i7� rs� c. ®Certified copy is hereby furnished � ' Cer�fietl copy is filed with the city 'Idi Div ion. Date '^�C ^dr- Applicant EXEMPTION FROM WORKERS' COMPE=NSATIbN DECARATION (This section need not be Completed if the permit is for on hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, i shall not employ any persori in any ur so s jp be ome subject to the Worker ' Compens ion lbws of Call rnla. f lA Date Signature ~ l f�.�l\\ J - - 'NOTI E: If, after ma ing this declaratio ,you sho Id ocome subJect to the Workers' Compensation provisions of the Laber Code, You must forthwith Comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I . I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name - ---- Lender's Address OWNER BUILDER DECLARATION ' i hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's LJcense 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 /031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). LJ I, as owner of the property or •my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work hlrnself/herselt or through his or her own employees, provided that such improvements are not intended or offered for sale. It, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose Of sale)'. I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s)license pursuarit to the Contractor's License taw). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner i hereby' certify that I have read this application and state that the above Information is orre . agree tom, mply with all city and county ordinances and state la r ng bulId g ohstru n, and hereby authorize repre- sentatives f this ,icy enter' u On t hove -mentioned property for Inspection rpose \ - —#) S Signature Date Drivers' License or SS � E:-7 (--I I IZ_ PLUMBING FEES )2 TYPE OF CONSTRUCTION NEW 0 ADD LJ ALTERATION U REPAIR Showers ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A. P. 4I, DESCRIPTION OF WORK/USE OF BLDG. Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. S Main Building: Bathtubs Sewer Connection E TYPE OF PERMIT GRADING El FOUNDATION El STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Meter ❑over 100 amps ❑ OTHER Solar Piping A Hear Dryers ❑Gas []Electric Sub Panel C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Motors 1 HP ❑ 1 14 - S Inc. Solar 09.15 HP 1316-15+ CON STRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping, Ref. Remarks: Planning Notes: 5819 1 / I b/85 4.50 TL I AccessoryBuilding:Parking Req./Provided CMF 0865.46, rev. 10/84 Whit y - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas []Electric Sub Panel Drinking Fountains Floor Drains Solar Tank Swimming Pool w/Spa Fan F.A.U. Motors 1 HP ❑ 1 14 - S Inc. Solar 09.15 HP 1316-15+ Floor Sinks Urinal - Fixtures Microwave - Gas Service Outlets Interceptors Water Closet Water Heater Device Boxes Outlets Pole Light Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap- Laundry Trays Generator DD -5 KW 05.15 KW Trash Compactor Roof Drains Reinspection Fee S15 Issue Fee S 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES RECIUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By----. Date I _fb Bailer Hood or Type I ❑ Canopy Type 11 ❑ Duct - Under Ground Duct - Structural Refrigeration System DO -100,000 BTU 0100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ S $ ENERGY P.C. $ 5 4, OC) GRADING $ $ SO MICROFILM $ $ TOTAL FEE :S So $ Exhaust System ❑ Multiple 0 System Repair/Alteration Firepl/Fact. Bit. ICBO Fire Dampers Heating System & Ducting Eh-100,ODOSTU❑100,000BT Registers Reinspection Fee S15 Issue Fee $ 3 CMF 0865.46, rev. 10/84 Whit y - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING -APPROVALS Permit # Date Inspector POI._ & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole n 52. Pool & Equipment Location 2. Soil�P,ipe-Undrgrnd 53. Steel Reinforcement 3r-Elect'rical Conduit Utility-Undrgrnd. 54. Forms 4-.'Electrical Conduii-Undrgrnd. ^. 55. Electrical Bonding 5. Steel-;Reinforcement 56. Rough Plumbing & Pressure Test C� 6. Electrical UFER Grnd. r �� 57. APPROVAL TO COVER-GUNITE i 7.. Footings '+* 58. Electrical Conduit-Undrgrnd. n 8: Foundation rr 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. %_ 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10.' Structural Floor System �' 61. APPROVAL TO DECK 11. 'Property Sewer Line & House CoA nection 62. Backwash & Receptor-Final 12.."Sewer Cap ` ' �, � 63. Heater &Vent-Final 13. Roof Drains J 64. Plumbing System . Final y 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. POOLISPA SYSTEMS FINAL -19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 31Plaster Brown Goat 79. FINAL INSPECTION 32' Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric�� c� Notes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41, Solar Domestic•Final 42. Backflow Preventer 43. Backflow, Irrigation 44. Landscape Irrigation System K 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 (714) 754-5273 • Fax (714) 7544856 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT. . PERMIT PERMIT NUMBER j B00-00445 T7 FAIR DRIVE, iCOSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 04/06/2000 Issued: 04/06/2000 Arch Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF EXISTING 12 -UNIT COMMERCIAL BUILDING (BUILDING B) FOR ,"MESA BUSINESS CENTER ASSOCIATES" (120 SO). TEAR OFF EXISTING BUILT-UP ROOFING & INSTALL NEW BUILT-UP ROOFING SYSTEM - BASE, 2 -PLY, AND CAP, Plan Check: $0.00 BUILDING PERMIT $391.25 Job Address: 711 W 17TH ST SMIP Cam: $5.25 Suite: B Inspection: $0.00 Vicinity: BUILDING 8 Parcel Number: 93983013 Zoning: Applicant: ROGERS, MIKE Address: 2626 NEWPORT BL Phone: (949) 548-1645 COSTA MESA, CA Zip: 92627 Owner: MESA BUSINESS CENTER ASSOCIATES Address 711 W. 17TH STREET COSTA MESA, CA Phone: (714) 548-0783 UNIT H-1 Zip: 92627 Contractor: PETRONELLA ROOFING Address: 2626 NEWPORT BL Phone: (949) 548-1645 COSTA MESA, CA Zip: 92627 License: 460707 PERMIT NUMBER j B00-00445 T7 FAIR DRIVE, iCOSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 04/06/2000 Issued: 04/06/2000 Arch Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF EXISTING 12 -UNIT COMMERCIAL BUILDING (BUILDING B) FOR ,"MESA BUSINESS CENTER ASSOCIATES" (120 SO). TEAR OFF EXISTING BUILT-UP ROOFING & INSTALL NEW BUILT-UP ROOFING SYSTEM - BASE, 2 -PLY, AND CAP, Plan Check: $0.00 Permit: $391.25 SMIP Res: $0.00 SMIP Cam: $5.25 Other: $0.00 Inspection: $0.00 Total: $396.50 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Exi_ sting: 0 FEE SUMMARY. PLANNING & ZONING Rear 0-0 Left 0-0 Rear 0-0 Left 0-0 Required: 0 Proposed: 0 Calc Valuation: $25,000.00 Claim Valuation: $25,000.00 Right 0-0 Right 0-0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not -commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate o1 consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. (JS_ihave and wttt maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My w�pfrkfers1�' compo sation Insurance carrier and policy number are: . �� O� 2�' L Carrier: lT l_ __ _ ____ _ _ _ Policy Number: _ - _ . "L (This section n not be completed if the permit is valued of one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to became subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 the Labor Code, I shall forthwith comply with these pro ions. j Applicant Signature: r 2 t] Date: Oct WARNING: FAILURE TO SECURE WORKERS' OOMPENSA71ON COV GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO MMINAL P ES L FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE COST OF ENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under proviglons of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profs Ions Code, and my license is in full force and effect. Uc. N P Class # _ 3 Contractor's Signature: Data: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Chill Code). Lender's Name: Lender's Address: Signature: _ _ Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a cMI penalty of not more than five hundred dollars ($500).): 0 F, as owner of the property, or my amphoyees with wages as their sots compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner at property who builds or improves thereon, and who does such work himself or herself or through his or her OwR employees, proMded that such Improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner o1 the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature. Date: Owner fD verified by driver's license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet In depth Into which a person is required to descend, will be made in connection with work authorized by this permit, end that no bullding structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: _ Date: Division of Industrial Safety Permit Number: - HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health rind Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 it an RMPP intly s preserequired, has Section 25534 of the California Health and Safety Code been fully compiled with? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application agermit for such construction or mod4ication from the South Coast Air Quality Managomeni District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requestod Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the cuter boundaries of a school? ❑Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Heatth and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all o1 the disclosures prescribed by Califomis Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certity that under penalty of perjury the information given above Is correct. I agree to comply with all state taws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is Correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. Sign ture Of Legal Owner(s) DaLV D And(Or onzed Applicant ate CODE !. INSPECTIONTYPE jig IffI169L5 CODE• INSPECTION TYPE gd1E INTITIA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof fla LA) 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 Applicant to fill In all spaces except these within heavy border lines end sign all appropriate declarations. CITY OF COSTA MESA, CONSTRUCTION PERMIT Applicant's Mailing Address Project Address ;U1 7- 17't R112!1�- $-A -K 110572*I�G'5�l Owner's Name 'hone 77/-Y& Address TN y— Arch/Eng. License No. Address Contractor's Nam one Address (moiling) License No.7li�� - - - LICENSE& CONTRACTOR DECLARATION I;hereby affirm that I am licensed under provisions of Charter 9 (commencing with, -section 7000) of Division 3 of the Business and Professions Code, and my license is In f I force and effect. 7�-Z �lJcanse Class "��1 _._ _LJcense No,, -0-:� Signature RKERS' COMPENSATION DECLARATION reby affirm that I have a certificate of consent to self -insure or a certificate. - of Workers' Compensation Insurance, or a certified -Copy thereof (Section 3800, tib. Policy No. TaD122 a . _ Company &eigi'x&-Zisr_ 06 Certified copy Is hereby furnished. - Car fe copy,l fled with the city BL4121ng Dlv Date1s�-a Applicant s EXEMPTION FROM WORKERS' COMPENSAT46N DECLARATION -(Thissection need not be completed if the parmK Is foCone hundred ($100) or less);. ' I certify,that in the performance of the work for which this permit is issued I shall,not employ any person In any manner so as to become subject.to the Workers' Compensation Laws of CallfornP. Date Signature NOTICE: If, after -making this declaration, You should' become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith, comply with such Provisions -or this permit , shall be deemed revoked: ' CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a Construction fending agency for the performance, of the .work for which this permit Is *Issued (Section 3097 CIV: C.) Lender's- Name _ - L ander's Address OWNER BUILDER DECLARATION ' I hereby affirm that I am examptilrom tne.Contractor's Licenie Law for the following reason (Section 7031,5 Buslnes5 and Professional, Code: Any city or County which requires a permit to construct, alter Improve, demolish or repair any structure, prior to Its Issuance, also requires the apPIGnt for such permit ' 'o file a signed statement that he/she Is licensed pursuant to the provisions of le Contractor's License Law (Chapter 9 (6ommencing'wlth Section 7000) of ,iIvislon'3 of the Business and Professions Code) or that he/she is,exempt therefrom -and the basis for the alleged eXamption. Any violation'of Section 7031,5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500): I, as'owner of the 'property or my employees with wages as their sole compensation will do the work, and the structure. Is not Intended or offered for sale (SeCfion 7044, Business and Professional Code:, The' Contractor's , License Law does not apply to an owner of a property.who builds or Improves .thereon, and who does such work himself/hofself or through his or her own employees, provided that such Improvements are;not intended or offered for sale. If, however, the bulld[ng or improvement Is sold within one. Year of Com• pletlOn, the owner -will have the burden Of proving he/She ditl not build or im- I + rove nor the purpose of sale). ' I, as owner Of the property, am exclu5ly. contracting with licensed con- ' tractorsto,construcl the project (Section 7044, Business and Professions.Code: The Contractor's License Law a08s not ePpiy to an owner Of property who ' builds or Improves' thereon, and who contratts for suCh projects with a con- trattor(s) license pursuant to the Contractor's License Law). ❑ I am exempt under Section B. & P. C. for this reason I Date _ - - ' owner — I herebycertify-that i• have' -read this appliCatton -arid -state• that the above ' Information Is correct, I agree to comply with all city. and County ordinances and 'state taws relatingto building construction. and hereby authorize repre- sentatives of ,thls ,City to enter upqn the above-mentioned property for a 1 TYPE OF CONSTRUCTION M NEW L1 ADD LJ ALTERATION LJ REPAIR ElCONVERSION 1:1DEMOLISH ❑ OTHER nc-L DESCRIPTION OF WORK �D/2Y—` emjN sr -f' TYPE OF PERMIT. U GRADING LJ FOUNDATION LJ•STRUCTURAL ❑ TENANT 1-1ELECTRICAL ❑.PLUMBING. EDMECHANICAL- ❑,OTHER PROJECT DESCRIPTION SQ. F1 X OCCUPANCY CON STRUCTION TYPE _ __ VALUATION $ A $DD.htrl ZON)c GRADING CU.YDS. ACRI=S Remarks: or Sink ackflow Preventer ackflow Irrigation athtubs i Dishwasher Drinking Fountains Floor Drains r Floor Sinks Gas Service ,Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains, Showers Service Sink I ! Boiler. Duct Under Ground ; Duct - Structural ! Duct- Ventilating Exhaust System C1Multiple ❑ Firepl/Fact, Blt. ICBO+ HeatingtSystem & Ducting [30-100,000'BTU 0100,000BTL Hood or Type I ElCano ( T ' e I I ❑ lnspection urp s s. 1 f i I _ P Signature it e ; t rs iste i Drivers' Liren'se or SS { Regj GMF 0865-46 rev, 12/82 White - Building; Canary - Applicant; Pink - Accounting; GoldenYod - Assessor PLUMBING Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank ' Swimming Pool vv/SpaUrinal Water Closet i Water Heater Water Service _ Reinspection.Fee , Issue Fee ' Refrigeration System i ❑a100,000BTU 0100,0009TU System Repair/Alteration Reinspection Fee r Issuo Fee $15 $ 3 A. P. Y# 6241-7 PLNG. RE F. -0 TO BUIL ODING PRPERTY LINE LEFT SIDE YARD PKG. SPACE REO. STREET WIDTH ' SPECIAL CONDITIONS: 6217 : /24/6 GVIVG ' BUILDING c�•�Ton ry r/�' �`T` REAR YARD (TO P/L) RIGHT SIDE YARD PROVIDED PARK FEE $ u4eUC TL Automatic Washer Meter Uover 1GOamps _ Construction Pole Sub Panel, Cooking Unit I Sub Pole Dishwasher Motors 00-1 HP 01%-8 Dryers ❑Gas ❑Electric Inc.Solar ❑g -i5 HP ❑16-15+ Fan Microwave F.A,U. Pole Light Fixtures _ Range_ Device Boxes Sign. Outlets Standing Sections Switches Trash Compactor Garbage Disposal Generator 00.5 KW 115-15 KW i Transformer 015.50 KW t ❑50+ KW' Reinspection Fee 815 Meter ❑up to 100 amps i Issue Fee • $ 3 Zoning Approved By Date Application Approved By ..Date 1 �S Application Issued By Date + U 5IRY OF FEES 'BUILDING PERMIT $ 7V'' SM IP $ + ? PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK.$ } I GRADING ` $ ELECTRICAL $� I $ PLAN CHECK, $' i MICROFILM $ 'MECHANICAL $: TOTAL FEE, ! $ I ;PLAN CHECK. $° i ` LESS } i f ADVANCED PC ' $ 1 1 ; FINAL FEE $"Z -- `CONSTRUCTION,AND.PL+AN ING , { Y - _ P0�_ 3, SPA r { _ Date r JAPP.ROVALS Permit # G Inspector t -APPROVALS Permit--# Date I nspecior „a � , r _. 1,- G emporary,Electrical Service o_r Pole J _z z ^ ` " 'f 52-% Pool &Equipment Location int ,2; Pip'e-Undrgrndr f. 53: Steel Reinforcement 15ai1 3: Electrical Conduit Utility-Und'rgrnd:. 4 I �54Forms _ 4. Electrical Conduit-Undrgrnd•. t r 55. Electrical Bonding 5: Steel Reinforcement' 56. Rough Plumbing &Pressure Test + I 6: tlectrical UFER Grnd.. , ? - n _ 57;. APPROVAL -TO -COVE R-GUNITE* 7. Footings , F ti J T 158. Electrical Conduit-Undrarnr{,- -_ 8. oundatiori - 4 ; �•. 59. Gas Pipe, -0 Undrgrndr; Test , r 9. Water Pipe-Undrgrnd.! L- 60. Backwash Lines, P- Trap, ©Undrgrnd. ,. 10. Structural Floor System CEE a 61. APPROVALTO DECK ' 11. Property Sewer Line & House Connection 62. Backwash &Receptor -Final 12. Sewer Cap= 63. Heater &Vent -Final. '. 13. Roof'Draini ` 64. Plumbing -.System Final _. I 14, Rough Plumbing 65. Electrical-Firial 15. -Rough -Electrical -Conduit" T "' - Y _ - i 66- Solar System -Final `- } I r <a16.' ough,Electric•Wiring• ' ! " ` 1 _ } _ ti` _ -`67.' Fencing &Access Approval - II , ` ; _.Rough�Wiring S-gn': - �, { . ` "_ : +_ ` w `_ { _ 4 68.1 APPROVED FOR PLASTERING' - I i 1 r 113. Rough ElectriIdal;T,Bat Ceiling; 1 I r I _ = " I - r' { 69.' POOL/SPA SYSTEMS FINAL -+ 19 'Rou-Heating Heating &-Air Conditionin ; 9 9 9 'r I �; r ' FIRE DEPT.'REQUIREMENT- - _ ' APPROVALS' ; Pe'rmit # 20r..Rough Factory Fireplace' I I " 21, .Ducts,• in Structure ! i , i 70.1 Underground Hydro - ; s, 22. Ducts,;Venfilating { i r ,I , I 71.1 Product Piping Gas ❑ Oil ; l r23. Gas Pipe -Rough & Test �.,E: I s 4 �! i7i, Underground Flush 24, 'Roofy Framingr 1 I ! 73.1 UnderI grnd. Storage lank❑Gas ❑Ail 25. (Roof Sheathing I 74.' Overhead Hydro t11,26. T -Bar Ceiling {Structural). & Monocoat , - ` ; i 75. Dry Chemical 1.27. Frame and Flashing i I l :. 76. Dry Standpipe !{ 28. 'Lathing & Siding Ir /r ' fro I 77.1 FIXED SYSTEM -FINAL Y " ? l X78.1 FIRE PREV, FINAL 129. .Insulation f r '3d. ,Drywali Nailing I FNoies:, 31%'Plaster Brown Coat 32. Electrical Power MeteriFinal 33. 'Final Electric } 1 tI ►_ i r 4 # ; _ 34.4 Final Heating & Air Conditioning 35, Final Gas! Pipe -Test: 36. Hood or Canopy= 37. Final factory FirepIlace`- ! Q,i i yy' c. I , r .sir, , i. R s i 38. Final Plumbing I r. ;' r r _ j ! __ '• :, , 39. Water Service -Final; r 40. Gas Serviee-Final t G 3 ! I 1. 41, Solar Domestic -Final j 42. Backflow Pre'venter' la'r -j 43. Backflow Irrigations I 1 r _ 44. Landscape lrrigation:System i 45. Sound'' Attenuation r r;' c r - s 46. Handicap Regulations ,11 1. 1 47. FINAL STRUCTURE & BE TIDING ,. f i ► 48. Special Requirements Completed 49. Electric Release to Edison 1 50. Gas Release to Southern California Gas Co I I { 1 I 51. CERTIIFICATEOFjOCCUPANCY :- N0. - -l' _�' Date -- _ -- _ ._� I l i ;_-'_' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations- _ _ ! 4�� 6/294: 3 9.27 TL CITY OF COSTA MSSAPERMIT. NO. TRA9T NO. LQT,NO. BD ; &_ NSTR IJC Tf6N PERMIT f 79. '0 9 / ' t - Applicenta Mailing Address 6 -S' TYPE OF CONSTRUCTION LJ NEW ADD UALTERATION LJ REPAIR + ' Pro}Bct Add, "tel sp ❑ CONVERSION .❑ DEMOLISH OTHER abs %�i Owntfr's Name hone` - _ DESCRIPTION OF WORK vS �i 1 K 67 /L K f tL pXera9� w3.0 P a'i r ,iG I G U na IONS Address +�. r RQ`� • - TYPE OF PE RMI Trr�vv[[ LJ GRADING - FOUNDATION STRUCTURAL A. P; qW• ZONE rry.G Arch/Eng, License No, ® TENANT CLI ELECTRICAL ® PLUMBING ® MECHANICAL" PLNG. REF. -0- r BUILDING - Address ❑ OTHERl TO BUILDING Contractor's Nam - hone ' PROJECT DESCRIPTION' SQ. FT, OCCUPANCY �� ? - -PROPERTYINE Ri AR YARD (TO P/L) CONSTRUCTION TYPE _ TI� VALUATION $-t�]`�G d� LEFTSIDE YARD •�. RIGHT SIDE YARD �x7 r�tpjL Address (mailing) i License NoZONF_ GRADING CU.YDS. ACRES _ PKG. SPACE REO, PROVIDED ' . __ LICENSED CONTRACTOR DECLARATION l Remarks: STREET WIDTH ' PARK FEE $ I.hereby affirm that •1am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3' of the Business and Professions Code, and ', ! SPECIAL CONDITIONS: y my license is in full -force and effect. Lica. se Class License No. ' PLUMBING ) >}e Signature ' ',RKERS' COMPENSATION DECLARATION r ` } Sar Sink 1 Sewer Cap" ` ELECTRICAL reby affirm.thai I have a Certificate of consent to,selfansure or,a.certificate ._ _ _ _ Au,tOmatic Washer_ Meter _ over 1Ob amps _ Backflow Preventer - Sewer Connection of Workers' Compensation Insurance,' or a certified -copy thereof (Section i Construction Pole" , Sub Panel /� ge Solar Collectors 1 3800, Lab, c.) � Backflow Irri tion , -- ! 1c, LC�Ni G.Cooking UnitSub PoleCompany furnished,Bathtubs Solar Piping ith the cit Ivi ClarifiersSolar Tenk I Dishuyasher Motors 0-1 HP ❑1 h-8 Applican _ _ EXEMPTION FROM WORKERS' CO PEN TI DECLARATION Swimmin Pool wlSpa } ; ; Dryers- ❑Gas : ❑Electric' " ' _ {Thissettlon need not be completed if the permit for, one hundred (S100) or £ Dishwasher + g _ Inc.Solar.❑9-15 HP ❑16-15+ less). ; ' Fen + y Microwave I certify that In the performance of the work for which this permit Is issued, I i Drinking Fountains Urinal i ' shall not employ any person In any manner so as to become Subject. to Workers',Compensation �Laws of Callfornia.° , 1 Floor Drains j Water Closet' F.A.U. ` Pole Light �+ 1 Date ' Signature NOTICE., if, after making this declaration, you shoWd become subject to the—r Floor Sinks — —• - - Fixtures Water Heater, - O Range CSS Workers" Compensation provisions of the Labor, Code, you must forthwith ` comply with • such provisions' -or ..th Is, permit +shall be 'deemed' revoked Gas $er4icR' Outlets . - / i�lrater SENit[! _ . r , _ Device Boxes ; Sign! CONSTRUCTION. LENDING AGENCY 1 I hereby affirm that there is alconstruction lending ager;cy for theperformancel ; ' Interceptors 4 ' : , , ` Outlets f Standing Sections ! Srp of the work for which- thW, permit is issued .(Section _3097 Civ, C,} Lender's Name Kifchem5ink ' i - F" Switches p li J 1 I Trash Com actor c OWNER BUILDER DECLARATION - I ` LaVatClflBS- t r " Garbage Disposal I hereby affirm that t am -exempt; frorii the Contractor's. License Law for the' y - 'Generator 00-5 KW 05.15 KW fallowing reason:(Section' 7031:5 Business and Professional Cade: Any city or' ^ ?—Trap, r county which, requires a permit -to construct, alter, improve, demolish or. repair _ Transformer F ''any structure, prior to Its Issuance, also requires thea licant for such ermiti r- " l ;% ❑ 15-50 KVV , pp p Roof Drains + v� file a signed statement that he/she Is licensed pursuant to the -provisions of 05U + KW' Contractor's License Law;(Chapter 9 (commencinglwith Section 7000) of - ; I jReinspeation Fee $�$ lvision ;3'of the Business and Professions Code)"or that, he she' is:exempt 1 Showers Reinspection Fee $15 ?t" refrom and the, basis for the alleged exemption. Any violation of Section , Meter ❑up to 100 amps ' 'Issue Fee $ 3 7031.5 by any applicant for- a, permit subjects the applicant to a Civil - - ' alty of not more than five hundred dollars (y500): Service Sink Issue Fee . 3 e , .. .'; I f _ ` Zoning Approved BY Data ' ',!U I,'as,owner of the property or -m employees with wageslas their sole r MECHANICAL i /� i41 eo pensation wlll' do the work, and the structure -is not intended or offered + , I Application Approved By W ate for sale>(Sec{ion 7044, Business: and' Professional Code: The; Contractor's , i I LlCense Law does not apply to an owner of a property who builds or improves I Bailer' , ~ - ` Refrigeration System r 1 r h ; i , therean,ldnd who does such work himself/herself or through his or her own T Application Issued ey Data i employees, provided that such -improvements are,not Intended or offered for , ❑01000DOBTU ❑100,0006T1J sale. If, however, the building or Improvement is sotd within one'year:of com- I ; Duct - Under.Ground SUMMARY OF FEES pletlon, the owner, will have the burden of proving he/she did not build or im- , 1 t ; rave for the purpose oftsate). , , l -" , + Duct - Structural System Repair/Alteration ' 1• ' . BUILDING P MIT $ ' } SMTP e $ ' • � I, as owner .of the property, am exclusively contracting with'Ilcensed con- , _ ' ! tractors to construct tha'pro]ect (Section -7044, Busirtess,and,Professlons_Code:. '. .- Duct - Ventilating ! _ t J��tfq, c. .� , c� ! PLAN CHECi�.?�$ PERMIT' , The Contractor's License Law does not apply to an owner of property who ' �. - _ ' I ISSUANCE $ ' builds or Improves thereon, and who contracts for such projects with a con- Exhaust System ❑ Multiple ❑ _-� �} ., • pa PLUMBING tractor(s) license pursuant to the Contractor's License La ( < 1 I 1 r +PLAN CHECK' I $' ) GRADING i J $ ❑ I am exempt under Section P. C. or this reason Firepl/Fact. Bit. ICBO # I i 1 .� r`. - I + y t Date I Own Heating'System & Ducting - r ; ;ELECTRI'CAL' $ �' 3 I $ I herebyY certify -that I have read tills ap catl and -state that the ab a- -ti ❑010 ,000'BTU 0100,p00BT r- , :1PLAN CHECKS MICROFILM � $ Information Is correct. 1 agree to comply !th al ity. and county ordinances i Mood or i r Y { t f ` MECHANICAL $ TOTALIFEE ( $ i and state laws_ r a ing to bulE g conrucNon, and hereby authorize repre- ,, sent as ofmn-�44 to r up the above-mentioned property •for ! TYPe I ❑I ? Reinspection Fee, i$15 ; I LESS = ' ! Inspection puCano 7 e I1 ❑ ' r ,;TPLAN CHECK( $ f 'ADVAricED PC I $i Date ' ] 1 FINAL FEE' $ , Drivers' Llcense or' S I ) Registers , Issue Fee i $ 3 i I l I - _... CMF 0865-46 rev. 12/82 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor �ONS_T�ULCTION-AAID�PLAJ NING "-' ' ` P0. SPA r' PPROVAS r Permit # r Date Inspector. ; PPI'16VALS ;-Permit # ' Date Inspector is 1� temporary -Electrical Service or _Pole i ; '" �:, 52' Pool &'E Location r - i �a Soil t ipe-Undrgrnd: '' .. " r+ ' 53. Steel Reinforcement I ,. _ , _ - '3? Electrical Conduit Utilitv-Undrgrnd. 54. Forms .: 4' Electrical Conduit-Undrgrnd: } r i ' 'Z ;, ° n 1F55 Electrical,Bonding • 5: Steel Reinforcement. ` ,, ° `• f 56.. Rough Plumbing`& Pressure Test 6• f=€ectrical LIFER Grnd. ; ' 57 APPROVAL'T0 COVER GU_NITE _- - 7. Footings 58. ElectricalCpnduit-Undrornii_ 8. Foundation r I -59. Gas Pipe; ❑ Undrgrnd'., Test' 9. Water Pipe Uriiirgrnd. 60. Backwash` Lines', P -Trap, ❑ Undrgrnd.. sr ' ' 10. Structural Floor System ;+ 61. APPROVAL TO DECK -_ J 11. Property Sewer Line &=House Connection[ L62. Backwasti &-Receptor Final 12. Sevv6 �ICap nt-Final'63. Heater &Ve 13. RoofDrains 64. Plumbing:System Final - r' 14, Rough Plumbing 3 •65. Electrical -Final"' - - J 3,-15: Rough "Electrica€-Coriduii 'I" i ' -,g6.1 Solar System Final _ i I 16. 'Rough Electric Wiring -67. Fencing & Access.Appraval "' _ - 1-17. `Rough-Wiriing•Sign'' , 68. APPROVED FOR PLASTERING - i _ j 16..Rough=ElectricahT`•Bac Ceiling �! I ! i ' �`� ! •, POOL/SPA SYSTEMS FINAL i }69., 19. ►Rough -Heating &Air Conditioning FIRE DEPT. REQUIREMENT ` APPROVALS Permit # 20. -Rough-factory Fireplace 21.'Ducts, in Structure I 170. Underground Hydro -22. !Duets, Ventilating f. ;w ! € ; { ` 71.' Product Piping ❑ Gas ❑ Oil t X23. ;Gas Pipe -Rough & Test , t r ;s { ' +72. Underground Flush' ' W 0-24. Ro6f Framing ;7 3.; Undergrnd. Storage Tank ❑Gas ❑Oil 25. ipoof Sheathing 74: Overhead Hydro 26. T -Bar Ceiling (Structural), & Monocoat ! i l 75.' Dry Chemical '- 27. 'Frame and Flashing ' I ! 76. Dry Standpipe i 2B. 'Lathing &Siding' 5 € G I $ I l i 77• FIXED SYSTEM FINAL 29.'�!lnsulat�ion� i78. FIRE PREV, FINAL i r I I 4 30. ;Drywall Nailing ' ' ! I ; Notes: 31. Plaster Brown Coat F u �• k '- 32.4 Electrical'Power Meter. Final 33.'Fina€ Electric ___* - - - 7 y t j 1 34. Final Heating &,Air Conditioning i f a , r. > 35. Final Gas Pipe=Test `� l :' 36. Hood or €CanooVJ 37. Final Factory Fireplace` 38. Fina ✓Ei�!%• f%4Q/f VIVO?' 39. Water iService-Final ; • • � I tj C 40. Gas Service -Fina! 41, Solar Domestic -Fina€ 42. Backflovv Preventer K � . j I V, i 43. Backfiow Irrigation F 44, Landscape Irrigation System ' 45. Sound FAttenuation r( t 46. Handicap Regulations I 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release`to 'Edison f t 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ' �� -Psi 155.5►� ti� r.l Q 77Q'i d:'r� _L(l), 14890 COSTA MESA BUILDING -SAFETY DEPARTME J } P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant tp Fill in Completely RE CEIyjE0 BY DATE RE EIVED DATE ISSUED BUILDING -71 ! 17711 5l ( la ,�Q �_/b/- Z3 ADDRE 1 1 PERM ADDRESS BET. MAIN & ACCESS. BLDGS. OWNER DATE MAIL APPROVED ADDRESS r . CITY TE CIT1 j �. NO pk CONSTRUCTION LIG. NO, LENDER THE AMOUNT SHOWN UNDER VALUATION IS FOR BRANCH OF LOT(� ADDRESS NOW ON LOT ARCHITECT i� . w TE _ t .. n n • ..ems ,. 1 win ..ti11 �XY44. ADDRESS BET. MAIN & ACCESS. BLDGS. CONTRACTOR DATE ADDRESS APPROVED APPROVED/&/d URV TEL. CITY NO. STATE CITY LIC. NO. LIG. NO, SIZE THE AMOUNT SHOWN UNDER VALUATION IS FOR NO. OF SLOGS. OF LOT(� '� NOW ON LOT USE OF EXISTING BLDG. SIZE O Q O. OF NEW BIG. C,ROOMS STORIE.' EXTERIOR WALL ROOF COVERING COVERING USE OF BUILDING AND WORK TO BE PERFORMED A.P. NO. I I L --)40 -O -A- LDING}` r) y IDRESS J j - t � 1H AD . V 1 -Irl �TRACV''SA 461 BLOCK OWNER FIRE ZONE APPROVED VALUE 48, (�f $ /-- TYPE r IJP GROUP r DATE ZONE NO, OF USE OF NEW /Nil U57 1 PLANS BUILOING YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM C/L STREET Al ^1� DISTANCE BET. MAIN BLDGS, BET. MAIN & ACCESS. BLDGS. VAR. :W DATE C. V.P. * APPROVED APPROVED/&/d URV nerK I �b I hereby acknowledge that I have read this application and state cpE(, that the above information is correct and agree to comply with 7 all laws regulating building construction, and I shell not employ / any person in violation of the workman's compensation laws of the State of California. m tp I hereby certify that I am properly licensed as a contractor under the State of California Busines: and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect, or I am exempt from the provisions of the State of California Business THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. VALUATION and Profess io Sion 3, Chapter 9, N PERMIT FEE S Sloneture - m �� Permittee S// /} �J� PLAN CHECK $ E % Authorized Agent U. TOTAL FEE $ r � A i (714) 754-5273 • Fax(714)754-4856 .lob Address: 711 W 17TH ST Suite No B Vicinity Parcel Number: 93983089 Applicant: ROGERS, MIKE CITY OF COSTA MESA BUILDING DIVISION PERMIT NUMBER DEVELOPMENT SERVICES DEPARTMENT. PERMIT 77 FAIR DRIVE, COSWX4WW Mt9 MECHANICAL PERMIT r Status: ISSUED Applied: 05/01/2000 Issued: 05/01/2000 ISSUED BY: Address: Owner: ".,'CROSSLEY,-MICHAEL - Address 120 33RD ST �' REPLACE ROOF A1C UNITS FOR SUITES 1,2, 11. SAME WEIGHT OF PREVIOUS UNITS. NEWPORT BEACH, CA Contractor: - GARY L ROGERS Address: 1302 LONGFELLOW RD V I STA, CA Arch 1 Eng Address: Phone: 949-548-1645 Zip: 92663 Phone: Zip: 92663 'Phone: 949-7954605 _ Zip: 92083 License:- 564276 Phone: - IZip: License: COMMENTS 1 SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with ail applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not -commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 SCOPE OF PERMIT REPLACE ROOF A1C UNITS FOR SUITES 1,2, 11. SAME WEIGHT OF PREVIOUS UNITS. - FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 - Repair /Alt Absorbtion Unit $0.00 0 Inst FAU <100 k BTU $0.00 0 Repair 1 Alt Refrigeration Unit $0.00 0 Inst FAU X100 k BTU $0,00 0 Ventillation System 4 $0.00 0 Repair/ Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst 1 Rep, Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Ref rig Sys <100 k BTU $44.40 3 Domestic Incinerator $0.00 0 Ref rig Sys X100 k BTU $0,00 0 Compressors I Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100k BTU _ $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp 1500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 ' 0, 15 To 30 hp / 1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50'hp 11,750 k BTU $0.00 0 Vent Fan 1 Single Duct $0.00 0 Over 50 hp I Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers < 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers > 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $67.90 COMMENTS 1 SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with ail applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not -commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: reby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workom' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Lssued. My workers' compensation Insurance carrier and policy number are: . Carrier: ' Policy Number: (This section need not be completed 1t the permit Is valued at one hundred dollars ($100) or less.) ❑ I certify that in the performance of the work for which this permit Is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become Subject to the workers' compensation provisions of Sectio 3700 0t the Labor Code, I shall forthwith comply with these provi Applicant Signature: 4- Date: rr� WARNING: FAILURE TO SECURE WORK SCOMPENSATIO60OVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIM;& PENAL ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDRION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST. AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: hereby affirm that I am licensed unge provisions of Chapter 9 (commencing with 5ecti0rt 7800) of Division 3 of the Busine d Pr lessions Code, and my license is i force and effect. Lic. # 2 CC' Class # Contractor's Signature: Date: o' CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: . Date: OWNER -BUILDER DECLARATIONS. I hereby effirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I; as owner of the property, or my emptoyoes with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sate.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Drivers License Na. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby Certify that no excavation five (5) or more feet In depth into which a person is required t0 descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Cade). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from thty division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 o1 the California Health and Safety Code requires, with some exceptions, (hat a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume o1 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feat of compressed gas at standard temperature and pressure). 3 Does or will the applicant or pretent or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application armit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency] gge Yes U No (Section 65850.2 of the California Goverment Code requires that the requested information be furnished on applications for non-residential building permits). 6 WIII any part of the facillty t0 be'con5tructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air poi)ubon control district or agency is required for the work which is The subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8 (If 'yes', attach certificate o1 compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree t0 comply with all state laws and city ordinances relating t0 building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. Signature Of Legal Owner(s) Date 'S' ov -7 r2 5r Authorized Applicant Date COE L MpEc7IDN TYPCODE! INSPECTION 7YPE 2AR �A P 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200! Final Re -Roof 210 Final Electrical 201 Final Block Retaining Wall 212 Final Fire Prevention 202' Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 24A6 -A6 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 711 W 17TH ST Status: ISSUED Suite No 8012 Applied: 09/27/2000 Issued: 09/27/2000 Vicinity: Parcel Nunmber: 93983024 ISSUED BY: Applicant: FERRER, GUY Address: 711 W 17TH ST #13-12 Phone: 949-515-0118 COSTA MESA, CA Zip: 92627 Owner: FERRER, GUY Address 711 W 17TH ST #B-12 Phone: COSTA MESA, CA Zip;, 92627 Contractor: Address: Phone: Zip: License: Arch / Eng Address: ` Phone: Zip: License: SCOPE OF PERMIT " EXTEND EXISTING GAS LINE TO RE- LOCATE SUSPENDED HEATER. A-ZI-9iIC'u[�►iMZVA COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 t446 ae JUDD) AMT QTY -AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub 1 Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 . 0' Swimming Pool '. $0.00 0 Backflow Preventer $0.00 0 - P -Trap $0.00 -0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urini l' ''$0.00 0 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr-Bkflow(1 4) $0.00 0 Conned (Ice,Soda,etc), $0.00 0 Receptors $0.00 0Vacuum Brkr Bkflow(5+), $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00. 0 Sewer Cap for Demo $0.00 .0 Wash Basin Set ' , $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater 1 vent $0.00 0 Drinking Fountain $0.00 0- Sink, bar, $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00, 0 Water Service $0.00 0 Gas (1-4 outlets) $6.15 1 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0.00 0 1 TOTAL CALCULATED FEES: $29.65 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 t446 ae JUDD) DECLARATI ONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and wlll maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued, My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit Is valued of one hundred dollars ($ f 00) or fess.) ❑ I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that i1 I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), 1N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect. Lic. a Class N Contractor's Signalure: Dale: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit s jects the applicant to a civil penalty of not more than five hundred dollars ($500).): I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her awn employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant onir tors License Laws.). ❑ I am exempt u er sec. Business and Professions Code for this reason: -Stgnatur Date: Owner 1D verifie b I s ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership b (t a of document, i.e. -property tax bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and cartity a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 2DO cubic feet of compressed gas at standard temperature and pressure). 2 Does or will iiia applicant or present or future building occupant need to file a registration form far acutely hazardous materials? [} as p n!0 (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). - .. .............._ _ ......................... _........................................................_........................... ------............. ---...................... _._....... _ _ _ ..... ...... _................... _.._.._............ ...-...... — 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department, 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑ No ................................................................................................................................................................................................................................................................................................................................. _._..................... .................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes j,.] Na (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ..............................................._................................................................................."w""....................f'o".......................................................ie of a • •---.......---......--•--•-----....................................... 6 Will any part of the facility to be ❑onstructed under this permit be within 1000 feet from the outer boundaries of a school? Yes ❑ No (if 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 8 (If yes", attach certitiraie of compliance from the appropriate air pollution conlrot officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. 1 agr to comply with I state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above descri property for on purposes. I agree not to occupy or allow occupancy of any building authorized by this p 11 erm until fans n. -Sfgnature pf'Cegai Owners) �/Jp �y^C Datd And/Or Authorized Applicant Date COWL INSPECTIONTYPE 2AR IST L3" CROEI MSPECTIONTYPE RM f2fMio� 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing -3 0 (- 200 Final Re -Roof 210 Final Electrical 201 Final BlocklRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final BuiltlingtOCcupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT - Job Address: 711 W 17TH ST Status: ISSUED Suite No B012 Applied: 04130/2001 Vicinity: GUY FERRER ART STUDIO Issued: 04/30/2001 Parcel Nunmber: 93983024 Applicant: FERRER, GUY Address: 711 W 17TH ST #B-12 COSTA MESA, CA Owner: FERRER, GUY Address 711 W 17TH ST #B-12 COSTA MESA, CA Contractor: OWNER -BUILDER Address: Phone: 949-515-0118 Zip: 92627 Phone: Zip: 92627 Phone: Zip: License: 0 l ISSUED BY: SCOPE OF,PERMIT ' INSTALLATION OF 2.LIGHTS IN AN -EXISTING COMMERCIAL CONDO FOR "GUY FERRER ART STUDIO" IN STE B012-- 2 LIGHTING FIXTURES, 1 SWITCH,, FEE SUMMARY+% -- Quantity Quantity,'/' ISSUE FEE $23.50 Temp Dist System} Lighting $0.00 0 %` Temp service test $0.00 Busway'1100 ft $0.00 r,o' Res. ale package $0.00 . Standing Section $0.00 0; • New Res (1- " $0.00 0 �',% Misc Electrical Equipment $0.00 r��0 New Res (3+units) $0.00 0 ; '� '' } Tr ansformers,up.to 1 kvalkw $0.00'; l0 Pool l Spa `•$0.00 0 .......up to 10 kvalkw $0.00',' 0 Lighting Fixts $2.20, 2a; .:... :.up to 50.kvalkw-.:5 .; $0.00` 0' Recept Outlets �/" $0.00�� " 0� �, , � - ..........up to 100 kvalkw � " � $0.00 / 0 SwitchesNon Res A I ��C,/� $1 10 �� 0`�' �� :....� ��........over 100 kva/kw� %� /., / 50.00.x` � 0 PP \ ��N c - �l/ Low Voltage EquipmeriG� $0:00 �\/xo Res Appl V�� s0�00 U 0 --_ " Low-VoltWiring. Sys et m_,7 Ckt 10.00; �0 ., Service to 200a $0.00 �� 0'~ = Misc. Conduit '_ $0 00 -' ,-0 � Service to 1000a $0.00, Misc. Conductor `$0:00 0// Service over 10004 $0.00 :; / 0 ' rri� Circus_( gen orV _ride)- "$0.00 , ; 0 Motors to 1 hp ,$0:00, ` % o,__ Circus (mech ride'o�.lights) ,$0.00 ` 0 Motors to 10hp $0.00- \ Christmas Tree Stand " � $0.00 0 Motors to 50hp $0.00' 0 --- �. Fireworks Stand -, __�- 0.00 0 Motors to 1 oohp $0.00 0 _ Other Electrical Fee '__ $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 - "" -investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $26.80 Intermed Pole 50.00 0 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work most comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244646 (6=) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued, ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation insurance carrier and policy number are: Carrier: Policy Number: (This section need not be Completed if the permit is valued at one hundred dollars ($100) dr less.) ❑ I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,0001, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lie. N Class # Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date - OWNER -BUILDER DECLARATIONS: hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any City or county which requires a permit to Construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit kocis the applicant to a civil penalty of not more than five hundred dollars ($501).): I, as owner of the property, or my employees with wages as their sole Compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, XCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec, 7044, Business and Professions Code: The contractors L nae w does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors) license pursuant to thanti tors License Paws.). ❑ 1 am exempt under s c. Business and Professions Code for this reason: Signature: Date: Owner ID verified by r iC ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership b oidocument, Le. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap, 3.2, Grp 2, Art 2, Sec. 341, Title 8, Callfomia Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .............. ..................................................................................................................................................................................................................................................................................................................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ...................................................................................................................................................................................................................... ...................................... 3 Does or will the applicant or present or future building occupant need to prepare an RM PP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ................................................................................................................................................................................................................................................................................................................................................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No - ............................................................................................................................................... ....-............................. ._............................ ............................. .-•--•.................................. 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apemlit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Il Yes 19 No (Section 65550.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). _......................._............_..............._- ...................... _................................................................._............................................................................................... ..... _......................................................... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (if *yes". the facility must most the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................................. ..................1............ 7 !f a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes C1 No _...._... _ ..._......... W___..._................................-----.................._..._.__...................._.—........................................................................ — - ....--.................. ....................... ....._.... 8 (11 'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I cerfity that under penalty of perjury the information given above is correct, i agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signalure: Dale: CERTIFICATE OF COMPLIANCE AUTHOR ON OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with sl laws an ity ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for in tion pu o s. I agrge not to occupy or allow occupancy of any building authorized by this permit until final inspection. e f IOwner(s) Date And/Or Authorized Applicant Data COVE F, INSPECTIONTYPE 2LU INTMAL COBE/ INSPECTION TYPE INTITIA45 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.M+ �LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 711 W 17TH ST Suite: B012 Vicinity: GUY FERRER ART STUDIO (STE B01 2) Parcel Number: 93983024 Applicant: FEIRRER, GUY Address: 711 W 17TH ST #B-12 Phone: COSTA MESA, CA Owner: FERRER, GUY Address 711 W 17TH ST #13 -12 - • License: COSTA MESA, CA Contractor: OWNER -BUILDER Address: Zip: Arch Address: Phone: Zoning: ISSUED Phone: 949-515-0118 Zip: 92627 Phone: Zip: 92627 Phone:" • License: 0 Eng:. Address: ISSUED BY: Status: ISSUED Applied: 04/30/2001 Issued: 04/30/2001 Phone: Zip: License: License: SCOPE OF PERMIT DEMO EXISTING NONPERMITTED STAIRS. FEE SUMMARY Plan Check: $0.00 __ _ _ _' ,�' Calc Valuation: $75.00 Permit: $23.50 -- -Claim Valuation: .$75-00 SMIP Res: $0.00 SMIP Com: $0.50 Other: $0.00 Inspection: $0.00 Total: $24.00 i SETBACKS MAIN STRUCTURE Front' 0-0 ''\-� Rear.'=0}0S Leff-0=0'''� Right '= 0-'0 ACCESSORY Front. o-0 ��'_�,;� Ream -0-0 Left 070 "�"�1 Right_��"0-_0 PARKING Existing: ;0-; _ ._ Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 244646 (6100) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the parlor-mance of the work for which this permit is Issued. ❑ t have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued, My workers' compensation Insurance carrier and policy number are: Carrier: Policy Numberi (This section need not be completed if the perm!! Is valued at one hundred dollars ($100) or less.) ❑ I certify that in the performance of the work for which this permit Is Issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE Ii100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is In full farce and effect. Lic. 0 Class p Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Coda), Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm the[ under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE UAW for the following reason (Sec. 7031.5, Business end Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a clvll penalty of not more than five hundred dollars ($500).): I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sole (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himsell or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion. the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project {Sec. 7044, Business and Professions Code: The contracto se Law does not apply to an owner Of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to a Con rectors License Laws.). ❑ f am exempt un r sec. Business and Professions Code for this reason: Signature: Date: 0 Owner ID verified b driv II ❑ Yes ❑ No Driver's License No. Expires: Verification of Owners i b ( of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, An 2, Sec. 341, This 8, California Administrative Code). ❑ As owner-bullder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII'the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume at 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ..... ............................ ».....»................ ............. ................... ...................................................... »................... ................ ......... _..... __._..... _—............. 2 Does ar will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safely Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .... __._..............»...............................»_.._...._........................---.................... _._.............................. ............................................. ........................................ .............. _... ...............................................»— .. 3 Does or will the applicant or present Or tutus building occupant meed to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomla Health and Safety Coda provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire [)apartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. _............_..............._—............... ..................»......._..._.......................»..............................._........................... _..................................................................... ._..................... —................. _... ............... »............... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code boon fully compliod with? ❑ Yes [I No »................ »»....................---...----..._........................... _.._.................................................................................. _._.......... ................... .».......» ».........».». 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this 2pplication a Permit for such construction or modification from the South Coast Air Ouality Management District or from any other air pollution control district or agency? U Yes No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the out boundaries of a schoof? ❑ Yes ❑ No (If Tres", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). _........................................».............»......»................................................�......................................*.................. ...........................................................----......................................... _............................. _.................» 7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ...............__.....................---a-..............._.........................---e-•popria................11uti—...................ffic........................................................................•....................................................................... ......._....................... 6 {If 'fres ,attach certific8le of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Data: CERTIFICATE OF COMPLIANCE AND A OR TION OF ENTRY: I certify under penalty of perjury that I have read this application and slate that the information given Is correct. I agree to comply with all stat aws an ry ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Ins n pu s. I a not to occupy or allow occupancy of any building authorized by this permit until final inspection. -&Za Signatur f r(s) Vale And/Or A I dr zed Applicant Date CODE !. INSPECTION TYPE Q&u Jig ;J= INSPECTION TYPE DAA INTITIA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy T Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 111 W- 1 Tµ t—zcReET Applicant's [Nailing Address LE321 SIfgC_jA sr, "et4 RM:T t3EJaFA Owner's Name O hone ls(a-6:22 7/ Address 4--321 Bl gaki n !r Atselt/Eng, f�,lA! D L - 12C1;�j�.Vig License No. _2___ ! (dy ( - Address Contractor's Nam l'L �� YVC O►f Phone 0�3Z Address Imailing) 13 i0 NS W rs' 4 t. c7S r(Prl c7 C.R. Ile7� City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effct. License 'asap �� LICC No. � 3zSo \fv� DatelL—.fs�r Signarg ture WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure ora Certificate of Workers' Compensation Insurance, or a certif etl Opy thereof (Section ( 3800, Lab. C� / {` Policy No. lfJ Company l _Certified copy is hereby I fished. Cep itfiled wit the city u' r (vision Date rtified copplicant EXEMPTION FROM WORKERS' COMPENSATION DEC TION (This section need not be completed if the permit Is for orVFh0ndred ($100) or less). 1 certify that In the performance of the work for which this permit Is issued, I shalt not employ any parson in any mann as to be a subject to the Workers' for pC�sa .Laws of Califor - Date i� (i .1= Signature 'NOTICE: It, after making this declaration, you should becotDoPfubject to the Workers' Compensation provisions of the Labor Code, ymust forthwith comply with such provisions or this permit Shall b0 deemed revoked. CONSTRUCTIDN LENDING AGENCY I hereby affirm that there IS a construction landing agency for the performance of the work for which Allis permit is Issued ($action 3097 Civ. C.) Lender's Name �f'b �-- -- Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city.or county which requires a permit to construct, altar, improve, demolish or repair 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 the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031,5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Buslness'and Professional' Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own employees, Provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of COM- Dietion, the owner will have the burden of proving he/she did not build or Im- nrove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensetl con- tractors to construct the project(SectIon 7044, Business and Prolesslons Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects With a Con- tractor($) license pursuariCto'the'Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner 4,eby certify 'that I haveread this application and stale that the above mationrree to Comply with allcityand_unty ordinances statelawbuilding constructionantl herebauthorize repre- tivesofenter n the above-entinod property for ctlon purls J/_/ -A(` )rivers' License or SS 4 0865-46, rev, 10/84 ;PE&AN - 1 TRACT NO. LO NO, UNIT O, TRUC,T:I NEW ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TYPE OF PERMIT GRADING ED FOUNDATION 11 STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 'SQ. FT. OCCUPAN Y CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS, ACRES Remarks- - Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P --Trap Roof Drains Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑ 0-100,000 BTU ❑ 100,000 BT Reinspection Fee White - Building: Canary - Applicant; Pink - Accounting,, Goldenrod - Assessor $15 I PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Tray, II Issue Fee MECHANICAL r Hood or Type I ❑ Canopy Type II ❑ Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dempers Registers , Issue Fee FEES I $ 3 3850 11/08/65 ;5af3 -f.. A.P. # rZ44- Q l H I Zone FEES S Main Building: Accessory Building: E T Front Z O B A Rear N I C Right N K S Left G R Ping. Ref. + Parking Req./Provided E Planning Notes: ` M r� VL t�%1fr 1J T 5 ELECTRICAL ✓ r I FEES Automatic Washer Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes i Outlets Switches Garbage Disposal Generator 00-5 KW E]5-15'KW r Transformer ❑ 15-50 KW ❑ 50 + KW Meter Llup to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0-1 HP 01.g - B Inc. Solar 09-15 HP ❑16.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 1I Reinspection Fee 1 $15 Issue Fee S 3 FEES DEVELOPMENT SERVICES REQUIREMENT �cr� �e Zoning Approved ByrA1q^' ate Building Approved By Date Application Issued By Dat SUMMARY OF FEES BUILDING PERMIT $ �"� - 50 $MIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE ' S PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING S PLAN CHECK 50% S MICROFILM S MECHANICAL S TOTAL FEE ' $_ PLAN CHECK 25% $ $ 3 r CONSTRUCTION AND PLANNING s APPROVALS Permit ,i� Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Uiility-Undrgrnd: 54. Forms , 4.'Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5."Steel Reinforcement 56. Rough Plumbing & Pressure Test 6 .-Electrical UFER Grncl 57. APPROVAL TO COVER-GUNITE 7. Footings , 3 -�- 58. Electrical Conduit-Undrgrnd. ; B. Foundationi3 �� 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water. Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System + , 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains' 64. Plumbing System - Final 14, Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66, Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval .17. Rough Wiring Sign 68, APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74, Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat �.- 75. Dry Chemical 27. Frame and Flashing $T 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: ! j 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 36. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43, Backflow Irrigation ; 44. Landscape Irritation 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 /CJ _P)10-�- / Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. r OF CESTA MESA /'CONSTRUCTION PERMIT PEIT NO. TRACT NO, LOT NO. UNIT NO. Project Address r// I � r;:f -,-i --JL- Applicant's Mailing AddressK el C Owner's Name Jot�nj W/1Z--eA-41 S Phonel43�`761161 Address &rnF _ Arch/Eng. License No. Address COAQio ' amP IV, h •—�1r1�� ' ��--Phone�e 4 Address imailingl-103�Z TY/f-��-01-_ City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in f I force and effect. 7•�.•,ac��t Ucenie Cass `3 ansa No.`s r oa 1 _ _ Date Signature WORKERS' COMPENSATION D LARATI I hereby affirm that t have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800,' Lab. C.) Policy No. Comps Certified copy is hereby furnished. Ce (i gd s flletl with the cit ui Div Date i 2 - oA Applican EXEMPTION FROM WORKERS' COMP r4SAT10 CLARATION (This section need not be CompletedLif the permit is for one hundred (5100) or less). I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner So as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shalt bo deemed revoked. CONSTRUCTION LENDING AGENCY . I hereby affirm that there'is a construction lending agency for the performance of the work for which this permit is issued (Section 3087 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the ' following reason {Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of .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 appilcant to a civil nenatty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale, If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving ne/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and _who contracts for such projects with a con- traCtor(S) license pursuarit to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Date Owner i hereby certify that 1 have read this application and.state that the above information is torr ct. I agree to comply with all city and county ordinances and state law to 1drng construction, and hereby authorize repre- sentatives t tit a ter upon the above-mentioned property for Inspectlo pure e i TYPE OF CONSTRUCTION LJ NEW LJ ADD Jb1 ALTERATION- LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. qjE DESCRIPTION OF'WORK/USE OF BLDG. r S Main Building: TYPE OF PERMIT E GRADING f1 FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear - ❑ OTHER A C R ight PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU. YDS, ACRES Ping, Ref. 9W Remarks: - �jZ Planning Notes: i Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO Heating System & Ducting ❑ 0.100,000 BTU ❑ 100,000 BT Reinspection Fee Drivers' LicIrnse or SS _ CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor $15 Hood or Type I ❑ Canopy Type I I ❑ ' Refrigeration System ❑O-100,000 BTU 0100,000 BT System Repair/Altoretiorr, Fire Dampers Registers Issue Fee FEES L 1,717 117:M/Ar, Zone Accessory.Building: - Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas 06ectric-1 Fan F,A•U. -Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 115-15 KW Transformer ❑ 15.50 KW ❑ 50+ KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0.1 HP ❑ 1 f. - 8 Inc. Solar 09.15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor $ 3 Reinspection Fee $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date i Application Issued By Data PLUMBING Bar Sink Showers Backflow Preventer -Service Sink, Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa' Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P -Trap Laundry Trays Roof Drains Reinspection Fee $15 Issue Fee' i Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO Heating System & Ducting ❑ 0.100,000 BTU ❑ 100,000 BT Reinspection Fee Drivers' LicIrnse or SS _ CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor $15 Hood or Type I ❑ Canopy Type I I ❑ ' Refrigeration System ❑O-100,000 BTU 0100,000 BT System Repair/Altoretiorr, Fire Dampers Registers Issue Fee FEES L 1,717 117:M/Ar, Zone Accessory.Building: - Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas 06ectric-1 Fan F,A•U. -Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 115-15 KW Transformer ❑ 15.50 KW ❑ 50+ KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0.1 HP ❑ 1 f. - 8 Inc. Solar 09.15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor $ 3 Reinspection Fee $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date i Application Issued By Data Z O N 1 N G R E O M T S rrr� FEES $ 3 SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25%, $ ENERGY P.C. ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ - $ 3 Z O N 1 N G R E O M T S rrr� FEES $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement�c 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 16. Electrical UFER Grnd. f�`_�r 57. APPROVAL TO COVER-GUNITE 7. Footings ` �'��' 58. Electrical Conduit-Undrgrnd. ,, r B. Foundation (`�� r� 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd, u� 60. Backwash Lines, P -Trap, ❑ Undrgrnd. It - 10. Structural Floor System L 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final -12. Sewer Cap `' �v 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22.' Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil ' 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling -(Structural) & Monocoat 75. Dry CherRia 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. • FIXED SYSTEM FINAL, 29. Insulation 78. FIRE PREY. FINAL 30.,Drywall Nailing HEALTH DEPT. REQUIREMENT 31: Plaster Brown Coat 79. FINAL INSPECTION 32, Electrical Power Meter -Final FOOD CERTIFICATE ISSUED 33. Final Electric rr Notes: r: 34. Final Heating &.Air Conditioning 35. Final Gas Pipe -Test �t� j` � LV2 36. Hood or: Canopy 37. Final Factory Fireplace 38. Final Plumbing p�lZSle(�� 39. Water Service -Final 40. Gas Service -Final ��l� WSJ Com' 41. Solar Domestic -Final 42. Backflow Preventer 43, Backflow Irrigation 44. •Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all approp roArr nin I i nT kin I i.— - d TFyCOSTA MESA CON$fIUCTION PERMIT ProI ct Address —? Applicant's Mailing ddres 4AL&EA7 IA /,�J! ' Owner's Name QV & Phone Address Arch/Eng. License No - Address Contractor's Nam Phone Address (mailing) City License No..,1�1 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in ful rce nd ffect. 31dZDLicens CI e2 License No 30 -2.2,07— a -It, at Signature WORKERS' COMPENSATION D ARATION 1 hereby affirm that I have a certific to of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. Company _ BCertified copy is hereby furnished.'- Certified copy is filed with the city Building Division, Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION '- (This section need not be completed if the permit is for one hundred ($100) or less). I certify that In the performance of the work for which this permit is issued, I� shall not employ any person in any manner so as to become subject to the Workarcr Co�ppns io Laws ofCali -a. Dater Signature 'NOTICE: If, after making this decla ion, ou should become subject to the Workers' Compensation provision of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lenders Address OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 malty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. It, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove r the purpose of Sale). Con—❑ I, asToowner of the property, am exclusively contracting with licensed tractors to construct the protect (Section 7044, Business and Professions Code: The Contractorts License Law does not apply to an Owner of property who builds or Improves thereon, and _who contracts for such projects with a con- tractors) license pursuarit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner' I hereby'certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for inspection p ses Signature Date—A /!Y - Driver: ' Drivers' Llc se or,55 L-. ;7. 8,11-3 ..... _. TYPE OF CONSTRUCTION NEW ADD r_1 NO. ALTERATION LJ REPAIR ratio LJCONVERSION DEMOLISH OTHER A.P. + DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi E TYPE OF PERMIT LJ GRADING FOUNDATION 0 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right S Left CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU. YDS. , ACRES Ping. Ref. # Remarks: Planning Notes: I PLUMBING " I FEES I Sar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service , Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 0&100.000 BT El 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays L 9916 3/25/135 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pale Sub. Cooking Unit Dishwasher �•� Dryers 013as 'ElElectric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW ❑5-15 KW Transformer ❑ 15-50 KW ❑ 50+ KW Meter LJup to 100 amps Meter Dover 100amps Sub Panel Motors ❑ 0-1 HP Ell 8 Inc. Solar 09-15 HP 1116-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 10955 TL FEES I Issue Fee $ 3 MECHANICAL I FEES Reinspection Fee $15 Issue Fee $ 3 Z 0 N I N G R E Q M T S Hood or Type I ElDEVELOPMENT SERVICES REQUIREMENTS: Canopy Type 11 ❑ Zoning Approved By Date Building Approved By Application Issued By t- Date Dat Refrigeration System 130.100,000 BTU ❑100,000 BTU BUILDING PERMIT PLAN CHECK $ $ SUMMARY OF FEES SMIP PERMIT $ System Repair/Alteration Fire Dampers PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% $ $ $ $ ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ Registers MECHANICAL $ TOTAL FEE $ Issue Fee $ 3 PLAN CHECK 25% $ -' CONSTRUCTION AND PLANNING PPRDVALS Permit # `} G Date Inspector POOL &SPA APPROVALS Permit # Date Inspector J: Temporary Electrical Service or P 4 i 52. Pool & Equipment Location ,-J I I 2.fl Pipe-Undrgrnd. ,,rJ Y ;53. Steel Reinforcement Wei 3�.Ele trill Condo Lltyi6ty Undrg"riid. 54. Forms 4'Electrical Canduiftitlridrgrrul. � .� nr 55. Electrical Bonding i 5`.1 St 613einforce ent ! u' 56. Rough Plumbing & Pressure Test .= 6•-Ele [ ical UFEW&Ad. fa 57.. APPROVAL TO COVE R-GUNITELA f} FootingsfZn ` . 58. Electrical Conduit-Undrgrnd. ci8 Foundation n 59. Gas Pipe, E3Undrgrnd., Test rl� �- 9. Witer Pipe-Undrgrnd. 1 r 1 60. Backwash Lines, P -Trap, 0 Undrgrnd. 1,0!1Structural Floor Sy.5em i 61. APPROVAL TO DECK 11:kOr6perty Sewer Lirie & House Connection R t 62. Backwash &Receptor -Final 1 2. jS;yver Cap L,+ n 63. Heater & Vent -Final u� +� 13�of Drainsv � 64. Plumbing System -Final 14. Rough Plumbin94 ZL49 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final " 16. Rough Electric Wiring 67. Fencing & Access Approval 1'7.'. Rough Wiring Sign 68. APPROVED FOR PLASTERING 1,8. Rough Electrical -T Bar Ceiling 69. POOLISPA SYSTEMS FINAL .1 Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20.. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping E3 Gas ❑Oil 23. Gas Pipe -Rough & Test 72. UnWerground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical . 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air -Conditioning 35. Final Gas Pipe -Test s ld� CZAP 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing j2�jr 5 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 W Appllcanl to fill In all spaces ekcept these within heavy border lines and sign all appropriate declarations, CITY OPCOSTA MESA CONSTRUCTION PERMIT f7 Project Address _elf �JGs� C2T! Applicant's Mailing Address / t7c-C �✓• dS` Owner's Name a 3 Address �� y Arch/Eng. se No. Address Contractor's Nam c' 6z e. 1? Address (mailing) City License No. LICENSED CONTRACTOR OtCLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license !s i full force and f ct. „ License Class ens V Date Signature WORKER COMPENSATION DE RATION I hereby affirm that 1 have a certif! to of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. _._.—. Company ofn Certified copy is hereby furnished ,1 B Vie py I with the Cit uilding DA en. Date ' Applicant (C EXEMPTION FROM WORKERS' CO ENSATION D CLARATION (This section need not be completed if he permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit Is Issued I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. _Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provi%ions of the Labor Code, you must forthwith comply with such provision% or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a Cbnstructlon lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name --- Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she I$ licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000) of - Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the property or my employeeS with wages as their sole compensation, will do the work, and the structure is not intended or offered for safe (Section 7044, Business and Professional Code: The ContraCtor's 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 employees, provided that such improvements are not intended or offered for sale. 1f, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con. tractors to construct the proloct(Section 7044. BuslneSS and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant'to the'Conr tracto's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state Paws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for inspection purposes. Signature Date Drivers' License or SS 99� PERMIT NO. 21 �3 TRACT NO. LOT NO. UNIT NO 41113 TYPE DF CONSTRUCTION LJ N=DO LJ ALTERATION LJ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF SLOG. REPAIR A.P,# Zone S Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU. YDS. ACRES E T Front Z O A Rear N 'OTHER C Right N Lef g t G R Ping. Ref. #Parking Req./Provided E Remarks: Planning Notes: G M T S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink _ Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps Dishvvasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Floor Drains Solar Tank Swimming Pool vv/Spa Fan F.A.U. Motors 00.1 HP 01 h - 8 Inc. Solar 09-15 HP El 16-15+ Floor Sinks Gas Service Outlets Interceptors Urinal Water Closet Water Heater Fixtures Device Boxes Outlets Microwave Pole Light Range Kitchen Sink Lavatories Water Service Auto -Wash Switches Garbage Disposal Sign ! Standing Sections P --Trap Gundry Trays Generator ❑0.5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 Boiler MECHANICAL Hood or Type I ❑ Canopy Type II' ❑ FEES DEVELOPMENT SERVICES Zoning Approved By Building A pproved By Application Issued By R EGUI REMENTS: Date data Data �J �!/ ^O✓ Duct - Under Ground Duct - Structural Refrigeration System 00.100,000 BTU ❑ 100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% $ $ $ $' $ $ $ $ SUMMARY OF FEES SMIP $ PERMITPLUMBING ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ �'U TOTAL FEE $ . 1z q r �f Exhaust System ❑ Multiple ❑ System Repair/Alteration Firep!/Fact, Bit. ICBG # Fire Dampers Heating System & Ducting 00.100,000 BTU❑100,000 BT Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10184 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor /- CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd, 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER.Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electricai-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 ('i Zz' Lin FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush - 24, Roof Framing 73. Undei-grnd. Storage Tank ❑ 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 PREY. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32, Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System t 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date M Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION rr-KNIT PERMIT NO. _ TRACT NO. LOt NO. UNIT NO Project Address _711 W: 17th St._ Bldg. (Bi Unit 1 Applicant's Mailing Address 13110 Sat icon• St.—N. Hal lywood Owner's Name ' Tray Investment Fund _Phone 549-2988 Address t Arch/Eng. Mgrin JRock License No. Addresa2,&Rl Knott Ave- .911ite 216 Contractor's Name1h1CAa Air ennrji tiOl i lsFhone 982—L2_L6 Address (mailing) City License No. i' .q 2 5 LICENSED CONTRACTOR 13ECLARATION I hereby affirm that I am Ficgnsed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Profess[ s Code, and my license is in full forced eff License lass C LI se 251 Date Signature WORKERS' COMPENSATIO 0 LA RATION I hereby affirm that i have a cert' icate of consent to self -insure or a certificate 3f Workers' Compensation Insurance, or a Certified copy thereof (Section 3800, Lab. c.) WC9824 Lumberman Policy ND. COm pony eCertified copy is hereby furnished. Certifi o is filed with the city Build-I� Di stun Date Applicant ... .Y: . EXEMPTION FROM WORKCRS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that In the performance of the work for which this permit is issued, i shall not employ any person In any manner s0 as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: 11, after making thiodeclaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply ,with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby afflrm that there is a construction lending agency for the performance of the 'work for which thiS permit Is Issued (Section 3097 Civ. C.)_ Lender's Name _ Lender's Address OWNER BUILDER DECLAF7ATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any City or county which requires a perrflit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a'signed statement that he/she Is licensed pursuant to the provisionS of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of DiviSion 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031,5 by any applicant for a permit subjects the applicant to a Civil ,� enalty of not more than five hundred dollars ($500). ' I, as owner of the property or_my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not applyto an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not 'intended or offered for sale. If, however, the bullding or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- reve for the purpose of sale). I, as owner of the property, am exclusively contracting with licsnsed con- tractors to construct the projOct(Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuarit to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section 13. & P. C. for this reason Date Owner'_ I hereby certify that I' have read t Information correct, 1 agree to CO and state w relating to building i sentaIN of his city, ant insp.0i o s. Signature Drivers' LI rise or SS :p TYPE OF CONSTRUCTION NEW ADD ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH CD OTHER A.P. � DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL B Rear ' ❑ OTHER A PROJECT DESCRIPTION SQ. FT, OCCUPANCY C Right CONSTRUCTION TYPE VALUATIONS g Left ZON£ GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: FEES Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Conne6tion Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank r Floor Drains Swimming Pool vv/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen `Sink Water Service Lavatories "Auto -Wash P—Trap Laundry Trays Roof Drains $ �plicatlon and state that the above 1 with all City and county ordinances uCtion, and hereby authorize repre- he above -mentions r arty or ~ Dat X Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO -/k Heating System & Ducting ®0-100,000 BTU ❑ 100,000 BT r 1 Reinspection Fee I $i5 CMF 0865-46, rev. 10/84 Whito - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee _ I S 3 FEES Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑{}100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers, Registers Issue Fee 1 $ 3 l 746 Zone Accessory Building: Z O N I N i G R Parking Req,/Provided E M T S ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F. A. U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW El 5-15 KIN Transformer ❑ 15.50 KW ❑ 50 + KW Meter LJup to 100 amps Meter Dover 100 amps Sub Panel Motors E10-1 HP❑134-8 Inc. Solar 09.15 HP Ell 6-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 4 FEES I I Reinspection Fee 1 $15 1 1 Issue Fee I $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Qat Z SUMMARY OF FEES BUILDING PERMIT $ SMIP $ ' PLAN CHECK $ PERMIT ' PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ -1.3 00 ` TOTAL FEE $ IS -50 _ - - PLAN CHECK 25% $ _2 , 54 CONSTRUCTION AND PLANNING APPROVALS - Permit# Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool .& Equipment Location 1 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 f 58. Electrical Conduit-Undrgrnd. 8: Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd, r ; 60. Backwash Lines, P -Trap, ❑ Undrgrnd. J 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection, 62. Backwash & Receptor -Final 12. Sewer Cap j 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydra 22. Ducts, Ventilating 71. Product Piping ❑ Gas 0 Oil 23. Gas Pipe -Rough & Test 72, Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25, Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL ,30.. Drywall Nailing HEALTH DEPT. REQUIREMENT .31. Plaster Brown Coat 79. FINAL INSPECTION 32.' Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final f 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45, Sound Attenuation 46, Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date 1 - Applicant to till In all spaces except those within heavy border lines and sign all appropriate declarations. KIIVIDO COSTA MESA J CONSTRUCTION PERMIT Project Address Applicant's Mailjr(g Address �+ Owner's Name Phone Address ArchlEng, License No. Address vr� Contractor's Nam Phone ��►ia�F Address (mailing) . /�� •S:�� 64 City License No. 3 -LICENSED CONTRACTOR DECLARATION 'I hereby affirm that 1,am licensed under provisions of Charter 9 (commencing, with section 7000) of Division 3 of the Business and Professions Code, and my license is in full orce and effect. License Class - License 3��%% Date Signature ' 'HORKERS'.COMPENSATION DEC RATION - hereby affirm that I have a certificate of consent to self -Insure or a certificate f Workers' Compensation Insurance, or a certified copy thereof (Sei:tlon 3600, Lab, C.) / -55! �2 Policy No. C" (e , ComPdny eCertified copy is hereby furnished.1 la 12CeJJ�tified co !s !led with the city B ng D vision, r VfoeW Applicant EXEMPTION FROM WORMERS' COMP SATION DECLARATI N ` (This section need not be completed if trM permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued I . shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California, Date Signature - y NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor- Code, you must forthwith. comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING_ AGENCY r I hereby affirm that there is a construction lending agency for the performance, _ of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name _ Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and PrOfeSSlbnal Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any "structure, prior to its issuance, also requires the applicant for such permit to file •a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of,the Business and Professions Code) or that he/she 'is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to. a civil enalty of not more than f!ve,hundred doll4rs ($500). I, as owner of the property or my employees with wages as their sole 'o compensation, will do the work, and. the structure Is not intended r offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not.apply to awowner of a property who builds or Improves thereon, and who does such work himselt/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of Com- pletlon, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). , - ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7644, Business and Professions Code: The Contractor's License Law does not apply to an owner of property, who builds'or improves thereon, and _who contracts for such projects with a con- tractor(s) 1)cense pursuarit to the Contractor's License Law). I am aware that Proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section - B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above Information is correct. I agree to comply With all city and county ordinances and state laws relating to buildinq*onstryctlon, and hereby authorize repre- sentatives of t ' city to ent upon the above-mentioned property for inspection p es. Signature ??yrs //�� Date b 1 6�110- W -I le— - TYPEOFCONSTRUCTION 0 NEW 0 ADD Ll ALTERATION 0 REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A,P. # DESCRIPTION OF WORK/USE OF BLDG. - S Main Building: E TYPE OF PERMIT In GRADING E FOUNDATION STRUCTURAL -T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ ,OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY IC Right CONSTRUCTION TYPE VALUATION $ C4, Left ZONE GRADING CU. YDS. ACRES' Ping. Ref.' Remarks: w / 7 a1 Qn Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtukis Clarifiers-', Dishwasher Drinking'Fountains Floor Drains Floor Sinks Gas Service t Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct.j Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO Heating System & Ducting 00-100,000 BTU ❑ 100,000 BT Drivers' Lic se or S! Reinspection Fee CMF 0865-46, rev. 10/84 White - Building; f,`,anary - Appllcant; Pink - Accounting; Goldenrod - Assessor S15 PLUMBING FEES Showers Service Sink $ Sewer Cap $ Sewer Connection Solar Collectors r $ Solar Piping Solar Tank $ Swimming Pool w/Spa $' Urinal $ Water Closet $ Water .Heater $ Water Service $ Auto -Wash $ Laundry Trays $ Issue Fee j S 3 (ANICAL FEES Hood or Type I ❑ Canopy Type II ❑ Refrigeration System ❑0-100,000 BTU 0100,000BTU System Repair/Alteration Fire Dampers Registers ! Issue Fee I • $ 3 3676 H106165 . . ;Fo75 T1 Zone Accessory Building: Z O N I _ N G R Parking Req./Provided E Q M T ELECTRICAL Automatic Washer - Transformer ❑ 15-50 KW Construction Pole Sub. • ❑ 50 + KIN i Cooking Unit Meter ❑up to 100 amps Dishwasher 1 Meter 5Rver 10_0 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors ❑0-1 HP El'h S F, A, U, Inc. So lar 1__) 6-15 HP ❑1G-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal ; Standing Sections Generator El 0-5 KN ❑5-15 KW I Trash Compactor -FEES .;Z. Reinspection Fee $15 Issue Fee S 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date -BaNc il"pproved By !f- - Date/! 6 ' SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT, PLUMBING $ ISSUANCE $' PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ aj^�S MICROFILM $ MECHANICAL $ TOTAL FEE $ (010.715- � PLAN CHECK 25% PLAN $ t+ `CONSTRUCTION AND PLANNING r �r APPROVALS Permit# Date Inspector POOL-& SPA APPROVALS Permit# Date Inspector . A. Temporary Electrical Service or Pole n 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd.y 53. Steel Reinforcement +3. ,Electrical Conduit Utility-Undrgrnd.' !� 54. Forms 4"Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5.r Steel Reinforcement. iJ ` . 56. Rough Plumbing & Pressure Test 6.' Electrical UFERoGrnd. 57• APPROVAL TO COVER-GUNITE 7: Footings .4 , 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑Undrgrnd., Test 9.*Water Pipe-Undrgrnd: 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line .& House Connection 62. Backwash & Receptor -Final 12, Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing`, ' 65. Electrical -Final 15. Rough Electrical Conduit /( 1 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test r 72. Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat r 75. Dry Chemical 27• Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31 Plaster Brown Coat 79. FINAL INSPLgTiON 32; Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED \ 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace + 38. Final Plumbing E 39. Water Service -Final - 40. Gas Service -Final 1 41. Solar Domestic -Final 42. Backflow Preventer - 4.;Back flow'Irrigation t 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 r 51. CERTIFICATE OF OCCUPANCY No. ' Date r"'' �- Applicant to fail In all spaces except those within heaNFy bor5820. 1Y 161.85 �u art CITY Q&COSTA MESA ' CON$ T UCTION PERMIT PERMIT NO TRACT NO. LOT NO. UNIT NU. rr v • tJ �roject.Address Applicant's Mailiin7�C' g -Address _ Owner's Ndme 390-, Ml- V S i - CAi k Phone Address Arch/Eng. License No. Address Contractor's Name M ORR% X IPLCIL L-tiRIC_ Phone7%%2 C Address (mailing `r I -V sati W Cm N City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with sectinn 7000) of Division 3 Hess and Profession$ Code, and my license is in fu I force and clic r Licens Cla,,,�ss�� -Signature License p Dater Signature 7RKERS' COMPENSATION DECLARATION ereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thareof (Section 3800, Lab./C.�) �..} Policy No. t.V �'- L3� 9 c3 7C) �0 4 Certified copy is hereby furnished. . Certified copy i$ fled with the city uil 1slo Date '-��`ya Applicant '�•'�� EXEMPTION FROM WORKERS' COMPENSATION &ECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance _ of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name ' Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division,3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any 'applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- traCtor(s) license pursuarit'to'the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner - I hereby c tify that I have r d informat n ct. I agree t c and state la ela g to bulld�ng sentatives of t is c y to ent r Signaturel!! � Drivers' License or SS =hh thi application and state that the above with all city and county ordinances c n ruction, and hereby authorize repre- i n the above-mentioned property for to TYPE OF CONSTRUCTION U NEW L1 ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # Zone DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: E - TYPE OF PERMIT 0 GRADING OFOUNDATION LJ STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ -OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CON STRUCTION TYPE VALUATION $ S Left ZONE GRADING CU. YDS. ACRES Ping. Ref: Parking Req./Provided Remarks: Planning Notes: Z O N I N G R E Q M T S TL Reinspection Fee 1 $15 Boiler Duct . Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO Heating System & Ducting ❑ 0.100,000 BTu Ell oo,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Builbing; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Reinspection Fee Automatic Washer Construction Pole Sub, Transformer 0 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection -'� Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors ' Dishwasher Meter Dover 100 amps Dishwasher Solar Piping SUMMARY OF FEES $ $ $ $ $ H-oo $ $ $ Dryers ❑Gas ©Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 0.1 HP ❑ 1'r4 - 8 p p Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP Ell 6-15+ Floor Sinks Urinal Fixtures Microwave' Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections 1P- rap Laundry Trays Generator 00-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee 1 $15 Boiler Duct . Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO Heating System & Ducting ❑ 0.100,000 BTu Ell oo,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Builbing; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 HAIVICAI_ FEES DEVELOPMNT SERVICES REQUIREMENTS: E Zoning Approved By Building Approved By Application Issued By_ _ — Date Date Data Hood or T Type I ❑ Canopy Type 11 El ' Refrigeration System ❑0.100,000 BTU ❑100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ H-oo $ $ $ SMIP $ PERMIT ISSUANCE S ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ ALL System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 t' CONSTRUCTION AND PLANNING APPROVALS Permit # Date r Inspector POOL & SPA APPROVALS Permit # Date � Inspecror 1. Temporary Electrical Service or Pole :t 52. Pool & Equipment Location -2. Soil Pipe Undrgrnd v t` NJ 53. Steel Reinforcement 3' Eieci ical Condu t Utility-Undrgrnd. j_, 1 v 54. Forms 4,'Electrical Conduit-Undrgrnd. � r 55. Electrical Bonding 5s 5teeliReinforcement 56. Rough Plumbing "& Pressure Test `1 6. ElectricalUFER.Grnd. 57. APPROVAL TO COVE R-GUNiTE Footings `ti 1 58. Electrical Conduit-Undrgrnd• }' 8.,Fourndation �� ry 59. Gas Pipe, ❑ Undrgrnd., Test ; 9:^,Wate7, Pipe-Undrgrnd. ' 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10 fStructural Floor System 61, APPROVAL TO DECK 11 -Property Sewer Line-& House Connection _ ^ 62. Backwash & Receptor -Final 12, Sewer Cap �; l 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 66. APPROVED FOR PLASTERING 18, Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace i 21. Ducts,. in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 129, Insulation 78. FIRE PREV. FINAL I3r, Drywall Nailing HEALTH DEPT. REQUIREMENT 13l', Plaster Brown Coat 70, FINAL INSPECTION 132, Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 133. Final Electric CI Lo Notes: _ 134. Final Heating & Air Conditioning 135. Final Gas Pipe -Test �36, Hood or Canopy 137. Final Factory Fireplace 38. Final Plumbing 39, Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. ,Landscape Irrigation System h� 45. Sound Attenuation 46, Handicap Regulations 47, FINAL STRUCTURE & BUtLDING 48, Special Requirements Completed 40• Electric Release to Edison + 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY _UF COSTA MESA�CONSTRUCTION PERMIT P MIT Mn TRACT NO LOT No - Project Address -<,� % GC/ Applicant's Mallirig Address J AI Owner's Name T% u Phone Address Arch/Eng. License No, Address Contractor's Nam Phone77. Address (mailing) �s� �✓ City License No. 7 -IM/ N LICESEO CONTRACTOR DECLARATION 1 hereby affirm that,I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is In f I for a nd effect. License Class License No 30 2-X07 Date, — Signature WORKERS' COMPENSATION DE RATION I hereby affirm that 1 have a certificate of consent to self -insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) } •' Policy No. Company BCertified copy is hereby furnished, r Certified copy Is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit Is for one hundred ($100) or less). 1 certify that in the performance of the work for which this permit is issued 1 , shall not employ any person in any manners as to become subject to tke• Work e Co pe sat' n Laws of Calif. , Oate�—Signature NOTICE: If, after making this deciara - n, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY • I hereby affirm that there is a construction lending agency for the performance of the work for which tnis permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License taw for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects -the applicant to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's' 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is Sold within one year of com- pletion owner will have the burden of proving he/she did not build or Im- Bove for the purpose of sale), r I,'as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a con- tractors) license pursuant'to'the Contractor's License Law), I am aware that Drool of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and stale that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this c' y to enter upon the above-mentioned property for inspection purpo Signature Date Drivers' UcenNA or SS :P �i ,/ Y114 UNIT N+�, TYPE OF CONSTRUCTION U NEW LJ ADD ALTERATION El REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K' CONSTRUCTION TYPE VALUATION $ $ I Left ZONE GRADING CU.YDS- ACRES Ping. Ref, # Remarks: Planning Notes: ar Sink ackflow Preventer ackflow Irrigation athtubs Dishwasher Drinking Fountains Floor Drains, Floor Sinks Gas Service 1 Outlets Interceptors Kitchen Sink Lavatories P—Trap 'Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. iCBO # Heating System & Ducting ❑ 4100,000 B T U ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 9917 3/25/65 Zone Accessory Building: Parking Req./Provided IG;,50 TL PLUMBING FEES Showers ELECTRICAL FE ES Service Sink Automatic Washer Transformer ❑ 15-50 KW Sewer Ca ❑ 50 + KIN Cap Cpnstruction Pole Sub. Sewer Connection Crooking Unit Meter ❑up to 100 amps Solar Collectors Dishwasher `' ' Meter ❑over 100 amps Solar Piping Dryers ❑Gas ❑Electric Sub Panel Solar Tank Fan Motors 00.1 HP Ell 1/2 -8 Swimming Pool vv/Spa F.A.U. r Inc.Solar ❑9-15 HP 016-15+ Urinal Fixtures Microwave Water ClosetDevice Boxes Pole Light Water Heater Outlets Range Water Service Switches Sign Auto -Wash Garbage Disposal ; Standing Sections Laundry Trays Generator El 0-5 KW El 5-15 KW Trash Compactor Z O N I N G R E- O M T S Issue Fee $ 3 FEES Reinspection Fee $15 Issue Fee $ 3JIIIIIIIIIIIt �ANICAL Hood or Type I DEVELOPMENT SERVICES REQUIREMENTS: ❑ Canopy Type I l ❑ Zoning Approved By Date Building Approved By Date Refrigeration System Application Issued By ----4 { / f Date �2- �S 00-100,000 BTU ❑ 100,000 BTU SUMMARY OF FEES System Repair/AIteration BUILDING PERMIT $ SMIP $ Fire Dampers PLAN CHECK $ PERMIT PUMBING $ ISSUANCE $ Registers PLAN CHECK 25% $ r S ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ Issue Fee $ 3 PLAN CHECK 25% $ ar Sink ackflow Preventer ackflow Irrigation athtubs Dishwasher Drinking Fountains Floor Drains, Floor Sinks Gas Service 1 Outlets Interceptors Kitchen Sink Lavatories P—Trap 'Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. iCBO # Heating System & Ducting ❑ 4100,000 B T U ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 9917 3/25/65 Zone Accessory Building: Parking Req./Provided IG;,50 TL PLUMBING FEES Showers ELECTRICAL FE ES Service Sink Automatic Washer Transformer ❑ 15-50 KW Sewer Ca ❑ 50 + KIN Cap Cpnstruction Pole Sub. Sewer Connection Crooking Unit Meter ❑up to 100 amps Solar Collectors Dishwasher `' ' Meter ❑over 100 amps Solar Piping Dryers ❑Gas ❑Electric Sub Panel Solar Tank Fan Motors 00.1 HP Ell 1/2 -8 Swimming Pool vv/Spa F.A.U. r Inc.Solar ❑9-15 HP 016-15+ Urinal Fixtures Microwave Water ClosetDevice Boxes Pole Light Water Heater Outlets Range Water Service Switches Sign Auto -Wash Garbage Disposal ; Standing Sections Laundry Trays Generator El 0-5 KW El 5-15 KW Trash Compactor Z O N I N G R E- O M T S Issue Fee $ 3 FEES Reinspection Fee $15 Issue Fee $ 3JIIIIIIIIIIIt �ANICAL Hood or Type I DEVELOPMENT SERVICES REQUIREMENTS: ❑ Canopy Type I l ❑ Zoning Approved By Date Building Approved By Date Refrigeration System Application Issued By ----4 { / f Date �2- �S 00-100,000 BTU ❑ 100,000 BTU SUMMARY OF FEES System Repair/AIteration BUILDING PERMIT $ SMIP $ Fire Dampers PLAN CHECK $ PERMIT PUMBING $ ISSUANCE $ Registers PLAN CHECK 25% $ r S ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ Issue Fee $ 3 PLAN CHECK 25% $ Z O N I N G R E- O M T S Issue Fee $ 3 FEES Reinspection Fee $15 Issue Fee $ 3JIIIIIIIIIIIt �ANICAL Hood or Type I DEVELOPMENT SERVICES REQUIREMENTS: ❑ Canopy Type I l ❑ Zoning Approved By Date Building Approved By Date Refrigeration System Application Issued By ----4 { / f Date �2- �S 00-100,000 BTU ❑ 100,000 BTU SUMMARY OF FEES System Repair/AIteration BUILDING PERMIT $ SMIP $ Fire Dampers PLAN CHECK $ PERMIT PUMBING $ ISSUANCE $ Registers PLAN CHECK 25% $ r S ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ Issue Fee $ 3 PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit # " R Date Inspector POOL & SPA APPROVALS Permit # Date Inspector i 1 ; Temporary Electrical Service or P6fe52: Pool & Equipment Location _ t 2. SoVipe-Undrgrnd. •aR r -y;i 53. Steel Reinforcement I 3 ; IF ical Cnd�ility-UndrgJn.Elear + 54_ Forms 4. Elect it ca! Conduit;U d�grntl. B 55. Electrical Banding _ t• Steel Reinforceme T� qty ..�. 56. Rough Plumbing & Pressure Test b clrical UFER,Grnd. '57. APPROVAL TO COVER-GUNITE 7. F,00t'ngs ` _ 58. Electrical Conduit-Undrgrnd, 8' dation 59. Gas Pipe, ❑ Undrgrnd., Test 9. WkPipe-Undr, rnd. i er # � � I 1 � 60. Backwash Lines,"P-Trap, ❑Undrgrnd. f � -lelSt�uctural Floor S�Vm i 61. APPROVAL TO DECK 1 `'7operty Sewer Ling & House (�n rection 62. Backwash & Receptor -Final 12, Sewer Cap �1 .� • -✓ y 63. Heater &Vent -Final 4 . / •, 1-q 13� Roof Drains Ll© 64. Plumbing System -FinalAll `h 14.1 Rough Plumbingr �+- (�� 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. DuctS.; in Structure 70- Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Uaderground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33.. Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water'Service-Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer . _-7- � 43. Backflow Irrigation - 44, Landscape Irrigation System r 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 •„ ._J Applicant to fill, In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COST MESA CONS BJ�,II ION P M17 PERMIT NO. TRACT ND. LOT NO. UNIT N6 Project Address Applicant's Mailing Address /,3//o /GD Owner's Name i64n:_:7r Address -L ArchlEng. License No. Address Contractor's Narn ffo e L Address (mailing) City License No, LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in f fort tl effa License 1 s / icens N Datta' Signatur WORKERS' COMPENSATION DE RATION - I hereby affirm that I have a certlfi to of consent to self -insure or a certificate of Workers' CoMpensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. Company Certified copy is hereby furnishe e 'fie pY �} ifetl with a cit i viSip at ppi)cant EX MPTION FROM WORKERS' CO PENSATIO Cr) CLARATION (This section need not be completed the permit is foone hundred ($100) or less). I Certify that in the performance of the work for which this permit is Issued I shall not employ any person in any manner So as to become subject to tke Workers' Compensation Laws of California. Data Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm tnat there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Buslness and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed Statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter g (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five.hundred dollars ($500). L) 1, as owner of the property or my employees with wages as their sole compensation, will do the work, antl the structure is not Intended or offered for sale (Section 7844, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, howevef, the building'or Improvement is sold within one year of com- pletion, the owoe ill have the burden of proving.he/she did not build or Im- Elrove for the purpose sale). l,, as owner Of the property, am exclusively' contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) )icens& pursuarit'to the Contractor's License Law), I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner 1 hereby certify that I have read this application and state that the above information IS correct. I agree to comply with all city and county ordinances and State laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for Inspection purposes. Signature Date Drivers' License or SS zhk 2 1 FEES / 4412 11/19/65 �cc4 TYPE OF CONSTRUCTION LJ NEW LJ AOD 0 ALTERATION , REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # Zone DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: Cooking Unit TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ ,OTHER T Front p B A 1. Rear N 1 C Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES S Left G R Ping. Ref. # Parking Req./Provided E iRemarks: 'Planning Notes: a M Fixtures � Microwave T Oevice Boxes S Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink . Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact, Blt. ICSO # Heating System & Ducting 00-100,000 BTU ❑ 100,000 Reinspection Fee 1 $15 GMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Abiryu Showers FEES ELECTRICAL r FEES Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW Sewer Cap Sewer Connection Cooking Unit Meter Cup to 100 amps Solar Collectors Dishwasher Meter Dover 100 amps Solar Piping $ 3 Dryers ❑Gas ❑Electric Sub Panel Solar Tank REQUIREMENTS: Fan Motors ❑0-1 HP 011/-8 Swimming Pool wlSpa F.A.U. Inc.Solar 1:19-15 HP 016-15+ Urinal FEES ' SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTAL FEE I Fixtures � Microwave Water Closet Oevice Boxes Pole Light Water Heater Outlets Range Water Service Switches Sign Auto -Wash Garbage Disposal ! Standing Sections Laundry Trays 7 Generator 0015 KW 05.15 KW Trash Compactor Issue Fee $ 3 Fee $15 Issue Fee $ 3 iANICALReinspection Hood or Type I ❑ Canopy Type I I ❑ FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: ate _ Date Data p 7 f Refrigeration System ❑0-100,000 BTU E1100,000BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 5096 MECHANICAL' PLAN CHECK 25% SUMMARY OF $ $ $ $ $ $ $ $ FEES ' SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTAL FEE I ; $ $ $ , $ $ $ System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date' ! Inspector POOL & SPA APPROVALS Permit # Date - Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. , . 57. APPROVAL TO COVE R-GUNITE 7, Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection _ 62. Backwash & Receptor -Final 12. Sewer Cap ,. 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65.'Electrical-Final 15. Rough Electrical -Conduit _ 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. `Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning f (2 G,I50 FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑ Oil .23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank D Gas ❑ Oil 25. Roof Sheathing + 74. Overhead Hydro 26 T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 7� 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 i _ i •L 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39, Water Service -Final 40. Gas'Service-Final 41, Solar Domestic -Final 42. Backflow Pre venter' , 43. Backflow Irrigation - 44, Landscape Irrigation System 45. Sound Attenuation 46.. Hand icap.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 �►n_.�-� Date i f. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 'CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. L07 NO. UNIT NO. Project Address 711 W.171 h St .Bld . (B) Unit 2 1 I Zr 13110 S N Hd TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR Applicant's Mailing Address SatiCO t- 011YWOO Owner's Name Troy Investment Fund phone 549-2988 Address4321 Birch St. _Newport Beach, Ca: Arch/Eng. Marin J. Rock License No.. Address 12881 Knott Ave. Suite 216 Contractor's Name. Dur.Q Air--Conditionin Phone 982-1216 Address (mailing) 13110 Sariaa St- N� ,�rwOod,Ca1 City License No. 39 25 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed undkr provisions of Charter 9 (commencing with section 7000) of Division 3 Of the Business and Prof Sion$ Code, and my license is in full forc_nd J 34b251 License Class ns N Date 4 18/84 Slgnatu WORKERS' COMPENSATION DE RATION I hereby affirm that I have a certi ate of consent to self -insure or a Certificate of Workers' Compensation ins nce, or a certified, copy thereof (Section 3800, Lab. C.) WC4824 Lumberman Policy No. Company BCertified copy is hereby furnished. Cert -f' U Ca•Qy is filed with the City Buill�ng Division f Date_, �� a Applicant �I. A, .F EXEMPTION FROM WORKERS' COMPENSATION OECLARATION (ThiSSeCtlon need not be completed If the permit is for one hundred ($100) or I certify that in the performance Of tho work for which this permit Is issued I shall not employ any person In any frlanner so as to become subject to the Workers' Compensation. Laws of California.. .Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit i shall be doomed revoked. CONSTRUCTION LENOING,AGENCY I hereby affirm that there Is a constructionlending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender_'s Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city Or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 malty of not more than five hundred dollars ($500). I, as. owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work hirnself/herself or ,through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement Is Sold within one year Of com- pletion, the owner will have the burden of proving he/she did not build or im- rove farr the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed COn- tractors to construct the protect (Section 7044, Business and Professions Code, The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) 11cen$e pursuant to the Contractor's License Law), I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B, & P. C. for this reason Date Owner _ 'hereby certify that I have read this application and state that the above Information Is Correct. l agree to�gpmbly with all city and county ordinances and state I lacing ,to b.II or rJ construction, and hereby authorize repre- sentatives f t is city to a er upon the above-mentioned pf rty r inspectlo pur ses, Signature Drivers' LI se or SS CMF 0865-46, rev. 10/84 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER PLUMBING A,P.4% DESCRIPTION OF WORK/USE OF BLDG. Bar Sink Showers Backflow Preventer Service Sink Issue Fee Automatic Washer - Construction Pole Sub, S Main Building: Bathtubs Sewer Connection E Cooking Unit TYPE OF PERMIT GRADING C1 FOUNDATION 17 STRUCTURAL Clarifiers T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 0 MECHANICAL Meier ❑over 100 amps' B Solar Piping ❑ OTHER Dryers ❑Gas ❑Electric A Rear Solar Tank Refrigeration System 00-100,000 BTU E1100,000BTU C Right PROJECT DESCRIPTION SQ. FT, OCCUPANCY Swimming Pool vv/Spa K F.A.U. CON STRUCTION TYPE VALUATION $ Floor Sinks S Left ZONE GRADING CU.YDS. ACRES Microwave Ping. Ref, # Remarks: _ Planning Notes: 171,7 4/24/85 15.50 Zone Accessory Building: Parking Req./Provided Z O N I N G R E a M T S I PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Issue Fee Automatic Washer - Construction Pole Sub, Transformer ❑ 15.50 KW ❑ 50+KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter Oup to 100 amps Clarifiers Solar Collectors $ 3 Dishwasher Meier ❑over 100 amps' Dishwasher Solar Piping REQUIREMENTS: Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Refrigeration System 00-100,000 BTU E1100,000BTU Fan Motors ❑0.1 HP ❑ VA • B Floor Drains Swimming Pool vv/Spa SUMMARY OF FEES S $ $ $ 5 S $ - 13-00 $ 2.50 F.A.U. Inc,Solar ❑9•i5 HP 016.15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Interceptors Kitchen Sink Lavatories Water. Closet ' Water Heater Water Service Auto -Wash _ Device Boxes Outlets Switches Garbage Disposal Pole Light Range Sign ; Standing Sections P—Trap Laundry Trays.- Generator ❑0-5 KW ❑5-15 KW Trash Compactor Roof Drains Issue Fee $ 3 Reinspection Fee Boiler $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ FirepllFact. Bit. ICBO # Heating System & Ducting 1 90-100,000 OT ❑ i w000 BT, Reinspection Fee White . Suildthg; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 i Issue Fee $ 3 Reinspection Fee $15 issue Fee $ 3 MECHANICAL Hood or Type I ❑ Canopy Type 11 ❑ FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By _ REQUIREMENTS: Date Date Data z 3_ Refrigeration System 00-100,000 BTU E1100,000BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PIAN CHECK 25% SUMMARY OF FEES S $ $ $ 5 S $ - 13-00 $ 2.50 SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRAOING $ MICROFILM $ TOTAL FEE $ 15.50 System Repair/Alteration Fire Dampers 6 Registers 6 00 Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location r i 2. Sail Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement �� 56. Rough Plumbing & Pressure Test 6• Electrical LIFER Grnd. 57. APPROVAL TO COVE R-GUNITE 7. Footings t 58. Electrical Conduit-Undrgrnd, r1 r 8' Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. -10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Whi ection 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas 13Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding' 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32' Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning Z"9, -r /J 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43, Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49. Electric Release to Edison 50, Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF•COSTA MASA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. L07 NO. UNIT NO, Project fAddress "/ �y / % �.� C_.A:7,-A AfrLr Applicant's Maaiili�g tAddress Owner's Name /- Wit' i+��lV1 rEN '►` Phone Address Arch/Eng, License No. Address _ Contractor's Namara +2� %S ;? i FCT2 jL _Phone sr c Address (mailingK ja Q_ Aml s-, ECG r� •4 x31 Jf City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I em licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Mess and Professions ode, and my license is in full forte and effect License Cl ss — icense No. - Date Signature WORKERS' COMPENSATION DECI.A ATION hereby affirm that I have a certificate of consent to elf -insure or a certificate Jf Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab.iC,.)� e�/� '7 Policy NO. s�✓�� *-93 /f1' Co y eCertified copy is hereby furnished, _ Cer Itietl co py�i5,l;ilktl with the city uil - g ivi5ion- Date"�p rbi ,w- ApplicantI __ JL, L EXIEWPTION FROM WORKERS' COMPENSATION 4ECLARATION (This Section need not he completed If the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit Is Issued, i shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date _ Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shail be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name _ Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 malty Of not more than five hundred dollars (5500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure 15 not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden Of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's Lictnse Law does not apply to an owner of property who builds or Improves thereon, and _who contracts for such projects with a con- tractor(sj license pursuarit'to tha Contractor's License Law). I am aware that proof off their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that 1 have rea- informatio I agree to and state aws ting to buildir sentatives of is ity to enter Inspection r Signature Drivers' License Or SS W- 4 this -application and state that the above ;amply !th all city and county ordinances const tion, and hereby authorize repre- upon a abgve-mentioned property for [-s1 Date i-10 - G PLUMBING FEES TYPE OF CONSTRUCTION NEW LJ ADD U ALTERATION U REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Showers A.P. 0 DESCRIPTION OF WORK/USE OF BLDG. ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. 5 Main 8uildi Bathtubs Clarifiers Sewer Connection Solar Collectors E Cooking Unit Dishwasher TYPE OF PERMIT C1 GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Solar Tank i Swimming w Pool /Spa Urinal Water Closet Water Heater Water Service Auto -Wash ❑ OTHER Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal A Rear Laundry Trays C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CON STRUCTION TYPE VALUATION S S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: S 3 Planning Notes: �. 591 1!16/85 Accessory Building: Parking Req./Provided G-50 TL Zone Z O N I N G R E Q M T S CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap - Bathtubs Clarifiers Sewer Connection Solar Collectors —T Cooking Unit Dishwasher Meter Cup to 100 amps Meter Cover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories Solar Tank i Swimming w Pool /Spa Urinal Water Closet Water Heater Water Service Auto -Wash Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Motors 1 HP Ell %-8 1 66 Inc. Solar 09- 15 HP 016•15+ Microwave Pole Light Range Sign ! Standing Sections P—Trap Laundry Trays Generator ❑0.5 KW 1:15.15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee S 3 Reinspection Fee $15 Issue Fee $ 3 Boiler Duct -Under Ground MECHANICAL Hood or Type 1 ❑ Canopy Type I1 ❑ FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued B _y REQUIREMENTS. Date Date p FRO Date O Duct - Structural Refrigeration System 00. 100.000 BTU ❑100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE S S ENERGY P.C. $ $+Od GRADING $ $ —__fir [L_ MICROFILM S $ TOTAL FEE $ — $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers Heating System & Ducting ❑0.100,000 BTU 11100,0008T Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspeczar 1. Temporary Electrical Service or P61e 52. Pool &Equipment Location 2,1 Soil.Pipe-Undrgrnd rj 53. Steel Reinforcement 3�Electrical Condui0tL�y Undrgrnd. 54. Forms 4"hElectrical Conduit-Undrgrnd. 1 tj 55. Electrical Bonding 5:'SteelfReinforcem'ent 0 �.r r 56. Rough Plumbing & Pressure Test j 6' Eledthcal UEER'Gi'nd. 57, APPROVAL TO COVER-GUNITE i:. Footings ;� F� 58. Electrical Conduit-Undrgrnd. 8,iFountlation �; �� 59. Gas Pipe, ❑ Undrgrnd., Test j 9. 'Watef Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10�, Structural Floor System 61. APPROVAL TO DECK 11, -Property Sewer Line'& House Connection 62. Backwash &Receptor -Final 12ASevver Cap 6. - r 63. Heater & Vent -Final 13�Roof Drains �; 64. Plumbing System - Final i} 14. Rough Plumbing) t� 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd, Storage Tank ❑ 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 PREY, FINAL 3O;: Drywall Nailing HEALTH DEPT. REQUIREMENT 31'. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow'Preventer 43. Backflow Irrigation 44. Landscape Irrigation System n 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 OF,COSTA MESA CONSTRUCTION PERMIT Project Address Applict7t'zJAniling Addres$ �+ y� Owner's Name~ T/' ��`yPS ��r°� -Phone di -Phone Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT N`NOOr.�r TRACT NO. LOT NO. U�V�T f)IDi5 Address - v •.rch/Eng. License No. Addreu Contractor's Name Phone �cr% Address imniIing) -es< City License No. LICENSED CONTRACTOR DECLARATION 'I hereby affirm that I am licensed under provision$ Of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full orce nd effect. License Class J Licen •1 y'�-3/7 Signature ✓ WORKERS' COMPENSATION DEC RATION I hereby affirm that I have a certificate of consent to self4nsure Or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lam. C.�) /� J �/� Policy No. ZXg ' e /.•3_ 2 Company 8 Certified copy is hereby furnished. CeJ tified co is filed with the city B 'ng D vtsiony y Oalt 2' � Applicant ✓ EXEMPTION FROM WORKERS' COM SATION DECLARATI N ' (This section need not be completed If tht permit is for one hundred (5100) or less), I certify that In the perforMance of the work for which this permit Is Issued I shall not employ any person In any manner so as to become subject to tine Workers' Compensation LaWs of California. Date Signature "NOTICE: If, after making this declaration, you Should become subject to the Workers' Compensation provisions of the Labor. Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending agency for the performance" Of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name Lender's Address .. OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of. the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars (S500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds Or improves thoreon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the prOject(Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or Improves thereon, and who contracts for such projects with a con- tractor(s) license pursuarit"lo'the Contractor's License L.aw). I am aware that proof o// their Worker's Compensation Insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above Information is correct. 1 agreeto comply with all city and county ordinances and state laws relating to puild)n onstruction, and hereby authorize repre- sentatives of tw city to ent Pon the above-mentioned pfoperty for Inspection p es. Signature -rJ" 1,/�'�? Date Drivers' License or SS $ TYPE OF CONSTRUCTION LJ NEW LJ ADD U ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. � DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 8 Seer ❑ 4THER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right C0NSTRUCTIONTYPE VALUATION I $ I Left ZONE GRADINGCU.YDS. ACRES 71 Ping. Ref.9W' Remarks: 5,0 1 Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee I 315 Boiler Duct - Under Ground Duct -Structural Duct -'Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO Heating System & Ducting 00-100,000 BTU 0100,000 BT Reinspection Fee 1 $15 PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water -Heater Water Service Auto -Wash Laundry Trays Issue Fee MECHANICAL Hood or Type I ❑ Canopy Typeil ❑ Refrigeration System ❑0-100,000 BTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee I $ 3 FEES $ 3 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer - Construction Pole Sub. Cooking Unit Dishwasher Dryers ©Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 110.5 KW 05-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps f Meter ver 100 amps Sub Panel Motors 00-1 HP 01 14 - 8 Inc. Solar 119-15 HP 1116.15+ Microwave Pole Light Range Sign r ; Standing Sections Trash Compactor FEES 'Z. Z O N 1 N G R E Q M T S I I Reinspection Fee 1 $15 1 1 Issue Fee I $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By_' __ -Quildift(-'Approved By = _ Application Issued By �n1 PLAN CHECK 25% $ $ 'Lf_ SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.C. ELECTRICAL $ GRADING PLAN CHECK 50% $ �L MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ $ 'Lf_ Alk 14STRUCTION AND PLANNING 'PPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector . Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Oil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54.' Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5.•'Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9.'Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing . 65. Electrical -Final 15. Rough Electrical -Conduit �{ 1Sr65 �+ +� 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 20. Rough Factory Fireplace FIRE DEPT. REQUIREMENT 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 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Rooi Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat R 79. FINAL INSPEfTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace ' 38. Final Plumbing t . 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43.•8ackflow 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 C31 51. CERTIFICATE OF OCCUPANCY 0 Date f t: Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. ` CIiL(;F COSTA MESA' i -_, _ PMYT NO. TRACT NO. LOTNO.BLD ',�ONSTRWCTIOA PERMIT Appljcant`p MaiUn AddressAr"YTYP OF CONSTAL:CTION ' NEW LJ ADD ALTERATION REPAIR 1` Project Address' + {-] CONVERSION ❑ DEMOLISH ® OTHER i�7.//yrr.rle" �[�/�SQ- i DESCRIPTION OF ORK ye S Ownet's,Nerne 'r21�6 ,.Phon -..T_ ; ` S L 41 rr&JtU SAJIl'if-f ZONIi Addienl � C �'-• TYPE OF PERMIT ORADtNO FOUNDATioN STRUCTURAL : A. P.'0 Z L4 07 '1 —'I 1 ZONE ;74' -� r AichlEng., 1 License No. TENANT ® ELECTRICAL! ®,PLUMBING. Ice MECHANICAL i f PLNG. REF, vY' +�-~ - BUILDING - Atldress , r l® - 'LI,OTHER ;I Kitchen Sink 70 BUILDING' PR PERTY i ;REAR YARD (TOCP/L) ant'.' ;0''s Na"m hone'7f�-i hYfr PROJECT DESCRIPTION. SG oCCUPANC 1, as:ownar Of. the ,property or my employees with wages as their sole compensation will do the work, grid the strutture ks not Intended or offered Tor sale (Sec{ion 7044, 9ustness, end' Profasslonal Code:' Th.•Contractor's j License Law does not apply td an owner of a property who buElds or Improves thereon,°and who does such work himself/herself or through his or her own employees, provided that such Improvements are'not Intended or offered for 1 ;. sale. if however, the bulldlnp or Irttpfovemen1 is sold wlthln one yea r. of Com- plotion, the owner will have the burden of proving he/she did not build or Im- 1 Erove for the purpose of, sale), ! ! -- r i le as owngr of the property, am exclusively contracting with licensed con- tractors to construct the projgct (Section 7044. Business and professions Code:.: The Contractor's License Law does not apply to an owner of property who ' builds or improves thereon, and who contracts for such projects with a con. i tractor(s) license pursuant to the Contractor's License Law). ❑ I am exempt under Sectio p—L B. d P. C. for this reason $ A Address �imailing) '6&AAFAWAW 1 '' ` CONSTRUCTION TYPE Vi4LUATION t.41 $ LEFT SIDE YARD R T SIDE YA ! 6'o Duct - .Ventilating 2ONJ= GRADING CU. YDS. ACR PKG. SPACE REG, P DED Lkerise No'. . L.t iff ,Af! Q/1P sa�rSrarr� u�wa�y yfl $ 1 i LESS ' AQVANCED PC _ Date i Owner,' ' I herebyy-certify that•i'heval read -this application•and-state that' the above" �; InformaTlon Is correct. I agree to comply with all city and county ordinances and state laws Watt building COnStruCtlOn, and hereby authorize repre- sentatives of,"s cl o ytlter..upon the above-mentloned pr rty for Inspection p Signature t ! Detey� fDrivers' License ,55 `a Remarks: ti .'.• i t FINAL FEE - ' STREET WIDTH ! !PARK FEE $ L`ICfiNSBD CONTRACTOR DECLARATION 3 .. , I'her6yl affirm that I am licensed under provisions I of Charter 9 (cominendng f SPECIAL CONDITIONS: I I with section 70001 of Division 3 of the Business end Professlons Code, and rhy license is In full tom anffect. PLUMBING I Date signature f ' I RKERS, C MPENSATIQN DB RATION , roby'Affirm that I have a certjifl4ate of consent'to self -Insure or a certlflrate•. r 3i Norkers' C ompensation Insuranco.! or a certlfledt copy thereof (Section Bar Sink •- Backflow Preventef Backflow Irrigation i 00, Lab. C.) 1 Policy No. "MIR8•Ci I _ Company s7AVE42VA0, il�✓JO I j poll Certified copy Is hereby furnished. i 1 i i i LJ Certified copy Is filed with the Oty.Bullding Division. i I Data Applicant 4 EXEMPTION FROM WORKERS' COMPENSATION DECLARATION 7 ? (This section need not be completed If the permit Is for one hundred ($100) or Bathtubs r Clarifiers Dishwasher i Drinking Fountains r I c tlfy,that'In the performance of the work for'which this porrfllt IS Issued I ,' shaft not employ any Person In artyy manngr so,as to become Subject. to the ' Workers' CompensatlonlLaws of �1ltornla:; 4 e ; ! Floor Drains•,. !X Date - - signature - NOTICEi if, after inaking this declaration, you should become, subject to the • Workers', Compensation provisions of the Labor Code, you must, forthwith comply !wltW such brOv)slons.or this ,Parrolt;sh#ll beideemeQ revoked. CONSTRUCTION ; LENDINQ AGENCV ' I hereby affirm that there is afconstfuctlon I&ding agency for -Iho� performance, I of the ,work for whlch;, this; permit • V !Issued (Section 3097 Civ. C:)' Landi►'s, Name. '1 Floor Sinks'�j • +t� w 't ' .; Gas Service. ; "\'loutlets9J'� .ti Interceptors Kitchen Sink Lender's Addreas OWNER BUILQUIll OECLJk TION ' - ° ; i I harebviaffirm that 1 arn'exempt from thelContractcr's �Llcanse Law for the following reason' (Section 7031;5 Business and Professlone 1,Code : Any city Or county which requires a permit to Construct, alter improve, demolish or repair 1 any structure, prior to It$'issuance, •also requires the applicant for suchpermit• to file a signed statement that he/she is licensed pursuant to the provisions of •he4Contractor's-License Law.(Chaptar 9 (commencing with Section.7000) of $,on .3 of. the Business ancl: PPrrofessions Code or that he/she is exempt 1 afrom-end the basis for the alleged exemption: Any violation;of, Section I J15 b 'airy appilcani fpr,a'Permlt subjects the applicant to a civil Wally of not more than Tlve hundred dollars {3500). Lavatories_ p_Tr y , .apf Roof Drains r" I Showed ' ServitaSirik', a 1, as:ownar Of. the ,property or my employees with wages as their sole compensation will do the work, grid the strutture ks not Intended or offered Tor sale (Sec{ion 7044, 9ustness, end' Profasslonal Code:' Th.•Contractor's j License Law does not apply td an owner of a property who buElds or Improves thereon,°and who does such work himself/herself or through his or her own employees, provided that such Improvements are'not Intended or offered for 1 ;. sale. if however, the bulldlnp or Irttpfovemen1 is sold wlthln one yea r. of Com- plotion, the owner will have the burden of proving he/she did not build or Im- 1 Erove for the purpose of, sale), ! ! -- r i le as owngr of the property, am exclusively contracting with licensed con- tractors to construct the projgct (Section 7044. Business and professions Code:.: The Contractor's License Law does not apply to an owner of property who ' builds or improves thereon, and who contracts for such projects with a con. i tractor(s) license pursuant to the Contractor's License Law). ❑ I am exempt under Sectio p—L B. d P. C. for this reason $ A ELECTRICAL arc Boiler ! i Duct' Under Ground ' 1 PLAN CHECK;- Duct - Structural MICROFILM Duct - .Ventilating i Exhaust System. C1Multiple ❑' TOTALIFEE: Firepl/Fact. Bit. ICBO 1 i I $ 1 i LESS ' AQVANCED PC _ Date i Owner,' ' I herebyy-certify that•i'heval read -this application•and-state that' the above" �; InformaTlon Is correct. I agree to comply with all city and county ordinances and state laws Watt building COnStruCtlOn, and hereby authorize repre- sentatives of,"s cl o ytlter..upon the above-mentloned pr rty for Inspection p Signature t ! Detey� fDrivers' License ,55 `a Heating;System & Ducting 06100,000 BTU '❑100,000 BTL t FINAL FEE - ' Hood Of. T YRe! ❑ Can { T 1 ❑ Registers t GMF 0865-46 rev. 12/82 Applicant; Pink - Accountingi Goldenrod - Assessor Sewer Cap Sewer Connection' War Collectors ' Solar Piping \ Solar Tank 1 Swimming Pool WfSpa �• ! Urinal` -PLAN CHECK, Water Cloa4:t If�,. PERMIT j Water !'!.,ater - 7 Water Service ! , $ ' ;PLAN CHECK' 1 V:' GRADING $ A D rryyr .. . 4,406Relnspection,Fee , $15 Issue Fee S 3 4ANICAL Refrigeration System 1 ❑0-100,000 BTU ❑ 100,000 BTU System Repair/Alteration �/LUu d'O Reirt&pection Fee' $15 i { Ise Fee } 3 -t - Automatic Washer e Construction Pole Cooking Unit Dishwasher Dryers ❑Gas' ❑Electric Fan ' F.A.U. i Fixtures ' Device Boxes j Maur . Dover 1 Ob amps . . ! Sub Panel, -Sub Pole Motors 00.1 HP Jf1%-8 f Inc.Solar'119-,15 HP 1:11 6-15+ I i Microwave E Pole-Lighl i I r.: Range...... i..... J Outlets i 'Standing Sections Switches ' ,Trash Compactor Garbage Disposal 4 Generator 130.5 KW 05-15 KW , Transformer E115-50KW ❑5U + Kwi ( rReinspaction Far S16 Meter ❑up to 100 amps -Issue Fee 3 Zoning Approved By Det! i Application Approved BX bi, 4 d2ate Application Issued By ate SUMMARY OF FEES ` BUILDING PERMIT S S-605 SMTP - I $ -PLAN CHECK, '� .� �a 01.! $-l�.L__fL1 PERMIT j _ PLUMBING , $, ISSUANCE } $ ' ;PLAN CHECK' 1 V:' GRADING $ A ELECTRICAL arc $ i PLAN CHECK;- $., MICROFILM $ I � s ' TOTALIFEE: $ ' ,MECHANICAL' PLAN CHECK 1 I , $ 1 i LESS ' AQVANCED PC $ i r• 1 E � - i i t FINAL FEE - ' $ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. VT OF COSTA MESA' P.Lp MIT NO TRACT NO. LOT NO. Q,3 7547 ' 4/2,_'/B� gG; E '7L f' FCONSTRUCT[ON PERMITNj, TYPE OF CONSTRUCTION (p NEW ADD ALTERATIO -Applicant's Meiling Address Za%��'r Ay Cir -p � -• ❑ CONVERSION ❑ DEMOLISH ® OTHER Project Address Owner's Name .�Y�i �`y/�"��•w•l� Phont>-�� DESCRIPTION OF�M-C� K U t $' �+l' a.' 1REGULATIONS Address �7 e L-� - O TYPE OF PERMIT GRADING FOUNDATI STRUCP. Z�f O i-1 — 1� ZONE Arch/Eng. License No. ® TENANT ® ELECTRICAL IO�NI Pa,PLUMBING is MECHANICNG. REF, 906 �� BUILDING Address ❑OTHER BUILDING' NE Y 1Address SETBACK r1l ST REAR YARD (TOCP/L)- Contractor's Name&At�Eddifw6fGSdtiPr�y �F�1.4�Phone r0 PROJECT DESCRIPTION 50:FT OCCUPANPE SIDE YARD R HT SIDE YA 1ma(Gng) CONSTRUCTION TYPE' �e+� VALUATION_ $FT ZON)= GRADINGCU•YDS. ACRE PKG. SPACE REQ. P V DED License No, �� ' __ LICENSED CONTRACTOR DECLARATION Remarks: STREET WIDTH PARK FEE $ I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code. and SPECIAL CONDITIONS: my license Is In full fo an ffect. �" n PLUMBING ; ucense 1 Lica se N Date Signature ;` • Bar Sink � Sewer Cap � - ' ELECTRICAL -'ORKERS' C MPENSATION DH RATION-�YT/`r breby affirm that I have a certificate. of consent to self -Insure or a -certificate Backflow Preventer - - -Sewer Connection' Automatic Washer Meter Dover 100 amps Workers' Compensation Insurance, or a certified copy thereof (Section Construction Pole Sub Panel 3800, Lab. C.) , Baekflow Irrigation Solar_ Collectors Policy No. S/9l9B"- -'- Company - copy Is hereby furnished, Bathtubs - Soler Piping ' Cooking Unit -Sub Pole Certified Certified copy is filed with the city Building Division. Or lar Tank Dishwasher Motors ❑0-1 HP Ki h-$ 1 Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers ! Dishwasher Swi Povl wlSpa Dryers El Gas ❑Electric 1 Inc.Svlar'❑9-15 HP El 16-15+ (This section need not be completed if the permit is for one hundred (E100) or — Fan ! Microwave less). I certify that in the performance of the work for'which this permit is Issued I In manner so as to become subject, to the Drinking Fo�ntairis _rine - F.A.U. Pole shall not employ any person any Workers' Compensation Laws Of California.' Floor Drains at r t -Light . Date SignatureI NOTICE: If, after rnaking this declaration, you should become'iubject to the Floor Sinks - ater eat , Fixtures Range .. Z Workers' Compensation provisions of the Labor Code, you -must forthwith _- ' ice Device Boxes ' Sign comply •with, such provisions -or this permit shall be deemed revoked. I , Gas Service .Outle arer - _ CONSTRUCTION LENDING AGENCY - ' , 1 hereby affirmthat there Is a construction Winding agency for the performance ( '_ Interceptors , outlets 'Standing Sections of the work for which this permit is ;issued (Section 3097 Civ, C.) Switches ' t Trash Compactor Lander's Name- Kitchen Sink - - _ Lender's Address '• ' Lavatories ' Garbage Disposal ; OWNER BUILDER DECLARATION , I hereby'affirm •that I am exempt from the,Contractor-s License Law for the r Generator 130-5 KW 06-15KW following reason (Section 7031:5 Business and Professional Code: Any city or P-Tra , P• -- - _ • county which requires a permit to construct, alter improve, demolish or repair any structure, prior to Its'Issuance,•also requires the applicant for such permit- F. - Roof Drains r Transformer 1115-50KW to file a signed statement that he/she Is licensed pursuant to the provisions of 05U+ KW Reinspection Fee $fig 'he Contractor's.Llcense Law (Chapter 9 (commencing with Section -7000) of vision 3 of the Business and. Professions Code) -or that he/she Is exempt Showers . Reinsperaion Fee $.16 erefrom ^af Section and the basis for the alleged exemption,. Any, vlolation Meter ❑up to 100 amps .issue Fee $ 3 031.5 by any applicant for a' permit subjects ►he applicant to a civil anally of no► more than five hundred dollars (5500). Service Sink , Issue Fee S 3 Zoning Approved By Date I, as owner of tha,property or my employees with wages as their sole I MECHANICAL ' compensation will do the work, and tho structure Is not intended or offered for sato (Section 7044, Business and Professional The tractor's Application Approved By ;7/ a ate ' 9ff •Coda: - L[cense Law does not apply to an owner o1 a property who builds or Improves Bpiler i ^: Refrigeration System Application Issued By Date thereon, and who does such work himself/herself ar through his or her own ; employees, grovlded that such Improvements are'not Intended or offered for sale. If, however, the building or Improvement Is sold within one year.of corn Duct'- Under Ground ❑0100,000 BTU El 100,006 BTU SUMMARY OF FEES •• - pletlpn, the ownor,will have the burtlen of proving ha/she did not build or Im- rove for the purpose of, sale), Duct -Structural System Repair/Alteration BUILDING PERMIT $ d rSMIP $-�a I U1, as owngr of the property, am exclusively contracting with licensed con- , tractorsto construct.the'project {Section 7044, Business and Professions Code: t0 _ Duct - Ventilating _ Il I �C� (1 fJSl PLAN CHECK: $ A � PERMIT The Contractor's License Law does not apply an owner of property who • builds or Improves thereon, and who contracts for such projects with a Con. I El I Exhaust System Multiple ❑ � / � � f MtaU r90 PLUMBING $• ISSUANCE 5 tractor(s) license pursuant to the Contractor's License Law), CHECK $ GRADING 5 ' ❑ l am exempt under Section B. & P. C. for this reason Firepl/Fact. Bit. ICBO 0-- $ Heating System & Ducting r ELECTRICAL $�'' MICROFILM. 5 Date Owner ' I hereby certify that I have read•th15 application and State that the above I ❑D-100,000 BTU ❑100,0008 - - PLAN CHECK,. $ TOTAL FEE $ ' Information Is correct, 1 agree to comply with all city and county ordinances MECHAN_ICAt $ and state laws sting building construction. and hereby authorize repro sentatives of;4(s c1 o gMer . upon the above-mentioned pr rty for Hood or Type[ ❑ Cano " ❑ Reinspection Fee $75 l PLAN CHECK $ LESS inspettlon p � � nature Date I T e II ' ( I' AD NCEo PC $ SI g Registers i Is�ta Fee $ 3 i I l I ' I FINALFEE $ �-+ Drivers' can o 55 I CMF 0865-46 rev. 12/82 White - Building; Canary - Applicant; Pink - Accountirig; Goldenrod - Assessor CONSTRUCTION_AND PLANNING ;?n , OPOOk ;PA - _ ;- _ G r.:Date •APPROVALS .- Permit# - lrispecto� << �' -APPROVALS' Permii# Date Inspector r` 1ATm eporary Electrical Service or Pole 52 Rool &Equipment Location _ 2' Soil Pipe-Undr'grnd: iz,t' _ " - �, 53:} Steel Reipforcement 3? Electrical conduii:U4111t3; i'drgrnri. r T - 54.* Forms c' t 4- Electrical Conduit-llndrg1 ndt - :552 Electrical Bonding F S&J Reinforcemed x 1, :.1 ' Rough Plumbing.& Pressure.Tesi _56.; _ 6- VledtticallUFER Grnd ".i ' ' `-' - 57'..` APPROVAL TO COVER•GUNITE ; 7. Fboeings le5$' Electrical Conduit=Undrarnrl. ,. 8. Fpundatiori ss G�, r• `?59. Gas Pipe, ❑ Undrgrno., Test 9, Mte' Pipe-Undrgrnjd. ,` , 3 �y �' ' 60. Ba&wasfi-'Lines,.P-Trap, ❑ Undrgrnd. 10. Structural Floor System i' r - = 61. APPROVAL'TO•DECK 11. Prpperty Sewer Line & House'Connection = 62. Backwash & Rece for -Final p rr 12. Sewer Cep '63. Pe'ater&Vent-Final 13. Roof ;Drains I r _ _ 64. Plurmbi ng� System - Final > 1 - 14. Rau h'Plumbin ! ! 9 9 u . • 65. Electrical -Final - 15: ' Rough`Electrical-Conduit- - r �' r- !_T_ ? fifi.�+Solar System'Final -- _ ;l E I cr u9h;IeticIWig 67.+ Fencing&RaAccess Approval - - {�,'1G % ; �€ 17: 'Rou h' Wiriri `Si n Y) '• r' 9 9 9 l - r i 68. APP.ROVEC? FOR PLASTERING r r ti = t „ ^ I , _j , - 18. IRou h-Elect'ric`al-T`Bar Ceiling''1 =- ; 9 ,; - I ' I •= € - � F I f 69.1 POOL/SPA SYSTEMS FINAL - n ,. , •,�� ., , ., _ { r Tb "FG "qg K'Heating &!Air Conditioning " 1 ! FIRE DEPT. REQUIREMENT N l I 1 I ' APPROVALS Permit # i. 2Q. Rou h' Factor Fireplace' t i g y a l ► I I ,, it ,-n + k I I f ' 21 Ducts, in S�ructure.y ; 1 1 1 70.!.Wderground Hydro , + I Ducts, Ventilating Product Piping El Gas ❑Oil }422. ` ,7.1.E :1,:23. Gas' i e-Rou h & Test - 9, t i - - z--' 72, Underground Flush �• s , I ; 24, Roof Flaming'- ? ; ;i I s I +. I I :. 73., Und6grnd. Storage Tank ❑ Gas ❑ Oil Roof $66'thinq r .74. Overhead Hydro _25. ;. •26. T _bar Ceiling (Structural). & Monocoat 1 - { �,�{ !�'' 75.1 pry Chemical r .27. Frame-antl Flashing' ! , ` 76.} Dry Standpipe I ;1 28. 'Lathirig. &�Siding' t 1 I I �77.i FIXED SYSTEM FINAL :. 29. llnsulat{on _ t l i r!` 78.; RIA E-PREV. FINAL , 30. brywall'�lailing J'F l , Notesa,� ±i 31. plaster Brown Coat ,I 32. Electrical Power Mpter-Final { r , 33. 'Final`Electric s 34. Final Heating &,Air Conditioning ,I 35. Fsrial'Gas Pipe-Tesf 36. Hood or Canopy 37. Final Factory Fireplace c r It 38. Final Plumbing I- 39. Water Service -Final i - 40. Gas Service -Final ' 41. Solar Domestic -Final 42. Backflow Preventers 43. Backflow Irrigation ! - ; ' I ! •' ; 44. Landscape Irrigation System I- 45. Sounds Attenuation ; • ! , } _ { 46. Handicap Regulations 47. FINAL STRUCTURE & B61LDING 48. Special Requirements Completed !! 1- l 1 49. Electric Release.to Edison to Southern California Gas Co41 50. Gas Release 51. CERTIFICATE OF'OCCUPANCY 'I No. Date } I , �' •+ ; - APPII@ailt to fill In 211 SP41COS except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA' 7 PERMIT NO. TRAT NO. LOTNO.BLDG. N0, CONSTRUCTION PERMIT:171 77 4�.. fdW. 1 7- &;&;pe I LC - App!j�;entl Mailing Address 22 e 2 TYPE OF CONSTRUCTION • NEW ADD, LJ ALTERATION REPAIR 7 0 E ess' ❑�iw�LIS�_i OTHER /i" ProJ4Ft Addlf qa'LL �!�4 (4 �Z, CONVERSION 0 DF_SCRIprioj4OFWORK -4 Pr!&q[ "IA_e� O�vnir's Name _L::tA.424_ 0 1. 1. 1 -1 Ce A6 TYPE OF PERMIT U GRADING LJ -FOUNDATION STRUCTUR 1 4U b 291X �11 J 9). P7 TL Arch/Eng.. License N9., TENANT ELECTRICAL PLUMBING• DS MECHANICAL PLNG. REF. 106P P BUILDING 4ildren -OTHER T TO BUILDING L byanyapplicant subjects the applicant to a cJvil 11 of not More than live, hundred dollars (S500 Oontractor!% hone PROJECT DESCRIPTION SQ) FT.-'— OCCUPANCY El" PROPERT INC REAR YARD (TO P/L) . Add, ess(maillng) CON STRUCTjiON TYPE- VALUATION $ 1 LEFT SID L SIDE RIGHT SIDE YARD .1 I ZONF_ GRAE>INGCU.*YDS.-- PKG. SPACE REter PROVIDED License No. n ate Cldrifiers Solar Tank LICENSED CONTRACTOR DECLARATION Ramer STREET WIDTH PARK FEES 1 hareby'affirm that -1 am ilconsed'under provisions of Charter 9 (commencing 4- Dryeis"OGa 13EIectrid1,' there0n.'and who does SuCh work or through his or her own employees, provided that such,imprOvOments are not Intended or offered for t Dishwasher i with section 7000) of Division 3, of the Business and Professions Code, and lass I I &Ify;that In thip perforrmance " I of the work for'which this permit Is Issued I employ In any Mannqr so as to become subject. to the SPECIAL CONDITIONS. Drinking Fountains my license Is In full force and affect. Fan ho sale. If, waver, the building or Improvement Is Sold within one-year,of COM- platlo the owner'will have the burden of proving he/she did not build or lm - n. Shall -not any person Workers', Co rr!p0ns!tfon i Law$ of California.! 1, iI i �1_11, License6ALS canse No., 7 - PLUMBING Water Closet F.A.U. Date Signature ORKERSI COMPENSATION DECLARATION ' i Bar Sink t Sewer Cap Floor Sinks ELECTRICAL areby affirm that I have * certificate of consent to self -Insure or a certificate_. 7— Backflow Prmmnter Sower Connection. - AiAtomatir.Washer Workers' Compensation Insurance,' or a certified - copy thereof (Section t :Issue Fee byanyapplicant subjects the applicant to a cJvil 11 of not More than live, hundred dollars (S500 Construction Pole 3800, Lab. C.) -2,�,oxey $ 3 Backflow Irrigation Solar Collectors - — - onto ,gCPo y rnpai y, c ortlifid copy is hereby furnlshad::� i 1 Bathtubs Solar Piping Co Cooking Unit Ce rtltjad copy Is filed with the c1l: )VI n ate Cldrifiers Solar Tank Dishwasher Dat )9,�p�lcan , -' =S:V CO ExEmpriolld FROk WORKERS' CO PVENTI DECLARATION t peh (This section need not be completed if the permit for, one ndr, d ($100) or I 4- Dryeis"OGa 13EIectrid1,' there0n.'and who does SuCh work or through his or her own employees, provided that such,imprOvOments are not Intended or offered for t Dishwasher Swimming Pool w/Spa t i, lass I I &Ify;that In thip perforrmance " I of the work for'which this permit Is Issued I employ In any Mannqr so as to become subject. to the Drinking Fountains Urinal Fan ho sale. If, waver, the building or Improvement Is Sold within one-year,of COM- platlo the owner'will have the burden of proving he/she did not build or lm - n. Shall -not any person Workers', Co rr!p0ns!tfon i Law$ of California.! 1, iI i Fl6or Digins; Water Closet F.A.U. Date signature ,NOTICEp If, after making IOUs- declaratl6n. -you - sh ould'beedme, subject to the- FEES Floor Sinks -Water Heater, - Fixtures Workers'! Compensation provisions of the Labor.. Code, you must forthwith comply with! such provISIon1.':.or this:.,parrrilt shfil be Ap!7e4- revoked Service; Gas So ic .Outlets 'Water Service iDevice Boxes i CONSTRUCTION. LENDING AGENCY Duct w'Veqtilating t y.IP Outlets I hereby affirm that there is a'constructlon lending agency.for the' performance; thlsy �Issued Clv: PERMIT interceptors Exhaust System 0 Multiple 0 of the lwork for. whlch..- permit -is .(S�Kllon x3097• c.}; I j PLUMBING $� _7_7 SwW has i c Lender's; Name: Lander's Address - i_ �,- 1 OWNFRBUILDER DECLARATION _TlFi�epl/Fact. l6ichen�Sink! Garbage Disposal $ t i I hereby a ffirm that I am-exerript,froTri the Contractor's,Ucensa Law for the':; Business Professional Any r .7 i :` Generator D0-5 KW 0 5-15 KW following reason:(Section 7031.5 and Code. city or'P-Trap- county which requires a permit to construct altar Improve, demolish or repair 'any structure, prior to its l3suance, also requires the applicant for such permit, i to file a signed statement that he/she IS IlCansed pursuant to the provisions of MICROFILM, i Data -1 -h rtity-that I hav4 read this cati nd jta�e that -the ab4Cv-1 .&P Inform.L.Cne Is correct. I Ct. I alifee to comply 21,th a I ty and county ordinancAs - Transformer ❑ 15-50 KW ©51y+ I Roof Drain's Contractor's License Law {Chapter 9 (commencing.with Section 7000) of Revision:3-of the -Business and' Professions Code)' or that he/she Is exempt Showers Rainspection Fee i S15 KW Meter pp.-qr 100 amps Sub Panel� Sub Pole Moto� ;qo-1 HP 0 1'/._8 Inc.Solar 139-,15 HP 016:1 Ej+ Microwave Pole 'Light Range J. Sections �pactor $ jRainspectlon Fee ,,,�Verefrom and the basis for the alleged exemption. Any violation of Section 4 ;�st631.5 for'-,a:permit r , , L . I Meter 0upto100am amps :Issue Fee byanyapplicant subjects the applicant to a cJvil 11 of not More than live, hundred dollars (S500 Service Sink - . Issue Fee $ 3 Zoning Approved By W_ 14 - — - onto as owner of, the property or -my employees with waQdVaS theli sole co pensation wlll'do the work, and the structure Is not Intended or offered 5 for 7044, and' Professional Code: Contractor's MECHANICAL a Application Approved 13 n ate sale (Socilon Business' The License Law do not apply to an owner of a property who builds or Improves j a, himself/herself i BoilerI , . 'e. I t J Refr,igeration System Application laced By ate there0n.'and who does SuCh work or through his or her own employees, provided that such,imprOvOments are not Intended or offered for t Duct- 'Under.G round 00:1100,01XIBTU 01W,0WBTU ho sale. If, waver, the building or Improvement Is Sold within one-year,of COM- platlo the owner'will have the burden of proving he/she did not build or lm - n. SUMMARY FEES we fo! the purpose ol� sala)� : . .: - 1 91. Duct -structural t T System Repair/Alteration MIT BUILDING PPI i IF SMIF as owner of the property, am exclusively contracting with:11cansed con- tractors to construct the project (Section -7044, Business and. Professions Coclai:. Duct w'Veqtilating t y.IP ks�a 1 44 PERMIT The Contractor's Ucense LAw does not apply to an owner of property who mprow builds or Improves thereon, "d who contracts for such project p with a con. Exhaust System 0 Multiple 0 I j PLUMBING $� _7_7 ISSUANCE tractor(s) Il..n.. pursuant to the Contractor's License Law)J ? 11 fam exempt under Section P, C or thIs realon _TlFi�epl/Fact. ICSO 4 jPLAN CHECK $ GRADING Heating'Systern & Ducting 0().100,000,0TU 0J00,0()bM= :ELECTRICAL 'PLAN CHECK! 0, MICROFILM, i Data -1 -h rtity-that I hav4 read this cati nd jta�e that -the ab4Cv-1 .&P Inform.L.Cne Is correct. I Ct. I alifee to comply 21,th a I ty and county ordinancAs - I T&ALIFEE' and state laws r a 109 to pull 9 con uction and hereby authorize repro- bu up th! a �ve sentatives Of to up the ablow0imntioned property Oar Inspection 0 u s. Hood Hood or Type I H; 0! Cabo Type it I J i Reinspection Fee 15 .ME6HAN'ICAL IPLA� CHECK! I I --r LESS Signatu I ADVANCED PC AC Drivers.!: U. .0 of' Licani L Isle F�6 $ 3 i FINA L FEE CMF 0865-46 raw. 12/82 White - Building; Canary - Applicant-, Pink - Accounting; Goldenrod - Assessor $ $ ..anfto fill in all spaces except those wlthin heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA _ /3 '- 1 (J Lenla��_ CONSTRUCTION PERMIT TRACT NO. L07 NO. BL 11096 ; 1 & 2 B TYPE OF CONSTRUCTION ADD 1.2 ALTERATION LJ REPAIR M.[—]- CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # 2 ~O DESCRIPTION OF WORK S Main Building: TYPE OF PERMIT �GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT L1I ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Hear ❑ OTHER A PROJECT DESCRIPTION Sq. FT. OCCUPANCY B—z C Right CONSTRUCTION TYPE VALUATION $ _ ;15, 264 a-0 S Left ZONE GRADING CU. VDS. ACRES. Ping, Ref. Z� Remarks: _ Parking Req./Provided Use of Building: PLUMBING FEES Planning Notes: Project Address III- w. i LL n b L r e e r Applicant's Mailing Address : 2418 MacArthiir Eavd, D Owrler's"Name Trrfy investment_ Fund Phone- 549 8 Address 4321 Birch St. New ort Beach Arch1Eng!" M, L. P t: r e i r a A S S O Qicense No. Address 2 4 18 MacArthur -Blvd,. Corona del Ma Contractor's Nam Phone Address imailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am ticensed under provisions of Charter 9 (commencing with section 7000) of DIvIslon 3 of the Business and Professions Code, and my license Is in full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION greby affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section X800, Lab. C.) 11,111, No. -1A r a o n o ut 2 4 2 0 Q 016 8 3 Company - eCertified copy is hereby furnished. Certifiedcop is filed with the city B ild ng Dlvisio Data Applicant EXEMPTION OROM WORKERS' COMBENSATION DECLARATION (ThISsection need not be completed If the permit is for one hundred ($100) or I certify that in the performance of the work for which this permit Is issued 1 Shall not employ any person In any manner so as to become subject to the workers' Compensation Laws of California. DateSignature NOTICE: If,iafter making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this .permit sha41 be deemed revoked. CONSTRUCTION LENDING AGE14CY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued •(Section 3097 Civ. C.) Lender's Name ..__ _.. Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's- License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is ticensed pursuant to the provisions of the Contractor's Litense Lays tChapter 9 (commencing with Ssct;On 7000) of ,vision•3 of the Business and Professions Code) or that he/she Is exempt Irefrom and the basis for the alleged exemption. Any violation of. Section j31.5 by any applicant for'a•permit .subiects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the. property or' my employees with wages'as their sole caMpansatlon will do the work, and the.structure is not Intended or offered for sale (Sac{ion 7044, Business and Professional Code: The Contractor's License Law does not apply to an'owner of a property who builds or improves thefeon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not Intended or offered for of com- safe. If, however, the bulltling or improvement Is sold wlthin ane year plativn, the owner wit! have the burden of proving heJshe did not build or Im- rovafor tfie purpose of sate}. as owner of the property, am exckuslvely contracting wlth'llcen$ad con- aC{drst6 construct the project (Section 7044, Business and Prafesslans Code:- The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who Contracts for Such projects with a con- tractor[$) I1CBnSe pursuant to the Contractor's License Law}. ' ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have -read s application and state that the above information Is correct. I agree to c reply with all city and county ordinances w and state las relating t0 building construction, and hereby authorize repre- sentatives of this city t enter upon the above-mentioned property for Inspection Irposes. SIat re Date ar Sink Dishwasher Drinking Floor Floor Gas Interceptors Showers ackflow Preventer ackflow irrigation Service Sink Sewer Cap ethtubs Sewer Connection larifiers Solar Collectors Solar Piping Fountains Solar Tank Drains Swimming Pool w/Spe Sinks Urinal Service Outlets water Closet G Water Heater Itchen Sink Water Service Clarifiers D D F F I K Lavatories P—Trap Roof Drains Reinspection Fee I $25 Boiler Duct :Under Ground Duct - Structural Duct - Ventilating. Exhaust System El Multiple ❑ Firepl/Fact• Bit. ICBO # Heating System & Ducting ❑0-100,000.eTU 0100,0008T gn u Reinspection Fee $25 Drlvers' c rise or SS CMF 0865-46 rev. 12/83 White - Sul Id Ing; Canary - Applicant; Pink - Accounting; Goldenrod -Assessor Issue Fee a ►NICAL $ 3 FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑E[ectric Fan , F.A.U. _ Fixtures •' Device Boxes Outlets . Garbage Disposal Generator 0 0-5 Reinsoection~Fea $25 Zone - Accessory Building: Park. Fees $ ELECTRICAL 5-15 KW ' Transformer ❑ 75-50 KW ❑ 50 + Kw Mater LJup to 700 amps Meter Dover 700 amps Sub Panel Motors ❑0-1 HP ❑ 1 :5 - B Inc. Solar ❑9-15 HP El 16-15+ Microwave Pole Light Range Sign _ ' Standing Sections Trash Compactor KW 0 Issue'Fae 3dra27 11 � Z f D N I N R E D U I R E M E N T S FEES Hood or Type I , El. PUBLIC',SERVIGES REQUIREMENTS:A "' 'f�'�� K L _ G Canopy Type II' El ZoningApproved BY Date Building Approved By AO�lacataan Issued'$y - - i Date pal G Refrigeretian System 00-100,000 BTU_ ❑100,000 BTU .+SUM ARY F FEES ' �-,BUILDING-PERMIT ? $ � �d., SMTP' $ 7 System Repair/Alteration PLAN CHECK $ .i PERMIT r PLUMBING PLAN CHECK ''25%'- ELECTRICAL 11 PLAN CHECK ;5096 ""-MECHANICAL' $ ' $ " $,MICROFILM $ ISSUANCE $ ENERGY P.C. `$ GRADING .$ TOTAL FEE $ • 3 is 4 47 17 - ' • Issue Fee $ 3 PLAN CHECKS 25% ' $ - �j - 7.Lr I f'.-CONSTRUCTION•AND PLANNING APPROVALS Permit # Date Inspector POOL ?A APPROVALS - Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & EquipmentLocation 2. Soil Pipe .Undrgrnd. 53. Steel Reinforcement - 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 7- 4. Electrical Conduit-Undrgrnd. 4. 55: Electrical.Bonding - 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test . 6' Electrical LIFER Grnd. 57: APPROVAL -TO COVER-GUNITE . 7. Footings 58. Electrical Conduit-Undrgrnd. - 8. Foundation 59. Gas Pipe,.❑ Undrgrnd., Test :9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, ❑ Undrgrnd. , ' .10. Structural Floor System 61, APPROVAL TO•DECK .t Z141. Prgperty Sewer Line &House Connection 62. Backwash & Receptor -Final '_. 12. Sewer Cap 63. Heater& Vent-Fihal -1f3. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Fina! 15. Rough Electrical -Conduit 66. Solar System' -Final 16. Rough Electric Wiring 67. Fencing & Access Approval -- - 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING. r 18. Rough Electrical -T Bar Ceiling 69. POOL'/SPA SYSTEMS FINAL { 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit* 3 20. Rough Factory Fireplace 21. Duets, in Structure t 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ,:b Oil 23. G ,Pipe -Rough & Test 72. Underground FlushS 24. PL -of Framing .73. Undergrnd. Storage Tank © Gas •l -]{Oil 25..Roof_Sheathin5 74. Overhead Hydro 26. T -Bar Ceiling {Structural} & Monocoat 75. Dry Chemical 27. Frame and Flashing a 76. Dry Standpipe 28. Lathing &Siding77. !a&A av�"'o FIXED SYSTEM FINAL - 29. Insulation �f/�� 78. FIRE PREV,. FINAL 30. Drywall Nailing i IHEALTH DEPT. REQUIREMENT ; 31. Plaster Brown Coat 79, FINAL INSPECTION p 32, Electrical Power Meter -Final 80, FOOD CERTIFICATE'ISSUED 33, Final Electric Notes:, l06 34• Final Heating & Air Conditioning ` 6 35. Final Gas Pipe -Test 36. Hood or Cano'pY • _- 37. Final 'Factory Fireplace 38 -Final PlumbingkA 39. Water Service -Final.-- ' 40. Gas Service -Final 41. Solar Ubmestic-Final 5 _' Y 42, Backflow Preventer i I 43. Backflbw Irrigation - 44. Landscape Irrigation System ; - 45. Sound Attenuation' _ e � 46. Handit;ap Regulations } 47. FINAL STRUCTURE & BUILDING /�_�� 48. Special Requirements Completed z - ` 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. L Daie -- ` 11 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. ONST CTION PERMIT''i� r, PER IT NO. TRACT NO. LOT NO. UNIT NO. with section 7000) of Division 3 of the Business and Professions Code, and my license is in It force and effect. license Class IF 0.1-icanie-No abor Y %&ITO COSTA MESA C RU — ' ��$ , r _ t[� Bar Sink WORKERS' COMPENSATION OEC ATION hereby affirm that I have a certificate of consent to self -insure or a certificate f Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C') C Policy No. 7� V. ••-7�1�47� Company SF�r _ __ _ - Backflow Preventer - Backflow Irrigation BCertified copisy is hereby furnished. Ce t'fietl cop Iled with the city visi Project Address 1 i T �S 1 Clarifiers (This section, need not be completed if thTj permit is for one hundred ($100) or less). I certify ,that in the performance of the work for which this permit is issued, I i shall not employ any person in any manner so as to become subject to the Dishwasher Drinking Fountains Workers' Compensation Laws of California. ' Floor Drains Date Signature Applicant's Mailing Address _ F1 S k TYPE OF CONSTRUCTION NEW ADD1. ❑ CONVERSION =❑ DEMOLISH C1OTHER PAI R =PAIR 5of V Signature —7 Date Drivers' Lice a or'SS Owner's Na e - Pone DESCRIPTION OF WORK/USE OF BLDG. A.P. Main Building: Address l-� a� ��" �r �1�/ nF/ _ 11 Arch/Eng.�!_J,J•�a ��{E� ,�'sI/ License No.��.r�SL TYPE OF PERMIT ❑GRADING FOUNDATION STRUCTURAL T Front ' /� A,i�u ❑ELECTRICAL ❑PLUMBING 1:1 MECHANICAL V Address Q?I2 "� c "Un- /�� r ❑ OTHERT A Rear Contractor's Nam Phone�li C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K 1 Address (mailing) �!/� 35q"-, CO N STRUCTION TYPE VALUATION $ S Left City License No. ' ZONE GRADING CU.YDS. ACRES Ping. Ref. # LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under orovision5 of Charter 9 (commencing Remarks:, i �i•i4=� # , Planning Notes: with section 7000) of Division 3 of the Business and Professions Code, and my license is in It force and effect. license Class IF 0.1-icanie-No abor Interceptors Kitchen Sink Date -6-w Signature Bar Sink WORKERS' COMPENSATION OEC ATION hereby affirm that I have a certificate of consent to self -insure or a certificate f Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C') C Policy No. 7� V. ••-7�1�47� Company SF�r _ __ _ - Backflow Preventer - Backflow Irrigation BCertified copisy is hereby furnished. Ce t'fietl cop Iled with the city visi . Bathtubs Date? Applicant EXEMPTION FROM WORKERS' CO P SATION DECLARATION Clarifiers (This section, need not be completed if thTj permit is for one hundred ($100) or less). I certify ,that in the performance of the work for which this permit is issued, I i shall not employ any person in any manner so as to become subject to the Dishwasher Drinking Fountains Workers' Compensation Laws of California. ' Floor Drains Date Signature 'NOTICE: If, after making this declaration, you should become subject to the ' C t"f th LC d Ou must forthwith _ F1 S k Workers ompensa on provisions o e o e, y par in s comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY , Gas Service'Outlets. I hereby affirm that there is a construction lending agency for the'performance I I i h th' It . l tl Sti e n 3097 Civ C) of the -waror wh c is perm is ssue { c o - Lender's Name• Interceptors Kitchen Sink Lender's Address - DWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a,signed statement that he/she Is licensed pursuant to the provisions of 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,vlolation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil EDenalty of not more than five hundred dollars ($500). I, as, owner of they property or -my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044 Business and Professional Code: The Contractor's Lavatories I P -Trap 'Roof Drains ' - - - - - Reinspection Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date 1 6 Duct- Ventilating ' Refrigeration System 00-1100,00OBTU ❑ 100,000 BTU GMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING ' Showers Service Sink - Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa - Urinal - Water Closet Water Heater Mter Service Auto -Wash Laundry Trays 3742 12/10'/64r Accessory Building: Parking Req.fProvided ELECTRICAL Automatic'Washer` Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps - Dryers ❑Gas ❑Electric Sub Panel Fan Motors 00-1 HP El 1% S F•A,U. Inc. Solar ❑9-15 HP 1:116-15+ Fixtures �iit... .... - - Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW ❑5-15 KW •� 21ou� Zone Pole Light , Range Sign Standing Sections Trash Compactor Z O N I N G R E Q M T S _No License Law does not apply to an owner of a propertyiwho builds or improves thereon, and,who does such work himself/herself or through his or tier own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I. as owner of the property, am exclusively contracting with licensed con- 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 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 proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason ' Issue Fee $ 3 ' Reinspection Fee - , - Boiler _ MECHANICAL FEES Duct - Under Ground Hood or Type I ❑ Canopy Type 11 ❑ Duct - Structural DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date 1 6 Duct- Ventilating ' Refrigeration System 00-1100,00OBTU ❑ 100,000 BTU Exhaust System ❑ Multiple ❑` Firepl/Fact. Bit. ICBO # Date Owner I hereby certify that I'have read -this application antl state that -the above information is correct. I agree to comply with all city and county ordinances and State laws relating to building cons ction, and hereby authorize repre- sentatives this cit to errte"f up a above-mentioned property forinspection Heating System & Ducting 13 0-100.000 BTU ❑l00,000BTU Fire Dampers 5of V Signature —7 Date Drivers' Lice a or'SS Reinspection Fee $15 GMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING ' Showers Service Sink - Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa - Urinal - Water Closet Water Heater Mter Service Auto -Wash Laundry Trays 3742 12/10'/64r Accessory Building: Parking Req.fProvided ELECTRICAL Automatic'Washer` Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps - Dryers ❑Gas ❑Electric Sub Panel Fan Motors 00-1 HP El 1% S F•A,U. Inc. Solar ❑9-15 HP 1:116-15+ Fixtures �iit... .... - - Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW ❑5-15 KW •� 21ou� Zone Pole Light , Range Sign Standing Sections Trash Compactor Z O N I N G R E Q M T S _No ' Issue Fee $ 3 ' Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Hood or Type I ❑ Canopy Type 11 ❑ DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date 1 6 Refrigeration System 00-1100,00OBTU ❑ 100,000 BTU SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $1 ENERGY P.C. $ ELECTRICAL {{p� C�_ZD GRADING $ PLAN CHECK 50°� Z$J_- MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% - $ 1 Z1 r-1 ", System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 ,r 7.CONSTRUCTION AND PLANNING APPROVALS Permit # Date ; Inspector PooT'& SPA APPROVALS - Permit # Date InspPtsnr ' ,1. Temporary 15lectrical Service or Pole 52. Pool & Equipment Location 2. Soil Pi a-Undr rnd. �' p 9 . 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 1 ' 58. Electrical Conduit-Undrgrnd. 8. jFoundation 59. Gas Pipe, E] Undrgrnd., Test 9.. Water Pipe Undrgrnd'. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10' Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line ,& House Connection 62. Backwash & Receptor -Final 12. Sewer Cap i 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 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 g C� Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace ;y 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 Attentiation 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 _ City, of Costa Mesa Development Services Department Building Safety Division CERTIFICATE OF OCCUPANCY No. 00149 4 P. O. Box 1200 Costa Mesa, California The Building located at 711 W. 17th Suet (UrLits Bl s B2) has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B-2 Occupancy. Use of Building Office • 1 f. Legal Description AP #424-091-11 i r ISee reverse side for Metes andBounds)P--18113 P-18114 Building Permit No B-21362 Electrical Perm�i3tNo -17214 E-2152yumbing Permit No.P-2'1797 1N-$8578 M-21738 1 Mechanical Permit No. wx- R —2 1739 Number of apartments � and/or guest rooms, [SSU ED TO: Building Official to, TROY INVESTMENT F[lND 4321 Bib Birch Street y Newport Beach. Cali.fomia Date_ , This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except bV the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. f CMF 1015.46 rev. 1/63 White - Owner; Canary - Numerical File; Pink • Bldg. Permit File t � �t City of Costa Mesa De ielopment Services Department Building Safety Division CERTIFICATE O F O C C U P A N.0 Y No. � P. O. Box 1200 Costa Mesa, California ' The Building located at 711 ;1• 17th stmeat {Uhlt3 Bl & B2} has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B-2 Occupancy - Use of Building Office Legal Description AP U424-091--11 (See reverse side for Metes and Bounds) p_18113 P-1$114 1 Building Permit No 8-21iU Electrical P`e7rmli No.- 1711.4 E-21.52p0jumbing Permit No.P`21797 . 141-1:8378 1,4--21738 p Mechanical Permit No. l *--� p�7a F f"71 Number of apartments and/or guest rooms ISSUED TO: f Building Official ft/• K • 110Y nvtVsrIIx- 4321 Birch Street lay ;`Fe3oort Heath California - Date This Certificate of Occupancy SHALE 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 le} U.B.C. CMF 1015-46 rev. 1/93 White - Owner; Canary - Numerical File; Pink - Bldg. Permit File 4 City of Costa Mesa Development Services Department CERTIFICATE OF OCCUPANCY No. 902303 Building Safety Division P. 0. Box 1200 Costa Mesa, California The Building located at 711 W. 17th Strnseat , flni.f-Q P117 A QA has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group Occupancy. Use of Building Oiflce/r-3grn?hntlnp Legal Description 424-091-11 (See reverse side for Metes and Bounds) Building Permit No. $_ 328.83 Electrical Permit No. E17115, 1.174P,16mbing Permit Nopt Al 1 9. 01 011 Mechanical Permit No. M 18580E+1 N 18581 Number of apartments and/or guest rooms ISSUED TO: Tho Troy Invostment Fund 1,321 Birch Str3et -Ijwaort Roach,. CA 92660 Building Official William T. Howard by Date December 9,, 1988 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C. CMF 1015-46 rev. 1/83 White - Owner; Canary - Numerical File; Pink - Bldg. Permit File Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CO S t� CTION PE IST PER NQ, TRACT UNIT NO, Project Address I Q `� Ccs 13 �� r'Q� 19LOTNO.C'A4. ' _ S �3 Applicant's rens Mailing Address fJ r2 (� TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION DEMOLISH 1-1 OTHER A.P. Owrier's Name Phone , __: - 01 DESCRIPTION WORK/USE OF BLDG. -- — -- - Address121rQA 440tfQP Arch/Eng. License No. G01 Address Contractor's Name _,C a� v�Strtfl�/_Phone �¢ d Address (mailing) City License No. LICENSED CONTRACTOR DECLARATIONIf 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect, License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION ' hereby affirm that I have a certificate of consent to self -insure or a certificate f Workers' Compensation Insurance, or a certified copy thereof (Section j800, Lab. C.) Policy No. Company Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that in the performance of the work fo h1 h MI.- mit is sued, I shall not employ any person in any man as to b E to the Worker Co a "on Laws of California. Oate - y ignature NOTI E: If, after making this declare ou should become subject to the Workers' Compensation provisions oLoChe Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there I$ a construction lending agency for the performance Of the work for which this permit Is Issued (Section 3097 Civ, C.) Lender's Name Lender's Address OWNER BUILDER 13ECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file asigned statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of `'livision 3 of the Business and Professions Code) or that he/she is exempt erefrom and the basis for the alleged exemption. Any violation of Section x31.5 by any applicant for a permit subjects the applicant to a civil alty of not more than five hundred dollars ($500). as owner of the property or my employees with wages as their sole /toinpensation, will do the work, and the structure 15 not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose Of sale), ❑ I, as owner Of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and who contracts for such projects with a Con- tractor(s) license pursuant to the Contractor's License Law), t am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this appl information is correct. I agree to comply wl and state Paws relating to building constr sentatives of Chi city to, enter upo inspection pu>. Signature Drivers' License or SS 99L state that the above id county ordinances rAby authorize repre- ronedpr ert for �at.e APR - 4 ISO � f>1? f / 1 r_. _ M Q WQENfaG�lf•� r L s PLUMBING Main Building: rrrccessory Dunuiily. _ E Showers $15 I Z TYPE PERMIT GRADING FOUNDATION STRUCTURAL T Front Automatic Washer Construction Pole Sub. O TENANT El ELECTRICAL ❑ PLUMBING ❑ MECHANICAL Bathtubs Rear I rQ 1 Circe- /�-� Tt N LJOTHER a Solar Collectors Dishwasher Meter El over 100 amps C Right SM)P $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING S MICROFILM $ TOTAL FEE, $ N PROJECT DESCRIPTION SQ, FT, OCCUPANCY. - Drinking Fountains Solar Tank Fire Dampers G CONSTRUCTION TYPE VALUATION S $ Left F.A.U. Inc, Solar ❑9-15 HP 016-15+ Floor Sinks Urinal R ZONE GRADING CU. YDS. ACRES Ping. Ref. Parking Req,/Provided E Remarks: -TIT. � Ll�.✓z{ OA& Id R Planning Notes: Interceptors M Outlets Range T S Reinspection Fee I S15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Oucting C3 0-100,000 BTU 0100,000 BT Rainspeclion Fee I $15 i CMF11111119'f!`"-46, rev. 10/84 White -Building; Canary -Applicant: Pink - Accoun6rtg; Goldenrod -Assessor Issue Fee § 3 PLUMBING FEES Bar Sink Showers $15 I ELECTRICAL FEES Backflow Preventer Service Sink MECHANICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter El over 100 amps Dishwasher Solar Piping SM)P $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING S MICROFILM $ TOTAL FEE, $ Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fire Dampers Fan Motors 1:10-1 HP 1:11 h B Floor Drains Swimming Pool vv/Spa F.A.U. Inc, Solar ❑9-15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections P --Trap Laundry Trays �Gener.t.,1010-5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee I S15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Oucting C3 0-100,000 BTU 0100,000 BT Rainspeclion Fee I $15 i CMF11111119'f!`"-46, rev. 10/84 White -Building; Canary -Applicant: Pink - Accoun6rtg; Goldenrod -Assessor Issue Fee § 3 Reinspection Fee $15 I I Issue Fee S 31. MECHANICAL FEES DEVELOPMENT SERVICES REOUIR Zoning Approved By MM- Building Approved By Application Issued By ENTS: CCP -Datel Dater670 Data Hood or Type I 1:1 Canopy Type I l ❑ Refrigeration System 00.100,000 BTU ❑ 100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY. $ ,_, S4_°"' $ $ $ $ $ $ $ OF FEES SM)P $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING S MICROFILM $ TOTAL FEE, $ System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS •Permit# Date Inspector POOL & SPA APPROVALS Permit # Date 'Inspector 1. Temporary Electrical Service or Pole , s, 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54• Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings gQ� V �� Fr p 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64• Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Etectrical-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 APPROVALS Permit # f. 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71 • Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Ory Chemical 27. Frame and Flashing , �ti O 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL- 29, Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning - 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 3B. Final Plumbing �' .-' �• 39. Water Service-Final ° r 40. Gas Service-Final I 41. Solar Domestic-Final ' 42. Backflow Preventer .:.' 43. Backflow Irrigation 44. Landscape Irrigation System „ 45. Sound Attenuation 46. Handicap Regulations �' ' •. •- ; 47. FINAL STRUCTURE & BUILDING 1 .; 48., Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51 • CERTIFICATE OF OCCUPANCY No. 4 Date ---------- Applicant to fill in all spaces except those within heavy border lines and Sign all appropriate declarations. CITY OF COSTA MESA CONS RUCTION PERr�{ IT P MIT N TRACT NO. LOT NO. UNhT CbO. Project Address �' U Applicant' ,MaiIin9 Address L Owner's Name �J �v hone Address Arch/Eng. License No. Address Contractor's Name .S0 ' Phone Address (mailing) — 2% ""a ,�� '- City License No. �1 - —/ LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full fort nd effect. Licens lass C' License No. Date Signature WORKERS' COMPENSATION DEC ARATION I hereby affirm that I have a certificate of consent to Self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. Company BCertified copy is hereby furnished. , Certified copy is filed with the city Building Division. f Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (S1 00) or less). I certify that in the performance of the work for which this permit is issued,'I� shall not employ any person In any manner so as to become subject to the - Work s' Comp Laws of Calif r a. Date ^ Signature NOTICE: If, after making this declar ' n, you should become Subject to the Workers' Compensation provisions o the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that i am exempt from the Contractor's License Law for the toIiowing reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to fife 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 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 chatty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does Such work himself/herse)f or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have- the burden of proving he/she did not build or im- prove for the purpose of sale), ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and _who contracts for such projects with a con- tractors) license pursuarit.to the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for inspection purpo Signature Date �i L Drivers' Llc or SS Io I TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION I-1 REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 4 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT LJ GRADING FOUNDATION LJ STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATION S S I Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Reinspection Fee I $151 1 Issue Fee MECHANICAL Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑ 0-i 00,000 BTU Eli 00,000 BT Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee Automatic Washer Construction Pole,Sub. Cooking Unit Dishwasher Dryers OGas ❑Electric Fan F.A.U. Fixtures Device Boxes 9918 3/25/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Outlets Switches Garbage Disposal Generator ❑0-5 KW 05-15 KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0-1 HP ❑154-B Inc. Solar ❑9-15 HP 1-116-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor $ 3 PLUMBING FEES Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories A uto-Wash P—Trap Laundry Trays Roof Drains Reinspection Fee I $151 1 Issue Fee MECHANICAL Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑ 0-i 00,000 BTU Eli 00,000 BT Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee Automatic Washer Construction Pole,Sub. Cooking Unit Dishwasher Dryers OGas ❑Electric Fan F.A.U. Fixtures Device Boxes 9918 3/25/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Outlets Switches Garbage Disposal Generator ❑0-5 KW 05-15 KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0-1 HP ❑154-B Inc. Solar ❑9-15 HP 1-116-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor $ 3 I-, Reinspection fee $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By I SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $-5 0 ENERGY P.0 ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTALFEE PLAN CHECK 25% $ $ 3 10.50 XI. Z O N I N G R E O M T S FEES $ 3 r CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit Date InspPctor 1. Temporary Electrical Service or Pow y 52. Pool & Equipment Location 2. SailPipe-Undrgrnd. A i 1 �a 53. Steel Reinforcement 3.`. Ele'grical Condult�lJtili y Undrgrnd. 54. Forms f 4 El,Rncai Conduit;;uri grnd. �. e. nz• n 55. Electrical Bonding 5: Sr + ef Rei iforcerneni - m 56. Rough Plumbing & Pressure Test Y�I n .6•' lEec�rical UFER. nand. fr 57. APPROVAL TO COVER GUNITE 17. F,00fings L) ;J 58. Electrical Conduit-Undrgrnd. , f3 FoTndation (rte �t G� 59. Gas Pipe, ❑ Undrgrnd., Test . - / 9. Water Pipe -Un rAd. .. !i 60. Backwash Lines, P -Trap, ❑ Undrgrnd. L',". 10., Structural Floor System 61. APPROVAL TO DECK 11n P operty Sewer Line & House Connection i 62. Backwash &Receptor -Final 12� Sewer Cap 63. Heater &•Vent -Final 11k Roof Drains _ 64. Plumbing System - Final 1V Rough Plumbing 65. Electrical -Final �r 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 APPROVALS Permit # + 120. Rough Factory Fireplace 21, Duets, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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:e9la- ro.0egga" One 40] 34. Final Heating & Air Conditioning 35, Final Gas Pipe -Test _ 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing�� n 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 1 47. FINAL STRUCTURE & BUILDING 4B. Special Requirements Completed 49. Electric Release to Edison , 50. Gas Release to Southern California Gas Co i , 51. CERTIFICATE OF. OCCUPANCY No. '` 'Date �. 111 co N Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. " LOT NO. UNIT NO" Project Address 711 ..W. 17th St. Bldg. (B)- Unit 3 Appiicant'lMailing Address 13110 Saticoy St. N.Hollywood Owner's Name Troy Investment Fund' hone Address 4321 Birch St. NewPort Beach, Ca. Arch/Eng. Marin .J . Rock License No. Address 12881 Knott Ave. Suite 216 Contractor's Name_ Duco Aix ConditioninP.-Phone 982-1216 Address (mailing) 13100 Saticoy St. N.Hollywood,Ca. City License Na. 3.3925 _ LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 9J.,the Business d Professions Code, and my license is in full force agd,effe 346251License Class LV se No. Date ! 11 R /R4 Signature M. WORKERS' COMPENSATION D LARATION I hereby affirm that I have a cert' Icate of consent to self insure or a certificate , of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C-) WC9824 Lumbermans Policy No. Company 8 Certified copy is hereby furnished. Certify�dlcp is filed with the city Buildi ,L)lyi;�on. j n Date.— `�_...-_y_�if�] Applicant �1•«-LJ +(% EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred (5100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature -NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION'LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance ofthe work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION - I hereby affirm that I am -exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code-. Any city or county which requires a permitto construct, after, improve, demolish or repair 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 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 nnalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their Sale . compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such irriorovements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- ro ve for the purpose of sale). ., I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuarit'to'the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ lam exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. !agree mply with all city and county ordinances and state laws relating to b - tl g Co.onstruction, antl hereby author ere re- Sentatives his city toAn r upon the above-mentioned pr erty Inspect 1 0 pur uses. /7/ Signatur Date Orivers' Li se or SS GMF 0865.46, rev. 10/84 17.48 4/24/85 i5, 50 Bar Sink Backflow Preventer Backfiow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO + Heating System & Ducting 1 I;0-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES ELECTRICAL FEES Showers TYPE OF CONSTRUCTION NEW LJ ADD 0 ALTERATION' LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. Zone 5 Mein Building: Accessory Building: Sewer Ca P TYPE OF PERMIT GRADING LJ FOUNDATIQ]�gI STRUCTURAL ❑ TENANT ED ELECTRICAL ❑PLUMBING lJ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION S ZONE GRADING CU.YDS. ACRES E T Front Z O B A Rear N C Right N $ Left G R Ping. Ref.# Parking Req./Provided E Remarks: Planning Notes: z M Water Closet T S Bar Sink Backflow Preventer Backfiow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO + Heating System & Ducting 1 I;0-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES ELECTRICAL FEES Showers Service Sink Automatic Washer HTransformer ❑ 15-50 KW �' Construction Pole Sub. ❑ 50+ KW Sewer Ca P Sewer Connection Cooking Unit Meter ❑up to 100amps Solar Collectors , Dishwasher Meter Cover 100 amps Solar Piping Dryers ❑Gas ❑Electric Sub Panel Solar Tank Fan Motors E10-1 HP ❑ 135 - B Swimming Pool w/Spa F.A.U. Inc. So lar El 9-15 HP 1:116-15+ Urinal Fixtures Microwave j Water Closet Device Boxes Pole Light Water Heater Outlets Range Water Service Switches-- _ Sign -Auto-Wash Garbage Disposal ; Standing sections Laundry trays Generator 00-5 KW ❑5-15 KW Trash Compactor i Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Hood or Type I ❑ Canopy Type I I ElZoning DEVELOPMENT SERVICES REQUIREMENTS: Approved By Date Building Approved 8y Date Application Issued By— Date Refrigeration System 00-100,000 BTU E1100,000BTU SUMMARY OF FEES BUILDING PERMIT $ $MIA i $ PLAN CHECK $ PERMIT { PLUMBING $ ISSUANCE $ . PLAN CHECK 25% $ ENERGY P.C. S ELECTRICAL $ GRADING S PLAN CHECK 50% $ MICROFILM S i MECHANICAL $ 13,00, TOTALFEE $ 15.50 PLAN CHECK 25% $ 2 50 System Repair/Alteration Fire Dampers Registers - - Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POOL do SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52, Pool & Equipment Location I !' .y .2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement t . o 3, Electrical Conduit Utility-Undrgrnd. 54.. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 1 �� 5. Steel Reinforcement 56. Rough Plumbing" & Pressure Test /. ,1, �' e 6. Electrical UFER Grnd. 57. APPROVAL TO COVE R-GLIN ITE 7. Footings 58. Electrical Conduit-Undrgrnd. , 8: Foundation �" 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. - A 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61..APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash &Receptor -Final , 12. Sewer Cap 63. Heater & Vent -Final 13, Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final -r 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducis, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test .72. Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 26. Lathing 8t Siding' 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 4B, Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date CITY OF"COST+.A�MESA CONSTRUCTION PERMIT Project Address LL! .(.! ] %TH _5 j r _i�' �'1 %L.1 .A Applicant's, Mailing Address Owner's NamC Phone Address Arch/Eng. License No. Address Contractor's Nam-MCkPIS S LI?c� Phone ��'`a Address (mailinglll&fa�J IYAtj l ST.1Tk,0,qfWAMA !f2Jib City License No. 3.3�!_� o LICENSEO CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and eff License Class & Llcensa g Date "4 _�12 -.3*_Signature WORKERS' COMPENSATION O£CLAR TION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) .CisI.) Policy Nofrr�L-.t bG!3 7y an 4L 10Z BCertified copy is hereby furnlshe Certifie copy Ised with the ci Bui ng vision. Date__J �V- ; Applicant L A EXEMPTION FROM WORKERS' COMPENSATION UCLARATION (This section need not be completed if the permit Is for one hundred (5100) or less). I certify that in the performance of the work for which this permit is Issued, l shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE; If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY•' I nereby affirm that there Is a construction lending agency for the performance of the work for. which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am -exempt from the Contractor's License Law for the following reason. (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). i, as owner of the'property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement i$ sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or lm - Eva forr the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law docs not apply to an owner of property who builds or. improves thereon, and _who contracts for such projects with a con- tractof(s) license pursuant*to'the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section a. & P. C. for this reason Applicant o fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. I LOT NO. I UNIT NO. Date Owner _ I hereby certify that I4have read .I information is gree to co and State la rela Ing t building sentatives o this Ity enter u inspection p rpo$ Signature Drivers' License or SS V*, sapplication and state that the above ply withcity and county ordinances nstructigtr, and hereby authorize rapre- on the ,9tYove-mentioned property for ■ . • ,1m E71 -II I z) TYPE OF CONSTRUCTION LJ NEW LJ ADD L_I ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 2# DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT LJ GRADING ID FOUNDATION EISTRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ ,OTHERA PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION S S Left ZONE GRADING CU.YDS. ACRES— Ping, Ref. # Remarks: Planning Notes: Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting 1:10- 100,000 B T U 1:1100,000 BT Reinspection Fee 1 $15 CMF 0865-46,*rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee 3 FEES Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System Do- 100,000 BTU ❑100,000 BTU System Repair/Alteration ) Fire Dampers Registers Issue Fee 1 $ 3 Automatic Washer 5822 1/10B5-- ��'g _I•L Zone Accessory Building: Parking Req./Provided ELECTRICAL Construction Pole Sub. Cooking Unit Dishwasher Dryers [:]Gas ❑Electric 'Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW ❑5-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter Uup to 100 amps Meter ❑over 100 amps Sub Panel MotorsN0-1 HP ❑ 1% - 8 Inc. Solar El 9-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES Z O N I N G R E 0 M T S Reinspection Fee PLUMBING FEES Bar Sink Backflow Preventer Showers Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection ti Clarifiers Solar Collectors Dishwasher Solar Piping — Drinking Fountains Solar Tank Floor Drains Swimming Pool wlspa ' Floor Sinks Urinal Gas Service -Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P --Trap Laundry Trays Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting 1:10- 100,000 B T U 1:1100,000 BT Reinspection Fee 1 $15 CMF 0865-46,*rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee 3 FEES Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System Do- 100,000 BTU ❑100,000 BTU System Repair/Alteration ) Fire Dampers Registers Issue Fee 1 $ 3 Automatic Washer 5822 1/10B5-- ��'g _I•L Zone Accessory Building: Parking Req./Provided ELECTRICAL Construction Pole Sub. Cooking Unit Dishwasher Dryers [:]Gas ❑Electric 'Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW ❑5-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter Uup to 100 amps Meter ❑over 100 amps Sub Panel MotorsN0-1 HP ❑ 1% - 8 Inc. Solar El 9-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES Z O N I N G R E 0 M T S Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE :$ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ LA'QO� GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE r , c $ i.�.._ `QC) PLAN CHECK 25% $ " CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date wF InspecFnr I ' 1. Temporary Electrical Service or Pale 52. Pool & Equipment Location 2, Soil-Pipe-Undrgrnd, �+Li r3 nY 53. Steel Reinforcement -3,'Electrical Conduit,Utility-Undrgrnd. �' �� 54.. Forms t 4`'Electrical Conduii=nd.;�grnd. 55. Electrical Bonding 5,IrSteel'Reinforceme t, 56. Rough Plumbing & Pressure Test 6� Electrical UFER-Grnd. 57. APPROVAL TO COVER-GUNITE 7"Footings �0 58. Electrical Conduit-Undrgrnd. t �8. Foundation ��' ' 59. Gas Pipe, ❑ Undrgrnd., Test rR 9r Water Pipe-Undrgrrui. ;.� 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10 -Structural Floor System ,'i 61. APPROVAL TO DECK 11:=Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12.,Sewer Cap ;e- �y 63. Heater & Vent -Final r 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydra 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 307;Drywall Nailing HEALTH DEPT. REQUIREMENT 31'., Plaster Brown Coat 79. FINAL INSPECTION 32, Electrical Power Meter -Final - 80. FOOD CERTIFICATE ISSUED 33. Final Electric 1, 0 Notes: 34• Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Mood or Canopy 37, Final Factory Fireplace 38, Final Plumbing 39, Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations , 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY N, n. Date - Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. 9919 3/25/95 10950 TI. CITY OF COSTA MESA CQj�l$T TIO PERMIT Project Address �� tYY , - _ r — i� / nna �w. �•+• y[YI VVI J�. ! Of,Applicant's Mallin Address ` (c OWner's Name Phone Address Arch/Eng, License No. Address Contractor's Name' Phone Address (mailing) City License No. „ LICESED CONTRACTOR DECLARATION N 1 hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is In f for n effect. �J IJcen a Class Licens0 No. -C �-� • bate Signature 0 TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P.906 Zone S Main Building: Accessory Building: TYPE OF PERMIT LJ GRADING D FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRESR E T Front Z O A Rear N C Right N K S Left G Ping. Ref. # Parking Req./Provided E Remarks, Planning Notes: O M T S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES WORKERS' COMPENSATION OEC RATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW __d❑ 50 + Kw -,of Workers' Compensation Insurance, or a certified copy thereof (Section 3aoo, Lab. c.) Policy No. Company Certified copy Is hereby furnished. BCertified copy is filed with the City Building Division. �, Date Applicant ' EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit I$ for one hundred (E100) or less). ! certify that in the performance of the work for which this permit is Issued, I shall not employ any person In any manner o as to become subject to the WorkeLS' Camgen t Laws of Calito a. _ Date *� _/,�' Signature 'NOTICE: If, after making this deClara n, you should become subject to the Workers' Compensation provisions o the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ, C.) Lender'$ Name Backflow Irrigation Sewer Cap Bathtubs Sewer Connection - Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps Dishwasher Solar Piping Dryers []Gas ❑Electric Sub Panel Drinking Fountains Solar Tank r Fan Motors ❑0 7 HP ❑1 h - 8 Floor Drains Swimming Pool w/Spa _ F.A.U. Inc. Solar 09.15 HP ❑16-15+ Floor Sinks Urinal Fixtures Microwave ! Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink ( Water Service Switches Sign Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any City or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sola compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: -The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. 11, however, the building or Improvement Is sold within one year of com- pletion. the owner will have the burden of provinO he/she did not build or Im- prove for the purpose of Salo). ❑ I, as owner of the property, am exclusively contracting with licensed con -Duct tractors t6 construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves, thereon, and _who contracts for such projects with a con- rLicense Law). I am aware that ' tractor(s) license pursuarit'to the Contractors Proof of their worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Lavatories Auto -Wash Garbage Disposal ;Standing Sections P—Trap Laundry Trays Generator 00.5 KW 05.15 KW Trash Compactor P Roof Drains Reinspection Fee $15 Issue Fee $ 3 i 1 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Data Building Approved 8y —Date Application Issued By , ,�___ —Date. Boiler Hood or Type I ❑ Canopy Type 11 ❑ Duct - Under Ground - Structural Refrigeration System 110-100,000 BTU ❑100,000 BTU Duct - Ventilating SUI LDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 2596 SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ $ GRADING $ $ MICROFILM $ $ c� TOTAL FEE $ $ Exhaust System ❑ Multiple El System Repair/Alteration Firepl/Fact. Bit. ICBG # Fire Dampers Date Owner 1 hereby certify that I have read this application and state that the above information is correct. I agree to comply with at city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this City to priter upon the above-mentioned property fin inspection%�- purpo Signature Date Drivers' Lice or SS Heating System & Ducting ©0-100,000 BTU 0100,000 BTU Registers Reinspection Fae $15 Issue Fee $ 3 AF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CON�TRUCTION•AND PLANNING APPROVALS Permit # Lfi 11 Date InspectorDate POOL, SPA APPROVALS ' Permit + Inspector .1. Te;nporary Electrical Service or pole 52. Pool & Equipment Location 2. Soil. Pipe-Undrgrnd. � t � 53. Steel, Reinforcement ' a Electrical Conduit Utility. Undrgrndt .. L, ��.14 54. Forms _ 41 Electrical Canduii-Unit grnd. rt 55. Electrical Bonding 5., Steel ReinforcemenIf _ � 56. Rough Plumbing & Pressure Test •' ;' 6; Electrical UFER'G�d. 57. APPROVAL TO COVER-GUNITE F, ;7 Footings ,r "A 4 58. Electrical Conduit-Undrgrnd. 8 Fpundation{ ! �-�+ �"� 59. Gas Pipe, ❑ Undrgrnd., Test w 9. Wat e�Pipe-Und'lnd. if .11 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10 tSLr,,uctural Floor System " ` 61. APPROVAL TO DECK _1.1/1 Pperty Sewer Line & House Connection 4 � 62. Backwash & Receptor -Final � 112! Seirver'Cap -► �. 63. Heater & Vent -Final J 13. Roof Drains .64. Plumbing System - Final �w 101Rough Plumbing 65. Electrical -Final }-v 15. -Rough ElectricalConduit }. 66. Solar System Final j6, Rough Electric Wiring i 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 APPROVALS Permit` 20.' Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25.Roof Sheathing 74. Overhead Hydro ' 26..T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and .Flashing 76. Dry Standpipe 213. 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, S��/�`• [,t,p 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final _ 42. Backflow Preventer 43. Backflow Irrigation; 44. .Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison r 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF'OCCUPANCY No. Dafe _. , 13 W Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITYOF COSTA MESA CONSTRUCTION PERMIT Project Address 711 W: 17th St Bldg. (B) UNit 4 Applicant's Mailing Address13110�Saticoy St. N.Hollywood, Owner's Name Troy Investment Fundphone 549 2988 Address 4321 Birch St. Newport Beach, Ca. Arch/Eng. —Malin J.Rock —License No. Address 12881 Knott Ave. ' Suite 216 Contractor's Nam it Conditioning Phone 982--1216 Address (mailing) 131I0 Saticoy St. N.Holl ytaood, Ca. City License No. 33925 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in full fo and effect 346251 License Class.tee e Date 4113/$4 Signature WORKERS' COMPENSATION De RATION - I hereby affirm that I have a certte of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C•) WC9824 Lumbermans Policy No. Company Certified copy is hereby furnished, Certs I a c y is filed with the city Buil ng Dlvisia f ' Date Applicant_��-� ��y EXEMPT) N FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or I certify that in the performance of the work for which this permit is issued, I shalt not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. . Date - Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shalt be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) en Lder's Name _ Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or'repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 1031.5 by any applicant for - a permit subjects the applicant=to a civil penalty of not more than five hundred dollars ($500).. �❑ I, as owner of the property 'or my employees with wages as their sole .compensation will do the work, and the,structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, andrwho does such work himself/herself or through his or her own employees, provided that such, Improvements are not.intended or offered for sale. if, however, the building or improvement is'sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale) - El I, as owner of the property, am exclusively contracting with licensed con- tractors t6 construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who buiids or improves thereon, and who contracts for such projects with a con- tractors) license pursuarit•to the Contractor's License Law). I am aware that proof,of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section I H. & P. C. for this reason Date owner I hereby certify that I have read this application and state that the above nformation is correct, 1 agree to comply with all city and county ordinances and state laws relatingto bu' ng construction, and hereby authors a rep e- ientative his 'city to r upon the above-mentioned erty or nspectI ur oses. .L Signature �� ate Drivers' nse or SS 1749 4/24/65 15o50 TL PERMIT NO. _ TRACT NO. LOT NO. UNIT,N , TYPE OF CONSTRUCTION LJ NEW LJ ADD -LJ ALTERATION LJ REPAI ❑ CONVERSION ElOEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. ' R A.P. qlf: Zone S Main Building: Accessory Building: TYPE OF PERMIT Li GRADING 0 FOUNDATIn STRUCTURAL El TENANT ElELECTRICAL 1:1 PLUMBING rLMECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT, OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES E T Front Z Q A Rear - N C Right N S I Left R Ping. Ref. # Parking Req./Provided is E Q Remarks: Planning Notes: M T PLUMBING FEES Bar Sink Shower's ELECTRICAL FEES Backflow Preventer - Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW' ❑ 50 + KW Backflow Irrigation i Sewer Cap Bathtubs Sewer Connection Cooking Unit . Meter ❑up to 100 amps Clarifiers Solar Collectors >" Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric iSub Panel Drinking Fountains Solar Tank f` Fan Motors 00-1 HP ❑1 A - 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 HP ©16.15+ Floor Sinks ` Urinal Fixtures Microwave " Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator ❑0-5 KW E) 5-15 KW Trash Compactor Roof Drains -. r Reinspection Fee $15 Issue Fee _ $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By at Boiler Duct - Under Ground Hood or Type 1 ❑ Canopy Typell ❑ Duct - Structural Refrigeration System ❑0-100000 BTU ❑i00,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY $ $ $ $ $ $ $ 13.00TOTAL $ 2'. OF FEES SMIP $ RMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ FEE $ 15 .50 50. Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. )CBO # Fire'Dampers 1 Heating System & Ducting IJO700,000BTU ❑100,0006I U Registers 6 00 4 00 ' Reinspection Fee $15 ; Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS - Permit # date _ ' Inspector POOL - SPA -APPROVALS Permit # Date Inspector 1. T%-nporary 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 f 56. Rough Plumbing & Pressure Test 6• Electrical LIFER Grnd. t 57. APPROVAL TO COVE R-GUNITE r7. Footings 58. Electrical Conduit-Undrgrnd.: 8' Foundation L , 59. Gas Pipe, ❑ Undrgrnd.; Test 9. Water Pipe-Undrgrnd. ,•' 60. Backwash Lines, P-Trap, 0 Undrgrnd., 110.,Structural Floor System ', 61. APPROVAL TO DECK ~" 11. Property Sewer Line & House Connection 62. 8ackwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 1.3. Roof Drains 64. Plumbing System - Final _ 14, Rough Plumbing 65. Electrical-Final t 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71: Product Piping []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 PREY, FINAL 30, Drywall Nailing HEALTH DEPT, REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 1.2 f ey- 1j,;z 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41, Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation, 44. .Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed ' + 49. Electric Release to Edison - -. 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date _67_r Applicant to Fiji In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF"COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT Mn. LOT NO. UNIT Nb Project Address 711 % 7 wsT Applicant4Mailin Address ��i ,tel Y`+ tj ltd i �'1 Owner's Name % S t — —Phon Now Address Arch/Eng. License No. Address Contrac10r's Nam C hone Address (mailingJq L5_/1&Y4.-' City License No. _ 331(3 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the aMsiness and P fesslon Code, and my license is in fulE rce and off License Class t' License Date r'") Signature WORKERS' COMPENSATION DECLARATION _ I hereby affirm that I have a certificate of consent to self -insure or a certificate sof Workers' Compensation Insurance, or a certified copy thereof (Section 38, Lab Policy N o F) ' O 91 7thC7` eCertified copy is hereby furnishe ` Certified copy isliled with the cf Buil Ing ❑ islon. Dater¢ -S Applicant EXEMPTION FROM WORKERS' COMPENSA ION D CLARATION (This section need not be completed if the permit is for one hundred ($100) or - less). I certify that in the performance of the work for which this permit is issued 1 shall not employ any person in any manner so as to become subject to tie Workers' Compensation Laws of California. Date; Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's. License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Oivision 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 malty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for Sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im - rove efor the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- tractorsto construct the project (Section 7044, Business and Professions Code: The Contractor's License tow does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a con- tractor(s1 license pursuant'to the Contractor's License Law). 1 am aware that proof off their worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Oate Owner I hereby certify that I have read this application and state that the above information is torr agree to c0 ply wi ali city and county ordinances and state ws ting pp building onstruc o , and hereby authorize repre- sentative of t +s city t0 enter on the a ove-mentioned property for inspectio urp S. Signaturev___ Date b Drivers' License or SS =P r TYPE OF CONSTRUCTION LJ NEW LJ ADD U ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 4L DESCRIPTION OF WORK/USE OF BLDG. S Main Buiidi E TYPE OF PERMIT LJ GRADING 11 FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ -OTHER A PROJECT DESCRIPTION SO. FT. OCCUPANCY C Right K' CON STRUCTION TYPE VALUATIONS S I Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks: I Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee Showers Service Sink Sewer Cep Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal ' Water Closet Water Heater Water Service Auto -Wash Laundry Trays $15 Issue Fee MECHANICAL Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Fjrepl/Fact. Bit. ICBO # Heating System & Ducting ; ❑0-100,000 BTU ❑ 100,000 BT Reinspection Fee I $i5 CMF 0865-46, rev. 20/B4 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type 1 ❑ Canopy Type If ❑ Refrigeration System ❑0-100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers' Registers Issue Fee FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric 5623 1116/65 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW _k_� ❑ 50 + KW Fan , F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW 05.15 KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors 1 HP ❑ 1'h 8 Inc. Solar 09.15 HP 1-116-15+ Microwave - Pole Light Range Sign Standing Sections Trash Compactor La 50 TL FEES Z O N I N G R E Q M T S '3 3 Reinspection Fee $15 1 1 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved, By Application Issued BY Date Date Date BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50%'$ MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ I $ $ bU • $ $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ 1 r $ 3 'POO ' CONSTRUCTION AND PLANNING APPROVALS Permit # _ Date Inspector � c, SPA APPROVALS Permit # Date Inspector ' 1. Tevmporary Electrical Service or Pole !; 52. Pool & Equipment Location 2. Soil' Pipe-Undrgrnd 53. Steel Reinforcement 3�Electrical Cond�3it Utility Undrgrnd. } i 54. Forms 4.. Electrical Conduits-Undigrnd. !=J 55. Electrical Bonding .5!Steel` Reinforcemenf 56. Rough Plumbing & Pressure Test C, 6., Electrical UFERIG end. 57. APPROVAL TO COVER-GUNITE 7Footings t: ^y 56. Electrical Conduit-Undrgrnd. -Bc1Fou dation r� y 59. Gas Pipe, ❑ Undrgrnd., Test 9'. „Water Pipe-Undrgrnd, N 60. Backwash Lines, P -Trap, Undrgrnd. I f -10'.'Structural Floor System 61. APPROVAL TO DECK 1 It Wroperty Sewer Li `.-& House Connection Ire 62. Backwash & Receptor -Final 12.tiSeW Cap ? 63. Heater & Vent -Final 13. Rao Drains r '-' i ,.5 ' h.r m 64. Plumbing System Final 14. Roug' Pfumbing ' . 65. Electrical -Final V 15, Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 66. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REOUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydra 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 7B. FIRE PREV, FINAL 30., Drywall Nailing f, HEALTH DEPT. REQUIREMENT 311. Plaster Brown Coat 79. FINAL INSPECTION 32} Electrical Power Meter Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating'& Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39, Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. .Landscape Irrigation System 45. Sound Attenuation 46, Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison '50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No, Date , Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 9920 3/25/85 10.50 TI. CITY O.FvCOSTA MESA TION ERMIT P RMIT N k / / 7 TRACT NO. LOT NO. 1 UNI I T 6, CONSTRU T'roiect Address V. _L_ --- s Applicant's Mallin Address 1 Q 0C_Xl Owner's Name hone Address TYPE OF CONSTRUCTION NEW ADD ALTERATION ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. REPAIR A.P. # Zone S Main Building: Accessory Building: Arch/Eng. License No. Address TYPE OF PERMIT LJ GRADING 1:3FOUNDATION C1 STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ -OTHER PROJECT DESCRIPTION Sq. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU. VDS. ACRES E T Front Z O B Rear N I Contractor's Nam e52 Phone:?77 � V / Address (mailing) / l� b� ��..�} City License No. _ LICENSED CONTRACTOR DECLARATION A C Right h1 $ Left (, Ping. Ref. # Parking Req./Provided E Q Remarks: Planning Notes: M 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force nd effect. Lice Class License No.�C��s-- - Dat Signatur - T S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES WORKERS' COMPENSATION RATION I hereby affirm that I have a certificate of consent to self -insure or a certificate Backflow Preventer Service Sink Automatic Washer Construction Pole Sub, Transformer ❑ 15-50 KW ❑ 50 + KW of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. Company "� eCertified copy is hereby furnished. = Certified copy is filed with the city Building Division. Backflow Irrigation Sewer Cap Bathtubs Sewer Connection - Cooking Unit Meter ❑up to 100 amps Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION �- (This section need not be completed if the permit Is for one hundred ($100) or less). � ., I certify that in the performance of the work for which this permit is issued I1 shall not employ any person in any manner so as Wbecome subject to the: Work ' Co ens Laws of Califon Date r Signature NOTICE: If, after making this declarat you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name L Clarifiers Solar Collectors Dishwasher Meter ❑Over 100 amps' Dishwasher Solar Piping dryers ❑Gas ❑Electric - Sub Pane( Drinking Fountains Solar Tank Fan Motors E10-1 HP Ell 'A - B Floor Drains Swimming Pool vv/Spa F.A.U. Inc. Solar E19-115 HPE)16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service lOutlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 LJenalty of not more than five hundred dollars ($500), I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work hlmself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden Of proving he/she did not build or lm- rove for the purpose of sale). nI, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuarii to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me, ❑ I am exempt under Section B. & P. C. for this reason Lavatories Auto -Wash Garbage Disposal Standing Sections P—Trap Laundry Trays Generator 00.5 KW 05-15 KW Trash Compactor Roof Drains Reinspection _Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL Boiler FEES Hood or T e l ElDEVELOPMENT yP Canopy Type I I ElZoning SERVICES REQUIREMENTS: Approved By Date Building Approved By Date Application Issued By III Duct - Under Ground Duct - Structural Refrigeration System ❑0-1.00,000 BTU 01100,000BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING CHECK 25% ELECTRICAL PLAN CHECK 5096 MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ , $ PERMIT $ 17, $ $ / S ENERGY P.C. $ $ GRADING $ $ MICROFILM $ $ t/f TOTAL FEE $ $ Exhaust System ❑ Multiple El System Repair/Alteration _ Firepl/Fact. Bit. ICBO # Fire DampersISSUANCE Date Owner I hereby certify that I have read this application and state that the above Information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for Inspection purpos Signature � Date 2 - Drivers' Licen or SS Heating System & Ducting ❑0.100,000 BTU El 100,000 BTL RegistersPLAN Reinspection Fee $15 • Issue Fee S 3 Goldenrod - Assessor :MF 0865.46, rev. 10/84 White - Building; Canary - A pllcant; Pink - Accounting; CONSTRUCTION AND PLANNING - APPROVALS Permit # `� Date Inspctor POOL & SPA - APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole., : 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd.,t 1 53. Steel Reinforcement 3'-Undrgrnd. ni 54. Forms 4 Ele icai Conduit-tJr{drgmd. 55: Electrical Bonding n 9 'v 55 �%el+Reinforceme�t -- 56. Rough Plumbing & Pressure Test a� 6� lectrical OFER,Grn d. L� 57. APPROVAL TO COVER GUNITE n 7r s Footin rj x � g �_ � 58. Electrical Conduit-Undrgrnd. i .1 Fpu�ation r 59. Gas Pipe, ❑ Undrgrnd., Test f el 9. At& Pipe-UndfTr d. � � 60. Backwash Lines, P -Trap, ❑ Undrgrnd. � } _1O)St}•uc#ural Floor System + 61. APPROVAL TO DECK - 11 � operty Sewer Cine & House C rn ction 3 62. Backwash & Receptor -Final 12. SeWer,Cap �1 63. Heater & Vent -Final v� 1`3!� � oeDrains � 64. Plumbing System - Final S 147 Rough PlumpinA �/ 9T_ 4X0 65. Electrical -Final .'V 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:'DE;PT. REQUIREMENT APPF40VALS Permit # 20: Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd- Stdrage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro .26.'T -Bar Ceiling jStructurali & 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 �ly� Cab 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final r ,� 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 e, 48. Special Requirements Completed ; 49. Electric Release•to Edison ' 50. Gas Release to Southern California Gas Co " 51. CERTIFICATE OF OCCUPANCY No. Date ' M 0) Cf Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT . Project Address -711 W. 17 th St Bldg. (B) Emit 5 Applicant's Mailing Address' 13100 Saticoy St. N.HDllywood' Owner's Name _ Troy. Investment Fund phone 549-121 Address4321 Birch `St.- Newport Beach, Ca. Arch/Eng. 'Marin J. Rock License No. Address 12881 Knott Ave. Suite 216 Contractor's Name Duco Air Conditioning Phone 982-1216 Address(mailing)- 13110 Saticoy St. N. Hollywood, Ca. City License No. 25 ^ LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 ofhe Business and rofessions Code, and my license is In full fDrce,and effec 346251 License Class G LU Date ' 411P84Signature WORKERS' COMPENSATION DE ARATION I hereby affirm that I have a certifl to of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) WC9824 Lumbermans Policy No. Company ®Certified copy is hereby furnished. Dateertifi opy is filed wiAtpPhca city Building Qlvisioryi I� EXEMPTION FROM WORKERS' COMPE{NJS�AT[�I,O�N DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less), I certify that in the performance of the work for which this permit is Issued I shalt not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit ; shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's'Address OWNER BUILDER DECLARATION 1 hereby affirm -that I am exempt from the Contractor's'License Caw for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 enay of not more than five hundred dollars {$500). ' J HI, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License law does not apply to an owner of a property who builds or Improves thereon, and who- does such work himself/herself or through his or her own employee$, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of Com- pletion, the owner will have the burden of proving he/she did not build or Im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project(Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who 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 proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for tpis reason Date Owner ;— I hereby certify that t have read this information I rrect. t agree to Com and state s r toting to building c sent of ih s city tsnte u inspec rp s. �Gsw Signature Drivers' Li se or SS fit ppcation and state t with all city and couJ •uction,.and hereby ;rr the above-mentio d fR P TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LI REPAIR ❑ ❑ ❑ Bar Sink Showers CONVERSION DEMOLISH OTHER Service Sink A P DESCRIPTION OF WORK/USE OF BLDG, Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher S Main Building: Solar Tank Floor Drains. Swimming Pool w/Spa Floor Sinks FUNDATiON TYPE OF PERMIT GRADING O STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING IN MECHANICAL B Lavatories _ ❑ -OTHER P—Trap A Rear PROJECT DESCRIPTION SQ. FT. OCCUPANCY C K Right CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: $ 15..50' Planning Notes= above Inances 9 repre- rtw for 1 Reinspection Fee I $15 Boiler ' Duct - Under Ground, Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO Heating System & Ducting UO -100,000 BTU ❑ 100,000 BTL Reinspection Fee I $15 RF 0865-46, rev. 10/84 White - Building; Canary - Applicant; pink - Accounting; Goldenrod - Assessor FEES Issue Fee I $ 3 FEES Hood or Type ❑ Canopy . Type 11 ❑ Refrigeration System • E10-1 00,000 BTU ❑ 100,000 BT System Repair/Alteration Fire Dampers Registers Issue Fee I $ 3 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas ©Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW ❑5.15 KW Transformer ❑ 15-50 KW' ❑ 50+KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0-1 HP ❑ 135 - 3 Inc. Solar 09-15 HP El 16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES Z O N I N G R E O M T S I Reinspection Fee 1 $15 1 { -Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: - PLUMBING Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains. Swimming Pool w/Spa Floor Sinks Urinal Gas Service ' Outlets Water Closet Interceptors Water -Heater Kitchen Sink r - Water Service Lavatories _ Auto -Wash P—Trap Laundry Trays Hoof Drains - ELECTRICAL above Inances 9 repre- rtw for 1 Reinspection Fee I $15 Boiler ' Duct - Under Ground, Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO Heating System & Ducting UO -100,000 BTU ❑ 100,000 BTL Reinspection Fee I $15 RF 0865-46, rev. 10/84 White - Building; Canary - Applicant; pink - Accounting; Goldenrod - Assessor FEES Issue Fee I $ 3 FEES Hood or Type ❑ Canopy . Type 11 ❑ Refrigeration System • E10-1 00,000 BTU ❑ 100,000 BT System Repair/Alteration Fire Dampers Registers Issue Fee I $ 3 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas ©Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW ❑5.15 KW Transformer ❑ 15-50 KW' ❑ 50+KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0-1 HP ❑ 135 - 3 Inc. Solar 09-15 HP El 16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES Z O N I N G R E O M T S I Reinspection Fee 1 $15 1 { -Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: - Zoning Approved By Date Building Approved By Date Application Issued By DilleZ SUMMARY OF FEES BUILDING PERMIT S SMTP S PLAN CHECK $ PERMIT PLUMBING 5 ISSUANCE S PLAN CHECK 25% S ENERGY P.C. $ ELECTRICAL S GRADING $ PLAN CHECK 50% S MICROFILM . $ MECHANICAL $ 13.00 TOTAL FEE $ 15..50' PLAN CHECK 25% $ '3 CONSTRUCTION AND PLANNING APPROVALS . Permit # Date Inspector POOL SPA APPROVALS ' Permit # Date Inspecrnr 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ` 2. -Soil Pipe-Undrgrnd. 53. -Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms - -4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ;5..Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. +, �� 57. APPROVAL TO COVER -GUN ITE 7. Footings 1 58. Electrical Conduif Undrgrnd, i 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test f% 9. Water Pipe-Undrgrnd. r 60. Backwash Lines, P -Trap, ❑Undrgrnd. �f ' '10. Structural Floor System 61. APPROVAL TO DECK I ,11. Property Sewer Line & House Connection 62. Backwash &Receptor -Final ' ��• 12. Sewer Cap 63. Heater & Vent -Final -4 . 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. POOLISPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75, Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30.. Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32.- Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39, Water Service -Final 40. Gas Service -Final 41'. Solar domestic -Final 42. Backflow Preventer -43. Backflow Irrigation 344. Landscape Irrigation System 45. Sound Attenuation +46. Handicap Regulations X47 FINAL STRUCTURE & BUILDING 148. Special Requirements Completed 49. Electric Release to Edison ti50.- Gas Release to Southern California Gas Co ,x,51. CERTIFICATE OF OCCUPANCY fVo. Date _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 504 1/16/05 ale 30 %-/ TRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. CITY Of COSTA MESAkm "Project Address l l TrJ �s �M M " Applicant's MaiIIiAAddress Owner's Nae /-*-`C'i -Z J J fzS 7 M(Z,%,o , Nam - Phone Address Arch/Eng. License No. Address Contractor's Name JMQ8R4l- il:LICTIA IC- Phone R!)7"-c$tro Address (mailing)Wrt'r ar rin.,-T S' Q,c�.:.i++f.w�,io/++ 23J City License No. _ 5C3 - LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. �a:3 Licens .�Cllasss �-110- - License No. A Date r Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section Lab. !!G ^7 Policy No. 4 �•� Polic / Company �� ej eCertified copy is hereby furnishe Certified copy i ed with the ci�Bunqvision Date til O -- Applicant EXEMPTION FROM WORKERS' COMPENSATION bECLARATION (This section need not be completed if the permit is for one hundred (5100) or less). I certify that in the performance of the, hlch !hi permit issued, I shall not employ any person in any ann s0 S to bac me $u j t to the Workers' om ansa Laws of Callt rnl Date �� r Signature 'NOTICE: If, after making this declaration, you shoultl become subject to the Workers' Compensation provisions of the Labor Cod , you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any Structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that' he/she is exempt therefrom and the" basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a properly who builds or Improves thereon, and who does such work himself/herself or through his or her own employee$, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build Or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 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 proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Dat Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply ith all city and county ordinances and state la to building co_nstr ion, and hereby authorize repre- sentatives f th s ity o enter up n h above-mentlonetl property for Inspection purpo �O ��— Signature Date Drivers' License Or q¢ TYPE OF CONSTRUCTION LI NEW LJ ADD LJ ALTERATION L REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.Zone DESCRIPTION OF WORK/USE OF BLDG. 5 Main Building: Accessory Building:. E TYPE OF PERMIT LJ GRADING 0 FOUNDATION 11 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SG. FT. OCCUPANCY C Right K , CONSTRUCTION TYPE VALUATION 5 SI Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Parking Req./Provided Remarks: Planning Notes: Reinspection Foe I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO �W Heating System & Ducting 00-140,000 BTU ❑100,000$T , I Reinspection Fee 1 $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor MEC Issue Fee Hood or Type ❑ Canopy Type 11 ❑ FEES Refrigeration System CIO-1100,00OBTU 0100,0008T System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 ELECTRICAL FEES Z 0 N I N G R E M T S Automatic Washer Construction Pole Sub. PLUMBING Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool wlSpa Floor Sinks Urinal Gas Service Outlets Water Closet interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains $15 Reinspection Foe I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO �W Heating System & Ducting 00-140,000 BTU ❑100,000$T , I Reinspection Fee 1 $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor MEC Issue Fee Hood or Type ❑ Canopy Type 11 ❑ FEES Refrigeration System CIO-1100,00OBTU 0100,0008T System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 ELECTRICAL FEES Z 0 N I N G R E M T S Automatic Washer Construction Pole Sub. H.Transformer ❑ 15.50 KW ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter El over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan /Motors RD -1 HP ❑ 1 % - S QQ 74 F.A.U. Inc. Solar ❑9.15 HP C1 16-15+ Fixtures Microwave Device Boxes Pale Light Outlets Range Switches Sign Garbage Disposal ! Standing Sections Generator ❑0.5 KW 05-15 KW Trash Compactor Reinspoction Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By SUMMA OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.C. ELECTRICAL •5� GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ S $ S 'CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspecrnr 1. Temporary Electrical Service or Pole ,� �� ' 52. Pool & Equipment Location 2. Soil=Pipe-Undrgrnd., s i 53. Steel Reinforcement 3'7E1ectrical Conduit Utility-Undrgrnd. r, r i 54. Forms 4`lElectrical Conduit-Un`d grnd, r 55. Electrical Bonding �Steel;Reinforcement! �;� 56. Rough Plumbing & Pressure Test ,. Electrical UFER,Grnd. 57. APPROVAL TO COVER -GUNITE 7. Footings tZ 1 58. Electrical Conduit-Undrgrnd. T $, �Fouridation ! 59. Gas Pipe, ©Undrgrnd., Test � r 9"Wate? Pipe-Undr6RO. 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 112.lSewer Cap 6e R 63. Heater & Vent -Final i 13.7"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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas 0Oil 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 3QiDrywall Nailing HEALTH DEPT. REQUIREMENT 31., Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Com- Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer .r 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 0 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. ITi' a*.CosTA*7�V�I sAM1 e•Ct�1ST UTI N P�tr►�RMIT PER 411[_IT NO. `� TRACT NO. LOT NO. UNIT Nb. "Proje��gddress r r U). ! t,OS j* i GS A � 7 y ; "piicant's Mailing Address• i r TYPE OF CONSTRUCTION NEW ADD 71 ALTERATION REPAIRAPR ' ❑ CONVERSION 1:1 DEMOLISH Owner's Name9 140 14, is ` SD Phon 7 El OTHER A.P.# pi.. Zone / DESCRIPTION OF WORK/USE OF BLDG. Address V1 -aI �k2h'a �`"Y e kR�]f� ►� S Main Building: Access ' g Y ilAr Arch/Eng. License No. TYPE OF PERMIT GRADING FDUNDATION STRUCTURAL T Front ZO ❑ Address TENANT ❑ ELECTRICAL 1:1PLUMBING 11MECHANICAL B Rear N OTHER A Contractor's Nam OCCUPANCY Phone ❑ PROJECT DESCRIPTION SQ. FT, C Right N Address (maili,,gl CONSTRUCTION TYPE VALUATIONS S Left City License No. ZONER LiC6iSED CO►` TRACTOR DECLARATION GRADING CU. vpS. ACRES Ping. Ref. ;i� Parking Req,/Provided E I hereby afflrrs that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes; Q with section 7000) of Division 3 of the Business and Professions Code, and M my license is In full force and effect, , T License Class License No. S Date— Signature PLUMBING FEES WORKERS' COMPENSATION DECLARATION Bar Sink Showers I hereby affirm that I have a certificate of consent to self -insure or a certificate ELECTRICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 3800, Lab. c.) Automatic Washer Transformer El 15-50 KW Policy No. Company Backflow Irrigation Sewer Cape ❑ 50 + KW Certified copy is hereby furnished. COnStructiDn Pole Sub. Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Rate Applicant Clarifiers EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Solar Collectors Dishwasher Meter Cover 100 amps (Thissection need not be completod if the permit is for one hu dred ($100) or less). Dishwasher Solar Piping Dryers ❑Gras ❑Electric Sub Panel i certify that in the performance oft ork for which this rmit is issued, I shall not employ any person in an ma ner so as•to beco a eCt to the Drinking Fountains Solar Tank Fan Worker y�Co pens�yte� Laws oT Cal orni Motors ❑0 1 HP ❑1 h - 8 Date ?=��r� -r / Signature Floor Drains Swimming Pool w/Spa F.A.U. NOTICE: if, after making this declara ' , you show become subject to the Inc. Solar 09.15 HP ❑16-15+ Workers' Compensation provisions O e Labor ode, you must forthwith Floor Sinks Urinal Fixtures Microwave comply with such provisions or s permit shall be deemed revoketl. CONSTRUCTION LENDING AGE CY Gas Service Outlets Water Closet Device Boxes p I hereby affirm that there Is a construction lending agency for the performance ole Light of the work for which this permit Is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Ran Lender's Name Range Lender's Address - Kitchen Sink Water Service OWNER BUILDER DECLARATION Switches Sign I hereby affirrn that I am exempt from the Contractor's License Law for the Lavatories Auto -Wash following reason (Sectlon 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—Tra any structure; prior to its issuance, also requires the applicant for such permit p Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor to file a signed statement that he/She is licensed pursuant to the provisions of Roof Drains the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by arrY applicant for a permit subjects the applicant to a civil e any of not more than five hundred dollars ($500). I, as owner of the property Reinspection Fee S15 Issue Fee $ 3 I I4wilt do the work, and the structure is not Intended or offered Reinspection Fee S15 Issue Fee S 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 awn 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 11 ❑ Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or Im- Duct - Under Ground prove for the purpose of sale). Building Approved By Date ❑ I, as ownef of the property, am exclusively contracting with licensed con- Duct - Structural Refrigeration System Application Issued By- 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 130-1100,000BTU ❑ 100,000 BTU build$ 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 ❑ Multiple 11 System Repair/Alteration BUILDING PERMIT $ SMIP$ proof of their Worker's Compensation insurance should b provided to me. PLAN CHECK $ PERMIT C1 am exempt under Section B. & C. for this reason Firepl/Fact. Bit. ICBO # Fire Dampers PLUMBING S ISSUANCE $ Date Owner Heating System &Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ 1 hereby certify that I have re his applicati n nd State that the above 00-100,000 BTU ❑100,000 BT GRADING $ Information is correct. I agree t omply with all city and county ordinances ELECTRICAL $ and state s relating to buildl g co str ction, and hereby authortxa repre- PLAN CHECK 50% 5 MICROFILM $ sentativ0 p this city tp ter u n e above-mentioned p opertt Inspectio ose5. ��''t Signature Data MECHANICAL S TOTAL FEE , $ K/'� Drivers' i nse or SS Reinspection Fee 515 Issue Fee $ 3 PLAN CHECK 25% $ GMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3, Electrical Conduit Utility-Undrgrnd. 54. Forms 4, Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9, Water Pipe-Undrgrnd: 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater.& Vent -Final 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOLJSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating , - : 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe Rough &Test 72. UndeE round Flush 24. Roof Framing ;,s 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat ; ' 7-5 Dty Chemical 27. Frame and Flashing 76.''Dry.Starid pipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation r.� 78. FIRE RREV. FINAL 30, Drywall Nailing ` HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 78,. F.1NA•L INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric 7 Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36.. Hood or Canopy 37: Final Factory Fireplace 38: -Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final r 42. Backfiow Preventer „43. SBackflow Irrigation - - ,'44: Landscape Irrigation System Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special'Requirements Completed � 49."'Electric'Re lease to Edison G 50, Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY X, No. Date ,, r, City of Costa Mesa Development Services Department Building Safety Division CERTIFICATE OF OCCUPANCY No. Go"L i 35 P. O. Box 1200 Costa Mesa, California The Building located at 711 inj_ 17_}11 gt.rpet Atlllciina B6 has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B2 Occupancy. Use of Building Commuter room, lunch room dressing room, and shower Legal Description 424-091-11 (See reverse side for Metes and Bounds) REP25119 B$P25119 Building Permit NoBEP25119 Electrical Permit No.E17118 Plumbing Permit No, P18118 Mechanical Permit No. M18583 Number of apartments and/or guest rooms Building ti i ISSUED TO: Building Of _.•_ c` -t Trov Investment Fund 4321 Birch Street by f Newport Beadh , CA Date f �� 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 L N IN Applicant; to fill in all spaces except those within heavy border tines and sign all appropriate declarations. - P MIT O TRACT NO LOT NO UN T O CITY OF COSTA MESA CONSTRUCTION P R�T_' 2�~ ��p SUMMARY OF FEES I . N Meter ❑up to 100 amps 77 Date Owner I hereby certify Cha have read this informatlon is corro agree tv c mp and state laws relati to building c sentatives of this t to enter o inspection purpo p. Signature OL Driverrs' License or SS qr _ _ ___ _ application and state that the above with all city and county ordinances truction, and hereby authorize repre- the above-mentioned property for Date ftp $ ' Project Addresslih Sub Panel PLUMBING Fan F,A'.U. Reinspection Fee $15 TYPE OF CONSTRUCTION NEW LJ ADD KALTERATION LJ REPAIR Applicant's Mailing Address ❑'CONVERSION 1:1 DEMOLISH 1:1 OTHER Owner's Name , 702 114 0 Phone ./ `1 DESCRIPTION OF WORKIUSE OF BLDG. Address Y Q Garbage Disposal Arch/Eng. G License No. C-6jCDj TYPE OF PERMIT r LJ GRADING El FOUNDATION LJ STRUCTURAL_ annal 131e-- TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL Address Gl% - Contractor's Name Ute' r� a El OTHER $ PROJECT DESCRIPTION Sp. FT. 592110 OCCUPANCY B - Z Address imailing) y COfVS7RUCTION TYPE � _VALUATIONS -- City License No. `C = ZONEGRADING CU.YDS. ACRES...'�- LICENSED CONTRACTOR OEGLARAT -L ••' ' ;t I hereby affirm that I am licensed under ro islons of Charter 9 (commencing: Remarks: e- 9 -s�(p A with section 7000) of Division 3 of th Bu iness and Pr Sessions Code, ar�da my license Ls in tull fo cean efi / 7�♦��-- ,fi License Class License Date Signature >+ r' PLUMBING FEES WORKERS' COMPENSATION DECLAFZATI Bar Sink Showers I affirm that I have a certificate of Co e t to sell -Insure or a certificate _hereby Workers' Compensation Insurance, or c tified copy thereof (Section Backflow_ Preventer Service Sink 100, Lab.*L _,.,�, � !rp �•�IrG c] Comp $ackflow Irrigation Cap Policy No. ny ❑pertifled copy is hereby furnished. �, L!!'Cert' y lied with the city B i Division -.ti= !•. Sewer r Bathtubs' Sewer Connection Date Applicant EXEMPT40N FfIOM WORKERS' CO NSAT Q CLARATION a Clarifiers Solar Collectors (This section need not be completed If the permit is fhoobne hundred($100) ox.' ; Dishwasher Solar Piping less). . . I cortlfy that in the performance Of the work for which this permit issued, I -_ - •is shatl not employ any person In any manner'so as to become subject to the , r' - Drinking Fountains Solar Tank Workers' Compensation Laws of California. - Date Signature __ Floor Drains Swimming Pool vv/Spa NOTICE: If, after making this dectaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal comply with such provisions Or thig permit shall be deemed revoked. _ CONSTRUCTION LENDING AGENCY I Gas Service Outletsk Water Closet 1 hereby affirm that there Is a construclign lending agency for the performance' of the work for which this permit Is issued (Section 3097 Civ. C.) Interceptors • �' Water Heater Lender's Name Lender's Address _ - __ - - -_ _ " + , kitchen Sink - - Water Service r OWNER BUILDER DECLARATION I hereby afflrm that I`am exempt from the Contractor's License Law for the 'Lavatories v. ,� Auto -Wash following reason (Section 7031.5 Business and Professional Code: Any city or " county which requires.a permit t0 construct, alter, improve, demolish or repair P=Trap ' �- :u -Caundry Trays , any structure, prior to its issuance, a1sG 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 'a (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 altegeci exemption. Any violation of Section , ]31.5 by any applicant for a perrhit subjects the applicant to a civil enalty,of not more'than five hundred gollars ($500). $ 3 ❑ 1, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee' compensation, will do the work, and the structure Is not Intended or offered ,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 Hood or Type I ❑ employees, provided that such Improvements are not Intended or offered for sale. It, however, the bullding'nr improvement is sold within one year of corn- Canopy Type 11 Elpletion, the owner will have the burdeh of proving he/she did not build or Im- Duct -Under Ground for the purpose of sale). �Eve 1, as owner of the property, am extlusively contracting with licensed con- Duct - Structural Refrigeration System . tractors to construct the projectfSectIon 7044, Business and Professions Code: Law docs not to an owner of property who 0D-100,000 BTU ❑100,000 BTU The Contractor's License apply builds or improves thereon, and who Contracts for such projects with a con- Duct - Ventilating tractof(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System El Multiple El System Repair/Alteration proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section — B. & P. C. for this reason Firepl/Fact. Bit. ICBG I Fire Dampers CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor f 1 • A.P, # f S Main Building: E T Front B Rear A C Right SLeft Ping. Ref. # Planning Notes: 2125 5/27/86 77.11 7t. I Zone Accessory �Building: __ 11 ELECTRICAL Automatic Washer Cortstiuction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW SUMMARY OF FEES Heating System & Ducting Cl 0-100,000 BTU ED 100.000 BT Meter ❑up to 100 amps Registers Date Owner I hereby certify Cha have read this informatlon is corro agree tv c mp and state laws relati to building c sentatives of this t to enter o inspection purpo p. Signature OL Driverrs' License or SS qr _ _ ___ _ application and state that the above with all city and county ordinances truction, and hereby authorize repre- the above-mentioned property for Date ftp $ ' Dryers ❑Gas ❑Electric Sub Panel PLUMBING Fan F,A'.U. Reinspection Fee $15 Fixtures'. Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor f 1 • A.P, # f S Main Building: E T Front B Rear A C Right SLeft Ping. Ref. # Planning Notes: 2125 5/27/86 77.11 7t. I Zone Accessory �Building: __ 11 ELECTRICAL Automatic Washer Cortstiuction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW SUMMARY OF FEES Cooking Unit Meter ❑up to 100 amps Dishwasher Meter Clover 100 amps $ ' Dryers ❑Gas ❑Electric Sub Panel PLUMBING Fan F,A'.U. Motors OD -1 HP 01%-8 Inc, Solar 09.15 HP 016-15+ ISSUANCE ' Fixtures'. Microwave Q Device Boxes t OutPets Pole Light Range 2 C Switches . Sign Q Garbage Disposal Standing Sections MICROFILM r Generator 00.5 KW 0545 KW Trash Compactor TOTAL FEE PLAN CHECK 25% $ r Reinspection Fee $15 1 Issue Fee $ 3 DEVELOPMENT SERVICES REOUIR Zoning Approved By ,Building Approved By Application Issued By S $ S SUMMARY OF FEES BUILDING PERMIT $s-0 SMIP 25 o PLAN CHECK $ ' • 2/ PERMIT PLUMBING $ 7,-00 ISSUANCE ' PLAN CHECK 25% $ LSO ENERGY P.C; ELECTRICAL S 7. 6C>- GRADING PLAN CHECK 50% $ - _ L• JC) MICROFILM MECHANICAL S TOTAL FEE PLAN CHECK 25% $ S $ S CONSTRUCTION AND PLANNING APPROVALS Permit # Date _. Inspector POOL &SPA APPROVALS Permit # Date Inspector I . Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test - 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing �� 65. Electrical -Final 15, Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring4 �� rt 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- APPROVALS Permit # 20. Rough Factory Fireplace 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 ❑ Gas ❑ Oil °'- 25. Roof Sheathing 74. Overhead Hydro ' 26. T -Bar Ceiling (Structural) & Mono coat 75, Dry Chemical 27. Frame and Flashing 76. Dry Standpipe H 28. Lathing & Siding 77. FIXED SYSTEM FINAL } 29. Insulation, 78. FIRE PREV. FINAL 30. Drywall Nailing +�6 HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION , ti 32. Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: S �G 34. Final Heating &Air Condinnnir g 35. Final Gas Pipe -Test 36: Hood or Canopy ` +�b k) (Z ` 37- Final Factory Fireplace r 38. Final Plumbing /D'( -Yb L•+ti.� 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 - 471 FINAL STRUCTURE & BUILDING `p b '0A- 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. %7.3 Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONST_RUCTION P RMT 6 111 PERMIT NO. TRACT NO. LOT NO. UNLT�IU. . Project Address W 171 Applicant's Mailing Address577 dsk.—) Owner's Name Phone Address Arch/Eng. — — License No. Address Contractor's Nam P one777 Address (mailing)�— City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in ful rce !;feet. �021��% Ucen Class icense No. Date r Signature WORKERS' COMPENSATION DECLYRATION I hereby affirm that I have a certificate of consent to self4nsure or a certificate -)f Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab, C.) Policy No. -- Company eCertified copy is hereby furnished. - Certified copy Is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or lest). I I certify that in the berformance of the work for which this permit is issued [ shall not employ any person in any manner s as to become subject to tke Workeri an Com sa p ws of Calif Date 4r Signature 'NOTICE: If, after mA,king this declara[ , you should become subject to the Workers' Compensation provisions of 1he Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction tending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER (DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter. Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 oenalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will qo the work, and the Structure is not intended or offered for sale (Section ,7044, Business and Professional Code: The Contractor's License Law does npt apply to an owner of a property who huilds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale, If, however, the building or Improvement Is Sold within one year of Com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuarit to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason 9521 3/25/85-- 10.TL TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ A.P. 46 Zone DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: E TYPE OF PERMIT GRADING FOUNDATION1:1 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ 5 Left ZONE GRADING CU. VDS. ACRES Ping. Ref. # Parking Req./Provided Remarks: Planning Notes: Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Date Owner Heating System & Ducting I hereby certify that 1 have read this application and state that the above ❑a100,000STU0100,000BT Information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorizerepre- sentatives of this City to enter upon the above-mentioned property for Inspection purp s. J1�� Signature Date 7 Reinspection Fee DriversLite or SS Ir GMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Issue Fee Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑a100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee ELECTRICAL Automatic Washer Construction Pole Sub. Cdoking Unit Dishwasher DFyers ❑Gas ❑Electric Fen F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 1:15-15 KW Transformer ❑ 15-50 KW L1 50+KIN Meter L )up to 100 amps Meter Dover 100 amps Sub Panel 'Motors 130,11 HP❑IA - B Inc. Solar ❑9-15 HP 1:116-15+ Microwave Pole Light Range Sign ! Standing Sections Trash Compactor FEES $ 3 Reinspection Fee $15 Issue Fea $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By[ Application Issued By ( >' Dat Z O N I N G R E Q M T S PLUMBING FEES Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Gas Service Outlets Interceptors Urinal Water Closet Water Heater Kitchen Sink Water Service Lavatories A uto-Wash P—Trap Laundry Trays Roof Drains Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Date Owner Heating System & Ducting I hereby certify that 1 have read this application and state that the above ❑a100,000STU0100,000BT Information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorizerepre- sentatives of this City to enter upon the above-mentioned property for Inspection purp s. J1�� Signature Date 7 Reinspection Fee DriversLite or SS Ir GMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Issue Fee Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑a100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee ELECTRICAL Automatic Washer Construction Pole Sub. Cdoking Unit Dishwasher DFyers ❑Gas ❑Electric Fen F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 1:15-15 KW Transformer ❑ 15-50 KW L1 50+KIN Meter L )up to 100 amps Meter Dover 100 amps Sub Panel 'Motors 130,11 HP❑IA - B Inc. Solar ❑9-15 HP 1:116-15+ Microwave Pole Light Range Sign ! Standing Sections Trash Compactor FEES $ 3 Reinspection Fee $15 Issue Fea $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By[ Application Issued By ( >' Dat Z O N I N G R E Q M T S SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ , PLAN CHECK 25% $ ZENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ $ 3 =� CONSTRUCTION AND PLANNING APPROVALS Permit # Date 1 / Inspector tlr POOL __ SPA APPROVALS . Permit # 4 Date Inspector 1. Temporary Electrical Service or P6 e / 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement !y !Eiettrical Condo,l#ility-Undrg fnd '0 54. Forms rnd. 4"Electci6l CondA-lhi r �� ru 9 I v 55. Electrical Bonding v y 5 )5tt�el7Reinforcer nt Ll 56. Rough Plumbing & Pressure Test �6�s, ElectricalUFEeG-rfi'd. rr� 57. APPROVAL TO COVER-GUNITE f3 73 Footings w �.,� 58. Electrical Conduit-Undrgend. � 8. F,dliriation 59. Gas Pipe, ❑ Undrgrnd., Test E 9:�Ia of Pi a Undrgrnd. P . r ;� 60. Backwash Lines, P -Trap, ❑ Undrgrnd. -10!StruciuraI FtoorrSysot em ° 61. APPROVAL TO DECK r 11,,% Property Sewer Line &!-louse Cannection . r ti"P jol A I 1 62. Backwash &Receptor -Final A :12"Ser Cap yr ` 1 ' 63. Heater &Vent -Final 113„Roof Drains y� n 64. Plumbing System - Final r ljr,Rough Plumbint9� v y �� p 65. Electrical -Final v 15. ,Rough Electrical -Conduit 66. Solar System -Final 16. IRough Electric Wiring 67. Fencing & Access Approval 17..I'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 APPROVALS Permit # ~ 20.p Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydra 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush . 24. Roof Fi taming 73. Undergrnd, Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical - 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test S�crl �s- CLQ 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer r 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 ' _ N41,91 Q n Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NQ. S_Tq_, 2, TRACT NO. LOT 1V0. UNIT NO. TYPE OF CONSTRUCTION NEW ADD ALTERATION 44(JJ�1 REPAIR - ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. ' S Main Building: E TYPE OF PERMIT 0 GRADING ElFOUNDATION I[ STRUCTURAL T Front El TENANT El ELECTRICAL 1:1 PLUMBING I - MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right KLeft CONSTRUCTION TYPE VALUATION $ g ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks: Planning Notes: CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 711 W. 17 th ST. Bldg (B)^ Unit 6 Applicant's Mailing Address 13110 Saticoy St. N.H011�WOOd� Owner's Name T��Tn�r��tm�ntPhone54954�422Z-294 8 Address 4371 Ri rcli St_ Newport Bearhy Ca- Arch/Eng. MarinJ. Rnnk License No. Address 17881 Knou Ave. Suite 916 Contractor's Name_- - pe. 1. Air C_,___n ___,nrl i ti nny ngPhone -- 982.-.. 1Z16 Address (mailings Y St ; N .1Hn1 l yw0o� Cg - City License No. 33995 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 mmencing with section 7000) of Division 3 of t e Business ana Profess Code, and my license is in full force neffect License Class C__ L se 51 Date_ 118184 Signature WORKERS' COMPENSATION DEC RATION I hereby affirm that I have a certifi to of consent to self -insure or a certificate -)f Workers' Compensation Insurance, or a certified copy thereof (Section Polio, Lab. c:) WC9824 Lumbermans Policy No. Company Certified copy is hereby furnished. Gerti i r�pp�[ is filed with the city Build}d Division. - Date L�7 Applicant + i..lt"1� EXEMPTION FROM WORKERS' COMPENSATION DECLA ATIDN (This section need not be completed if the permit is for one hundred ($100) or less), I I certify that In the performance of the work for which this permit is Issued I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California, . Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of 'the Labor Code, you must forthwith comply- with such provisions or this permit 'shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address - OWNI R BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 '031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and, Professional Code: The Contractor's 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 employees, provided that such -improvements are not intended or offered for sale. If, however, the building or improvement Is sold within ono year of com- pletion , the owner will have,the burden of proving he/she did not build or im- rove forr the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuar t'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided, to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state It information is correct. I agree to mply with all city and coun and state laws r lating to buil construction, and hereby au sentatives of city to a er upon the above-mentiane inspoCti0, e5. Signator Dat Drivers' Li or SS the above ordinances Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground ' Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ FirepllFact, Bit. ICBG * Heating System & Ducting 1, IN0-100,000 BTU El 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor IMBING � FEES Showers Zoning Approved By Service Sink Sewer Cap Building Approved By Sewer Connection Solar Collectors Application Issued By Solar Piping —Date._ Solar Tank Swimming Pool w/Spa Urinal , $ 'Water Closet c $ Water Heater $ Water Service -= Auto -Wash $ Laundry Trays' $ PLAN CHECK 25% $ ENERGY P.C. $ Issue Fee $ 3 iANICAL FEES Hood or Type I ' ❑ Canopy Type II ❑ 50% $ Refrigeration System ❑Q100,000 BTU ❑ 100,000 BTU $ System Repair/Alteration $ 13.00- Fire Dampers $ 15 • 50 Registers 6 Issue Fee ' $ 3 1751 6/24/85 15080 TL Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas DElectric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW 05-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors 00.1 HP Ell 8 Inc. Solar ❑9-15 HP El 16-15+ Microwave Pole Light Range Sign I Standing Sections Trash Compactor i FEES r Z O N 1 N G R E Q M T S I I Reinspection Fee f $15 1 j Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By —Date._ SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ 13.00- TOTAL FEE $ 15 • 50 PLAN CHECK 25%,$ 2.50 'POO CONSTRUCTION AND PLANNING Date APPROVALS - Permit # Inspector. � SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location r 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding S. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFEfR Grnd. j 57. APPROVAL TO COVER-GUNITE '; �.•, 7. Footings?. 58. Electrical Conduit-Undrgrnd. f 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test -9. Water Pipe-Undrgrnd. " 60. Backwash Lines, P -Trap, ❑ Undrgrnd. r* 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12, Sewer Cap r 63. Heater & Vent -Final r.. 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Struculre 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 ❑ 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 1,�� 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38, Final Plumbing 39. Water Service-Firial 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 Completedi 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY Nn. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERC, LT NO. NO. LOT NO. UNIT NO. Project Address I J W r7'714 S e C -4z � M "A C 1, �� TRACT g1 - b Applicant's Mailing Address TYPE OF CONSTRUCTION NEW ADO ALTERATION REPAIR t Owner's Name -T_'JU 0 N Phone Address Arch/Eng. License No. Address Contractor'sNamnMdZOWS Address (mailing) �i �63J li3F'•!„'T s'T F3r-Ca%'I�r•ty]�,.1 y3%� City License No. -LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professio Code, and my license Is in full force and effe License Class icense o. Date Signature WORKERS' COMPENSATION DECLARATION ` ..t hereby affirm that I have a certificate of consent to self -insure or a certificate f Workers' Compensation_ Insurance, or a certified copy thereof (Section n�800. Lab., C. Policy No.lk)L 5 051_72Q C 8 Certified copy is hereby furnished. Cer lfied cop riled with the cit Build g ' isiorn, Date O Applicant EXEMPTION FROM WORKERS' COMPENSATION ECLARATION (This section need not be completed If the permit Is for one hundred ($100) or less): I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name - Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Corttraclor' License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demoiish.or repair any structure, prior to its'issuance, also require% the applicant for such permit to file a signed statement that he/she Is licensetl pursuant to the provisions of the Contractor's License Law (Chapter 9 (Commencing.with, Sect !on 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 '031.5 by any applicant for a permit subjects the applicant to a civil ; malty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractor(s) license pursuarit't0 the Contractor's License Law), i am aware that proof of tneir Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P.C. for this reason Date 1 hereby certify information is c and state I sentatives f tt inspection urpt Signature Drivers' License Owner that I have read this application and state that the above rect. I agree to comply with 411 city and county ordinances Xf—into building nstructi n, and hereby authorize repre- city to enter u on the 4ove-mentioned property for Date_% r55� 5825 1/16/85 uo5p ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. # Zone S Main Building: Accessory Building: TYPE OF PERMIT GRADING 0 FOUNDATION 0 STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ -OTHER E T Front Z O B A Rear N I C Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION S ZONE GRADING CU, YDS. ACRES 3 G Left R' Ping, Ref. # Parking Req./Provided E Remarks: Planning Notes: Q IM T S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers 8ackflow Preventer Service Sink Automatic Washer - Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap -7 Bathtubs Sewer Connection Cooking Unit Meter El up to 100 amps Clarifiers Solar Collectors ' Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors &D-1 HP 01%-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP ❑16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Interceptors Water Closet Water Heater Device Boxes Outlets Pole Light Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash, Garbage Disposal ; Standing Sections ' P—Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection ,Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL_ FEES _ DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By _ Data Boiler Hood or Type I ❑ Canopy Type I I ❑ Duct - Under Ground Duct - Structural Refrigeration System ❑0-100,000 BTU ❑10D,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 2596 ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY $ $ $ $ $ _ L� $ $ $ OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ .IYI GRADING $ MICROFILM $ TOTAL FEE $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # I Fire Dampers Heating System & Ducting 00-100,000 BTU E31 00,000 BT Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev, 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor TL CONSTRUCTION AND PLANNING APPROVALS Permit# r Date` Inspector POO, -4 SPA I 1.APPROVALS Permit Date Inspector 1. Temporary Electrical Service or Pole :j - 52. Pool & Equipment Location 2.,SoilaP.ipe Undrgrnd. .0 53. Steel -Reinforcement 3''Electrical Conduit iJtilitY Undrgrnd. +� 54. Forms 4�"Electr'ical Condw11•Jndr9rnd. `1 f; 55. Electrical Bonding -5*Steel•'Reinforceriment 6.' - 56. Rough Plumbing & Pressure Test 6! Electrical UFER'Grnd. � - 57. APPROVAL TO COVER-GUNITE 7,jFootings : , 5B. Electrical Conduit-Undrgrnd. " 8. Foundation Cj 59. Gas Pipe, ❑ Undrgrnd., Test 9:. Water Pipe Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. ' 10rjStructural Floor System fit. APPROVAL TO DECK 11j Property Sewer Line;& House Co'nnectian ^ 62. Backwash & Receptor -Final 12� Sewgr Cap ` 63. Heater &Vent -Final 13.Roofi rains i~ 64. Plumbing System - Final 14. Rouglli Plumbing,; ,- 65. Electrical -Final ti 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough &Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 Drywall Nailing HEALTH DEPT. REQUIREMENT 314, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final _ 42. Backflow Preventer 43. 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 RIO. Date. 0 -r City of Costa Mesa Development Services Department CERTIFICATE OF OCCUPANCY No. 0 0 3 Building Safety Division P. O. Box 1200 costa Mesa. California The Building located at 711 id. 17th STreet Building Bl has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B2 _Occupancy. Use of Building Commutcr room, lunch room, dressing room, and shower Legal Description 424-041-11 (See reverse side for Metes and Bounds) BEP25119 BEP25119 Building Permit NoBEP25119 _E lectrical Permit No.E171 1 c Plumbing Permit No.P18119 Mechanical Permit No. M185 R4 Number of apartments and/or guest rooms r ISSUED TO: Trov Investment Fund 4321 Birch Street Building Official by Newport Reach, CA Date 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 2015-46 rev. 1/83 White • Owner; Canary - Numerical File; Pink - Bldg. Permit File ,,Z:� ,.fir ; `"ate, A pllcan 4illr� all spates except those within heavy border lines and sign all appropriate declarations. ._ ' "' TRACT NO. LOT, NO. + (/v(J/J �C t s P T' O. UNIT cITY+OF co9TA MES . sCONS JCTION T j_ � 25' r� { i Na. i 2125 8/27/86— r,II'' f"4Q MI t y7;11 TL Project Address +w ' -><1- i PE OCgNSTAUCTION NEW A" �AL7ERATION REPAIR' t 'r Applicant's MailingiAddress }- _ i I 'r NVERSION� ❑ EMOLISH CJ OTHER A.p_�, Zpne Owner's Nam hone • j ''i ,.._•- , ._ ._�..... 1 i6'�SC1i1PT10N OFiWOF KJUSE OF BLDG.F��T 1N:E r Address S Main Building: I t Accessory Building: ArchlEng. G License No. C-9: rOj-� _ 'TYP,E dfePERMIT i GRADING FOU'N'DATION STRUCTURAL T Front' 0 Address ,A lek — 7:£NANT ;❑ ELECTRICAL :❑ PLUMBING ❑ MECHANICAL 8 C.��•s� /•.�CJC P�fi� a ` Rear Contractor's Name '� OTHER,_ -- ---- -- - A Right - I r: �i 'r PROJECT DESCRIPTION SO. FT. OCCUPANCY. 512a C g N Address (mailing) � K G -1 -7 M1. CONSTRUCT;ION�1fPE �� VALUATIONtb S�Q;?�- S Left R City License NO. — - j L •ZONE �/{i'-s GRADING CU.YDS. ACRES" r { : •a ,,,,� -r•"' Ping. Ref. # P r 'ng q,/Provi t E IL LICENSED CONTRACTOR DECLARA7 ,j j ' Q I hereby affirm chair 1 am 1lcerlsetl under ro isions of Gharler 9 (cdmmencln�; �' Remarki + 49 9 -�� i } 1 i Punning Notes:, - ; M I with section 7000) of Division 3 Oft Bu iness and Pr fesslons Code, and- my Ilcense.is In full fo ce an eff =a : i ( i T %license CIa55 /—License /��`'•! - ,� S r i Dale Signature - +• I PLUMBING FEES y� WORKERS' COMPENSATION DECLARATI - v ry ; ' hereby affirm that 1 have a certificate of co t to set -insure or alcertiTlcato' Bar Sink Showers ELECTRICAL , FEES workers' Compensation Insurance, or c tlfled copy thereof (Section B CIC#IOw.Prevenler Service Sink - "G $ - Automatic Washer Transformer D' 15.50 KW ' .800, tab.�s PoFicY coma ny ,�:• - Backflow Irrigation t - - - - ga _ Sewer•Cap Construction Pole Sub_ ❑ 50 +,KW ' �ertified copy i hereby furnished. r r I� NCert" ' y lied with the city B I Division .. � Bathtu�is" Sewer Connection � Cooking Unit ' Meier ❑up to 100 amps Date Applicant EXEM ON AOM WORKERS' CO PENSAT D CLARATION rj' ifiers :Solar Collectors Dishwasher Meter. ❑over 100 amps (This section need not be completed If the permit is' ne hundred-($100) or,.' lass). !� ~ Dishwasher l _. Solar Piping - Dryers ❑Gas ❑Electric $uh Panel 1 Certify that In the performance of the work for which this permitls issued � I� .- - - shall not employ any person In any manner'so as to become sut;ject to tke, F - Drin_kiiig Fountains. Solar Tank Fan Motors ❑_0 1 NP ❑ 1'/a - 8 S Workers' Compensation Laws of California. ' ' Date Signature ' `4 1 loor Drains' Swimming Pool w/Spa F,A;U. Inc' polar ❑S-i5 HP ❑1fi 15+ NOTICE: If, atter•making'•thi"eclaralion, you should become subject to-the- - - - Workers' Compensation provisions sof the tabor Code, you must forthwith Floor Sinks I Urinal - FixtUfeS " Microwave comply with $uCh ; provl$ion$ or . this permit shall be deeezed revoked. '' o CONSTRUCTION LENDING' AGENCY Gas Service Outlet`s," Water Closet Oe3ice`_Ooxes Pale Li hr 1 hereby affirm that thi re is a construction lending agency for,the performance - g Of the work :for ,which this permit : is Issued (Section. 3097i;Civ. C.) I (erCi' tors .. ` Whtef Heater i ! /7 I p Outfets�-' Range G Lender's Name • • - _ . Lender's.Address - , - 540 sr -- --- Kjtchen Sink - -�- Water-Service - - -• •-i Switches - _ OWNER BUILDER'CiECrLARATION •. - _- ' J Sign ; Q I hereby affirm that lvani exempt from the Gontractor,s License L.awifor the ••+atones �+ ',},�! _ ' 1vtD-Wash ' _ Gaitiage�Disposa! - Standing Sections following reason (Section 7031.5 Business and Protessionat Code: Arlylcity or county which requlrgs,a permit to construct, alter; improve, demolish or repair P'-.Tr .rte I +' �`�Laundr Tra s i G r - any structure, prlor;lo'!ts issuance; also requires the applicant forssuch;permlt ,+)P _ "' y' y gPerator ❑0-5 KW ❑5-15 KW Trash Compactor to file a signed statement that he/she Islticcnsed pursuant to the provisions Of ' r,�: ;•f- _ -y'"' Gof Drains .•� . .. ; the Contractor's License lLa,�w (Chapter 9-(commenting with Section.7000) of g. 'M"11vI5fOn-3-of the'Busind ss-and-Professions'Code)-or that heJshe-is�xempt-'•• - } • - - - _ - refrom. and the basis for the alleged.exemptlon. Any viol.-tion of Section < , 31,5 by any applicant for a permit subjects the applicant to is civil S 4 'z nalty.ofmot more'than five hundred dollars.($500). ! + [ + _ 1 I, as' owner of the property Or my employees with wages as their soleelnspeCtlOn:FCo $15 j ', i Issue Fee' $ .3 r i compensation, mill do.lhe work, and the structure is not Intended or offered Reinspection Fee .! $15 Issue Fee r -. $ 3 _- for sale (Sect lon:;7044, Business and Professional Code: The Contractor's {::; ° MECHANICAL .FEES LJcense _Law does not apply to an ownerFof a Property who builds or Improves ` thereon,. and who does such work;hlmselt/herself Or through his or her own golfer ype I ❑ DEVELOPMENT SERVICESREQUIREM S employees, provided that'such Improvernents are not Intended or offered for - >-lood,or T _ � .sate. If, however,_th'e bultding'or improvement is sold within one year of com• Canopy . Type 11 ❑ Zoning Approved By, ate pletlon," the owner will have the burden of proving he/she dip not build or im- Duct - Under Ground _ tp- - rove for the purpose Of sale). - - Building Approved By - 'Date �: I, as owni:r;of,the property, am exclusively contracting with licensed con- Duct -Structural s Refrigeration System' Application Issued By Det Z tractorslo construct the project (Section 7044, Business and Profession$ Code: The Contra ctor's=License Law does not apply to an,ownar'of property who Duct - Ventilating ❑4.100,000 BTU ❑ 100,000 BTU SUMMARY OF FEES builds or Improves thereon, and who contracts for such projects with a con- - - - tractor(s) llcense:pursuant to the Contractor's License Law), t am aware that'. Exhaust System ❑ Multiple 0 System RepairJAiteration' BUILDING PERMIT $ ' sd SMIP $ O' �� ' proof of their;Worker's Compensation insurance should be Oovidea to me: _ �. 2.�7�a PLAN CHECK $ • 2� �PERMITr- ❑.I am exempt under Section' - _ .B. & P. C. for this reason - Firepl/Fact: Blt. ICBO Fire Dampers :a PLUMBING $. �'OQ l ISSUANCE S Date: " Owner Heating Sysiern & Ducting Registers. - Ot'J ENERGY P.C: $ _ information certify .tha have read this application and state that the above 0o-1 00,00.0 BTU Eli 00,000?B _ PLAN CHECK 25% $ = , information Is corre agree to c mp with all city and county ordinances - ELECTRICAL $ -7• 6& GRADING $ and state laws Vel It to building c lruction, and hereby authorize repre- ' - _ _ sentatives of.•this t to enter o the ,above-mentioned property for -, - PLAN CHECK 50% $ MICROFILM $ } Inspection purpo MECHANICAL $TOTAL FEE $ % rr %: Signature ' Data - OriverV'License or S5 Reinspection Fee $15 Issue Fee $ .3 PLAN CHECK ••25% $ naris-aF-•rev- 10/84 white - Ruild!na: Canary - Aoplicant: Pink - Accounlinq: Goldenrod Assessor _ `•, ' 3 CONSTRUCTION AND.'PL•ANNING APPROVALS ', Permit #'i l ;'� Date ` _'. L �•;. �• Inspector POOL & SPA' '' APPROVALS Permit Date 5 _. Inspector 1. Temporary Electrical Service or Pole i 52, Pool & Equipment Location 1, 2. Soil Pipe•Undrgrnd:" ': i f 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 Grndr, 57. APPROVAL TO COVER GUNITE r 7. Footings 1 58. Electrical Conduit•Undrgrnd. • • S F. 8. Foundation i 59. Gas Pipe, ❑ Undrgrnd., Test 9. U4later`Pipe Undrgrnd'. 60. Backwash Lines, P -Trap, 0 Undrgrnd.. s ' 10. Structural Floor System-' ,` '. ; 61, APPROVAL TO DECK 11. Property Sewer Line & House. Connection 62. Backwash & Receptor -Final' r ; 12. Sewer Cap _: 63. Heater & Vent -Final 13. Roof Drains' ` 64. Plumbing System - Final , 14., Rough Plumbing /J 65. Electrical -Final , l 15. Rough Electrical Conduit :. 66. Solar System -Final 16. Rough Electric Wiring c,6n AD67. Fencing &Access Approval 17, Rough Wiring Sign - 68. APPROVED FOR PLASTERING 'T a 16. Rough Electrical -T :Bar Ceiling: 69. POOL/SPA SYSTEMS FINAL 119. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT.- EQUIREMENT..20. APPROVALS Permit¢ 20.Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydro 7. 4 22, Ducts, Ventilating 71. Product Piping ❑Gas ❑Oil 23, Gas Pipe -Rough & Test 72. Underground Flush •f 24, Roof Framing ❑ 1.73. Undergrnd. Storage Tank Gas ❑ Oil J'� .'.. ,3 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 0 75, Dry Chemical +.. 27. Frame and Flashing NI „ D 76. Dry Standpipe 28. Lathing & Siding 1 77. FIXED SYSTEM FINAL�� 29. Insulation 78. FIRE PREY. FINAL t --- i @ 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 6; Notes: 8 � �G ' go 34. Final Heating & Air Condi ir4Q � cud SAVL � � K 35, Final Gas Pipe -Test r-4 !160f 36: Hood or Canopy pb w G :� 37Final Factory Fireplace r 38, Final Plumbing 39.' Water Service -Final s � - 40, Gas Service -Final .41. Solar Domestic -Final ` 42. Backflow Preventer - 43. Backflow Irrigation - ti r) 44. Landscape Irrigation System 45. Sound Attenuation r • .r 46. Handicap Regulations 47L FINAL STRUCTURE & BUILDING `p b o-* ,v 48. Special Requirements Completed 1 ` 49. Electric Release to Edison CIt 50. Gas Release to Southern California Gas Co , 51. CERTIFICATE OF OCCUPANCY No. Date 7 1 - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. n .IIT 111!1 I 'rOAr•T Ain i nT nin II IAIIT A,h 11 CITY 0E -COSTA -MESA C NST�UC�JON P RMIT 7 Project Address — Applicant's Maiii ddress L . Owner's Name A Phone Address _ Arch/Eng. License No. Address Contractor's Nam Phone �V Address imailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full orce an ffcI. �f License Class License No. Date Signature WORKERS' OMPENSATION DE ARATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate .of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No, Company eCertified copy is hereby furnished. Certified copy is filed with the city Building Division. pate Applicant EXE=MPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or, less). 1 certify that in the performance of the work for which this permit is issued I shall not employ any person In any manner s0 as to becortle Subject to t6 Work ' Com c tion Laws of Calif -Date Signature 'NOTICE: If, fter making thit declarati you should become subject to the Workers' Compensation provisions Of a Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDINQ AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement thm he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business end 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 nenalty of not more than five hundred dollars ($500). I, as owner of the properly or my. employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Buylness and Professional Code: The Contractor's 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 employees, provided that Suth Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletlon, the owner will have the burden of proving he/she did not build or im- rove for the purpose of saloj. I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project(Section 7044, Business and Professions Code: The Contractor's License Lkw docs not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a con- tractors) license pursuarit't0 the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. :l 1 am exempt under Section B. 8. P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above Information Is correct. I agree to comply with all city and county Ordinances and state laws relating t0 bUilding construction, and hereby authorize repre- sentatives of this city t Anter upon the above-mentioned property for Inspectionour S. Signature 11 Date k�1"' Drivers' Ll.eY or SS =01 Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG + Heating System & ducting [:10- 100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 4F 0865-46, rev. 10/84 White - Building; Canar - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee I S 3 IANICAL Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers 9922 3/25/85 Zone Accessory Building: Parking Req -/Provided ELECTRICAL Automatic Washer CSnstruction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW 05-15 KW i- !Reinspection Fee 1 $15 FEES Issue Fee I $ 3 Transformer ❑ 15.50 KW ❑ 50+KW Meter ❑up to 100 amps Meter Dover.100 amps Sub Panel Motors ❑0.1 HP Ell %- 8 Inc.Solar El 9-15 HP El 16.15+ Microwave Pole Light Range Sign ,Standing Sections Trash Compactor Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By -L Date IN50 TL FEES $ 3 Z O N I N G R E Q M T S SUMMARY OF FEES BUILDING PERMIT S TYPE OF CONSTRUCTION NEW ADD Al TERA710N REPAIR PLAN CHECK ❑ CONVERSION ❑ DEMOLISH ❑ OTHER PERMIT A.P. # DESCRIPTION OF WORKIUSE OF BLDG. S D ISSUANCE $ PLAN CHECK 25% $ S Main Building: ELECTRICAL S E $ TYPE OF PERMIT EJ GRADING DFOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL —_... - TOTAL FEE $ ❑ $ A Rear -OTHER C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CON STRUCTION TYPE VALUATION 5 S Left ZONE GRADING CU. YDS. ACRES Ping. Ref. Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG + Heating System & ducting [:10- 100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 4F 0865-46, rev. 10/84 White - Building; Canar - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee I S 3 IANICAL Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers 9922 3/25/85 Zone Accessory Building: Parking Req -/Provided ELECTRICAL Automatic Washer CSnstruction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW 05-15 KW i- !Reinspection Fee 1 $15 FEES Issue Fee I $ 3 Transformer ❑ 15.50 KW ❑ 50+KW Meter ❑up to 100 amps Meter Dover.100 amps Sub Panel Motors ❑0.1 HP Ell %- 8 Inc.Solar El 9-15 HP El 16.15+ Microwave Pole Light Range Sign ,Standing Sections Trash Compactor Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By -L Date IN50 TL FEES $ 3 Z O N I N G R E Q M T S SUMMARY OF FEES BUILDING PERMIT S SMIP $ PLAN CHECK S PERMIT PLUMBING S D ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL S GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ —_... - TOTAL FEE $ PLAN CHECK 25% $ = CONSTRUCTION AND PLANNING APPROVALS Permit # t Date inspector •1 POOL tx SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 1. 52. Pool & Equipment Location 2. SoilPipe-Undrgrnd- ^ro R^ 53. Steel: Reinforcement 3.eElectrical Condtpit;UtilJy-Undrgrnd �1 54. Forms 4-Electfi al CondUi l.ind�`grrsd. 55. Electrical Bonding i *^ 5 � &,-f einforceent 56. Rough Plumbing & Pressure Test -6 �E ect ical UFER,'�rr"d.` 57. APPROVAL TO COVER-GUNITE " 7 F�ootT gs 7 1 1 58. Electrical Conduit-Undrgrnd. ' W ^t8r' F�iin cation i^ 59. Gas Pipe, ❑ Undrgrnd., Test SIS 9.'UVa+er Pipe-UncIrg7nd. 60. Backwash Linesr P Trap, ❑ Undrgrnd, 10'StrApctural Floor System 61. APPROVAL TO DECK 11 Property Sewer Line &House CoJnfDe iection i 62. Backwash & Receptor -Final I2'vaer Cap V, /1 j A r 63. Heater &Vent -Final 1-3, tgj Drains I� � 64. Plumbing System - Final 1.4rR6ugh Plumbing+ r 65. Electrical -Final 15.-R - ough Electrical -Conduit 66. Solar System -Final 1 Rough Electric Wiring 67, Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical --T Bar Ceiling 69. POOLISPA SYSTEMS FINAL 19.'Rough•Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # ' 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32.' Electrical Power Meter-Finai 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test shlaS7- GZ0 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape irrigation System 45. Sound Attenuation , 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING i 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date - A CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 711 W. 17th ' ST . BLDG . (B) Unit 7 Applicant's Mailing Address' 13110 Saticoy St. Saticoy St. N.HolI�OOd Owners Name TrQy_,.I13Y?stment Fund Phone 549-2938 Address 4321 Birch St. Newport Beach, CA, - Arch/Eng.—Marin-J. Rlack- -- License No. Address L2881 Knott Ave.Suite 216 Contractor's Nam e-1)UCLl Air Condit'ionirtvPhone _982-1216 Address (mailing) 1311() Satsray St-, N-Hol1yWood-CA. City License No.339.25 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Buslness , Professions Code, and my license is in full force and effec ,10-711 License Gl�si — e No., 346251 8184 Date �f 11 Signature WORKERS' COMPENSATION DE ARATION I hereby affirm that I have a cert' tate of consent to self -insure or a certificate ,)f Workers' Compensation Insurance, or a certified copy thereof (Section ;800, Lab. C.) WC9824 Lumbermans Policy No. Company BCertified copy is hereby furnished, Gertifi Cop is filed with the city Buildig. DIv si � Date '"L Applicant I&A EXEMPTION FROM WORKERS' COMPENSATION D CLARATION (Thissection.need not be completed if the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit [s Issuetl I shall not employ any person in any manner so as to become subject to tl�e Workers' Compensation Laws of California. Date Signature NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY thereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C,) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt -therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will d0 the work, and thestructureIs not intended or offered 'for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. It, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- reve for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who 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 proof of their Worker's Compensation insurance should be provided to me. 0 l am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state i information is correct. I agree t omply with all City and cou and state la lilting to buil n construction, and hereby a sentatives f t is city tq a upon the above-mentioned inspectlo pupphw Signature Drivers' Li se or SS CMF 0865-46, rev. 10184 t the above r ordinances pplicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations, PERh/�l^T NO.� + rIOCFZOSIIVNSTRUCTIIIION TRACT NO. L07 NO. UNIT N� Backflow Irrigation 1 752 h/Eh /85 I N 5Q TYPE NEW, LJ ADD LJ ALTERATION LJ REPAIR IS Solar Collectors Dishwasher ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A,P, :0 Zone Floor Drains DESCRIPTION OF WORK/USE OF BLDG. Floor Sinks Main Building: Accessory Building: Water Closet interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Tree TYPE OF PERMIT GRADING 0 FOUNDATION 11 STRUCTURALT Roof Drains Front PLAN CHECK 25% $ O ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL $ GRADING $ PLAN CHECK 50% O'rHER ❑ A Rear $ 13 on TOTALFEE N PLAN CHECK 25% G Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY K G CONSTRUCTION TYPE VALUATION S $ Left R' ZONE GRADING CU. YDS. Ping. Ref,`- ITkingACRES Req./Provided E O' Remarks: Planning Notes: is MT; Bar Sink Showers Backfiow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Tree Laundry Trays Roof Drains $ Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact, Bit, ICED =# Heating System & Ducting 1 ❑0.100,000 BTU 0100,000 BT Reinspection Fee 1 S15 licant; Pink - Accounting; Goldenrod - Assessor FEES issue Fee $ 3 -IANICAL FEES Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers 6 Issue Fee I $ 3 ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW C1 5-15 KW Transformer ❑ 15-50 KW ❑ 50 + KW Meter LJup to 100 amps Meter Dover 100 amps Sub Panel Motors 00-1 HP ❑ 1 A - 8 Inc. Solar 09-15 HP ❑16.15+ Microwave 'Pole Light Range Sign Standing Sections Trash Compactor FEES Y I I Reinspection Fee 1515 1 I Issue Fee I 5 3 1 I DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application issued By Dat a SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ 13 on TOTALFEE $ 15-5n� PLAN CHECK 25% $ 2,50_ CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POOL - SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location f .2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical -Bonding 5. Steel Reinforcement r 56. Rough Plumbing & Pressure Test, 6. Electrical UFER Grnd. l�� 57. APPROVAL TO COVER-GUNITE j 7. Footings 58. Electrical Conduit-Undrgrnd. 1 t 8. Foundation ; 59. Gas Pipe, ❑ Undrgrnd., Test r 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System i 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro 22. Ducts; Ventilating 71. Product Piping ❑ 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 35. Final Gas} Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. - Date V Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. 'C}TY OF'COSTA MESA CONSTRUCTION �t,PERMIT Project Address "7 11 Cel J7'i]r-1 S� �IC�S�i �' zs r T Applicant's Mailing Address Owner's Name Trz y :rp V rLd Phone Address Arch/Eng. License No. Address Contractor's Named tlikRks R -L tTAi L Phone ¢77`L""8'0 Address (mailing)/9 S6] =-Z81411 _1177 lOGrxMs:� City License No. 3.3`7 Q. LICE14SEO CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in fuM forcend efte 1 License Class ` License d. Date -X Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate if workers' Compensation Insurance, or a certified copy thereof (Section ;800, Lab. C.) -7 Policy _ Policy NOW Viii C., G BCertified copy is hereby furnished. Certifietl copy is sled with the city�U.'i. Date f �!d ^�-� Applicant EXEMPTION FROM WORKERS' COMPE SATION D CLARA ION (Thissection need not be completed if the permit Is for o e hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit t0 file a signed statement that he/she is IiCensed pursuant to the provisions of 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 violatlon of Section 7031.5 by any applicant for a permtt subjects the applicant to a civil enalty of not more than five hundred dollars ($500)- ' I, , owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 nor own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale), ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractors) license pursuant -to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ i am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have ream this information is c rre I agree to co K and state la re ng o building C r sentatives f this(c ty to enter up inspection p po es Signature �. n the tion -and state that the above all city and county ordinances and hereby authorize repre- ove-mentioned property for Date 1-1 -� � FLRMII NU. I11AUI NU. LUI NU.I UNIT NO. 161 TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. + DESCRIPTION OF WORK/USE OF BLDG, S Main Building: E TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear _ ❑ •OTHER A PROJECT DESCRIPTION SO. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ g Left ZONE GRADING CU.YDS. ACRES Ping. Ref.` Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firep!/Fact. Blt. ICBO # Heating System & Ducting ❑0-100,000 BTU Ell 00,000 BT1 Reinspection Fee I $15 Drivers' License or SS �p CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Soler Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000BTU ❑ 100,000 ST System Repair/Alteration Fire Dampers Registers FEES 5826 1/16/B5 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer * Construction Pole Sub. i Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW El 5-15 KW S 3 Reinspection Fee $15 FEES Issue Fee 1 $ 3 Transformer ❑ 15-50 KW ❑ 50+ KW Meter Llup to 100 amps Meter ❑over 100 amps Sub Panel Motors)UO-1 HP 0 -8 Inc. Solar ❑9-15 HP 016-15+ Microwave" Pole Light Range Sign ;Standing Sections 1 Trash Compactor Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Data 4064 !L FEES $ 3 Z O N I N G R E Q M T S PLAN CHECK 25% $ SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING ,$ ISSUANCE $ PLAN CHECK 25% S ENERGY P.C. $ ELECTRICAL' $ 4-0o GRADING $ PLAN CHECK 50% $T MICROFILM $ MECHANICAL. 1 $ TOTAL FEE $ PLAN CHECK 25% $ CONSTRUCTION AND PLANNING t APPROVALS Permit # Date Inspector POOL L a SPA APPROVALS Permit # Date Inspecrnr ' 1. Temporary Electrical Service or Pcle 7 52. Pool & Equipment Location 2. SoiLPipe-Undrgrnd.,yN ,. 53. Steel Reinforcement 3. -Electrical Conduit Utility-Undrgrnd. f-- r 54. Forms 4. Electrical Condbit-Und�grnd. ? 55. Electrical Bonding 5.-Steel;ReinforcerWt" 56. Rough Plumbing & Pressure Test `r 6= Electrical UFER,'Grnd. 57. APPROVAL TO COVER-GUNITE 7,� Footings �1 ' 58. Electrical Conduit-Undrgrnd. 8?Voundation 59. Gas Pipe, ❑ Undrgrnd., Test . 9: Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. -- 10` "Structural Floor System ti 61. APPROVAL TO DECK 11,:;Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap ''J `� ; 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System •Final 14. Rough Plumbing- `h 65. Electrical -Final 15. hough 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, hough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 311. Plaster Brown Coat 79. FINAL INSPECTION 32.'Eiectrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, 'Final Electric e Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. 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 511. CERTIFICATE OF OCCUPANCY No. f Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF CQSTA M �A ICONS TRUCT10,N PER �T P I NO.Nd,/ �/ TRACT NO. LOT NO. U (y ,. Project Address _O V Applicant's Mallin dress TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR Owner's Name Q V hone Address — -- Arch/Eng. I~icense No. Address Contractor's Nam Phone 7 Address (mailing) ) L City License No - LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisigns of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in ful force and effect. Licen Class License N Date Signature WORKERS' CO PENSATION DE RATIDN I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab. C.) Policy No. Company '! BCertified copy is hereby furnished. • '' Certified copy is filed with the city Building bivision, l Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (5100) or less). I certify that in the performance of the work for which this permit is Issued I, shall not employ any person In any manner so to become subject to tke. Worker Corrie UQ�y. es of Califor Date — —1 . X `� s'ignature & NOTICE: if, after making this declarat o you should become subject to the Workers' Compensation provisions of a tabor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and professional Code: Any city or county which requires a permit to Construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensett pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade) 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 malty of'not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sale compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/her%elf or through his or her own employees, provided that such improvements are not intended or offered for Sale, If, however, the building or improvement is sold within one year of Com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sate). El 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contract% for such projects with a con- traCtor(s) license pursuant 'to'the-Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building constructioh, and hereby authorize repre- sentatives of thi city o enter upon the above-mentioned property for Inspectlon pu s. P Signature , ate -7 --- Drivers' Lice se ar SS 7F ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P. -6 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT L1 GRADING1:1 FOUNDATION 0 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ -OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION SS Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Reinspection Fee 1 $151 1 Issue Fee I $ 3 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. 1CBO # Heating System & Ducting El &100,000 BTU ❑100,000 BT Reinspection Fee f $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor MECHANICAL Hood or Type I ❑ Canopy Type 11 El Refrigeration System 00-100,000 BTU 11100,Ooo BTU System Repair/Alteration Fire Dampers Registers Issue Fee Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric 9923 3/25/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Fdn F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 05-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter Oup to 100 amps Meter ❑over 100 amps Sub Panel Motors G70-1 HP ❑ 1'A - 8 Inc. Solar ❑9-15 HP Ell 6-15+ Microwave Pole Light Range Standing Sections Trash Compactor Reinspection Fee $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Data PLUMBING l FEES Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service j outlets Water Closet interceptors Kitchen Sink Water Heater I Water Service Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains Reinspection Fee 1 $151 1 Issue Fee I $ 3 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. 1CBO # Heating System & Ducting El &100,000 BTU ❑100,000 BT Reinspection Fee f $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor MECHANICAL Hood or Type I ❑ Canopy Type 11 El Refrigeration System 00-100,000 BTU 11100,Ooo BTU System Repair/Alteration Fire Dampers Registers Issue Fee Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric 9923 3/25/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Fdn F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 05-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter Oup to 100 amps Meter ❑over 100 amps Sub Panel Motors G70-1 HP ❑ 1'A - 8 Inc. Solar ❑9-15 HP Ell 6-15+ Microwave Pole Light Range Standing Sections Trash Compactor Reinspection Fee $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Data I MIG TL Z O N I N G R E Q M T S FEES $ 3 SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $CE ' PLAN CHECK 25% $ ENERGY P.0 ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ $ 3 I MIG TL Z O N I N G R E Q M T S FEES $ 3 ? CONSTRUCTION AND PLANNING -''APPROVALS - Permit # Date Inspector POOL (xSPA APPROVALS Permit # Date Inspector • 1. Temporary Electrical Service or Pole: " 52. Pool & Equipment Location :'2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement Xr_. • i +Ele' rical Conduritfltility:Undrgrnd 54. Forms 1i 1 47 Electrical t:--' Conduilfn[l�grnd. 1t? r� '� 55. Electrical Bonding 57 SterelfReinforcement '1 1'7- 56. Rough'Plumbing & Pressure Test 6"E ect'rical UFER Grnd. 57. APPROVAL TO COVER-GUNITE ' -7 Foot, ��%t � 58. Electrical Conduit-Undrgrnd. �>> tt 8. F,odploation s-- `� 59. Gas Pipe, D Undrgrnd., Test y 1Nat2r Pipe Undrgrnd. N 60. Backwash Lines, P -Trap, 0 Undrgrnd, r� ;10. St uctural Floor�SYstem 61. APPROVAL TO DECK !11r.'�Pioperty Sewer Line & House Conriection 62. Backwash & Receptor -Final A 1.2 , er Cap � � ;t' 63. Heater & Vent -Final N' 13.Roof Drains 1 64. Plumbing System - Final r 14`.'Rou h Plumbin�i+ _ 9 9 �S- (,Ej) 65. Electrical -Final r �i5�'Rough Electrical -Conduit 66. Solar System -Final Q,6.; Rough Electric Wiring 67. Fencing & Access Approval 17, Rough Wiring Sign 68. APPROVED FOR PLASTERING 1B: Rough Electrical -T Bar Ceiling 69. POOL/SPA,SYSTEMS FINAL .1 Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro . 22. Ducts, Ventilating 71, Product Piping E7 Gas E1 Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank D Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling {Structural} & Monocoat '75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 26. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30.t 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-Te5t 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39, Water Service -Final ' �9 f�f' 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflovv Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation ' 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING , 48. Special Requirements Completed 49. Electric Release to Edison - ' - 50. Gas Release to Southern California Gas Co , 51. CERTIFICATE OF'OCCUPANCY No. - Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT ,Project Address 711 td. 17th St Aldg.(B)1jnit 8 Applicant's MailingAddre43110 Saticoy St. N.Iiollywood Owner's Name TroyInvestment Fund--Phone.S49—?988 Addre,J321 Birch 5t. Newport Beach, Ca- Arch/Eng. Marin J.Rock _License No. Address 12881 Knott Ave_, Suite 21(1 Contractor's Name .DucO Air Conditianint7 Phone .- 9R2�I 7_ F Address (mailing) 13110 5a tray St _ N _FI [ll 1 Fwnnr3,� f'_ City License No. __3,3925 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business an Professions Code, and my license is In full force and eff ur s seq Cbj7 — i No._ 346951 Date—Signature C4'�• wORKERS' COMPENSATI0, DLA RATION I nereby'affirm that I nave a cert irate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab. C.) Policy No. WC9824 Company Lumbermans eCertified copy is hereby furnished. . Certl i �qpY is filed with the city Building�0iv Data •� Applicant �(� f EXEM I N FROM WORKERS' COMPENSATIDN DECLA ATION (This section need not be completed if the permit is for One hundred ($100) or Less). I certify that In the performance of the work for which this permit is issued 1 shall not employ any person in any manner so as to become subject to tete Workers' Compensation Laws of California. Date Signature 'NOTICE: It, after making this declaration, you should become subject t0 the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of trio work for Which this permit Is issued (Section 3097 Civ. C.) Lender's Name Lender's Address__— OWNER BUILDER tjECLARATION ' I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed Statement that he/She is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such -improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletlon, the owner will have the burden of proving he/she did not build or Im- prove for the purposg of sale). - ❑ I, as owner of theproperty, am exclusively contracting with licensed con- tractors to construct the protect (Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con. tractor(s) Ilcense pursuant'to the -Contractor's License Law). I am aware that proof off their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt and@r Section B. & P. C. for this reason Date Owner J hereby certify that I have read this appllcalfon and state that the above information is Corregt. I agree comply with all city and county ordinances and state la relating to b g construction, and hereby authorize repre- sentatives Is city n r upon the above-mentione pert1pM Inspectl our ores. L3 Signator �� Dat Drivers' Li Se or SS CMF 0865-46, rev. 10/84 TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. -0 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front E] TENANT ❑ ELECTRICAL El PLUMBING Q MECHANICAL A Rear ❑ •OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION S S Left ZONE GRADING CU.YOS. ACRES Ping. Ref. 46 Remarks: Planning Notes: 1753 4/24/85 r _ Zone Accessory Building: z 0 N N G R Parking Req./Provided E 0 M T S Reinspection Fee Boiler $15 Duct - Under Ground Duct - Structural Ddct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO 11 Heating System & Ducting C)t0-100,000 BTU ❑ 100,000 BT' Reinspection Fee 1 $15 Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee ANICAL Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU 1:1100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee S 3 PLUMBING FEES Reinspection Fee Bar Sink Showers $ 3 ELECTRICAL FEES Backflow Preventer _ Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW 0 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection + SMIP $ PERMIT ISSUANCE $ ENERGY P.C. S GRADING $ MICROFILM $ TOTAL FEE $ 15.50 Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers IJGas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan ' Motors El 0-1 HP ❑ 1 4 - 8 Floor Drains Swimming Pool w/Spa F,A.U. Inc.Solar 1:19-15 HP ❑16.15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Interceptors Kitchen Sink Water Closet Water Heater Water Service Device Boxes Outlets Switches Pole Light Range Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator 00.5 KW 05.15 KW Trash Compactor Roof Drains Reinspection Fee Boiler $15 Duct - Under Ground Duct - Structural Ddct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO 11 Heating System & Ducting C)t0-100,000 BTU ❑ 100,000 BT' Reinspection Fee 1 $15 Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee ANICAL Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU 1:1100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee S 3 Reinspection Fee $15 1 1 Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: - - Date Date Dat BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ S $ S S $ $ 13.00 $ + SMIP $ PERMIT ISSUANCE $ ENERGY P.C. S GRADING $ MICROFILM $ TOTAL FEE $ 15.50 $ 3 CONSTRUCTION AND PLANNING 'APPROVALS : Permit # Date Inspector POOL a sPA APPROVALS Permit # Date inspector 1. Temporary Electrical Service or Pole 52. Pool•& Equipment Location f ' "2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' • 3. Electrical Conduit Utility-Undrgrnd. 54. Forms t 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement r 56. Rough Plumbing & Pressure Test r' • '� ` . 6. Electrical UFER Grnd. ? �� 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8: Foundation i 59. Gas Pipe, ❑ Undrgrnd., Test r ' 9. Water Pipe-Undrgrnd. 1 60. Backwash Lines, P -Trap, ❑ Undrgrnd. • .A 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16, Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24.,, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30.. Drywall Nailing HEALTH DEPT•, REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service-Finai 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 551. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations, PITY O9 COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. MIT No. 'Project'Address 7/Z li s�J l M {SLS/ Applicant's Mailing Address Owner's Name r • c> Z_J air' eta Phone Address Arch/Eng. - License No. Address _ — Contractor's Name-GtilcL ! S iz/-)I -i O e C Phone lL77- &P Address(mailing))L-tg"- ORwiojl S-%� City License No." r LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 the Business and Profession$ Code, and my license Is in fu force and•eff t. License Class _ License N ,� Date I L' Signature WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure or a certificate -)f Workers' Compensation Insurance, or a certified copy thereof (Section 800, Lab, C.) _ Policy No. WC �..-IC' cf3 7a' Compaq ®Certified copy is hereby furnishe Certiflotl opy " -led with the cit Buil ig vision. Date d' Applicant EXEM ION FROM WORKERS' COMPENSATION kECLARATION (This section need not be completed If the permit is for one hundred ($100) or less) I certify that in the performance of the work for which this permit is issued I strait not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for, which this permit is issued (Section 3097 Civ. C.) Lender's Name -_ Lender's Address , OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requireg the applicant for such permit to file a signed statement that he/she is licensea pursuant to the. provisions of the Contractor's License Law (Chapter 9 (commgncing 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 4 malty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensItton, will do the work, and the structure is not intended or offered for sale(Section7044. Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sate. If, however, the building or Improvement is sold within one year.of com- pletion, the owner will have the burden of proving he/she did not build or im- rove Tor the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License "w does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects -with a con- tractors) license pursuant't0 the Contractor's LIcense Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section--- - — B. & P. C. for this reason Date Owner I hereby certify that- I have4 read this application and state that the above information is correc agree to comply with ait city and county ordinances and state I ng uilding,6onstruc n, and hereby authorize repre- sentatives of th1 ity to enter upon th gove•mentioned property for inspection urp Signature Date f!4 , r`S Drivers' License or SS 5527 1/16/85 4954 TL VZ0 ELECTRICAL FEES BUILDfNG PERMIT PLAN CHECK PLUMBING PLAN CHECK 2596 ELECTRICAL PLAN CHECK 5096 13 -�3' Automatic Washer Transformer ❑ 15.50 KW Construction Pole Sub. ❑ 50 + K W $ $ $ l , $ $ TYPE OF CONSTRUCTION LJ NEW LJ ADD LIALTERATION LJ REPAIR Cooking Unit Meter ❑up to 100 amps - ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # Zone DESCRIPTION OF WOR KJUSE OF BLDG. 5 Main Building: l Accessory Building: Fixtures ` Microwave E Device Boxes Pole Light Z TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front Garbage Disposal ; Standing Sections O ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B N ❑ -OTHER A Rear I C Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ S G Left R ZONE GRADING CU.YDS. ACRES Ping. Ref, # Parking Req.IProvided E Q Remarks: Planning Notes: M T - — S Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct . Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact, Bit, ICBO# Heating System & Ducting ❑0-100,000 BTU ❑ 100,000 BT Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/spa Urinal Water Closet Water Heater Water Service Auto -Wash. Laundry Trays Issue Fee MECHANICAL Hood or Type I ❑ t Canopy Type I I ❑ Refrigeration System .110-100,000 BTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES ELECTRICAL FEES BUILDfNG PERMIT PLAN CHECK PLUMBING PLAN CHECK 2596 ELECTRICAL PLAN CHECK 5096 -.r Automatic Washer Transformer ❑ 15.50 KW Construction Pole Sub. ❑ 50 + K W $ $ $ l , $ $ i Cooking Unit Meter ❑up to 100 amps - Dishwasher Meter Cover 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors 1 HP 0 X 8 F.A.U. Inc. Solar 09-15 HP El 16-15+ Fixtures ` Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal ; Standing Sections Generator ❑t 5 KW 05-15 KW Trash Compactor $ 3 FEES I Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date_�r,T MECHANICAL $ TOTAL FEE $ 4-50 $ 3 PLAN CHECK 25% $ BUILDfNG PERMIT PLAN CHECK PLUMBING PLAN CHECK 2596 ELECTRICAL PLAN CHECK 5096 SUMMARY OF FEES $ $ $ $ � $ =F $ Sn SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM $ $ $ l , $ $ MECHANICAL $ TOTAL FEE $ 4-50 $ 3 PLAN CHECK 25% $ . CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Peimit # Date Inspecrnr 1, Temporary Electrical Service or Pole rl 52. Pool & Equipment Location -2. Soil,Pipe-Undrgrnd. C'" ? 53. Steel Reinforcement 3!Electrical Conduit;UtiRty-Undrgrnd. 54. Forms 4';ElectricaE Conduit Undrgrnd. ty 55. Electrical Bonding .5. Steel Reinforcement r1 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. ., y 57. APPROVAL TO COVER GUNITE t, 7. Footings -N rj 58, Electrical Conduit-Undrgrnd. j �- 8., Foundation i 59. Gas Pipe, ❑ Undrgrnd., Test t 9" Water Pipe-Und grra. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. ; 16'Structural Floor System 61. APPROVAL TO DECK 11 Property Sewer Line & House Connection 62. Backwash & Receptor-Final i 2 � Sewer Cap 5 63. Heater &Vent-Final 13. Roof Drains i3 64. Plumbing System - Final _ 14. Rough Plumbing., 65. Electrical Fina! 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring i 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 1] 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 PREY. FINAL 30..6rywaII Nailing HEALTH DEPT, REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32" Electrical Power Meter-Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric tzhkro-,# Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37, Final Factory Fireplace 38, Final Plumbing 39. Water Service-Final 40, Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer A 43. Backflow Irrigation, 44, Landscape Irrigation System Y 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed' 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date 1 PROJECT ADDRESS: - 71'1 W 17TH §T-" UNIT: 9 OWNER'S NAME: INTRA WEST SALES ADDRESS: SAME _. 714-642-7088 ARCHIENGINEER: REG.NO,: ADDRESS: UNIT: PERMITTEE: WALKER ELECT (714)970-5800 ADDRESS: 21079 CARLOS RD YORBA LINDA CA 92686 LICENSED CONTRACTOR DECLARATION: Ihereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70D0) of Division 3 of the Business and Profkssions Code, and my license is in full force and effect. CITY LIC.: 0 4 9 5 9 0 STATE LIC.: uss: c' 10 Date: Signature: WORKERS' COMPENSATION DECLARATIO : I hereby affirm at I have a certificate of consent to self -insure at a cerMWicale of War rs' Compensation Insurance, or a certified cop thereof (Section 3800. Lab. C). POUCY NO.: 0 4 6 9 0 UN I T 0 018 4 EXP. DATE: 01 /01/91 COMPANY: STATE Certliled copy Is hereby furnished, ® Cenifled copy is riled with the city Building Division. date: — — Applicant: -- EXEMPTION FROM WOMKERS' CDMMKSA 0 O0 4ECLARATION: 4 neck. need not be eorrrpleted If the permil l. fa.orre hundred (5100) or less). I certify that in the performance of the work tar which this permit is issued. I shall not employ ary person in any manner so as to become subject to the Workers' Compensation Laws of Califomia. Date: Signature: - NOTICE: 11, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must iorlhvAlh comply with such provisions or this permit shall be deemed revoked. . CON3TRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097, Gv, Q. LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors. State License Law for the following reason (Section 7031.5 Business and Professional Cqde: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permrit to file a signed statement that helshe is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 4 (commending with Section 70DD) of Division 3 of the Business and Professions Code) or that hellshe is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500)., i, as owner of the property or rrry employees .with wages as their sole compensation, will do the work, and the El structure is not intended or offered lot sale (Section 7044, Business and Professional Code:. The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himselflhersefi or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however the building or •improvement is sold within one year of completion, the owner will have the burdemof proving heishe did not build or improve for the purpose of sale). I, as owner of the property, am excluOvely contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Pmtessions Code: The Contractors' Swo License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a cenlractor(s) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 6 P. C. for this reason: Date: Owner. I do hereby certily, that I am aware of and understand the requirements of California Health and Safely Code Sections 25505, 25533, and 25534 and that I or any future building occupant will/will not (circie one) need to comply with said state codes and the requirements for a permit for construction or modification from the Arm Management District. Residential construction applications are exempt from . these provisions. Date: Applicant: I hereby cerlily that I have read this applicatipn and state that the tonne information is correct. I agree to comply with all city and county ordinances and state laws relating to building carrstructien and hereby authorize representatives of this city to enter upon the above•menlloned property for Inspection purposes. I Date: Signature: Driver's License or Social Security M: r . 1$47.I6 While-0uildirtq; Green—Code t_ntorcemenk Canary—AOOIiCerti: Pink—Revenue: Gddenro0—Asaeeeor PERMIT .9.75 7 CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 045706 PERMIT NO: E 045706 PLAN CHECK NO: N, GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT -TYPE: ELE*. ` •PURPOSE: OTH JOB DESCRIPTION : ELECT FOR CONVEYOR BELT SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: / COMMENTS: TOTAL PAID DUE >rt>rt>rt+E,�*>rt•��>rt>rt>rt��**�•��•�*+E+E,�,�,�it��•��•�*+E>rt>rt>rt,��**•x•*>rt,�it�t��,��,��***�,�*�+E,��t�•��•**�� 9.75. 15.00 0.00 Z O N I N G R E Q U I.R E M E N T S TOTALS-->. COLLECTED: S E T B A C K S ,00 -------------- MAIN BUILDING ---=------ -------- ACCESSORY BUILDING---------- FRNT: FT IN REAR: FT IN FRNT• FT IN REAR: FT IN LEFT: FT IN,RGHT: FT IN LEFT: FT. IN RGHT:' FT IN !! iF iE it it it * * * tt it � dE * * it if it it it it dE dE 4F }!• 4F }!• il• il• ie it it it it � I N D I V I D U A L F E E PARKING REQ• PROV: PARCEL: 00000000 ZNE: rREF NO: PLANNING NOTES>' UNIT COST ;TOTAL I COST ELE 3 RECEPT/OUTL'ET 1 ST 20 EA. .75 iE iE iE ie ik ik * !E * �E in * iE it it ie rt � iE it � iE iE iE iE * ik it:dE if ik il• � ie il• il• ik iE * iE il• il• ik ie il• iE iE * il• il• !E !E !E !E il• !E !E il• if if if if ik •IE •IE ik ik if iE iE iE iE it it iE iF !E iE dE D E V E L O P M E N T S ER V I C E S R E Q U I R E M E N T S ZONING APPROVED BY — _ DATE: BUILDING APPROVED BY DATE: APPLICATION ISSUED.BY: 24.75 I DATE: I-- iro- it 4l• it * * iE iE T(• it• iE it iE iE ik if if If if IF dE iX DATE: 01/11/90 TIME: 15:13 � ie it ie it iE iE iE it it dE it it ' it• iF if +L if if if * !E !E iE !E !E it it aro- it it ie ie ie il• it il• ie dE ai iE et iE it et et ie it et ie it ie dE * it• * it• it• * it• � +Jt * +Jt * * * * * +Jt * i[• * * it if * � it � if * it it * et * it et et it � LEGALIZATION:N F E E; S,U M M A R Y STRUCTURAL SEGMENT. -N -- BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMTP/RES GRADING PERMIT .9.75 ;501 SMIP/NON—RES PLAN ISSUE FEE 15.00 BUILDING --DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS-- ;-->' 9.75. 15.00 0.00 24.75 ' 24.75 .00 REVENUE DIVISION TOTALS-->. COLLECTED: 24.75 OVER/SHOAT: ,00 BLDG PMT'PLUMBING ELECTRIC MECHANIC FIRE SMTP/TOT -GRADING PLAN—CHECK , 24.75 r if dE * * iE iE iF � * * il• ik il• if ik il• if it � iE � iE iE iE dE in � trt il• il• ie * if fE il• il• il• il• iE if iE dE iE iE iF !! iF iE it it it * * * tt it � dE * * it if it it it it dE dE 4F }!• 4F }!• il• il• ie it it it it � I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C I P T I O N UNIT COST ;TOTAL I COST ELE 3 RECEPT/OUTL'ET 1 ST 20 EA. .75 2.25 , ELE 1 MOTOR/POWR-APPARATUS 1.1 — 10,0 HP 7.50 7.50 r END OF FEES 01 0005 1664 —0005 1664 T O T 24.75 DATE: 01/11/90 TIME: 15:13 CONSTRUCTION AND PLANNING POOL 'A APPROVALS Permit # 7Datelnspector APPROVALS Permit # Date Inspector 1. Temporary, Electrical Service or Polc .-v 52. Pool & Equipment Location - 2.. Soil Pipe-Undrgrnd. 53. Steel Reinforcement r Electrical Condui� z• 54. Forms Electrical Conduit%I ndrgrnd. 74 55. Electrical Bonding i5. Steel Reinforcement- ' }. 56. Rough Plumbing & Pressure Test -. r6. Electrical UFER G'd. 57. APPROVAL TO COVER-GUNITE - "J. Footings -`� _ 58. Electrical Conduit-Undrgrnd. - 8. Foundation 59. Gas Pipe, ❑ Undrgrnd.• Test 9. Water Pipe Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. ' 10. Structural Floor System i - i 61. APPROVAL TO DECK J• 11. Property Sewer Line'& House*Connection 62. Backwash & Receptor -Final 12. Sewer Cap ril - 63. Heater & Vent -Final 13. Roof Drains , rc. 64. Plumbing System • Final 14. Rough Plumbing i 65. Electricai-Final f 15. Rough Electrical -Conduit 66. Solar System -Final 66.I U11 16. Rough Electric Wiring- 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling r 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ;_Permit # .� 20:-Rou6h Factory Fireplace Z�, <i -3'APPROVALS 21 -Dins, in`Structtiii 3 �� '' - 70. Underground Hydro rr 22: -Ducts, Ventilating ,, ,- s=• _ v -71. Product -Piping ❑ Gas ❑roil 23. Gas-Pipe=Rough & Test ^ - : r { :t; 1' 72. Undergro`nd Fli7sfi' , yS 24. Roof F Ing -73=Undengrnij. Storage Tankw❑ Gas O Oil 25. Roof Sheathing ~74 -Overhead Hydro';. r 'S. 26.; T -Bar Ceiling (Structural) & Monocoat j, w; 75-- Dry Chemical 27:,Frame and Flashing.' = 76. Dry Standpipe 728.� Lathing:& Siding Y � � � " • ". ~;x ; 77;, FIXED SYSTENi;F1NAL .. 29. Insulation + + '' 78 FIRE PREY. FINAL - I ► 30. Drywalk.Nailing = '.HEALTFTQD Pf REQUIREMENT x ,; , ,. --31. Plaster Brown Coat_ : _ ~ ;* "79. FINAL INSPECTION 'K Power Mer-Final ;32,ElectricTl et '80'FOOD CERTIFICA7> ISSUED_ '-33=Fici2l Electric , c. �. i 0 Notes: _-' :Y34:'Fina1 [ten. •.r' y� r Heatir4& Air•Coi+ditioning': t� .-U - 35TFi'I Gas Pipe Test. :°136. Mood oi•-Canopy 4 T -1 C : r rt. • Z 4 :37...Firal Factory Fireplaces. t.c � rA �38. Final Plumbing 39. Water Service -Final. 140. Gas Service -Final * r "" "" s Y41. Solar Domestic -Finial' 42'Backflow Preventer•, 43. Backflow Irrigation, �'' ,: t^ tit w K f Landscape lii-igati h System•"r; ',� F'44� _ r45.,:Sound ,Attenuation - ..., :. - r, t ti• _ ,� c, '" 46. Handicap Regulations - :, 4 + y c `• `� - t A C '�.' tK X r l c 47 =FINAL STRUCTURE & BUILDING 48=FINAL PLANNING :,49rElectric Release totiEdison { r a� a 50 _Gas Release to Southern California Gas Co X51. CERTIFICATE OF OCCUPANCY No. date lA 1 0 IOJECT ADDRE99 711 W 17TH ST `. UNIT: B9 OWNER'S NAME: ANDERSON—STANTON ADDRESS: SAME ARCNIENGINEER: ZORAH SHEFFNER REG,ND.:S7%D IT: ADDRESS: N / A L,A. CA 90000 PERMITTEE: ANDY ANDERSON (714)G42-7088 ADDRESS: 711 W. 17TH ,ST C.M. 'CA 9262G LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commending with Section 7000) of Division 3 of the Business and Pmfessiorrs Code, and my license is in tall form and effect. CrTYDate LIC.: // � � STATE LIC.: {late: Signature:2— WORKERS' COMPENSATION DECLARATION: I hereby affirm that i have a ceruhcale of consent to seif•irlsure or a certificate of Workers' Compensation Insurance, or a cerufied copy thereof (Section 3BDO, Lab. Q. POLICY NO.: EXP. DATE: COMPANY: r] Certified ropy is hereby famished. ❑ Certified copy is filed with the city Building Division. .,ate: Applicant: ExEmPTMN FROM WORKERS' COMPENSATION DECLARILTION: (This section need w be completed it the permit is tar one hundred (SIOD) or less). I cartiry that in the performance of the work for which MIS permit is issued. I shah nyyyl,,,eeemploy arty person in any manner so as to become subject to the Work/yrs' Compensation Laws of California. �� Date: +'� ' '�` s� nature:NOTICE: 11, after making this declaratio should become subject to the Workers' Compensation provisions of the Labor 4' Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097, Civ. Q. LENDER: ADDRESS: '. OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7091.5 Business and Professional Code: Any city o1 county which requires a permit to construct. alter. Improve, demolish, or repair any structure, prior to Its issuance. also requires the applicant for such permit to file a signed statement that helshe is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professlats Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation o1 Section 7031.5 by any applicant for a'permit subjects the applicant to a civil penalty of not more than five hundred dollars (S5D0). I, as owner of the property or my employees with wages as their sole compensation. wig do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not appy to an owner of a property who builds or improves thereon, and who dors such work himselfRrersell or through his or her own employees. provided that such improvements are not intended or offered for sale. tf, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose o1 sale). I, as owner of the propsrry, am exclusively contracting with licensed contractors to constructthe project (Section 7044, Business ❑ and Professions Code: The Contractors' hate License Law does not apply to an owner of property who btalds or improves thereon and who contracts for such projects with a contractoris) license pursuant to the Contractors' State License Law), I am aware that proof of their Wort r s Compensation insurance should tie provided to me. ❑ I am exempt under Section: B. r;, P. C. for this reason: _ Date: //, 1 do hereby certiry that I am aware of and understand the requirements of California Health and Salary Code Sections 25505, 25533, and 25534 and that I or any tenure building occupant wiNlwill not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Au uality Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certiry that I nave read this application and state that the above Information is correct. I agree to comply with all city and county ordinances and state laws refatinp to building construction and herebyr�ntatives of this dry to Xnter upon the above-mentioned property for inspectwpuses. Date: '/ Signature: Driver's License or Sociai,Secudry r1 1641.46 white—Building; Green—Code Enforcement: Canary—Applicant; Pink --Revenue:' Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B, 045005 PERMIT NO: B 045005 PLAN CHECK NO: 01451-89 S GOVT: N SUP,P: N CONSTRUCTION.TYPE: V—N PERMIT TYPE: STR PURPOSE: ADD JOB DESCRIPTION .: AD,D 400 SF STORAGEMEZZANINE SQ FT: 745 CLAIM VALUE: 7,400.00 CALC—VALUE: 7,390.40 GROUP OCC: B-2 / COMMENTS: REFER TO P.C. #489-89S Z O N I N G R E Q U I R E M E N T S S E T B A C K S — MAIN BUILDING ---------- -- — — ACCESSORY BUILDING --- --- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT, IN LEFT: FT 'IN RGHT: FT IN LEFT: FT- IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 00000000 ZNE: MG REF NO: PLANNING N TES> APPROVAL TO INSTALL 400 SQUARE FOOT MEZZANINE !h 1� 1� if if dE dE if if if if * * 1� ii ii if if ic• ic• * ii it it it it * * dE iE ii it * * * iE * iE iE ii * it * ic• dE dE if it ;>< if ;� ;� it it it iE iE iE if iE * if• iE iE ii it iI• i4lE !h ;� it i6 iE ;� it iE it it• D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N•t/'S ,7ANING APPROVED BY [�_`— -DATE: BUILDING APPROVED BY DATE: • r. APPLICATION ISSUED BY: DATE: #' if• .� ic• ic• iE iE if it• if * >F iE if if ii it• if• it• if if ic• ic• iE iE if it• if it• ic• iE ii iE �E if• if ie �E !h !h iI• iI• * dE !h !h * !E iI•,rF',rF !E !h lh;� !E IF iI• iI• �' * !E !h * iI• it iI.1[• * ;� � !E ;� it• if• �E iE iE iE iE if 74 it 74 if if iE if if !E !h * it• dE iI• it iI• iI• !E iE it if it• if• i6 iE if it• if• * if iE if LEGALIZATION:N F E E S U M M A R Y STRUCTURAL'SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE 'SHIP/RES GRADING PERMIT 99.00 SMIP/NON—RES PLAN 64,35 1.11 ISSUE FEE BUILDING—DIV--> PERMIT, ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS -7--> 100,11' 0.00 64,35 164.46 164,46 .00 REVENUE DIVISION TOTALS--> COLLECTED: 1.00.11 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC.MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 99.00 1 1.11 r iI• dE !h !h !h it• iE iE * YF in if * if iE iE ii * if if iE iE if iE iE it• if• it• if• iE iE iE it ii it• if• * * ic• iE iE ii it• it• if if if it• * * if !E ?f dE dE iI• it iI• it * * dE * iE iE iE iE sE * iE iE �E iE ii it• I N D I V I D U A L F E E B R E A•K D O W N TYPE QTY D E S C R I P T I O N SFC 745-- OFF—TNT. ALTER TYPE V—N —AVER END OF FEES r UNIT COST TOTAL COST n15m 7,390.40 No CITY OF COSTA MESA , r rr CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL 'A APPROVALS . Permit # Date Inspector 1. Temporary Electrical Service or Pole 52, Pool & Equipment Location 2:C.SoR Pipe--Undrgrnd. 53. -Steel Reinforcement �'3 -'ElectricaF Coriduit.Utility-Undrgrnd. 54. Forms 4 Electrical+ Conduit Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 4 6. Electrical- UFER Grnd. 57. APPROVAL TO COVER•GUNITE 7.: Footing Z 58, Electrical Conduit-6ndrgrnd. J 8' Foundation _ 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. ' 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line,& House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains.- -- 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval =57. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical•T Bar Ceiling 69., POOL/SPA SYSTEMS FINAL 19.' Rough Heating & Air Conditioning _ -.FIRE-DEP-T. REQUIREMENT APPROVALS;.- . Permit # y 201,Rough Factory l:ire'place - _ a' _ 21.' -Du=' Du= , in StruCtu[e' _ �~ ',70. Underground•Hydro 22. -Ducts, Ventilating, --' �_ - v '.71. Product Piping ❑ Gas ❑'Oil 23. -Gas PiperRo�gh & Test 72. Underground Flush 24,Roof Framing ,, Y r i 73: Undergrnd. Storage Tank ❑Gas ❑Oil 25. Roof Sheathing 74, Overhead Hydro - 26.'.T -Bar Ceiling (Structural) &-Moniocoat 75:WDry Chemical 27TFrame and Flashing _ _ - * 76- pry Standpipe _28. Lathing & Siding - _ e 77. 1 FIXED SYSTEM FINAL;- INAL;29. 29.Insulation 78 FIRE PREV. FINAL x 30. Drywall -Nailing F" _ s ,� HEALTH DEPT' REQUIREMENT 131. Plaster Brown Coat' _ r '• i -79, FINAL INSPECTION ' <32.' Electrical Power Meter=Final , r 80. FOOD CERTIFICATE ISSUED ._ 'T'33. Final Electric- 4 f. Notes: - !,34._ Final Heating& Air Conditioning `�' x _ T' 35. Final Gas Pipe -Test• L36. -Hood oF-Canopy ., - ` x `37. Final Factory Fireplaces "-38.Fin ai Plumbing„' - 39 -.Water Service;Final, 40. Gas Service -Final Z41. Solar Domesiic•Final 42. Backflow Preventer' - 43. Backflow Irrigation: Landscape IFrigation System'''•' t "T -45.-Sound Attenuation - 746, -Handicap Regulations .47. -FINAL STRUCTURE & BUILDING 48.=FINAL PLANNING Ele tric.Release to Edison 50:=Gas'Release to Southern California Gas Co 51. CERTIFICATEOF'OCCUPANCY No. Date Y' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CliY OF COSTA IV�ESA CON RUC N PER IT Project Address /114 W / >< d q Applicant's Mailin ress r Owner's Name #Phone Address Arch/Eng. License No. Address Contractor's Namhone Address (mailing)- 91S7iJ City License No. N LICE5CD CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Divislon 3 of the Business and Professions Code, and my license is in fulWorced effect. License Class IF, C. License NoT_:�_O 2—ZCtl Date Signature WORKERS' COMPENSATION DE ARATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate ofWorkers' Compensation Insurance, or a certified copy thereof (Section 3800, lab: C.) Policy No. Company - BCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (5100) or less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' CoLaws of CaliVla. Ci Date ,MVK Signature •NOTICE: If, after making this declar on, you Should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Cly. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions Of 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 enaity of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is Sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant 'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. Iagree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for Inspection purposSi. Signature ate Drivers' Licen or A� P RMIT NO'?� / TRACT NO. LOT NO. UNI NO� 9920 3/25/65 10050 TYPE OF CONSTRUCTION NEW ADD LJ ALTERATION U ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. REPAIR A,P-916 Zone S Main Building: Accessory Building: TYPE OF PERMIT GRADING ❑ FOUNDATION ❑ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION S ZONE GRADING CU.YDS. ACRES T Front p B A Rear N I Right N K g Left R Ping, Ref. 90 Parking Req./Provided E Remarks: Planning Notes: Q M T S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Ji– Automatic Washer Construction Pale Sub. Transformer Cl 15.50 KW 7. D 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps Dishwasher Solar Piping Di -vers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00-1 HP 01 h - B Floor Drains Swimming Pool w/Spa F.A.U. sr Inc. Solar 09.15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service i} Outlets Water Closet Device Boxes Pate Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator ❑0-5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Hood or Type I El CanoPY Type II 0 SERVICES Zoning Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date Dat Duct - Under Ground Duct - Structural Refrigeration System DO- 100,000 BTU 0100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ ! 0 ISSUANCE $ $ ENERGY P.C. $ $ GRADING $ $ MICROFILM $ $ TOTAL FEE $ $ ,/O, Exhaust System ❑ Multiple 0 System Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers Heating System & Ducting ❑&i 00,000 BTU ❑100,000 BT Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865.46, rev. 10/84 White - Building; Canary '- Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING 1.. APPROVALS Permit # 41 Date _ I nspector _ i4 POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary ElectricM Service or Pole 52. Pool & Equipment Location i '2. Soil Pipe-Undrgrnd. y y 53. Steel Reinforcement J,. J- Ele trical CnnduieUtility-Undrgindi �� 54. Forms Elec$�'cal Conduit lJnr,lrgrnd. ,�� 55. Electrical Bonding r1 - 5.S�eel Reinforcements ` 56. Rough Plumbing &Pressure Test .rs� �'�Jc rical LIFER rnd , - � 57. APPROVAL TO'COVER GUNITE O Ings Ind '� L� - t� 58. Electrical Conduit-Undrgrnd. cundation 59, Gas Pipe, ❑Undrgrnd., Test ✓ ter Pipe-Unnd. 9 60. Backwash Lines, P -Trap, D Undrgrnd. {i► 1,9' Structural Floor System 61. APPROVAL TO DECK ] .ir, Property Sewer Lirr& HouseConnection I# 62. Backwash & Receptor -Final 1 -12-.'-v r Cap 63. Heater & Vent -Final J r ,.1 1',3.� Roof Drains r • 64. Plumbing System - Final r 14!Rough Plumbin'g� �r ��j) 65. Electrical -Final _ ^' 1 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, POOVSPA SYSTEMS FINAL 19. -Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace -21. Ducts, in Structure 70. Underground Hydro 22.. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Uoderground Flush 24. Roof -Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling {Structurals & 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 I HEALTH DEPT. REQUIREMENT 31., Plaster Brown Coat 79. F;INAL INSPECTION J 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33.1 Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test �`� 0900 - 36. Hood or Canopy ! - 37. Final Factory Fireplace i 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation _ 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 1 49. Electric Release to Edison - - - 50. Gas Release io Souihern California Gas -Co ' 51. CERTIFICATE OF OCCUPANCY. i No - Date I r0 Applicant to fill in all spaces except those within heavy border lines and.sign all appropriate declarations. C(TY OF COSTA MESA CONSTRUCTION PERMIT 1 PERMIT NO. TRACT NO. LOT NO: UNj,T Project Address ; •71'1 W. 17th St. Bldg. (B) Unit 9 - ;a(i1J~ Applicant's Mailing Address 13110 Satico nSt. N. Hollywood Owner's,NameTrny In Fund Phone 549-2988 Address 4'121 Birch St . _N_ewport, _Beach, Ca.� Arch/Eng. Marin J. ROCK License No. Address 1 2,$Rl Knntt Ave. Suite 216 Contractor's Name—fur-0 Air Conditioning Phone 982-1216 Address imailing) 13110 Saticoy St. N.Hollywood, Ca. City License No. _ 33925 LICENSED CONTRACTOR DECLARATION ' I hereby affirm that I am licensed under provisions of arter 9 (commencing with section 7000) of Division 3 of the Business an mfessions Code, and my license is in full force and_effe • C License Class — s No- - _3/+5251 'Dat Signature 'WOR CER COMPENSATION D LARATION I hereby affirm that I have a cer . tate of consent to stili -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section ' 3800, Lab. -C. -. - - - policY No. 09824 Company l.umberlllala5 eCertified copy is hereby furnished. Certifi cpp� iS tiled with the city Bujlging ¢Ivision� Date L Applicant - j Jt k IE EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). 1 certify ,that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date - Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, You must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction- lending agency for the performance of the work for, which this permit is issued (Section 3097 Civ. C,) under's• Name Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and•Professlonal Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 malty of not more than five hundred dollars ($500). I,�as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of safe). [:] 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant'to the Contractor's License Law), I am aware that proof of their Worker's Compensation insurance should be provided to me. -❑ I am exempt under Section LB. & P. C. for this reason m l c>�:? TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR El CONVERSION 1:1 DEMOLISH El OTHER A.P: # DESCRIPTION OF WORK/USE OF BLDG: S Main Building: TYPE OF PERMIT El GRADING 0 FOUNDATION II ❑ STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING L%I MECHANICAL 6 Rear ❑ OTHER _ A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ $ Left` ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service ` Outlets Interceptors Kitchen Sink P—Trap Roof Drains Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Date i Owner Heating,System &Ducting I hereby certify that I have read this application and state that -.the above , 170-100,000 BTU -❑1,00,000 BT information is correct. 1 agree t comply with all city and county ordinances and state laws ating to bui 9 construction, -and hereby authoriz repre- sentatives h' city' t r upon the above-mentioned pro rty or Inspectio es. Z Signature Date Drivers' se ar Reinspection Fee $15 CMF 0865-46, rev. 10/84 _ White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection' Solar COI lectors Solar Piping Solar Tank Swimming Pool w/Spa , Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays . I Issue Fee MECHANICAL Hood or Type I ❑ Canopy Type 11'. ❑ Refrigeration System ❑0-100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES -- - Automatic Washer - - L' Construction Pole Sub. Cooking Unit Dishwasher Drvers ❑Gas FIE IF! ctric Fan F.A.U. Fixtures i Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW C 5.15 K 1755 -4/24/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer - C1 15 -50 -KW 50+KW Meter ❑up to 100 amps I Meter ❑over 100 amps Sub Panel Motors E10-1 HP ❑ 1 )4- 8 Inc.Solan❑9-15 HP ❑16-15+ Microwave Pole Light Range Sign Standing Sections W Trash Compactor - 159PO TL A- $ 3 Reinspection Fee $15 Issue Fee $ 3 - FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By— y REQUIREMENTS: Date ' Date SUMMARY SUMMARY OF FEES BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% , $ $ PLAN CHECK 5(r. $ MECHANICAL $ 13.00 _ PLAN CHECK 25% $ 2.50 SMIP' $ PERMIT ISSUANCE $ ENERGY P.C. $ f GRADING $ MICROFILM $ TOTALFEE $ 15.50 i -ELECTRICAL $ 3 r CONSTRUCTION AND PLANNING Date APPROVALS - Permit # t' Inspector POOL ac SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement r 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd.. - 55. Electrical Bonding 5. Steel Reinforcement Z 6. Rough Plumbing & Pressure Test 6, Electrical LIFER Grnd. r 57. APPROVAL TO COVE R-GUNITE f" 7. Footings ' 58. Electrical Conduit Undrgrnd. 8.' Foundationf s� 59, Gas Pipe, ❑ Undrgrnd., Test 9. Water Pips-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. -10. Structural Floor System 61. APPROVAL TO DECK 11- Property Sewer Line & House Conjiection 62. Backwash &Receptor -Final 12. Sewer Cap f 63. Neater & Vent -Final 13. Roof Drairls 64. Plumbing System - Final ; . 14. Rough Plumbing 65. Electrical -Final f -15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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. F I NA L I NSPECT ION 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final ' 42. Backflow Preventer 43. Backflow Irrigation 44. .Landscape Irriqation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49. Electric Release to Edison i 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF -OCCUPANCY No. Date _ N Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations, PERMIT NO. TRACT NO. I LOT NO. I UNIT NO. CITY OF COST�Ai MESA CONSTRUCTION PERMIT Project Address" /�I &2 _n7,4s C_[bS7'A %1'1 �S Applicant's Mailing Address Owner's Name / '�+`' `� "V `r C5 s N'i f[ !y , Phone Address Arch/Eng. J License No. Address G� ' Contractor's Name�bt42fl l2 4�C�� ! C_ PhoneS__C G s� Address Imai Iing)/'zzt� X1�1c--Z7mA.ts� ci%1.3A City License No- / - LICENSED CONTRACTOR DECLARATION i hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of th usiness and[ofdessi s Ce, and my license is in fui force and eff ct.License Class ' , ✓ / Date_)=/CP 'A•, Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate 7f Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab. C.) , Policy No:4�C'•s Compan — �• BCertified copy Is hereby furnishe Cer[tlfied copy Is t led with the CIt Buil I,, - Date, ion. Date,�j —L a `- Ar� Applicant EXEMPTION FROM WORKERS' COMP15f;SA'1riON DE LARATION (This section need not be completed if the permit is for one hundred ($100) or less). Icertify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address . OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or. repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 menatty of not more than five hundred tlolLars ($500). i, as owner of the property or my emPloyees with wages as their sale Compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or impioves thereon, and who contracts for such projects with a con- tractor(s) license pursuarit'to'the Contractoi's License Law). I am aware that proof o their Worker's Compensation insurance shoultl be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Owner Date 1 hereby certify that I have read this appli information Is come I. agree to Com ly wIl and state I in9 building co struct sentatives f this 'ty t enter up n the inspection rpo Signature Drivers' License or SS ; Lion -and state that the above all city and county ordinances i, and hereby authorize repre- �ove-mentioned property for Date %V - 9� air 1 711 1. . Bar Sink Showers L3-1 - Service Sink TYPE OF CONSTRUCTION LJ NEW 0 ADD ❑ CONVERSION ❑ OEMOLISH ❑ OTHER LJ ALTERATION LJ REPAIR Bathtubs A.P. # DESCRIPTION OF WORK/USE OF SLOG. Solar Collectors $ Main Building: Drinking Fountains TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ •OTHER E T B A Front Rear PROJECT DESCRIPTION SQ. FT, OCCUPANCY CONSTRUCTION TYPE VALUATION $ C S Right I Left ZONE GRADING CU. YDS• ACRES Ping. Ref. # Remarks: Auto -Wash Planning !Votes: Reinspection Fee $15 I I Issue Fee MECHANICAL Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Oucting 00.100,000 BTU ❑100,000 BT Hood or Type I ❑ Canopy Typell ❑ FEES Refrigeration System ❑0-100,000 BTU 0100,000BTU System Repair/Alteration Fire Dampers Registers Reinspection Fee I $15 I 1 Issue Fee 1 $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 5528 I/16/H Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ©Gas ❑Electric Fan F,A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 05.15 KW Transformer ❑ 15-50 KW ❑ 50 + KW Meter LJup to 100 amps ,Meter ❑over 100 amps Sub Panel Motors fiS0-1 HP ❑1 i - B Inc. Solar ❑9-15 HP El 16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor LaK TL Z O N I N G R E' Q M T IS FEES u I I Reinspection Fee 1 $15 1 1 Issue Fee 1 1 $ 3: 1 1 DEVELOPMENT SERVICES REQUIREMENTS: PLUMBING Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains PERMIT Reinspection Fee $15 I I Issue Fee MECHANICAL Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Oucting 00.100,000 BTU ❑100,000 BT Hood or Type I ❑ Canopy Typell ❑ FEES Refrigeration System ❑0-100,000 BTU 0100,000BTU System Repair/Alteration Fire Dampers Registers Reinspection Fee I $15 I 1 Issue Fee 1 $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 5528 I/16/H Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ©Gas ❑Electric Fan F,A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 05.15 KW Transformer ❑ 15-50 KW ❑ 50 + KW Meter LJup to 100 amps ,Meter ❑over 100 amps Sub Panel Motors fiS0-1 HP ❑1 i - B Inc. Solar ❑9-15 HP El 16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor LaK TL Z O N I N G R E' Q M T IS FEES u I I Reinspection Fee 1 $15 1 1 Issue Fee 1 1 $ 3: 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date SUMMARY OF FEES — — — BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING .$ 1 ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ f-{ •OQ _ GRADING $ i PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTA:L FEE $ —i' AO PLAN CHECK 25% $ ■ •CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL a SPA APPROVALS Permit # Date Inspector ' •1. Temporary Electrical Service or Pole /r f> 52. Pool & Equipment Location ,2. Soil, Pipe-Undrgrnd. �f;u 53. Steel Reinforcement 3:Electrical Conduit Utility-Undrgrrid. %; �Y 54. Forms 4,Electrical Conddit-LIhdrgrnd. 55. Electrical Bonding 5,-Steel)Relnforcement, `� V, 56. Rough Plumbing & Pressure Test =' 61 Electrical UFER•GGnd. ^J 57. APPROVAL TO COVER-GUNITE 7. Footings �^ t; 58. Electrical Conduit-Undrgrnd, �- B -Foundation �'i' 59. Gas Pipe, ❑ Undrgrnd., Test f� 9'. Wate'r Pipe-UndrgrAd� N "60: Backwash Lines, P -Trap, ❑ Undrgrnd. , 10.,Structural Floor System 61. APPROVAL TO DECK 11}~Property Sewer Linea& House Connection i"1 62. Backwash & Receptor -Final 12N»Sewer Cap �� ;; ,v r 63. Heater & Vent -Final f. 13. Roof Drains64. 471 Plumbing System - Final J 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. POOLISPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro .22. Ducts,, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 31R. -Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer r-- 43. Backflow Irrigation 44. Landscape irrigation System ,x 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49, Electric Release to Edson 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF,DCCUPANCY No. Date - r Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTIDNPER MIT Project Address 7 [ Q Applicant's Mailing Address Owner's Name CAT—IPhone Address Arch/Eng. License No. Address yy �.�' i Contractor's Name J s Phone 2,2?,Pr VL Address (mailing) / r City License No. "!II57 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) o7 Division 3 of the Business and Professions Code, and my license is in full force and effect. Ucen�KERS' Class License No -310 Date SignatureWOR�Ihat SATION DE RATIONI hereaffirhave a certitic to of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. Company V. ®Certified copy is hereby furnished. Certified copy is filed with the city Building Division. j - Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). r, 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 WorkCompe sat' n taws of Calif _ I Date Signature 2 'NOTICE: If, after m ing this deciar i yoLf Shoultl become subject to the Workers' Compensation provisions o the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY ' I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ, C.) Lender's Name I-ender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 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 proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner' — I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for inspection pur s Signature Date2_ Drivers' Licen br SS CMF 0865-46, rev. 10/84 Wh f IVIJy,I IV �� I ,II+V 4 Irv, �v, ICY• VIV I�/� TYPE OF CONSTRUCTION 0 NEW LJ ADD D ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. 5 Main Building: TYPE OF PERMIT GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUM13ING ❑ MECHANICAL B Rear ❑ LOTHER A PROJECT DESCRIPTION Sri. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks: t Planning Notes: ' I r 9925 3/25/85 Zone Accessory Building: Parking Req./Provided 10x50 TL Z O N I N G R E Q M T S Reinspection Fee 1 S151 1 Issue Fee Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Beating System & Ducting ❑ 0-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 nt; Pink - Accounting; Goldenrod - Assessor $ 3 MECHANICAL FEES Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System E-10-100,00OBTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee I S 3 Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By 4 Date Application Issued By Datp PLUMBING FEES ELECTRICAL FEES !-automatic Washer '. Transformer ❑ '15-50 KW Construction Pole Sub. ❑ 50 + KW Bar Sink Showers ' Backflow Preventer Service Sink Backflow Irrigation Sewer Cap' Bathtubs Sewer Connection $ 'Cooking Unit Meter El up to 100 amps Clarifiers Solar Collectors ISSUANCE Dishwasher Meter Dover 100 amps ; Dishwasher Solar Piping - $ Diyers ❑Gas []Electric Sub Panel Drinking Fountains Solar Tank PLAN CHECK 50% Fan Motors 00-1 HP ❑1f: -B Floor Drains Swimming Pool VV/Spa $ F,A.U. Inc. Solar 09-15 HP ❑16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets' Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator 00-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee 1 S151 1 Issue Fee Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Beating System & Ducting ❑ 0-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 nt; Pink - Accounting; Goldenrod - Assessor $ 3 MECHANICAL FEES Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System E-10-100,00OBTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee I S 3 Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By 4 Date Application Issued By Datp SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. - $ ELECTRICAL $ �� GRADING $ PLAN CHECK 50% $ MICROFILM $ I MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ G$ONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector. i' POOL a SPA APPROVALS Permit # Date Inspector Temporary Electrical Service or Pole ., � 1 52. Pool-& Equipment Location • 2' Soil,Pipe-Undrgrnd. nR� 53.,Steel Reinforcement % ' 4,#Elect fical Conduit 'til ty-Undrgrn`ci - r;�j CIO 54. Forms 4�EIectFica! Conciui� end -trod. �� 55. Electrical Bonding 5j StpeljReinforcem'ent 0 u 56. Rough Plumbing &Pressure Test . =-6• Electrical UFER Grnd. 57. APPROVACTO COVER-GUNITE .� n 7rFootings r"� ` 58. Electrical Conduit-Undrgrnd. $,,Foundationf - i 59. -Gas Pipe, El Undrgrnd„ Test B§?Water Pipe-Undrgrnd. y ✓',: n Y 60. Backwash Lines, P -Trap,'❑ Undrgrnd. �✓ .10. Structural Floor System, ti .�' 61. APPROVAL TO DECK _:Y"Prope'rty Sewer Line & House Condnection .1 62. Backwash &. Receptor -Final 12rSewer Cap�.� 63. Heater & Vent -Final 13: Roof Drains ''lip I 64. Plumbing System - Final f lr4!4Rough Plumbing;. (f0 65. 'Electrical -Final kms,• 15�'eRough Electr,ical`Conduit 66. SolarSystem=Final" 16. Rough Electric Wiring 67. Fencing & Access Approval - 17. Rough Wiring Sign. 68. APPROVED -FOR PLASTERING 18. Rough Electrical -T Bar Ceiling M1 69. POOL/SPA SYSTEMS FINAL 19: Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20., Rough Factory Fireplace 21. Ducts, in Structure round Hydro 22. Ducts, Ventilating Piping [:]Gas ❑ Oil 23. Gas Pipe -Rough &Test round Flush '.24. Roof Framing _ KUndergrnd. nd. Storage Tank D Gas D Oil 25. Roof Sheathingd Hydro 26. T -Bar Ceiling (Structural) & Monocoat mical 27. Frame and Flashing 76. Dry Standpipe 28. 'Lathing & Siding 77. FIXED SYSTEM FINAL 29. 'Insulation , 78. FIRE PREY. FINAL ,30.. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. 'Electrical Power Meter Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric { Notes: 34. Final Heating &'Air, Conditioning 35. Final Gas'Pipe-Test i 36. Hood or.Canopy i t 37. Final Factory Fireplace T 38. Final Plumbing 39. Water Service-Final- ervice-Final40. 40.Gas Service -Final , t 41. Solar Domestic -Final I 42. Backflow 'Preventer' 43. Backflow Irrigation t ' 44. Landscape Irrigation System 45. Sound Attenuation i ' 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 I Date s I q L Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OFCOSTA MESA CONSTRUCTION PERMIT PERMIT NO. r, TRACT NO. LOT NO. UNIT NQ. Project Address 7_11_-.W. 17th ST. Bldg. (B) Unit 10 Applicant's Mailing Address '_1.3110 --Saticoy St . N - HollywOO Owner's Name Troy Investment Fund Phone 549-2988 Address _4321 Birch St. New Port, CA._ _ __ Arc WE ng. Marin, J. ROCK R—License No. Address 12Ave-,-Suite 216 Contractor's Name nuco Air COnditiOT1iCl9_Phone 982-1216 Address (mailing) 1.311e1 Sariroy St. N, Ho11yHooda Ca. City License No. 33975 LICENSED CONTRACTOR DECLARATION 1 hereby affirm that 1 am Iicensea-under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and ofessions Code, and my license is In full fo�1 and effec 346251 License Class C Li a o. Date -4/ 18.194- -- Signature WORKERS' COMPENSATION DLARATION I hereby affirm that I have a cert) tate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section Polio, Lab. ca WC9824 Lumbermans Policy Na. Company Certified copy is hereby furnished. Certify (c pfiled wlth the city Bui}�ing ivision. Date �tY Applicant [� �J EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that In the performance of the work for which this permit is issued I shall not employ any person In any manner so as to become subject to tke Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or - this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency far the performance of the work for which this permit is issued (Section 3097 Civ, C,) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for Such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 i ere from 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 enafty of not more than five hundred dollars ($500). I,- as owner of the properly or my employees with wages as their solo Compensation, will do the work, and the Structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a properly who builds or Improves thereon, and who, does such work himself/horself or through his or her own employees, provided that Such Improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she aid not build or Im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors W construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improve$ thereon, and _who contracts for such projects with a.con- tractor(sj Ilcense pursuarit'to tno Contractor's License Law). I am aware that proof off their Worker's Compensation insurance should be provided to me, ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify trial I' have read this application and state that the above information is correct. I agree to Omply with all city and county ordinances and -state laws relating to buil Construction,and hereby author a repre- sentatives is city to a upon the above-mentioned arty or Inspectionr ses- Signature Date Drivers' Lite ar SS TYPE OF CONSTRUCTION LJ NEW LI ADD LI ALTERATION L_J REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. y# DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TYPE OF PERMIT El GRADING FOUNDATION 0 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL B Rear ❑ •OTHER A PROJECT DESCRIPTION SQ. FT, OCCUPANCY C Right CONSTRUCTION TYPE VALUATIONS g Left - ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact, Bit, ICBO + 1 Heating System & Ducting 4100,000 BTU Cl 100,000 BT Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type 1 ❑ Canopy Type Il ❑ Refrigeration System ❑4100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 1756 4/2k/85 Zona Accessory Building: Parking Req./Provided 15.50 TI, PLUMBING Bar Sink Showers Backflow Preventer _ Service Sink Backflow Irrigation Sewer Cap' Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P -Trap Laundry Trays Roof Drains v $ 3 Reinspection Foe $15 Issue Fee Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact, Bit, ICBO + 1 Heating System & Ducting 4100,000 BTU Cl 100,000 BT Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type 1 ❑ Canopy Type Il ❑ Refrigeration System ❑4100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 1756 4/2k/85 Zona Accessory Building: Parking Req./Provided 15.50 TI, $ 3 FEES ELECTRICAL FEES Reinspection Fee . Automatic Washer' - Transformer ❑ 15-50 KW ' Construction Pole Sub. ❑ 50+ KW Cooking Unit Meter ❑up to 100 amps FEES Dishwasher Meter Clover 100 amps REQUIREMENTS: Dryers ❑Gas ❑Electric Sub Panel Date Date Date Fan Motors ❑41 HP 011A - 8 F.A.U. Inc. Solar 139.15 HP ❑16.15+ BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% Fixtures- Microwave SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE ' $ Device Boxes Pole Light Outlets Range Switches Sign 6 Garbage Disposal ! Standing Sections 4 Generator 045 KW ❑5-15 KW Trash Compactor $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By— REQUIREMENTS: Date Date Date BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ $ $ —13 • UO- $ 2.50 SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE ' $ 15.50 6 00 4 00 $ 3 Z O N I N G R E Q M T S 'CONSTRUCTION AND PLANNING APPROVALS. Permit # Date Inspector POOL a SPA APPROVALS Permit # Date Inspector ' 1. Temporary Electrical Service or Pole 52. Pool &Equipment Location r� 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement f - 56. Rough Plumbing & Pressure Test *6. Electrical UFER Grnd. f i 57. APPROVAL TO COVER-GUNITE 7. Footings j 58. Electrical Conduit-Undrgrnd. 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test •' ' 9. Water Pipe-Undrgrnd. r 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System - �� ., 61. APPROVAL TO DECK 11, Property Sewer Line & House Conr;ection 62. Backwash & Receptor -Final 12. Sewer Cap k 63. Heater & Vent -Final ; 13. Roof Drains 1 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ 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 - INAL30.. 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 y 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date s _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY Of COSTA MESA CONSTRUCTION PERMIT- PERMIT NO. TRACT NO. LOT NO.UNIT NO. .rI ll 2Z :3 t� '?reject Address l�-- 1 f CGf j i�__ii �S . Applicant's Mailing Address TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION IREPAIR Owner's Name C' Te J Lr ES i i'1 C-Nk -Phone Address Arch/Eng. License No. Address Contractor's Name14Gh'RIS 616A CTR i C Phone -f5L7.7' L Sit Address (mailinglo & �r r►�ia}f.li j r I i s --r1 4 -920N -72J/ -City License No, LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business an Professions Code, and my license Is In full rce effec . Licens Class ~ It License o. 3% Date O ' -S Signature _WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof. (Section 3800, Lab. C. . Policy NoW� .�/p �-7 0 QnCertified copy is hereby furnish DateCert'f�g4 py Issj)ed with the ciivlslon. Applican EXEMPTION FROM WORKERS' COMPENSATION D CLARATION {7hissect on need not be completed if the permit is for one hundred ($100) or less). ' I certify that in the performance of the work for which this permit is issued I shall, not employ any person in any manner so as to become subject to tke Workers' Compensation Laws of California. Date—Signature "NOTICE: It, after making this declaration, you should become subject to the Workers' Compensation_ provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ- C.) end Ler', Name._ - Lender's Address OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to Construct, alter, Improve, demolish or repalr 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 the Contractor's License Law (Chapter 9 (commencing with Section 7000) of- ! Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for' a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sola compensation will do the work, and the structure is not Intended or Offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for ' sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- 6 rova for the purpose of sale). I, as owner of the property, am exclusively Contracting with licensed Con- tractors t0 construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who buildsor improves thereon, and who Contracts for such projects with a Con- tractor) s 11cense pursuant'to the Contractor's License Law). I am aware that Drool oftheir Worker's Compensation insurance Should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date ' Owner I hereby certify that I have read this application and state that the above information I ct, ree to comply with all city and county ordinances and state Ia s relat to uilding DnStruc ' n, and hereby authorize repre- sentatives this i y t enter u on th bove-mentioned property for inspection p r o Signature Date rf� `gs Drivers' License or SS ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT 0 GRADING DFOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear C1 OTHER PROJECT DESCRIPTION SO. FT. DcCUPANCY C Right K Left CONSTRUCTION TYPE VALUATION $ $ ZONE GRADING CU.YDS. ACRES Ping. Ref. # , Remarks: Planning Notes: FEES 5829 '1/16/85 Zone Accessory Building: Parking Req./Provided Ls ElO TL Z O N I N G R E a M T S Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink — Automatic Washer Construction Pale Sub, Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection rt Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors c I Dishwasher- Meter ❑over 100.amps Dishwasher Solar Piping SMIP $ PERMIT ISSUANCE S ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan t Motors �i HP ❑ i % - B j Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 HP ❑16-15+ Floor Sinks - Urinal Fixtures Microwave Gas Service Outlets Interceptors Water Closet Water Heater Device Boxes Outlets Pole Light Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator 13 0-5 KW ❑5.15 KW Trash Compactor Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑ 0. 100,000 BTU ❑ 100,000 BTi Reinspection Fee F $15 CMF 0865-46, rev. 10/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee MECHANICAL Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU 0100,000 BT System Repair/Alteration Fire Dampers Registers Issue Fee Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved:By Application Issued By Date Date Data SUMMARY OF FEES BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ {-4 add PLAN CHECK 50% '$ - SO MECHANICAL $ PLAN CHECK 25% $ SMIP $ PERMIT ISSUANCE S ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ $ 3 �CONSTRUCTION AND PLANNING %APPROVALS Permit # r Date Inspector POOL & SPA APPROVALS Permit # Date Inspecrnr I 1. Temporary Electrical Service or Pole 52. Pool &Equipment Location -2. Soi( Pipe-Undrgrnd 53. Steel Reinforcement -3;;Electrical Conduit Utility-Undrgrnd. - 1 54. Forms 4-1 Electrical Conddit-Undrgrnd. 55. Electrical Bonding 5 ;Steel Reinforcemerit,' 56. Rough Plumbing & Pressure Test 6: Electrical 11FER:Grnd. 57. APPROVAL TO COVER-GUNITE 71. Footings 58. Electrical Conduit-Undrgrnd, b rJ B. ,FouAdation - 59. Gas Pipe, ❑ Undrgrnd., Test 9, Watei Pipe-Undrgrnd. 60. Backwash Lines, P--Trap, ❑ Undrgrnd. 10 Structural Floor System 61. APPROVAL TO DECK '~ 11 Property Sewer Line-& House Connection i� 62. Backwash & Receptor-Final r^� 12:`Sewer Cap 63. Heater & Vent-Final i 13.YRoof Drains `> 64. Plumbing System - Final 14. Rough Plumbing.. ; 65. Electrical-Final 115. 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 122. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 31V Plaster Brown Coat 79. FINAL INSPECTION 32i Electrical Power Meter-Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric ' Lih-t Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requimments Completed 49, Electric Release to Edison 50: Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CON TRU_CTION PERMIT R l2 pERD T NO. T P,C6LOT NO. UN x No. '�t A ri-hess ;W /% + 7- �. Co STA &g;5A CA Z �(e $� r ` TYPE OF CONSTRUCTION NEw Abd ALTERATION REPAIR Bathtubs Sewer Connection ,A,, rcant's Mailing Address A d. ¢¢_�^ ii{CCCOwner's Phone& ❑ CONVERSION ❑ OEMOLISH ❑ OTHER Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Name / I C O N� �i A DR � � DGZ DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Address µr �7i NG• Y G . 'TYP�E'tOF - Solar Piping Arch/Eng. License No. F PERMIT GRADING FOUNOATION STRUCTURAL T Front Address _ 1:1 TENANT. ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ff ❑ OTHER A Fan Contractor's Nam Phone PROJECT DESCRIPTION SQ. FT. OCCUPAN Y 2- C Right �N� Address Imailingl 'CONSTRUCTION TYPE VALUATION $ C7. 0D S Left City License No, ZONE GRADING CU. YDS. ACRES Ping. Ref. # LICENSED CONTRACTOR DECLARATION Urinal Fixtures 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks:' Planning Notes: may' with section 7000) of Division 3 of the Business and Professions Code, and CONSTRUCTION LENDING AGENCY Gas Service Obtlets Water Closet my license is in full force and effect. G A 33 3 $ S I hereby affirm that there is a construction I ding agency for the performance License Class ----License No. of the work for which this permit is issued (Section 3097 Civ. C.) Date Signature PLUMBING FEES Outlets WORKERS' COMPENSATION DECLARATION Bar Sink Showers 1 hereby affirm that I have a certificate of consent to self -Insure or a certificate Lender's Address _ Kitchen Sink Water -Service ^f Workers' Compensation Insurance, Or a certified copy thereof (Section Backflow Preventer Service Sink OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the Automatic Washer 00, Lab, C.) Garbage Disposal following reason {Section 7031.5 Business and Professional Code: Any city or ilicy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. BCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Hood or Type I ❑ Canopy Type 11 ❑ Cooking Unit ' Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher (This section need not be completed if the permit is for one hundred ($100) or less). Dishwasher - Solar Piping Dryers ❑Gas C I certify that in the performance of the Work fo which this permit is Issued, I in over to ec :^ "' :��o he - Drinking Fountains g i Soler Exhaust System C3 Multiple El Sys Repair/Alteration - any m shall not fnptoy an y person Worke C mppnsa}Ipn,�aws of Calif la. -Tank Fan Dat „L/ (d�_Signature Floor Drains Swimming Pool w/spa Heating System & Ducting El 0-100,000 BTU ❑100,0 T F.A.U. NOTICE: If, after making this decla roA, ou oul become subject to the — Workers' Compensation provision$ of the r Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this pe t shall be deemed revoked. ee - Issue Fee S 3 CONSTRUCTION LENDING AGENCY Gas Service Obtlets Water Closet Device Boxes I hereby affirm that there is a construction I ding agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Lender's Name Lender's Address _ Kitchen Sink Water -Service Switches OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the Lavatories- ~ r Auto -Wash Garbage Disposal following reason {Section 7031.5 Business and Professional Code: Any city or county which requires a permit to'constfuct; alter, improve, demolish or repair P—Trap Laundry Trays Generator 0019 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 Profession$ Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section '31.5 by any applicant for a permit subjects the applicant to a civil ratty of not more than five hundred dollars ($500). Reinspection Fee $15 Issue Foe $ 3 11, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered Reinspection Fee for sale (Section 7044, Business and Professional Code: The Contractor's of a property who builds or Improves MECHANICAL FEES NEW V 9613 6/01/27 - 0'.11— // I Zone M Accessory Building: 1-11 Parking Req,/Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50 + KW Meter Ljup to 100 amps Meter ❑over 100 amps Electric Sub Panel Motors ❑ P 01'%.8 Inc ar 09.15 HP ❑16.15+ Pole Light Range Sign Standing Sections KW 05-15 KW Trash Compactor $15 I I Issue Fee FEES $ 3 Z O N I N G R E Q M T S License taw does not apply to an owner thereon, and who does such work himself/herself or through his or ner own employees, provided that such improvernents are riot intended or offered for sate. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/She did not build or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con. 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contrdctor's License Law). I am aware that proof of their Worker's Compensation insurance should Abe provided to me, ❑ I am exempt under Section . & P. C reason Boiler Hood or Type I ❑ Canopy Type 11 ❑ DEVELOPMENT SERVICES EQUIREMENTS- Zoning Approved By. _ Date �— Building Approved By Date Application Issued By Data Duct - Under Ground Duct - Structural Refrigeration System ❑0-100,00 'BTU ❑ 100,000 BTU Duct - Ventilating SUMMARY OF FEES BUILDING PERMIT 5� SMIP $ PLAN CHECK $ 2 - Z PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. S ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ y MECHANICAL 5 TOTAL FEE 5 ' 0 Z PLAN CHECK 25% $ Exhaust System C3 Multiple El Sys Repair/Alteration Firepl/Fact. Bit. ICBG # ire Dampers Date - Owner I hereby certify that I have re this i cation and state that the above Information is correct. I agree to comply th all city and county ordinances and state laws relating to bu'Idin. const tion, and hereby authorize repre- sentatives of this ci o ter u - entioned Propegy f r Inspection�urposes / Signature Data f Z �� Drivers' License o Heating System & Ducting El 0-100,000 BTU ❑100,0 T Registers ttFleinspectio ee $15 Issue Fee S 3 CMF 0865-46, rev. 10/84 Wh Mk - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52, Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd, 54. Forms 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER•GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd, 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Finbi 15. Rough Flectrical•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 APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing fo f �- 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL - 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing y �' /`� HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. F I NA L I NSPECT ION 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 u 37. Final Factory Fireplace f . • - 38. Final Plumbing f 39. Water Service -Final ,40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer r -43. Backflow Irrigation 44. Landscape Irrigation System , 45. Sound Attenuation 46. Handicap Regulations ; 47'. FINAL STRUCTURE & BUILDING17 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co / 51. CERTIFICATE OF OCCUPANCY No. Date _ �, M Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OFCOSTA MESA CONSTRTI P RMT Z P MIT NO. / TRACT NO. LOT NO. UNIT NO�� 'Project Address r / r TYPE OF CONSTRUCTION NEW 0 ADD LJ ALTERATION LJ REPAIR Applicant's Mailing Address Owner's Name hone Address - Arch/Eng. License No. Address Contractor's Nam Address (mailing) City License No- LICENSED CDNTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in f I force and effect. ++�� Ljcen Class License No.;Sr% '. Date. Signal ur WORKERS' COMPENSATION D LA RATION I hereby affirm that I have a certificate of consent to self -insure or a certificate ,3f Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. - Company Certified copy Is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant .� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need -not be completed if the permit is for one hundred ($100) ort less), I certify that in the performance of the work for which this permit is issued, 1' shall not employ any person in any manner so as to be6ome subject to the Work en ti Laws of CMif+Srrr�. Date ^ Signature NOTICE: If, after making this declare , you should become subject to the Workers' Compensation provisions of he Labor Code, you must forthwith comply with such provisions of this permit shall be deem4b revoked. CONSTRUCTION LENDING AGENCY, I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ, C.) Lender's Name Lender's Address , OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7431.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 permlt subjects the applicant to a civil Eenaity of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work nimself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. It, however, the buliding or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of $a14). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improve$ thereon_ , and _who contracts for such projects with a con- tractors) license pursuant twine Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Cl Date Owner I hereby certify that 1 h 've read this application and state that the above Information is correct. I ree to comply with all city and county ordinances and state laws relating o building construction, and hereby authorize repre- sentaIt ps of this cit t enter upon the above-mentioned property for inspection pur Signature r/ Date r Drivers' LicenMRr-SS# . 9927 3/25/65 ❑ CONVERSION T -I DEMOLISH '❑ OTHER A.P. S Zone DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: E TYPE OF PERMIT ❑ GRADING D FOUNDATION 0 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CON STRUCTION TYPE VALUATION $ S Left ZONE GRADING CU. YDS. ACRES Ping. Ref. Parking Req./Provided Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service f Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee ) $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System d Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 00-100,000 BTU [:1100,000 BT Reinspection Fee 1 $15 AF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal Water Closet Water Heater Water Service Aulo-Wash Laundry Trays Issue Fee IANICAL Hood or Type ❑ Canopy Typell ❑ Refrigeration System 00-1100,000BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 10,60 TL Z O N I N G R E O M T S FEES i ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW 'Caking Unit Meter E]up to 100 amps Dishwasher Meter ❑over 100 amps `Sub Dyers ❑Gas ❑Electric Panel Fan F,A.U. Motors ❑0-1 HP ❑ VA - 8 Inc. Solar 09-15 HP 016-15+ Fixtures Microwave a Device Boxes Outlets Pole Light Range Switches Garbage Disposal Sign ; Standing Sections Generator ❑0-5 KW 05-15 KW Trash Compactor $ 3 Rejnspeclion Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By pate Application Issued By fr Dat BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE $ $ —� / a{� ENERGY P.C. $ $ GRADING S S MICROFILM $ S TOTAL FEE $ S $ 3 3 I 'CONSTRUCTION AND PLANNING APPROVALS Permit # Date. inspector POOL„ SPA- APPROVALS Permit # Date Inspector ` 1. Temporary E:lectricM Service or Pole ,r, 52. Pool &Equipment Location }2. Sail P"pe-Undrgrnd. �.� r { 53. Steel Reinforcement ► I. 3Elec tical Condpi� Uf1ji�y-Undrgrnd. 54. Forms t 4rElectri6al Conduit ldfdrnd. 55. Electrical Bonding i 5+4St ItReinfarcem.ennt- tr . 56. Rough Plumbing & Pressure Test 6� •Ele�tjicaI UFE.R'rGr. nd. 57. APPROVAL TO COVE R-GUNITE Z 7, '�ootgs 58. Electrical Conduit-Undrgrnd. l? F8unation-A59. Gas Pipe, 11Undrgrnd., Test _� 9'..rated Pipe-Undr.gFnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. A�o 1r0��5t'�ru tura) Floor'System [EA:PPROVAL TO DECK 11./Pr perty Sewer -Line & House G'66 4 ction 62. Backwash & Receptor -Final 112ISewer Cap 63: Heater & Vent -Final ' 3. Roof Drains f 64. Plumbing System - Final 14.1 Rough Plumbing V ��+5-(,�-p 65. Electrical -Final •15.' Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 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 APPROVALS Permit # 20, Rough Factory Fireplace -21. Ducts, in Structure 70. Underground Hydro ' 22. Ducts, Ventilating X71. Product Piping ❑ Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ Gas 0 Oil . 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27• Frame and Flashing 76. Dry Standpipe 28. -Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation' 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34• Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing , 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer9 43. Backflow Irrigation - 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap, Regulations 47. FINAL STRUCTURE & BUILDING , 48. Special Requirements Completed i 49. Electric Release to Edison 50, Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No.- ._ Date _ ,._ Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF.COSTA MESA UuMi l PUCTtON PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. Project Address T. rA P1,F54 Applicant's Mailing Address w Owner's Name I^i�Ile.eCJA !3,4=1&A7_Q—Phone 44 � Address eea auz 4,tlP,tLA 45/c CcknAA (lEc_ Ae gg l Arch/Eng. License No. Address Contractor's Name Phone��R Address (mailing) City.License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate ,f Workers' Compensation Insurance, or a certified copy thereof (Section 300, tab. C.) .•olicy No. - Company BCertified copy is hereby furnished, Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for whit this permit is issued, I shall not em loy any person in any manna as becom�to the Workers'Lo pe a on Laws of Californla Date Com— Signature NOTICE: f, after making this deciaration, y should become subject to the Workers' Compensation provisions of the Mbor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License taw for the fallowing reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any Structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section '131.5 by any applicant for a permit subjects the applicant to a civil 2I. as alty of not more than five hundred dollars ($500). owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for Sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License taw). I am aware that proof of their Worker's Compensation insurance should be provided to me, ❑• I am exempt under Section 1371&-A_Qfor this reason Date Owner 1 hereby certify that I have read thi application and state that the above Information is correct. I agr a to_ corn ly with all city and county ordinances and state laws relating uild 9 construction, and hereby authorize repre- sentatives of this cit e r upove-mentioned pro rty for inspection purpos Signature "1 G� Drivers' License or S iM ZB-7aI TYPE OF CONSTRUCTION Lj NEW LJ ADD LJ ALTERATION Ll RE=PAIR ❑ CONVERSION ❑ DE=MOLISH ❑ OTHER A.P. # DESCRIPTION OF WDRK/USE OF BLDG. S Main Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ ME=CHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SO. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ $ Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: - Planning Notes: Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting E10-1 00,000 BTU ❑ 100,000 BT Reinspection Fee i • $1s CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor r- 9056 G/'_4/'7 f^nyE, Yr Zone Accessory Building: Z O N I N G R Parking Req./Provided E M T S ELECTRICAL I FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator El 0-5 KW El 5-15 KW Transformer ❑ 15.50 KW ❑ 50 + KW Meter ❑up to 100 amps ' Meter Dover 100 amps Sub Panel Motors ❑ 0-1 HP ❑ 1 A - 8 Iiic.Solar 09-15 HP ©16-15+ Microwave Pale Light Range Sign Standing Sections Trash Compactor Issue Fee $ 3 S Reinspection Fee $15 Issue Fee $ 3 PLUMBING FEES Bar Sink - Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal' Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Trap Laundry. Trays Roof Drains Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting E10-1 00,000 BTU ❑ 100,000 BT Reinspection Fee i • $1s CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor r- 9056 G/'_4/'7 f^nyE, Yr Zone Accessory Building: Z O N I N G R Parking Req./Provided E M T S ELECTRICAL I FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator El 0-5 KW El 5-15 KW Transformer ❑ 15.50 KW ❑ 50 + KW Meter ❑up to 100 amps ' Meter Dover 100 amps Sub Panel Motors ❑ 0-1 HP ❑ 1 A - 8 Iiic.Solar 09-15 HP ©16-15+ Microwave Pale Light Range Sign Standing Sections Trash Compactor Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Hood or T Type I ❑ Canopy Type I I ❑ ` DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By _ Date Refrigeration System ❑0-100,000 BTU 0100,000BTU SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ to ' TOTAL FEE $ PLAN CHECK' 25% $ '-7 System Repair/Alteration Co Fire Dampers Registers Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd, 53, Steel Reinforcement 3, Electrical Conduit Utility-Undrgrnd, 54. Forms 4. Electrical Conduit-Undrgrnd. 55, Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59.• Gas Pipe, ❑ Undrgrnd., Test 9, Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap- - 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final r 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. POO [-/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # _ 20. Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating ��r7 CA/771. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing -73. Undergrnd. Storage Tank ❑ Gas D 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 N 36. Hood or Canopy 37. Final Factory Fireplace ' 3B. Final Plumbing 39.'Water Service -Final 40. Gas Service -Final , 41. Solar Domestic -Final 142. 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 CI Applicant to fill ir,Valf spaces except those within heavy border lines and sign all appropriate declarations, CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. I ' ' 'Project Address 711 W.17th St Bldg.(B) Unit 12 {Z 1758- 4/24185 15eEO TL Applicant's Mailing Address 1311A Satico St. N,H011 OC TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR Owner's Name _ Troy Investment Fund - _Phone 549-2988 Address 4321 _ i rah St. Newport Beach, Ca. ArchlEng. Marl n J. ,Bock License No. Address 128$1 Knott Ave, Suite 216 Contractor's Namp T1nrn Air Ccinditioninfs_Phone 982`1216 Address (mailing)—]111f] SatlMy St- N.Hollywood,Ca. City License No. _ 33929 LICENSED CO N7RACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 o he Business an rofesslons Code, and my license is in full fot$p and effe 346251 License Class LLU c S NO. Date. _ signature A 1-001 WORKERS' COMPENSATION Dranco,Or ON I hereby affirm that 1 have a Cortisent to salt -insure or a certificate of workers' Compensation lnsu certified copy thereof (Section 3800, Lab. C) Policy No. Company WC9824 Lumbertllans Policy 8 Certified copy is hereby furnished. II! Certifi cop is filed with the City Building `Dl`v ion. /, I Data Applicant,... SSV A j EXEMPTION FROM WORKERS' COMPENSATION DECLA ATION (Thissection need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued I shall not employ any person in anymanner so as to become subject to the Workers' Compensation Laws of Call fornia. ' Date — Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097 Clv. C.) Lender's Name _- Lender's Address OWNER, BUILDtR DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit,to construct, alter, improve, demolish or repair any Structure, prior to its issuance, also requires the applicant for such permit to fiie a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License taw (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 malty of not more than five hundred dollars ($500). I, as owner of the' property or my employees" with wages as their sole compensation, will d0 the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law doss 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner Of proptrty who builds or Improves thereon, and who contracts -for such projects with a con- tractor{s) Ilcensa pursuant'to tne'Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner 1 hereby certify that 1 have read this application and state that the above Information is correct. I agree to comply with all city and county Ordinances and state laws relating to buildi onstruction, and he authoriZ repre- sentatives is city to on pen the above-mentioned rty r Inspectlo ur set. Signatur Dat Drivers' L nse or SS AF 0865-46, rev. 10/84 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # Zone DESCRIPTION OF WORK/USE OF BLDG. ' S Main Building: Accessory Building:. � TYPE OF PERMIT GRADING LJ FOUNDATION E Z Front STRUCTURAL T O ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL B Rear N ❑ -OTHER A I PROJECT DESCRIPTION SQ. FT, OCCUPANCY K Right N CON STRUCTION TYPE VALUATION S Left G R ZONE GRADING CU.YDS. ACRES Ping. Ref. # Parking Req./Provided E Q Remarks: Planning Notes: M T S Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection .Fee Boiler Duct - Under Ground Duct - Structural $15 Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting 1 Cap 1 00,000 BTU ❑ 1001000 BT Reinspection Fee 1 $15 PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee MECHANICAL Hood or Type I ❑ Canopy Type Ill. ❑ Refrigeration System 00-100,000BTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A:U. Fixtures - Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW ❑5-15 KW Transformer ❑ 15-50 KW - C1 50+KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑o-7 HP 0 )1 • 8 Inc.Solar 09-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES 5 FEES Reinspection Fee $15 Issue Foe $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved ByDate Building Approved By Date Application Issued BY Data - Z3 SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ' ENERGY P.C. S ELECTRICAL 5 GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $nn ' 1�-,� TOTAL FEE $ 11.5,0 PLAN CHECK 25% $ 2� 4 Qp $ 3 CONSTRUCTION AND PLANNING APPROVALS • Permit # Date Inspector POOL «SPA APPROVALS Permit # Date Inspector i 1 . Temporary Electrical Service or Pale 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd. 53, Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54.. Forms i 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �f 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. �� 57. APPROVAL TO COVER-GUNITE r 1- 7. Footings 58. Electrical Conduit-Undrgrnd. j.' , 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pi a-Undr rnd. � 60. Backwash, Lines, P -Trap, ❑Undrgrnd. 10. Structural Floor System 'i 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor -Final , 12. Sewer Cap i 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 ,9 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final ' 42. Backflow Preventer 1 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 Cc 51. CERTIFICATE OF OCCUPANCY No. Date _ t Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. LOT NO. CITY OF COSTA MESA CyjivSTRUCTION PERMIT Project Address v� _ _�- ?--1-t ` l7., Li7t -f t_ Applicant's Mailing Address�SZL1�3-/�Ft Owner's Name�� Phonew�t' Address II W. U 5-1 Arch/Eng. Arch/Eng. - - License No. Address /-t�`,_y, Contractor's Nam/ -a � � :M(-PhoneT4(-_1 Address Imailing) =i7ar�. C,o1 City License No. S,t.,G,a t (v3 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and My license is in f 11 force's d eff ct. License Class s is se No. fr�QtOv'[_— Date'U ery Signature 'WORKERS' COMPENSATION DECLARATI N �I hereby affirm that I have a Certificate of consent to so •insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section )Boo, Lab. - Policy No, h�dm pany Certified copy Is hereby furnished. Certifie op s filed with the cit ikll D I Date )Z .... - Applicant EXEMPTION FROM WORKERS' COMPENSAT ON DECL A 1 N (This section need not be completed if the perms is for one n(lr (5100) or less). I certify that in the performance Of the work for which this permit is Issued I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature -NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Of the work for which this permit Is issued (Section 3097 Civ, C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm -that I am exempt from the Contractor's License taw for the following reason (Section 7031,5 Business and Professional Code; -Any city or county which requires a p@rmit to construct, alter, improve, demolish or repi;ir 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 the Contractor's License Lbw (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) of that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section •031.5 by any applicant- for a permit subjects the, applicant to a civil ,enalty of not more than five hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, f3usiness and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does s4ch work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the builging or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or. improves thereon, and who contracts for such projects with a con-• tractor($) license pursuarit'to the. Contractor's License Law). i am aware that proof of their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Date Owner I herebycertify that I have read this application and state that the above Information is correct. l agree to comply with all city and county ordinances and state laws r�toildingtruction, and hereby authorize repre- sentatives of ththe above-mentioned property for Inspectlo Signature Date r),l,.nrc' 1 iepnse TYPE OF CONSTRUCTION LJ NEW LJ ADD L, ALTERATION LJ EPAIR* ❑ CONVERSION ❑ DEMOLISH ❑ OTHER �� A.P. # DESCRIPTION OF WORK/USE OF BLDG. -- S Main Building: E TYPE OF PERMIT GRADING El FOUNDATIOry 0 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING l)< MECHANICAL A Rear El OTHER PROJECT DESCRIPTION So. FT. OCCUPANCY $- C Right K CON STRUCTIDNTYPE VALUATIONS $I Left ZONE GRADING CU. YDS. ACRES Ping, Ref. Remarks: 'e' _Int 1•-e 1 it, 1 I • - Planning Notes: ri1 I /(1r/An n r+n Tt Zone Accessory Building; O N I N G R Parking Req,/Provided E Q IN 4 M T ZI5 Reinspection Fee S15 1 1 Issue Fee -MECHANICAL Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO * Heating System & Ducting E30-100,000VJ0-100,000 BTU 100,000 BT Reinspection Fee 1 $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; pink - Accounting; Goldenrod - Assessor Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000 BTU 0100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee I(� --, 5 3 Reinspection Fee $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By 'Building Approved By Application Issued By S 3 _ PLUMBING , FEES ELECTRICAL FEES Bar Sink Showers Backflow Prevenler Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW H❑ 50 + KW Backflow Irrigation Sewer Cap . Bathtubs Sewer Connection Cooking Unit Meter 0 u to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00.1 HP Ell 'A - 8 Floor Drains Swimming Pool w/Spa F.A.U. lnc.Solar 09-15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave - Gas Service Outlets Interceptors Water Closet Water Heater Device Boxes Outlets Pole Light flange Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P -Trap Laundry Trays Generator ❑0-5 KW 1:15.15 KW Trash Compactor Roof Drains - f Reinspection Fee S15 1 1 Issue Fee -MECHANICAL Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO * Heating System & Ducting E30-100,000VJ0-100,000 BTU 100,000 BT Reinspection Fee 1 $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; pink - Accounting; Goldenrod - Assessor Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000 BTU 0100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee I(� --, 5 3 Reinspection Fee $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By 'Building Approved By Application Issued By S 3 _ BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL '. PLAN CHECK 50% MECHANICAL PLAN CHECK 25% $ S S $ $ $ S $ SUMMARY OF FEESV SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTAL FEE $ S S $ $ $ C� $ -CONSTRUCTION AND PLANNING %J ` APPROVALS• i' Permit # Date Inspector POOL _SPA -SPAAPPROVALS APPROVALS Permit # Date Inspector 1 . Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduif-Undrgrnd. 8' Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap. ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line &!-louse 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 `l�. Rough Electric Wiring 67. Fencing & -Access Approval 17. Rough Wiring Sign 14 68. APPROVED FOR PLASTERING 18: Rough Electrical-T Bar Ceiling 69. POOLISPA SYSTEMS FINAL Rough Heating & Air Conditioning r�n FIRE DEPT. REQUIREMENT APPROVALS. Pe;mit # �2 Rough Factory Fireplace 21Ducts, in Structure 70. Underground Hydro' 22. Ducts, Ventilating .71. Product -Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73, Underg rnd. Storage Tank ❑ Gas E] 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. P12,ster Brown Coat 79. FINAL INSPECTION 32. Electrical Power M ter-Final 80. FOOD CERTIFICATE ISSUED 33. "1 al Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy jor 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final ' 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43, Backflow Irrigation ^ r• 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 Nn. Date t'`* J :J CITY OF'COSTA MESA CONSTRUCTION PER MIT Project Address ` a,,,f :% 71"/ Applicant's Mallin ddress_c, Owner's Name - WL �1/ ��/// ho.4Q Address_ -7- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. Arch/Eng 4 O v,e License No.�^6 Z S� Address / Q ' Z O Contractor's Nam UG D fp�Qne 2 Z 1 G Address (mailing) City License No. Tn? L10E145ED CONTRAACTT,OR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in ful OrCe�pnd effect. LlceIn s t cense ZS4<2 Date Signatureaid WOR ERS COMPENSATION DE ARATION I hereby affirm that I have a certlf to of consent to self -insure or a certificate ' Workers' Compensation InSur nce, or a certified copy thereof (Section 800. Lab. �� r�t �•� Policy N, �, CompanY'TA/�z-1 L' LN/ t � eCertifle copy is hereby furnished. I i Certified copy is filed with the city Building Division• Date . Applicant 'EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit IS for one hundred (5100) or less). I certify that In the performance of the work for which this permit is Issued, I shall not employ any person In any manner so as to become subject t0 the Workers' Compensation Laws,of California. pate —1 Signature — - 'NOTICE: If, after making this declaration, you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit_ shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constructlnn lending agency for the performance oft he work' for which this permit is Issued (Section 3097 Clv. C.) Lender's Name Lender's Address _ OWNER GUILDER DECLARATION_ I hereby affirm that I am exempt -from the Contraitor's License taw for the following reason (Sectlgn 7031.5 Business and Professional Code: Any city or county which requires 4 permit t0 construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions Of the Contractor's License Law (Chapter 9 (commenting with Section 7000) of Division 3 of the BLSihess and Professions Code) or that he/she is exempt .erefrom and the -basis for the alleged exemption.'Any violation of Section --;-.)31.5 by any applic8nt for a permit subjects the applicant to a civil »'=malty of not more than five hundred dollars ($500). - I, as owner of the property or my employees with wages as their sole compensation; will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employyees, provided that such Improvements are'not intended or Offered for ' Salo. 1f, however, the building or Improvement is sold within one year of Com-pletion, the owner will have the burden of proving he/she did not build or lm - rove for, the purpose of sale); ' r I, as owner of the property, am exclusively contracting with licensed con- tractors to construct th@'project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or. improves thereon, and who contracts for such -projects with -a con- tractors) license pursu$rit to the Contractor's Ll Cense Law). l am aware that proof Of, their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date r Owner I hereby , certify that 1 have read this application -and state that the above Information is correct. I�agree to c ply with alhcity'and county ordinances and State 1 relating to builds nstruction, and hereby authorize repre- sentatives f his city to on!ef LjAon the above-mentioned prop ty for Inspection ur Ose$: • Signature At Dat P Drivers' Llc se or SS PERMIT NO TRACT NO. LOT NO. U NO. 3557 12/07/84 TYPE OF CONSTRUCTION NEW LJ ADD LJ ALTERATION ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. _ REPAIR A.P. # Zone $ Main Building: - Accessory Building: TYPE OF PERMIT GRADING LJ FOUNDATION 11 STRUCTURAL_ ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING p4 MECHANICAL ❑ BOTHER PROJECT DESCRIPTION SQ. FT. ' OCCUPANCY CONSTRUCTION TYPE VALUATION 5 ZONE GRADING CU. YDS. ACRES t E T Front Z 0 B A RB8r I N Right N K S- Left i R Ping. Ref, qjE Parking Req./Provided E Remarks: — i Planning Notes: Q M T S PLUMBING FEES Bar Sink Showers ELECTRICAL i FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer-❑ 15 -50 -KW 1 ❑ 50 + KW, Backflow Irrigation Sewer Cap I Bathtubs , Sewer Connection Cooking Unit Meter El Lip to 100 amps' ' Clarifiers Solar Collectors Dishwasher _ Meter Dover 100 amps ; Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0-1 HP ❑ 1 Floor Drains Swimming Pool w/Spe F.A.U. , Inc. Solar 119.15 HP ❑ 16-15+' Floor Sinks. Urinal - Fixtures - Microwave Gas Service Outlets Interceptors Water Closet Water Heater Device Boxes Outlets Pole Light Range Kitchen Sink - Water Service Switches Sign ; Lavatories ' Auto -Wash Garbage Disposal Standing Sections P -Trap - - Laundry Trays _Generator 00.5 KW D5-15 KW Trash Compactor Roof Drains Reinspection Fee S15 tte Fee Reinspection Fee 515 Issue Fee S 3 - MECHANICAL Boiler - Duct -Under Ground' Hood or Type I 1❑ Canopy Type I I ❑ FEES � DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By r Date Date Date. ' Duct - Structural I Refrigeration System ❑0-100,000 BTU 0100,000 BTU _ oust - Ventilating SUMMARY BUILDING PERMIT $ PLAN CHECK $ PLUMBING S PLAN CHECK 25% $ ELECTRICAL (5 PLAN CHECK 50% $ MECHANICALS .' PLAN CHECK 25% $ OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING! $ MICROFILM $ TOTAL FEE $ Exhaust System ❑ Multiple❑ System Repair/Alteration Firepl/Fact. Bit. ICBG # Fire Dampers Heating System & Ducting 7 t R}0-100,000 BTU-0100,0006TL Registers 5 Reinspection Fee 515 Issue Fee $ 3 A-V CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor FL CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POOL SPA APPROVALS Permit Date Inspector 1. Temporary Electrical Service or.Pole - 52. Pool & Equipment Location •� r, 2. Soil Pipe-Uh drgrnd. ; 53. Steel Reinforcement 3. Electrical Conduit Utility.Undrgrrid. 54, Forms 4. Electrical Conduit-Undrgrrid. 55, Electrical Bonding 5. Steel Reinforcement, 56. Rough Plumbing & Pressure Test t "i 6• Electrical UF ER Grnd. 57. APPROVAL TO COVE R-GUNITE 7. Fbotings 58. Electrical Conduit-Undrgrnd. M ' B. Foundatibn 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor -Final ' 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final *� 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit' 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. 'Rough Wiring Sign 68. APPROVED FOR PLASTERING 18, Rough Electrical•T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23.'Gas Pipe -Rough & Test 72. Underground Flush f 24, hoof Framing 73. Undergrnd, Storage Tank ❑ Gas ❑ Oil a 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 PRE,V`FINAL 30., Drywall Nailing 01HEALTH DEPT. REQUIREMENT t 31. Plaster Brown Coat 79. F I NA L INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy' 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 4B. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co •51. CERTIFICATE OF OCCUPANCY No. Date C Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. ONSTRUCTION PERMIT I PER O. TRACT NO. LOT NO. UNIT NO. — ;? da /-- - c;-Cjr CITY OF COSTA MESA Project Address 211 7 ILI& Lif e Applicant's Mailing Address Owner's Name +HiPhone cb�J Address 7/l Le/ 17ek Arch/Eng. License No. Address y Contractor's Nam f'Phone .� .S Address (mailing) • lrr v it City License No. lcgk % LICENSED CONTRACTOR OECLARAT ON I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and,Professions Code, and my license is in full force a d e!f t. License Class Licens o. d0 909 Date Signature WORKERS' CO PENSATION DECLAR N I hereby affirm that 1 have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section 300, Lab. C.) Policy No. Company eCertifiedcopy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION' (This section need not be completed if the permit is for one hundred ($100) or less). Icertify that in the performance of the work for which this permit is issued I Shall not amp oy any person in any mann �y, is to cpm subject to the Workers' 25 Laws of California ./y Y, Date O Signature —y - NOTICE: If, after making this declaration, you Should became subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the fallowing reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant t0 the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) -or that he/she Is exempt ,erefrom and the basis for the alleged exemption. Any violation of Section )31.5 by any applicant for a permit subjects the applicant to a civil analty of not more than five hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the Structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however,.the,building or improvement is sold within one year of com. pletion, the owner will have the burden Of proving he/she did not build or im- rove for the purpose of sale), I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this app information is correct. 1 agree to comply w and state laws relating to buildi g co ur sentatives of this city to nt up th inspection purposes. !� Signature Drivers' License or SS :P CMF 0865-46, rev. 10/84 White -n and state that the above city and county ordinances and hereby authorize repre- ve-mentioned property r 069- Date eb49 f�� TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P,+ DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING 11 FOUNDATION M STRUCTURAL T Front ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATION $ S ILeft ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: n Planning Notes: 9466 E/I1/27 Zone Accessory Building: Parking Req./Provided Z O N I N G R E Q M T S licant; Pink - Accounting; Goldenrod - Assessor PLUMBING I FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter El up to 100 amps Clarifiers Solar Collectors Dishwasher Meter El over 100 amps Dishwasher. Solar Piping Dryers ©Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fanr Motors ❑0-i HP 591%-B Floor Drains Swimming Pool w/Spa F.A,U. Inc. Solar ❑9-15 HP C3 16-15+ Floor Sinks Urinal Fixtures Microwave , Gas Service Out Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink . -, Water Service - Switches Sign 1 Lavatories Auto -Wash Garbage Disposal Standing Sections P --Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee S 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICALFEES . Boiler Hood or Type ElDEVELOPMENT Canopy Type I I ❑ SERVICES.REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Date —D-10 62-11 Duct - Under Ground Duct - Structural Refrigeration System 00-1100,000BTU ❑ 100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLAN CHECK' 25% ELECTRICAL = PLAN CH'ECK' 50°,6 MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SM1P $ $ PERMITPLUMBING $ ISSUANCE $ $ ENERGY P -C. S 1577GRADING $ MICROFILM $ $ $ _ TOTAL FEE $�"0-k0 $ Exhaust System ❑ -Multiple ❑ System Repair/Alteration FirepllFact. Bit. ICBG # Fire Dampers Heating System & Ducting ❑0.100,000 BTU IJ 100,000 BTUF Registers • Reinspection Fee S15' Issue Fee $ 3 licant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector -POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4, Electrical Conduit-Undrgrnd. 55'. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58, Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10, Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12- Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 4. Plumbing System - Final 14. Rough Plumbing 5. Electrical -Final 15. Rough Electrical -Conduit J67. Solar System -Final 16. Rough Electric Wiring l 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75, Dry Chemical 27. Frame and Flashing 76, Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36.' Hood or Canopy 37. Final Factory Fireplace , 38. Final Plumbing 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 6TY'09COSTA MESA CONSTRUCTION PERMIT project Address7a f 7 S�C}� 1 6 Mr Applicant's Mailin Add dress -01 _ Owner's Name ' " r i� V fcrirM 1F� 7 Phone Address Arch/Eng, License No Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. Address Contractor's Name MOrZ fZ LsLI rt AC T1Z S _PhonpR22 _,RY' Address (mailing)Pg Sl&e Q eA,,f M l�7t 23r City License No. 3-7°3 LICENSED CONTRACTOR DECLARATION I herebyaffirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and off Ucense Class } " Licens No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent t self -insure or a certificate 'f workers' Compensation Insurance, or a certified copy thereof (Section 800, Lab. C.) Policy No.4-4<- -00 93'7-' " ComP -S;:, Z"�G r eCertified copy is hereby furnishe . Cer fiedaopyk iViled with the Ci Bu in Division pate�� Applicant EXEMPTION FROM WORKERS' COMPENSATION ECLARATION (Thissection need not be completed If the permit is for;one hundred ($100) or less). I certify that In the performance of the work for which this permit is issued I shall not employ any person In any manner so as to become subject to tee Workers' Com ensation'Laws of California. Date .� / Signature NOTICE: It, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with Such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY. I hereby affirm that there Is a construction lending agency for the performance of Lha work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name' Lender's Address . OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the'Contractor's License taw for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Con tfacto r's.License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt 'herefrom and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars (5500), - ' ❑ I, as owner of the property or my employees with wages as their sole compensation, will tlo the work, and the structure I$ not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, howuver, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im. prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project(Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who builds or Improves thereon, and _who contracts for such projects with a con- tractor(s) license pursuant'to the Contractor's License taw). I am aware that proof of their worker's Compensation Insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I.have read this application and state that the above Information is correct. I agree toff with all City -and county ordinances and state Taws ng to buildiructlon, and hereby authorize repre- sentatives is ity to entethe above-mentioned property for inspection urp Signature Dale Drivers' License or SS �f - RMIT NO. TRACT NO. LOT NO. UNlT NO. .-/�PE 5631 I 16/65 4,j0. TI`llZ OF CONSTRUCTION NEW ADD ALTERATION 1:1 CONVERSION 1:1 DEMOLISH ❑ OTHER FTDESCRIPTION OF WORK/USE OF BLDG. REPAIR A.P. 916 Zone S Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL. 1:1 TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ ,OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CON STRVCTION TYPE VALUATION $ ZONE GRADING CU.YDS• ACRES E T Front Z 0 B A Rear N I C Right N S G Left R Ping, Ref. # Parking Req./Provided E Remarks: Planning Notes: O M T S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink ,. Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Clarifiers Sewer Connection Solar Collectors - Cooking Unit Dishwasher Meter ❑up [0 100 amps Meter Dover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan+ Malars 0-1 HP ❑ 1% - B + Floor Drains Swimming Poo( vv/Spa F.A.U. Inc. Solar 09.15 HP ED 16-1s+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pale Light Interceptors Water Heater Outlets Range Kitchen Sink - Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator 00.5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Feb $ 3 Reinspection Fee $15 Issue Fee $ 3 Bailer Duct - Under Ground MECHANICAL Hood or Type I EDDEVELOPMENT Canopy Type 11 ❑ FEES SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date ` Date l - I Duct - Structural Refrigeration System 00-100,000 BTU 0100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25°% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ � j .$ +--t•OO GRADING $ $ MICROFILM $ �S TOTAL FEE $ $ Exhaust System ❑ Multiple ❑ System Repair/Alteration FirepllFact. BIL. ICBG # Fire Dampers Heating System & ducting ❑0.100,000 BTU ❑ 100,000 BT Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev, 10/84 ' White - Bullding; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor `.`CONSTRUCTION AND PLANNING APPROVALS Permit # Date i Inspector POOL SPA APPROVALS Permit # Date InspPcrar 1. Temporary Electrical Service or Pore n 52. Pool & Equipment Location 2,- Soi{,Pipe Undrgrnd 3.`'Eiectrical Conduit Utei�ty-Undrg�n%d. � 53. Steel Reinforcement 54. Forms 4!7Electrical Conduii-Undrjgrnd. `� Ej 55. Electrical Bonding ,5!Steel,Reinforcement V) 56. Rough Plumbing & Pressure Test 6: Ele6irical UFER dAd. 57. APPROVAL TO COVER-GUNITE N n .7MFootings + 58. Electrical Conduit-Undrgrnd. 1� 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9.`tWater Pipe-Undigrnc�. -,� 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10;Structural Floor Sy"stem i 61, APPROVAL TO DECK 11Property Sewer Lind& House Connection r ;y' 62. Backwash & Receptor-Final _ 12 Sewer Cap 63. Heater & Vent-Final 13"'Roof Drains �- �� .� 64. Plumbing System - Final T, 14. Rough Plumbingr� �� 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 3o. Drywall Nailing HEALTH DEPT. REQUIREMENT 31:. Plaster Brown Coat 79. FINAL INSPECTION 32) Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric 2, cj Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41, Solar Domestic-Final 42. Backflow Preventer 43, 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. Hate CITY OF COSTA MESA CONSTRUCTION PERa,MIT Project Address i) Lk • 17tk• 1.7�.�3 Applicant's Mailing Address�� Owner's Name E Phone 1.�Z.7L-._q_(9_Q Address �lI ix' • rZ. 11 Y Arch/Eng. - __,. License No. Address Contractor's Nam If'/hone Address imailing) A ELI L City License No. 0JR11 6-? LICENSED CONTRACTOR DECLARATION I hereby affirm that t am licensed under provisions of Charter 9 (commencing withsection 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. 009 p License Class e e No. 6 Date Signature WORKERS COMP NSATION DECLARATIO ',ereby affirm that I have a certificate of consent to self -Insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section .00, Lab. C.) Policy No, Company BCertified COPY is hereby furnished. - Certified copy is f;led with the city Building Division. Date.,_, _ Applicant EXEMPTION FROM WORKERS' COMPENSATION O£CLARATION (This section need not be completed if the permit Is for one hundred (5100) or less). I certify that in the performance of the work for which this permit Is Issued, I Shall not employ any person in any mannerto be e s act to the Workers' C satlon Laws of California. Date Signature • - -- NOTICE: If, "after this declaration, you should become Subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with Such provisions or this permit snail be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby atllrm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER I]ECLARATION I hereby affirm that I am exempt from the Contractor's -License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit I0 flee 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 'lvlsion 3 of the Business and Professions Code) or that he/she is exempt gefrom and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a permit subjects the applicant to a civil malty of not more than five hundred dollars ($500). 6 I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work hlmsdlf/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. It, however, the building or improvement Is sold within one year of com- pletion, Ithe owner will have the burden of proving he/she did not build or Im- rove fOr the purpose of sale).. , as owner of the property, am exclusively contracting with licensed con- 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 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 proof of their Worker's Compensation insurance should be provided to me, ❑ 1 am exempt under Section B. & P. C. for this reason Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PER T NO. t TRACT NO. I LOT NO. I UNIT NO. Date Owner I hereby certify thbt I have read thls application and state that the above information Is correct, I agree to comply with all city and county ordinances and state laws'relating to bwing con tructlon, and hereby authorize repre- sentatives of this City to a up the bove-mentioned pro arty for inspection purposes. dQ Signature Date Drivers' License or SS :It X30 TYPE OF CONSTRUCTION LJ NEW L-AAOO L_J ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. qct, DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TYPE OF PERMIT�� El GRADING 0 FOUNDATION E STRUCTURAL T Front 11 TENANT 2/ ELECTRICAL ❑ PLL.1 BBING ❑ MECHANICAL B Rear ❑ OTHER V A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ $ Left ZONE GRADING CU.YOS. ACRE Ping, Ret, # Remarks: I Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Glanders Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepi/Fact. Bit. ICBG # + Heating System & Ducting [10- 10(),000 B T U 0100,000 BT1 Reinspection Fee 1 $15 AF 0865-46, rev, 10/84 White . Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor JIBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urina) Water Closet Water Heater Water Service Auto -Wash Laundry Trays FEES Issue Fee $ 3 FEES Hood or Type I ❑ Canopy Type 11 0 Refrigeration System ❑0-100,000 BTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee I $ 3 9425 4/26/8r` Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas []Electric Fan F.A.U. FlxIuraS Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW ❑5-15 KW Transformer ❑ 15-50 KW ❑ 50 + KW Meter ❑up to 100 amps Meter Clover 100 amps Sub Panel Motors 00-1 HP Ell 'A.8 Inc. Solar 09-15 HP ❑16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor I soorr TL FEES Z O N I N G R E O M T S I I Reinspection Fee 1515 I I Issue Fee # 15 1 $41 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By ► n S $ $ SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.C. ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ S $ $ CONSTRUCTION AND�PLANNING APPROVALS Permit # s - Date Inspector 1 POOL & SPA APPROVALS Permit # Date Inspector 1.'Aemporary Electrical�S&vice or Poie 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. = + 55. Electrical Bonding 5. Steel Reinforcement •"• 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation t r 59. Gas Pipe, 0 Undrgrnd., Test 9. Water" Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System fit. 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 00il 23, Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0 Oil s 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 �; y 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED f 33, Final Electric Notes:+1 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36, Hood or Canopy 37. Final Factory Fireplace :4 38. Final Plumbing ' .z 39. Water Service -Final r 40. Gas Service -Final i I „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 , Y_ - CITY OrCOSTA MESA, C NS�TiRUCTIION PERMIT Project Address T, w l T ;013 2. Applicant'sMailin�jAdress q Owner's Name tIA ITdIi �I A - -nAiN&Io Phone Address Arch/Eng. License No. Address Contractor's Name �e CAV V5 —7— Phone Address(mailing) �iD� 5U t1�O City License No. _ 319 -- -- LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in cull fAr a d effect. rL Llcens CI C� License o "{ Date Signature WORKERS' COMPENSATION DECLA TION I hereby affirm that I have a certificate consent to self -Insure or a certificate ' Workers' Compensation insurance or a�ortified copy thereof (Section boo, Lab. ) 661 �m Policy No, � ComAPa,y yn-; Certified copy is hereby IurniShed. 4III Ce4 rtjfleA fepp sailed with the city Bu4�� , Date 75 7" Applicant EXEMPTION FROM WORKERS' COMP N ATION DECLARATIO (This Section need not be corTptetetl If th rmit Is for one hundred (5100) or less). I Certify that in the performance of the rk for which this permit IS issued, I shall not employ any persorh in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: if, atter making this declaration, you Should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit snall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a Construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am ekempt from the Contractor's License Law for the following reason (Section 71331.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement ttyat he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Profession$ Code) or that he/She is exempt tierefrom and the basis for the alleged exemption. Any violation of Section 131.5 by any applicant for a permit subjects the applicant to a civil enalty of not mere than five hundred dollars (5500). (� I, a5 owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who build$ or improves thereon, and who does such work himself/herself or through his or her own employees, provided that Such improvements are not intended or offered for safe. If, however, the building or improvement is sold within one year of com- pletion, the owner will havk the burden of proving he/she did not build or Im- prove for the purpose of sal@). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project Section 7044, Business and Professions Code: Tho Contractor's License Law oes not apply to an owner of property who bultds or Improves thereon, and who contracts for such projects with a ton- tractor(S) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Cgmpensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason CI Date I herebycerti Information is and statelaws sentatives of inspection Dur' Signature Drivers' Lice AF 0865-46, re gwner that I hale read this application and state that the above rect. I agree to comply with all city and county ordinances ating to hu {ding construction, and hereby authorize repro- ; city to to upon the above-mentioned rp!perty r Date l.2 or SS :r aplicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. LOT NO. UNI ELECTRICAL P 2 qL751J Bar Sink Showers MO Service Sink g p4 Automatic Washer Construction Pole Sub. TYPE OF CONSTRUCTION NEW ADO ALTERATION REPA)R / 4 9L� Bathtubs ❑ ❑ ❑ Cooking Unit CONVERSION DEMOLISH OTHER A.P. qjr= zone Solar Collectors DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: Dishwasher Solar Piping E Dryers []Gas ❑Electric Sub Panel 2 TYPE OF PERMIT LJ GRADING 11 FOUNDATION El STRUCTURAL T Front Fan O ❑ TENANT ❑ ELECTRICAL 1Z PLUMBING ❑ MECHANICAL B Swimming Pool w/Spa N ❑ OTHER A Rear I Mjcr ave C Right Water Closet N PROJECT DESCRIPTION SQ. FT, OCCUPANCY ole Light Interceptors Kitchen Sink Water Heater Water Service G CON STRUCT(ON TYPE VALUATION S Left Lavatories R ZONE GRAOINGCU.YDS. ACRES Ping. Ref. # Parking Req,/Provided Standing Sections E P --Trap Laundry Trays M Remarks: Planning Notes: M REF, B2_8-65-6 s 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES ELECTRICAL FEES i Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW / Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter El over 100 amp, Dishwasher Solar Piping Dryers []Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0.1 01%-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 9-15 HP ❑16.15+ Floor Sinks Urinal Fixtures Mjcr ave Gas Service Outlets Water Closet Device Boxes ole Light Interceptors Kitchen Sink Water Heater Water Service x p Outlets Switches Range Sign Lavatories Auto -Wash Garbage Disposal Standing Sections P --Trap Laundry Trays Generator 00-5 K 5-15 KW Trash Compactor Roof Drains �. Reinspection Fee $15 Issue Fee $ 3 ReinspectionFea $15 Issue Fee $ 3 Boiler Duct - Under Ground MECHANICAL Hood or Type I El' Canopy Type I I El -A FEES DEVELOPMENT SERVICES Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date Dat Duct - Structural Refrigeration System ❑0.100,000 ❑100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ r PERMIT S _7 r Q O ISSUANCE $ L7, .1—,o ENERGY P.C. $ $ GRADING $ $ MICROFILM $ $ TOTAL FEE $ $ Exhaust System ❑ Multiple ❑ Sys Repair/Alteration % Firepl/Fact. Blt. ICBG # Fire Dampers HeAing System & Ducting Cj0 00,000 BTU ❑1 , ooBT Registers a nspection Fee $15 Issue Fee S 3 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND"PLANNING APPROVALS Permit Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3, Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd, 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13, Roof Drains 64, Plumbing System - Final 14. Rough Plumbing b 87) 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd, Storage Tank ❑ 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: _rq_ r7 Nor 610V. G,,i4 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36, Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. 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 (714) 754-5273 • Fax (714) 754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 711 W 17TH ST Suite No B012 Vicinity: GUY FERRER ART STUDIO (STE B012) Parcel Nunmber; 93983024 Applicant; FERRER, GUY Address: 711 W 17TH ST #8-12 4ssued: COSTA MESA, CA Owner: FERRER, GUY Address 711 W 17TH ST #B-12 j COSTA MESA, CA Contractor: OWNER -BUILDER Address: _ ISSUED BY: Phone: 949-515-0118 " Zip: 92627 Phone: Zip: 92627 Phone Zip Status: ISSUED Applied: 09/27/2000 4ssued: 0912712000 FEE•SUMMARY ,» AMT ;.' AAItT � Q7Y,; � ,r' /�� i AMT QTY ISSUE FEE '� ,� $23.50 c Laundry7ub ! Washer ; $0.00 0� Sump Pump-, j $0,00 0 Backftow irrigation. `Laridscape.Irrigation" = f $0.000 >�Swimming Pool / i $0.00 0 Backt)ow Preventer �� $0.00' o x \ .. p $0.00 .-0 �: Trap'PrimerV , $0.00 0 ` Bathtub s0.00' % 0,� �_ `,-Pressure Regulator) ;-s0:00 .' _o�> ��'VpaCu'um`Brki� !rinal i $0.00 0 Clarifier System `$000 ; 0, ; . ProcessPiping (per 10ft)-. - $0.D0 -0 Bkfldw(1-4) $0.00 0 Connect (Ice,Soda,etc) $0.00 '0 -Receptors $0,00 .. r 0 : Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00, 0 '� /' Septic Tank $0.00 ''0, ' Wash�Basin $0.00 0 Dishwasher $0.00 --0- - � .. Sewer'Cap for Demo $0.00 , x,01 �� Wasli Basin Set $0.00 0 Drain, Floor $0.00 -0 Sewer Connect i. 50.00 -- '0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 _ - 0_1_ --, Water Closet (Toilet) $0.00 0 Drain, Roof $0.00 0 -Shower $0.00' ''0 - Water Heater / vent $12.30 1 Drinking Fountain $0.00 0 Sink, -bar _ __ __ ___-s0.00 -. 0 Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial s0.00 0 Water Re -pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas (1-4 outlets) $6.15 1 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0.00 0 TOTAL CALCULATED FEES: $41.95 COMMENTS 1 SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, of if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 240 46 IrvDU) License: 0 .Arch / Eng Address: j .,Phone: - _ -- ,Zip' License: SCOPE OF PERMIf'_�.�,�; EXTEND EXISTING GAS LINE TO RE- LOCATE SUSPENDED HEATER. ' 1 WATER HEATER ADDED TO PERMIT (4130101) FEE•SUMMARY ,» AMT ;.' AAItT � Q7Y,; � ,r' /�� i AMT QTY ISSUE FEE '� ,� $23.50 c Laundry7ub ! Washer ; $0.00 0� Sump Pump-, j $0,00 0 Backftow irrigation. `Laridscape.Irrigation" = f $0.000 >�Swimming Pool / i $0.00 0 Backt)ow Preventer �� $0.00' o x \ .. p $0.00 .-0 �: Trap'PrimerV , $0.00 0 ` Bathtub s0.00' % 0,� �_ `,-Pressure Regulator) ;-s0:00 .' _o�> ��'VpaCu'um`Brki� !rinal i $0.00 0 Clarifier System `$000 ; 0, ; . ProcessPiping (per 10ft)-. - $0.D0 -0 Bkfldw(1-4) $0.00 0 Connect (Ice,Soda,etc) $0.00 '0 -Receptors $0,00 .. r 0 : Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00, 0 '� /' Septic Tank $0.00 ''0, ' Wash�Basin $0.00 0 Dishwasher $0.00 --0- - � .. Sewer'Cap for Demo $0.00 , x,01 �� Wasli Basin Set $0.00 0 Drain, Floor $0.00 -0 Sewer Connect i. 50.00 -- '0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 _ - 0_1_ --, Water Closet (Toilet) $0.00 0 Drain, Roof $0.00 0 -Shower $0.00' ''0 - Water Heater / vent $12.30 1 Drinking Fountain $0.00 0 Sink, -bar _ __ __ ___-s0.00 -. 0 Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial s0.00 0 Water Re -pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas (1-4 outlets) $6.15 1 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0.00 0 TOTAL CALCULATED FEES: $41.95 COMMENTS 1 SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, of if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 240 46 IrvDU) DECLARATIONS WORKERS' COMPENSA710N DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance carrier and policy number are: Carrier. Policy Number. {This section need not be completed it Cie permit is valued at one hundred dollars ($100) or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIOfY 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Uc. N Class q Contractor's Signature: Data: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code), Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that l am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a CMI penalty of not more than five hundred dollars ($500).): I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, es owner of the pr cry, a EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contr ors Licens Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a coniractor(s) license pursu t to the Conir ctors License Laws.). ❑ I am exempt radar sec. Business and Professions Code for this reason: Signalui I Date: Owner ID verifie by ens . ❑ Yes ❑ No Driver's License No, Expires: Verification of Owners by (type of document, i.e. properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to fife and certify a Business Plan for emergency response to release or threatened ralease of a hazardous material? ❑ Yes ❑ No (Section 25505 o1 the California Health and Safety Code requires, with soma exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .__........................................._..._..................................'e''d, .......iie,.....r'e"'...............................o-'r-..........................................-........da"I's"?, ...........--.................---................................................... 2 Does or will the appSiCant or present or future building occupant need to file a registration form for acutely hazardous materials? [Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............. ...................... .......................................... .............. ........................................................................................................... _...........................................................................................................--...................................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No [Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire impartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ............. .............. --•--............................................ _...... ,...,.......................................................... _....................................................................... ........................................................................................... 4 I1 an RMPP Is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ......................................................................................................................................................................................................................................................................................... _ -..-.-.-.-.-...................-.-.....-..-........................ I .................. 5 Doss or will the applicant or present or future building occupant requ"ire for the work which is the subject of this a plication a ermit for such construction or modification from the South Coast Air Oualily Management District or from any other air pollution control district or agency? LJ Yes f No (Section 65650.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits), ..................................................................................................................................,...............-----............................._......— ...... .....-.. • ..... • .-..................................--•.---.........-...........................__............................-...-.. 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). -...._.-.-..--.......................... __............ _..---..................... _.......................... ...... _.....-•--............. .--............................... .._._ _.._.................. ....... _ _.-.......—...--............................... 7 11 a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Hoahh and Safety Code Section 42303 boon made? ❑ Yes ❑ No ................................._.-_......erti.................._................_._._................__.........................._..........-..-.-.-..- - -•-•--.................................._...._.....,.......-.-•--------•--.............----._.............-.-....-..................-....._...................__............--..............-- B {If ryes", attach Certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspetti rpos . I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection, C,�gn re wnerys) � � Data And/Or u viz ppllcant Date CODE 1. INSPECTION TYPE jtAiE IKtMALCODE P INSPECTION -TYPE um iNTinA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 1 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. To A f`T Kin 1 1 nT Kin CITY OF COSTA MESA CONSTR TION PER _ r Project Address « ` 7��C Applicant's Maifirta.F.ddreT ;% -7 4 V Owner's Name A/W Ile C I Phone Address Arch/Eng. _ License No. Address Contractor's Nami, ity% o '01-5 Phone �7 7_7q Address (mailing) I .r `� �+ Q C L' City License No. '% S 7— r� 9 2 Ct_2 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and ect. Licensee Class 5Z " ff License No. rZ�� Z O Date .Sc & I y Signaturg WORKERS' COMPE SATION DE ARATION I hereby affirm that I have a certificate of consent to solf-Insure or a certificate of Workers' Compensation insurance, or a certified copy thereof (Section 600, Lab. C.) olicy No. Company eCertified copy is hereby furnished. f Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKER%' COMPENSATION DECLARATION (This section need not be completed If the permit is for one hundred ($100) or less). I certify that in the performance of thework for Ich this permit is issued I shall not employ any person In any manner s to become subject to titre Work e CQmpensa I wS of Callfor pate "' "f 1Signmure 'NOTICE: if, after making this dec lar.tTTd.V.0 should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions Or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address — - - -- OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit to construct, alter; Improve, demolish or repair any structure, prior to its ISSUahce, also requires the applicant for such permit to Tile 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 Division 3 of the Business anq Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section '031.5 by any applicant for a permit subjects the applicant t0 a civil nalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale {Section 7044, Business and Professional Code.. The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or tnrough his or her own employees. Provided that such improvements are not Intended or offered for sale. If, however, the bullding qr improvement is Sold within one year of com- pletion, the owner will have the burden of'proving he/she did not build or im- prove fOr the purpose of sate). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors t6 construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and r_ctwho contracts for such projects with a con- tractosi license pursuant'to the Contraor's License Law), I am aware that proof o[ their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section—, — B. & P. C. for this reason Date owner I hereby certify that I have read this application and state that the above Information Is correct. I agree to comply with all city and county Ordinances and state laws relating to builqing construction; and hereby authorize repre- sentatives of this city o enter upon the above-mentioned property for inspection p es. Signature Date Z— Drivers' License o�' TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P. 46 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ ,OTHER A PROJECT DESCRIPTION So. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ $ I Left ZONE GRADING CU.YDS. ACRES Ping. Ret. Remarks: Planning Notes: I PLUMBING I FEES i Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service / Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventifating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO + Heating System & Ducting 00.100,000 BTU 1:1100,000 BT Reinspection Fee I $15 CMF 0865.46, rev. 10/114 White - Building; Canaryr -Applicant; Pink -Accounting; Goldenrod -Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service - Auto -Wash Laundry Trays Issue Fee $ 3 HANICAL FEES Hood or Type I ❑ Canopy Type II ❑ Refrigeration System 00.100,000 BTU 01D0,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures - Device Boxes 9938 3/25/05 Zone Accessory Building: Parking Req./Provided ELECTRICAL Outlets Switches Garbage Disposal Generator 00-5 KW ❑5-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter Cup to 100 amps Meter Cover 100 amps Sub Panel Motors 00.1 HP ❑ VA - 8 Inc. Solar 09-15 HP ❑ 16.15+ Microwave Pole Light Range Sign ;Standing Sections Trash Compactor 10e3� TL FEES N G R E a M T S I I Reinspection Fee I S15 I I Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: SUMMARY OF FEES Zoning Approved By Date Building Approved By Aonfiration Issued By • w. Z Date y nate SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK S PERMIT PLUMBING S ISSUANCE $ PLAN CHECK 25% S �% CEO ENERGY P,C. $ ELECTRICAL $ GRADING S PLAN CHECK 50% $ MICROFILM S MECHANICAL $ TOTAL FEE S PLAN CHECK 25% S �•: CONSTRUCTION AND PLANNING Date APPROVALS Permit # Inspector POOL A APPROVALS Permit # - Date Inspector 1. Temporary Electrical Service or Pole52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd.. 53. Steel Reinforcement 3. E4ctrical Conduit Utility-Undrgrnd. 1t 54, Forms 4..-lectrical 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 i' 59. Gas Pipe, ❑ Undrgrnd.,.Test 9, Water Pipe Undrgrnd. 60, Backwash Lines, P -Trap, ❑ Undrgrnd. f 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62, Backwash.& Receptor -Final f2. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing L� (,�rj 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 APPROVALS Permit # 20' Rough Factory Fireplace 21; Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydra 26. T -Bar Ceiling (Structural) & Monocoat 7.5. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78, FIRE PREV. FINAL 30, Drywall Nailing HEALTH DEPT, REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED .33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing C" 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 & BUIL•DING. 48. Special Requirements Completed 49. Electric Release to Edison _. 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date f G� Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. TRACT NO LOT NO 11111110 CITY 01F COSTA MESA CONSTRUCTION PERMIT: Project Address %/1 G•l i 7TH -ST Co _0A NIFsA- Applicant's Mailing Address Owner's Name /_,Q�l l I� ui2J M,* r Phone Address Arch/Eng. License No., Address ;�� Contractor's NamImpR i . l -C ice. L IG Ci 2 1C - Phone f7 7 ')' 4!;V'C1 Address {mailing} kJ K'1 �• (S L��C1•}1,y u•�,ti X12 % CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector _ 'A APPROVALS Permit Date Inspector 1.'Temporary Electrical Service or Pole z 52. Pool & Equipment Location 2. Soil;Pipe-Undrgrnd ��,. 53. Steel Reinforcement 3. Electrical Conduit U,tility-Undrgrnd+ 54. Forms 4. Electrical Conduit; Undrgrnd. c 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 9. ,Water Pipe-Undrgrnd. r^' 60. Backwash Lines, P:Trap, ❑ Undrgrnd. 10.'Structural Floor System - '► 61. APPROVAL TO DECK 11 -Property Sewer Line'& House Connection � 62. Backwash & Receptor -Final ' i 12. Sewer Cap 63. Heater & Vent -Final 13, Roof Drains , v 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. POOLISPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping D Gas D Oil `23. Gas Pipe -Rough & Test 72, Underground Flush 24. Roof Framing 73. Undergrnd, Storage Tank 7 Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Stroctural) & Monocoat 75, Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30.. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32" Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric_ Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final _ 42. Backflow Preventer ` 43. 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 Nr�. Date - POOL I Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT 111 PERMIT No. TRACT NO. LOT No. tfruir Nn Project Address 711 W. 17th St. Bldg.(C) Unit 11 Applicant's Mailing. Address I'll 10 Sati r.0y St. N -Hal lvwno Owner's Name Trn T1317-pctmc?ut Filnrl Phone SCSI -7488 Address 41211 Birch St. New.poxt Reach,Ca. Arch/Eng, Marin -T, Rock —License No. Address 12881—Kn -- Contractor'sName DITCO Air Condition asPhone981-1711 16 Address (mailing) — 1 '11 10--Sa t i my S t- _ N _ Hn1 1 vwnnrl _ C 8 _ City License No. i 1925 LICENSED CONTRACTOR OECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division of the Buslness ae professions Code, and my license Is in full force aoC ec 346251 License Class [V I No, Date Sig naesura_nce. WORKERS' COMPENSATIOARATION I hereby affirm that I have a of consent to self4nsure or a certificate sof Workers' Compensation or a certified copy thereof (Section aoo, Lab. V6824 Lumbermans {'--Policy No. Company 'H F�-"-1I Certified copy is hereby furnished. Certlf- yo y is filed with the city Built(g 1v�ion,A - J �' I L Applicant J �} Tri EXEMPT ON FROM WORKERS' COMPENSATION DECL)kRATION (This section need not be completed if the permit is for one hundred (5100) or fess). I certify that in the performance of the work for which this permit Is Issued, I shall not employ any person In any manner se as to become subject to the Workers' Compensation Laws of California,. Date Signature -NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - -.1 I hereby affirm that there !$ a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender'sAddress OWNER BUILDER UECL"ARATION I hereby affirm that I am exempt from the Contractor's License Law for the following rea$on (Section 7031.5 Business and Professional Code: Any city or county which requires d permit to construct, alter, Improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/sho Is licensed pursuant to the provisions of 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 i,)31.5 by any applicant for a permit. subjects the applicant to a civil .1.nalty of not more than five hundred dollars ($500). 'a I, as owner of the pro perty,Or- my. employees with wages as their sole compensation, will do the work, and the structure Is not intentled or offered for sale (Section 7044, Buslness and Professional Code: The Contractor's License Ldw does not apply to an pwner of a property who builds er improves thereon, and who does such work himself/herself or through his or her own employees, provided that Such improvements are not Intended .r. for sale. If, however, the building or Improvement [s sold within pne year of com- pletion, the owner will have the burden of proving he/she tlld not build or im- p,ove for the purpoSa of Salo), ❑ i, as owner of the property, am exclusively contracting with licensed con- tractors t6 construct the Projact (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a-con- tractor(s) license pursuarit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ ram exempt under Section B. & P. C. for this reason Date i i Owner I hereby certify that I. have re this application and State that the above information is correct. I agree vmpi' with all city and county ordinances and state la elating ,to bu k construction, and hereby authorlp repre- sentatives ;t Is'.It y, to t u on the above-mentioned groiffirty Joy lnspectlo purp s Signature Drivers' Li a or 55 CMF 0865-46, rev. 10/84 White - Building; Canary TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION LJ REPAIR SUMMARY OF FEES BUILDING PERMIT $ SMTP $ PLAN CHECK S PERMIT PLUMBING S ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ 13.00 TOTAL FEE $ 15.50 PLAN CHECK 25% $ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. 6 OC S Main Building: E TYPE OF PERMIT GRADING FOUNDATION STRUCTVRAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING P MECHANICAL B Rear ❑ ,OTHER A PROJECT DESCRIPTION SQ, FT. OCCUPANCY C K Right CONSTRUCTION TYPE VALUATIONS $ Left ZONE GRADING CU.YDS. ACRES plug. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under, Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 1 C10.100,000 BTU ❑ 100,000 BT' Reinspection Fee I $15 Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool Yd/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or. Type ❑ Canopy Type Ih ❑ Refrigeration System ❑0-100.000 BTU 13100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES (ray u/ru/p7 ' ZO ne Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW ❑5-15 KW Transformer ❑ 15-50 KW ❑ 50+ KW Meter ❑up to 100amps Meter Dover 100 amps Sub Panel Motors 00.1 HP ❑ 1'A - 8 Inc.Solar 09-15 HP ❑16.15+ Microwave Pole Light Range sign Standing Sections Trash Compactor $ 3 Reinspection Fee $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By— 7 WOR 109 t TL I FEES $ 3 Z O N 1 N G R E Q M T S SUMMARY OF FEES BUILDING PERMIT $ SMTP $ PLAN CHECK S PERMIT PLUMBING S ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ 13.00 TOTAL FEE $ 15.50 PLAN CHECK 25% $ 6 OC $ 3 CONSTRUCTION AND PLANNING APPROVALS -. Permit'# Date Inspector POOL 'A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location . f. 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement -- ; 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement rr ',!! 56. Rough Plumbing & Pressure Test- 6. Electrical LIFER Grnd. t 57. APPROVAL TO COVER-GUNITE ; +. 7. Footings 58. Electrical Conduit-Undrgrnd. r L 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. Y`, 60. Backwash Lines, P-Trap, ❑ Undrgrnd. ..10. Structural Floor System ` 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash &Receptor-FinaE 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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating i 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical , 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding' 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32.- Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 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 CITY"CU CC*TA MESA CONSTRUCTION PERMIT g Applicant to fill in all spaces except these ~eavy border Imes and sign all appropriate declarations. 136 - Q pE MIT NO. TRACT NO. LOT NO. BLD 110 Ei 1 & 2 C Project Address 71 1 W _ 1 / th Street - _ TYPE OF CONSTRUCTION, NEW ADD ALTERATION LI REPAIR Sewer Cap 1vd C M ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. ch" Applicant's Mailing Address :2-41 9 MacArthur B . r .-D . ` - 4z --+-t)3 Owner'sNamerOV Investment -Fund -Phone549-2968 Owner'sName rOy OESCRIPTIONOFWORK -Extar}c4_Alterati-ons ---- S Main Building: Address ,4321 Birch St._, Newport Beach TYPE OF PERMIT 0 GRADING FOUNDATION Z2 STRUCTURAL T Front Arch/Eng. W1n, L. Pereira AsSOL�'icense No. ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B. Cooking Unit Address Arthur Blvd., -Corona del Ma ❑ OTHER p` Rear Solar Tank Contractor's Nam Phone PROJECT DESCRIPTION SQ. FT. OCCUPANCY B-2 __ C Right NV Address (mailing) CONSTRUCTION TYPE VALUATION $ 75 - 264.00 S Left Dryers ❑Gas ❑Electric ZONE GRAOING CU.YOS. ACRES Ping. Ref, City License No- Floor Sinks Urinal LICENSED CONTRACTOR DECLARATION Remarks: P -.0 . # 2 0 -8 4 S Parking Req./Provided I hereby affirm that I am licensed under provisions of Charter 9 (commencing Gas Service Outlets Water Closet F.A.U. • with section 7000) of Oivis€on 3 of the Business and Professions Code, and Interceptors Use of Building: my license is In full force and effect. Fixtures License Class License No. PLUMBING FEES Planning Notes: Date Signature Bar Sink Showers Device Boxes" WORKERS' COMPENSATION DECLARATION Pole Light Lender's Address •' - OWNER BUILDER DECLARATION ' Hereby affirm that I have a certificate of consent to self -insure or a certificate Backflow Preventer Service Sink Workers' Compensation Insurance, or a certified copy thereof (Section - - - , ,Range 0106 5/I0/B4 I Zone IN4,(V_ ' Accessory Building: Perk. Fees $ 36C,e27 Tt Z O N I N G R E Q U I R E M E N T ]o, Lab, C.) ropey N0. 5 2 4 2 0 0 016 8 3 Company A o n Ut eCertified copy Is hereby furnished- Backftow Irrigation Sewer Cap ELECTRICAL FEES Bathtubs Sewer Connection Automatic Washer Transformer ❑ 15-50 KW Cer "fi d c p is filed with the city B €Iding Divislo . Dat Applicant Z2� OIL Construction Pole Sub. 050+ KW Clarifiers Solar Collectors Dishwasher Solar Piping Cooking Unit Meter ❑up to 100 amps EX EM IO FROM WORKERS' CO P NSATION DECLARATIDN (This section need not be completed If a permit is for one hundred ($100) or Drinking Fountains Solar Tank ' , Dishwasher Meter Dover 100 amps less). I certify that In the performance of the work for which this permit Is Issued 1 shall not employ any person in any manner so as to become subject to tke Workers' Compensation Laws of California, Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric , Sub Panel Date Signature _ NOTICE: If,iafter making this declaration, you should become subject to the Workers' Compensation provisions of .the Labor Code, you must forthwith comply with such provisions or . this • permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Floor Sinks Urinal Fan Motors ❑0-1 HP ❑1 Gas Service Outlets Water Closet F.A.U. • Inc. Solar ❑9-15 HP ©16.15} Interceptors Water Heater Fixtures Microwave 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097- Civ, C,) Lender's Name Kitchen'Sink Water Service Device Boxes" Pole Light Lender's Address •' - OWNER BUILDER DECLARATION Lavatories.N - Outlets - - - , ,Range I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031:5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair anystructure, 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 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 -from and the basis for the alleged exemption. Any violation of Section P -Trap Switches - Roof Orains _' f i Garbage Disposal : Generator ❑0 5 KW ❑5 15 KW Stertding•Sectipns , Trash Compactor, r p ,�. L5 by any applicant for a permit -subjects the applicant to a civil dty of not more than five hundred_ dollars ($500). u i, as owner of the property'vir. my employees with wages as their sole compensation will do the work, and the structure Is not Intended or offered for sale. (Sec1'lon 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for sale. If, however, the bulltling or Improvement is sold within one year of com- tfonthe gwner,will have ,the burden of proving he/She d1d not build or Im- vefarthe purpose of sale), 1,anerofthe propertyamecuslv.lycontracting_Itlicensed con -❑x100,000 construct the project (Section 7044, Business and Professions Coda: e Contractor's License Law does not apply to an owner of property who �rh bullds or improves thereon, antl who contracts for such projetts with a con- tract.r(s) 13tense pursuant to the Contractor's License Lawj. ❑ I am exempt under Section B. & P, C. for this reason Reins ttjon Fee Pe $25 Issue Fee r 3 _ Reinspection Fee $25 •Issde Fee -� $ 3 MECHANICAL i FEES Boiler. Hood or -Type I ❑• Duct -Under Ground Canopy Type 11 ❑- PUBLIC SERVICES REQUIREMENTS: f�• ' r'` - _ C Zoning Approved By _pate �p r -Bdilding'Approved By r Date Apolication Issued.By • • Dat Duct •Structural Refrigeration System BTU ❑100,000 BTU f 1"torst6 _ Duct -Ventilating- � i BUILDING PERMIT PLAN CHECK PLUMBING` 1 PLAN CHECK 2596 ELECTRICAL, lr , PLAN CHECK .. 5096 MECHANICAL, -PLAN CHECK %25% SUMMA $ 3,c $ $ $ _ $ %• $ '• "• $ $ Y O� FEES r ' y n d SMIP $ PERMIT ,)SSUANCE A $ ENERGY P.C. $ „GRADING .� ,$ , MICROFI L'MZ' $ ' _ _ TOTAL FEE y $ � Exhaust System ❑ Multiple ❑ System Repair/Alteration Firep I/Fact. Bit. ICe0 # Date Owner I hereby -certify that I have rex fits application and state that the above ' information is correct. I agree t0 comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repro- sentatives of this • city' enter t upon the above-mentioned property for Inspection% rposeS. r Signature Date. 2 F Drivers' License or SS # Heating System & Ducting ❑0-100,090 BTU ❑100,0008 _. Reinspection Fee=$25 Issue Fee $ 3 CMF 0865-46 rev. 12/83 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor -CONSTRUCTION AND PLANNING APPROVALS Permit # Date: Inspector POOL 8 APPROVALS " Permit-# - pate c r _ 4 Inspector (' 1.. Temporary Electrical Service'or Pole 52." Pool & 'Equipment Location T2. 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 Plu¢nbing'& Pressure Test 6. Electrical UFER Grnd. -. 57, APPROVAL TO'COVER GUNITF = .7. Footings r , .58. Electrical-Conduit-Undrgrnd. 8. Foundation 59, Gas Pipe, D Undrgrnd., Test ,-9. Water,Pipe-Undrgrnd. - 60. Backwash' Lines,,P,-Trap, ❑ L1 rgrnd.' 10. Structural Floor System, 61. 'APPROVAL -TO DECK 1 11. Properlty Sewer Line &-House Connecfon : Finyal62. Backwas& Receptor '- - 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains -64. Plumbing System - Final 14. Rough Plumbing65. !electrical Final' - r ` 15. Rough Electrical -Conduit -" _` 66. Solar System -Final T -` .16. Rough Electric Wiring - 67. Fencing & Access Approval Rough Wiring Sign 68. APPROVED FOR PLASTERING s 18.1 Rough Electrical -T Bar Ceiling 69.' POOL/SPA SYSTEMS FINAL 19 Rough Heating & Air Conditioning r FIRE DEPT. REQUIREMENT, APPROVALS Permit'# + 20. Rough Factory Fireplace 21Y Ducts, in Structure __ s 70.; Underground Hydro r i L 22."u cts; Ventilating 71. Product Piping ❑ Gas • ,❑ Oil F ; X23. Gas Pipe -Rough & Test 72. Underground Flush I 24*oof Framing73. Undeegrnd. Storage Tank❑ Gas '©:Oil , 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical I - ' 127. Frame and Flashing 76. Dry Standpipe 28. Lathing'&,Siding �� f�" 77. FIXED SYSTEM FINAL _ + r ; r I I 29, Insulation i '78. FIRE PREV,. FINAL I 30. Drywall Nailing r HEALTH DEPT. REQUIREMENT ; 31. Plaster Brown Coat �� Ste` 79. FINAL INSPECTION 1 i 32, Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. FinalElectric I Notes: GD ^1 S , 34. Final'�Heating & Air Conditioning 35. FinallGas Pipe -Test 0 �_ r0 1 ''' 36. Hood. or Canopy _ 37. Final.Factory•Fireplace b ZASIV 38. Final�Plunnbing F 39. Water Service' --Final L 40. Gas Service -Final 41. Solar. -Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation - 44. ,Landscape irrigation System 4 p 45, Sound Attenuation' 46. Handicap Regulations e 47. FINAL STRUCTURE & BUILDING -44 . A 48. Special Requirements Completed 49. Electric Release to Edison 3i 50. Gas Release to Southern California Gas Co i 51, CERTIFICATE OF OCCUPANCY No. Date 7 I Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. L r CITY OF C�'TA MESA CONST UCTION F '#(MIT � PERMIT NO. TRACT NO. LOT NO. T NO. ((' /1 3510. E s?/4�J/�(1 I �'i a I„ ! �, Project Address Applicant's Marlin Address ; A r, �� TYPE OFC NSTRUCTION ❑ ❑ NEW ADD' ALTERATION' ❑ OTHER REPAI R f Owner's Name�7 d X Phoned ��7 CONVERSION DEMOLISH ' A.P. #' Zone Iz T DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: Address 2 Arch/Eng License No.T } ` _ TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL E T. Front Z O ,JJ Address d� v� {J j L ZO ❑ TENANT ❑ ELECTRICAL' ❑ PLUMBING ❑ MECHANICAL A Rear N b Z i ❑'+OTHER Contractor's Nam Pho _ I C R ight - N l _' .-. 31!-6 \ 4r1 PROJECT DESCR(PTIdN SQ. FT. OCCUPANCY K. G Address {mailing) -!. p CO N ST RUCTION TYPE VALUATION $ S " Left Ti R City License No. 33 I 'Z-1 _ _. LICE45ED CONTRACTOR DECLARgT10N ZONE GRADINGCU.Y05., ACRES Ping. Ref. 0 Parking Req./provided 1 ' 1 hereby affirm that I -am licensed under provisions of Charter 9 (commencing Remarks: _ -- 'Planning Notes: ,M !with section 7000) of Division 3 of the Business and: Professions Code, an my license Is in full ice apd6ffec ~ (b1 S License 5s lc e� O. Datpn Signature PLUMBING FEES WO ERs' COM ENSATION DE LARAT10 Bar'Sink Showers ELECTRICAL FEES I hereby affirm that I have a certi Le 4f consent to self -insure or,a certificate 1 ' -f Workers' Compensation Ins ance,_or a certified copy. -thereof (Section j3ackflowPreventer Service Sink-- - - Automatic Washer" Transformer ❑' 15-5D KW ��' 300, Lab. r P—il///id-�iC/S eU •Ditty No. � Company -- $ackflow Irrigation Sewer Cap ; Construction Pole$ub. H❑ 5D+ KW • 8 Certifled copy is hereby furnished. Certifled copy is filed with the city Buliding Division. Bathtubs Sewer Connection, Cooking Unit Meter ❑up to 100 amps ' pate Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter El over 100 amps ' (This section need not be completed if the permit is for one hundred ($100) or Dishwasher Solar Piping ! Dryers ❑Gas '[]Electric - Sub Panel, less): I certify that in the performance of a work for which thl ermit is Issued, I shall: note ploy any person- in an nner so to be a subject to the Drinking Fountains ,Solar Tank ! Fen - i Motors ❑0-1 HP 01 h - B Work r ' pC dti n Laws of Ca f nia, .: Date Signature Floor Drains } Swimming Pool w/S a 9 P F.A.U. Inc. Solar ❑9-15 HP ❑lfi 15+ 4 "\\ I NOTI : If, term king this declare n, you shoultl ecome subject to the Workers'_ Compensation provisions the Labor Code, you must forthwith — Floor Sinks — Urinal - i Fixtures- MiCroWav2 - - .comply with suchi provisions or is permit shall be deemed revoked. 'CONSTRUCTION LENDING AGENCY' - Gas Service Outlets Water Closet Device Boxes p ole Light, I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 -Civ, C.) Name ! ,. Interceptors 1 Water Heater Outlets ,Switches Range Lender's Lender's Address� Kitchen Sink - Water Serviced - Sign OWNER BUILDER DECLARATION , I hereby affirm that I am exempt froal the Contractor's License Law for the Lavatories Auto -Wash' Garbage Disposal ; Standing Sections fallowing reason (Section 70317.5 Business and Professional Code: Any city, or, ' county which requires a permit to construct; alter, Improve, demolish or.,repair P—Trap Laundry Trays „ Generator E10-5 Kw❑5-15 KW i Trash Compactor any structure, prior to Its Issuance, also requires the applicant'for such permit r? to file a signed statement that he/she is licensed pursuant to the provisions of r. Roof. Drains the Contractor's License,Law-(Chapter g (commencing with Section 7000) of Divislon 3 of the Business and..Profe%slons;Code) or that -he sheris exempt n: , therefrom and the basis for the alleged exemptioAny violation of•Section - - �:,k,031.5 by any applicant.,for 'a permit subjects. the -applicant to a civil = nalty of not more than five'hundred dollars ($500). - Reinspection - $15 i i J $, 3 7 ; I, as owner of the property ornly employees with- wages as their sole Fee -- Issu _ - compensation, will.do the work, and the structure is not intended or offered Reinspection Fee $15 issue Fee $ 3 • for sale (Section 7044, Business and Professional Code: The .Contractor's ' - r MECHANICAL FEES ' License Law does not apply to an owner of a property who builds or improves thereon, and who does such work hinnself/herself or through his or her own Hood or Type I t❑_ - #(DEVELOPMENT SERVICES REQUIREMENTS:. , employees, provided that such improvements are:not intentled or offered for If, however, the building or Improvement❑ IS sold within one year of Com- Boiler 'Canopy Type I{ ' Zoning Approved By , Date 1 sale. pletion, the owner will have the burden of Proving he/she did not build or im- Duct - Under Ground _, Building'Approved By Date ' rove for the purpose of sale •licensetl = ' 1, as owner of the property, am exclusively contracting with con- Duct -Structural Refrigeration System , Application Issued By Data tractors to construct the project (Section 7044, Business and Professions Code: i License Law does not apply to an owner of property who Duct - Ventilating ❑0-100r000 BTU ❑ 100,D00 BTU - , SUMMARY OF, FEES The Contractor's builds or -improves thereon, and who contracts for such projects with -a con- r tractor( sj license pursuant.to the Contractor's License Law). I am aware that ; Exhaust System ❑ Multiple ❑ ,System Repair/Alteration BUILDING PERMIT .$ SMIP $ proof o their Worker's Compensation' insurance should be provided to me, I , tri PLAN CHECK $ PERMIT ❑ 1 am exempt under Section B. & P. C. for this reason Firepl/Fact. Bit. ICBO # Fire�Dampers' ISSUANCE $ i Heating System & Ducting r2 x0,-100,000 ❑100,10 77 RegistersI • - ^- - - D PLUMBING $ PLAN CHECK 25% $ ENERGY P.C. $ f Date Owner I hereby certify, that I have read-thi% application and State -that the above - comply BTU ELECTRICAL i '$ GRADING $ information Is!correct, I agree to with all city and county ordinances to bulldi onstructlon, hereby repre- MICROFILM S and state'. ws relating and authorize sent o this city to e t pon the' above-mentioned prop ty r Inspection poses: I 'PLAN CHECK 5D% S r '' O _ �1 f� MECHANICAL $ } a- TOTAL FEE $ Signature Dater Reinspection Fee $15 Issue Fee $ 3 i •„ PLAN CHECK 25% $ Z ! r 3 Drivers' Li nee or SS :il;, CMF 0865-46, rev, 30/84 White - Bullding; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor ,� / CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL �..?A APPROVALS Permit # Date Inspector ,1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ` -2. Soil Pipe-Undrgrnd. i 53. Steel Reinforcement 3. --Electrical Conduit Uiility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding , 5. Steel Reinforcement , 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. '57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. , 8 -Foundation _ 59. Gas Pipe, ❑ Undrgrnd., Test 9.•Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10.•Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap, 63. Heater & Vent -Final 13. Roof'Drains i 64. PIumbing.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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts; in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush ` 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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`.F.INAL 29. Insulation 78, FIRE PREY., INAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Piaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD;CERTIFICATE ISSUED C' 33. Final Electric Notes:' [,o 34. Final Heating & Air Conditioning / T 35- Final Gas Pipe -Test Go d i 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 .ham - 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE BUILDING 48. Special Requirements Completed 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF -OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. r CITY O,WCOSTA MESA CONSTRUCTION VE -K if PERMIT NO. _ TRACT NO. LOT NO. UNIT NO. Project Address % i 1 gi r l i7!LSZ, CQ S rA M A S A Applicant's Mailing Address Owner's Name &✓ —AZ&&SC& U_i •- _Phone 0 Address Arch/Eng. icense No. Address Contractor's Nam oneo� Address (mailing► City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provi$idhs of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my Ilcense•isin f ll force and effect. License Class Li o, Date — �VelSignature WORKERS' COMPENSATION OEC RATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation insurance, or a certified copy thereof (Section '800; Lab. C.) volley No. Company Certified copy is hereby furnished. I Ce r Ified cop I filed with the city 8 1 ivis' n Date Applicant , EXEMPTION FROM WORKERS' COMP SATION DECLARATION (This section need not be completed if t e permit is for one hundred (5100) or I certify that In the performance of the work for which this permit is Issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature _ NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the.performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's. Name Lender's Address — — - OWNER BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section•7031,5 Business and Professional Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Coge) 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 onalty of not more than five hundred dollars ($S00). I, as owner of the property or my employees with wages as their sole Compensation, will do the work, and the structure Is not intended or offered forsale (Section 7044, Business and. Professional- Code: The Contractor's License Law does not apply to an owner of a property who, builds or Improves thereon, and -who does such work himself/hersolf or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- i rove for the purpose of sale). 1, as owner of the property, am exclusively Contracting with licensed con- tractors to construct the projectSection 7044, Business and professions Code; The Contractor's License Law oes not apply to an owner of property who builds or improve$ thereon, and who contracts for such projects with a Con- tractor(9 11cense pursuarit to the Contractors License Law), I am aware that proof o their Worker's Compensation Insurance should be provided to "me. ❑ I am exempt under Section T B. d, P. C. for this reason le 10 5S� LJ ADD L_I ALTERATION LREPAIR TYPE OF CONSTRUCTION LJ LJ REPAIR ❑ CONVERSION_ ❑ DEMOLISH ❑ OTHER 'DESCRIPTION OF WORKIUSE OF -BLDG. A.P. 90: S E T B A Main Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ -OTHER Front - Rear PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION 5 ZONE' GRADING CU. YDS. AC RES C S Right Left Ping. Ref, # Remarks: ;, �(� Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains, Floor Sinks Gas Service Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection ,Fee Boiler V43 12/10/B4 Zone Accessory Building:, . ParkingReq./Provided $15 Duct - Under Ground Duct - Structural Duct - Ventilating _ Exhaust System Multiple ❑ Firepl/Fact. Bit. ICBO # Date Owner _ Heating System c, Ducting I hereby certify -that I have read this application and state that the above ❑0-100,000 BTU El 100,000 BT information is correct. I agree to comply with all city and county Ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this �ci y to enter up the above-mentioned property for , inspection C` Signature Date,ci �a--94, Drivers' Ucen or SS Reinspection Fee GMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Z O N I N G R Q M T S PLUMBING FEES 1 Showers ELECTRICAL Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW El 50 + KW Sewer Cap, = Sewer Connection Cooking Unit Meter ❑up to 100 amps Solar Collectors Dishwasher Meter Dover 100_ amps Solar Piping Date Date Dat Dryers ❑Gas. ❑Electric Sub Panel Solar Tank Fan Motors ❑Q1 HP Ell h - 8 Swimming Pool vv/Spa Zr CDQ F,A,U. Inc. Solar 1:19.15 HP 016-15+ Urinal Fixtures Microwave Outleis, Water Closet Registers Device Boxes Pole Light Water Heater Water Service Outlets Switches Range Sign Auto -Wash Garbage Disposal ; Standing Sections Laundry Trays. Generator 00.5 KW ❑5-15 KW Trash Compactor $15 Duct - Under Ground Duct - Structural Duct - Ventilating _ Exhaust System Multiple ❑ Firepl/Fact. Bit. ICBO # Date Owner _ Heating System c, Ducting I hereby certify -that I have read this application and state that the above ❑0-100,000 BTU El 100,000 BT information is correct. I agree to comply with all city and county Ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this �ci y to enter up the above-mentioned property for , inspection C` Signature Date,ci �a--94, Drivers' Ucen or SS Reinspection Fee GMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Z O N I N G R Q M T S Issue Fee $ 3 I I L Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Hood or Type I ElDEVELOPMENT ' Canopy Type 11 ❑ SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS:. Date Date Dat 2410 Refrigeration System 00.100,000 BTU ❑ 100,000 BTU SU MARY OF FEES BUILDING PERMIT $ ' PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ I4 47) PLAN CHECK 50A06�0 MECHANICAL S PLAN CHECK 25% $ �� SMIP $ PERMIT ISSUANCE $ ENERGY O.C. $ GRADING $ MICROFILM $ TOTAL FEE $ Zr CDQ System Repair/Alteration Fire Dampers Registers - Issue Fee $ 3 �.CONSTRUCTION AND PLANNING r APPROVALS Permit# Date Inspector POOL .3?A APPROVALS Permit # Date _ ins Pctnr - 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location '2. Soil Pi a-Undr rnd. _ 53. Steel Reinforcement ; f 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 9.'Water'Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10.,Structurai 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 Wiriog 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 APPROVALS Permit # 20.' Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 7& Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION - 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes' 34. Final Heating & Air Conditioning 35. Final Gas.Pipe-Test 36. Hood or Canopy �~ 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Pre'venter 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 N�, Date ' n' !, r<s owner of the property, em exeluslvely eontraeting with licensed con- ❑0 100,D00 BTU 0100,000BTU 3 Applicant CITY OF COSTA MESA �l 7 to fill in niuspaces except those within heavy border lines and sign all appropriate declarations. tractorstb construct the project Section 7044, Business end Professions Codes �oes Duct - Ventilating - IT NO. TRACT NO. LOT NO. BLD CONSTRUCTION PERMIT �1Q90 1 & 2 C Exhaust System C3 Multiple E3 0115 5/0/84 Project Address, 711 W. 17th Street Applicant's Mailing Address. 2418 MacArthur Blvd. , C - D OFCDNSTRUCTI N NEW ADO ALTERATION' REPAIR CDNVERSI0N DEMOLISH ❑ OTHERA.P. F71 $ L�Z4— I _� 0 d Q ZonaOwner'sName Troy Investment FundPhone 549-298SCRIPTION OF WORK$ PLAN CHECK Main Building: Accessory Building: Address 4321Birch Street, Newport -_Beach Arch/Eng,Wm. E,. Pereira AssQ�jvenseNv. Address M Contractor's Name hone n eiNO. CityAddLicessense City license No. TYPE OF PERMIT GRADING FOUNDATION _91STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL r . ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ 800-00 ZONE GRADING CU.YDS. ACRES Bit. IC8C+ # T Front r B A Rear C Right S[Left PLUMBING $ Ptng. Ref. Z �.. O � 2-� Park.Fees $ Remarks: P.C. #20-84S g Sy em Ducting Heating System Parking Reci./Provided PLAN CHECK 2596 LJCEAISED CONTRACTOR DECLARATION ! hereby affirm that I am licensed under provisions of Charter 4 (commencing with section 7000) of Division 3 of the Business and Professions Code, and I herebyy cert fy that I have -read s application and state that the above Information Is correct. I agree to comply with all city and county ordinances ❑0-100,000 BTU 01100,000 BTL Use of Building: my license is In full force and effect. $ PLUMBING FEES Plannin Notes: g License Class License No. Date, Signature WORKERS' COMPENSATION DECLARATION Bar Sink Showers $ MICROFILM sentatives of this city enter upon the above-menttoned property for Backflow Preventer Service Sink `ereby affirm that I have a certificate of consent to sett -Insure or a certificate Workers' Compensation insurance, or a certified copy thereof (Section Lallo,b. C 2420001683 Company ArgonautBackflow P01'1!Y' BCertlfied copy Is hereby fUrnlShed. Irrigation Bathtubs Sewer Cap Sewer Connection ELECTRICAL Automatic Washer Transformer ❑ 15.50 KW Certified copy Is filed with the city Building Division. Date— Applicant Construction Pole Sub. ❑ 50 + KW Clarifiers Solar Collectors EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This sectlon need not be completed If the permit Is for one hundred ($100) or DishwasherCooking Piping l Soar pg Drivers' L•nee or SS -jp Unit Meter ❑Up to 100 amps - less). I Certlty that In the performance of the work for which this permit is Ensued I shall not employ any person In any manner so as to be ome subject to tare Worker o p rlsatlon Laws of Call rnia. Date SignaturelAb NOTIQ : It,i fear making this doctor ton, you should become subject to the Workers' Compensation provisions the labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING: AGENCY Drinking Fountains Solar Tank $ Dishwasher Meter Dover 100 amps ' Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Dryers ❑Gas ❑Electric Fan Sub panel ' Motors ©0 ] HP [3136 - 8 Gas Service Outlets Water Closet F.A.U. Inc. Solar 09-15 HPE]16,15+ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097 Civ. C.) Interceptors Water Heater Fixtures Microwave Lender's Name Lancer's Address OWNER BUILDER -DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter Improve, demolish or repair any structure; prior to Its Issuance, also requires tits applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of Kitchen Sink Water Service Device Boxes pole Light Lavatories Outlets Range P -Trop Switches Sign Roof Dieing' _ Garbage Disposal Blending Sections the Contractor's -License Law (Chapter 9 (commencing with Section 70DD) of I.PIvlslan 3 of the Business and Professions Code) or that he/she -Is exempt l�Orafrorn and the balls for the alleged exemption. Any violation of Section =31.$ by any applicant for a permit- subjects the applicant to a civil Y `';•a+alty of not more than five hundred dollars ($500). L� I, as owner of the property or my erriployees with wages as their sole compensation will do the work, and the structure IS not Intended or offered for sale (Secflon 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, ahd'who does such work himself/herself or through his or her own employees, provided that such'Improvements are not intended or offered for if, however, the bultding or improvement Is sold within one year of corn- pletlon, the owner'wlll have the burden of proving he/site did not build or im- rove for the purpose at sale). Generator ❑a5 KWE15-15 KW Trash Compactor Reinspection Fee $25 issue Fee S 3 Reinspection Fee $25 Issue Fee MECHANICAL FEES Boiler Hood Or Type I ❑V Duct - Under Ground Canopy Type II 1:1sale. PUBLIC SERVICES REQUIREMENTS f\ �L Zoning Approved By ate_ Building Approved By ate— Application Issued BY 110f I Ara Duct -Structural Refrigeration System !, r<s owner of the property, em exeluslvely eontraeting with licensed con- ❑0 100,D00 BTU 0100,000BTU tractorstb construct the project Section 7044, Business end Professions Codes �oes Duct - Ventilating - SUM_ NJARY F FEES The Contractor's License LAW not apply to an owner of property who builds or Improves thereon, and who contracts for such protects with a con- Exhaust System C3 Multiple E3 System Repair/Alteration BUILDING PERMIT $ S SMTP �([� trattor(s) license pursuant to the Contractor's License I..aw). ❑ 1 sectlon S. & P. C. for Firepl/Fact. PLAN CHECK $ PERMIT am exempt under this reason Bit. IC8C+ # PERMIT SUANCE PLUMBING $ >r . Data Owner _ g Sy em Ducting Heating System PLAN CHECK 2596 $ ENERGY P.C. I herebyy cert fy that I have -read s application and state that the above Information Is correct. I agree to comply with all city and county ordinances ❑0-100,000 BTU 01100,000 BTL ELECTRICAL $ GRADING and state laws relating to building construction, and hereby authorize repro- PLAN CHECK 5096 $ MICROFILM sentatives of this city enter upon the above-menttoned property for Inspection r osas, Signature i Dete MECHANICAL $ TOTAL FEE Drivers' L•nee or SS -jp El Reinspection Fe $26 Issue Fee $ 3 PLAN CHECK 25% $ ' CMF 0565-46 rev. 12/83 White - Building; Canary - Applicant; Plnk - Accounting; Goldenrod - Assessor 15.0 Z O N I N G R E _ d U f R E M E N T S FEES $'3' J7 •, CONSTRi1CTlON ANd.PLANNING Date APPROVALS Permit Inspector POOL i a ` _ APPROVALS Peimit.*- date • _ . •. N � Inspector 1.• Temporary Electrical Service or Pole 52. Pool & Equipment Location r' _ 2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement -- 3: Electrical Conduit Utility-Undrgrnd. 54. , Forms _ 1:4. Electrical Conduit-Undrgrnd. _ 55: Electrical Bonding 5.- Steel Reinforcement 56. Rough Plumbing& Pressure Test ' 6-• Electrical UFER Grnd. 57. APPROVAL TO COVE R -G UNITE 7. Footings 58' Etectrical Conduit-Undrgrnd. r. 8. Foundation 59. Gas Pipe, O.Undrgrnd„ Tes't'' 9. Water Pipe•Undrgrnd. 60. Backwash'Lines, P -Trap, ❑ Undrgrnd. 10, Structural Floor System 61. APPROVAL TO DECK - ' 11. Property Sewer Line& House Connection 62. Backwash&'Receptor-Final 12. Sewer Cap -63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System -Final' '- > 14. Rough Plumbing 65. Electrical-Final- lectrical-Final15. 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'FINAI_ 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT" + ' APPROVALS Permit A- 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro - 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil + 1 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank © Gas .0 QiI ` 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 t , 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 m „ 36. Hood or Canopy • r 37. Final Factory Fireplace r 38.'Final Plumbing 39. Water, Service -Final - 40. Gas Service -Final - 41, Solar -Domestic -Final - - ,-- 42. Backflow Pr&enter !_ ! 43, Backflow Irrigation 44. Landscape,I,eigation System r 45. Sound Attenuation , 46. Handicap Regulations , 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed ` 49. Electric Release to Edison _ - k 50. Gas Release to Southern California Gas Co ter, 51. CERTIFICATE OF OCCUPANCY No Date City of Costa Mesa Development Services Department Building Safety Division CERTIFICATE OF OCCUPANCY No.> P. O. Box 1200 Costa Mesa, California The Building located at 71 1 14, 1 7th Street Sul to R3.1,. _ has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B2 Occupancy. Use of Building Legal Description industrial 424--091-11 (See reverse side for Metes and Bounds) E17123 101817' Building permit No x24744 Electrical Permit No.C24744 Plumbing Permit N#'2iz7` Mechanical Permit No. x;24744 , f1185R8 Number of apartments and/or guest rooms t , ISSUED TO: Building Official Trov Investment Fund ` 4321 Birch Street by Newnort Reach, ari Date 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 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCT P R IT $—�/ PER N . l TRACT �°� PO� UNIT NO., Project Address i - �l'1�+ ` _ ^/"J�7441 3 Applicant's Mailing Address C� _ TYPE OF CONSTRUCTION NEw ADD ALTERATION r REPAIR ❑ CONVERSION ❑DEMOLISH ❑OTHER / P. L Owner's Name LJ ri V one D RIPTION OF ORK/U OF BLDG. A P Address�r S Main Build if Arch/Eng. License No. -TY E OF PERMITn G ING ' FOUNDATI IO�NI• TRUCTURAL T Front f Address TENANT Lg LECTRICAL LUMBING MECHANICAL B Rear O'A Contractor's Name ' f1 O-rHER / C ` A ��1 I�i+one s , ;7 .PROJECT DESCRIPTION 54. FT_ 1 OCCUPANCY K Right Address Imaijing) -7.r-—,R CONSTRUCTION TYPE VALUATION 5 City License No. (a — S Left / r ZONE y G RAGING CU. YDS..- ACRES Ping. Ref. LICENSED CONTRACTOR DECLARATION - I hereby affirm that I am licensed under provisions of Charter 9 (Commencing ,'Remarks:PA # o ^ Qn �� i �� Planning Notes: with Section 7000) of Division 3 Of the Business and Professions Code, and Boiler my license is in full force And effect. Duct - Under Ground License Class License No. Date Signature Refrigeration System ❑0 i 00,000 BTU ❑ 100,000 BT r7 WORKERS' COMPENSATION DECLARATION I hereby affirm that I hav6 a certificate of consent to self -Insure or a certificate Bar Sink {<l Backflow Preventer - `-Workers' CompensatiOn Insurance, or a certified copy thereof (Section f 00, Lab. C.) Backffow irrigation ealicy No. Company BCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Bathtubs„ Date - Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - Clarifiers _ (This section need not be Completed If the permit Is for One hundred ($100) o, - less). I certify that In thc.performance of the work forJOhich this permit is Issued I shall not employ any person in anyas to bet pe subject to tie - _ Workers' Compensatl n ws of Call r Date Signature • NOTICE. If, t Maki this declaration, yog stickid become subject to the - Workers' Compensation provisions of the Labor Code, you must forthwith 'Dishwasher Drinking Fountains Fjoor Drains Floor Sinks comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance Of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name II Gas Service Outlets •r- - r IntercaptOrs Kitchen Sink r -Lender's Address , OWNER BUILDERDECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit to Construct, alter improve, demolish or repair any structure, prior to It§ issuance, also requires tie applicant !or such permit to file a signed statement that he/she is licensed pursuant to the provisions Of the Contractor's License taw (Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Profession$ Code) or that he/she is exempt 'herefrom and the basis for the alleged exemption. Any violation of Section ?13,5 byany applicant for a permit subjects the applicant to a civil ty of not more than five hundred dollars (5500). as owner Of the •property or my employees with wages as their sole ensation, will do the work, and the structure is not Intended or offered • for sale (Section 7044, Business and Professional Code: The Contractor's . License Law does not apply to an owner of a properly who builds or improves uch work himself /herself or through his or her own _ Lavatories + P—Trap Roof Drains t� BUILDING PERMIT Reinspection Fee �?LL, SMIP g PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal ,t Water Closet Water Heater rWater Service Auto -Wash ' Laundry Trays W 7/28/86 87.10 TL- -� Zone fZ Accessory Building: • z O N I N G R Parking Req./Provided E T S FEES Automatic Washer• Construction Pale Sub.- Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F,A,U. Fixtures 2 Device Boxes ELECTRICAL I utlets 2 Switches , Garbage Disposal Generator 00-5 KW.05-15 KW i $151 1 Issue Fee, S 3 MECHANICAL FEES thereon, and who does s mployeas, provided that such Improvements are not Intended or offered for ,aleIf, however, the buliding or Improvement Is sold within one year of Com- pletion, the owner will have the burden of proving he/she did not build or !m- prove for the purpose Of sale). ❑'1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the projectSection 7044, Business and Professions Code: The Contractor's' License taw Res not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a can- tractor(s) license pursuant to the Contractor's License Law). I am aware that ' proof of their Worker's Compensation insu ante should be provided to me. ❑ 1 am exempt under Seetion B. & P. C. for this reason. Boiler Hood or Type I ❑ Canopy Type If ❑ Duct - Under Ground Duct - Structural Refrigeration System ❑0 i 00,000 BTU ❑ 100,000 BT Duct - Ventilating Exhaust System ❑ Multiple ❑ System Repair/Alteration - Firepl/Fact, Bit, ICBO ik Fire Dampers Date I heieby certify that haverea t s piiCat on 6nd state that the above Heating System & Ducting ❑0.100,000 BTU ❑ l00,0005T r Registers information is Correct. i gree to comp) with all City and county ordinances and state tin tl building Construction, and hereby authorize repre- ses ctl of is i to enter n the above-mentioned property f � fns ctl n os ri r- Reinspection Fee S15 Issue Fee Drivers' License o $ CMF 0865-46, rev. 10/84 White - Building: Canary - Applicant: Pink - Accounting: Goidenrod - Assessor 2 2 $ 3 Transformer El 15-50 KW El50+KW Meter Oup to 100 amps Meter ❑over 100 amps Sub Panel Motors 170-1 HP Ell 56 - B Inc. Solar ❑9.15 HP 1716-15+ Microwave Pole Light . ` Range Sign Standing Sections Trash Compactor Reinspection Fee I $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQ REMENTS: Zoning Approved By ILA.4 r3 1 Z Dates Building Approved By ate Data- Application Application Issued 8y Dat 6 ' ISUrM�j RY�O�F FEES BUILDING PERMIT $ �?LL, SMIP g JCJ PLAN CHECK S PERMIT PLUMBING PLUMBING S- ISSUANCE $ PLAN CHECK 25%- S ENERGY P.C. 5 ELECTRICAL $ . GRADING S PLAN CHECK 50% $ J MICROFILM S MECHANICAL $� TOTAL FEE S / i PLAN CHECK 25% $ 0,0 CONSTRUCTION AND PLANNING -`Date 'APPROVALS Permit # ' ;J Inspector - POOL &SPA APPROVALS Permit # Date Inspector 1i )Temporary Electrical, Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7.,Foot'Pgs ��.0 `7 58. Electrical Conduit-Undrgrnd. B.. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9-Water'Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, ❑ Undrgrnd. 10. Structural Floor System ' 61. APPROVAL TO DECK 11. Property Sewer Line &!-louse 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 �� gf�4, 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 APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in Structure 10_ f --VL L 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas 0 Oil 23. Gas Pipe -Rough & Test 72, Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro S. 26. T -Bar Ceiling (Structural) & Monocoatj 75. Dry Chemical k 27. Frame and Flashing 0 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 1 , 78. FIRE PREY. FINAL 30. Drywall Nailing `� HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 60. FOOD CERTIFICATE ISSUED, T 33. Final Electric g rP�� Notes: 8 ' 34. Final Heating & Air Conditioning �0- tr4 c4e-& 35. Final Gas Pipe -Test 36: Hood or Canopy y �'��on 1'U 37. Final Factory Fireplace 38. Final Plumbing ' 39. Water Service -Final /Q -f -m LIQ 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 & 8UILDING i� pfQ (•, . 48. Special Requirements Completed 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY, No. 13�&__ _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations, CITY OF COSTA MESA C T U ON PER T P MIT N TRACT NO. LOT NO. UN' NO Project Address Applicant's Mailing Address Owner's Name Phone Address Arch/Eng. License No. Address �j ,� yi Contractor's Nom _Phone —.- %:Z Address (mailing) l 7' 1 �LtG /V V L. . City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed undf4r provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in fuil ce ajW ejfect. ^ License Class License No. L�d Date Signature WORKERS' COMPENSATION DE RATION I hereby affirm that I have a certificate of consent to sell -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. Company Certified copy is hereby furnished. Certified copy is filed with the city Buil ins D vision. Date Applicant _ EXEMPTION 0 ROM WORKERS' CO f+ISATION DECLARATION (This section need not be completed if a permit is for one hundred ($100) or lass). '1 l certify that in the performance of trig work for wnich this permit is issued, 1, shall not employ any person In any rhanner so as to become subject to the Workers' Compensation Laws of California. Oate Signature 'NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must fortnwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that I am exempt frorn the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 1 nalty of not more than five hundred dollars ($500). 1, as owner of the property or rrry, employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work hirnself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burdrtn of proving he/she did not build or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively Contracting with licensed con- tractors to construct the project(Section 7044, Business and Professions Code: I Tho Contractor's License Law does riot apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- traCtor(s) license pursuant't0 the Contractor's License Law). 1 am aware that proof of their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section - B. & P. C. for this reason Date Owner _,_ I hereby certify that I have read this application and slate that the above information is correct. f agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upgn the above-mentioned property for inspection purp s, Signature Date2 Drivers' Lice a or SS TYPE OF CONSTRUCTION NEW ADO U ALTERATION I I REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A,P.516 DESCRIPTIONOF WORK/USE OF BLDG. $ Main Building: E TYPE OF PERMIT GRADING El FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMRING ❑ MECHANICAL B Rear ❑ ,OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right IK CONST RUCTION TYPE VALUATION $ $ Left ZONE GRAOtNG CU.YDS. ACRES Ping, Ref. 546 Remarks: Planhing Notes: I PLUMBING I FEES I Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service { Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee Boiler Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wesh Laundry Trays $15 1 I Issue Fee MECHANICAL Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO 9P - Heating Heating System & Ducting ©0.100,000 BTU ❑ 100,000 BT M Roinspection Fee 1 $15 CMF 0865-46, rev. 10184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type I ❑ Canopy Type II ❑ Refrigeration System 00-100,00OBTU 0100,000131T System Repair/Alteration Fire Dampers Registers Issue Fee Washer m Pole Sub. 9926 3/25/85 Zo no Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW 4__� ❑ 50 + KW Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A,U, Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW ❑5-15 KW Meter LJup to 100 amps Meter Clover 100 amps r Sub Panel Motors ❑0-1 HP ❑ 1'% - B Inc. Solar 09-11S HP ❑16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor $ 3 � Reinspection Fee $15 1 1 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By - r Building Approved By Application Issued By- A SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING S ISSUANCE PLAN CHECK 25% $ —Z CO ENERGY P.C. ELECTRICAL S GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ $ 3 $ 10. 5U 1'L FEES $ 3 Z O N I N G R E Q M T S CONSTRUCTION AND PLANNING Date APPROVALS Permit # Inspector POOL & SPA APPROVALS Permit #. Date Inspector 3 1.. Temporary Electrical Service or Pole ( 52. Pool' & Equipment Location 2. Soil Pipe-Undrgrnd_ y 53. Steel Reinforcement 13. Electrical Canttit�lltility-Undrgrnd. ' 54. Forms . 4. Electrical Condu tUndrgend. l�. + 55. Electrical Bonding .e 5. S4et Reinforcement �`� 56. Rough Plumbing & Pressure Test v t,.6'Electrical UFER--Grnd i 57, APPROVAL TO COVE R-GUNITE r 7.. Footings �} lei `0`1 58. Electrical Conduit-Undrgrnd. { -8. Foundation f l' �� ? �� 59. Gas Pipe, ❑ Undrgrnd., Test � "? • 9. Water Pipe-Undrg'rsnd. S t 60. Backwash Lines, P -Trap, I] Undrgrnd. 10., Structural Floor System �� 61. APPROVAL TO DECK f' ,`11 ., Property Sewer Line & House Connection 62. Backwash &Receptor -Final r.7 '-01 Sewer Cap �, f ' 63. Heater & Vent -Final 13'.�Roof Drains ci 64. Plumbing System - Final ,NJ 14!Rough Plumbingr ✓ �� - (, 65. Electrical -Final - 15. Rough Electrical -Conduit 66. Solar System -Final i'16. Rough Electric Wi'ring 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 Ideating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # ,20. Rough Factory Fireplace 21- Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas C1 Oil .23. Gas Pipe -Rough & Test 72. Underground Flush _24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION Y 32. Electrical Power Meter-Firial 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test C40 36. !deed or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer a� ' 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 s 50. Gas Release to Southern California Gas Co 51, CERTIFICATE OF.000UPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. QTY O�COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NQ. LQT NO. UN! f NCl Project Address 71 "4:9 L Chl S Applicant's Mailing Address_ nn Q a Owner's Name 9-0'/ 'K AI "_I �Phone Address Arch/Eng, License No, Address nn Contractor's NameMc2r= �� {�� C 1`12 / C Phone Addresslmailing) City License No.er� LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business andProfessions Code, and my license is in full orce and effec License Ciass License No. Date - Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that t have a certificate of consent to Self -insure or a certificate ,it Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab .,C S%rO Policy Na.C�`33 7d p -� c BCertified copy is hereby furnishe n Corti ietl copy is filed with the ci Bul n !vision. �f/1 Date , �� % Applicant EXEMPTION FROM WORKERS' COMpE145ATI0 DECLARATION (This section need not be completed It the permit is tor one hundred ($100) or less). I Certify that in the performance of the work for which this permit is Issued I shall not employ any person In any planner so as to become subject to tyre Workers' Compensation Laws of California. . Date Signature ..� - 'NOTICE: If, after making this declaration, you should become Subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit $hail be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for- which this permit is Issued (Section 3097 Civ. C.). Lender's Name — ---.� -- ---- Lender's Address - - -- OWNER BUILDER DECLARATION I hereby affirm that I am exempt frons the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to conUruct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subject$ the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or My ,employees with wages as their sole Compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Cade: The Contractor's License Law does not apply to an owngr of a property who builds Or improves thereon, and who does such work hlrhself/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im. rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Sectlgn 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon_ *and who contracts for such projects with a con- tractors) license pursuant to the -Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that !'have read this application and state that the above iniormati ' c t. 1 agree to comply with all city and county ordinances and stat laws lati g to buil ng corlsrliction, and hereby authorize repre- sentative of hici y POThe en upohe above-mentioned property for inspectio pur s - Signature _ Date I"/t�t�� Drivers' License or SS _r 5830 1/I6/85 TYPE OF CONSTRUCTION U NEW LJ ADD L_J ALTERATION U REPAIR ❑ CONVERSION -❑ DEMOLISH '1:1 OTHER A,P• # Zone DESCRIPTION OF WORK/USE OF BLDG.' S Main Building: Accessory Building: E TYPE OF PERMIT 11 GRADING ED FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ -OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right Left VALUATIONCONSTRUCTION TYPE VALUATIONS S ZONE GRAOiNG CU. YDS. ACRES Ping. Ref. # Parking Req./Provided Remarks: Planning Notes: be 50 TL Z O N I N G R E M T S CMF 0865.46, rev. 10184 Wnite - Buildirtg; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES ' - Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Clarifiers Sewer Connection Solar Collectors :-. Cooking Unit Dishwasher Meter ❑up to,100 amps + _ Meter ❑over 100 amps _ Dishwasher Solar Piping Dryers DGas. ❑Electric Sub Panel Drinking Fountains Floor Drains Solar Tank Swimming Pool w/Spa Fan+ F.A.U. Motors 1 HP Ell fi - 8 j oCs Inc. Solar 09-15 HP Ell 6-15+ Floor Sinks Gas Service Outlets Urinal Water Closet Fixtures Device Boxes Microwave Pole Light Interceptors Kitchen Sink Water Heater Water Service Outlets Switches Range Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P -Trap Laundry Trays Generator 00.5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee s15 Issue Fee S 3 Reinspection Fee $15 Issue Fee 5 3 ' - MECHANICAL FEES DEVELOPMENT SERVICES REOUIREMENTS: Zoning 9 A pproved By Date Building Approved By Date Application Issued B_y—_ Data I Boiler Duct - Under Ground Hood or Type 1 ❑ Canopy Type I1 ❑ Duct - Structural Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU Duct - Ventilating SUMMARY OF FEES BUILDING PERMIT $ SMIP $ $ PLAN CHECK PERMITPLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ 7 � ELECTRICAL $ "1 •Gc) GRADING $ PLAN CHECK 50% $ MICROFILM $ 1 MECHANICAL $ TOTAL FEE $ `'t - sad PLAN CHECK 25% 1$ l Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/F,act. Bit. ICBG # Fire Dampers Heating System & Ducting El 0-100,000 BTU Ell 00,000 BT Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865.46, rev. 10184 Wnite - Buildirtg; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor " CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date InspecTor + 1, Temporary Electrical Service or Pole 52. Pool & Equipment Location 2,. Soil Pipe Undrgrnd � , 53. Steel, Reinforcement 3�Elecirical Conduit Utility-Undrgrnd ; , ' 54. Forms 4-'bectrical Conddii-Undrgrnd. ! 55. Electrical Bonding 5"Steel ,Relnforcem`ent, 56. Rough Plumbing & Pressure Test 67 Electrical UFER Gfnd. 57. APPROVAL TO COVER-GUNITE Fooii-ngs -- 58. Electrical Conduit-Undrgrnd. t� 8.^Foundation 59. Gas Pipe, ❑ Undrgrnd., Test ,7 9.'Water'Pipe-Undrgrnd 60. Backwash Lines, P -Trap, ❑ Undrgrnd• 10.,Structural Floor System 61. APPROVAL TO DECK 11:roProperty Sewer Line& House Connection 62. Backwash & Receptor -Final 12.. Sewer Cap 63. Heater & Vent-Finalell 13r4Roof Drains v ,' 64. Plumbing System - Final y? 14, Rough Plumbing", ;r? 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 16. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 300 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 bleating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40, Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer ` 43. Backflow Irrigation 44, Landscape Irrigation System k 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 Ca 51, CERTIFICATE OF OCCUPANCY No, Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO TRACT NO. LOT NO. o UNIT NO in CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 711 W. 17 th St i - BLdg. (B) Unit 11 Applicant's Mailing Address -13110 Saticoy St. N.Hollywvod, Reinspection Fee Owner's Name _Troy Investment Fund Phone 549--2988 Address 4321 Newport Beach. -Ca. iANICAL FEES _ Arch/Eng. Marin J. Rock License No. DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Address Knott Ave. Suite 216 Date Date at _12981 Contractor's Name DIIrQ Air Conditionin Phone 982-1216 Address (mailing) 13110 Saticoy St. N.Hollywood.--Ca. City License No. '33925 ((�� L'ICENSED CONTRACTOR DECLARATION System Repair/Alteration hereby affirm that I am licensed under provisions of Charter 9 (commencing Co11 W with section 7000) of Division 3 of the Business an Professions Code, and li se is full force effect r ns TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR 1:1 CONVERSION 1:1 DEMOLISH ❑ OTHER A.P. # OESCRIPTION OF WORK/USE OF BLDG. - S Main Building: E TYPE OF PERMIT GRADING FOUNDATIOfy STRUCTURAL T Front El TENANT 1:1 ELECTRICAL 1:1 PL MECHANICAL B Rear El -OTHER A PROJECT DESCRIPTION SQ. FT, OCCUPANCY K Right • K CON STRUCTION TYPE VALUATION $ S Left - ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: my cen 4 License Class c—� . No346251. Date _.14118194 Signature WORKERS' COMPENSATION DVnce, ATION I hereby affirm that I have a certifconsent to self -insure or a certificate of Workers' Compensation Insurr a certified copy thereof (Section 3800, Lab. Ca WC9824 Lumbermans Policy No. Company Certified copy Is hereby furnished. Certil MIS filed with the city Bullq ip g Dlvi ion. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers', Compensation Laws of California. ' Date Signature 'NOTICE: It, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit- shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption, Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- 1rove for the purpose of sale).. , as owner of the property, am exclusively contracting with licensed con. 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 builds or improves thereon, and _who contracts for such projects with a con- tractor(s} license pursuarA'to the Contractor's License Law). I am aware that proof o their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason r Date Owner 1 hereby certify that I have read this application and state that the above .1 Information is correct. I agree to comply with all city and county ordinances and st93lating ,to buil ' g construction, and hereby authorize repre- sentatis city to upon the above-mentioned r rty or inspectSignatDaDriverr SS Bar Sink Backflow Preventer ; Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink ' Lavatories P—Trap Roof Drains Reinspection Fee - • I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit, ICBO # Heating System & Ducting Q0-100,000 BTU ❑100,000 BTL Rainspectian Fee 1 $15 CMF 0865-46, rev. 10/84 llcant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal . Water Closet Water Heater Water Service Auto -Wash Laundry Trays FEES r Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures - Device Boxes . 1757 4/24./85 Zone Accessory Building: I Parking Req./Provided ' ' ' F ELECTRICAL Outlets Switches Garbage Disposal Generator 00-5 KW ❑5-15 KW Transformer ❑-15-50-KW 50 + Kvf Meter ❑up to 100 amps Meter ❑aver 100 amps Sub Panel ,Motors ❑0-1 HP ❑ 11% - 8 Inc.Solar D9- 15 HP El 16-15+ Microwave Pole Light Range Sign ! Standing Sections Trash Compactor 15950 TL FEES Z O N I N G R E Q M T S Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 iANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Date at Hood or Type ! ❑ Canopy Type 11 ❑ - Refrigeration System ❑0-100 000 BTU E1100,000BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ $ $ —11,00 $ _ 2.50 SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING S MICROFILM $ TOTAL FEE $ 15.50 System Repair/Alteration Fire Dampers Registers 'ELECTRICAL Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS . Permit # Date Inspector POOL & SPA APPROVALS' Permit # Date Inspector 1. 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 f ` _7. Footings 58. Electrical Conduif-Undrgrnd. 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final , 12, Sewer Cap i 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. !Rough Plumbing 65. E4ectrical-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 APPROVALS Permit # 20.' Rough Factory Fireplace 21Aucts, in Structure 70. Underground Hydro 22.'Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23.'Gas Pipe -Rough & Test 72. Underground Flush 24., Roof Framing 73. Undergrnd. Storage Tank ❑ 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 /yp 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preveiiter 43, Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING a 48. Special Requirements Completed 49. Electric Release to Edison 50, Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: ' 711 W 17TH OWNER'S NAME: DOUG TEMPLAN ADDRESS: 711 W 17TH ST COSTA MESA CA 92627 (714)631-8480 ARCHIENGINEER: ADDRESS: ST .00P UNIT: B-11 #B-11 REG.NO,: UNIT: PERMITTEE: R. J, SUSSMAN ELECTRIC (714)642-7118 ADDRESS: 8 9 0 W 15TH ST 85 NEWPORT BEACH CA 92663 LICENSED CONTRACTOR DECLARATION: I hereby aNirm that I am licensed under provisions of Chipter 9 (commencing with Section 7600) of Division 3 of the Business and Professions Code. and my license is in full force and effect. CITY LIC.: 0 5 0 110 STATE LIC.: 55807 C : C— Date:— nature: Si �- -- WORKERS' CO PEEN g SAOHDE�/LARATION: I hereby affirm that I hav certificate of consent to sell -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof {Section 3800. Lab. C). POLICY NO.: EXP. DATE: COMPANY: ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. A: __ Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred (5100) or less) I certify that in the performance of the work for which this permit is issued, I shall lot employ any person in any manner so as to become subject to the Worker Comp e atiun Laws of California. Date: [ 4 Signaturc: NOTICE: 11, a ter making ilii declaration, you should become subjee the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this pernr shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued {Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structufe, prior to its issuance, also requires the applicant lar such permit to We a signed statement that he)she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt thcielrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale (Section 7D44, Business and Professional Code: The Contractors' State 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 employees. provided that such improvements are not intended or offered for sale. If, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sate). 1, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for „uch projects with a contractors) license pursuant to the Contractors' State License Law). I am aware that prool of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section- B. & P, C. for this reason: Date Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that 1 or any future building occupant will not (circle one) need to comply with said state codes and the requirements lot a permit luz construction or modification from the Air Oualily Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to h tiding construction and hereby authori representatives f this city to enter upon the above-mentioned property for inspection urpeses. Date: , — Signature: Driver's License ur Social Secbri q: 1641-d6 While—Building: Green—Code Enforcement: Canary—Applicant: F"k—Revenue: Goldenrod—Assessor .190 CITY OF COSTA MESA - BUILDING PERMIT PERM NO: E 054449 PERMIT NO: E 054449 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: ELE JOB DESCRIPTION : 100 AMP METER & SUB PANEL CLAIM VALUE: CALL -VALUE: PURPOSE: OTH SQ FT: GROUP OCC: B-2 / COMMENTS: NO 'BLDG,' PERMIT INVOLVED. Z O N I N G S E T B A C K S R E Q U I R E M E N T S --------- MAIN BUILDING ---------- --------- ACCESSORY BUIL'DING----------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REO: PROV: PARCEL: 00000000 ZNE: REF NO: PLANNING NOTES> > #F * #F'lE �F �F'lE'lE'lE #F #F * iF iE iF iF #F iE #F iE iE iE �E #F iF 1E iE iF #F #F #F;#F #F iE iF iF #F #F � #F iE * �F TF •MF * * }F iE #F #F * �F �F'1F TF #F #F iE �E * iF #F #F #F * iF iF #F iE #F #F #F #F #F #F #F 9t �E D E V E L O P M E N T S E'R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE; BUILDING APPROVED BY : r DATE: f f APPLICATION ISSUED BY: DATE: #F #F iE iE #F iE i4 i4 iE i4 #F #F #F •MF }F #F 9t iF iF }F iF it 9E y4 ik * iE � #F iE -1E �F �f TI- F F*U LEGALIZATION:N FrE,Ek k1 M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT ,25,50 50$ SMIP/NON-RES PLAN ISSUE FEE 15.00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 29,50 15,00 0,00 44.50 44.50 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 44.50 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 44.50 '16 iF If #F #F 9t it- if if 9t #F � iI- iI- #F #F ik �E #F * * � ik iF 1E ik ik ik ik'lt• ik ik ik'lt•'lt• #F #F ik #F .� * 9t 3F 9t 9t 9t iF iI.9t #F #F dfr #F iE 9t 9t �t it• #F i4 iE iE ik #F #F #F •1F iE #F iE #F #F i4 •MF #F ik iE iE * , I N D I V'I D U A L F E E B R E A K D O W N TYPE -QTY ELE ELE 1 D E S C R I P T I O N SERVICES BELOW 600 V & BELOW.201 AMP SUB -PANEL END OF FEES UNIT COST TOTAL COST 18.50 18.50 11,00 11.00 01 0C0q9640Ju09966G T' --T �4, 3n DATE: 10/1419l T?rlE: 1�; CONSTRUCTION AND PLANNING POOL ' 'A APPROVALS Permit # Date I Inspector APPROVALS Permit # Date inspector 1. Temporary Electrical Service,or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. r 53. Steel Reinforcement 3:-Eectrical Conduit Utility-Undrgrnd. - 54. Forms - 4; -Electrical Conduit-Undrgrnd.... 55, Electrical Bonding 9 5: Siiel Reinforcement' 56. Rough Plumbing & Pressure Test lei'Electricai-LIFER grpcl. 57. APPROVAL TO COVER-GUNITE 7.: Footing.s _ 58. Electrical Conduit Undrgrnd. f. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe•Undrgrnd, ti 60. Backwash Lines, P -Trap, 0 Undrgrnd, 10. Structural Floor System f cif 61. APPROVAL TO DECK 11. Property Sewer Lin e.& House -Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63, Heater & Vent -Final -IA 13. Roof Drains r. % 64. Plumbing System - Final ��• 14. Rough Plumbing 65. Electrical -Final 15. Rough EleCtrical-Conduit 66. Solar System -Final 16. Rough Elettric.Wiring r, ` 67. Fencing & Access Approval X17. 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 rAPPROVA S 3 ,T ;;Permit 20.tRoz0h Fac ry Fire lace y' to p 1 , ;1 21 Duct, in_Structu7'* X70, lJndergroLfnii Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas DOil 23':Gas PipetRough &'Test 72. Underground Flush: T y 24.TRoof Framing�733 0 Undergrnd. Storage Tank Gas ❑ Oil - 25. Roof Sheathing 74.f Overhead Hydro-` 26:' T -Bar Ceiling f Structural) & Monocoat n . 75. Dry Chemical 27._Frame and Flashing. j 76. Dry StanIOPe 2B.' Lathing-& Siding 77�- FIXED SYSTEM'RINAL X29. lnsulatiln ' ='' �� ' 783 FIRE PREV. FINAL 30. Drywall`Neiling • 1'J ^; HEALTH'DEPTr REQUIREMENT _x • -31. Plaster Brown Cq< 7 FINAL INSPECTION' = '32. Electrical Power1,il'lleter-Final ' �`' OOD CE'RTIFICAT_E ISSUED 33. -Final Electric > x, `•`.34. Final Heating&,,ir,Conditionjrig _ I {; J, '. 35.7Firnal Gas Pipe -Test'' i r 1 r '• 36.' Hood or Canopy 37. -Final Factory Fireplace , -38. Final Plumbing _ /i f E . - -39. Water Service -Final. X40. Gas Service -Final -,A1. Solar Domestic -Final, _ d 42. -Backflow Preventer~- i- 43. Backflow IrrigationZ. ,44. Landscapt Irrigatign System V .45.�Sound Attenuation a X46. Handicap Regulations y 4T. FINAL STRUCTURE & BUI'LDING ^ _. 48.'FINAL PLANNING Lf- 'I T ,%•', r z49.' Electric Release to, Edison r� L50:Ka�:R:e:1ease to Souihern California Gas Co 151. CERTIFICATE OF�OCCUPANCY `o. Date (714) 754-5273 • Fax (714) 754-4856 • www.cl.costa-mesa. ELECTRICAL PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 711 W 17TH ST Suite No A009 Vicinity: INSIDE BLDG Parcel Nunmber: 93983004 Applicant: CHRISTENSEN, SCOTT Address: 2035 WAVERLY DR CHANGE -OUT OF AN NO OTHER WORK�AL Phone: 714-235-2601 Zip 92802 Phone: Zip: 92662 Phone: 714-235-2;W .ai Zip: 92802 F t License: 8361tt.�21do r� 3OPE OF PERMI' AW CE FROM OOAyT,i status. ISSUED Applied: 0811512005 Issued: 08/152005 ISSUED BY: ZRE� t%� DATE �4tl MAN IN UNIT vs Quantity Quantity . U SEE �' $23.5 .* Tem Dist Syst !Lighting $0.00 0 n service test 50.0 3 -r Bus+ka1 y J1f10'H $0.00 0 'alcp�a"ckage $010=' StantlingSeEtion $0.00 0 - . :(`9�2unitsj $00� 0 Mis 'Electr•�ca�;�quipment $0.00 0 mT3+units $ 00 0 Tra foirrier5 up to 1 kvalkw $0.00 0 ;paj+ $Ov00 0i .....?;iii t6'10 kvalkw $0.00 0 j Fulls $t1,"00 0 w %:':up to 50 kvalkw $0.00 0 O�itlets $ !00 0 � � . ..... !4?`�up tot 100 kvalkw $0.00 0 ;g $ 00 0 - r�� ? ' ........ =ova ,100 kvalkw $0.00 0 S Appl $ 0 x , L,,. LowVoftagefEquipment $0.00 0 pl $0:00 0 s'Y _ Lo II VoIE ring System l Ckt $0.00 0 to 200a $3.50 MisC. onduit $0.00 0 to 1000a $_00 0 �--� Misc. Conductor $0.00 0 over 1000a $0 0 0 Circus ( gen or ride) $0.00 0 to 1 hp $0. 0 0 Circus (meth ride or lights) $0.00 0 to 10hp $0.D 0 Christmas Tree Stand $0.00 0 to 50hp $0.00 0 Fireworks Stand $0.00 0 to 100hp $0.00 0 Other Electrical Fee $0.00 over 10�#1p $0.00 0 Acation roes t:` $0.00 0 Investigation Fee $0.00 nel'to'200a'�'?v, 50.00 0 Plan Check Fee $0.00 3ht Pk $0.00 0 Reinspection Fee $0.00 rcutts $0.00 0 kwr P' Ie $0.00 0 TOTAL CALCULATED FEES $54.00 ti Pole $0.00 0 COMMENTS i SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days, INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable Codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 zusr46 ism ANAHEIM, CA Owner: MULLIN, MICHAEL W TR Address 711 W 17TH ST NO A-9 COSTA MESA, CA Contractor: MAKO ELECTRIC Address: 2035 WAVERLY DR ANAHEIM, CA CHANGE -OUT OF AN NO OTHER WORK�AL Phone: 714-235-2601 Zip 92802 Phone: Zip: 92662 Phone: 714-235-2;W .ai Zip: 92802 F t License: 8361tt.�21do r� 3OPE OF PERMI' AW CE FROM OOAyT,i status. ISSUED Applied: 0811512005 Issued: 08/152005 ISSUED BY: ZRE� t%� DATE �4tl MAN IN UNIT vs Quantity Quantity . U SEE �' $23.5 .* Tem Dist Syst !Lighting $0.00 0 n service test 50.0 3 -r Bus+ka1 y J1f10'H $0.00 0 'alcp�a"ckage $010=' StantlingSeEtion $0.00 0 - . :(`9�2unitsj $00� 0 Mis 'Electr•�ca�;�quipment $0.00 0 mT3+units $ 00 0 Tra foirrier5 up to 1 kvalkw $0.00 0 ;paj+ $Ov00 0i .....?;iii t6'10 kvalkw $0.00 0 j Fulls $t1,"00 0 w %:':up to 50 kvalkw $0.00 0 O�itlets $ !00 0 � � . ..... !4?`�up tot 100 kvalkw $0.00 0 ;g $ 00 0 - r�� ? ' ........ =ova ,100 kvalkw $0.00 0 S Appl $ 0 x , L,,. LowVoftagefEquipment $0.00 0 pl $0:00 0 s'Y _ Lo II VoIE ring System l Ckt $0.00 0 to 200a $3.50 MisC. onduit $0.00 0 to 1000a $_00 0 �--� Misc. Conductor $0.00 0 over 1000a $0 0 0 Circus ( gen or ride) $0.00 0 to 1 hp $0. 0 0 Circus (meth ride or lights) $0.00 0 to 10hp $0.D 0 Christmas Tree Stand $0.00 0 to 50hp $0.00 0 Fireworks Stand $0.00 0 to 100hp $0.00 0 Other Electrical Fee $0.00 over 10�#1p $0.00 0 Acation roes t:` $0.00 0 Investigation Fee $0.00 nel'to'200a'�'?v, 50.00 0 Plan Check Fee $0.00 3ht Pk $0.00 0 Reinspection Fee $0.00 rcutts $0.00 0 kwr P' Ie $0.00 0 TOTAL CALCULATED FEES $54.00 ti Pole $0.00 0 COMMENTS i SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days, INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable Codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 zusr46 ism DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a condicare o1 consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Coda, tot the performance of the work for which this permit is issued. ❑ 1 navu and will maintain workers' Compensation insurance, as required by section 3700 of Tho tabor Code• for rho performance o1 the work for which this porrnil is issued. My wuh,urs' compensation Insurance Carrier and policy numoer a(e: Carnor: Policy Numb.ir: (7nfs s0CDon heed nor be Comploted It the pornpr is valued at one hundred ovildrs (S 100) Or JOSS,) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any mariner SO as to become subject to the workers' compensation laws of California, and agree that if I should become subleCt to the workers' compensation provisions of Section 3700 of the Labor Coda, I Shall fortnwiih Comply with these provisions. Appficanl Signature: Dalu; WAFVIiNG• FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUEUECT AN EMPLOYER TO CRIMINAL PFNAUTIES AND CIVit. FINES UP 10 ONE, HUNDRED 1HOUSAnD DOLLARE 15,100,(W), IN ADDITILIN TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 370601' THE LABOR CODE, INTEREST, AND AT1Or1NEY'S FEES. i LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensud under provisions a1 Chapter 9 (commencing with Section 7000) of Division 3 Of the Businel:s and Professions Coda,rend my license is in full rotes ane effect. Liv ■ Class s Contractor's Signalufe: Uate: !. f 5 } CONSTRUCTION LENDING AGENCY: f ❑ 1 heraby ahon) that there is a ronstruction lending agency for the pertotmanCe of Me work for wnich,tAis'permlt.tis issued. (Sec: 3097,•Civil Col de). Lenders Name: Lender's Address:' t r, Signarcru: — Date: 1 J l S OWNER-BUILDER DECLARATIONS: ti � •' - i I harooy affirm that under penalty Of perjury thin I am EXEMPT FROM THE CONTRACTORS t1C£NSE LAW for the following reason (Set. 7031.5, Business and Professions Cone: Any city or cOunly which requires & permit to construct, atter, improve, domofish, or repair any strucluie, prior.tp its issuance, also requires the applicant for such permit to lite a signed statijimenf that he or She is licensed pursuant to the provisions o1 the CentraCtorii License Luw (Chapter 9 (commenting with Section 7000) of Division 3 of Ina Business and Professions Coda) Or that he or she is exempt therefrom and the basis for ttie alleged exemption. Any violation of Section 703%.5 by any applicant for a pernlit subjects trio applicant to a civil penalty of not more than live nundrpd dollars (5500).): � � ! � � 1 iI ❑ 1, as owner 01 the ptOpeny, or my OMPlOY605 with wages as their sole-ODmpenSalion, WILL DOtTHE WORK, end trio structure is not intended or ortered for sale (Sec. 7044, Bustna:s and Professions Code: 1 he Contactors 1.icanse Law does not iipply til an owner of properlyFwho builds or Improves thereon, and wno does such work himsult or hefsell Or rhrough his or het own amployeas!provkW that such improvamiints are not Infended or otfeted for sale. 11, however, the building or improvument is sold within one year of completion, Ina owner-builder will have the burden od proving that he Or she did not build or improve fortpurpose bl sale.). ❑ 1. as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the proiact (Sec. 70"4, Business and Processions Code: The contractors License Law does not apply l0 an owner of property who builds qtr imprOveS thereon, and who r:0ntraCl9 tot juch'proleCl with a contractor(s) license pursuant to Ina Contractors License Laws.) J I am exempt untlor set. � '�' � �' •• Business and Professions Code for this reason' Signatuto: t� 7 i i ( : 1 Data: 1' Owner ID verified Dy driver's ilcense, ;_ 0 YesS Co No { Drive'r's Licans-e No. I Expires: Ven+Ication ul Ownership f lay (type OI dacurrient,'ie. • property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PER1ilfT CERTIFICATION: �. '1 I I ' ❑ I noreby cerlily inat no ex6avalion five (5) or more feel in depth into which a person is required to descend, will be made in connection with work authorized Dy this permit, and that no building structure, scatlolding; talsewoik, or demelilion orrdismanllinq theiaol, with be more than thirly-six (36) feel high. (Chap. 3.2, Grp 2, An 2, Sec. 541, idle 8, Caldomia Administrative Code). ( i ❑ As owner•buitdor,'1'*111 not employ anyone to do work,whioh would require a permit'from the Division o1 industrial Safety, as noted above, unless such person has a permit to d0 Su6h work from the division. ,'• f 7ignature: �• 7 Date: Divisrdn of lndustriallSafety Permit Number" • .J i• %', f HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will theapplicant or present orjfi tura building occupant need to file and certify a Business Plan for omorgency response to release or mromoned release of a hazardous inalunul? ❑ Yes' -C] NO• , .' t' lSociion 25505 of the Catdomia Heatttl,end Safely Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Depanmenl by every business which has at any one lime during a (oponed year a quantity DI hazardous materials equal to or greater than d weight of 500 pounus, or a vutumo of 55 gallons, :)r 240 cuoic that o1 •Compressed gas at Standard lemperature and pressure). 261 ...................�..__................. _.._�.........,.......,...,................ .............................. ............................. ,............ .......................... ...... .............. ....-................. .........................•..................................... oes lir will the applicant or present'or future boding occupant freed to file a registration form lot acutely hazardous materials? ❑ Yes ❑ No (Section 2553 of the California Hrealth and Safely Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time ties un nand-a-quantity o1 acutely hazardous matariBls equal to or greater than a weight of 500 pounds, or a volume of 5$ gallons, or 200 cubic fuel of Cnrnpfessee gas at stanoard temperature and pressure). ..................................................._,.,..................-._.........................._.................................. ...................,...,............ ............. ............. ........................_.....__.... 3 ........ ................. `pons of will Uyo applCant or present or futwe Dudeing occupant need to prepare an I1MPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yu.., n 1,10 (Suction 2553" of the California Health and Safely Code provides that the Costa Mesa Fire Department may require the preparation, Certification and filing with the Fire Uapanment of an RMPP Uy DusinesseS which are required to register acutely hazardous materials with the Fire Department. ........ir an titAi'P is p.rosontly required, nes SeCiion'......---..._..............................._..............................................................................................................-. ......................-...................................................................- p 25534 01 the California Healtn and Safety Code been fully complied wi:h7 ❑ Ye5 ❑ NO ......... .................................................. .............. ........ .... ..... %................................. ........,...........-.,................................. ,... ...,.......... ....... ....................... .-.....,.......................,............................... .....................,................................ __... 5 t)ees or will trio upplicant or present or future budding occupant require for the work which is the subject of this ,Npticafion a stmt for Such Cens[(DC[1Dr1 or modification from filo South Goast Air UUalny Managemont Uistrrtt or from any Otner air pollution control district or agoncy? U Yes No ISectlon 656!,0.2 of trio Cafitornia Government Goch requires that the requested Information ba furnished on applications tot nonresidential building permits), y.� ...................................... ............................................... ....................................................._..»............................. ....-.......,...................................,.,.............................................-.................................... li yVill err art of 1130 landfy l0 be constructed under this permit De within 1000 lost from the outer boundaries of a school? ❑Yes ❑ NO Of -yOS", the NiAny must must the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a pamut h4,n Ino South Goasl Air Quality Management DrSvul Or other au pollution cont of district or ag ncy s Q fort e work whim is friar subject Of this upplicaticm, n4vis all of Ina di5C1o5UrOS prescribed by California Health and Safety COda Section 42303 Doan made? E) Yes EJ No A..... III Nos", attach cortdlCala of compliance from trio appropriate air pollution control officer). ........................... - ............ CF.RIiFICA71: OF COMPLIANCE: I certiry that under penally of perjury the inlOrmation given above is Correct. I agree to comply with all Stale taws and city ordinancos regarding Hazardous Maiurials and Emissions Signature: pale: CERTFFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I comity under penalty of perjury that I have read this application and slate that the mformatinn given is Correct. I agree to comply with all state laws end city Ordinances relating to Dullding construction, and auinofile represontatives of the City of Costa Mesa to enter upon the abov(r-described properly for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Ownerls) Data And)Or Autnuraed Applicant Dalo Si4PL IHSPE 1 T pX p INT111AL CODE s INSPECTION TVP I D IE IIYIQJAL a 1616 Fixed System Flnet•Fire Prevention -`^"� 200'+"'Final: MbchenlCaS^��y,,, 1266Poof Silo Pilafs! gc,..r t z �' r .208 - .,FihliE Pllembinp ' { "� 'r -' / 210 1 sf llectrical 20e'r ),r Flnaf Fio•RoOf i fiineIEi 204;`'~' Ficial BIOCWRetaininy Wall .n > l 212 FIne1 Fire,Prevention-vA rF 202 t±Filial FeCtoryFiro PIa00'ti at. 4 r n 220 Fidel Planning Approval 1 r '.'Ai, l 203 VIKC Slpn + `x 222 r Final Site ) `� t ? '�' i' mew K "'• i 204 Final Derrioiition x7 i +- '' . 250 Final BuildingrOccupancy l �.' sY - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations, CITY OF COSTA MESA — 13 9 CONSTRUCTION PERMIT Projecj, Address _? 1.1 ,W.... 17th. Street Applicant's Mailing Address. 2415 MacArthur Blvd, C.0 Owner's NameTroy investment Fund Phone 549_-295 Address 4321 Birch Street, Newpgrt Beach_ Arch/Eng. Wm - L P e r Pi r a A s s ot0cense No. Address 2415 MacArthur Blvd., Corona del Ma Contractor's Nam 1 hone Address (mailingl /45 -- City License No. LICENSED CONTRACTOR DECLARATION t hereby affirm that I am licensed under Arovislons of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION liereby affirm that I have a certificate of consent to selfdnsure or a Certificate I Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C. ' Policy No. 24200016.3 Company Argonaut 8 Certified copy Is hereby furnished. Certified Copy Is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ITh1s section need not be completed If the permit Is for one hundred (3100) or. fess). I certify that in the performance of the work for which this permit is Issued I shall not employ an person In anyy anner so as to ecome subject to the Worker h n Laws of Ca It n! . Date Signature NDTICEr lf,iaft r making this doclar n, you should become subject to the workers' Compensation provisions Wthe Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Cir. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that t am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter Improve, demolish or repair any structure, prior to Its Issuance, also requires tits applicant for such permit to file a'slgned statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of ^Ivlsion 'o' the Business and Professions Code) or that, he/she is exempt' erefrom and the basis for the alleged exemption. Any violation of Section J31.5 b any applicant for' a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation will do the work, and the structure is not intended or offered for sale 1Secflon 7044, Business and Professional. Code: The Contractor's 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 employa�s, provided that such improvements are not intended or offered for sale, If, however, the bu!ltling or Improvement is soltl wlthln one year of com- pletion, the owner will here the burden pf provin9 he/she did not build or Im- rovayfor the purpose of sale). 1, as owner of the property, am exclusively coniratting with licensed con- ' iiiractors to construct the protect Isectlon 70d4, Buslno33 antl Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractor{s) license pursuant to the Contractor's License L.aw). ❑ I am exempt or Section B. & P. C. for this reason Date Owner , I herebyy certl thot-I have read t Is application and state that the above lnformatfon Is correct. I agree to ply with all city and county ordinances and'state laws relating to building cons ruction, and hereby authorize repro- sentatives of this city enterupon the above-mentioned property for Inspection r„ 2 Signature esA..... S, Data Drivers' I c nso or S5 CMF 0865.46 rev. 12/83 L: - .-1-1, 096 1 & r2 TYPE OF CONSTRUCTION U NEW U ADD LA ALTERATION 0 REPAIR-, M. ❑ CONVERSION ❑ DEMOLISH ❑ OTHER�gW ZLI-09/-03 DESCRIPTION OF WORK Exterior Alterations- - 06 Canopv S Main'Building:- TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ED OTHER A PRI CT DESCRIPTION SQ, FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ 3 , 000 . OC S Left ZONE GRADING CU.YDS. ACRES Ping, Ref. Remark.: Canopy between bldgs. B -C Parking Req./Provided P. C. #20-84S Use of Building: PLUMBING FEES I Planning Notes: HOLD FOR 0123 5/10/96 Zone Accessory Building: Z O N N G R E Park.Fees $ 1 Q Bar Sink Showers Backflow Preventer Backflow Irrigation Service Sink Sewer Cep ELECTRICAL l S FEES Bathtubs Sewer Connection Automatic Washer Construction Pole Sub, Transformer ❑ 15.50 KW - ❑ 50 + KW Clarifiers Solar Collectors Dishwasher Solar Piping Cooking Unit Meter ❑up to 100 amps Drinking Fountains Solar Tank Dishwasher Meter ❑over 100 amps Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel Floor Sinks Urinal Fan Motors ❑0.1 HP Ell 'A - 8 Gas Service Outlets Water Closet F.A.U. Inc. Soler'119-1-5 HP 13 16-15+ Interceptors Water Heater. Fixtures ' Microwave Kitchen Sink Water Service Device Boxes Pole Light Lavatories Outlets Range P—Trap, Switches Sign Roof Drains Garbage Disposal Standing Sections Generator ❑0-5 KW El 5-15 KW Trash Compactor Reinspection Fee ” , ' $25 Issue Fee $ Reinspection Fee $25 Issue Fee $ 3 MECHANICAL FEES PUBLIC SERVICES REQUIREMENTS: , Zoning Approved By VS ate ' 3-2--j — Building, Approved By Date 'V16 i Application Issued By Dat E Boiler Duet -Under Ground Hood or Type I ❑ Canopy Type I I ❑ - Duct - Structural 1 Refrigeration System ❑0-10000 BTU 0100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK ' PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES S �ic SMIP $ PERMIT S ISSUANCE $ S ENERGY P.C. S $ GRADING $ $ MICROFILM $ $ TOTAL FEE $ S:! $ 0 a Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG 9P Heating System & Ducting 110.100,000'BTU 0100,000 BT ' Relnspectian Fee $25 Issue Fee $ 3 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor -CONSTRUCTION AND PLANNING DateInspector APPROVALS , Permit # POOL _,_,,PA APPROVALS- Permit'# _ Date , r Inspector , , ... Temporary Electrical Service or Pole 4 52. Pool & Equipment Location 2.PSoil Pipe-Undrgrnd, 53. Steel Reinforcement ' " c 3.' Electrical Conduit Utility-Undrgrnd. - 54. Forms tet. 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 _ 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. i 10. Structural Floor System 61. APPROVAL TO -DECK r 5 11. Property Sewer Line & House Connection 62. Backwash'& Receptor -Final 12. Sewer Cap 63. Heater &'Vent -Final + 13. Roof Drains 64, Plumbing System; Final nr 14. Rough Plumbing -65. Electrical -Final - i 15. Rough Electrical -Conduit 66. Solar System -Final r 16. Rough Electric Wiring 67. Fencing & Access Approval ; ' T 1 T 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING L' l 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS'FINAL ' 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit,# ~ ' ' 20. Rough Factory, Fireplace 21. Ducts, in Structure 70. Underground Hydro, l 22. Ducts, Ventilating 71. Product Piping ❑ Gas "0 Oil .23. Gas Pipe -Rough & Test 72. Underground Flush t Y, 24. Roof Framing 73. U6dergrnd. Storage Tank ❑ Gas: O Oil' ' 25. Roof Sheathing 74. Overhead Hydro 26. T -bar Ceiling (Structural) & Monocoat 75. Dry -Chemical I - • 27. Frame and Flashing 76. Dry Standpipe . 28. Lathing & Siding 77. FIXED SYSTEM FINAL ; 29. Insulation ! 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED i 33. Final Electric Notes: I 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 3 = 40. Gas Service -Final ' 41. Solar.Domestic-Final 42. Backf tow Preventer , 43. Backflow Irrigation 44. •Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations I 1 47. FINAI- STRUCTURE & BUILDING, { 48. Special Requiirements Completed 49. Electric Release to Edison ! - 50. Gas Release to Southern California Gas Co { i 51. CERTIFICATE OF OCCUPANCY No. ' Date -- - -- - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations, CITY OF COSTA MESA, �7 CONSTRUCTION PERMIT l�f 00 0124 S/ rated l 7Vr_ PE RMIT NO. TRACT NO. LOT NO.. BLD . - 11096 1 & 2 Project Address 71L --W. 17th Street -- Applicant's Mailing Address • 4e $ MacArthurB1Vd . C.D. TYPE OF CONSTRUCTION LJ NEW LJ ADO &XALTERATION LJ REPAIR ❑CONVERSION ❑DEMOLISH ❑OTHER A. P. ' qI_ o 5 Zone 'F y Stment Fund Phone549-2988 Owner's Name V Ing Address Arch/Eng.wm _ F. _ PPYP_i ra ASSOak:enseNO. 2418 acbrthttr Mud-, Corona del OESCRIPTIONOFWORK EXt i-rinr AltEratlQri- —__ Cano 5 Main Building: Accessory Building: Z N I N G R E TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL 1:1 TENANT El ELECTRICAL ❑ PLUMBING ❑.MECHANICAL ❑OTHER PROJECT DESCRIPTION . SQ. FT, OCCUPANCY . CONSTRUCTION TYPE VALUATION 5 3 r 000 0 0 T Front B A Rear Address , -Mar Contractor's Nam hone Address (mailing} C Right K SLeft PIng.Ref.�# Z O — Parking Req./Provided Use of Building: it Park. Fees $ City License No. LICENSED CONTRACTOR HCLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is In full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section ZONE GRADINGCU.YDS. ACRES Q U R E M E N T S Remarks: Canopy between Bldgs. B—C P . C . #20-84S PLUMBING FEES ttc Planning Notes: HOLD FOR SPECT ) Bar Sink Showers Backflow Preventer Service Sink 3800, Lab. C.) Backflow Irrigation Sewer Cap ELECTRICAL FEES Policy No. ^ 52420001683 Company Argonaut eCertlfled copy is hereby furnished. Bathtubs Sewer Connection 4 Automatic Washer Transformer El 15-50 15.50 K Certified copy Is filed with the city Building Oivislon. Date Applicant Construction Pole Sub. ❑ 50 + KW Clarifiers Solar Collectors EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or Di shwasher Solar Piping p g Cooking Unit Meter ❑up to 100 amps leis) I certify that In the performance of the work for which this permit Is Issued I shall not employ any person in any m nor so as t come subject to the workers pen Laws of Califo a. Data ignature NOTICE: If,iaf r making this tleclaratl you show d become su Jact to the Workers' Compensation provisions of a Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY Drinking Fountains Solar Tank Dishwasher Meter Dover 100amps, ' Floor Drains Swimming Pool w/Spa Dryers Gas ❑Electric Sub Panel Floor Sinks Urinal Fan Motors ❑0 i HP ❑1 i5 • B Gas Service Outlets Weter'Closet+ F.A.U. Inc.Solar 09-15 HP 1116-15+ Interceptors Water Heater Fixtures Microwave I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097 Civ. C.) Kitchen Sink' Water Service- Device Boxes Pole Light Lender's Name Lender's Address OWNER 801LOER DECLARATION I hereby affirm that t am exempt from the Contractor's License Law for the following reason (Section 7031.5 Buslness and Professional Code: Any city or county which requires a permit to construct, alter Improve, demolish or repair any structure, prior to its Issuance, also requires tie applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of Lavatories Outlets Range P—Trap p Switches Sign Roof Drains — Garbage Disposal Standing Sections Generator.00-5 5 KW ❑5.15 KW Trash Compactor 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 _ Reinspection Pe Fee $25 Issue Fee - $ 3 7031.5 by any applicant for a permit subjects the applicant to a civil analty of not more than five hundred dollars ($500). I, as owner of the property 'or my employees with wages as their sole compensation will do the work, and the structure IS nal intended Or offered for sale (Se Ion 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. It, however, the building or Improvement is sold within one year of corn- plation, the owner will have ha burden of proving he/she did not build or Im- Erove for the purpose of sale }, I, as Owner of the property, am excluslvely contracting• with licensed con- tractorst6 construct the project `Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who 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 exempt under Section B. & P. C. for this reason r A,PLUMBING Reinspection Fee $25 Issue Fee $ 3 MECHANICAL _FEES Boiler Hood or Type 1 ❑ Canopy Type I I [JC PUBLIC SERVICES REQUIREMENTS: _ Zoning Approved By G hate ^Zi 6 Building Approved By Data Application issued By Data Duct =Under Ground Duct Structural Refrigeration System r 110-100,000 BT_ U [31D0,000BTU Duct • Ventilating, BUILDING PERMIT $ PLAN CHECK $ $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 5096 $ MECHANICAL 5 PLAN CHECK 25% s S RY OF FEES r �d $MIP PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ r Q a Exhaust System ElMultipte El System Repair/Alteration Firepl/Fact. Bit. ICBO # Date 41 Owner I hereby cert) y that I have rea - Is application and state that the above information Is correct. I agree to mpt y with all city and county ordinances and state laws relating to build cons ructlon,'And hereby authorize repro- sentatives of, this city enter upon the above-mentioned property for inspection ursea. • Signature + . Data .7 ?fa Drivers' License or 55 ;!s Heating System & Ducting ❑0.100,000 BTU ❑100,ODOBT Reinspection Fee $25 Issue Fee $ 3 CMF 086546 rev. 12/83 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor ::CgNSTRUCTION AND PLANNING 'APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1, Temporary Electrical Service or Pole 52. Pool & Equipment Location = 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3.' Electrical Conduit Utility-Undrgrnd, 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding - 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test - 6: Electrical LIFER Grnd. 57: APPROVAL TO COVER•GUNITE - 7. Footings 58. Electrical Conduit-Undrgrnd.- ` 8. Foundation 59. Gas Pipe,'O Undrgrnd:, Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines; P -Trap, 0 Undrgrnd. 10- Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash&.Receptor-Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final - 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 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- REQUIRIEMENT APPROVALS Permit# -. , 20 -Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑ Oil I' 23. Gas Pipe -Rough & Test 72., Underground Flush 3 24. Roof Framing 73., Undergrnd. Storage Tank 11 Gas 0 Oil ' 25. Roof Sheathing 74. Overhead Hydro ` 26. T -Bar Ceiling {Structural} & Monpcoat 75, Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29, Insulation 78. FIRE PREV,. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION ' 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood'or Canopy 37. Final•Factory Fireplace 38. Final Plumbing 39. Water Service -Final ; 40. Gas Service -Final 41. Solar Domestic -Final - 42. Backflow Preventer .' 43. Backflow irrigation �- 44- .Landscape Irrigation System 45. Sound Attenuation T" 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING is 48. Special Rdquirerrients Completed 49. Electric Release to Edison w 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. _- Date - - - .,A' _ ' 1 � s Applicant to,fiil In all spaces except those within heavy border tines and sign all appropriate declarations. CITY OF COSTA MESA ��/ PE MlT -I TRACT NO. LOT NO. BLD . CONSTRUCTION PERMIT 11096 1 & 2 Project Address' -W-7-7-7 S t ree Applicant's Mailing Address. 2418 MacArthur Bldd , C.D. OWner'sName Troy Investment Fu_nC549-2988 Address 4321'13irch Street, New2ortB_eac_h_ Arch/Eng. WM . L , Pereira A S s Q ,cense No. Address 2418. MacArthur Blvd.. _Corona del Ma Contrector's Name I Phone Address (mailing) City License No. LICENSED CONTRACTOR ECLARATION I hereby affirm that 1 am llcensecl under provisions of Charter 9 (commencing 1 with section 7000) of Division 3 of the Business and Professions Code, and (V_J, my license Is in full force and effect. \ license Class License No. \ Date Signature WORKERS' COMPENSATION DECLARATION vaby affirm that I have a certificate of consent to self -insure or a certificate Norker$' Compensation insurance, or a certified Copy thereof (Section _-JO, Lab. C. Policy No. 2420001683 Company Argonaut BCertified copy Is hereby furnished. Cer %202 s fi ed with trio city ilding Olvisi Dale Applicant EXEM iON PROM WORKERS' CNSATION DECLARATION (This section need not be completed' 9 permit Is for one hundred ($100) or less). I certify that In the performance of the work for which this permit Is issued I shall not employ any person In any manner so as to become subject to tare Workers' Compensation Laws of California. Date Signature NOTICE: If,iafter making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Codo, you must -forthwith comply with such provisions or. this ,pormlt shall be deemed revoked., CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION ' I hereby affirm that I am exempt from tho Contractor's License Law for the following reason•(Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter improve, demolish or repair any structure, prior to Its issuance, also requlres the applicant for such permit .to file a signed statement that he/she Is licensed pursuant to the'provisions of the Contractor's License Law (Chapter 4 (commencing with Section 7000) of ,`Mylslon, 3 of the Business and Professions Code) or that he/she Is exempt ?, t4.i{efrom and the basis for the alleged exemption. Any violation of Section JJ_5 by any applicant for a permit subjects the. applicant to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation will do the work, and the structure is not intended or offered for sale (Sec{fon 7044, Business and Professional Code: The Contractor's License law does not apply to an owner of a property who bullds or Improves thereon, and who does such work 'himself/herself or through his or her own employees, provided that such -Improvements are not Intended or offered for sate. If, however, the bulldlny or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or lm - rove for the purpose of sale). .I, as owner of the property, am exclusively contracting' with licensed Con- ' -ors to td construct the project (Section 7044, Business and Professions Code. The Contractor's Ucense Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License taw). r ❑ 1 am exempt under Section H. & P. C. for this reason Pate Owner I 'hereb tort fy that I have ree Is appllCatlan and state that the above Informs Ion Is correct. I agreeto omply with all city and county ordinances and stale taws retating'to bullding construction, and hereby authorize repre- sentatives f this city, to) enter upon tho above-mentioned ,pro arty for Inspection Slgnature �/LLLv►L Data Drivers' nse or 55 0125 5/10/84 ,5(.&* T1_ TYPE OF CONSTRUCTION LJ•NEW LJ ADD Z -A ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P., ^Q3 QS Zone f T DESCRIPT(DN OF WORK — 5 Main Building:. Accessory Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B ❑ OTHER A Rear C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE - VALUATION 5 3 , 000 00 S Left IR ZONE GRADING CU. YDS. ACRES Ping. Ref. # z -L_ Park. Fees S Remarks: Canopy adjacent to west property line. Parking Req./Provided P.C. #20-84S Use of Building: PLUMBING FEES Planning Notes: EQUIREMF.MTS Bar Sink ShowersHOLD Backflow Preventer Service Sink Backflow Irrigation Sewer Cap ELECTRICAL FEES Bathtubs Sewer Connection Automatic Washer Transformer C115.50 KW ' Clarifiers Solar Collectors Construction Pole Sub. ❑ 50 + KIN H Dishwasher Solar Piping Cooking Unit Motor ❑up to 100 amps Drinking Fountains Solar Tank Dishwasher Meter Cover 100 Bmps,-' , Floor Drains Swimming Pool w/Spa Dryers ❑Gas (DElectric Sub Panel Floor Sinks Urinal Fan Motors CIO-I'HP ❑ 1% - B Gas Service Outlets • Water Closet F.A.U. Inc. Solar'09-115 HP ❑16-15+ Interceptors - Water Heater Fixtures Microwave Kitchen Sink Water Service Device Boxes Pole Light Lavatories Outlets Range P—Trap Switches Sign Roof Drains ,Garbage Disposal 'Standing Sections - Generator 110.5 KW ❑5.15 KW Trash Compactor Reinspection Fee $25 issue Fee $ 3 Reinspection Fee $25 Issue Fee S 3 MECHANICAL FEES Boiler Hood or Type I ❑ PUBLIC SERVICES REQUIREMENTS: 1, 1) L' 3'2' 4 - Canopy Type 11 ❑ Zoning Approved By Y ate Duct •Under Ground Duct Building Approved By Date Duct - Structural Refrigeration System Application Issued By Dat Duct - Ventilating _ 00.100,000 BTU 0100,000 BTU , . SUMMARYRF FEES Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ r! SMIP $ Firep)/Fact. Bit. ICBO # PLAN CHECK i I S PERMIT •$ PLUMBING $ ISSUANCE Heating System & Ducting 1ENERGY PLAN CHECK 2596 $ P.C. $ ❑0.100,000 BTU (3100,000 BT _ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TDTAL FEE $ i Reinspection Fee $25, Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865.46 rev. 12/63 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 'CONSTRUCTION AND PLANNING. - C Date APPROVALS Permit # Inspector POOL A ,. . - , � `- APPROVALS ' Permit # _. -'Date r -.v r7 ' Enspector _. ' 1 _Temporary Electrical Service or Pole 52. -Pool & Equipment Location - t -2.zSoil Pipe-Undrgrnd. 53. Steel Reinforcement ' 3_ Electrical Conduit Utility-Undrgrnd. 54, Forms 4: Electrical Conduit-Undrgrnd. 55. Electrical Bonding r 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test. 6 Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE - 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash•Lines, P -Trap, ❑ Undrgrnd. _ 10. Structural Floor System 61. APPROVAL TO DECK t 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 i 18. Rough EEectrical•T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT" REQUIREMENT APPROVALS i . Permit # = i 20. Rough;Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro L , 22. Ducts, Ventilating 71. Product Piping ❑ Gas . ❑ Oil 1 ;� 23, Gas Pipe -Rough & Test 72. Underground Flush' 24. Roof Framing • 73. Undergrnd. Storage Tank ❑ Gas ❑ OII' 25. Roof Sheathing 74. Overhead Hydro 26, T"Bar Ceiling (Structural) & Monocoat 75. Dry Chemical �- + ,27. Frame and Flashing 76. Dry Standpipe 2B. Lathing & Siding ' 77.E FIXED SYSTEM FINAL 29. Insulation 78. FIRE PR.EV. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION i 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED s a 33. Final Electric ` Notes: 34, Final Heating & Air Conditioning i r 35. Final Gas Pipe -Test 36. HoocGor Canopy r 37. Final' Factory Fireplace 38. Final -Plumbing 39. Water Service -Final - - 40. Gas Service- Final' 41. Solar, Domestic -Final ' 42. Backflow Preventer 43. Batkffow Irrigation 44. -Landscape Irrigation System ? ' 45. Sound Attenuation 46• Handicap Regulations , 47. FINAL STRUCTURE & BUILDING �6 48.Special Requirements Completed 49. Electric Release to Edison { - 50. Gas, Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - No Date I - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. c u re N PERMIT PE IT NO. TRACT NO. LOT NO. UNIT NO. CI A I or cosi A MESA77 WNSTC %JR Project Address - �- / lf] -LL �.*L- _ - Applicant 's Mai' dress ' Owner's Narper4o Xf OnAr 5 Phone 151 Address Z4 j {- IVl Arch/Eng. .. License No. Address Backflow Preventer Service Sink Contractor's Nam Ph`o Address (mailing) Backflow Irrigation Sewer Cap City Li ease No. Sewer Connection LICENS CONTRACTOR DECLARATION Ihereby affi that t am t-Rcensed antler provi Charter 9 (commencing with section 7 of DIvlslon 3 of th s Hess and Professions Code, and My license is in full a antl effec Ucense Class License No. Date ignatu Dishwasher OR RS' PENSATION DEG TION ereb rm that I have a certificate Of Cons t to self -insure or a certificate �i W rke Cumoensation Insurance, or certified copy thereof (Sectlon 3800, t -ab, ,) Policy No. C pany 8 Certified cop is hereby furnWWO Certified copy filed with [n0 y Building Division. Date Appli nt EXEMPTION FROM RKE 'COMPENSATION DECLARATION (This section need not b o loietl If the permit I5 for One hundred ($100) or less). I certify that In the perf nce of the work for which this permit Is Issued, I shall not employ any rso n any manner so as to become subject to the Workers' CompenSati Laws California. Date -Signa e NOTICE: It, after aking this decl ation, you should beC6ma subject to the Workers" Comp sation provisions the Labor Cotle, You must forthwith comply with uch •provisions or th permit shall be deemed revoked. C0NSTRUC ION LENDING AGENC I hereby at rm that there Is a construction le Ing agency for the performance of the ark for -which this permit Is is d (Section 3097 Civ. C.) Lender' Nam. ' Lender's Address OWNER HUILOER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code= Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, alSO requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 'heContractor's License Law (Chapter 9 (commencing with Sectlon 7000) of t Avision- 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 enalty of not more than five hundred dollars ($500). I, as owner of the property or my emptoyeeS with wages as their solo compensation, will CIO the work, and the structure is not Intended or offered for sale (50 "on 71)44, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is Sold within one year of corn- ' pletion, the owner will have the tfurden of proving he/she did not build or im- rove for the purpose of sale). 1, as Owner of the property, am exciusively contracting with licensed corn tractors to construct the project (Section 7044, Susinoss and Professions Code: The Contractor's License Law does not apply to an Owner of ProporlY who 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 proof o/ their Worker's Compensation insurance should be provided to me. I am exempt under Section B. a, P. C, or this reason Date Owner I hereby certify that 1 have read this application and state that the above Information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of thiOs- �enter �tojponc eve -mentioned property for Inspection Dur Signature ate_ 1 r'ir� Drivers' License O .►. -M, 104 C TYPE OF CONSTRUCTION L'i NEW 1....1 ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION nI DEMOLISH 1:1 OTHER A� p 90 DESCRIPTION OF WORK/USE'OF BLDG. 5 Main Building: E TYPE OF PERMIT 0 GRADING 17 FOUNDATION In STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBiNG ❑ MECHANICAL a Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ g Left ZONE GRADING CU.YDS. ACRES Ping. Ret. # Remarks: Planning Notes: 9735 7/'I fl196 18.4d rt�l,t Zone Accessory Building'. Z O N 1 N G R Parking Req.fProvided E Q M T S Per Sink PLUMBING Showers FEEg ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer 0 15-50 KW '0'50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter Otip to 100 amps Clarifiers Solar Collectors Oishwasher Meter Dover 100 amps Dishwasher Solar Piping Dryers ©Gas ©Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 1:161 HP O 1'f, - 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections P—Trap Laundry Trays Generator 00-5 KW 05-15 KIN Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 Boiler Duct - Under Ground MECHANICAL Hood or Type i Canopy Type 11 O FEES DEVELOPMENT SERVICES REQUIREMENTS— Zoning Approved By Building Approved By Application Issued By Date Date —Dot Duct - Structural Refrigeration System ❑U-100,0006TU 0100,000 BTU Duct - Ventilating SUMIIAARY BUILDING PERMIT $ _ ��% PLAN CHECK $ $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% S MECHANICAL S PLAN CHECK 25% s QF FEES ^ SMIP $ - -' -4. .PERMITPLUMBING ISSUANCE $ --^ -- --- -- ENERGY P.C. S GRADING $ _ MICROFILM s TOTAL FEE s Exhaust System O Multiple 0 System Repair/Alteration Firepl/Fact. Bit. fCBO'# Fire Dampers Heating System & Ducting 00-100,000 BTU0100,000BT Registers Reinspection Fee $15 Issue Fee $ 3 GMF 0865-46, rev. 10/84 Whit t; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date inspector POOL & SPA APPROVALS Permit # pate inspector 0 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd, 54. Forms 4, Electrical Conduit-Undrgrnd. 55. Electrical Bonding -� 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7, Footings 58. Electrical Conduit-Undrgrnd. r 8. Foundation 59, Gas Pipe, 0 Undrgrnd„ Test 9. Water Pipe•Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd, 10, Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68, APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69, POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑Gas 00i1 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27, Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. insulation 78, FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE: ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations f� 47. FINAL STRUCTURE & BUILDING 2,3 48. Special Requirements Completed fr I 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date i Applicant to fill In all spaces within heavy border lines and sign all appropriate declarations. CITY OF OJTA MESA PERMIT NO + TRACT NO. LOT NO. BLDG. NO. - 647.1 - 10.00 TL CONSiftUC,TION PERMIT 302..?7/9� Project'Address zzl- r _ - �• _ TYPE OF CONSTRUCTION , c Owner pw V,4, -.p t=2- Phone SW S .9 J ❑ NEW ❑ ADD Address i P xn—,o . s. 412- AJ _ 6-' ❑ REPAIR ❑ CONV�ALTERATION SION ❑ DEMOLISH Arch/Eng. - , License No. "❑ OTHER I ZONING REGULATIONS r r•r _ A.P. DESCRIP N OF•WORK Address - ZONE PLNG. REF. - ' Contractor Phone TYPE F ERMIT -' LINE ' PRoflplp ,� G Address - ' " ' ' "- c ❑ ❑ FOUNDATION RUCTURAL- SET ACK C ST. - _ GRADING ,St YARD L t LICENSED -CONTRACTOR DECLARATION ❑ TENANT ❑'ELECTRICAL- ❑PLUM IN El MEC WIDE YARD -- -- -- - - t, - I hereby affirm thi,t l am licensed Under provisions of Charter 9; (com- 7000) Division 3 the Business ❑OTHER• - FLIGHT s ,mencing with section of of -and .Professions Code, and my license Is in full force and effect., i I; REAR YARD (TO P/L) ; PROJECT DESCRIPTION: - License Class License No. _ _ '. rs r', PKG. SPACE REQ.' PROVIDED DSte �' -Signature T :SQ. FT.' EPI SAP'. �� STREET WIDTH FEE WORKERS',COMPEN5ATiON DECLARATION. _ it t0 self -insure ora OCCUPANCY•' CONSTRUCTION TYPE_ ' ZONING APPROVED BY '.PARK DATE" hereby affirm that I have a certificate of consent VALUATION ZONE ' ' -tHicate of Workers' -Compensation insurance, or a certlfled-copy- - - - -- SPECIAL CONDITIONS reof (Section 380.0, Lab. C.). , GRADING CU.,YOS. ACRES - .Icy No. -` _ Company ^ - - - - -- - - - -� - -> L� Certified copy Is hereby -furnished. _ __ _ REMARKSx, ❑ Certified copy Is filed with the city Building Division. 'EXEMPTION-FROM'WORKERS' - *, rt t , COMPENSATION' DECLARATION (This section need not be completedthe_permit is for one hundred - •• _ ___ _ �Z' _ '� _ 'i - 'r`, •_._. ' ,if ($100) or less}. I certify that in they performance of the work for which this permit, is __ _: _.. �_- _�__ _ ` • _ ° J's _ _ _ �, _ •_ -- - - - issued, I shall not-employ'any person iri any manner so'as,to;become PLUMBING��,• c`i�` t, -PLAN CHECK -1`-' — ELECTRICAL -- - PLAN'CHECK subject to the Workers' Compensation- Laws of California. - ^ _ _ � _ - _ � ` BATHTUBS.^_". SHOWERS`' »- - -- - Date Signature NOTICE: If after making this declaration, you should become subject TO3LETS4_ - .,-URINAL'S,GENERATOR•- "-O-1 KW .__.. .1-104KW - to the Workers' Compensation provisions of the Labor Code, -you must forthwith comply with such provisions or this permit Shall be deemed LAVATORIES DOUBLE LAYS ,- •TRANSFORMER ••r 1 , APPLIANCE.' 10-50�KW;50-+ KW - - -� revoked. - _ _ _ _ :_ ._ 1. -_ - ___ CONSTRUCTION LENDING AGENCY _. -KIT, SINKS- "DISHWASHERS'- � - "MOTORS - '13-1 HP "- ' 1-10'HP' _ ,C �•- „ f I I I hereby affirm that there Is a construction lending agency for the per- SERVICE SINKS 7� ' r 'SUMPS- -r - - !(INC. SOLAR)- - 10.50 HP_ t 50 + HP - formance of the work for which this permit is issued (Section 3097 civ. C.): FLOOR SINKS --FLOOR-DRAINS'" i ''FIXTURES"" "-"OUTLETS-- SWITCHES- 'y' -- Lender's Name Lender's 'Address r DRINKING FOUNTAINS '" 1 ` ' ' GAS TUBE-SiGNS'- OWNER'BUIL•DER DECLARATION INTERCEPTORS CLARIFIERS �- POLE LIGHTS I hereby affirm that I am exempt from the Contractor's License Law for the following reason -(Section 7031.5 Business -and Professions Code: -SWIMMING POOL P'TRAP-- - - POLES METERED - - - SUB Any city or county which requires a permit to construct, alter, Improve, demolish°or repair any structure, priorto its issuance, also re- WATER SERVICE ALTERATION PANELS MAIN ' SUB quires the ap;.licant for Such permit to file a signed statement that he 4 1 Is -licensed pursuant to the provisions of the Contra ctor's- Licari se-Law•GAS SERVtCE'-• -OUTLETS - _r SERVICE-"' `^-' -' 'AMP - - d "Chapter 9 (Commencing with Section 7000) of Division 3 of the usiness and Professions Code) or -that he is exempt therefrom and the WATER HEATERS ' HTU OUTPUT - -- - esis for the alleged exemption. Any violation of Section 7031.5 by any applicant •for a -permit subjects the-applicant-to-a-clvft-penalty SEWER CONNECTIONS`- ( �' - 't' _ _ _ .._ __._ _ __ ,• of not more than five hundred dollars ($500). ❑ 1,'as owner.of'the property, or my'employees with wages as their SOLAR TANK --COLLECTORS sole compensation, will do the work, and the structure Is not intendea ' or offered for sale.•�(Section 7044, Business and Professions Code: The SOLAR PIPING SYS. '- , � ISSUE"FEE - Contractor's License Law does not apply to an owner of a property. who builds or improves thereon, and who does such work himself or - ISSUE FEE" , ; APPLICATION APPROVED BY - ^ -� DATE "' + through h.is Own employees, provided that such Improvements are not intended or offered for sale, if, however, the building or Improvem¢nt- MECHANICAL PLAN CHECK SUMMARY OF FEES, - r , is _sold within one year of completion, the owner will have the burden of proving he did. not build or' improve for the'purpose of sale). HEATING SYSTEM 0.100,000 BTU :BUILDING 0 ,, • r © I,- as Owner of -the property, am exclusively Contracting .with- 'AND DUCTING-"- - -' • - ' ' -' ' - PERMIT S r - ••-� - - SMIP S• --- - - - - - _ _� _ _ licensed contractors to construct the project (Section 7044, Business 100,0001+ BTU PLAN CHECK $ rPERMIT,, and -Professions -Code.* The Contractor's License Law does not apoly.to- - -- - ISSUANCE 5 an owner of property who builds or Improves thereon, and who con- to. REFRIGERATION 0-100,000 BTU PLUMBING S� i �• '= •,�' !GRADING`- tracts -from -such prefects wlth•a-contractors}. licesnotl pursuant the Contractor's License Law). SYSTEM-- ;%--- - - - 100,000•+ BTU - - +PLAN CHECK S $ r + ❑ I -am exempt under Section - B. & P; C:'for this BOILERS BTU. '- '- ELECTRICAL S r$ reason - _ - - PCAN'CHECK S- MICROFILM $ j Date Owner SYSTEM REPAIR,ALTERATION TOTAL FEE $ jMECHANICAL' S-- - - " I hav rad this a Iication and stat h hove I hereby Cert fy that ¢ ¢ pp ¢ that [ e d EXHAUST SYSTEM MULTIPLE ' - ,-. ,,• - LESS AD- I information is correct"`k agree t0 -"comply' wltFi'aN 'city and county information I, � PLAN CHECK' -'S' - -- VANCE PC $.. - ' ordinances and stale laws relating to construction, and hereby authorize - -, representatives D this City' to enter upon 'the above _ entl ad- property for acti�orC�/burp}o�_�/,{/^ � �7 FINAL FEE S 1-6-00-- Signature ,- - r' ' Date _ - Drivers' License or SSr -- - -ISSUE-FEE - 4`"A —CM I 0865 -•t5 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor 111i CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL' &SPA - - '+ � _ � _ -• _� r . APPROVALS - Permit # - Date Inspector 1. -Temporary Electrical Service or Pole 43. Pool.& Equipment Location— _ . Soil Pipe-Undrgrn _ 44. Steel Reinforcement - - 3-_ Electrical Conduit Utility-Undrgrn 45.. Forms 4.- Electrical Conduit-Undrgrn ._,_46. Electrica['Bonding - - - 5. tee ein orce 47. Rough Plumbing & Pressure Test - - - _6. Electrical UFER G_rn_ - 48. APPRpVALTO COVER-GUNITE - - - 7• Footings_ _ _ _ _ _ 49. Electrical Conduit-Undr rn' -8.. Foundation- 50., Gas Pipe_ D,Undrrn,Test ' 9.. Water.Pipe-Undrgrn,- _ _ 51 Backwash Lines P -trap. -D' ndr to 10• Structural Floor System 52. APPROVAL TO DECK' L .1.1 • Property Sewer_Line & House Connection 53. Backwash & Receptor -Final " 12. _Street Sewer -Connection ' 54. Heater-& Vent -Final 13. Rough Plumbing_ • 155. 14, Rough Electric -Conduit - --56;--Electrical-Final 15. Rough Electric- ring r - - 57. Solar System -Final 16. Rough -Heating & Air Conditioning bu. Fencing & Access Approval , 17: Ducts in Structure 59. APPROVED FOR PLASTERING 18'- Ducts, Ventilating._ 60. - POOLISPA-SYSTEMS FINAL' ' 19: Gas Pipe -Rough &Test- 20. Roof Framing - 21. Roof SheathingN - - - -- - NOTES: 22. Frame and Flashing_ 23. Insulation - `- 24. Lathing &-Siding - - - - -- - - 25. Drywall Nailing 26. Plaster Brown Coat ^ 27: Eiectrical- Power Meter -Final 28. Final Electric - - - - - 29. Final Heating & Air Conditioning 30' Final Gas Pipe -Test 31: Final{Plumbing _ 32. Water Service -Final .. 33. -Gas Service -Final 34. Solar Domestic -Final 'u ` 35. Landscape Sprinkling System ' 36. Sound Attenuation - 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No. Date { - h CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address ree Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. Applicant's Mailing Address'", _2418 MacArthur_ .Blvd, C.D Owner's Name ._T_LQY Investment 'Funs none 549-298 Address 4321 Birch Street, Newport Beach Arch/Eng, Wm -L-- Pereira ASSCIGcenseNo, Address 2418 MacArthur Blvd.. Corona del _Ma Contractor's Nam Phone Address {mai lingl _ City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Divlslon 3 of the Business and Professions Code, and my license is In full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION hereby afflrm that I have a certificate of consent to self -Insure or a certificate Workers' Compensation Insurance, or 'a certified copy thereof (Section J800, Lab. C.) Policy No. 524200016-83_ company Argonaut Certified copy Is hereby furnished, Cg, ( d o Is filed with the city tiding Dlvlsl Applicant EXEMPTIO FROM WORKERS' CO P NSATION DECLARATION (Thissectlon need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued I shall not employ any person in any manner so as ecome subject to tie Workers' Laws of Calif is Date _ Signature NOTICE It,iaft r a Ing this declarat o ,you Should become subject to the Workers' Compensation provisions of a Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked: CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C,) Lender's Name Lender's Address OWNER 13UICbER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason.(Sectlon 7031.5 Business and Professional Code: Any city or, county which requires a permit to construct, alter Improve, demolish^or repair any structure, prior to Its issuance,:also requires tike applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's.Llcense,Law (Chapter 9 (commencing'with Section 7000) of OIvlsion 3 of the Business and, Professions Code)' or that he/she Is exempt ierefrom and the basis for the alleged exemption. Any violation of Section .031:5 by. any applicant for a permit: subjects . the applicant to a civll enalty of not more than five hundred _ dollars ($500), 1, asFowner of the property or my employees'with wages. as their sole compensation' wlll� do the work, and the structure Is not Intended or offered for sale (Sec{ion 7044, Business and Professional Code: • Thel Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the bulidIng or Improvement Is sold within one'year of com- Pletlon, the owner will have the burden of proving he/she did not build or Im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- trrrrrrddddddcccccctorst0 construct the project (Sectlon.7044, Business and Professions Code: The Contractor's Ll cense Law does not apply to an owner of property who bullds or Improves the re0 n, and who Co ntrdct5 for SUCK prOjeCtS Wlth a con- tractor(,) license pursuant to the Contractor's License Law): ❑ l'am exempt under Section & P. C. for this reason Date Owner •1- hereb certi that I have read , s application and state that the above Information Is correct. I agree to c ply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city ta, enter. upon the above-mentioned property for inspection ur ase s, cy/'J Signature Date ,A to Drlvers' ense or SS CMF 0865-46 rev. 12/83 White - Building; PE lT NO. TRACT NO. LOT NO. BLD — 11096 1 & 2 TYPE -OF CONSTRUCTION 'NEW ADD ALTERATION LJ REPAIR M'. ❑ CONVERSION ❑ DEMOLISH ❑ OTHER' DESCRIPTION OF WORK FXterinr_AltP_t-ation- TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT [—]ELECTRICAL ❑ PLUMBING ❑ MECHANICAL• ❑ -OTHER PROJECT DESCRIPTION SCI. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ -Annn n(1 _ ZONE GRADING CU, YDS. ACRES 0122 _X3/ 1 0/8tl 39o0C - A.P. +_ D Zone G S Main:Building: Accessory Building: Z T Front N B A Rear l N C Right G S Left R E PIng, Ref. ,+ O ., Park. Fees $ Q Remarks: Canopy between hid s. A & D Parking Req./Provided I R ;P.C. #20-84S Use of Building: ■ E E PLUMBING FEES Planning Notes: HQLD FOR SPLOALM Bar Sink Showers N T S Backflow Preventer Service Sink Backflow Irrigation Sewer Cap ELECTRICAL FEES Bathtubs Sewer Connection Automatic Washer Construction Pole Sub.. Transformer ❑ 15-50 KW' - ❑ 50 + KW Clarifiers Solar Collectors Dishwasher Solar Piping Cooking Unit Meter ❑up to 100 amps Drinking Fountains Solar Tank Dishwasher Meter ❑over 100 amps,< < ' Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel Floor Sinks Urinal Fan Motors ❑0-1 HP 01%-8 Gas Service Outlets Water Closet F.A•U, Inc. Solar ❑9-15 HP 016-15+ Interceptors Water Heater Fixtures Microwave Kitchen Sink Water Service Device Boxes ' Pole Light Lavatories r Outlets Range P—Trap.• - _ ' �. • Switches Sign r Roof Drains Garbage Disposal Standing Sections ' " S Generator.00-5 KW 05-15 KW Trash Compactor Reinspection Fee $25' Issue Fee $ 3 I Reinspection Fee 1 $25 Issue -Fee $' 3 Boiler - Duct -'Under Ground MECHANICALFEES Hood or Type I ❑r' Canopy Type I1 ❑ r PUBLIC SERVICES REQUIREMENTS: Zoning Approved By Building Approved By ; Application Issued By RIC -Date Date Gam, Dat 7 —a Duct • Structural Duct - Ventilating : Refrigeration System ❑0-100,000 BTU. 0100,000 BTU SUMMARY BUILDING PERMIT $ �. _ PLAN CHECK $ I PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ OF FEES _ SMIP ; $ i PERMIT ISSUANCE $ ENERGY P.C. '$ GRADING '$ MICROFILM $ TOTAL FEE $ •6 Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit, ICBO # Heating.System & Ducting ❑0.100,000,BTU 0100,000BT - Aeinspection Feei T. $25 Issue Fee $ 3 -Applicant, Pink - Accounting; Goldenrod - Assessor TL - CONSTRUCTION AND PLANNING Date %APPROVALS Permit # Inspector -POOL .. ,rA APPROVALS; _ P.ermit-# y Date �. in . 1 .. Tgmporary Electrical Service or Pole 52. Pool &'Equipment Location '- i t 2.• ,soil Pi a-Undr rnd. _ P 9 53. Steel Reinforcement , . , _ i • _ . _ , , 3.. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6.' Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical"Conduit-Undrgrnd.= 8. Foundation 59. Gas Pipe; (]`Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd, _ 10. Structural Floor System 61, APPROVAL TO -DECK 11.Property Sewer Line & House Connection 62. Backwash &'Receptor -Final: 12. Sewer Cap 63. Heater & Vent -Final. r r 13. Roof Drains 64. Plumbing System -`Final ` 14. Rough Plumbing 65. Electrical -Final 15.` Rough Electrical -Conduit 66. Solar System -Final 7- 16.; Rough Electric Wiring 67. Fencing & Access Appi'roval " 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 ' APPROVALS Permit.A 20.' Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro i 22. Ducts, Ventilating 71. Product Piping ❑ Gas 0 Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑,Gas °O Oil: ` ' 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27, Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80., FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood. dr -Ca noPY - 37. Final'Factory,Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final ` 41. Solar bomestic-Final - 42. Backflow Preventer 43 Backflow Irrigation 44: ,Landscape Irrigation System t 45:'Sound Attenuation + _ i 46. Handicap Regulations �, _ 47. FINAL STRUCTURE & BUILDING r 48. Special Requirements Completed 9 i 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co " 51. CERTIFICATE OF OCCUPANCY No. Date Q121 ;5/10/84 61 rI zone IVIG Accessory Building:' 14 2-- Park. Fees $ eCertified copy Is hereby furnished. Bathtubs Sewer Connection Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. Certified copy Is filed with the city Building Division. _ CITY OF COSTA MESA 7 Fixtures MIT NO, CT NO, LOT NO. BL . CONSTRUCTJON PERMIT 1 / 11096 1 & 2 Solar. Collectors Lavatories Construction Pole Sub. Project Address '-la. W-- 17th Street- Applicant's Mailing AOdress,'2 418 MacArthur Blvd, -C.p.CONVERSION Qwner'aNeme ` t= hone 549-2988 Address 43_21 Birch Street, Newport _Beach_It Arch/Eng. WM - L- e r e i r a ASS911censeNo. Address 2418 MacArthur Blvd._, Corona del_M Contractor's Nam hone Address (mailing) City License No. E OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑DEMOLISH ❑OTHER FDESCRIPTIONOF.WORK Exterior Alte"tioR_•-_ CanoRy A.P. S T B A C S Main Building: TYPE OF PERMIT 0 GRADING LJ FOUNDATION U STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANiGAL X ❑,O-fHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTtON TYPE VALUATION s 3 , 000.00 ZONE GRADING CU. YDS. ACRES - - — Front Rear Right Left Ping, Ref, 915 Z_ JE Remarks: Canopy between Bldgs. A & D Parking Req./Provided PLUMBING LICENSED CONTRACTOR OE ATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is In full force and effect. License Class — License No. 3 3 - Use of Building: PLUMBING F ES Planning Notes: Bar Sink Showers \ Date Signature -'OR KERS' COMPENSATION DECLARATION Backflow Preventer Service Sink Irrigation Sewer Cap $ { - ` ereby affirm that I have a certificate of consent to self -insure or a Certificate Workers' Componsatlon Insurance, or a certified copy thereof (Section 3800, Lab. C.Backflow Policy No. 000168 3 Company . argonaut Q121 ;5/10/84 61 rI zone IVIG Accessory Building:' 14 2-- Park. Fees $ eCertified copy Is hereby furnished. Bathtubs Sewer Connection Gas Service Outlets Water Closet Automatic Washer Certified copy Is filed with the city Building Division. Interceptors Water Heater Fixtures I hereby affirm that there Is a construction lending agency, for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Kitchen Sink Water Service Date Applicant Clarifiers Solar. Collectors Lavatories Construction Pole Sub. EXEMPTION FROM WORKERS' COMPENSATION DECLARATIONpishwasher p -Trap Solar Piping t -_ - Roof Drains - - Cooking Unit (This section need not be completed If the permit is for one hundred (5100) or Generator 00-5 KW Reinspection Fee $25 Issue Fee $ 3 - Canopy Type 11 ❑ ❑ I am exempt under section B. & P. C. for this reason fess). I ssiAlfy that In the performance of the work for which this permit Is Issued I to the Drinkin Fountains 9 Solar Tank PLUMBING Dishwasher shall not employ any person in any an so as to me subject workers' a Laws of Calif r I Floor Drains: , Swimming Pool w)Spa Building Approved By Dryers ❑Gas ❑Electric Date �I ` Signature NOTICE: lf, after making thls cleclar$U6, you should become subject to the Workers' Compensatlgn provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Floor Sinks Urinal - Fan Gas Service Outlets Water Closet F,A,U. CONSTRUCTION L$ND1NG AGENCY Interceptors Water Heater Fixtures I hereby affirm that there Is a construction lending agency, for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Kitchen Sink Water Service Device Boxes ' Lander's Name Lender's Address OWNER BUILDER DECLARATION Lavatories Outlets ' I hereby affirm.that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which require% a permit to construct, alter Improve, demolish or repair any structure; prior tg its Issuance,' also requires tba applicant for such permit 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 ')Ivlsion 3 of the Business and Professions Code) or that he/she Is. exempt nerefrom and the basis for the alleged exemption. Any violation of Section 1031,5 by any applicant for a permit sublects the applicant to a civic enalty of not more than five hundred dollars ($500) p -Trap switches t -_ - Roof Drains - - Garbage Disposal _ r Generator 00-5 KW Reinspection Fee $25 Issue Fee $ 3 - Canopy Type 11 ❑ ELECTRICAL Transformer ❑ 15-50 KW - ❑ 50 + KW' Meter 0 u to 100 amps Meter ❑over 100 amps ` Sub Panel Motors El 0-1 IIP Ell 1/2 - B Inc.Solar 09.15 HP 1:116-15+ Microwave Pole Light Range Standing Sections 5-15 KW Trash Compactor I, as owner ofthe property or my employees with wages as their soie MECHANICAL FEES Reinspection Fee S25 Issue Fee compensation will do the work, end the structure Is not intended or offered for sale (Sac{ion 7044, Business and Professional Code: The Contractor's SU MARY Q FEES The Contractor's LAW does not apply an owner of property who builds or Improves thereon, and who contracts for such projects with a con- PUBLIC SERVICES REOUIREMENTS: Exhaust System ❑ Multiple El System Repair/Alteration BUILDING PERMIT License Law does not apply to an owner of a property who bullds or improves SMIP Boiler Hood or Type I ❑ thereon,+and who clogs such work himself/herself or through his or her own $ PERMIT - Canopy Type 11 ❑ ❑ I am exempt under section B. & P. C. for this reason Zoning Approved By ? gmployyaes, provided that such Improvements are not Intended or offered for sale. I}, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- PLUMBING Duct- Under Ground ISSUANCE t $ Date Owner I Building Approved By rove for the purpose of sale) ' I Duct - Structurat Refrigeration�System P.C. $ { Application issued By 39e01 TL. Z Q N I N G R E Q U I R E M E N T FEES NEW ME M■ I, as owner of the property, am exclusively contracting with licensed con- t ors to construct the project (Section 7044, Business and Professions Code: Llcanse to ❑0 100,000 BTU ❑100,DOD BTU Duct - Ventilating _ SU MARY Q FEES The Contractor's LAW does not apply an owner of property who builds or Improves thereon, and who contracts for such projects with a con- Exhaust System ❑ Multiple El System Repair/Alteration BUILDING PERMIT $ SMIP $ s-0 tractor(s) license pursuant to the Contractor's Ucense Law). PLAN CHECK $ PERMIT - ❑ I am exempt under section B. & P. C. for this reason Firepi/Fact. Bit. ICBO -0 ' PLUMBING $ ISSUANCE t $ Date Owner I Heating System & DuctingENERGY PLAN CHECK 2596 $ P.C. $ { f harab cert) y that -I have read(It s application and state that the above I ith II I t dlnances ❑0.100,000,BTU'❑100,00013T ELECTRICAL !$ GRADING. _ ;$ p' Informa ton s correct, I agree to c plyy w a c ty. and coup y or and state laws relatlrlg to building construction, and hereby authorize repre- santatives�gns.e is city enter upon the above-mentioned property .for Inspectionses. Signature Date Drivers' or SS 9jt Reinspection Fee CMF 0865-46 rev. 12/83 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE �$ $25 Issue Fee $ 3 PLAN CHECK 2596 $ f t CONSTRUCTION AND PLANNINGPOO LAPPROVALS Permit # bate Inspector L - SPA c APPROVALS Permit #' y Date r' u C7 inspector 1', Tc-nporary Electrical Service or Pole 52: Pool &'Equipment Location _ 2.• Soil Pipe-Undrgrnd. 53. Steel Reinforcement' v 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55:' Electrical Bonding 5: Steel Reinforcement 56. Rough Plumbing & Pressure Tesi 6. Electrical UFER Grnd.-- - 57.. APPROVAL TO COVER-GUNITIt 7. Footings 58. ElectricaFConduit-Undrgrnd.' - r 8. Foundation 59. Gas Pipe, ❑ Undrgrnd:, Test _ 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. , 10. Structural Floor System 61. APPROVAL TO'DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Finat 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 `- T , 16. 'Rough Electric Wiring 67. Fencing &Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 19. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 211. Ducts, in Structure 70. Underground Hydra 22. Ducts, Ventilating 71. Product Piping ❑ Gas - ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush x , 24• Roof Framing 73. Undergrnd. Storage Tank ❑ Gas '❑ Oil -' 25. Roof Sheathing 74. Overhead Hydro t 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical A r w 27. Frame and Flashing 76. Dry Standpipe f 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. F I NA L I NSPECT ION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heatiing & Air Conditioning t ' 35. Final Gas Pipe -Test a s- z 36. Hood- 6r Canopy ' 37. Finai'Factory Fireplace :r M , - 38. Final Plumbing i. I 39. Water, Service -Final ' 40. Gas Service -Final r 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 • - s 50. Gas Release to Southern California Gas Co r s 51. CERTIFICATE OF OCCUPANCY No. Date _ - _ { - - a-•" ''r ; _ _ •_ Applicant to fill in all ipac._tiKeept those within eavy border lines and sign all appropriate declarations. PER IT'NO. J (� L_ IJ TRACT NO. LOT NO. UNI( Nd. : . �^ T7T,i� T^/E�&/�� bF COST A�Cr�5 CONSTRUCTION PERMIT ' •- Pro)ect Address �7 YX f �� A� I '"1 J _ �I G,G • TYPE OF CONSTRUCTION; - NEW ADD ALTERATION REPAIR . 7 Applicants Mailing Agdress� ;� - - I Vy�/Mr ❑ CONVERSION ❑,DEMOLISH r ❑ OTHE A. P•# _ - 1 Zone. ' Owner's Name _ Phone DESCRIPTION PF WORKIUS OF BLDG. Q�'G 1 Address '" -r'QC `f N g f A. S Main Building: - _Accessory Building:, i- Arch/Eng. r License No.' ,�s 1 TYPE OF P RMIT G7RADIfVG~ ^FOUNDATION STRUCTURAL' T Front J n O - ❑ TENANT -❑ ELECT R` CA PLUMBING ❑ MECHANICAL Rear a N Address. Name �d Cie- ie Tv! f :❑ A �� N Right �; Contractor's _ .yL✓.Li�� Pho �^1 PROJECT DESCRIPTION' Sri. FT. l - OCCUPANCY C G Addr!ss'(mailing)'d'fF�2 - CONSTRUCTION TYPE VALUATION $ S � $ Left City`LicenseNo. v ZONE G RADI - - NG CU. YOS, •ACRES , Ping, Ref. # Parking Req.IProvided _ R" ' LICENSED CONTRACTOR DECLARATION - , Q Q { s (.hereby, affirm that -1 am.lice sed under` rovisions of Charter 9 commencing p ' Remarks: , ; �� - Planning Notes: - M with section 7000} of Division 3 ofnusinessand Professions Code, and • my license'is in ful ce and effect. ( l ! I S `L•i•Cense CI ss ' LlCense l I + Date Signature PLUMBING FEES I WORKERS' COMPENSATION DECATION gar SinkShowers i ELECTRICAL FEES 1 I herebylaffirm that 1 have a certificate of consent to sell -insure or a certificate , -,f Workers' Compensation Insurance,' or a certified copy thereof (Section -Lab: --- Backflow Preventer_ Service Sink - Automatic Washer — t a — ❑ 15 SO KW }800, C.)- i ''^ 1Transformer ❑ ' Policy No, Company Backflow Irrigation Sewer Cap Construction Pole Sub. 50 } KW - Certified copy is hereby furnished. - HCertified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter El up to 100 amps. Date, —A pplicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher ;Meter El Over 100 amps' . (This section need not be completed if mit is for one hundred ($100) or less). " Dishwasher Solar Piping , Dryers ❑Gas ❑Electric Sub Panel is Issued, I I certify that In the p@rformance of he w rk or which this p mLe shall not employ any person in an nor o as too -b s to ,the Worker ' p t' Laws pf Cal ia. Drinking Fountains Solar lank ; Fan Motors ❑0-1 HP ❑1 + x ..Date Signature Floor Drains Swimming Pool vvlSpa F,A,U. Inc. Solar.❑9.15 HP,-C�16-15} NOTICE: If, ter making this tleclara ion, you shoultl b came subje to the - workers' Compensation provisions of the Labor Cod you must forthwith ' Floor Sinks Urinal _ Fixtures comply with such provisions or this permit she be deemed revoked. _ CONSTRUCTION LANDING AGENCY Gas Service Outlets Water Closet - Device Boxes - , 'Pole Light •i Il �, "5 I hereby affirm that there is a construction lending a en Cy for the performance ,, of the 'work for which this permit is. Issued lSectlon 3097 Civ. C.) 1 Interceptors p Water Heater Outlets_ .Range - -- Lender's Name Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto -Wash - Garbo9 a Dis oral . p r, ;$eetiony' t 1 Standing ' following reason (Section 7031.5 Business and Professional Code: Any city or _ _..w �Ccm county which requires a permit to construct, alter, improve, demolish or repair P—Trap LaundryTrays'Trash` y ,• Generator ❑Q5 KW ❑5-15 KW - ctor any structure, prior to its issuance, also requires the applicant for such permit . to file a signed stateMenl•that he'/she Is licensed pursuant to the provisions of Roof Drains ; r the Contractor's Llcerlse 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 - '� - L •,y 7031.5 by' any applicant for a permit subjects the applicant to a civil - • penalty of not more than five hundred dollars ($500). as their sole Reinspection Fee $15 Issue Fee $ 3Trl � '� '�-_•� ' ;_J I, as owner of the property or my'employees with wages compensation, will aq the work, and the structure Is not intended or offered Reinspection Fee $15'1 Issue Fee I - $ 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 dges such work himself/herself or through his or her own 1 Hood or Type I ❑ - DEVELOPMENT SERVICES REQUIREMENTS- ` ++ ~J employees, provided that such'.improvements are not Intended or offered for 'or Boiler ❑ Zoning Approved By -'"'' Date •'-• sale, If, (however, the building improvement Is sold within one year of com- pletion,:the owner will, have; the burden of proving he/she did not build or im- Duct - Under Ground8�ildjng Canopy Type II ' a Approved By +� 1 ^""� ! rove for the'purpose of sale}, ; E1, Iarowner of the property, am exclusively contracting with licensed con- E Duct - Structural 1 Refrigeration System _ Application Issued By ' �. • F Date tractors to construct the project(Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who ; Duct - Ventilating ; ❑0-100,000 BTU ❑ 100,000 BTU ' • - - _-__ _, _,.._. SUMMARY OF FEES - builds or. Improves. thereon, and who contracts for such -projects with a con- -to l BUILDING PERMIT = $'' traCtor(s) 11cense pursuant the Contractor's License Law). I am aware that Exhaust System ❑ Multi pie ❑l System RepairlAlterativn - $ �n ',$MIP r proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT '. ❑tl'am exempt under Section B. & P. C. for this reason Firep1lFact. Bit. iCBO # f Fire Dampers r PLUMBING g • - 'ISSUANCE �$ ` Date Owner Heating System &Ducting Registers i _ PLAN CHECK o ENERGY P.0 $' l 25,6 $ , _ 1 hereby-cer that !-have read this.application and state that theabove1. ❑0-100,000 BT.U.❑100,000 BT r — _ - - - _ - --. _ I`" r - - T ELECTRICAL _ 'i , '�` '+•• $ + 7 '+ ••GRADING., $• - r•' �f�• informati s c reef. I agree to comply with all city and county ordinances and stat laws ildin c nstruction, and hereby authorize repre- ! r PLAN CHECK. • r 50°6" $ '! 1 "�MICROF(LM' $sentative �inspectio me on the above-mentioned property for PI l , Date �' '� A�o s MECHANICAL 1 I Vj{J1 i Signat 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 Ida CONSTRUCTION AND PLANNING = Date APPROVALS Permit # Ternporary Electrical Service or P6.19, Inspector / POOL & SPA APPROVALS Permit # 52. Pool & Equipment Location Date Inspector - r 2. Soil Pipe-Undrgrnd. 3. Electrical Conduii Utility'Uncl4rnd. l( 53. Steel Reinforcement 54. Forms ,4.Ele&trical ConduitAndrgrnd. 55. Electrical Bonding �Aee i�nforcenient J71'99 56. Rough Plumbing-& Pressure Test r 6; Ele'trioaI UFER'Grnd. 57. APPROVAL TO COVER GUNITE o$ins r fsr " 58. Electrical Conduit-Undrgrnd. B., Foundation `f ` - Ir �W r 59. Gas Pipe ❑ Undr nd., Test g 97Mer, Pipe-Undegr 60. Backwash-Lines,'P-Trap,'I] Undrgrnd. 10f $tructyral Floor System 61. APPROVAL TO DECK 11,.M)perty Sewer Line & House Connection i A l " 62. Backwash & Receptor -Final ell 2:rSewer Cep _ 63. Heater & Vent -Final 13 Rib' of Drains ','! �i. r 64. Plumbing System - Final ' 14.'RQ ugh Plumbing �' . j r �. `� 65. Electrical f=inal ' 15'-Rdugh ElectricaPConduit -66. Solar System -Final '16. Rough Electri firing 67. Fencing'& Access Approval - 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18.. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 2,1. Ducts, in Structure. 70. Underground Hydro 22, Ducts; Ventilating 71. Product Piping ❑ Gas ❑ Oil 23.`Gas Pip, Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergmd. Storage Tank ❑ Gas ❑ Oil 25. Roof Stoathing 74. Overhead Hydro 26. T Bar Ceiling (Structural) &. Monocoat 75. Dry Chem`ic81 27. Brame and Flashing 76. Dry Standpipe . 28. Lathing & Siding 77. 'FIXED SYSTEM FINAL 29, lnsulation 78. FIRE PREV, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:Z1W 44 -to & r7c - 34. Final Heating,& Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy i �7i$DLJ�¢fL ��/DLJ piG 37. Final Factory Fireplace(,✓/gL SV�j�/ lc�� 38. Final Plumbing V�rwT Cr,L 677 -Ft- Oy[ rO OWpctr- 111re-1 39. Water Service -Final 8 40. Gas Service -Final 41. Solar Domestic -Final _ r' 42. Backflow Preventer 43. Backflow Irrigation 44. ,Landscape Irrigation System , Agaldej 45. Sound Attenuation 46, Handicap Regulations OQ 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 _ C' nE5_ ?c r Moc/'g' I Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 9;iiJ� ,j/ ��/ 3jJ - �Oo nu I L CITY OF COSTA MESA CONSTR�CTIION PER��rT ` ^ ' 9C�MIT NO TI�ncT tun I nT Nn uniiT n Y, Project,ACtidress 7'�� W / 7 V T` 1 dd C" Applicant's Mailing Address.n V L .J L, Owner's Name �'e tl tZ Y� r W Phone ' Address .._- Arch/Eng. License No. Address �+ Contractor's Namp.� / A+ t'^ dc's P C'�P Phone 7 -7 7"2-7 Address (mailing)% i LAJ� Y001161 /_ City License No. 7 _T_ LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of ,the Business and Professions Code, and my license is in full force antl effect. -7 License Class 0' " License No„3 O Z 24 [ Date Z'^ i 4r ^ 8 -5 -Signature WORKERS' COMPENSATION DEWLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) - n Policy No. Company BCertified copy is hereby furnished. �. Certified copy is filed with the city Building Division, �. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit.is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manners 0'as to become subject to the, Workers' Compensa on Laws of Calif�r�a Date 9 r�/ Signature ��J - _ NOTICE: If, after making this dec,.rat�n, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name, Lentler's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section'7031.5 Business and Professional'Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requireg the applicant for such permit to file a signed statement that he/she is licenseq pursuant to the provisions of 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 renalty of not more than five hundred dollars ($500). ' LJ I, as owner of the. property or my' employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section .7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove far the purpose of sale), - ❑ 1, as owner of the property, am exclusively contracting with licensed con- tracturstd construct the project (Section 7044, Nosiness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds.or improves thereon,,and who contracts for such projects with a con- tractors) 11cense pursuant 'to the Contractor's License Law). I am aware that ' proof of their Worker's Compensation insurance should be provided to me. ❑ i am exempt under Section 0. & P. C. for this reason Date Owner Y I hereby certify that I' have read this application and state that the above information is correct. I agree to comply with hil City and county ordinances and state laws relali P9 to building construction, and hereby authorize repre- sentatives of this i to enter upon the a4ave-mentioned property for inspection p3Vose �J 1 f Signature Date Z �t Drivers' Licbfise or SS :P -/ Ell rp-S TYPE OF CONSTRUCTION LJ NEW LJ ADD Ll ALTERATION LI REPAIR ❑ CONVERSION` ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. Reinspection Fee $15 1 1 Issue Fee ' S Main Building: TYPE OF PERMIT GRADING ❑ FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B ❑ LOTHER A Rear SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE • $L� C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ 5 Left ZONE GRADING CU.YDS. ACRES Ping, Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen'Sink; I Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler- Duct--,Under ailerDuct"-.Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBG # Heating System & Ducting ❑ 0.11 00,000 BTU ❑ 100,000 BT Reinspection Fee ! $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto.Wesh Laundry Trays Issue Fee MECHANICAL Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑x100,000 BTu ❑1oo,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automatic Washer Construction Pole,Sub, Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan r F.A.U. Fixtures Device Boxes Zone Accessory Building: Z O N I N G R Parking Req./Provided E Q M T S ELECTRICAL FEES Outlets Switches Garbage Disposal Generator ❑0.5 KW ❑5-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter Clover 100 amps Sub Panel Motors 1:10.1 HP 0114 - 8 Inc.Solar ❑9-15 HP ❑16-15+ Microwave Pale Light Range Sign Standing Sections Trash Compactor $ 3 I � Reinspection Fee $15 1 1 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved Byte Application Application Issued By / Date Dat 3 gs BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ r $ %r< $ $ $ $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE • $L� $ 3 Jam•.. t ✓1�• �- .. CONSTRUCTION AND PLANNING ArPROVALS Permit # r Date -Inspector POOL & SPA APPROVALS Permit # Date ' In'spettor 1" Temporary Electrical Service or Pole :52. Pool & Equipment Location ; 2. Soil Pipe-Undrgrnd. - 53: Steel'Reinforcement :_3 Electrical Conduit' Utility-Undrgrnd.- X54. Forms 4. Electrical Conduit-Undrgrnd. .55. Electrical Bonding -5. Steel Reinforcement 56. Rough Plumbing-& Pressure Test , 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. " 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe=Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. .10. Structural Floor System 61: APPROVAL TO DECK 11. Property Sewer Gine & House Connection 62.- Backwash & Receptor -Final . 12, Sewer Cap 63, Heater & .Vent -Final ,13, Roof Drains 64. Plumbing System - Final 14, Rough Plumbing �l �� 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 _f9. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # { 20, Rough Factory Fireplace 21. Ducts, -.in Structure 70. Underground Hydro .22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank El 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 r Notes: 34, Final Heating& Air Conditioning 6/lliS-f� 35. Final Gas Pipe -Test` 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final j_s 67 L 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventerj-$ =y 7 43. Backflow Irrigation 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations - _ , ' i 47. FINAL STRUCTURE & BUILDING ' 48. Special Reqdirements Completed 49. Electric Release to Edison 50, Gas Release to Southern California Gas CO I I 51. CERTIFICATE OF OCCUPANCY No. .Date' r Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. �� PERMIT NO. TRACT NO. LOT NO. O. UN4REPAI DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Pl�Date Gl"�125 Date Date E , � , TYPE OF CONSTRUCTION NEW ADD ALTERATION R SUMMARY OF S $ $ $ S L+ -Co S $ $ FEES SMTP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ rJr� ❑ ❑ ❑ — CONVERSION DEMOLISH OTHER A.P. 90 — DESCRIPTION OF WORKIUSE OF BLDG. S Main Buildi E TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL - T Front ❑ TENANT ❑ ELECTRICAL- ❑ PLUMBING ❑ MECHANICAL B [:],OTHER A Hear Right %6 PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATION 5 S •Left. ZONE GRADING CU. YOS. ACRES Ping. Ref. Remarks: Planning Notes: CITY OF COSTA MESA CON_STR UCTION PERMIT Project Address '7/t Ai 1 7 r N f - C�t-L ! ESA Applicant's Mailing Address Owner's Name !�� %� 7"� �'�-M� ^j ' Phone Address Arch/Eng. License No. Address _ Contractor's NameMOI' ArS Phone -977"6& Address (mailing)I— F '� �-S7 City License No. LICENSFD CONTRACTOR O£CLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Iness and Profes ' ns Code, and my license is In full force and effe , License Class — Licens jVo.- Date%!£�- - Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab. C.) _ G rolicy Not)" ..i/0y-7 �n mpa eCertified copy is hereby furnishetl. Certi(ie� pyi fled with the city u' islon. Date (� ifs Applicant EXEMPTION FROM WORKERS' COMPENSATION CLARATION (This section need not be completed if the permit I$ for One hundred ($100) or fess). I certify that in the performance of the work for which this permit Is Issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to tho Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C,) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License law for the following reason (Section 7031.5 Business and Professional Code: Any city Or county which requires a permit to construct, after improve, demolish or repair any structure; prior to Its issuance, also requires tie applicant for Such permit 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 Division 3 of the Business and Professions Coda) or that he/she is oxempt therefrom and the basis for the alleged exemption. Any violation of Section ,j 031.5 by any applicant for a pormit subjects the applicant to a civil .. wnalty of not more than five hundred dollars ($500). ?`_,� I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Codo: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively Contracting with licensed con- 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 builds or improves thereon, and _who Contracts for such projects with a con- tractor(s) license pursuark'to the Contractor's License Law), I am award that proof o, their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify tha I have rea this Ilcation and state that the above Information is or c . agree to compl ith all city and county ordinances and state la. s r ting o buildi g con r ction, and hereby authorize repro- sentatives f th s. city to ento upo a above-mentioned property for Inspection rpo s. Signature Datej'"u� Drivers' License or SS 0 Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets interceptors Kitchen Sink Lavatories P—Trap , Roof Drains Reinspection Fee Boiler Duct -'Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting E30-1 00,000 BTU ❑ 100,000 BT Reinspection Fee I $15 CMF 0865-46, rev. 10184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash - Laundry Trays Issue Fee S 3 MECHANICAL FEES Hood or Type I ❑ Canopy Type 11 ❑ i Refrigeration System ❑0.100,000 BTU 0100,000BTU System RepairlA Iteration Fire Dampers Registers Issue Fee I $ 3 5832 1 6/85 4o50 TL' Zone Accessory Building: Z O N I N G R Parking RecidProvided E D M T S ELECTRICAL Automatic Washer Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures ' Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 05-15 KW Transformer ❑ 15-50 KW ❑ 50 + KW Meter Llup to 100 amps Meter ❑aver 100 amps Sub Panel MotarsjliM1 HP 01%-8 Inc. Solar ❑9.15 HP ❑16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES y Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Pl�Date Date Date E , BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF S $ $ $ S L+ -Co S $ $ FEES SMTP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ rJr� — — 'CONSTRUCTION AND PLANNING APPROVALS Permit # =. Date n inspector POOL, 'A APPROVALS Permit # Date Insp?crc>r -1, Temporary Electrical Service or Pole /+ 52. Pool & Equipment Location 2. Soils Pipe- Undrgrn i ; 53. Steel Reinforcement 3r Electrical Conduit Utility-Undrgrnd, 54. Forms 4f Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5."Steel.Reinforcement. ' 56. Rough Plumbing & Pressure Test 6. Electrical UFER,Gend. 57. APPROVAL TO COVER-GUNITE 7.Footings i 58. Electrical Conduit-Undrgrnd. 1 BFoundation i 59. Gas Pipe, ❑ Undrgrnd., Test 9.,Wate"r Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10;Structural Floor System '' 61. APPROVAL TO DECK 11: `Property Sewer Line,& House Connection } 62. Backwash & Receptor -Final 12.,Sewer Cap v 63. Heater & Vent -Final 13.'Roof Drains ., � G� 64. Plumbing,System -Final r 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 APPROVALS Permit # 20. Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydro .22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 30.1 Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32, Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric /�1. [t L Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36, Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow irrigation 44. Landscape Irrigation System ti 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 Nio. Date -- I Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT _ PERMIT No. TRACT No. LOT NO. UN O.` $ Project Address 711 w- 17th St, Bldg, (C) Unit I Date / 1,q 1 R4 Signatu FZ 14. PLUMBING Bar Sink 1- $ Applicant's Mailing Address 1311OSatiCOy St. N.HollyWO.Od, TYPE OF CONSTRUCTION NEW ADD ALTERATIQN REPAIR 1-1CONVERSION❑ DEMOLISH ❑ OTHER T Workers' Compensation Insurance, or a certified copy thereof (Section s00, Lab.'C_k9824 Lumberinans rolicy No. Company B Certified copy is hereby furnished. is filed with the city Buil 'ny ivision� )� Date— 44JJ Applicant t1l Dat EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Backflow irrigation Owner's NomeTrny-"Tn e, tment Fund Phone 549-2488 DESCRIPTION OF WORK/USE OF BLDG. A.P. # Dishwasher Drinking Fountains Address h Ca. Floor Drains' S Main Building: Arch/Eng. _Marj,13 J. RDCk License No., TYPE OF PERMIT ❑GRADING FOUNDATION ❑ STRUCTURAL �- T Front CONSTRUCTION' LENDING AGENCYGas 1-1 TENANT ❑ ELECTRICAL '0PLUMBING ®MECHANICAL Interceptors _ Kitchen Sink Address 12RRI knott gyp glli t -e %1H ❑'OTHER A Hear Contractor'sNamdl„nn Air Cnnriitinnin Phone 982-1216 g -Reinspection 'Fee C Right Address'(mailing) 1_1 WO G'at•�i— St; i99d,Ca. PROJECT DESCRIPTION SQ. FT. OCCUPANCY K 3339 _N,HC`11Y 25 CONSTRUCTION TYPE VALUATION $ $ Left City'License Na. ZONE GRADING CU. YDS. ACRES Ping. Ref. # LICENSED CONTRACTOR NN DECLARATION - I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: .Outlets, thereon, and who does suc w g employees, provided that such improvements are not intended or offered'for sale. If,however, the building or improvement is'sold within one year of com- pletion, the owner will have the burden of proving he/She did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 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 proof o their Worker's Compensation insurance should be provided to me. with section 7000) of Division 3 Q1 the Business a Profession$ Code, and Boiler BUILDING PERMIT my license is in full fprcVe and eft 346251 License Class [i e No $ Duct - Structural $ PERMIT Date / 1,q 1 R4 Signatu FZ 14. PLUMBING Bar Sink 1- $ WORKERS' COMPENSATION D LARATION , I hereby affirm that I have a cert tate of consent to self -insure or a certificate Backflow Preventer C N MCertifillcn T Workers' Compensation Insurance, or a certified copy thereof (Section s00, Lab.'C_k9824 Lumberinans rolicy No. Company B Certified copy is hereby furnished. is filed with the city Buil 'ny ivision� )� Date— 44JJ Applicant t1l Dat EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Backflow irrigation Bathtubs Clarifiers - Heating System & Ducting ❑0.100,000 BTU El 100,000 BIT {This section need not be completed if the permit is for one hundred ($100) or - less). I certify that in the performance of the work fortwhich this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Dishwasher Drinking Fountains $ .15.50 Workers' Compensation Laws of California. Floor Drains' Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks comply with such provisions or this permit shall be l deemed revoked. Service - CONSTRUCTION' LENDING AGENCYGas 1 hereby affirm that there is a constructioniending agency for the performance of the work for which this permit is issued (Section 3097 Civ- C.) Lender's Name- r Interceptors _ Kitchen Sink Lender's.Acidress OWNER BUILDER DECLARATION ` I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Divisions 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 131.5 by any applicant for a permit subjects the applicant to a civil laity of not more than five hundred dollars ($500). .-1 I, as• owner of the property or my'employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves h ork himself/herself or throw h his or her own Lavatories P -Trap - Roof Drains -Reinspection 'Fee - - .Outlets, thereon, and who does suc w g employees, provided that such improvements are not intended or offered'for sale. If,however, the building or improvement is'sold within one year of com- pletion, the owner will have the burden of proving he/She did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 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 proof o their Worker's Compensation insurance should be provided to me. SUMMARY OF FEES Boiler BUILDING PERMIT Duct -Under Ground ' $ Duct - Structural $ PERMIT Duct - Ventilating - PLUMBING Exhaust System El Multiple El $ _ Firepl/Fact. Bit. ICBO # ❑ I'am exempt under Section B. & P. C. for this reason t ELECTRICAL $ GRADING Dat'e Owner I I hereby certify that 1, have read_this application and state that the above I - Heating System & Ducting ❑0.100,000 BTU El 100,000 BIT Showers Service Sink . Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal ' Water Closet Water Heater Water Service 'Auto -Wash Laundry Trays Issue Fee ' Hood or Type 1 ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTU 1_11100,00013T System Repair/Alteration Fire Dampers Registers information is correct. l agree t amply with all city and county ordinances , Ind 'State la lating to bui , construction, and hereby authorize repre- sentatives f t is city,t t upon the above-mentioned rty or inspectio put p ses. 4 'i Signature Date 1 ' Drivers' Lic se or ss Reinspection Fee $15 Issue Fee CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor FEES $ 3 Automatic Washer r ' Construction Pole'Sub. r. Cooking Unit Dishwasher ,, Dryers ❑Gas []Electric Fan F.A.U. Fixtures Device Boxes '• Outlets Switches Garbage Disposal Generator ❑0-5 KW 05-15 K 1759 x/24/55 15f►5a �L t ' Zone Accessory Building:.,, Z 0 N I G R Parking Req./Provided E Q - - M S ELECTRICAL Transformer ❑ '15-50 KW El 60 + KW Meter El up to 100 amps Meter El over 100 amps Sub Panel Motors El0-1HP Ell % - 8 Inc.Solar ❑9-15 HP El 16-15+ Microwave !' Pole Light Range Sign Standing Sections - W Trash Compactor Reinspection Fee $15 Issue Fee, DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By M■ M■ M■ M■ M■ �W psi SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING ' $ PLAN CHECK 500% $ MICROFILM $ MECHANICAL $ 13 QA TOTAL FEE $ .15.50 PLAN CHECK 25% $ ?, O , CONSTRUCTION AND PLANNING APPROVALS = Permit # Date Inspector POOL PA APPROVALS Permit # Date 'Inspector a,1. Temporary Electrical Service or Pale 52. Pool & Equipment Location 4 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms - }_ 4. Electrical Conduit Undrgrnd._ 55. Electrical Bonding 5. Steel Reinforcement i 56. Rough Plumbing & Pressure Test f a 6• Electrical UFFR Grnd. / 57. APPROVAL TO COVER-GUNITE A: 7. Footings 58. Electrical Conduif-Undrgrnd. i. 8: Foundation %'; 59.• Gas Pipe, ❑ Undrgrnd., Test ,•• ' 9. Water Pipe-Undrgrnd. s; 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System ` .. 61. APPROVAL TO DECK .11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final .12, Sewer Cap 63. Heater &•Vent -Final 13. Roof Drains 64. Plumbing System - Final �j 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test c 72. Underground Flush 24, Roof Framing 73. Undergrnd. Stdrage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydra 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27, Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77, FIXED SYSTEM FINAL ' 29. Insulation - 78. FIRE PREV, FINAL 30.. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED » 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final - 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING' 48. Special Requirements Completed 49. Electric Release to Ediion 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. P RMIT NO. TRACT NO. LOT NO. • UNIT NtS. � CITY OF COSTA MESA CONSTRU ON PERMIT Project Address Applica"Cs Mailing Address J '-� �(� - r^ • � Ownsr'�Name � V "+` Phone $15 Issue Fee Accessary Building: $ 3 DEVELOP NT SERVICES REQUIREMENTS:' TYPE OF CONSTRUCTION- NEW ADD ALTERATION REPAIR �CONVERSiON ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. Address O Zoni pproved By _ IN - INI Arch/Eng. - —License No. Address TYPE OF PERMIT GRADING ' FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL i�J PLUMBING ❑ MECHANICAL ❑ -OTHER - PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES Contractor's Name i M DM 'J! Phone 777 27if� Address (mailing) �� S-/ %j�'% -'� "� j/0,C84 I rr��I1 el City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that i am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. License Class License No. 3 n 2 2 0 7 late X" O, `/ � --- Signature r Remarks: Parking Req./Provided I E Application Issued By Q PLUMBING FEES { WORKERS' COMPENSATION DEC ARATION hereby affirm that I have a certificate of consent to self -insure or a certificate J� Bar Sink Showers00I I Backflow Preventer Service Sink -. �' c) of Workers' Compensation Insurance, or a. certified copy thereof (Section 3800, Lab. C.) Backflow Irrigation Bathtubs Sewer Cep Sewer Connection ,Policy No. Company eCertified copy is hereby furnished. Certified copy Is filed with the city Building Division, r Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION •• (This section need no be completed if the permit Is for one hundred (S100) or less). l r I certify that in the performance of the work f r which this permit is Issued I shall not .employ any person In any manger o as to become subject to the Glorifiers Solar Collectors ' - - Dishwasher - Solar Piping Drinking Fountains Solar Tank Workers' Compensation! aws of Calif ia• r Date ? i�Si- Signature 'NOTICE: if, after making this deClar on, you Should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY . I hereby affirm lhat•there is a construction lending agency for the performance of the work for which this permit i5 Issued (Section 3097 Civ. C.) Lender's 'Name i Lender's Address Floor Drains Swimming Pool w/Spa - Floor Sinks Urinal i2 Gas Service 1 Z Outtats . I ^ Water'Closet - q dU Interceptors Water -Heater] Z �G c� pU Kitchen Sink Water Service %'Z, 01OCA OWNER BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason {Section 7031.5 Buslnes5 and Professional Code: Any city or county wt%lch'require% a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (e.ommencing with Section 7000) of Division 3 of. the Business and Professions Code) or that he/she is,exempt therefrom and the basis for the alleged eXemption_. Any violation of -Section 7031.5 by any applicant for a permit subjects the applicant to a• civil penalty of not more than five hundred dollars ($500). _ r�'❑ I, as owner of the property or my employees with wages as their sole a.;'. impensation, will do the work, and'[he structure is not Intended or offered 5r sale (Section 7044, Business and Professional Code: The Contractor's ' 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvernent is sold within one year of com- pietion, the owner will have the burden of Proving he/she did not build or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and _who contracts for such projects with a con- tractor(s) llcense pursuant -to the Contractor's License Law), I am aware that proof of their Worker's Compensation losurance should be provided to me. , Zd.� Lavatories Auto -Wash (� P -Trap Laundry Trays Roof Drains ' - - Reinspection Fee - , $15 Issue Fee $'3 9� MECHANICAL .FE S `�• = ��- ��,• Boiler Hoo Type I ❑` nopy Type I �� Duct,- Under Ground ' MECHANICAL Duct - Structural Refrigeratio Sem , Duct - Ventilating ❑0 100,000 BTU ❑100,000 BTU TOTAL FEE Exhaust System ❑ Multiple System Repair/Altera ' Firepl/Fact. Bit. ICBO # Firo ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify_ that I have read this application and Stale that the above information is correct. I agree to comply with all city and county Ordinances and state laws relating to building constructlon, and hereby authorize repre- 5entatives of this C3 y to enter upon the above-mentioned property for Inspection pur Ose LY - Signature + t Date � -' ti Drivers' Lic rise or SS gj Heating System & Ducting Registers 00-100,000 BTU 0100,000 BT . Reinspection Fee , $15 Issue Fee $ 3 CMF 0865-46, rev. 10184 White - Building; Canary = Applicant; Pink - Accounting; Goidenrod - Assessor A.P. 9P S Main -Building: E T Front B Rear A C R ight K $ Left Ping. Ref. # Planning Nates: Automatic Washer Construction Pole Sub.. Cooking Unit Dishwasher Dryers ©Gas ❑Electric Fan F.A.U. Fixtures Device Boxes :Outlets Switches KW❑06K 7654 2/15/85 �I Zone W $15 Issue Fee Accessary Building: $ 3 DEVELOP NT SERVICES REQUIREMENTS:' Z O Zoni pproved By _ IN - INI ilding Approved By I 1 R Parking Req./Provided I E Application Issued By Q M SUMMARY OF FEES - S ELECTRICAL FEES Transformer El 15-50 KW- SMIP ❑ 50+KW Meter ❑up to 100 amps $ Meter Dover 100amps Sub Panel PLUMBING Motors 00-11 HP Ell % - 8 ISSUANCE Inc.Solair 1:19-15 HP El 16-15+ Microwave - - - $ O Pole Light $ Range ELECTRICAL Sign GRADING Standing Sections Trash Compactor $ 7 Reinspection $15 Issue Fee l $ 3 DEVELOP NT SERVICES REQUIREMENTS:' Zoni pproved By _ _.. mate ilding Approved By I Date Application Issued By SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ O ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ r� CONSTP.UCTION AND PLANNING POOL & 5. //� APPROVALS Permit # Date Inspector -,, APPROVALS Permit # Date Inspector 1 "Temporary Electrical Service or Pole 52. Pool & Equipment Location .; 2. $oi Pipe-Undrgrnd. -11 or 53. Steel Reinforcement 3.. Electrical Conduit (Utility-Undrgrnd, i 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5: Steel;Reinforcement - 56. Rough. Plumbing & Pressure Test i r - 6Electrical UFER•Grnd. if 57. APPROVAL TO COVER-GUNITE F 7. Footings 9 fT7 r 58. Electrical Conduit-Undrgrnd. . 8. Foundation i 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd, 10: Structural Floor System 61. APPROVAL TO DECK 11: Property Sewer Line &House Connection 62. Backwash & Receptor Final "12v Sewer Cap , -� i 63. Heater & Vent -Final 1 3''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 r� 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20: Rough Factory Fireplace '� 21. Ducts, in Structure yt j' 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test j; 72. U derground Flush Y 24. Roof Framing ) 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25." Roof Sheathing 74. Overhead Hydro f 26..TBar Ceiling {Structurals & Monocoat 75. Dry Chemical 27. Frame and Flashing rP. 76.rd] �'y,5tandpipe 28. Lathing & Siding 77. 'FIXED SYSTEM FINAL 29. Insulation 78.1rFIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION-, 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE'ISSUED 33. Final Electric Notes:` 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38, Final Plumbing I- 39. Water Service -Final I-5_-67 CA7 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 F49. Electric Release to Edison r `0. Gas Release to Southern California Gas Co 2 CERTIFICATE OF OCCUPANCY Date _ .If -.90 Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF, COSTA � MESA CONSTRUCTION PERMIT ^ E PERMIT NOi � �r TRACT NO. LO7 NO. U IT=p,. Project Address—LI t "17 ?}S� eO�-, 7A � C64 k-1 la Z TYPE OF CONSTRUCTION LJ NEW IJ ADD LJ ALTERATION LJ REPAIR Applicant's Mang Address ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P, # Owner's Name t Phone DESCRIPTION OF WORK/USE OF BLDG. Address S Main Buildi E Arch/Eng. License No. TYPE OF PERMIT GRADING 1:1FOUNDATION STRUCTURAL T Front Address _ _—_ ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear Contractor's Nam • JI• ❑ -OTHER C ' fGG hone �' i •%..da�'�^. C Right Address (mailingv f��S^% :�/�:i �! i i7�/'11s�S11S.l�7 "%Z_%/'{ PROJECT DESCRIPTION SQ. FT, OCCUPANCY K CONSTRUCTION TYPE VALUATION S S Left City License N0. Q ZONE GRADING CU. YDS. ACRES LICENSED CONTRACTOR DECLARATION Ping. Ref. =461 hereby affirm that 1 am licensed under provisions of Chart r 9 (commencing Remarks: Planning Notes: with section 7000) of Division 3 o he mass an � Prof dons Coda, and my license is in full orcq and effe . Llcen Class 49% Lice Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 have a certificate of consent to self-Insuro or a certificate Of Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab. 'ob`C!:) _ ey No. w CSS%Q 27 21.1 8 Certified copy is hereby furnishe CertLfied copy is Filed with the cit B i Division Date—/ �� Applicant EXEMPTION FROM WORKERS' COMPENSATIO DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued I shali not employ any person in any manner so as to become subject to tke Workers' Compensation Laws of California. Date --- Signature 'NOTICE: It, after making this declaration, you should become subject to the Workers' Compens4tion provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter improve, demolish or repair any structure, prior to Its issuance, also requires tfje applicant•for such permit 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 Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the pasts for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). t.1 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds Or improves ttiereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within one year of corn- ' pletion, the owner will have the burden Of proving he/she did not build or im- rOve for the purpose of sale). I, as owner of the property, am exclusively contracting, with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuarit*to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner — I hereby certify that I have read this information is co I agree to comp and state Latin to buik ing con sentatives of I Cit to en er upoj inspection our o s'. Backflow Preventer Signature 11 ication and state that the above wi h all city and county ordinances uct on, and hereby authOrIze repre- th habove-mentioned property for Date 1—/4D-110.-1 5833 1116185 h,50 TL Zone Accessory Building: Z O N - I N G R Parking Req./Provided E Q M T S Reinspection Fee ! $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0-100,000 BTU El 100,000 BT Reinspection Fee Drivers' License r SS CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Issue Fee '$ 3 PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 2596 ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% Cooking Unit Meter ❑up to 100amps Clarifiers Solar Collectors Fire Dampers Dishwasher _ Meter Dover 100 amps_ Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors Pisi HP 0 h - B Floor Drains SwimmingPool /Spa w F.A,U. Inc. Solar ❑9-15 HP El 16-15+ Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories Urinal Water Closet Water Heater Water -Service Auto -Wash Fixtures Device Boxes Outlets Switches Garbage Disposal Microvieve Poie Light Range Sign ; Standing Sections P—Trap Gundry Trays Generator 00.5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee ! $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0-100,000 BTU El 100,000 BT Reinspection Fee Drivers' License r SS CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Issue Fee '$ 3 Reinspection Fee $15 Issue Fee $ 3 iANI CAL FEES Hood or Types ❑ Canopy Type 11 ❑ DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date Data Refrigeration System ❑0-100,000 BTU 0100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 2596 ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ S S $ $_ _ -_'�TU $ $ S SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ 4-Sn System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 ' CONSTRUCTION AND PLANNING APPROVALS Permit # Date inspector POOL.. .,'A , APPROVALS Permit # Date Insprzcrnr *i. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil-Pipe,-Undrgrnd. �a 53. Steel Reinforcement 3 -Electrical ConduitkfFility-Undrgyd, \ 54. Forms 4`. Electrical Conduit'Undrgrnd. 55. Electrical Bonding 5..Steel'Reinforcernent' . r 56. Rough Plumbing & Pressure Test 6.' Electrical UFER•Gr"nd. 57. APPROVAL TO COVER-GUNITE 7, Footings 58. Electrical Conduit-Undrgrnd. 8, Fountlation t. / .1 59. Gas Pipe, ❑ Undrgrnd., Test 9C Water Pipe-Undrgrnd. z 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10' Structural Floor System 61. APPROVAL TO DECK 11 JProperty Sewer Line,& House Connection r 62. Backwash &Receptor -Final 12.,Sewer Cap t-� 63. Heater & Vent -Final 13.E 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL Drywall Nailing HEALTH DEPT. REQUIREMENT 31% Plaster Brown Coat i f 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric�� '� Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40, Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System lit` 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 mQ0 Q0 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. U �T Project Address Applicant's Mailing Address 13 110 S a t i c ri }r Sr N _ Ho 1 1 v17 TYPE OF Ck7NSTRUCTION N� ❑ ADD ALTERATION REPAIR Owner's Name Troy 7n Phone49 5$ ❑CONVERSION r_1 r_1 with section 7000) of bivlsion 3 of the Business and Professions Code, and OTHER my license is in full force and efte BUILDING PERMIT q p PLUMBING FEES DESCRIPTION OF WORK/USE OF BLDG. WORK RS' OMPENSATION D LARATI N 1 hereby affirm that I nave a cepAlicate of consent to self -insure or a certificate of Workers' Compensation Insurance,' or a certified copy thereof IS 1800, Lab. C.) Backflow Preventer Service Sink - Address4321 Birch Std. Neva rt Beach, Ca. 'olicy No, WGQR24 Company BCertified copy is hereby furnished. ' CertiflieQ cO y Is filed with the city Buil 9y {j]VjsiOrh Date z' _Applicant EXEND MPTION FROM WORKERS' COMPESATION EC ARATION Bathtuhs Sewer Connection Clarifiers Solar Collectors (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued I shall not employ any person In any manner so as to become subject to [ate S Main Buiidi �' $ Date Signature Floor Drains Swimming Pool w/Spa -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 ArchlEng. Mgri 1.�.._ICROCLicanse No. TYPE OF PERMIT GRADING FOUNOATION STRUCTURAL I hereby affirm that there is a construction lending agency for the performance T Front 12881 Knott❑ TENANT ❑ ELECTRICAL ❑ PLUMBING Q MECHANICAL OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires A permit to construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for Such permit to file a signed statement that he/she is licensed pursuant to the provisions Of 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 clvll enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sola compensation, will do the work, and the structuro'Is not Intended or offered for sale' (Section 7044 Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sate. 11, however, the building or improvement Is sold within one year of com- pletion. the owner. will have the burden of proving he/she did not build or im- B P—Trap Laundry Trays - Address Cl OTHER Reinspection Fee - ' $15 Issue Fee $ 3 A Rear Contractor's NameDJJ X Air C.Culd- hirininu _Phone 487-1 216 rOve•for the pUrpo50 of sale). 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con - tractor(s) license pursu$rit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance Should be provided to me. Duct - Structural C Right • PROJECT DESCRIPTION SQ. FT. OCCUPANCY — Exhaust System ❑ Multiple El. K System Repair/Alteration Address (mailing) CONSTRUCTION TYPE VALUATION 5 g Left City L+Cense No:9-25 ZONE GRADING CU.YOS. --ACRES— Ping. Ref. N LICENSED CONTRACTOR DECLARATION I hereby affirm that I aril licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: with section 7000) of bivlsion 3 of the Business and Professions Code, and SUMMARY OF FEES my license is in full force and efte BUILDING PERMIT License ClassC-2se No. �L.Fi7 j1 _ DateSignal PLUMBING FEES Bar Sink Showers WORK RS' OMPENSATION D LARATI N 1 hereby affirm that I nave a cepAlicate of consent to self -insure or a certificate of Workers' Compensation Insurance,' or a certified copy thereof IS 1800, Lab. C.) Backflow Preventer Service Sink - Backflow Irrigation Sewer Cap 'olicy No, WGQR24 Company BCertified copy is hereby furnished. ' CertiflieQ cO y Is filed with the city Buil 9y {j]VjsiOrh Date z' _Applicant EXEND MPTION FROM WORKERS' COMPESATION EC ARATION Bathtuhs Sewer Connection Clarifiers Solar Collectors (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued I shall not employ any person In any manner so as to become subject to [ate Dishwasher Solar Piping Drinking Fountains Solar Tank ' Workers' Compensation Laws of California. $ Date Signature Floor Drains Swimming Pool w/Spa -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. . Gas Service Outlets Water Closet - CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Cly. C.) Lender's Name _ -- interceptors Water Heater Kitchen Sink Water Service ' Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires A permit to construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for Such permit to file a signed statement that he/she is licensed pursuant to the provisions Of 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 clvll enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sola compensation, will do the work, and the structuro'Is not Intended or offered for sale' (Section 7044 Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sate. 11, however, the building or improvement Is sold within one year of com- pletion. the owner. will have the burden of proving he/she did not build or im- Lavatories Auto -Wash P—Trap Laundry Trays - Roof Drains ' - - ' Reinspection Fee - ' $15 Issue Fee $ 3 MECHANICAL Boiler FEES Hood or Type 1 ❑ Canopy Type I1 ❑ Duct - Under Ground rOve•for the pUrpo50 of sale). 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con - tractor(s) license pursu$rit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance Should be provided to me. Duct - Structural [ Refrigeration System ❑0.100,000 BTU 0100,000 BTU Duct - Ventilating — Exhaust System ❑ Multiple El. System Repair/Alteration — ❑ 1 am exempt under Section B. & P. C. for this reason Firepl/Fact. Bit. ICBG Fire Dampers Date Owner I herebycertify that �I have rea information is correct. I agree to and state la Eatin�to, sentatives t is ciinspectlo ur ses. Signature Drivers' LI se or SS :),%E Heating System & Ducting 6 Registers this application and State that the above 1 0^100,000 BTU ❑100,000BT 4 imply with all city and county ordinances construction, and hereby author a repre- upon the above-mentioned r erty for Dat Reinspection Fee $15 Issue Fee $ 3 CMF 0865.46, rev. 10/84' White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor f r � - 1760 4/24/85 Zona Accessory Building: Park ing'Req./Provided ELECTRICAL Automatic Washer Construction POIe Sub. Cooking Unit Dishwasher Dryers ❑Gas ©Electric Fan F.A.U. Fixtures — Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW I 15KW1 , Transformer ❑ 15=50 KW ❑ 50+KW Meter Uup to 100 amps Meter Dover 100 amps Sub Panel Motors DO -1 HP❑1h-8 Inc. Solar ❑9-15 HP 1:116.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 16050 , Tl. M M zM■ M M Z O N I N G R E Q M T S I I Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM � S MECHANICAL $ � TOTAL FEE $ __15.50_ PLAN CHECK 25% $� CONSTRUCTION AND PLANNING APPROVALS . Permit # Date Inspector POOL 4 _?A APPROVALS Permit # Date Inspectnr 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 y" 5. Steel Reinforcement i " 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. < 57. APPROVAL TO COVER-GUNITE 4 ''' 7. Footings 1• 58. Electrical Conduit-Undrgrnd. 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P Trap, ❑Undrgrnd, 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final o, 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 �y��- CZD 35. Final Gas Pipe -Test ylt�r� [,,?z 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final i 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 Nn. Date _ Ch-, Q gc' Applicant to fill in ail spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRI� TION PERMIT "19 MIT NO.9J� TRACT NO. LOT NO. UP N15m, Project Address S1 G �" Applicant's Mailin ddress % J ' f Owner's Name , �` -11 ' ry OW—Phone Address Arch/Eng. License No. Address �- Contractor's Nam,. ed Phoneme _7 I Address (mailing)% 8 7 �r �t? V Af_'J -/— 4,1415- VIA - City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and (tett. License Class [cense NO.� O 2- Z O Date- — 1 g Signature WORKERS' COMPENSAECLOSATION I hereby affirm that 1 have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab. C.) policy No. Company ®Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit IS for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, V shall not employ any person in any manners as to become subject to the Workers'- )4ensst yn Laws of Califo Date 'z 33 Signature 'NOTICE: If, after making this declarati , you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provision$ or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lander'$ Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires d permit to construct, alter, improve, demolish or repair any Structure, prior to Its issuance, also requires the applicant for such permit to file a Signed statemeht that he/she is licensed pursuant to the provision$ Of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the BuSihess and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Subjects the applicant to a civil enalty of not more than five hundred dollars ($500). .:] I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure IS not Intended or Offered for Sale (Section 7044, Business and Professional Code: The Contractor's 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 employyees, provided that such Improvements are not Intended or offered for sale. I}, however, the building or Improvement is sold within one year of com- pletlon, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of the Property, am exclusively contracting with licensed con- 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 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 proof o their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason l TYPE OF CONSTRUCTION 0NEw ADO ALTERATION U REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 06 DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi E TYPE OF PERMIT GRADING FOUNDATION D STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CON STRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES- Ping. Ref. 4 Remarks: Planning Notes: 9929 3/25/85 Zone Accessary Building: Parking Req./Provided 25.:0 Z O N I N G R E Q M T S Date Owner I hereby certify that 1 have read this application and State that the above information is correct. I agreeto comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this ci to enter upon the above-mentioned property for inspection p uses. -',l� Signature Date 6 Drivers' Lic se or SS Sit Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting [30.1 00,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting,, Goldenrod - Assessor Issue Fee $ 3 PLUMBING FEES ELECTRICAL FEES Bar Sink Showers r Backflow Preventer Service Sink SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $PERMIT PLUMBING ISSUANCE $ $ �L PLAN CHECK 25% $ .S7_ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ Automatic Washer Construction Pale Sub. Transformer it 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Clarifiers Sewer Connection Solar Collectors Registers - Cooking Unit Dishwasher Meter E) up to 100 amps Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0-1 HP ❑ 1'h - 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9.15 HP ❑16-15+ IGas Floor Sinks Service J Outlets Z Urinal Water Closet Fixtures Device Boxes Outlets Switches Microwave Pole Light Range Sign Interceptors Water Heater �` Kitchen Sink f Water Service OIL J Z Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator 00.5 KW 135.15 KW Trash Compactor Roof Drains Date Owner I hereby certify that 1 have read this application and State that the above information is correct. I agreeto comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this ci to enter upon the above-mentioned property for inspection p uses. -',l� Signature Date 6 Drivers' Lic se or SS Sit Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting [30.1 00,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting,, Goldenrod - Assessor Issue Fee $ 3 Reinspection Fee $15 1 1 Issue Fee $ 3 MECHANICAL FEES Hood or Type I ❑ Canopy Type 11 ❑ DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By I Date Z Refrigeration System 1_10-100,000 BTU 1:11100,000 BTU SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $PERMIT PLUMBING ISSUANCE $ $ �L PLAN CHECK 25% $ .S7_ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 'CONSTRUCTION AND PLANNING 1 ' Date ,' ' APPROVALS Permit # IAspector POOL ,.- ,PA 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 9 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 -9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. y10. Structural Floor System 61. APPROVAL TO DECK ,_11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit - 66. Solar System-Final ••16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 (Votes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test/�/3:f� 36. Hood or Canopy 37. Final Factory Fireplace - 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final ; 42. Backflow Preventer 17 L-00 43, Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations i 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed s 49. Electric Release to Edison rF 50. Gas Release to Southern California Gas Co 51. CERTIFICATE.OF OCCUPANCY No. 'Date V Applicant to fill in all spaces except those within heavy border lines andsign all appropriate declarations. CITY OF COSTA MESA CONSTR CTION PERMIT P AM1T N TRACT NO LOT NO UN NG .Project Address 7( - Wi r/I e :T711 C-3 Applicant's Mallin Address /,P 7s -t LAje w., Owner's Name e s Phone Address Arch/Eng. License No. Address Contractor's Nam 1Phone 711 2-r? Address (mailing► 7 Sr' Al .4 y I- J L A hit'_ U.1+ City License No. Z_ LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing With section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Glass " 6 License No -3 e! 2 2 O'7 pate -0 /` — A Signature WORKERS' COMPENSATION DEULARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section .800, Lab`C.) ,Iolicy No- Company eCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' (This section.need not be completed if the permit Is for one hundred ($100) or less). ; I certify that in the performance of the work for lith this permit is issued, I shall not employ any person in any ma er so s to become subject to the Workers' Com -pen tlo ws of Calif.? Date w Signature NOTICE: If, after making this declairatipb, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License taw for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). J I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for We (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- tractors t6 construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuarit•to'the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information Is correct. I agree to comply with all city and county ordinances' and state laws relatin o building construction, -and hereby authorize repre- sentatives of this cit to enter upon the above-mentioned property for inspect on psupr�es. cl a.— Signature 33// Date?--/!Y--I;- Drivers' ate 2.�� 7- I; - Drivers' Lic&Ae or SS =# TYPE OF CONSTRUCTION NEW LJ Ann LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi E TYPE OF PERMIT GRADING 0 FOUNDATION El STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY— C Bight K' CONSTRUCTION TYPE VALUATION S S Left ZONE GRADING CU. VDS. ACRES Piing. Ref, # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service / Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee I $15 Boiler Duct - Under Ground , Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0.100,000 BTU ❑ 100,000 BT Reinspection Fee I $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Appllcant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type 1 ❑ Canopy Type ii ❑ Refrigeration System 00-100,000BTU 1:1100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES 9930 3/25/85 Zone Accessory Building: Parking Req./Provided - 25. H ELECTRICAL I FEES Automatic Washer Construction Pole Sub, Transformer ❑ 15-50 KW 13 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors 1:10-1 HP Ell % - 8 F.A.U. Inc. Solar El 9-15 HP El 16-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal Standing Sections Generator El 0-5 KW El 5-15 KW Trash Compactor Z O N I N G R E Q M T S $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved ByI Application Issued By / 6 Date Date Dat BUILDING PERMIT PIAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ / s $ $ $ $ SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTAL FEE $ $ $ $ $ $ �2L� $ 3 CONSTRUCTION AND PLANNING Date: APPROVALS Permit # Inspector POOL SPA APPROVALS Permit # Date Inspector I s Temporary Electrical Service or Pale 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd- 53: Steel Reinforcement a. Electrical Conduit Utility-Undrgrnd. , - 54.. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Banding .. + 5' Steel, Reinforcement 56. Rough" Plumbing &Pressure Test "; & Electrical UFER Grnd. y 57. APPROVAL TO COVER-GUNITE 7. Footings . `. 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9' Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, ❑Undrgrnd. Structural Floor System 61. APPROVAL TO DECK ._-1 1. 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. t{ �Y 65. Electrical -Final I 5: Rough Electrical -Conduit f 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydra 22, Ducts, Ventilating 71. Product Piping ❑ 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 Hydra 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28.' Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31'. Plaster Brown Coat 79. FINAL INSPECTION 32. -Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33.• Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy l 37. Final Factory Fireplace 38. Final Plumbing fjc 39. Water Service -Final 40, Gas Service -sinal 41. Solar "Domestic -Final l 42. Backflow Preventer j--97 !Xn 43. Backflow Irrigation 44. .Landscape Irriqation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed ti ' 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co r ' 51. CERTIFICATE OF OCCUPANCY No. Date ' ' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT. Project Address—ILL .% Applicant's Mailing Address Owner's Name&LVy�Lt4 yC-ST-/mr+`!4 Phone Address ArchlEng. License No. Address Contractor's Narn men(i I.$ AZ C do-_Tn IC PhanaEll Address imailinV1 h jCARZAArr=s" L /g W- 'rCs~1 T23i6 City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing wlth section 7000) of Division usiness and Professlo Code, and my license is In full forge and eff t. ` Ucense Cla icense o Date 1 " Signature WORKE=RS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self4nsure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab.. C.)�i .1olicY N.etg'� 5 r 0 C?J .M. ~ Z C Certified copy is hereby furnlshed Certif'ad COpY Is filed with the cit Builtl ision. Date— Applicant J,, A, EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be Completed if the permit Is for one hundred ($100) or less). 1 certify that In the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for, which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve; tlemollsh or repair 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 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 jnalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale. (Section 7044, Business and Professional Code: The Contractor's License taw does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employee$, provided that Such improvements are not Intended or offered for sale. if, however, the building or Improvement is sold within one year of com- pletion , the owner will have the burden Of proving he/she did not build or im- rove efor the purpose of Sale). 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code; The Contractor's License Law doe$ not apply to an owner of property who 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 proof of their Worker's Compensation insurance should be provided to .me. ❑ t am exempt under Section B. & P. C. for this reason i Date Owner I hereby certify that I have read this application and -state that the above - informatrOgJr r agree to c mp with all city antl county ordinances and state Ing t bulldin co S uction, antl hereby authorize repre- sentatives city t enter up r the above-mentloned property for Inspection ,I Signature Date Drivers' License or SS TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR Bar Sink ❑ ❑ ❑ Backflow Preventer Service Sink CONVERSION DEMOLISH OTHER Sewer Cap A.P. DESCRIPTION OF WORK/USE OF BLDG. Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains S Main Building: Swimming Pool w1Spa ' Floor Sinks E Gas Service Outlets TYPE OF PERMIT GRADING 0 FOUNDATION M STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B P—Trap ❑ -OTHER Roof Drains A Rear ENERGY P.C. $ C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K' '$ SO CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. qW Remarks: I Planning Notes: Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ F irepl/Fact. Bit. ICBO =* Heating System & Ducting 00.1 00,000 BTU ❑ 100,000 BT' Reinspection Fee I $15 CMF 0865.46, rev. 10/84 White - Building; Canary - ApPlicant; Pink - Accounting; Goldenrod - Assessor issue Fee J $ 3 FEES Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System 00.100,000 8TU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 5634 1/16/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washef Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW ❑5.15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors 1 HP 011/4. 8 Inc.Solar 09.15 HP ❑16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 6.50 TL FEES Z O N I N G R E Q M T S I I Reinspection Fee 1 $15 1 1 Issue Fee I $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: PLUMBING FEES Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w1Spa ' Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains PLAN CHECK 25% Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ F irepl/Fact. Bit. ICBO =* Heating System & Ducting 00.1 00,000 BTU ❑ 100,000 BT' Reinspection Fee I $15 CMF 0865.46, rev. 10/84 White - Building; Canary - ApPlicant; Pink - Accounting; Goldenrod - Assessor issue Fee J $ 3 FEES Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System 00.100,000 8TU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 5634 1/16/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washef Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW ❑5.15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors 1 HP 011/4. 8 Inc.Solar 09.15 HP ❑16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 6.50 TL FEES Z O N I N G R E Q M T S I I Reinspection Fee 1 $15 1 1 Issue Fee I $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Data �Y SUMMARY OF FEES BUI LDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ 4-00 GRADING $ PLAN CHECK 50% '$ SO MICROFILM $ MECHANICAL $ TOTAL FEE $ 1 PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL _ ,PA APPROVALS Permit # Date Insp9ctor 1. Temporary Electrical Service or Pole .V- r �+ 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd,- ," 53. Steel Reinforcement 3 -'Electrical Conduit Utility-Undr "'d. �� 54. Forms 4'NElectrical 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 +� •` 9.;Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10.hStructurai Floor Syitem 61. APPROVAL TO DECK 11 ;Property Sewer Line & Nouse Connection „ 62. Backwash & Receptor -Final O 12 'Sewer Cap L 63. Heater & Vent -Final � 13. Roof Drains 64. Plumbing System • Final y 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 APPROVALS Permit # 20. Rough Factory Firepiace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating' 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 324 Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric!� /J� C Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System tdr 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 711 W. 17th St. Bldg. (C) Unit 3 Applicant's Mailing Address 13110 Saticoy ST . N.Hollgwo Owner's Name Troy investment Fund Phone 549-2988 Address 4_21 Birch St. Newport Beach, Ca. Arch/Eng. Marin J. Rock License No. Address 12881 -Knott -Aye. Suite 216 Contractor's Name Turn Air Conditioning Phone' 982'1216 Address (mailing) 13110 Saticoy St. N. Hollywood, Ca. City License No, 425 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 oUhe Business and P fesslons Code, and my license is in full force a26etfec 346251 License Glass LU Lir Da41e 4,11$/ 94 Signature WORKERS' COMPENSATION DE RATION I hereby affirm that I have a cerci ate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof_ {Section 1800, Lab. c-�c9824 Lumbermarts ,3olicy No. Company 8 Certified copy Is hereby furnished. CertiT cn Is filed with the city B Iln�gr+rs��ns�on Date _. __ Applicant— EXEMPTION FROM WORKERS' COMPENSATION DECL RATION (Thissection need not be completed if the permit is•for,one hundred ($100) or less), 1 certify that In the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California, , Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY.. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the following reason- (Section 7031.5 Business and Professional Code:, Any city or ' county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, -also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil )enalty of not more than five hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their sole compensation, will do the work, tl the structure Is not intended or offered an for sale (Section 7044. Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner wilt have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of theproperty, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(si license pursuant•to the Contractor's License Law). I am aware that proof off their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above 1 information Is correct. I agree comply with all city and county ordinances and state 1a toting to b ing construction, and hereby author' e r re- sentatives t is city to a er upon the above-mentione pert t inspectias, s. Lj Signature Dat Reinspection Fee , $15 L - Drivers' nse or SS # 4F 0865-46, rev. 10/84 White - Building-, Canary- Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES Bar Sink Showers Backflow Preventer TYPE OF CONSTRUCTION 0 NEW LJ ADD LJ ALTERATION LJ REPAIR Sewer Cap ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Sewer Connection A P # DESCRIPTION OF WORK/USE OF BLDG. Dishy asher Solar Piping _ Solar Tank Floor Drains S Main Building: Urinal - Gas ServiceOutlets E Interceptors TYPE OF PERMIT LJ GRADING 0 FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL B Rear ❑ .OTHER X A Issue Fee $ 3 C Right PROJECT DESCRIPTION Std. FT. OCCUPANCY CON STRUCTION TYPE VALUATION S SLeft ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Date Owner I hereby certify that I have read this application and state that the above 1 information Is correct. I agree comply with all city and county ordinances and state 1a toting to b ing construction, and hereby author' e r re- sentatives t is city to a er upon the above-mentione pert t inspectias, s. Lj Signature Dat Reinspection Fee , $15 L - Drivers' nse or SS # 4F 0865-46, rev. 10/84 White - Building-, Canary- Applicant; Pink - Accounting; Goldenrod - Assessor ReinspMion Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting 70.100,000 BTU 0 100,000 BT 1761 4%24/8.5 - I Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction' Pole -Sub. Cooking Unit Dishwasher Dryers ❑Gas. ❑Electric F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW El 5-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter El up to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0.1 HP ❑1 %6- 8 Inc. Solar 09.15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor I'S. E0 Z O N ) N G R' E _ n M T S FEES Issue Fee PLUMBING FEES Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishy asher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal - Gas ServiceOutlets -Water Closet _ Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Trap Laundry Trays Roof DFains 00 ReinspMion Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting 70.100,000 BTU 0 100,000 BT 1761 4%24/8.5 - I Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction' Pole -Sub. Cooking Unit Dishwasher Dryers ❑Gas. ❑Electric F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW El 5-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter El up to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0.1 HP ❑1 %6- 8 Inc. Solar 09.15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor I'S. E0 Z O N ) N G R' E _ n M T S FEES Issue Fee $ 3 Reinspection Fee $15 f -11---u. Fee $ 3 �1ANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Date Dat Ell2✓3 Hood or Type i ❑ Canopy Type 11 ❑ Refrigeration System 013-1100,00OBTU 0106,00dBTU SUMMARY OF FEES BUILDING PERMIT ' $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL ' $ PLAN CHECK 50% $ MECHANICAL $ 13.00 PLAN CHECK 25% $ 2.50 SMIP $ PERMIT 'ISSUANCE $ ' ENERGY P.C. $ GRADING $ MICROFILM $ TOTALFEE $ 15.50 System Repair/Alteration Fire Dampers Registers 6 00 Issue Fee $ 3 CONSTRUCTION AND PLANNING Date APPROVALS Permit # Inspector p POOL o _PA APPROVALS Permit #_ Date lnspecrnr 1 . Temporary Electrical Service or Pole 52., Pool & Equipment Location 2.'-Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms .-4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. ` 57, APPROVAL TO COVE R-GUNITE , 7. Footings 58. Electrical Conduit-Undrgrnd. 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test % 9, Water Pipe-Undrgrnd. f 60. Backwash Lines, P-Trap, ❑ Undrgrnd. , 10. Structural Floor System y 61. APPROVAL TO DECK ' 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final i r 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structurals & 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 L 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning �(�lS�b"S Ga 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Go 51. CERTIFICATE OF OCCUPANCY. No. Date Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. CITY 0 F.COSTAMESA CONSTRUCTION PERMIT I PERMIT NO. TRACT NO. LOT NO. UNIT NO. I:oject'Addr'es$IlLc-t-0'" S C" /6 Aints/ Applicant's Mailing Address Owner's Name 7 ori. n! `'f h, % -0 ' Phone Address-- Arch/Eng. , License No. Address _ Contractor's Nam - PI.t C -0211C P honed 1L-6 _JT6 Address (mailing!` 5'b- City License No. d LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Chartt9/7 0nCingwith section 7000) of Division 3 bf a and Profe, and my license is in fu�Jfar e�antl effect License Class ✓^ cerise Date Signature WORKERS' COMPENSATION OEQLARATION I hereby affirm that I have a certificate of consent to sell4nsure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800,Lab. C.) Policy No6icr_1O'f37C mpan BCertified copy is hereby furnished. y Cert fled copy is filed with the city ision Date - f — Applicant EXEM TION FROM WORKERS' COMPE SATIODECLARATION (Thissection need not be completed if the permit E for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued, l shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of CMifornla. Date Signature 'NOTICE: If, atter making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY ' I hereby affirm that there is a construction lending agency for the performance of the work for which this p@rmlt is issued (Section 3047 Cly. C.) Lender's Name — Lender's Address OWNER BUILDER DECLARATIQN I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/the is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she' is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil )enalty of not more than five hundred dollars ($540). J i, as owner of the property W my employees with wages as their sole compensation, will do the work, and the structure IS not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/horselt or through his or her own employees, provided that such improvements are not Intended or offered for sale. 11, however, the building or Improvement IS sold within one year of com- platlon, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of the property, ar'n exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for Such projects with a con- tractor{s1 license pursuarit to the Contractor's License Law'). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. s P. C. for this reason Date I hereby certify that I Informatlon 1 t. t and state la�th relati t Sentatives isc' y Inspection o Signature Drivers' License r SS =,,P CMF 0865-46, rev. 10184 . Owner have read this a plicat' and stale that the above agtee to rompl with ' City and county ordinances o uilding co truct and hereby authorize repre- t enter u 1 th above-mentioned property for TYPE OF CONSTRUCTION L_J NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. PLUMBING A P # S E T B A Main Building: TYPE OF PERMIT GRADING El FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ ,OTHER Front Rear PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU. YDS. ACRES C S Right Left Ping. Ref, 9{� Remarks: Planning Notes: 5846 1/16/85 Zone Accessory Building: Parking Req./Provided Lie 50 TL Z O N I N G R E Q M T S Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting [3(),100,000 BTU ❑ 100,000 BT Reinspection Fee cant; Pink - Accounting; Goldenrod - Assessor $15 Hood or Type 1 ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee I $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By X74.1 PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer - -Service Sink $ ISSUANCE Automatic Washer Construction Pole Sub. Transformer ❑ 15-5Q KW' ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection -" ; Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100.emps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank - Fan Motors Q1 HP ❑ 1% • 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9•i5 HP ❑16-15+ Floor Sinks Gas Service Outlets Urinal - Water Closet Fixtures Device Boxes Microwave Pale Light Interceptors Kitchen Sink Water Heater Water Service Outlets Switches Range Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections 1P -Trop Laundry Trays Generator ❑0.5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspaction Fee $15 Issue Fee $ 3 Reinspection Fee $i5 Issue Fee $ 3 MECHANICAL FEES Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting [3(),100,000 BTU ❑ 100,000 BT Reinspection Fee cant; Pink - Accounting; Goldenrod - Assessor $15 Hood or Type 1 ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee I $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By X74.1 SUMMAR OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.C. ELECTRICAL $ �k-00 GRADING PLAN CHECK 50% '$ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ $CONSTRUCTION AND PLANNING .APPROVALS Permit # Date Inspector POOL & _:JA APPROVALS Permit # Date Insp?crag •1„ Temporary Electrical Service or Pole on - 52. Pool & Equipment Location 2: Soli Pipe Undrgrnd e. 53. Steel Reinforcement 3:- Electrical Conduit t Utility-Undrdrrnd. 54. Forms 4. Electrical Conduit-Uhtrgrnd. i + 55. Electrical Banding 5t Steel,Reinfprcemeni, 56. Rough Plumbing & Pressure Test 1` 6.� Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings .' 58. Electrical Conduit-Undrgrnd, t 8. Foundation -, 59. Gas Pipe, ❑ Undrgrnd., Test r, Water Pipe Undrgrnd. iN 60. Backwash Lines, P -Trap, ❑ Undrgrnd, ' 10. -Structural Floor System 61. APPROVAL TO DECK 1 i; Property Sewer Line & House Connection 1 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- POO L/SPASYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 3Q. -Drywall Nailing HEALTH DEPT. REQUIREMENT 311 Plaster Brown Coat 79. FINAL INSPECTION 32r Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes'. 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy i 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY Nn. Date ' CITY Of G0STa��A {� T =TION PERMIT Project Address7// Z:>3' - Applicant's Mailing Address Owner's Name phone Address Arch/Eng, License No. Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. Address � / Contractor's Nam-F,(t'16<</S-r'��-� 7x�� Phone 42� Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I,am licensed under provisions of Charter 9 (commencing 'with section 7000) of Division 3 of flip Business and Professlons Code, and my license Is in full�prrceffect. SSS LicenseCl Datg!�,�L4� Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate of workers' Compensation Insurance, or a certified copy thereof (Section '800, Lab. C. E �r •olicy No.17-752 Comp; y �f DaA❑ copy is hereby furnished, Certified copy i led with the city 1 I g te _Certified Applicant e EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be Completed If the permit Is for one hundred (5100) Or less). I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to tits Workers' Compensation Laws of California. Date— Signature 'NOTICE: If, after making this declaration, you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER I3UILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 '031.5 by ,any applicant for a permit subjects the applicant to a civil realty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as; their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work hlmself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion. rove forthe the owner purpose ill have sale)the burden of proving he/she did not build or im- 5rove f I, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and who contracts for such projects with a con- traCtor(s) license pursuant'to the Contractor's License Law'). 1 am aware that proof off their Worker's Compensation insurance should be provided to me. C1 I am exempt under section B. & P. C. for this reason Date Owner I herebycertify that information Is correct. and state laws r ting sentatives of cit inspectioSlgnaturDrivers' e or SS ; 1 have read this application and state that the above I agree to comply with all city and county ordinances to building constructlgon and hereby authorize repre- Y t.6 enW uport. thg�above-mentioned property for Date/-,� PERMIT NO. TRACT NO. LOT NO. U IT NO. 6012 12/18/05 TYPE OF CONSTRUCTION NEW ffrADO ALTERATION U ❑ CONVERSION ❑ DEMOLISH ❑ 0A DESCRIPTION OF WORK/USE OF BLDG: !1? REPAIR ,P. Zone S Main Building: Accessory Building: TYPE OF PERMIT Ll GRADING FOUNDATION STRUCTURAL ❑ TENANT LP ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ 'OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES E T Front Z O B A Rear N I C Right N K S I Left G R Ping. Ref. # Parking Req,/Provided E Remarks, E 093 Planning Notes: M T S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES ' Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW 0 50 + KW _. Backflow,lrrigation Sewer Cap �.7 Z Bathtubs r}Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers []Gas ❑Electric Sub Panel Drinking•Fountains Solar TankFan J i Motors 0411 HP 01%-B Floor Drains Swimming Poo( w/Spa F.A.U. Inc. Solar El 9-15 HP []16.15+ Floor Sinks Urinal Fixtures Microwave I Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap • Laundry Treys Generator ❑45 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Foe $-3 Reinspection Fee $15 Issue Fee $ 3 Baler Duct - Under Ground MECHANICAL Hood or Type I ❑ Canopy Type 11 0 FEES DEVELOPMENT SERVICES Zoning Approved By - Building Approved By Application Issued By REQUIREMENTS: Date Date Date_ ALE Duct - Structural Refrigeration System ❑4100,000 BTU ❑100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL . PLAN CHECK 50% MECHANICAL' PLAN CHECK 25% $ $ $ $ $ $ $ $ 1 SUMMARY OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ + O MICROFILM $ TOTAL FEE $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact, Bit, )CBO Fire Dampers Heatirig System & Ducting ❑4100,000 BTU El 1 w000 BTu Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0665-46, rev, 10/84 White - Building; Canary - Applicant, Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING Date, APPROVALS Permit # Inspector POOL A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ;2.. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms %4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd, 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final -16., Rough Electric Wiring W k�-L-e5 , f C1 II� 67, Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical T Bar Ceiling'40 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd, Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. -r-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 Plaster Brown Coat 79, FINAL INSPECTION - 32. ,Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33.1 final Electric 30 Notes: 34. Final Heating & Air Conditioning 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 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 OFiOCCUPANCY ' No. Date I Q N I CI Applicant to fit$ in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF�COSTA MESA CONSTRUCTION PERMIT PERMIT NO- TRACT NO. LOT NO. uNET N(1 Project Address 711 -1d_- 17th St _ R1¢ (n)—uni I- Applicant's Mailing Address 1-31 10--Snticoy St N.14011ywood Owner's Name Troy InvesCttlent Fund Phone349-2.RRS Address4321 Birch Sr. N - D B a h, CA_ Arch/Eng..MArin J- ROCk License No. Address 1?RAI Knott Aye.__SuJt,- 916 Contractor'sNameDIICO Air Cnnditinning- Phone --982-12-16 Address(mailing) L1110 Saticoy St_ N-Ha11yrwnn___d, Ca - City License No. 39925 LICENSED CONTRACTOR DECLARATION I herebyaffirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business Professions Code, and my license is in full force and effe License Class _r,-20 f I e N. 346251 Dat4 1181 Rh Signature WORKERS' COMPENSATION DARATION 1 hereby affirm that 1 have a certi to of consent to self -Insure or a certificate of Workers' Compensation Insu ante, or a certified copy thereof (Section 3800, Lab. C.)wC9824Ltlmbermalls Policy No. Company 8 Certified copy is hereby furnished. Certi i Cff�is filed with the city Buildig DIl sin. t� A Date LL Applicant f EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section.need not be completed if the permit Is for one hundred ($100) or less) 1 certify ,that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3047 Civ. C.) Lender's Name' Lender's Address OWNER BUILDER DECLARATION I hereby affirm that f am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the Structure Is not intended or offered for Salo (Section 7044, Business and Professional Code. The Contractor's License Law does not apply to an owner of a property who bullds or Improves thereon, and who does Such work himself/herself or through his or her own employees, provided that such improvements aro not Intended or offered for sale. If, however, the building or improvement is Sold within one year of com- pletlon, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 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 proof oftheir Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date ' Owner I hereby certify that I have read this application and state that the above information Is correct. I agree to comply with all city and county ordinances and state91,olating to bu" ng construction, and hereby authoriz repre- sentativehis'city t ruponthe above-mentioned P o rl r lnspectl ose3. Signature pe Drivers' Le or 55 1p AF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q p 916 DESCRIPTION OF WORK/USE OF BLDG, S Main Building: E TYPE OF PERMIT LJ GRADING El FOUNDATION STRUCTURAL T Front ❑ TENANT 1-1ELECTRICAL ❑ PLUMBING X] MECHANICAL B Rear ❑ -OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K' 77 CON STRUCTION TYPE VALUATION $ S Left ZONE GRADING CU. YDS• ACRES Ping. Ref. + Remarks: Planning Notes: 1773 h/24/85 15,50 4L Zone Accessory Building: 2 O N I N G R Parking Req./Provided E 0 M T S Reinspection Fee Boller $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting Z&11 00,000 BTU (3100,000 BT Reinspection Fee 1 $15 Issue Fee$ 3 PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL i PLAN CHECK 25% Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter El over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0-1 HP ❑1 X - 8 Floor Drains' Swimming Pool w/Spa F,A,U, Inc.Solar 09-15 HP ❑16.15+ Floor Sinks Urinal Fixtures Microwave - - Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches , 7 Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P -Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee Boller $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting Z&11 00,000 BTU (3100,000 BT Reinspection Fee 1 $15 Issue Fee$ 3 Roinspection Fee $15 1 1 Issue Fee $ 3 1ANICAL FEES Hood or Type 1 ❑ Canopy Type I I ❑ DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: trate Date Qat Z Refrigeration System 00.100,000 BTU ❑100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL i PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ $ $ 13.00 $ 2 1; C11 SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTAL FEE r $ S $ $ . $ $ 15 so System Repair/Alteration Fire Dampers Registers Issue Foe $ 3 'CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & oPA 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 .f 4. Electrical Conduit-Undrgrnd. g 55. Electrical Bonding ! R 5. Steel Reinforcement 56, Rough Plumbing &Pressure Test , 1 f: 6. Electrical OF ER Grnd. _ %�� 57. APPROVAL TO COVER-GUNITE 7. Footings ------------------ 58. Electrical- Conduit-Undrgrnd. s 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test C 9. Water Pipe-Undrgrnd. i1 60. Backwash Lines, P -Trap, ❑ Undrgrnd. ~. 10. Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Convection 62. Backwash &Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 5 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydra 22. Ducts, Ventilating 71. Product Piping ❑ Gas 0 Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas 0 Oil 25, Roof Sheathing ti 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27., Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29, Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 4 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. .Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy borderl lines and sign all appropriate declarations. CONSTRUCTION PERMIT MIT NO. TRACT NO. LOT NO. UNIT NO. CITY OF GOSTA MESA Project Address 711 WEST 17th STREET- 13110 TREE'I AlSplicant's'Mailing Address I 3110 SATICOY owner's Name TROY INVESTMENT FUND phone 631-7616 Address . 4321 BIRCH STREET NEWPORT BEACH, CA. Arch/Eng, License No. Address \ Contractor's Name IICO ATE CONDITIONING Phone. 982-1216 Address (mailing)�13110, SATTC,QY N. . 91605 _ City License No. -'13425 LICENSEO CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of CharteV615' mmencing with section 7000) of Division 3 of the Business and ProfeCode, and my license is in ftl fgr6e and effect. .j1 {� License Class i L Lic No 1_ pate 1 2/ 1 R/ R �i Signature !� WORKERS' COMPENSATION DECL RATION i hereby affirm that I have a certificat of consent to Self -insure or a certificate of Workers' Compensation�s I/Inn�suralrn__e 1 or a certified copy thereof (Section \ :Y ,3800, Lab, C.) LU 1, Wf /ompany °olicy No. C (w a Certified copy is hereby furnished. V\ Certified copy i$ filed with the ci B "Iding Di pate Applicant CXE I F M WORKERS' COMP NSATION DECLARATION (This section need not be completed if th permit'is for one hundred ($100) or less). 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Walkers' Compensation Laws of California. Date Signature 'rdOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) i<ender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, after, improve, demolish or repair 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 the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 1 I, as owner of the property or my employees with wages as their sole _ ampensation, will do the work, and the structure is not intended or ollered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner Of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for We. 11, however, the building or improvement -is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of Sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, a_ nd _who contracts for such projects with a con- tractor(s) license pursuant'to the Contractor's License Law). I am aware that Clrof or their Worker's Compensation insurance should be provided to me. Cl I am exempt under Section B. & P. C: for this reason Date Owner I here y certify. that I have read this application and state that the above infor _tion is correct. I agree to c ply with all city and ounty ordinances nd a s relatinguildin nstructilin and here authorize repre. n i d this city en er on the above -menti ed pro rty for i ect u es. f Z7 Signa re Date ri s' Lice se or SS V 865-46, rev. 10/84 yt -.1 41) 1:513 -A- TYPE OF CONSTRUCTION LJ NEW LJ ADD LI ALTERATION L__i REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TYPE OF PERMIT' GRADING 11 FOUNDATION STRUCTURAL Y Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION$ S Left ZONE GRADING CU. YDS. ACRES P4ng. Ref, # Remarks: Planning Notes: 7160' 1/13186 Zone Accessory Building: Parking Reci./Provided 4 Z O N t N G R E Q M T S TL I Bar Sink PLUMBING Showers FEES ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan, Motors ❑ 0-1 HP ❑ 1 - S Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 HP E:)16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories- P—Trap Auto -Wash Laundry Trays Garbage Disposal Generator 00-5 KW ❑5-15 KW ; Standing Sections Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Hood or T Type I El Canopy Type I I El SERVICES REQUIREMENTS: Zoning Approved By Building Building Approved By Application Issued By, nate Date Dat Duct - Under Ground Duct - Structural Refrigeration System CIO-1100,00OBTU 0100,000 BTU Duct - Ventilating SUMMARY BUILDING PERMIT $ PLAN CHECK $ $ PLAN CHECK 25% $ . ELECTRICAL $ PLAN CHECK 50% $ + MECHANICAL' $a PLAN CHECK 25% $ _ OF FEES SMIP $ PERMITPLUMBING ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ r , TOTAL FEE ' S; Z Exhaust System ❑ Multiple ❑ System Repair/Alteration Firep(/Fact. Bit, fC60 #Fire Dampers Heating System & Ducting ❑0-100,000 BTU 0100,00087 Registers Reinspection Fee $15 Issue Fee $ 3 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor I CONSTRUCTION AND PLANNING ` APOROVALS Permit # Date inspector POOL & APPROVALS Permit # Date Inspector 1, Temporary Electrical Service or Pole 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd. 53. Steel Reinforcement r 3. Electrical Conduit Utility-Undrgrnd. 54, Forms '4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding S. Steel Reinforcement 56, Rough Plumbing & Pressure Test S• Electrical LIFER Grnd. "` 57. APPROVAL TO COVER-GUNITE t.: 7, Footings 58. Electrical Conduit-Undrgrnd. ; 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 1 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd, 1 10, Structural Floor System 4 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 1S, Rough Electrical -Conduit _ 66. Solar System -Final I 16. Rough Electric Wiring 67, Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20,, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil, ;. 25. Roof Sheathing 74. Overhead Hydro L 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76, Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe .Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final " 40. Gas Service -Final - - 41 . Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation t7 f 44. Landscape Irrigation System �'; 45. Sound Attenuation 46. Handicap Regulations �Y 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed _ 49. Electric Release to Edison . f 50. Gas Release to Southern California Gas Co ` 51. CERTIFICATE OF OCCUPANCY No, Date .. �. .. M mmqqq Applicant to fill in all spaces except those within heavy border lines end sign all appropriate declarations. P RMIT NO TRACT NO. LOT NO. U11 NO. 95142 3/25/65 I0e5WJ TL CITY OF COSTA MESA ONSTUCTi N PE IT k0- .� f 3 k Proiect Address Applicant's Mailing Address oe Owner's Name Rhone Address Arch/Eng. License No. Address r Contractor's Nem Address (mailing) City License No. _ '7 NS�� 1 LICESED CO_NTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force d tfect. License Class License NO.36 Date �gnatur WORKERS' COMPENSATION pE RATION 1 hergby affirm that I have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified Copy thereof (Section 3800, Lab. C.) Policy No. Company BCertified copy is hereby furnished. Certified copy is filed with the City Building Division. Date. _ _ Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred (5100) or less). I certify that in the performance of the work for whlth this permtt is Issued, I shalldnot employ any person in any manner S JS to become subject to the Worlte Co nss�&W Laws of Califoio Date �ft - Signature 'NOTI E: If, after making this deClar n, you should become subject to the Workers' Compensation provisions of the Mbar Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hergby affirm that there is a construction lending agency for the performance Of the work for which this permit is issued (Section 3097 Clv. C.) Lender's Name Lenger_'s Address OWNER BUILDER DECLARATION I horoby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any City or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 )ent,lty of not more than five hundred dollar$ (5500). 3 1, as owner of the property or my employees with wages as their sole Compensation, will do the work, and the structure is not Intended or offered for Sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale, If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden Of proving he/she did not build or Im- prove for the purpose of sate). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 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 ' proof of their Worker's Compensation insurance Should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hf!reby certify that t have read this application and state that the above information is correct. 1agree to comply with all city and county ordinances and State laws relating to building construction, and hereby authorize repro. sentatives of this cl to enter upon the above-mentioned property for inspection p ses Signature Date Drivers' Lic se or SS qt- CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor TYPE OF CONSTRUCTION in NEW LJ ADD ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. -0 Zone DESCRIPTION OF WORK/USE OF BLDG. $ Main Building: Accessory Building: E TYPE OF PERMIT El GRADING 0 FOUNDATION EISTRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ ,OTHER A PROJECT DESCRIPTION SQ. P'T. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION 5 S I Left ZONE GRADING CU.YOS. ACRES Ping. fief. Parking Req./Provided Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Orinking Fountains Floor Drains Floor Sinks Gas Service + Outsets Interceptors Kitchen Sink Lavatories P --Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑ 0.100,000 BTU ❑ 100,000 BT Reinspection Fee $15 PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee MECHANICAL Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System D0.1100,000BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES ELECTRICAL Automatic Washer_ Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan i F.A.U, Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW 05-15 KW Transformer ❑ 15-50 KW ❑ 50+KIN Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0.1 HP ❑1'rS - 8 Inc. Solar 09-15 HP ❑16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES Z O N I N G R E Q M T S $ 3 Iieirispection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved Byate Application Issued By REQUIREMENTS: Date Dat BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ 1.5— $ $ $ $ SMfP $ PERMIT ISSUANCE $ ENERGY P,C, $ GRADING $ MICROFILM $ TOTAL FEE $ d, $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # tj Date Inspector- ` POOL & _eA APPROVALS Permit # Date Inspector -, 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • r• '2. Soil Pi e-Undr rnd. p 9 � ? .9 53. Steel Reinforcement 1- Ele t'rical Conduit;,Ui 54. Forms moi+ 4� Electrical Condu t?Undrgrnd. L + 55. Electrical Bonding 5`?Steel-Reinforcement t 56. Rough Plumbing &Pressure Test , r 6; Electrical UFER,Grnd _ 57, APPROVAL TO COVER-GUNITE ; !7 �7;. Footings Cj ,.`� 58. Electrical Conduit-Undrgrnd. 8, Foundation" �' 59. Gas Pipe, ❑ Undrgrnd., Test r r '9'Wa e Pipe-Und g -W. t+ 60. Backwash Lines,'P-Trap, ❑ Undrgrnd. 10;,StructuralFloor System 61, APPROVAL TO DECK 11:3 Property Sewer Line & House (366dection 4 62. Backwash & Receptor -Final 12 :,Sewer Cap V ;/, �' t f 63. Heater &'Vent -Final 113n Roof Drains �� + 64. Plumbing System - Final + 14� Rough Plumbing, ` r 65. Electrical -Final 15, Rough Electrica'I tonduit 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' APPROVALS Permit # 20.1 Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping' ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling {Structural} & Monocoat 75. Dry Chemical 27, Frame and Flashing 76. Dry Standpipe a: 28. Lathing & Siding • 77. FIXED SYSTEM FINAL ; 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT + 31. Plaster Brown Coat 79. FINAL INSPECTION ,32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final _ 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation i 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Ca 51. CERTIFICATE OF.00GUPANCY No. Date i Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT j� Project Address --h u— rmff sriccIiY !� �nlf t3�rt Applicant's M = Lin-, � Qi i3ailing Address �a �� Owner's Name -[�� J&W=!& W�1_Sd' Y 0 Phone Address Aaaz' f5tga o"[ . wEwn)s'r n - -CA, Arch/Eng, t-. License No. It r Address ` Contractor's Nam � ion T Address {mai ring►'teL City License No. 3 Z LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (Commencing with section 7000) of bivision 3 of the Business and Professions Code, and my license is in full force aeffect Licens CI s (Canso Date Signature WORKERS' OMPENSATION DECLARATION I hereby affirm that I have acertificate of consent to self -ins. e r a certificate of workers" Compensation Insurance, or a certified copy thereof (Section 3800, Lan. TiiTE policy No. — Company At Certified copy is hereby furnished. Cer rfietl�ROI ith the city Building Division, eApplicant EXEMPTIOKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (3100) or less). I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which L i ermit is Issued (Section 3097 Civ. CJ Lender's Name Lender's Address OWNER BUILDER b CLARATION I hereby affirm that 1 zim exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permlt to construct, after, improve, demolish or ropair 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 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 gnalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as thoir sole inlpen9ation, will do the work, and the structure Is not Intended or offered fur sate (Section 7044 Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s) I1Cense pursuant'to the .ContraCtOr'6 License Law), I am aware that proof of their Workers Compensation Insurance should be provided to me. ❑ t am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this a este o�the bovE-ment{dned property�forinspection purSignature Date Z/+i Drivers' License or SS 71 TYPE OF CONSTRUCTION LJ NEW ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 90 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT ElGRADING El FOUNDATION UVTRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear C] OTHER PROJECT DESCRIPTION SQ. FT OCCUPANCY 3 --Z C Right CONSTRUCTION TYPE VALUATION $ �1 , (JVCJ S Left ZONE GRADING CV.YDS. AC RE5 Ping, Ref, # Remarks: G Planning Notes: :F� PLUMBING FEES Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ 0-100,000 BTU 0 100,00013T Reinspection Fee $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 5897 12/1-6/35 zone Accessory Building: Parking Req,/Prcvidec1.,d& }-,7oci TL z O N I N G R E a M T S Showers ELECTRICAL FEES Service Sink Automatic Washer Construction Pole Sub, Transformer ❑ 15-50 KW © 50 + KW Sewer Cap Sewer Connection Cooking Unit Meter ❑up to 100 amps Solar Collectors Dishwasher Meter [Dover 100 amps Solar Piping Dryers ❑Gas ❑Electric Sub Panel Solar Tank Fan Motors 110-1 HP 111% - 8 Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP ❑16-15+ Urinal Fixtures Microwave - Water Closet Device Boxes Pole Light Water Heater Outlets Range Water Service Switches Sign Auto -Wash Garbage Disposal ; Standing Sections' Laundry Trays Generator 1:10.5 KW CIS -15 KW Trash Compactor Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 iANICAL FEES Hood or Type I ❑ Canopy Type 11 El DEVELOPMENT SER. IC zoning Approved By Building Approved By Application Issued By REQ TS: Date �! ` Date I pat 17-466- Refrigeration System 00.100,000 BTU E1100,000BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL' PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SU $ $ $ $ $ $ $ $ AR F FEES rd SMTP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ 1? 7. 27 System Repair/Alteration Fire Dampers Registers Issue Fee S-3 _ CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & APPROVALS Permit # Date Inspector 1.t Temporary Electrical Service or Pole. 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd 54. Forms 4, Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5' Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7`. Footings- i L 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9, Water-Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10.,Structural Floor System 61. APPROVAL TO DECK 11: Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12, Sewer Cap - • ' 63. Heater & Vent-Final 13. Roof. 'Drains,64. Plumbing System - Final 141,, 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 APPROVALS Permit # 20. Rough Factory Fireplace 21.. Ducts, in Structure a 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73, Undergrnd, Storage Tank ❑ Gas ❑ Oil 25. ,Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75, Dry Chemical 27. Frame and Flashing f ! 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL •30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat . 79. FINAL INSPECTION I32! Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes; Z-2c) •-?'S jd5 M414 34: Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final" Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43, Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 3 a 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 7 1 1 W 17TH ST UNIT: C-4 OWNEWS NAME: DANIEL D. DARROW AODREss: 711 W 17TH ST #C-4 COSTA MESA CA 92627 ARCHlENG1NEER: (714)642-2684 K RAMER & AS S O. REG.ND.: S E?I O 9 ADDRESS: 3002 DOW AVE ' 136 TUSTIN CA 92680 PERMITTEE: DANIEL DARROW (714)642-2684 ADDRESS: 711 W 17TH ST c-5 COSTA MESA CA 92627 LICENSED CONTRACTOR DECLARATION: 1 hereby affirm trial I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. CITY LIC,: • STATE LIC.: CLASS: Dale: Signature: WORKERS' COMPENSATION 4ECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. Cf. POLICY NO.: EXP. DATE: Certified copy is hereby furnished. ❑ Certified copy is lifea with the city Building Division. Date: Applicant: EXEMPTION FROM WDRXERS' COMPENSATION DECLARATION: {Thissection creed not be completed d the perm isfor one hundred (Stec) or less). i certify that in the performance of the work for which this permit is issued. I shag not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date: _ Signature: NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shag be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ, Q. LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the foltowing reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance. also requires the applicant for such permit to We a signed statement that he/she is licensed pursuant to the provisions a: the Contractors' State License Law (Chapter 9 (commencing with Section 1000) of Division 3 of the Business and Professions Cade) or that he/she is exempt therefrom and the oasis for the alleged exemption. Any violation o1 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars (5500). I.as owner of the property or my emplpyees with wages aS their sole compensation, wi€I do the work, and the ❑ Structure is not intended or uttered for sale (Sect on 7044, Business and Professional Code: The Contractors' Slate License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himselflhersell or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build of improve for the purpose o1 Sale). I, as owner of the Properly. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business and Professions Code; The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contracfor(s) license pursuant to the Contractors' State License Law). I am aware that proof or their Worker's Compensation insurance should be provided to me. i am exempt under Section: B. B P. C. Icr this reason:/7 Date: —Z Cec �� /,d 7H�q�h,,anid do hereby coruty that I am aware of and understand the requirements niSafety Code Sections 25505, 25533,and 25534 and that I or any lutur@ building occupant willfmll not (circle one)cuard State codes and the requirements for a permit for construction or modahiWtion from the Air Ouatity Management Oisthcl. Residential construction applications are exempt from these provisions Date: Applicant: I hereby certify that I have read this application and State that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction and thereby authoriter representatives of this cirty to enter upon the above-mentioned property for mspediD purposes. Date: -i_; ��_ Signature. Driver's License or Social Steurily p %641-45 white-9usidina: Pink—Revenue: Goldenrod—Assessor 1' CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 05429 PERMIT NO: B 054292 PLAN CHECK NO: 03611-91 L GOVT: N SUPP: N CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION MOVE STAIRS, BUILD WALL & BEEF -UP FLOOR SQ FT: 7,000 CLAIM VALUE: 7,000.00 CALL -VALUE: 7,000,00 GROUP OCC: B-2 / COMMENTS: Z O N I N G S E T B A C K SR E Q U I R E M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT. FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: 292 PROV: 298 PARCEL: 42409111 ZNE: MG REF NO: PLANNING NOTES> TI TO AN EXISTING IND. BLDG. TO ADD APPROX. 180 SQ, FT. OF > 2ND STORY ADDITION IN CONJUNCTION WITH RELOCATION OF STAIRS. D E V E L O P M E N T S E R V I C E S R -E Q U I R E M E N%T'S ZONING APPROVED BY DATE: 'icb BUILDING APPROVED BY : S`4- DATE: r L O APPLICATION ISSUED BY: DATE: #F#F'1F�F#E****#F'1F'1F9EiEiEiE�til•�kitit��t�t��**�� * #E*it*�t�*�!#F***it it�t#F*�l��l��t�t#F*�!**�!***�t,**�#F�l�#F�#E* LEGALIZATION:N F E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 90,00 SMIP/NON-RES PLAN 58.50 1.47 ISSUE FEE BUILDING --DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS-----> 91.47 0.00 58.50 149.97 149.97 .00 REVENUE DIVISION TOTALS--> COLLECTED: 149.97 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 90.00 1.47 58.50 * 1F * �F �F #F �E �! #F �! #F 1F #F 1F 1F'1F �F * �F * !F �F �F #F �F �F �F �F � *'1F �E 1h'1F �! 1t• 1F * * �! * �F �F �F �F �E �F * * �! �F � * * �F �'1F'1F'1F'1F'1F �F �F �E 1h'1F �F * * �i �t �! �E 1F 1F #E 1F it it I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFC 7000 ALTER BY VALUE COMMERCIAL NOZONE 1.00 7,000.00 END OF FEES CONSTRUCTION AND PLANNING PO PA APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52, Pool & Equipment Location 2. Sdil Pipe-Undrgrnd. 53. Steel Reinforcement �-$'tlectrica't rti n utt Utility-Undrgrnd. 54. Forms '� r r,4:Elettrical3Conduit-Un3Jrgrnd. -I ,r .,. or�-.. 55. Electrical Banding •_i.. tgeYR"infb�cement 56. Rough Plumbing & Pressure Test - -..1.-L, ti.� tti 4' 6• ;flextrirat FER Grnd. .,• rte. 57, APPROVAL TO COVER-GUNITE 1 =�7C� "Foot ing _r; - 58. Electrical Conduit•Undrgrnd. 7 : Foundation _ 59. Gas Pipe, 0 Undrgrnd., Test ` 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, © Undrgrnd. ., 10. Structural Floor System 61. APPROVAL TO DECK ' 11. Property Sewer Line-& House Connection 62, Backwash & Receptor -Final 12. Sewer Cap :�. 0 63. Heater & Vent -Final 13. Roof Drains t} 1 64, Plumbing System - Final s 14. Rough Plum9k 65. Electrical -Final 15. Rough Electrica&Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencin & Access Approval 9 w t. ;17. Rough Wirtig Sjgh 68. APPROVED FOR PLASTERING •-'� 18. Rough Electricaf-f---T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS"*:)Termit # 4 �_ 20.,7RouEp Patton+ Fireplace r min a' -j y :, t3 T 2i .;Ducts, inrStrij Kttu 9.,; ., ,� .- gip, l n'dergro ., , , y x z od,Hycljo r 22. Ducts, Ventilatin yT. t ;5 5 * :- 1, Product fli.�ing 01GE•s ©Oil 23.'Gas;PiperRou h &' st ' o` � IL W i"72, Under ol+fld Flu ,� _ A a 7 V Ar g ;J' 24.•JRooY Framing- R i `-;-. ri x p r x 'lo- -• 4 w j3. Undergrnd?Storage Tank 19 Gas © O� -� •r 25. RooJ;ShFathingj ; Y ""414. F r ;tiverhead ydro 26.;iT-Bar Ceiling (Structural) & Monocoati: �. • i ,r - tzv . + ., 75.7Dry Chemical ] 'f. +-! ,. 27.1 FrarPe agsi Flashing` "� �� `� '' "t 76.' Dry Si�and t'�•' i 3. • - r it U F T SFr,: `-r f:l -0 1:1.1 H. -Lathing.& Siding ~I<x (9 �Ir 5 ••* T 77.7'FIXED SY9TEM"-P1NAL4 ._, t�• X29. Insulatia "" '' w `I_ `�_� x 78.j�IRE PREV. FII�A� >j tT30. Drywall=Nailing m'� .:,"f '�(• I HEALTH- 0EPTjR.EQUiREMENT 31. Plaster BFownyCoat I4§P.ECT10 ` d rt tT79.4INAL -32.;,Electrical+Pov�iter Meier*Final; _ ljo.15: :+ fUi •�,�� it80.ttf000 CER IFICATED E ISSU 33 "Fina Electri„ �` T r. t C3 +r I �H n= `� t`Not�'s: __j ' ; k -Fin6 Resting & Air.!X', ditio(+iggs f`C, Pi LE; "x. �. � u' r '�' 5 Ln0 35 ('Final Gas Pipe Test ►' 'x nv to 5 " V- !iC 1 t4 ti t'.: ,36. Flo or -Canopy r �Fireppe + sir .� r� -.+. t-1 i �k x n w 17: _37.CFinaVFaaory v 7' I , C x I s'f' * x � CJ _-38.cFinaJ,Plt nbing ,r •• •• i "39.rwat'et service -f=inal Y40. -Gas Srvice-F_4 e t to •S.Lin' x : + ,a l x i ;= _ , •, j -t n•n, 3.'41, Solar Domesttc•Final.S C' ^': �• + i tY t Sti' i- 'A Y : n �• a I It t tr [.• Ci �-42.' Backflov�Preventerx "Z.,'`= s "' 43. Backflow Irriation4� cr;'S 5 • _ v f- :- C •� 44. Landscape Qigati "' SystemDv, 141C .x t1l) ,, 7 t7*'+ tC (U t+a .-o {•3 Cy 745. 'Sound Atterivation• � � r� a 2: N I- [ •• r r-+ F-' zr,W x< f t * V . or r:1 U113, x W C -• � Y 0`7 r`' '�y. -i IM 46. HandicaR,Regulatigps ,.y * p� •47.-IFINAL STRUCTURE & BUILDING tt' ' C'� Su •Y T .rltr y . .4 48.' INAL PLANNINCyx I � too 1, .-t ,_A9.'_*Electric Release to Edison i [ : • • 0.1j tr o to Southern California Gas CQ ; +� ..50._Gas�Release l E . t! C)L11 CERTIFICATE OFaOCCUP�N& t^ Frim » No. Date f 41 CI Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. Project Address 7 i Sr' "�.S Applicant's Magio Address Owner's Name L#J Phone Address Arch/Eng. License No. Address — Contractor's Nam L 2r -1 I S f: Win« Phone?7L 0 Address (mailing) 7�O K-07--sr City License No. LICENSED CONTRACTOR DECLARATION t hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the gu&tVess and Pr fession$ Code, and my license isin ful f rce and effect License as, Icense 71-7 Date Signature WOR ERS' COM ENSATION DECLARATns.nt I hereby affirm that I have a certifi�atC of coself -insuro or a certltltate If Workers' Compensation Insurance, or a certified -copy thereof (Section Polliicy No.. C. . H Certified copy is hereby furnished CertiTed co%�y is iled with the Cit ui g ivision, Date � `•-' Applicant EXEMPTION FROM WORKERS' COMPS SATION IDECLARATION (This section need not be completed if the permit Is for one hundred ($100).or less). I certlfy that in the performance of the work for which this permit Is issued I shall not employ any person In any manner so as to become subject to the Workers' Compensation laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers'. Compensation provision% of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097 Civ, C.) Lender's Name Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any City or county which requires a permit to construct, alter, improve, demolish or repair any Structure, prior to its issuance, also requires the applicant for such permit ' to file a signed statement that ho/she is licensed pursuant to the provisions of 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 '031.5 by any applicant for a permit subjects the applicant to a civil ,enalty of not more than five hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their sole compensation, will do the work, And the structure is not intended or offered for Sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement is Sold within one year of Com- plotion, the the owner purpose ill have ale) the burden of proving he/she did not build or Im- prove f❑ I, as owner of the pioperty, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Profession$ Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractor(s� license pursuarit.to the Contractoi's License Law). I am aware that proof o their Worker's Compensatlon insurance should be provided to me, 0 1 am exempt under Section-- -- B. & P. C. for this reason Date Owner . I hereby certify that I have reaq Information re(i, aS.).4, a to c and state 1 5 re to b 1(dinsentatives Ihisto nter inspection urpo$ Signature Drivers' License or $5 11 thls application and state that the above ;c=,e-mentloned and county riteordinances cc/nstvuctl andby authorize repre- property for Date TYPE OF CONSTRUCTION EJ NEW 0 ADD LJ ALTERATION LJ REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. �(E DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ •OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CON STRUCTION TYPE VALUATION $ S Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher ' Drinking Fountains Floor Drains Floor Sinks - Gas Service Outlets Interceptors Kitchen'Sink Lavatories P—Trap - Roof Drains Reinspection Fee $15 Boiler Oui:t - Under Ground Duct - Structural Duct - Ventilating_ Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit, ICBO # Heating System & Ducting ❑ 0.100,000 BTU ❑ 100,000 BT Reinspection Fee I 515 AF 0865.46, rev. 10/84 White - 1344i1ding; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING I FEES I Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays i Issue Fee IANiCAL Hood or TypeI ❑ Canopy Type I I ' ❑ Refrigeration System ❑() 100,000 BTU ❑ 100,000 System Repair/Alteration Fire Dampers Registers Issue Fee 5635 1/16/85 Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Transformer ❑ 15.50 KW Construction Pole Sub, El 50 + KW Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 05-15 KW 4.50 TL. Zone Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors 0-1 HP ❑ 1 h - 8 Inc. Solar ❑9.15 HP 016.15+ Microwave Pole Light Range i Sign Standing Sections Trash Compactor FEES Z O N I N G R E Q M T S S 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: i Zoning Approved By Date Building Approved By Date Application Issued By Date 1 SUMMARY OF FEES BUILDING PERMIT $ SMIP '$ PLAN CHECK $ PERMIT PLUMBING 5 ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. S ELECTRICAL $ gLQD GRADING $ PLAN CHECK 50% $ SO MICROFILM $ MECHANICAL $ __ TOTAL FEE $ PLAN CHECK 25% $ S 3 CONSTRUCTION AND PI-ANNING APPROVALS Permit # Date Inspector POOL v. SPA APPROVALS Permit # Date Inspecinr ' • 1. Temporary Electrical Service or Pole .i 52. Pool & Equipment Location 2. Soil,Pipe-Undrgrnd. t l) 53, Steel Reinforcement 3�Electrical Conduit Utility Undrgrnd. 54. Forms 4: Eiectr.ical Conddit-Undrgrnd. ` 55. Electrical Bonding C. SSteel,Reinforcement- ' ` 56. Bough Plumbing & Pressure Test r F� Electrical UFER1G4nd. 57. APPROVAL TO COVER-GUNITE , 7'- Foo'ings , 1= 5B. Electrical Conduit-Undrgrnd. -,r, 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., 62. Backwash & Receptor -Final 12.,,Sewer Cap ' ti: `• 63, Heater & Vent -Final 13. Root Drains ' 64. Plumbing System - Final 14. Rough Plumbing. `r 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 F INAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing- 73. Undergrnd. Storage Tank ❑ 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 30D Drywall Nailing HEALTH DEPT. REQUIREMENT 31.. Plaster Brown Coat 79. F I NA L I NSPECT ION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric <el -c Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40, Gas Service -Final 41. Solar Domestic -Final 42. 8ackflow 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 PROJECT ADDRESS: 711 W 17TH ST OWNER'S NAME: DANIEL D. DARROW 'ADDREss: 711 W 17TH ST #C-4 f COSTA MESA . * CA 92627 :,+ (714)642-2684 ARCHIENGINEER: KRAMER & ASSO. ADDRESS: 3002 DOW AVE TUSTIN PERMITTEE: DANIEL DARROW ADDRESS: 711 W 17TH ST COSTA MESA UNIT: c-4 REG.NO.: S E 2 3 013 6 CA 92680 UNIT' (714)642-2684 C-5 CA 92627 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under p(wWo s of Chapter 9 (commencing valh Section 7000) of Division 3 at the Business and Professions Cade, and my license is in full force and effect. CITY LIT,: STATE LiE,: CLASS: pate: Signature: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate at consent to sell insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab, C). POLICY NO.: EXP. DATE: Certified copy is hereby furnished. ❑ Certified copy is flied with the city Building Division, te: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred ($100) or less). t certify that in the performance o1 the work for which this permit is issued, I shall not employ arry person in any manner -so as to become subtest to the Workers' Compensation Laws at California, pate: Signature: NOTICE: If, atter making this declaration, you should become subject to the Workers' Compensation provisions of the Labor A— Code. you must lonhwith comply wilh such provisions or Nus permit shall be deemed revoked, z CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance�of the work for Which this permit is issued (Section 3097, Civ. C). A !ENDER: ADDRESS: .r OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7D31.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance. also requires the applicant for'such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' Slate License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cutle) or that helshe is exempt thereftom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applieam for a permit Subjects the applicant to a civic penalty o1 not mare than five hundred dollars (5500). 1, as owner of the property or my Employees with wages as their sole compensation, velli de the work, and the ❑ structure is not intended or offered for sale (Seclion 7044, Business and Professional Code: The Contractors' Stale License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/hersell or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however the building or improvement is sold vithin one year of Complelion. the owner will have the burden of proving helshe did not build or improve !or the purpose of sate). IX I, as owner of the property, am excrusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a confracloris) license, pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt umec Section: B. & P, C. for this seas/on: Dale: �U! T � Owner: t do hereby certify that I am aware of and understand the requirements of , rnia }lean an Safety Code Sections 25505, 25533, and 25534 and that 1 or any luture building occupant will1will not (circle one) n to comply nth said state codes and the requirements for a permit for Construction or modification from the Air Duality Management District. Residential construction applications are exempt from Ifnese provisions, Date: - _ - _ - Appficanl: I hereby Cerldy that I have read this application and slate [hat the above information is correct. I agree to Comply vdih all city and county ordinances and stale laws relating to building construction and hereby au lorize representatives at this city to enter upon the above-mentioned property for mspecI- n ours es Driver's License or Social Security •r 16Al-46 While—Building; Green—Code Enforcement; Canary --Applicant; Pink—Revenue; Goldenrod --Assessor CITY OF COSTA MESA — BUILDING PERMIT E!E;RM NG: E 0 5 4 20 3 PERMIT NO: E 054293 PLAN CHECK NO; N . N SU CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE PURPOSE; OTH JOB DESCRIPTION ; MOVE STAIRS, BUILD WALL & BEEF—UP FLOOR SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC; B-2 / COMMENTS: RE: B54292 PRIMARY BLDG, PERMIT, Z O N I N G S E T B A C K S R E Q U I R E M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RIGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42409111 ZNE: REF NO: PLANNING NOTES> iF � ♦E iF iF iF if if iF iF iF if if iE iF if if iF iF iF iE if iF � * * * * * it iF iF iOif iOif• iOiF it it it iF it' iE * * * i4 iE iF * iE * iE * it' � iE iF if if ib ib it it if if if iOit it iF it' D E V E L O P M E N T S E7R V I C E S R E'Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : DATE: rA APPLICATION ISSUED BY: DATE• �� iE ♦E iF iF if if if if if if if if if if if iE iF iE it iE t>f ?� iE iF it i4 it �E iE iE iE if if iE ib iE if if if * if iF if i4 iE iF iE it it it• iE it• iE it• iE * � * it• it• * * it * iF iE iF iE iE * it * * it• i6 it it it iF ifif iE ib ib ib ib � if if iF ib it it it � if if iE i4 ib iF iE LEGALIZATION:N F E E` S U M A R Y STRUCTURAL SEGMENT:N PERMIT BLDG PMT PLUMBING ELECgTRIC MECHANIC FIRE SMIP/RES GRADING .75 PLAN 50t SMIP/NON—RES ISSUE FEE 15.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 9,75 15.00 0,00 24,75 24,75 .00 REVENUE DIVISION TOTALS-->- COLLECTED: 24,75 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 24.75 iF if• iF iF iE iE iE iE ♦f iE iE ♦f iE ♦f it' * iE � i4 iF iF i4 if if iF iF iF if i4 ib iF ib ib iF iE iF ib iF iF iF in ie' ib ib ♦E iE iE iE ♦E * * � iE iE if• iF iF if ♦f iE iE iE iE iE iE iE ♦f * * * * * if• iE iF ib ♦E I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 6 FIXTURES LIGHTING 1 ST 20 EA. .75 4.50 ELE 4 RECEPT/OUTLET 1 ST 20 EA. ,75 3.00 ELE 3 RECEPT/SWITCH 1 ST 20 EA. .75 2,25 END OF FEES i�'✓ L�"`.y��; r�r�'f w� r�i tJl� r is . �� i f ��, F-- � CONSTRUCTION AND PLANNING PC�PA APPROVALS Permit'# Date Inspector APPROVALS Permit +_ Date Inspector 1. Temporary Electrical Service or Pole 52. Poo! & Equipment Location 2. Sdil Pipe-Undrgrnd, 53. Steel Reinforcement '-t3• Eli rri&L-Cdeduit-'Wtility-Undrgrnd. 54• Forms ln� 41t�ctraFal_ConuifiUndrgrnd. 55. Electrical Bonding force 56. 56. Rough Plumbing & Pressure Test _ .6 rFlectrical UFS~Gfnd. 57. APPROVAL TO COVER-GUNITE `t -' ;7' Footings', � ,r 58. Electrical Conduit-Undrgrnd. + ' 8. Foundation 59. Gas Pipe, G7 Undrgrnd., Test f� Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO HECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12, Sewer Cap 63. Heater & Vent -Final 13, Roof Draint u 64. Plumbing System - Final 14, Rough PluF'ibaing rr 65. Electrical -Final 15, Rougt4;Elect6kai-Conduit 66. Solar System -Final 16, Rough,Electric Wiring _ 67. Fencing & Access Approval 17. RoughziNiring,5ign fib. APPROVED FOR PLASTERING e" 18. Rough Eiectripl•T Bar Ceiling POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT T 1'.41=-- ntr APP�01fAtSa,: Permit # •- v 261 Ra�ugh Fact6ry,:.i e p I a c e i .�:rj �•y ., y G ; X:I, t=-; 2f; 13,utts,.in SiuG�ce :�� ; ' } 70�Und�igrdu+adydro t 22. Ducts 2Ventalafing Kr y k cs 71.' Produt SPiping7fl:Gas D Oil 21).. Gas Pipe -Rough& Test � n it Qy � '� 72. Undergrn Fi�_ h � } � T 24; R6`6f Framing {i 73. Undergrnd, StoFa a Tank O Gas aoif.-s 4-0 25. Roof eathin g t �- �'} '-r rt n}.F '► =� 7d. Overhea191-[ydFo•" ?'�U i v ',✓ J �J A� [ J v K Tear Ceiling [5iructural) & Monocoattrj� 7.5. Dry Chemical x 27; Frame and Flashing 'r 76. Dry StIrtra&Vpe; p z$. Ld2hin &Siding � . }. y 7,7, FIXEQ i YST<EN� FINAL r I V�,z �, r 29, Insulation ' " _ :1k FIRE PREY. FINAL I 30. Drywal} Nailin NEAI;T•Fi DE RT..REQUl,REII;/IENT 31. Plasterflrown Coat ��~•'' "` X�. F INA L;1ti' PECTJON 3?, Electrical P wed=Metier Final' ! �• y 8Q. FOOD Ct'E TIFa:GATE ISSUED �• '�� In Final >Electfic •~ t %�� F'' Notes: �' •=X , 1: 34. Final Rea; ng $t i Cgjnditio�li g 'X , . 35' Final Gas Pper.es'i[LO ti r.' 'ti .. r v �litY ." w.y ,-.. }. aT 36. Hsod Canopy,.+ ; t^ .z [� �, •Y .� 5. lit . .. t.. •a- trl 11 C7 f: qtr 373 F46Factory Fireplace t �tT a, e lrJ C ; w. c7 C00tri 38. Filial P;umbing Y 0 3$• Water'&&ice-Final`' :.:th = IX 40• Gas SeOice-Final s .l t �,� j"� A r 41. Solar Domestic -Final ;�`- i ,F Y Y I 0, Backflow Prevenfer- I * :7 >' $ 4 43. Backflow Irrigation V ,s S`5: r ., , r x >> t 44. Landsca e�lrri anon S stent y.� ,. P 4 Y [ 1 r : �'� lJ n� '7 �trt. C'3 .. IZ " �: ' t, 4$3 Sound` Attgnuatien `�t;-. tr' =, 4 Handitap i egula ions �-., _ _ r .x ,x 5 F 47; Fi[NAL SULICTURE & eUILDING s '� ti J 4k FtNAL PL,4NNII�.GF- a9. OQctric Release to Edison IFz 5 Gas Release to Southern California Gas Co J 51. CERTIFICATE OF OCCUPANCY [ri:� 71 No, Date PROJECT ADDRESS: 711 W 17TH ST OWNER'S NAME: DANIEL D. DARROW ADDRESS: 711 W 17TH ST #C-4 COSTA MESA CA 92627 (714)642-2684 ARCHIENGINEER: KRAMER & ASSO. ADDRESS: 3002 DOW AVE TUSTIN PERMITTEE: DIEL DARROW ADDRESS: 711 W 17TH ST COSTA MESA UNIT: C-4 REG.NO.: SE2309 CA 92680 UNIT: 136 (714)642-2684 C--5 CA 92627 LICENSED CONTRACTOR DkCLARATION: 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) at Division 3 of the Business and Professions Code, and my license is in full force and effect, CITY tic,: STATE tic.: CLASS: Date Signature: WORXERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent 10 sell insure or a certificate of Workers' Compensation Insurance. or a certified copy thereof (Section 3800, Lab. C), POLICY NO.: EXP. DATE: Certified copy is hereby fumished. ❑ Certified copy is filed with the city Building Dr isian. date: _ Applicant: EXEMPTION FROM WORKERS' DOMPENSAIIDN DECLARATION: (This sectton need not be completed if the permit is for one hundred (SlOO) or less). I certify that in the pertormahce 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 %Yorkers Cbrnpensalion Laws at California. Date: — Signature: NOTICE: If. after making this declaration, you should become subject to the workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shalt be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency far the performance of the work for which this permit is issued (Section 3097, Civ, C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' Slate License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance. also requires the applicant lot such permit to file a signed Staterrrent that he/she is licensed pursuant to the pfovisiods 01 the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code( or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars jS500). 1, as owner o1 the property or my employees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himselllhersell or through his or her own employees. provided that such improvements are not intended or offered for We. ll, however the building or improvement is sold wiUun one year of completion, the owner will have the burden at proving helshe did not build or improve for the purpose of sale). I. as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business and Professions Golfe: The Contractors' State License Law does not appy to an owner of property who builds or improves thereon and who Contracts for such projects with a Contractors) license pursuant to the Contractors' State License Law). I am aware that pool of their Worker's Compensation insurance should be provided to me. I am exempt under Section: B. & P. C. for this r_eaSOW Date: �f1/ 7 4wnov I do hereby cendy that 1 am aware of and understand the requirements of nornii flea/ and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant willlwdl n t (circle one) n Ado comply ih said state codes and the requirements for a permit for construction or modification from the Air Quality Management Distdct. Residential construction applications are exempt from (hese provisions. Date, — — Applicant: I hereby certify that I have read this application and state that the above information is correcl. I agree to comply with all city and county ordinances and stale laws relating to building construction and hereby authorue representatives of this city to enter upon the above-mentioned properly Int inspection purposes. .0 _ ® / Driver's License or Social Security n - 164;.46 white—Bwldinq; Green—Code Enforcement; Canary—Apprirant; Pink—Revenue; Goldenrod—assessor CITY OF COSTA MESA - BUILDING PERMIT PERM NO., PERMIT NO: P 054294 PLAN CHECK NO: N , CONSTRUCTION TYPE: 5-N PERMIT TYPE: PLU PURPOSE: OTH JOB DESCRIPTION MOVE STAIRS, BUILD WALL & BEEF -UP FLOOR SQ FT: CLAIM VALUE: CALC-VALUE; GROUP OCC; B-2 / COMMENTS: RE: B54292 PRIMARY BLDG. PERMIT, 'I! 'IF'IF * iF '1I"IF'1I"1I' iF 1I"1I' #'1! iF'1!'1! * #E #E iF it• �t it if it d1"IF �F'IF #F 1F Irk * * * * * *' *' *' *' * *'11"1I"If 1I"1!'1!'1I' * iF #F if if iF * * 1F # il• ib * # # ib ib # # # �F # �! �F �F Z O N I N G S E T B A C K S R E Q U I R E M E N T S ------------ MAIN BUILDING ----------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT, FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42409111 ZNE: REF NO: PLANNING NOTES> > ib * 1F * 9! �F'k * * * * 1! Irk �F * � * � it• d1"It'It iE'It'It �[' ib ib ib ib iF 111F'IF'IF # lE'1! �F # iF lE �F i[• * � � 1F 1F'IF'IF'It'It'I!'It'I! 1T' 11' 1F'MF iF * *'1!'1! �t * * 1F'1!'1!'1! �t * iE �4'IF'IF D E V E L O P M E N T S E R V I C E S•,, R E Q U I R E M E N T S ZONING APPROVED BY fir: DATE: 'rr BUILDING APPROVED BY : DATE: APPLICATION ISSUED BY: } DATE: �F'1!'If'If'Ifil•***fit******�F'IF'1I"1I'�E'IF '1!********* 'If it LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 4,00 25! SMIP/NON-RES PLAN , ISSUE FEE 3.00 : BUILDING -DIV-> PERMIT ISSUE -PLAN-CHECK TOTAL PAID DUE TOTALS ---- > 4.00 3.00 0.00 7,00 7,00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 7,00 OVER/SHORT: .00 BLDG PMT PLUMBINGELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 7,00 S, �! x!'1!'1! * * * * *'1! �t'1! �t � �t'I! �F �F'I!'I!'I! * �! �!'1! *'1!'1!'1!'1! #E il•'1! }(�F �F * * * � IF * � � * �t �F'1! �t * * �t'1!'1!'1! �F 1F #F * frt * � �F'I!'I! � it'IF'IF'IF 9! 9! �! �! �t * * *'1! I N D I V I D U AiiL F E E B R E A K D O W N J TYPE QTY D E S C R I P T Ito N UNIT COST TOTAL COST PLU 1 SHOWER 2.00 2.00 PLU 1 SINK, BAR 2,00 2,00 "END OF FEES r' O r CONSTRUCTION AND PLANNING PO A• 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 t3_!'tlectr C$I'_Ccri8uit-LUtility-Undrgrnd. 54. Forms ""+ 1 `1, •.114 .5: . ! ElectricaLConduit-Vndrgrnd. 55. Electrical Bonding =r tee[�Re<i-#orceRent 56. Rough Plumbing & Pressure Test - .[. r1 'C'Iectniea') UF�:R.Grnd. 57. APPROVAL TO COVER•GUNiTE G- 7� Footing's T, Y'„•' 58. Electrical Conduit•Undrgrnd. Is-. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test Water Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, ❑ Undrgmd, 7. 10, Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final' 12, Sewer Capa r 63. Heater & Vent -Final r 13. Roof Drains; It 64. Plumbing System - Final 14. Rough PiuQ ing '' 65, Electrical -Final 15, Rough,Electr.isal-Conduit 66. Solar System -Final [ 16. Rough•Electrie Wiring 67. Fencing & Access Approval }' r 17 Rough`V$�ringsSi�n 68. APPROVED FOR PLASTERINd/ 18, Rough Electr it -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROV'A1 STC Permit # ' *• '' 20R6ugh:Fa ry;ireplace t u;ai <; ~ r ;j T :i . 1-7 2,T- D%cts;-in Stfuct�,t i ' `-'� A, r -a -.* .� ., �.�r ,T 70.t Undergro"d Hydro } 1 .. ._ 22. Du cts'Wentilatingx + .5 r •� i 71. Prodd'ic iping?t?fiGas ©Oil 23; Gas Pi'e Rough'&`Test "? ! + `- 72, Underground F1u�,h ti trj u 24- Rc��pf FramiAg v, r ` 3. T •- 731 Undergrnd. StorETP Tank ❑ Gas © Oil 25. Rof S-keathing ' = `' 74 Overhea�ljHydro� ; 2e. T;Bar Ceiling {S Ucturall Moo 0coat t - T' r Y * -, 75 Dry Chemical .- 271 F•raamynd Flashing i 7T Dry StagpipeW ;�+t a� rix 28. Lathing & Siding t - ;»'s u; y •-t. 'K 77: FIXED. SY-;STE=M'NPL' 29. Insulation 78, FIRE PREY. FiINAL * V �; ' 30. Drywalt Nailing4 i t# +M •i-4HEALT�i DEPT: REQUIREMENT s 31. Plaste�'Bropn Cit 1 �; 79 =FIiVN0NSPECtION irrr i 1z 32 Electrical P_gweCfUketer Final N }!Y t 80: FOOD rCERTIP-IOATE ISSUED r- 33: Final Elecj�rlc i d x th } t N8tes: �f g2 [704�Gxxie�- L4e1a + .. j 34. F`nal Fieatir g &TAir'Condiiior ii'ag� l 3X. Final 5ps PPe-Tett ua , 3'l Rood of CarnoPY. tC�`ra rt. " - i LO ..:ZLT., 3T: FiKal Factory FirBplace fir r izf I In €� + r. J 38. Final P�umhing p; ; ti ' �r G1S , , .1� T 39. Water!Service-Final r � � � rr tT' -jr [ r ;u t 40. Gas Service -Final'' r 41. Solar Domestic -Final. ^• cr 42: Backflow Prevent�jr' rs; J 43. Backflow Irrigation J s :� a.- 0 44. LandsVpe�lrrig4on SysteLnt,j..� W k t r�* * tt ;',j CO J �O tr 45! Sound Atthnuation �. �� t,: t -'r -t : x -+ e't. - C 4F: Handii_4 Regulations k lt! .. .. 1 ! / / !-ice• ..•-� T 47: FINAL STRUCTURE & BkJILDING'i l f t •- S` - t 4V F_M1AL PL-A NNIG j :., k ss f' r ri7 49; Electric Release to Edison 50. Gas Release to Southern Caiitornia Gas Co %m Y V 51. CERTIFICATE OF OCCUPAN Y r No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA��M,,ESppA CQNSTRU2TION PER VT P MIT N TRACT NO LOT NO. UN N6 Project Address -z�� 7 S�� C -q Applicant's Mailing Address �8 7 �� ad ZN L 2 Owner's Name R ✓ ° Phone Address Arch/Eng, License No. Address r+ Contractor's Nam 7 ^'f " d Q Phone 77,'7 1-7r1� Address (mailing) 7 dZ_ City License No. % 2I 5' 2 G $ fa N LicESEO CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Profossions Code, and my license is in full force an effect. License Class (2e. Icenso IV� 0 Z, Z ¢ 7 Date d+1s Signature WORKERS' COMPENSATION OEC RATION I. hereby affirm that I have a rartifiCate of consent to solf-Insure or a certificate if Workers' Compensation insurance, or a certified copy thereof (Section :800, Lab, C.) Policy No. _ Company `- eCertified copy is hereby furnished. ' Certified copy is filed with the city Building Division. Oate Applicant EXEMPTION FROM WO R KP-RS'COMPENSATION DECLARATION (This section need not be completed if the permit iS for one hundred ($100) or less). -11: I certify that in the performdnce of the work for which this permit is issued, I shall not employ any person in any manner 7o as to become subject to the, Date o lmp�ns oR_Uwgnaturellf 'SI NOTICE: If, after making this declaratfoilli, you should become subject to the Workers' Compensation provisions of the Labor Coda, You must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY ' I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address -- OWNER BUILDER DECLARATION I hereby affirm that I am ekempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any Structure, prior to its Isguance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commenting 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 jenelty of not more than five hundred dollars ($500). ❑ I, as owner of the properly or my empioyees with wages as their sole Compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own employees, Provided that such Improvements are not Intended or offered for sale. If, however, the bulldlr)g or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale), ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code; The Contractor's License Law does not apply to an owner of property who build$ or improves thereon, and who contracts for such projects with a con- traCtor(s) license pursuarit'tn_ the'contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that t have read this application and state that the above Informatlon is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city o enter upon the above-mentioned property for Inspection Pur s, r7 Signature Data L�" Drivers' LiceWge or SS # I PLUMBING I FEES I, Bar Sink Backflow Preventer Backfiow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service. / Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. tCBO # Heating System & Ducting 00-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor MEC Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee I $ 3 FEES Hood or Type 1 ❑ Canopy Type 11 ❑ Refrigeration System ❑o-100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 9931 3/25/65 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas OElectric Fan F.A.U.— - - Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW ❑5-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors 1:10.1 HP ❑1%-8 Inc. Solar 09.15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 10.56 FEES I Reinspection Fee 1 $15 1 1 Issue Fee f $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By SUMMARY OF FEES op— $ TYPE O/FCONSTRUCTION 0 NEW U ADO LJ ALTERATION REPAIR $ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER PLUMBING A.P. DESCRIPTION OF WORK/USE OF BLDG. PLAN CHECK 25% $ __--1T�_S ENERGY P.0 ELECTRICAL $ S Main Buildi $ MICROFILM E $ TYPE OF PERMIT El GRADING ElFOUNDATION 0 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B ❑ OTHER A Rear C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATION $ $ Left ZONE GRADING CU. YDS. ACRES Ping. Rei. # Remarks: Planning Notes: I PLUMBING I FEES I, Bar Sink Backflow Preventer Backfiow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service. / Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. tCBO # Heating System & Ducting 00-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor MEC Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee I $ 3 FEES Hood or Type 1 ❑ Canopy Type 11 ❑ Refrigeration System ❑o-100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 9931 3/25/65 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas OElectric Fan F.A.U.— - - Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW ❑5-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors 1:10.1 HP ❑1%-8 Inc. Solar 09.15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 10.56 FEES I Reinspection Fee 1 $15 1 1 Issue Fee f $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By PLAN CHECK 25% $ Z O N I N G R E M T S SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ __--1T�_S ENERGY P.0 ELECTRICAL $ GRAOING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ Z O N I N G R E M T S -F -ti r ;''. t CONSTRUCTION AND PLANNING APPROVALS Permit # Date, " inspector POOL a SPA APPROVALS Permit # - Date Inspector 1. Temporary Electrical Service or Pole r 52. Pool &'Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel'Reinforcement t 3: Electrical Conduit Utility-Undrgrnd. 54. Forms .4. Electrical Conduit-Undrgrnd. 1 55. Electrical Bonding �5Steel Reinforcement 56. Rough Plumbing &Pressure Test 6.4Eiectrical UFER Grnd. 57. APPROVAL TO COVE R-GUNITE 7• Footings 58, Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test _ 9. Water Pipe Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final •12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing,. G 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil .23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank'❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace - 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final �. . 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison " 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No, Date _ . , Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. LOT NO. U T b. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 711'W. _17th_ St. Bldg. (C) Unit 4 Applicant's Mailing Address 13110 Saticoy -St. -N.Hollywood Owner's Name Troy Investment Fund Phone 549-2988 Address 4321 Birch St. Ne ort Beach, Ca . - Arch/Eng. Marin .J . Rock License No. Address 12881 Knott Ave. Suite 216 Contractor's Name.—Oil itionin Phone 982-1216 Address lmailing)-13100Saticoy St N.Hollyw000d,Ca. City Licenie No, 33925 LICENSED CONTRACTOR DECLARATION I hereby affirm that f am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Pro ssions Code, and my license Is in full force and effec 346251 License Class Lice e Date 4119184 Signature WORKERS'COMPENSATION DE RATION I?ereby aft Irm that I have a Certif' to of consent to selfansure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section 800, Lab. C.) Lumbermans dolicy No. �_o� Company BCertified copy is hereby furnished. Certif'e y is filed with the city Buil g Division. Date — Applicant M�fin EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to tete Workers' Compensation Laws of California. Oate Signature 'NOTICE: If, after making this declaration, you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY .� I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name,-- Lender's ame-Lender's Address OWNER BUILDER DECLARATION I hereby affirm that t am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or.ropair 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 the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the property or my .employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvementsare not intended or offered for Sale. If, however, the building or improvement is sold within one year of com- pletion , the owner will have the burden of proving he/she did not build or Im- rove forr the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 bulldsor Improves thereon, and _who contracts -fpr such projects with a Can- , tractors) license pursuant to the Contractor's License Law). I am aware that proof o their Worker's Compensation Insurance should be provided to me. ❑ 'i am exempt under Section B. & P. C. for this reason Date Ihereby certify that I h information Is correct. I a and state I relating to sentative of this city b inspects p =L. os s, `(/,j Signal Driversense or SS 41 (2)sa3 c'.1 ` - TYPE OF CONSTRUCTION NEW Ll ADD Ll ALTERATION LJ REPAIR ❑ ❑ ❑ FEES Dishwasher Meter Dover 100 amps CONVERSION DEMOLISH OTHER .i Dryers ❑Gas' DElectric Sub Panel A.P. qtr, DESCRIPTION OF WORK/USE OF BLDG. F.A.U. Inc. Solar 09-15 HP El 16-15+ BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% Fixtures Microwave SMIP S PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ - S� 5 Main Building: Outlets Range E TYPE OF PERMIT GRADING1:1 FOUNDATION 0 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL B ❑ -OTHER A Rear C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY KLeft CONSTRUCTION TYPE VALUATION $ $ ZONE GRADING CU. YDS. ACRES Ping. Ref. Remarks: Planning Notes: Owner ve read this application and state that the above. 1 reecomDIY with all city and county ordinances bW i g construction, and hereby authorize repre- p r upon the above-mentioned—T,90erty r oat Z Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Interceptors Kitchen Sink - Lavatories P—Trap Roof Drains Reinspeetio� Fee Outlets F PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays $15 Issue Fee Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBD + Heating System & Ducting 0-100,000 BTU (JI 00,000 BT Rainspeltion Fee 1 $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor IANICAL Hood or Type 1 ❑ Canopy Type II ❑ Refrigeration System ❑x100,000 BTU ❑100,000 BTU System Repair/A iteration Fire Dampers Registers Issue Fee 1762 4/24/85 Zone Accessory Building: Parking Req./Provided 151,50 TL FEES ELECTRICAL FEES Automatic Washer Transformer ❑ 15-50 KW Construction Pale Sub. ❑ 50 + KW $15 I I Issue Fee Cob king Unit Meter ❑up to 100 amps FEES Dishwasher Meter Dover 100 amps .i Dryers ❑Gas' DElectric Sub Panel Fan Motors ❑O-1 HP Dl'/j - B F.A.U. Inc. Solar 09-15 HP El 16-15+ BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% Fixtures Microwave SMIP S PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ - S� Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal ; Standing Sections Generator ❑0.5 KW 05.15 Kw Trash Compactor Z O N I N G R E a M T S $ 3 I Reinspection Fee $15 I I Issue Fee $ 3 FEES DEVELOPMENT SERVICES REGUIREMENTS: Zoning Approved By Building Approved By Application Issued By - Date Date Dai BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ S S $ $ —_ 13.00 $ SMIP S PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ - S� $ 3 `- CONSTRUCTION AND PLANNING APPROVALS • Permit # Date r - Inspector POOL _. , PA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Poof &Equipment Location 2. •Sail Pipe-Undrgrnd. 53. Steel'Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding i 5. Steel Reinforcement r- 56. Rough Plumbing & Pressure Test /1 �` •, 6. Electrical UFER Grnd. ' /Z 57. APPROVAL TO COVER-GUNITE -7. Footings 58. Electrical Conduit-Undrgrnd. kL ` 8: Foundation r 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. �� 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 1.1. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 1 64, Plumbing System - Final Y 14. Rough Plumbing 65. Eiectrical-Final r' 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 Sar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping D Gas D Oil 23, Gas Pipe -Rough & -rest 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank D Gas D 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 76. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace s 38. Final Plumbing / • (RQ 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 1 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to 5dison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OPCOSTA MASA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO project Address t P c (-1 2� C-3, TYPE OF CONSTRUCTION I LJ NEW LJ ADD LJ ALTERATION LJ REPAIR qL_ Applicant's Mailing Address Owner's Name 1 a-� %� �`-' I" Phone Address _ Arch/Eng. License No. Address Contractor's Name) arg, S 6UJZACreZ ! C phon,.%=7'_e 4R,: Address (mailingr 3�Ci�/r1rn4 �-3 5Q7!{ City License No. _- r .:�!D LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions o Charter 9 (commencing with section 7000) of Division 3 of the Business a d ProfesSi s Code, and my license is in fu for o d of , Licens Class Lic e No. 3! Date to -;nc ignature WORKERS' COMPENSATION DECLARATIO I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section oliy cNo Lab. C.� 70 P S02kC c- I HCertified copy is hereby furnishe Certjfled cop�jis-tiled with the ci y Bu' in Division. Date !-'/� �S — Applicant EXEMPTION FROM WORKERS' COMPENSATION ECLARATION (This section need not he completed if the permit Is for one hundred ($100) or less). ' I certify that in the performance of the work for which this permit is Issued I shall not employ any person in any manner so as to become subject to the Workers' Compensation taws of California. Date _ - Signature 'NOTICE: If, atter making this declaration, you should become subject t0 the Workers' Compensation prOVISIOnS Of the Labor Coda, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY ' I hereby affirm that there IS a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097 Civ. C.) Lender's Name Lander's Address ' OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which require$ a permit to construct, alter. Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit t0 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 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 inalty of not more than five hundred dollars ($500). I, as owner of. the. property or. my"employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herseif or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletionor, the owner will have tho burden of proving he/she did not build or Im- prove fthe purpose of sato). ❑ I, a$ owner of the property, am exclusively contracting with licensed con- tractors to construct the project(Section 7044, BuSinesS and Professions Code: The Contractor's Licqnse Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) Ilcense pursuarit'to the CoMractar's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Date Owner 1 hereby certify that I have read this a Informationh,r;. re agree to amply and State ng buiIdin cons sentatives ity o enter upon Inspection Signature Drivers'License or SS # -ation and state that the above h ail city and county ordinances on, and hereby authorize repre- above-mentioned property for pate f—�f.�- ^ 4er ❑ CONVERSION -❑ DEMOLISH ❑ OTHER A P. # DESCRIPTION OF WORK/USE OF BLDG - S Main Building: E TYPE OF PERMIT El GRADING 0 FOUNDATION El STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ •0 -HER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Right K CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: 5836 1/16/85 Accessory Building: Parking Req./Provided �e63 . T1_ Zone Z O N I N G R E Q M T S CMF 0865-46, rev. 10/84 White . Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub, Transformer ❑ 15-50 KW ED 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps Dishwasher Solar Piping Dryers ❑Gas ElElectric Sub Panel Drinking Fountains Solar Tank Fan ! Motor HP ❑ 1'h - B Floor Drains Swimming Pool vv/Spa F.A.U. Inc. Solar 1:19.15 HP 016.15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Interceptors Kitchen'Sink Water Closet Water Heater Water Service Device Boxes Outlets Switches Pole Light Range Sign Lavatories Auto -Wash Garbage Disposal ! Standing Sections P -Trap • Laundry Trays Generator ❑0-5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee S15 Issue*Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date I Boiler Hood or Type 1 0 Canopy Type 11 ❑ Duct - Under Ground Duct - Structural Refrigeration System ❑0.100,000 BTU ❑ 100,000 BTU Duct -Ventilating BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% S $ PLAN CHECK 50% S MECHANICAL $ PLAN CHECK 25% S SUMMARY OF FEES SMIP $ PERMIT ISSUANCE S ENERGY P.C. $ _ _4 GRADING $ rD MICROFILM $ TOTAL FEE $ Exhaust System ❑ Multiple ❑ System Reps ir/Alterot ion Firepl/Fact. Bit. ICBO # Fire Dampers Heating System & Ducting ❑0.100,000BTU El 100,000 BTUELECTRICAL Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White . Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # T Date Inspector - POOL A APPROVALS Permit # Date w. InspPctor ' 1. Temporary Electrical Service or Pale or 52. Pool &Equipment Location 2. Soil Pipe Undrgrnd. 53. Steel Reinforcement 3r Electrical Conduit Utility-Undrgrnd, ^ ' 54. Forms 4'• Electrical Conduit-Undrgrnd. t 1 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:o Foundation ' ;' 59. Gas Pipe, ❑ Undrgrnd., Test r• 9,.. Water Pipe-Undrgrnd. 60, Backwash Lines, P -Trap, ❑ Undrgrnd, ' iOC'Structural Floor System 61. APPROVAL TO DECK 11'Property Sewer Line & House Connection (11 62. Backwash & Receptor -Final 12.; Sewer Cap 63. Heater & Vent -Final 13� Roof Drains _ 64. Plumbing System - Final 14, Rough Plumbing"4. . , 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. POO USPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd, Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77, FIXED SYSTEM FINAL 29, Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System r 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 Nip. Date - Applicant t0 fill in all spaces except those within heavy border lines and Sign all appropriate declarations. STA MESA CONSTRUCTION PERMIT e_ -E; PE MIT NO. TRACT(�N'O, PrOT N, U IT NO. W. I_ $3 o r r a% i� -- 5 - Project Addres- - JU W_ LtMllrw 21 QJIA 119J&4 C/ Applicant'- Mailing Address Owner+xName ___s� Phone Address Arch/Eng. ^T License No. Address Contractor's Name Phone Address Imailingi-- City License No. --2s.1016 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under Provisions Of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and etf License Class A/ i se � Date_Signature WORKERS C�OPENSATION DECLARATIO I hereby affirm that I have a certificate of con nt self -insure a certificate of Workers' Compensation Insurance, or certI letl copy r (Section 3800, Lab. C.) 'ACS' If r/ ` )Iicy No.,. CO any {! Certified copy Is hereby furnished. / , J Certified copy is filed with the city B Divis Date Applicant EXEMPTION FRO WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work r whi h th permit is issued, I shall not employ any person in any so a b subject to the Workers' Comgen tion Laws of Calif Date �� -- �� _ —Signature NOTICE: If, after making this declaration, you sho"Wbqkcime subject to the Workers' Compensation provisions of the Labor ode, "you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, after, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to filo 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 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 nendlty of not more than five hundred dollars (5500). I, as owner of the property or my employees with wages as their sole npensation, will do the work, and the structure Is not intended or offered ,r sale (Section 7044, Business and Professional Code: The Contractor's License taw 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 employees, provided that suCh improvements are not Intended or offered for sale. It, however, the building or improvement Is sold within one year of com- pletlon, the owner will have the burden Of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project(Section 7044. Business and Professions Code: The Contractor's License Law does not apply to anowner of property who 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 proof of( their Worker's Compensation insurance should be provided 10 me. ❑ 1 am exempt undo . on B. & P. C. for this reason DateVthl OWsplic 1 hereby certifven and state that the above Informationisrcity and county ordinances and state laws nd hereby authorize repre- sentatives of te-mentioned property for inspection purp ` Signature f Drivers' License or SS g¢ TYPE OF CONSTRUCTION LJ NEW LJ ADD &KALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER OESCgIPTION OF WORK/USE OF BLDG -S TYPE OF PERMIT GRADING FOUNDATION TRUCTURAL ® TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER A.P. 91h 4;ZA/-�9 _ ` Zone Main Building: Accessory Building: E T Front Z O A Rear 1 "� N PROJECT DESCRIPTION S . FT. O OCCUPANCY-- '~ CONSTRUCTION TYPE VALUATION $ ^3 x.40 ZONE GRADING CU. YDS. 4 ACRES -"a` --- C Flight N K S Left G R Ping. Ref. Parking Reg./Provided E Remarks: �.., -� Planning Notes: tgNAN7 • n Q W D Np, M U AJTi� /e T S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Drinking Fountains Solar Pipin Solar nk Dryers ❑Gas ❑Electric Fan, Sub Panel Motors ❑0.1 HP ❑ i r5 - B Floor Drains Imming Pool w/Spa F.A.U. 1nc.Solar ❑9-15 HP ❑16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories .; Auto -Wash Garbage Disposal Standing Sections P -Trap Laundry Trays Generator ❑0-5 KW 05-15 KW Trash Compactor Drains Reinspection Fee $15 Issue Fee S 3 Reinspection Fee $15 Issue Fee S 3 MECHANICAL FEES DEVELDPMENT SERVICES RE UIREMENTS: Zoning Approved By Date 5 �� Building Approved By IF Date Application Issued By Dat SUMMARY OFF S BUILDING PERMIT S SMIP � PERMIT PLAN CHECK S PLUMBING $ ISSUANCE 5 PLAN CHECK 25°6 $ ENERGY P.C. S ELECTRICAL $ `%.Z� GRADING 5 PLAN CHECK 50% $ MICROFILM S MECHANICAL $•damTOTAL FEE $ PLAN CHECK 25% $ I I 70r Boiler Hood or Type 1 ❑ Canopy Type II ❑ Duct - Under Ground Duct - Structural Refrigeration System 00- 100,000 BTU ❑ 100,000 BTU OD Duct - Ventilating Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepi/Fact. Bit. ICBO Fire Dampers Heating System & Oucting ❑0.100,000BTU ❑100,000BT Registers Reinspection Fee S15 Issue Fee $ 3 CMF 0865.46, rev. 10/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor _ CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA 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. 4. Electrical Conduit-Undrgrnd. 54. Forms 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE r7.• Fbotings 58. Electrical Conduit-Undrgrnd. 8. Foundation " 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. , 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring H ftJ if 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 "0 APPROVALS Permit r � 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil' i 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro t 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe ' 28. Lathing & Siding 77. FIXED SYSTEM FINAL -1 29. Insulation 76. FIRE PREV. FINAL 30. Drywall Nailing G/� HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION ', r 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric otes: }' 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace v. 38. Final Plumbing 39. Water Service -Final , •40. Gas Service -Final ; q41. Solar Domestic -Final '42. Backflow Preventer `43. Backflow Irrigation ,44, Landscape Irrigation System 45. Sound Attenuation 1 , 46. Handicap Regulations i f 47. FINAL STRUCTURE & BUILDING r•' s ' `. 48. Special Requirements Completed " 49. Electric Release to Edison / 50. Gas Release to Southern California Gas Co ! 51. CERTIFICATE OF OCCUPANC" No. Date ' ' - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. ' 7561 10/16/67 i 6.75 , TL CITY OF COSTA MASA. C TRUGiIQN PERMIT ProjVt Address �� tv 7 G- `7 T� Applicant's Mailing Address �OVJ�A , e ne Phone �,-�_� Owner's Name �/e �(5-7 Address 711 CA-) ! ` -'-7 t � PERMIT NO. �� `I TRACT NO. LOT NO. UNITIVO. L TYPE OF CONSTRUCTION NEW ADD ALTERATION � REPAIR ❑ CONVERSION ❑ DEMOLISH- ❑,OTHER DESCRIPTION OF WORK/USE OF BLDG.- q,p• qIE Zone 5 Main Building: Accessory Building: Arch/Eng. License No. Address TYPE OF PERMIT 'GRADING • FOUNDATION STRUCTURAL ❑ TENANT XELECTRICAL' ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY C O N STRUCTI ON TYPE VALUATION $ ZONE GRADING CU.YDS. ACRE S E T Front Z O A Rear • N �^ Contractor's Namr,e% v Phon 35 Address (mailing) 7Z C��i7?rSC� g7}J City License No. - -.-- - LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisi 9 (commencing with section 7000) of Division 3 of the B ess and Profes ns Code, and my license is in ful fo e a ff t. License Class erise No. Date �IA2-146-g7_ Signature C Right N K S Left G R Ping. fief, # Parking Req./Provided E Remarks: Planning Notes: Q M - T S PLUMBING FEES wOR'KERS' COMPENSATION DE LARAT N I hereby affirm that I have a certificate of c sent to self -insure or a certificate ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW - , of Workers' Compensatlon Insurance, or a certified copy thereof (Section 3600, Lab. C.) Policy No. _ _- Company eCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter El up to 100 amps. , Date - Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner o as to be c me subject to the Worker s'.0 mp at' Laws of Califo ata. Date f Signature ��A Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps ' Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel , Drinking Fountains Solar Tank Fan Motors El 0-1 HP ❑1 /z 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 HP. 016-15+ NOTICE: If, after making this declaratl n, ou should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction fending agency for the performance of the work for which this permit is issued (Section 3097 Civ, C.) Lender's Name FI00_r Sinks Urinal Fixtures Microwave Gas'Service Outlets Water Closet Device Boxes Pole Light cV Interceptors Water Heater. Outlets Range Kitchen Sink Water Service Switches Sign Q Lender's Address - OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5'BusineSS and Professional Code: Any city Or county which requireg a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for Such permit to fiie a signed staternent that he/she is licensed pursuant to the provisions Of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as -owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7084 Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale, if, however, the building or improvement is sold within one year of com- pletion, the owner wilt have the burden of proving he/she did not build or im- prove for the purpose of sate), [3I, as owner of the property, am exclusively contracting with licensed con- 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 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 proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under section B. & P. C. for this reason Lavatories Auto -Wash Garbage Disposal Standing Sections , P -Trap Laundry Trays'Generator ❑0-5 KW ❑5-15 KW Trash Compactor Roof•Drains (��1Q.�/??1'L.�l ."o �r t7 r� , Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $'3 MECHANICAL FEES - DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved ByDate Building Approved By - Date Application Issued By Dat Boiler Hood or Type ! ❑ Canopy Type 11 ❑ Duct - Under Ground Duct - Structural Refrigeration System 00-100,000 BTU ❑ 100,000 BTU Duct - Ventilating BUILDING PERMIT � PLAN CHECK PLUMBING PLAN CHECK 25% -E LECTR ICAL PLAN CHECK 50°/6 MECHANICAL PLAN CHECK 2595 SUMMARY OF FEES $ SMTP $ $ _ PERMIT $ ISSUANCE $ $ ENERGY P.C. $, �L� sf� GRADING $ $ $ J. "Y l MICROFILM $ $ TOTAL FEE $ $ I Exhaust System ❑ Multiple ❑ System Repair/Alteration _ Firepl/Fact. Bit. ICBO # Fire Dampers Date Owner • I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to buildin construction, and hereby authorize repre- sentatives of this city a upon the above-mentioned propertyf inspection pur s•�� Signature Dat Drivers' Lice a or 55 ' Heating System & Ducting ❑0-100,000 BTU ❑100,000BT Registers Reinspection Fee $15 Issue Fee $ 3 :MF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accountingi Goldenrod - Assessor TION AND PLANNING ALS Permit # porary Electrical Service or Pole Date Inspector POOL &SPA APPROVALS Permit # ' Date Inspector 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59, Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System y 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 i• r , 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOLISPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26, T-Bar Ceiling (Structurals & 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 Z10. FOOD CERTIFICATE ISSUED -i 33. Final Electric GJ�__N2tev 34, Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37:' Final Factory Fireplace I 38., Final Plumbing 39. Water Service-Final 40. Gas Service-Final r 41. Solar Domestic-Final "42. Backflow Preventer 43. Backflow Irrigation 44' Landscape Irrigation System �. r '145'. found Attenuation 46. I.,landicap Regulations y 47. FINAL STRUCTURE & BUILDING 48:< Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co , A 51. CERTIFICATE OF OCCUPANCY No. Date .. ; a Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT P MIT NO TRACT NO. LOT NO. UNiT`JVU,� Project Address 7 11 _V-6-1.4i"-7� s -r G Dishwasher Meter [Dover 100 amps Dryers ❑Gas ❑Electric Sub Panel TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. Applicant's Mailing Address / �'� A/ p Nrc+ r a Owner's Name Phone Address Inc. Solar ❑9-15 HP ❑116-15+ Fixtures Microwave Device Boxes Outlets Switches Pole Light Range Sign Arch/Eng. License No. Address / r /,,.a r+f 1 Phone?'? 7 -2-746❑ Nam57%,Phone TYPE OF PERMIT LJ GRADING El FOUNDATION El STRUCTURAL ❑ TENANT ❑ ELECTRICAL 11 PLUMBING C1 MECHANICAL OTHER / Address (mailing) !'1 /—A ,gf City License No. .47' Z i ___—_ S'L 6 R PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATIC)N $ TOTAL FEE Remarks: $ I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the guslness and Professions Code, and my license is in full fortan effect. License Class G, Ll cense No$C I1 0 7_ Date2 ^ I" + 2 C'SignaturePLUMBING FEES WORKERS' COMPENSATION DE RATION I hereby affirm that I have a certificate of consent to self -insure or a certificate Bar Sink Showers Backflow Preventer Service Sink of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Backflow Irrigation Sewer Cap Policy No, Company Certified copy is hereby furnished. H Bathtubs Sewer Connection Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - Clarifiers Solar Collectors (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for ich this permit is issued I shall not employ any person in any manryer s std become subject to the, Work �s'�C4rtlpert tlpwLaws of Califo Date YY ?�ee33 SS Signature Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa "NOTICE: 11, after making this declarati , you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. Floor Sinks Urinal ' Gas Service % Outlets Interceptors Kitchen Sink Water Closet Water Heater Water Service CONSTRUCTION LENDING .AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit ig Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 ekemption. Any violation of Section 7P.31 , 5 by any applicant for a permit subjects the applicant to a civil aly of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole conmpensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License taw 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 employees, provided that such improvements are not intended or offered- for Sale, If, however, the building or improvement Is sold within one year of com- the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not 4pply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains ReinspeetlOn Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Hood or Type I ❑ Canopy Type II Elpletion, Duct - Under Ground Duct - Structural Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU Duct - Ventilating Exhaust System El Multiple El System RepairlAlteration tractors) license pursuarit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. Firepl/Fact, Bit. ICBG # Fire Dampers ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances Heating System & Ducting ❑0-100,000 BTU ❑1w000BTL. Registers " and state laws relating to building construction, and hereby authorize repre- sentativesof this cit to enter upon the above-mentioned property for inspection p ses. r /�13�' Reinspection Fee $15 Issue Fee $ 3 .. Signature Drivers' License or SS CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 9938 3/25/85 A.P. S Main Building: Accessory Building: E T Front ARear C Right K S I Left Ping. Ref. + Parking Req./Provided Planning Notes: Zone ELECTRICAL Automatic Washer Construction POle Sub. Transformer D 15-50 KW ❑ 50 + KW Cooking Unit Meter El up to 100 amps Dishwasher Meter [Dover 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors ❑0.1 HP ❑ 1 4 - 8 F.A.U. Inc. Solar ❑9-15 HP ❑116-15+ Fixtures Microwave Device Boxes Outlets Switches Pole Light Range Sign Garbage Disposal ; Standing Sections Generator 00-5 KW 05-15 KIN Trash Compactor Reinspection Fee I $15 .LMIssue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By $ FEES $ 3 Z O N ( N G R E a M T S SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ _57—i9 ENERGY P.0 ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ $ FEES $ 3 Z O N ( N G R E a M T S CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL,_ .'A APPROVALS Permit # Date Inspector 1.. Temporary 1-lectrical 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. Efectrical 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 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK i 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. arses 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 APPROVALS Permit # 20i Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof f=raming 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26.1' T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27.' Frame and Flashing 76. Dry Standpipe 28.' Lathing & Siding 77. FIXED SYSTEM FINAL 29, Insulation 78. FIRE PREY. FINAL 30., Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: ' 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy _ 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer-,�f�d%,) 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 _ ,._o co C, r M Cr CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address -- - 711 , W. 17tt1_St. ' Bldg. (C) Unit 5 Applicant's Mailing Address 13110 Saticoy St. N.Holl wo Owner's Name - TroyInvestment Fund. Phone 549--29 Address 4321 Birch St. NeWport�Bt3aCi Ca. Arch/Eng. — Marin J _ ROCk - —License No. Address 12881, Knott Ave, St!_216 Contractor's Nam, ilurD Air c nrlitioning.Phone 982-1216 Address (mailing) 1 31 10 Sa t -i rrO St, N .H9J1ywOod, Ca. City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing With section 7000) of Division 3 of the Business an rofessions Code, and my license is in full force grid effe 346251 License Class Ll1 s No, Date 411 RIR4 Signature 41 WORKERS' COMPENSATION D�teof ON I hereby affirm that I have a certitsent toself-insure or a certificate of Workers' Compensation Insurance, or a ceftified copy thereof (Section 1800, Lab. C.) WC9824 Lumbermans Policy No. Company 8 Certified copy is hereby furnished. Certifi d c p is filed with the city Builcm ta"l�on.r, f� Date Applicant lJ A r Ext=MpT10 FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (5100) or less). I certify that in the performance of the work for which this permit is issued t shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Data Signature 'NOTICE: If, after making this declaration, you 4houfd become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shalt be deemed- revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section. 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License LAW for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to canstruCt, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/She is licensed pursuant to the pfoviSions of 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 '.131.5 by any applicant for a permit subjects the applicant to a Civil Ity of not more than five hrunadred dollars ($500). { as owner of the property or my employees with wages as their sole c mpensalion, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a prPPerty who builds or improves thereon, and who,does such work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, 13usiness and professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such protects with acon- tractor(s) license pursuant-to'the Contractor's License Law). I am aware that proof o their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section_ B. & P. C. for this reason Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. LOT NO. U . T plil. l �Sq q C� 5 Od TYPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR 88 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. DESCRIPTION OF WORK/USE OF BLDG. Date Owner I hereby certify- that I have read this application and state that the above information Is correct. I agree to comply with all city and county ordinances and•state lavi elating"to buil construction, and hereby authorize repre- sentatives t s city to e r upon the above-mentioned o rty or inspectio arca es. \iT' Signature Date Drivers' Lir7, or,55 0117 0865-46, rev. 10/84 White - Building; Canary - Applicant: Pink - Accounting S Main Building: E TYPE OF PERMIT El GRADING 11 FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 13 MECHANICAL B Rear ❑ -OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ SLe ZONE GRADING CU.YOS. ACRES Ping. Ref.+ Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—T rap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO 4# 1 Heating System & Ducting n0-100,000 BTU ❑ 100,000 BT Reinspection Fee I $15 ; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays FEES II Issue Fee $ 3 1 MECHANICAL FEES Hood or Type 1 ❑ Canopy Typell ❑ Refrigeration System 00-100,000 BTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 1763 4/24/85 Zone Accessory Buitding: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 130.5 KW 05.15 KW ITransformer ❑-15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0-1 HP 01'h B Inc. Solar ❑9-15 HP El 16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 15.50 FEES Z O N I N G R E Q M T S I Reinspection Fee 1 $15 1 1 Issue Fee I $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By R _ __rrR MECHANICAL $ 13.00 TOTALFEE $ 15.50 PLAN CHECK 25% $ 2.50 SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% S ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ 13.00 TOTALFEE $ 15.50 PLAN CHECK 25% $ 2.50 CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POOL, ,?A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ; 2. -Soil Pipe-Undrgrnd. 53. Steel- Reinforcement [ t' 3. Electrical Conduit Utility-Undrgrnd. 54. Forms i 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding i 5. "Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. = 57. APPROVAL TO COVER-GUNITE •. 7. Footings %. 58. Electrical Conduit-Undrgrnd. ;r 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test f 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, ❑ Undrgrnd. F•� 10.. Structural Floor System `l 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 t� 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32.' Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow'Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51`. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY of COSTA MESA . CONSTRUCTION PERMIT PERMITINO. TRACT NO. LOT NO. Project Address -��- % %_ ` % ,�'S TYPE OF CONSTRUCTION LJ NEW LJ ADD U ALTERATION REPAIR Applicant's Mailing Address Owner's Name i R� ! rtV �� ILJ� M E'l`> > Phone Address Arch/Eng. -License No. Address _ Contractor's Namem 001115,_�. L 6- C'T4Z ) i- Phone9-7-741b' Y0 Address (mailing).?�~�n City License No. cl LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter (commencing ofe with section 7000) of Division 3 of the B nese and Pri ns Code, and my license is in ful torte and effe Livens Clss li C" Livens o. , -4-121 �� Date Signature WORKERS' COMPENSATION DECLARATION ,I hereby affirm that 1 have a certificate of consent to self -insure or a certificate Workers' Cpensation Insurance, or a certified Copy thereof (Section 500, LabC )Orn r ,�.. .ti Policy No.. d9-7 7th Company 7 ! 1 RC BCertified copy is hereby furnishe . Ger 1M copy IJ IIed with the ci Buildi g ivision Date �r y' ApplicantI , — OL R �, — EXEMPTION FROM WORKERS' COMPENSATION CLARA ION (This section need not be completed if the permit is for One hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation' provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097- Civ. C.) Lender's Name - Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of - Division 3 of the Business and Professions Code) Or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil 'enalty of not more than five hundred dollars ($500). A I, -as owner of the property or my employees with wageVas their sole ,compensation', will do the work, and the structure Is not Intended or offered for sale' (Section 7044, Business and Professional Code! The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and 'who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im. for the purpose of sale). rove I, as owner of the property, am exclusively contracting with licensed con- tractorSto construct the project(Section 7044, Business and Professions Code: The Contractor's License Law does not apply t0 an owner of property who builds or improves thereon, and _who contracts for such projects with a con- tractor(s) license pursuant 'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section S. & P. C. for this reason Date Owner I hereby' certify that I have' read this app informatio torr I agree to comp w and state aw$ I in to buildi g co st ( sentativesSof thi city to ent upo hinspectionrpSignature' Drivers' License or SS :ation and state that the above i all city and county ordinances on, and hereby authorize repre- above-mentioned property for Date ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. - S Main Building: TYPE OF PERMIT GRADING 11 FOUNDATION - E STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑MECHANICAL B Rear - ❑ -OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K Left CONSTRUCTION TYPE VALUATION $ $ ZONE GRADING CU. YDS- ACRES Ping. Ref. # Remarks: Planning Notes: PLUMBING FEES 5637 1/15/65 Accessory Building: Parking Req./Provided 4.50 T6 Zone Z O N I N G R E- O M T S BafSink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washei Pole Sub. Transformer Q 15.50 KIN ❑ 50+KW Backflow Irrigation Sewer CapConstruction Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter LJ over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan MotorsW1 HP 011% - B Floor Drains Swimming Pool WISpa F.A.U. Inc. Solar 119-15 HP El 16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water,Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink, Water. Service Switches Sign Lavatories Auto -Wash Garbage Disposal ;Standing Sections P—Trap' Laundry Trays Generator 130-5 KW 05.15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee . $ 3 MECHANICAL EES F DEVELOPMENT SERVICES REQUIREMENTS:. Approved By Date Building Approved By Date Application Issued By Date 1 `� Boiler Hood or Type I ❑ Canopy Type 11 ElZoning Duct - Under Ground Duct - Structural Refrigeration System 00-100,000 BTU 0100.000BTU Duct - Ventilating SUMMARV BUILDING PERMIT S PLAN CHECK $ PLUMBING. $ PLAN CHECK 25% $ ELECTRICAL $ {i PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% '$ OF FEES SMIP $ PERMIT ISSUANCE •$ ENERGY P.C. $ ,w GRADING $ MICROFILM $ TOTAL FEE $ , L4 -so Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers Heating System & ducting El 0-100,000 BTU 0100,000 BT Registers Reinspection Fee $15 Issue Fee $ 3 'x 865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Alk CONSTRUCTION AND PLANNING APPROVALS Permit # Date, Inspector POOL , -.,A APPROVALS Permit # Date InspPcrnr ' 1. Temporary Electrical Service or Pole .; 52. Pool & Equipment Location 2. SoiI,Pipe Undrgrnd, !_ <. ti 53. Steel -Reinforcement 3. Elecfrical Conduit Utility-Undrgrnd. ¢ + 54. Forms 4, Electrical Conduit-Undrgrnd, 55. Electrical Bonding 5`I Steel; Reinforcement. 56. Rough Plumbing & Pressure Test n 6., Electrical UFER�Gend. 57. APPROVAL TO COVER-GUNITE 7. Footings 58, Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test .,9.;Water Pipe-Undrgrnd. j 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10"Structural Floor System 61, APPROVAL TO DECK 11,'_Property Sewer Line & House Connection - t 62. Backwash & Receptor -Final .r 12. -Sewer Cap ' t 63. Heater & Vent -Final 13. -Roof Drains '' .► r 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas 0 Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 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 C Notes: 34, Final Heating•& Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 'r 43. Backflow Irrigation 44. Landscape Irrigation System -45. Sound Attenuation 46, Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed, 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No, Date ' _ Applicant to fill in ail spaces except those within heavy border lines and sign all appropriate declarations. Tow" wily I 1 n -r hirN CITYOF COSTA MESA CONSTRU9TION PERMIT Project Address �, I/ %,-/r _ � 7_ __. -�T• C " Applicant's Mailiinn', d r.,s G a P Owner's Name ✓ hone Address Arch/Eng. License No. Address Contractor's Name S ^n /r S 0!V 4 A Phone 17 � 7 1 96 Address(mailing)ZR7,:/w�Pn �+�1*r� yr�►'^ City License No. % S' 2 '22 C. 9 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000), of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License Noo 77 Date ?-+f!II4 erlSignature WORKERS' COMPENSATION D LARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate -,f Workers' Compensation Insurance, or a certified copy thereof (Section 800, Lab. C.) Policy No. Company BCertified copy is hereby furnished., Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit Ls issued 1 shall not employ any person In any manner so/s to become subject to tNer Work "! T Y� S C rwe�]i�l Laws of Calif , Date - Signature NOTICE: If, after making this declara! , you Should become subject to the Workers' Compensation provisions of Ihe Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a Signed statement that he/She Is licensed pursuant to the provisions of 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 '1031.5 by any applicant for a permit subjects the applicant to a civil Penalty of not more than five hundred dollars (5500)• ❑ 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuarit'to the'Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to I. ding construction, and hereby authorize repre- sentatives of this city t enter upon the above-mentioned property for inspection purpvrtes) Signature .if - Date Drivers' License or SS 99L Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service % Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO * Heating System & Ducting C3 0-100,000 BTU ❑ 100,000 BT' Reinspection Fee I $15 CMF 0865-46, rev. 10/84 white - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service A uto-Wash Laundry Trays Issue Fee 5 3 FEES Hood or Type ❑ Canopy Typell ❑ Refrigeration System ❑o-loo,000BTu ❑loo,000BTUI System Repair/Alteration Fire Dampers Registers Issue Fee I $ 3 9933 3/25/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub` Cooking Unit Dishwasher I Dryers ❑Gas ❑Electric Fan F,A,U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW 115.15 KW Transformer ❑ 15-50 KW ❑ 50+ KW Meter ❑up to 100 amps Meter El over 100 amps r Sub Panel Motors ❑0-1 HP ❑ 1 A - 8 Inc. Solar ❑9-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor IVe50 TL FEES Z O N I N G R E Q M T S I I Reinspection Fee I $15 I I Issue Fee 1 $ 3 I 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR —/Data ❑ ❑ ❑ Application Issued By CONVERSION DEMOLISH OTHER A.P. 46 DESCRIPTION OF WORK/USE OF BLDG. SUMMARY OF FEES BUILDING PERMIT $ SMIP $ Main Buildi $ PERMIT E PLUMBING TYPE OF PERMIT GRADING FDUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B $ ❑ -OTHER $ A Rear MICROFILM $ C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K $ CON ST RUCTION TYPE VALUATION 3 $ I Left ZONE GRADING CU.YOS. ACRES Ping. Ref. 5Ik Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service % Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO * Heating System & Ducting C3 0-100,000 BTU ❑ 100,000 BT' Reinspection Fee I $15 CMF 0865-46, rev. 10/84 white - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service A uto-Wash Laundry Trays Issue Fee 5 3 FEES Hood or Type ❑ Canopy Typell ❑ Refrigeration System ❑o-loo,000BTu ❑loo,000BTUI System Repair/Alteration Fire Dampers Registers Issue Fee I $ 3 9933 3/25/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub` Cooking Unit Dishwasher I Dryers ❑Gas ❑Electric Fan F,A,U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW 115.15 KW Transformer ❑ 15-50 KW ❑ 50+ KW Meter ❑up to 100 amps Meter El over 100 amps r Sub Panel Motors ❑0-1 HP ❑ 1 A - 8 Inc. Solar ❑9-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor IVe50 TL FEES Z O N I N G R E Q M T S I I Reinspection Fee I $15 I I Issue Fee 1 $ 3 I 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By —/Data Date Application Issued By G SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ /0"S-0 PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPSOVALS Permit # Date Inspector POOL SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil.Pipe-Undrgrnd. 53. Steel Reinforcement iectrical Conduit Utility-Undrgrnd. 54. Forms 4. ertrical Conduit-Undrgrnd. 55. Electrical Bonding E. $teel' Reinforcement 56. Rough Plumbing & Pressure Test 6. Eie(trical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7, Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13, Roof Drains 64, Plumbing System - Final 14. Rough Plumbing4dy'" G+tt O 65, Electrical-Final 15. Rough Electricai'Conduit ,66. Solar System-Final _16, Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 1B. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air.Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping El Gas 11 Oil 23. Gas Pipe-Rough & Test 72, Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank []Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT, REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test fr 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing ZS ��' 39. Water Service-Final 1-:5'-17 L40 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 Reiease to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. CITY OF COSTA MESA %IVIva TRUCTIVIM Project Address 711W-._ _17th St. Bldg. (C) Unit 6 Applicant's Mailing Address 1 110 Sat Coy- ST. IL Hollywood -- Owner'sName Troy Investment Fund Phone 549-298 Address 4321 Birch _ST_.-_NeWPQrL B ,-CA--- -- - Arch/EngMarin 3 . ROCk License No. Address UBEULKnottAve- Suite 216 Contractor's Name ---D hone 987--1216 Address (mailing) 131 1 fl Sa t i rnv ST N fin l 1 vraOO d71,_ City License No. 3-4995 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Busin/1dft Professions Code, and my license is In full force agd,effect. License Class C-- No. 346251 Date— 4[1.8t84- Signature WORKERS' COMPENSATION OE RAT.10 I hereby affirm that I have a cerli le of consent to self -insure or a certificate of Workers' Compensation Ins ante, or a certified copy thereof (Section Lab. c.) Policy No. Company nlWC9824 Lumherans Policy H Certified copy is hereby furnished. Cerci i o is filed with the city Buil ng Q�slon. Date Applicant EXEMPTI N FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred (5100) or less). I certify that in the performance of the work for which this permit is issued I shall not employ any person In any manner so a$ to become subject to tke Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after makirig this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER D£CLARATIDN I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, altar, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit t0 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 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 nenatty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who dues such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered4or sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- �yve for the purpose of sale). LJ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuarit'to the*Contractor's License Law). I am aware that proof of their Worker •s Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for thls reason Date Owner I hereby certify that i -have read this application and state th Information Is correct. I agree to c mply with all city and count and state I elating to bull d construction, and hereby aut Sentative5 f t is city to gn pan the above-mentioned 1 inspectio pur SeS. Signature Drivers' Li se or SS $ CMF 0865-46, rev, 10/84 t the above f ordinances for a repre- FoOerty ^r Mtoo2�S 1 1 1 Cg TYPE OF CONSTRUCTION NEW ADD LJ ALTERATION Ll REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TYPE OF PERMIT LJ GRADING D FOUNDATION -�1:1 STRUCTURAL ❑ TENANT ❑ ELECTRICAL L1 PLUMBING K-.1 MECHANICAL ❑ •OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU. YDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee Boiler $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit, ICBO # Heating.System & Ducting [20-100,000 BTU ❑ 100,000 BT Reinspection Fee White - Buiiding; Canary Applicant; Pink - Accounting; Goldenrod - Assessor $15 PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays FEES Issue Fee I $ 3 J FEES Hood or Type 1 ❑ Canopy Type I I ❑ Refrigeration System 00.100,000BTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee I $ 3 A. P. 416 S Main Building: E T Front B Rear A C Right 5 Left Ping. Ref. # Planning Notes: I ie� cl/2t�rab 15o5p Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A;U, Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 1:10.5 KW 05-15 KW Transformer ❑ 15.50 KW ❑ 50 + KW Meter LJup to 100 amps Meter Dover 100 amps Sub Panel Motors 00-1 HP ❑ 154 - 8 Inc. Solar 09.15 HP 016.15+ Microwave Pole Light Range Sign i Standing Sections Trash Compactor FEES Z O N I N G R E Q M T S I I Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By_- SUMNfARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING. $ ISSUANCE PLAN CHECK 25% $ ENERGY P.C. ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ 13.00 TOTALFEE PLAN CHECK 25% $ $ 15.50 CONSTRUCTION AND PLANNING APPROVALS - Permit #_-- Date inspector POOL &SPA APPROVALS Permit # Date Inspecrnr .1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement .3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test .� 6• Electrical LIFER Grnd. f + �- 57. APPROVAL TO COVE R-GUNITE `" ! 7. Footings ! 58. Electrical Conduit-Undrgrnd. -` 8.' Foundation 1. 59. Gas Pipe, ❑ Undrgrnd., Test } '- 9. Water Pipe-Undrgrnd. 60, Backwash Lines, P -Trap, ❑ Undrgrnd. ' 10. Structural Floor System '+ 61. APPROVAL TO DECK 11. Property Sewer Line &!-louse 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 APPROVALS Permit # 20., Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 75. Dry Standpipe 28. Lathing & Siding 77, FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 97 L." 35. Final Gas Pipe -Test 36. Hood or -Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43. Back flow'lrrigation 44. Landscape Irrigation System 45, Sound Attenuation 45. 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 _ 0 4 � 64b COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only ADIDRESS LDING // `Arm 1-77# ��— O OWNER SlxS'A 1G+ Ca e/11} 2ii 1 J� ri MOD C e M ie 1 ADDRESS J!T !�(��r�/ CITY Cp S7� +- ' y S� NOL �1I CONSTRUCTION 4/Ll & C - LENDER / BRANCH ADDRESS ARCHITECT 1 TEL. OR FNGINEFR NO. ',PR 19-7hF , 00 913-, ****10.50 A�L If ATION FOR STRUCTURAL PERMIT IV D,BY I DATERECEI/IV��ED TE ISSUED r -Z10 v ti`s P R NO P. NO. BUILDING // n /7 /e /J ADDRESS (�� TYPE GRO P [A LOIPd) BLOCK NEW A DATE ADDRESS OWNER L'4 6 VALUE S I hereby acknowledge that I have read this application a state that the above Information Is correct and agree to comply with all taws regulating building construction, and I shall not employ any person In violation of the workman's compensation laws of the State of California, I hereby certify that I am properly licensed as a contractor under the State of California Business end Professions Code, Division 3, Chapter 9, and that such licenses ere in full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. Signature of%� ./^�' A n �• ape Permittee Authorized Agent`' /�'~' ' THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMIT FEE S PLAN CHECK 5 $ TAX S TOTAL PAID S I, Cil n to i m CD N m �o a ui M 0 ti z U y FIRE' — ADDRESS ZONE TYPE GRO P APPROVED CONTRACTOR BY DATE ADDRESS TEL. Zp NO. OF PLANS Z USE OF N r CITY NO. BUILDING STATECITY i3Loll" YARDS APPROVED YARDS APPROVED LIG, NO. OW,ILCW LIG. NO. MAIN BUILIQPG ACCESSORY BUILDING SIZE NO. OF BLOCS {FROM C/L S T) OF LOT NOW ON LOT RONT FT. FT. USE OF Al l�s EXISTING BLDG• SI F FT Separate permits are required for- L. s T. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCBET. BET. MAIN& MAIN BL ACCESS, BLDGS. �} /A Clc4,72a NfcL VAR. DATE ,v,5kni C.U.P, ,� APPROVED /Ai17�'Je%C_ AGTe?�774X/_ . // ,// .7 t4AA ne-rc '!r. I hereby acknowledge that I have read this application a state that the above Information Is correct and agree to comply with all taws regulating building construction, and I shall not employ any person In violation of the workman's compensation laws of the State of California, I hereby certify that I am properly licensed as a contractor under the State of California Business end Professions Code, Division 3, Chapter 9, and that such licenses ere in full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. Signature of%� ./^�' A n �• ape Permittee Authorized Agent`' /�'~' ' THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMIT FEE S PLAN CHECK 5 $ TAX S TOTAL PAID S I, Cil n to i m CD N m �o a ui M 0 ti z U y %9 CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 711 W. 17th St.BId (C) Unit 7 Applicant's Mailing Address 13110 Saticoy St. N.&ally Owner's Name Troy Investment Fund Phone 549-2988 Address 4321 -ir h St. Newport Beach, Ca. Arch/Eng, Marin J -ROCtC License No. Address 216 Contractor's Name Dlicn Air CnnditiOn�nSPhone 982-1216 Address( mailing) 1.3.110_Sa i-r-zfir_ N.Hollvwood.ga_ City License No. 33Q 25 LICENSED CONTRACTOR' DECLARATION I hereby affirm that I am Ilcensed under provlslons of Cha r 9 {commenc[ng with section 7000) of Division 3 he Buslness and o $$Ipn$ Code, and my license Is in full fC ce,�,d effe . 46251 License Class' L Lice N Date 411904 r Signature WORKERS' COMPENSATION DEC RATION I hereby affirm that I have a certifi to of consent to seff-insure or a Certificate pf Workers' Compensation insurance, or a certified copy thereof (Section 1900, Lab. C�0824Lumbermans ,lolicy No, Company BCertified copy is hereby furnished. Cert! 'e c y is filed with the city BuildrJ �ngi ❑(�iY1 "cion (' � Date Applicant �/ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' Compensation- Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit . shall be deemed revoked, CONSTRUCTION LENDING' AGENCY I nereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason {Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 '031,5 by any applicant for a permit subjects the ;applicant to a Civil ±natty of not more than five hundred dollars (5500). I, as owner of the property or my employees with wage$ as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's , 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 employees, provided that such improvements are not intended or offered for Sale, If however, the building or Improvement Is sold within one year of com- pletlon, the owner will have the burden of proving he/she did not build or im- prove for the purpose Of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon_ , and who contracts for such projects with a con- tractor(s) license pursuarit to the'Contractor's License Law). I am aware that proof or their Worker's Compensation insurance should be provided to 0 1 am exempt under Section B. & P, C. for this reason Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO.r�� I _ TRACT NO. LOT NO. U T wp iiYPE OF CONSTRUCTIOI ENEW ADD AL7ERATlON I I REPAIR Date Owne I hereby certify that I have re information is correct. I agree tr and state law elating to b sentat Ives is city o e Inspectlo u e Signa I. Drivers' nse.or SS to this application and state that the above comply with all city and county Ordinances ng construction, and hereby aut o ze r ore - r upon the above-mentione p,1_ ❑ CONVERSION ❑DEMOLISH El OTHER R A.P. DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING U FOUNDATION r'-'��STRUCTURAL T Front ❑ TENANT 1:1 ELECTRICAL El PLUMBING EkMECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. F7. OCCUPANCY C flight K Left CONSTRUCTION TYPE VALUATION $ $ ZONE GRADING CU. YDS. ACRES P1 no. Ref. # Remarks: Planning Notes: Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Kitchen Sink Water Heater Water Service Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains Reinspection Fee $15 Boiler Duct'- Under Ground Duct - Structural Duct - Ventilating Exhaust System © Multiple ❑ Firepl/Fact. Bit. ICBO * Heating System & Ducting E;:4100,000 BTU 0.100,000 BT Reinspection Fee CMF 0865.46, rev. 10/94 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 FEES Issue Fee $ 3 4ANICAL FEES Hood or Type I ❑ Canopy Type I I ❑ SMIP Refrigeration System ❑0-100,000 BTU 0100,000 BTU $ System Repair/Alteration PLUMBING* Fire Dampers ISSUANCE Registers S ENERGY P.0 4 $ GRADING f Issue Fee $ 3 1765 4/24/85 15o50 Zone _ Accessory Building: Z O N I N G R Parking Req./Provided E Q I M TI SI ELECTRICAL Automatic Washes Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A,U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW 05-15 KW Transformer ❑ 15-50 KW ❑ 50 + KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0-1 HP 01 h - 8 Inc. Solar ❑9-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES I I Reinspection Fee I $15 I I Issue Fee, J $ 3 [ I DEVELOPMENT SERVICES REQUIREMENTS. Zoning Approved By Building Approved By Application Issued By -- SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING* $ ISSUANCE PLAN CHECK 25% S ENERGY P.0 ELECTRICAL ' $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL PLAN CHECK 25% $ $ 13.00 TOTAL FEE 2 • 5` -CONSTRUCTION AND PLANNING - APPROVALS - Permit # Date Inspector POOL ?A 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 ( ; ,F r 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ; 6- Electrical UFER Grnd. ! 57. APPROVAL TO COVER-GUNITE 7. Footings �' 58. Electrical Conduif-Undrgrnd. 8: Foundation ? 59. Gas Pipe, ❑ Undrgrnd„ Test 'r . 9. Water Pipe Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd, 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash &Receptor -Final 12. Sewer Cap � 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final •'..` 14. Rough Plumbing ! 65. Electrical -Final 15. Rough Electrical -Conduit 66, Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17.: Rough Wiring Sign 68. APPROVED FOR PLASTERING 18• Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72• Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank []Gas ❑ Oil 25• Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77, FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 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 Nn. Date _ Applicant to fill in all spaees except those within heavy border lines and sign all appropriate declarations. rCITY CSF COSTA MESA CONS RUCTION PERMIT PE MIT NO TRACT NO. LOT NO. UNIT NO. 14.�Project Addr$1s l / s. G ��• Applicant's Mailin ddress % Owner's Name -�'t 1Cr Phone Address Arch/Eng. License No, Address Contractor's Name._ ' ^s /"'dr1�r5� �Phone Z>7 2-Z-2 44 Address (mailing)�� .$'�-' City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed tinder provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. [s License Class 4e License No:� WORKERS' COMPENSATION DE ARATION I hereby affirm that t have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section '3800, Lab. C.) ,olicy No. Company eCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Date ,--- Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred (5100) or less). I cert that in the performance of the work for hiCh this permit is issued I Shall not employ any person In any manner S s to^become subject to tie Workers' ComPensat�n Laws of Calif ..Date Signature 'NOTICE: if, after making this declarat n, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION L..ENOING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires tha applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's Licqnse 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 apbllcanl for a permit subjects the applicant to a civic nalty of not more than five hundred dollars ($500), 1, as owner of the property or my employees with wages as their Sole compensation, will do the work, antl the structure Is not Intended or a fored for sal¢ (Section 7044, Business and Professional Code: The Contractor's License Law does nqt apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or liar own employees, provideq that such improvements are not Intended or offered for sale. If, however, the building or Improvement Is Sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 bullds or improves thereon, and who contracts for such projects with a con- tractors) license ptlrsuarit-to'Ehe'Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner 'hereby certify that I have read this application and state that the above Information is correct, I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- Sentatives of this City enter upon the above-mentioned property for Inspection pu es, rpt C Signature Date Z eC'lf Drivers' Lic or $S :p CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor TYPE OF CONSTRUCTION El NEW ADD LJ ALTERATION ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. REPAIR A.P.# Zone S Main Building: Accessory Building: TYPE OF PERMIT 0 GRADING1:1 FOUNDATIDN LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ ,OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE, VALUATION $ ZONE GRADING CU.YDS. ACRES E T Front Z O A Rear N C Right N Left g G R Ping. Ref.+ Parking Req./Provided E Remarks: Planning Notes: Q M T S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub,, Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Clarifiers Sewer Connection Solar Collectors Cooking Unit Dishwasher Meter ❑up to 100 amps Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas DElectric Sub Panel Drinking Fountains Solar Tank Fan Motors 00-1 HP 01 'A - 8 Floor Drains Swimming Pool w/Spa _ F.A.U. Inc -Solar 09.15 HP El 16-15+ Floor Sinks Gas Service ! Outlets Urinal / Water Closet Fixtures Device Boxes Microwave Pole Light Interceptors Kitchen Sink Water Heater Water Service Outlets Switches Range Sign Lavatories Auto -Wash Garbage Disposal T ' Standing Sections P—Trap Laundry Trays Generator ❑0.5 KW ❑5-15 KW Trash Compactor Roof Drains 14 �' Reinspection Fee s15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee S 3 Boiler Duct -Under Ground MECHANICAL Hood or Type 1 ❑ Canopy Type I I ❑ FEES DEVELOPMENT SERVICES Zoning Approved By , Building Approved•By Application _Issued By REQUIREMENTS: Date Date l r Dat Duct - Structural Duct - Ventilating Refrigeration System DO- 100,000 BTU IJ 100,000 BTU L - BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ 7Z ISSUANCE s $ Z Z ENERGY P.C. $ S GRADING $ $ MICROFILM S $ TOTAL FEE S 14ja� $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Olt. ICBG,# Fire Dampers Heating System & Ducting Registers 00.100,000 BTU ❑100,0008Tli, Reinspection f=ee si5 Issue Fee s 3 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING } .APPROVALS Permit # Date Inspector - POOL .'A APPROVALS Permit # Date Inspector P:., I . Temporary ElectriMl Service or Pule 52. Pool & Equipment Location 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, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd, 10. Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap - 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing L� �,(d�� CIO) 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System Final 16. Rough Electric Wiring 67• Fencing & Access Approval W. Rough Wiring Sign 68. APPROVED FOR PLASTERING i8. Rough Electrical -T Bar Ceiling 69.-POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test .7.2. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32, Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. -Final Factory Fireplace 38. Final Plumbing 660 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 f CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address L 1 / 7 74 - I e-Z7� Z6 1 t sA Applicant's Mailing Address Owner's Name�r�� `l >.� ESzpr I Phone Address Arch/Eng. License No, Address Contractor's Name I -S C CG=� J C Phone4"f% bTS` Address(mailing)%Qa_:�1� Igr�l �rCDaa1►+�!�Z% City License No. r", I'D LICENSED CONTRACTOR DECLARATION I hereby affirm trial I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and PofesSicu Code, and my license is in full orce and effe License Class License os... -7 p Date _/ -rte'"S.S Signature WOR KERS'COMPENSATION DECLARATION 11, I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab C.I ohcy NoAk._ /o.73 70 5F_ z.6 c7 L� Certified copy is hereby furnished! ❑ Certified copy is filed with the cit uil vlsio Date.J�ly'r Applicant EXEMPTION FROM WORKERS' COMPENSATION D CLARATION (This section need not be completed if the permit Is for One hundred ($100) or less)rti. I cefy that in the performance of the work for which this permit is issued 1 shall not, employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. ' Date Signature 'NOTICE: It, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ' CONSTRUCTION LENDING AGENCY 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit t0 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 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 2,7031.5 by any applicant for a permit subjects the applicant to a civil •natty of not more than five hundred dollars ($500). 1. ,"A I, as'owner of the property or my employees with wages as their sole "Compensation, will do the work, and the structure Is not intended or offered for We (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ' ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Profession$ Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who cant(acts for such projects with a con- tractors) license pursuarit'to the Contrato' 's' License Law). 1 am aware that ' proof of their Worker'$ Compensation insurance should be provided to me. ❑ I -am exempt under Section ' B. & P. C. for this reason Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. LOT NO. UNIT N6. 3 c� 7 TYPE OF CONSTRUCTION NEW LJ ADD ALTERATION U REPAIR Date Owner 1 hereby certify that I•have. a� information is correct. I agree to and stateMthcity to bui dir. sentativesto a ter inspection Signature Drivers' License or SS 2)9� this application and state that the above 3ly with all city and county ordinances o struction, and hereby authorize repre- s O the above-mentioned property for Date ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P # DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TYPE OF PERMIT GRADING 0 FOUNDATION E STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ -OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION S S Left ZONE GRADING CU.YDS. ACRES Ping. Ref, # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee t PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping ' Solar Tank Swimming Pool w/Spa Urinal Outlets Water Closet Water.Heater Water Service Auto -Wash Laundry Trays $15 Bailer . Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 00-100,000 BTU ❑ 100,000 BT r Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White . Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee Hood or Type 1 ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 5638 1/1.6/85 Accessory Building: Parking Req./Provided ho5Q TL Zone Z O N I N G R E Q M T S FEES ELECTRICAL FEES Automatic Washer Construction Pole Sub, Transformer ❑ 15-50 KW } ❑ 50 + KW Cooking Unit Meter yup to 100 amps Dishwasher Meter ❑over. 100 amps_ Dryers ❑Gas ❑Electric Sub Panel Fan Motors 1 HP ❑ l % - 8 F.A.U. Inc. Solar 09-15 HP, 1:116-15+ FixturesMicrowave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal ; Standing Sections Generator 110-5 KW 05-15 KW Trash Compactor $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By _ Date l� BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES t $ $MIP $ $ PERMIT $ ISSUANCE $ 5 ENERGY P.C. $ S OO GRADING $ $ MICROFILM $ $ TOTAL FEE $ _,So! $ $ 3 CONSTRUCTION AND PLANNING " APPROVALS Permit # Date J Inspector POOL L A APPROVALS Permit # Date Inspector 1, Temporary Electrical Service or Pole ;� 52. Pool & Equipment Location 2. 'Soil Pipe-Undrgrnd., 53. Steel Reinforcement 3.�Elect�ical Conduit Utility Undrgrnd. 54. Forms • A. Electrical Conduit-Undrgrnd. �' � 55. Electrical Bonding " 5. Stee41einforcemeni 56. Rough Plumbing & Pressure Test y 6: Electrical UFER;Grnd. 57. APPROVAL TO COVE R-GUNITE l 7..Footings ; " 58. Electrical Conduit-Undrgrnd. � 8. Foundation ' . 59. Gas Pipe, ❑Undrgrnd., Test 9.' Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, C3 Undrgrnd. 10: Structural Floor Sysiem 61. APPROVAL TO DECK 11 - Property Sewer Line & House Connection ` - 62. Backwash & Receptor-Final 12., Sewer Cap ,. 5� 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 APPROVALS Permit # 20. Rough Factory Fireplace 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 ❑ Gas ❑ Oil 25, Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30" Drywall Nailing HEALTH DEPT, REQUIREMENT 31. Plaster Brown Coat 79" FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer `r 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 Nn. date _� Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 711,W. 17th St. Bldg.(C) Unit $ PERMIT NO. TRACT NO. LOT NO. ' ' UNIT N�. 1 1 766 4/24/85 Igo $0 i�.' TYPE OF CONSTRUCTION I J NEW LJ ADD LJ ALTERATION LJ REPAIR El CONVERSION ❑ DEMOLISH El OTHER DESCRIPTION OF WORK/USE OF BLDG. OD O N Applicant's Mailing Address 13110 Satidoy St N.HOLLYWOOD Troy Investments Fund 549-2988 Owner's Name hone Address 4321BirchSt. Newport Beach, Ca. A.P. # Zone S Main Building:, Accessory Building: Arch/Eng, Marin J.Rock License NO. Address 12881 Knott Ave. Suite 2_16 TYPE OF PERMIT GRADING FOUNDATION El STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CON STRUCTiON TYPE VALUATION $ ZONE GRADING CU.YDS. S ACRE E T Front Z O Rear N Contractor's Name nditionin Phone9$2--1216 Address (mailing) 13110 SatiC`Oy St. N.HO11yWOOd, Ca. City License No. _.-_ _CONTRACTOR DECLARATION LICENSED I hereby affirm tnat I arn.licensed under provisions of'Charter 9 (commencing with section 7000) of Dfvfsfon 3 of Business and ofessions Code, and my license Is in full forcCe acW,effec 346251 License Class Lll e s No. Date_4/1 RI,94 Signature WORKERS' COMPENSATION DE RATION I hereby affirm that I have a certf ate of consent to self -Insure or a certificate A K Right G S Left r R Ping. Ref. # Parking Req./Provided E Remarks: Planning Notes: Q M - T S PLUMBING FEES Sar Sink Showers ELECTRICAL FEES ' of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.y - WC9$24 Policy No. . Company Lulnbermans BCertified copy is hereby furnished. CertifT GQpy_is filed with the city Buil ig Division. 1/I pate.... �LF-It"�'l.:J Applicant.._- -( lf___ T !(:0 ftJ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completeq if the permit Is for one hundred ($100) or less . I certify that in the performance O7 the work for.which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of Ci lifornla. BackflowPreventer Service Sink - - Automatic'Washer Construction Pole Sub. r - Transformer 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap, Bathtubs Sewer Connection Cooking Unit Meter Ejup t0 100 amps Clarifiers Solar Collectors _ Dishwasher Meter El over 100 amps Dishwasher Solar Piping ❑ Dryers ❑Gas Electric 'Sub Panel Drinking Fountains Solar Tank Fan Motors 00-1 HP ❑l h -'B Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9.15 HP ❑16-15+ Date Signature 'NOTICE: If, after making this decl4ration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked.' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Floor Sinks - Urinal Fixtures +Microwave - Gas Service 'Outlets Water CIOSet Device Boxes Pole Light Interceptors Water Heater Outlets Range - Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 13usineSs and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chabter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt 'therefrom and the basis for the alleged exemption. Any violation of Section 7031,5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). •- I I, as owner of the property Or my employees with wages as their sole compensation, will do the work, and the Structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 awn employees, provided that such improvements are not Intended or offered for sale. If, however, the building Or improvement IS Sold'wlthin one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as'owner of the property, am exclusively contracting with licensed con- 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 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 proof of their Worker's Compensation insurance should be provided to, me. L7 I am exempt under Section --- B. & P. C. for this reason Kitchen Sink Water Service Switches Sign Lavatories - Auto -Wash Garbage Disposal ' Standing Sections , - P—Trap Laundry Trays Generator 1:10-5 KW E15-115 KW Trash Compactor Roof Drains - - _ - - Reinspection Fee I $15 Issue Fee ` $ 3 II Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Approved By pate Building Approved By Date Application Issued By Dat Boiler Hood or Type I ❑ Canopy Type li ElZoning Duct - Under Ground Duct - Structural Refrigeration System ❑0-100,000 BTU ❑100,000 BTU Duct - Ventilating SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ Exhaust System ❑ Multiple [3 System Repair/Alteration Firepl/Fact. Bit. ICBO + Fire Dampers Date Owner I hereby certify Ahat I have read this application and state that the above information is correct, -I agree omply with all city and county ordinances and state la s relating l bu' i construction, and hereby authorize re pre- sentatives his city to to upon the above-mentioned r perty or ppppppp inspectlo Dur oses, i SI nature Date' Drivers' tic se or 55 � 1 Heating System & Ducting �0-100,000 BTU ❑lbO,000BT Registers aQ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ ENERGY P.C. $ GRADING $ ' MICROFILM $ 13'00 TOTAL FEE $ 15.50 2.50 Reinspection Fee$15 Issue Fee $ 3 I Goldenrod - Assessor CMF 0865.46, rev. 10/84 White - Blaflding; Canary - Applicant; Pink - Accounting; CONSTRUCTION AND PLANNING APPROVALS • Permit #_� Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location i'. 2, .Sail Pipe-Undrgrnd. 53. Steel' Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd, 55, Electrical Bonding r 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 6. Electrical UFER Grnd• `'' 57. APPROVAL TO COVER-GUNITE j' 4 7. Footings r 58. Electrical Conduif-Undrgrnd. 8:, Foundation 59. Gas Pipe, ❑ Undrgrnd., Test ( ,9. Water Pipe Undrgrnd, f • %, 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System ='f 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� 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. POO USPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro -22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. -Gas Pipe -Rough & Test 72, Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31.'Plaster Brown Coat 79, FINAL INSPECTION 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning ^ y7 Li,0 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final' Plumbing 39. Water Service -Final - 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, .Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed ' 49. Electric Release to Edison ..50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. 'Date _� ' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONST��TION PERMIT Project ACCliess �_ I/ WR r -7 Applicant's Mailing Address 1 P 7 S' Owner's Name %� Phone' Address _ Arch/Eng. License No Address Contractor's Nam Phones Address (mailing) I'S % -</ -Y_ 4 /- A V L' City License No. �Z % �i'L s .� LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provislohs of Charter 9 (commencing with section 7000) of Division 3 of the Businegs and Professions Code, and my license is in full f9rce andffect. License Class c' License No.3 n - L a 7 Date 21 Ift Q r— Signature WORKERS' COMPENSATION DEC RATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 800, Lab. C.) Policy No. Company - Certified copy is hereby furnished. Certified copy is filed with the city Building Division. - Date Applicant - EXEMPTIDN FROM WORKERS' COMPENSATION DECLARATION ' (Thissection need not be completed if the permit is for one hundred ($100) or., less). I certify that in the performance of the work for hich this permit is issued, 1. shall not employ any person in any manner s as to become subject to the Work �5 Cqm en t- n Laws of Calif ia. Date `- / Signature NOTICE: If, after making this declar n, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or. this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is ISSuQd (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any City or county which requires a permit to Construct, alt@r, Improve, demolish or repair 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 the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions CO(Ie) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 1031.5 by any applicant for a permit subjects the applicant to a Civil enaity of not more than five hundred dollars ($U00). i_] I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the struct4re is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/hers@lf or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Ig Sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- rove for the purpose of sale). 1, as owner of the property, am exclusively Contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Cade: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) License pursuant t0 the Contractor's License Law). I am aware that proof o their Worker's Compensation insueante should be provided to me. ❑ 1 am exempt under Section—'B. & P. C. for this reason Date Owner I herebycertify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this ci to enter upon the above-mentioned property for inspection p ses. Signature Date Drivers' Lice se or SS 9935 3/25/65 10.50 TL P MIT NO. ¢ // / � TRACT NO. LOT NO, UNI!`plb� a o TYPE OF CONSTRUCTION N, FrADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. Zone 5 Main Building: Accessory Building: TYPE OF PERMIT GRADING 0 FOUNDATION 0 STRUCTURALT ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION S ZONE GRADING CU,YDS. ACRES Front O B A Rear N I C Right N S Left G R Ping. Ref. # Parking Req./Provided _ E Remarks: Planning Notes: Q M T 5 PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction P01;7SUb. Transformer ❑ 15.50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas DElectric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0-1 HP Ell % - B Floor Drains Floor Sinks Swimming Pool w/Spa Urinal F.A.U. Fixtures Inc. Solar 09.15 HP E116-1 5+ Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Kitchen Sink Water Heater Water Service Outlets Switches Range Sign Lavatories Auto -Wash = Garbage Disposal ; Standing Sections P -Trap Laundry Trays Generator 00-5 KW ❑5-15 KW Trash Compactor Roof Drains 1 Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By / _Dat Boiler Hood or Type I ❑ Canopy Typeil ❑ Duct - Under Ground Duct - Structural Refrigeration System ❑0.100,000 BTU El 100,000 BTU Duct - Ventilating SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ / ENERGY P,C. $ ELECTRICAL $ GRADING $ PLAN CHECK • 50% $ MICROFILM $ MECHANICAL S TOTAL FEE $ PLAN CHECK 25% $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers Heating System & Ducting ❑0-100,000 BTU ❑100,000 BT Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL ;PA APPROVALS Permit # Date Inspector 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 Banding 5_ Steel, Reinforcement - 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd, 57. APPROVAL TO COVER-GUNITE 7• Footings E - 58. Electrical Conduit-Undrgrnd. . 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd• 60. Backwash Lines, P -Trap, ❑ Undrgrnd. -10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12, Sewer Cap 63. Heater & Vent -Final •13. Roof Drains .64. Plumbing System - Final 14. Rough Plumbing ✓ 65. Electrical -Final 15, Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING - 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Underg rnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: , 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final ractory Fireplace 38, Final Plumbing G� ZS�S LiGLt{% 39. Water Service -Final 1-6--0 tZ7 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow' Preventers 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations , 47. FINALSTRUCTURE &BUILDING 48. Special Requirements Completed 49. Electric Release to Edison. - - 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY . No. Date T Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OP COSTA MESA CON TRUCTION PERMIT �t PERMIT NO. TRACT NO. L07 NO. UNIT N0. Project Address -7 11 � 1 7 T ICS— t O_S T !� M ��/ + TYPE OF CONSTRUCTION NEW 7ADD LJ ALTERATION LJ REPAIR Applicant's Mailing Address Owner's Name TR 1" yT tit it`s i 115 £ ySd h Phone Address - Arch/Eng. License No. Address Contractor's Name,ri. 2�GR/J; —Cl Lir:TR IC Phone 377-61Z " Address (mailing),_trfk6S jail, e4rf,T_xl1 ALC._.lm1I n M7/6 City License No, 37�r LICENSED CONTRACTOR DECLARATION I hereby affirm that I' am licensed under provisions of Charter (commencing vwlth section 7000) of Division 3 he B loess and ofe. ns Code, and my license is in fu force and effe License Class lcense f Date Signature WORKERS' COMPENSATION DECLA A- ION I hereby affirm that I have a certificate of consent to self -insure or a certificate '•I Workers' Compensation_ Insurance, or a certified copy thereof (Section 800, Lab. C.) r+ Policy Certified copy is hereby furnished. Cejfied copy is jjled with the city ui dl ision. •Date.,—/V—kS Applicant EXEMPTION FRgM WORKERS' COMPE SATION D CLARATION (This section need not be completed If the permit is for ne hundred (5100) or less). I Certify that in the performance of the work for which this permit is Issued t shall not employ any person in any manner so as to become subject to tyre Workers' Compengation Laws of California. Date Signature 'NOTICE: 11, after making this declaration, you should become subject to the Workers' Compensation provisions. of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097, Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 703I.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed Statement that he/she is licensed pursuant to the provisions of 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 '031.5 by any applicant for a permit subjects the applicant to a civil tenalty of not mgro than five hundred dollars ($500). 1� I, as owner of the property or my employees with wages as their sole Compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's LicenseLaw 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 employees, proviged that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I. as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuarit'to the Contractor's License Law), I am aware that Proof or their Worker's Compensation insurance Should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this information is correct. I agree to COMPI and state Q to buildin cons sentatives cit ,to enter upon Inspection s, Signature Drivers' License SS cation and state tnat the above h all city and county ordinances ion, and hereby authorize repre- above-mentioned property for Date / �/0''Vr ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P 4A DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT El GRADINGEl FOUNDATION El STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ, FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ $ I Left ZONE GRADING CU. YDS. ACRES Ping. Ref. Remarks: Planning Notes: 5839 1/16/85 Zone Accessory Building: Parking Req./Provided Lio50 TL Z 0 N t N G R E Q M T 5 Reinspection Fee $15 Boiler Duct -'Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑0.10D,000 BTU 0100,ODOBT Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee IANICAL Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,0006ITU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 PLUMBING FEES ELECTRICAL FEES Bar Sink I I Showers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Coilectors SUMMARY OF FEES $ $ $ $ $ -.00 $ _ _5ri $ $ Dishwasher Meter Dover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Floor Drains Floor Sinks Solar Tank Swimming Pool w1spa Urinal Fan F.A.U. Fixtures Motors)20-11 HP 0 35 8 Inc.Sofar 08-15 HP ❑16-15+ Microwave " Gas Service Outlets Interceptors Kitchen Sink Water Closet Water Heater Water Service Device Boxes Outlets Switches Pole Light Range Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections ' P—Trap Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor Roof Drains ' Reinspection Fee $15 Boiler Duct -'Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑0.10D,000 BTU 0100,ODOBT Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee IANICAL Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,0006ITU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved BY Application Issued By Date Date ++ Date 1 1/'1 BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ -.00 $ _ _5ri $ $ SMIP $ PERMIT ISSUANCE $ ENERGY P,C. $ GRADING $ MICROFILM $ TDTAL FEE I S 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL _.. oPA 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 tElec��ical on Undrgrnd. 55. Electrical Bonding Steel' Reinforcen5ent; 56. Rough Plumbing & Pressure Test 6, Electrical LIFER Grrid. 57. APPROVAL TO COVER-GUNITE 7: Footings 58. Electrical Conduit-Undrgrnd, 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9, Water:Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd, ' 10.;Structural Floor System 61. APPROVAL TO DECK 11; -Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12' Sewer Cap 63. Heater & Vent-Final �- 13. iRoof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Efectrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electricol-T Bar Ceiling 69, POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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".11 Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Goat 79, FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes; 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42, Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System y 45. Sound Attenuation 46. Handicap,Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison r 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. - Date AA COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 -�/ For Applicant to Fill in Completely — Use Ink Only BUILDING ,� ADDRESS OWNER - I MAIL A ADDRESS TEL. C14rl�! NO. CONSTRUCTION LENDER BRANCH ADDRESS ARCHITECT Tl L. OR ENGIN ER N 0. ADDRESS CONTRACTOR ADDRESS /��fJ CITY 4��, NOLCy/t3 !Q STATE CITY � LIC. NO. �1 LIC. NOer SIZE NO. OF BLDGS. OF LOT NOW ON LOT USE OF A EXISTING BLDG. Q 1 �C— Separate permits are required -for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED 2 an) � L � ! hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. . I hereby certify that I em properly licensed as a contractor under the State W California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 1, Chapter 9. Signature of Permittee A�L_ Authorizati Agent 2tM4:� 9_4�� OCT 17-77Pai0 cras400 805* ****73-10 AP LI AT ON FOR STRUCTURAL PERMIT RE D DATE RECEIVED D TE I EC ZZ PE T NO, A. P. NO. BUILDING ' f// ADDRESS c� TRACT LOT BLOCK W ADD I ALTER P QLISH OWNER %�L VALUE I IQ L: FIRE ZON E GROUP AP BY DATE Q cv�T.QAcr.4� rr-�. c� N NO. OF PLANS USE OF NEW/-7'&A/4r4 BUILDING YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM G/L STREET) VALUATION REAR VFT. FT. DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. SLOGS. VAR.* DATE C.U.P. */A' APPROVED APPROVED %% _ _ __ la—a-7_( - - - - _ . m SO. FT. a THE AMOUNT SHOWN UNDER VALUATION IS FOR pDp THE PURPOSE OF ESTABLISHING A PERMIT FIE" VALUATION PERMIT FEE 3 v Ln 7 V .' rn m o PLAN CHECK $ $ LL f TAX S V TOTAL PAID $ �'� CD Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. CITY OF COSTA MESA ' CONSTRUCTION PERMIT, PERMIT NO. TRACT NO. LOT NO. 1:77N6 Project Address l) vv 1 i N S 1 �`QlS / M E.S ZI Applicant's Mailing Address Owner's Name ?ROY Illi ae I mt~ NT Phone Address Arch/Eng. License No. Address Contractor's Name _LYURP11S E1.EC1RIC— PhoneIF77-69ff Address (mailing) M bS Rli?1/ ArT S -r, dL00mf ry611 i)/V r/'-;z,3Y, City License No. �� [( O LICENSED,CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the B ess and ProfessI s Code, and rry license is In full force andgife License Class 0 / U License t Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800,L ab'. C.) Policy No. *jCi_::�ID9 iia Co ELE� BCertified copy is hereby furnished, Certiflo8 co�y`L-c filed with the city oil vision. Date I� v� D J Applicant IZ Z, EXEMPTION FROM WORKERS' COMPS SATION CLARATION (Thissection need not be completed If the permit is f r one hundred ($100) or less). I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should, become subject to the Workers' Compensation, provisions_ of the Labor Code, you must forthwith comply with such provisions or this permit -shall be deemed revoked. CONSTRUCTION 'LENDING AGENCY - I hereby affirm that there is a construction lending agency for the performance of the work for which this. permit is ,Issued (Section .3097 Civ. C.), n Leder's Name - Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or County which requires a permit.to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file asigned statement that he/she is licensed pursuant to the provisions of 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 malty of not more than five hundred dollars ($500), 1,"as'owner of the property or my employees with -wages as their sole compensation, will do the work, and the structure is not intended or offered for sale .(Section 7044, Business. and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ' ❑ I, is owner of the property, am exclusively contracting with'licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractor(s) I)cense pursuarit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I.am exempt under Section I B. & P' C. for this reason Date 1 hereby certify that I information Is t, and state law resat' t sentatives of this inspection p r s - Signature r Drivers' License or SS :P AF oa65-46, rev. 10/64 Owner have'read this application and state that the above agree to com ly with all city and county ordinances o building nstru_c on, and hereby authorize repre- to enter on t above-mentioned property f/or TYPE OF CONSTRUCTION I NEW I.J ADD Al TERATION LJ REPAIR PLUMBING Showers ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ELECTRICAL FEES Backflow Preventer A P. DESCRIPTION OF WORK/USE OF BLDG. Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW — Cl 50+ KW S Main Building- TYPE OF PERMIT LJ GRADING ❑ FOUNDATION El STRUCTURAL T Front ❑ TENANT ❑ ELECTRtCAL ❑ PLUMBING ❑ MECHANICAL 13 Clarifiers ❑ -OTHER A Rear PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right -CONSTRUCTION TYPE VALUATION S S Left ZONE GRADING CU. YDS. ACRES Ping. Ref- + Remarks: Planning Notes: 5671 1/16/85 Zone Accessory Building: Parking Req,/Provided - ue5a TL z O N I N G R E 0 M T S Bar Sink I PLUMBING Showers FEES ELECTRICAL FEES Backflow Preventer Service Sink1 Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW — Cl 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection j Cooking Unit Matey C] 6p to 100 amps Clarifiers Solar Collectors Dishwasher _ Meter Clover 100 amps _ Dishwasher Solar Piping ' Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan j Motors 81.0.1 HP ❑1 h - 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-115 HP ❑16-15+ Floor Sinks - Urinal Fixtures Microwave Gas Service Outlets Water.Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash i Garbage Disposal ; Standing Sections P—Trap , Laundry Trays Generator ❑0-5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee -$15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Hood or Type I ❑ Canopy Type 11 ' El DEVELOPMENT SERVICES -REQUIREMENTS: zoning Approved By Building Approved By' Application Issued By Date Date + Date 1 Duct -Under Ground Duct - Structural Refrigeration System L-10-100,000 BTU ❑ 100,000 BTU Duct - ventilating SUMMARY BUI LDING PERMIT $ PLAN CHECK $ $ PLAN CHECK 25% $ ELECTRICAL $ �•�� PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ _ OF FEES SMIP $ PERMITPLUMBING ISSUANCE $ ENERGY P.C. $ GRADING ,$ SO MICROFILM $ TOTAL FEE $: Exhaust System ❑ Multiple ❑ System Repair/Alteration FirepllFact, Bit. ICBO # Fire Dampers Heating System & Ducting ❑0.100;000 BTU El 10.0,000 BTL Registers i Reinspection Fee $15 Issue Fee $ 3 - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL a SpA APPROVALS Permit # Date _ Inspector ,1. Temporary Electric8l Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ;5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & Nouse 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts; Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush -24. Roof Framing 73, Undergrnd. Storage Tank ❑ 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 'j � Notes, 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final _ 42, Backflow Preventer 43. 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.00CUPANCY f�io. Date - i - 1� Cr Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNI NO Project Address 711 W. 17th St. BLDG.(E)_Unit 2 Applicant's Mailing Address 13110 Saticoy St. N.Ho111ywoD Owner's Name TKOY Investment Fund Phone 549-2988 Address 4321 Birch 8t Newport Beach, Ca. Arch/Eng. Marin J. Rock _ License No. Address 12881 Knott_ Ay, _._,Site 216 Contractor'sNameDuco Air CQndttioning_Phone 982-1216 Address (mailing) _13-1.1O_S_a.tiay S.t-.--N-EOIIYW.Otad , Ca- City a-City License No. --39"-25 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing With section 7000) of oivislon 3 of the Business 4eo. L-3: ns Code, and my license is in full force and effec . License C ass off' C-20LrcL�j}��1 - Date 4 1_J_8 Signature WORKERS' COMPENSATION DEC RATION I nereby affirm that I have a certific' a of consent to self -insure or a certificate of Workers' Compensation insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. 4JC9824Company8r11F�^a.z&_ H Certified copy is hereby furnished. Certifie py is filed with the city Build Date Applicant f'C EXEMPTION FRDM WORKERS', COMPENSATION DECLARATION (Thissection need not be completed if the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. pate Signature 'NOTICE: If, after making this declaration, you Should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction tending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors tU construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuarit to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section B. b P. C. for this reason Date I hereby cert information u and state law sentatives e, inspection pur Signature _ Drivers' Licen 4F 0865-46, rev owner iat I have read this application and state that the above -ct. I agree to comply with all city and county ordinances ting to buil-g construction, and hereby authorize repre- city to 717 upon the above-mentioned property for Date rn -�) -2- �2 TYPE OF CONSTRUCTION NEWU ADD LJ ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Automatic Washer Construction Pore Sub. A. P. # DESCRIPTION OF WORK/USE OF BLDG. Cooking Unit Meter El up to 100 amps S Main Building: E Sub Panel TYPE OF PERMIT U GRADING El FOUNDATIO STRUCTURAL T Front ❑ TENANT 1:1 ELECTRICAL ❑ PLUMBING ��N1:1 l&I MECHANICAL B Inc. Solar 09.15 HP ED 16-15+ ❑ OTHER A Rear C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Range Sign CON STRUCTiON TYPE VALUATION 5 S Left ZONE GRADING CU.YOS. ACRES Ping. Ref. Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories' P—Trap Roof Drains Reinspection Fee I S15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 1 &0.1 D0,000 BTU ❑ 100,000 BT Reinspection FAR 3 or S5 _ f 1 10/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0.100 000 BTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 2258 5/03/85 Zone Accessory Building: Parking Req./Provided FEES ELECTRICAL Automatic Washer Construction Pore Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit Meter El up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fen Motors E] 0-1 HP ❑ 1 A - B F.A.U. Inc. Solar 09.15 HP ED 16-15+ Fixtures Microwave Device Boxes Pole Light Outlets Switches Range Sign Garbage Disposal ; Standing Sections Generator 00.5 KW 05.15 KW Trash Compactor $ 3 Reinspection Fee $15 Issue Fee, FEES DEVELOPMENT SERVICES REOUIREMENTS: Zoning Approved By Date _ Building Approved By Date— Application Issued By Dot -_f BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP S _ S PERMIT S ISSUANCE S -- $ ENERGY P.C. S _ $ GRADING S — $ MICROFILM S — S 00 TOTAL FEE $ i $ 2.50 $ 3 15,50 FEES $ 3 Z O N 1 N G R E Q M T S CONSTRUCTION AND PLANNING APPROVALS . Permit # Date Inspector POOL, ?A APPROVALS Permit # Date InspPcror 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 �r 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. i f:' 57. APPROVAL TO COVE R -G UNITE 7. Footings 58. Electrical Conduif-Undrgrnd. 8: Foundation i 59. Gas Pipe, © Undrgrnd., Test 9. Water Pipe-Undrgrnd. `-y'. 60. Backwash Lines, P -Trap, © Undrgrnd. 10. Structural Floor System ' ! 61. APPROVAL TO DECK 11. Property Sewer Line & House Connectign 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 APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ 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 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 48, 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 Nn. Date K 1' G Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRQCTIO PERMIT PER IT q TRACT NO. LOT NO. UNIT NO Pro� Address - Applicant's Mailin Addres Owner's Nama ^Ph Address Arch/Eng. License No. Address Contractor's Na Phon� .Address imailing) L City License N_o. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in f rc an effect. �r*7. Ocen Cl ss License No! in 2nr -1 Dat Signature WORKERS' COMPENSATION E RATION , I hereby,affirm that I have a Certi ate of consent to self -insure or a certificate 7f Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab. C.) . Policy No. _ - - Company Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date_ -- Applicant EXEMPTION FRAM WORKERS' COMPENSATION DECLARATION (ThiSsectlon need not be completed If the permit -is for one hundred ($100) or less). 1 certify that in the berformanCe of the work for'whlch this permit Is issued, I shall not employ any person in any manner so s to become subject to the Worker C , n on_laws Of.Callf DateSignature 'NOT E: a r king this declar "*you shou d become subject to the Workers' Compensation provisions o he Labor Code, you must forthwith - comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY. 1 hereby affirm that there is a construction tending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name Lender's Address - -- — OWNER BUILDER bECLARATION i hereby affirm that I am exempt from the Contractor's License Law for the following'reason (Section 7031.5 Business and -Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is, licensed pursuant to the provisions of 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 '031.5 by any applicant for a permit subjects. the applicant to a civil ienalty of not more than five hundred dollars ($500). ❑ I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does npt 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose Of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and _who contracts for such projects with a con- tractor(s) license pursuarit'tdthe Contractor's License Law), I am aware that proof o/ their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section 9. d. P. C. for this reason Date — Owner I hereby certify that f have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentattvesof ��......ppppppls Gi to enter upon the above-mentioned property r inspection o sea S Signature Date Drivers' rise or SS � �I�' IG-) I I d _ Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap ' Roof Drains Reinspection Fee $15 Boiler Duct -,Under Ground Duct - Structural Duct - Ventiiating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting 00-700,000 BTU ❑ 700,000 Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Ap (cant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink+ Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type 1 ❑ Canopy Type 11 ❑ Refrigeration System ❑o-1oo,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 5863 7/02/85 Zone Accessory Building: Parking Req./Provided IDo50 TL Z' O N 1' N G R E O M T S FEES ELECTRICAL FEES TYPE OF CONSTRUCTION NEW LJ ADD LJ ALTERATION REPAIR Automatic Washer Construction Pole Sub. ❑ ❑ ❑ CONVERSION DEMOLISH OTHER -- - - A =4#1 DESCRIPTION OF WORK/USE OF BLDG. Sub Panel Fan Motors 00-1 HP 01 %- 8 S Main Building: Fixtures E 2 cio TYPE OF PERMIT 0 GRADING M FOUNDATION El STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑PLUMBING 1:1 MECHANICAL B ? Standing Sections ❑ OTHER Generator 00-5 KW 05.15 KW Trash Compactor A Rear C Right PROJECT DESCRIPTION Sq. FT. OCCUPANCY Reinspection Fee $15 CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap ' Roof Drains Reinspection Fee $15 Boiler Duct -,Under Ground Duct - Structural Duct - Ventiiating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting 00-700,000 BTU ❑ 700,000 Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Ap (cant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink+ Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type 1 ❑ Canopy Type 11 ❑ Refrigeration System ❑o-1oo,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 5863 7/02/85 Zone Accessory Building: Parking Req./Provided IDo50 TL Z' O N 1' N G R E O M T S FEES ELECTRICAL FEES z Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit Dishwasher Meter 13 up to 100 amps Meter Dover 100 amps Dryers 3Gasy 0Electric Sub Panel Fan Motors 00-1 HP 01 %- 8 F.A.U. inc.Solar El 9-15 HP 016.15+ Fixtures Microwave 2 cio Device Boxes P016 Light Outlets Switches Range Sign Garbage Disposal ? Standing Sections Generator 00-5 KW 05.15 KW Trash Compactor S 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By _ Date Date ! -- Date—; !�� BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25%. $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ SUMMARY OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ -CSO GRAOING $ MICROFILM $ TOTAL FEE $— $ 3 'CONSTRUCTION AND PLANNING 1PPROVALS Permit Date Inspector POOL _ SPA APPROVALS Permit # Date Inspector ?. Tempary Electrical Service or Pole' 52. Pool & Equipment Location } 2. Soi1f?i+pe1Undrgrnd, r � Ci'�+ 53. Steel Reinforcement 3��ElecXcic9l Condu"1�Utiiity-UndgF�d:y � 54. Forms 4 _:Electiical ConduitaJndlr,grnd. 'y { 55. Electrical Bonding + 5_SteehRein#orcemeni r� 56. Rough Plumbing & Pressure Test 1rj ,Grk. 6• Electrical UFER,1. •r .1 ..1 T 57. APPROVAL TO COVENITE R -GU 7;�Footrngsr' 58. Electrical Conduit-Undrgrnd. 8. 'Foundation -+1 "� `�F+ ~' 59. Gas Pipe, ❑ Undrgrnd., Test `Water;Pipe.Undrgrnd:r %? 60. Backwash Lines, P -Trap, O Undrgrnd, r 10. Stru tL rrdt Floor Sy_*' m 61. APPROVAL TO DECK +1. Prcper�ty„Sewer Lie & House Cpnn fiction 62. Backwash & Receptor -Final 12. Sewer Ga✓�/ * 4 f 63. Heater & Vent -Final .l 13. Roof Drains �/S 1 1 64. Plumbing System - Final 14. Rough Plumbing/ ��f 65. Electrical -Final tv o' 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas O 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. REOUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace r 138. Final Plumbing 7 dl5 CEQ 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 s 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed / 49. Electric Release to Edison ;50. Gas Release to Southern California Gas Go 51, CERTIFICATE -OF OCCUPANCY No. Date (714)754-5273 - Fax(714)754-4856 Job Address: 711 W 17TH ST Suite No E003 Vicinity: E003 Parcel Nunmber: 93983051 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT ELECTRICAL PERMIT PERMIT NUMBER / E98-01027 V 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Ptb Applied: 09125/1998 Issued: 09125!1998 Applicant: RUSS TRUST Address: JARED RUSS SAN CLEMENTE Phone: 949361--31'14 143 CALLE CERVO , .: '` Zip: 92672 Owner: RUSS TRUST Address JARED RUSS Y "."SANCL'EMENTE, - Phone: 949361-3114 143'CALLE CERVO�, Zip: 92672 •�X Contractor: A'ddress: Phone:' 1 Zip: License. J SCOPE OF PERMIT UPGRADE ELECTICAL PANEL. FEE SUMMARY' \ Quantity r Quantity ISSUE FEE $22.00 Temp Dist System 1 Lighting. $0.00 0 Temp service test $0.00- ; Busway 1100 ft' ,' $0.00 0 Res. alc package $0.00 - Standing Section $0.00 0 " New Res (1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0" New Res. (3+units) $0.00 - 0 Transformers up to 1 kvafkw $0.00 0 Pool 1 Spa $0.00 0 ................up to'10 kvalkw $0.00 0 Lighting Fixts $0.00 0 .................up to 50 kvalkw $0.00 0, Recept Outlets \,,,,•,'$0.00 0 up to 100 kvaAw $0.00 , ' • 0 Switches ,s0.00 0 ........ ..over 100 kva/kw $0.00 ; 0 Non Res Appl, - `10.00 0 ; _, - Low Voltage Equipment $0.00"", 0 Res Appl $0.00;,,. 0 Low Volt Wiring System 1 Ckl $0.00 0 Service to 2006 $27.25`.; a 1 , `Mise. Conduit ' 50.00. 0 Service to 1000a 50.00 0 •' Misc.�Conductor, $0.00 '.', 0 Service over 1000a $0.00 0 Circus ( gen or ride) $0.00 0 Motors to 1 hp $0.00 _ 0 ` Circus (meth ride or fights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00, 0 / Motors to 50hp s0.00 01- Fireworks Stand Motors to 1 00h $0.00 0 Other Electrical Fee $0.00", Motors over 100hp s0.00- 0 Communication drops s0.00 0 ` Investigation Fee • - ' $0.00 Sub panel to 200a 50.00 0 Plan Check Fee ' ' $0.00 Pole Light Pkg $0.00 0 Reinspection Fee - $0.00 Sign Circuits $0.00 0 Temp Pwr Pole 50.00 0 TOTAL CALCULATED FEES $49.25 Intermed Pole $0.00 0 COMMENTS / SPECIAL CONDITIONS EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of penury one of the following declarations: ❑ i have and will maintain a certificate o1 consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. ❑ I have and will maintain workers' compensation Insurance, as required by section 3700 of the tabor Code, for the performance of the work for which this permit Is issued. My workers' compensation Insurance carrier and policy number are: Carrier. Policy Number. (This section need not be completed if the permit is valued at one hundred dollars (S 100) of fess.) ❑ 1 certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' OOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL4RE (S1o0,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNErS FEES, LICENSED CONTRACTORS DECLARATION: hereby affirm that I am licensed under proOsions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. Lic. 0 Class N Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penaltyof perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to Construct, alter, Improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code; The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I, as owner of the property, am EXCLUSIVELY CONTRACTING wrrH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contraclor(s) license pursuant to the Contractors License Laws.). ❑ 1 amEdflod p nder sec. Business and Professions Code for this reason: Signature: Data: Owner ID b rivers license. ❑ Yes o Driver's License No. Expires: Verification of n hip by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby cartity that no excavation five (5) or more feet in depth Into which a person Is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Callfomla Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ................................................................'u,"p"...........................................--'---,--........................................-.-.-......................................................................-.... 2 Does or will the applicant or present or future building occupant need to file a registration form far acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Cade, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acl ute)y hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at Standard temperature and pressure). ............................ ... ................................................................................ ........................................................................... .......................... ........................... I............... .Y-- Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes (a No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .............................................................................................................................................................. .. ................................................................................................. 4 If an RMPP is presently required, has Section 25534 of the Califomia Health and safety Code been fully complied with? ❑Yes ❑ No .................................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? [] Yes No (Section 85850.2 of the California Government Code requires that the requested information be tumished on applications for non-residontial building permits). ......................................................................................................................•---................................................................................................................... 6 Will any earl 01 the facility to be constructed under this permit be within i 0( 10 feet from the outer boundaries of a school? ❑Yes ❑ No (If 'fres', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............ ...................................................................................................................................................... .... .... ...... ... ........... ....... .................. I .......... ...-.......................... ................... 7 if a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No .................................................................................................................................................................................................................................................................................... 8 (If yes', attach certillcete of complianoe from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emlgsfons. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is oorrecf. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the aascribed property for in ' n p ses. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. SigniturM LegalOwner(s) I Date And/Or Authorized Applicant Date f3>lq_:L INSPECTION TYPE GATT: CODE INSPECTION TYPE 2ATE IIOIDALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 210 Final Electrical 18 2D1 Final BlockfRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 244646 Applicant to fill In all spaces except those Within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PER Project Address - _ 711 W. 17th ST Bldg. (E) Unit 3 PERMIT NO. M� 3 TRACT NO. LOT NO. UNIT ADD RATION REPAIR ,TYPE OF CONSTRUCTION LJ NEW ALTE ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. Applicant's Mailing Address 13110 Saticoy St. N. Hollywoo Owner's Name _ Troy Investment Fund Phone 549-2988 Address 4321 _Birch ST Newport Beach, Ca. - Arch/Eng. Marin J. Rock _ License No. Address 12881 Knott Ave, Suite 216 TYPE OF PERMIT 7 GRADING 0 FOUNDATION 11 STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING R) MECHANICAL El OTHER PROJECT DESCRIPTION 5Q.FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE - - -- -- GRADING CU. YDS. ACRES Contractor'sNamopuco Air Conditioning Phone 982-1216 Address(mailing) 13110 Satico St. N.hollyFood, CA. City License No. 33925 LICENSED CONTRACTOR DECLARATION Remarks: Application Issued By f.hereoy affirm that I am licensed under provisions of Charter 9 (commencing with section 700(}) of Division 3 f the Business an rofeSSlons Code, and Det L my Ilcense-Ls in full force and eff t. 46251 License Class Li se o.,�_ Date 4A&A8 .,.__ Signature ^ SUMMARY OF FEES PLUMBING FEES WORKERS' COMPENSATtOfv DECARATIO;V I hereby affirm that I have a cer[ific a of consent to self -insure or a certificate Bar Sink Showers Backflow Preventer Service Sink of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) 1olfcy No. - -RC9824 Company Lumbermans BCertified copy is hereby furnished. CertifiePY is filed with the city B Idin pivision. Date Applicant- i -I11 �� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or loss). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Backflow Irrigation Sewer Cap Bathtubs Clarifiers Sewer Connection Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Workers' Compensation Laws of California. Date — Signature Floor Drains Swimming Pool w/Spa '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 suth previsions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ, C.) Lender's Name Gas Service Outlets Water Closet ' Interceptors Water Heater Londer's Address Kitchen Sink Water Service OWNER BUILDLtR DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a Permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 ienalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves Maroon, and who does such work himself/herself or through his or her Own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement 15 Sold within one year of com- pletion, the owner will have the burden Of proving he/she did not build or Im. prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licoris0d con- tractors to construct the project (Section 7044, Business and Professions Code: Tho Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractor(s) license pursuarit'to the Contractor's License Ww). I am aware that of their WOrker'S Compensation insurance should be provided to me. Lavatories Auto -Wash P -Trap Laundry Trays ROOF Drains - , Reinspection Fee 515 Issue Fee ES 3 MECHANICAL FEES Boiter Hood or Type 1 ❑ Canopy Type I I ❑ Duct . Under Ground Duct - Structural Refrigeration System 00-l()0,000BTU 0100,000 BTU Duct - Ventilating Exhaust System ❑ Multiple ❑ System Repair/Alteration proof ❑ 1 am exempt under Section - B. & P. C. for this reason FirepUFact, Bit. ICBO + Fire Dampers Date Owner _ I hereby certify that I have read this application and state that the above Information is correct, I agree to ply with all city and county ordinances and State I elating to build' onstruction, and hereby authorize repre- sentatives f t is city to r Pon the above-mentioned property for inspection urp ses. Heating System & Ducting 1 [90- 100,000 BTU 0100,0008 Registers od Reinspection Fee 315 Issue Fee $ 3 Signature �y `�✓ Drivers' Lice or SS 91t CMF 0865-46, r9v. 10/84 White - Building; Canary - Applicant: Pink - Accounting: Goldenrod - Assessor A.P. -0 S Main Building: E T Front A Rear C Right K g Left Ping, Ref. Planning Notes: 2259 5/03/85 Zone Accessory Building: Parking Req,/Provided ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ©Gas []Electric 'Sub Panel Fan Motors 00-1 HP 011/2 - 8 F.A.U. Inc. Solar 09.15 HP C1 16-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches . Sign Garbage Disposal 'Standing Sections Generator 130.5 KW 125-15 KW Trash Compactor 15.50 TL FEES Z O N I N G R E Q M T S Reinspection Fee 1 $15 I 1Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By —Date Building Approved By Date Application Issued By Det L ^ SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE S PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ _1 3-00 TOTAL FEE $ 15.50 _ PLAN CHECK 25% $ 2 R0 CONSTRUCTION AND PLANNING APPROVALS • Permit # Date Inspector POOL 4. -?A APPROVALS Permit # Date Inspectnr 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement r r 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 COVE R-GUNITE ' 7. Footings 58. Electrical Conduif-Undrgrnd. 8' Foundation 59. Gas Pipe, El Undrgrnd., Test 9. Water Pipe-Undrgrnd. - t 60. Backwash Lines, P -Trap, El Undrgrnd, 10. Structural Floor System t 61. APPROVAL TO DECK 11. Property Sewer Line & House Connectign 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 76. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T gar Ceiling 69. POOL/SPA SYSTEMS FINAL 19.' Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS. Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydra 22, Ducts, Ventilating 71. Product Piping ❑ Gas 0 Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 // C 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CGT•1L OF-WSTA MESA • CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. i roject Address -711 w, ) '7?N Applicant's Mailing Address Owner's Name -TROYLy i�E<TmE/+>T Phone_ Address Arch/Eng. License No. Address Contractor's Name g3ga is OLec c Phone 'f77 -6k3-0 Address (mailing) tgS&-5 _&YdAJT_ S, ,l L0t)m1A1C—rpN F�j% City License No._ LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 ( mmencing with section 7000) of Division 3 of the Business and Prof ssio Code, and my license is in full force and effec + License Class C , cense 5 Date 1- 1Q- �Zl " Signature WORKERS' COMPENSATION OECLARA ION I hereby affirm that I have a certificate of consent to self -insure or a certificate ,)f workers' Compensatioh Insurance, or a certified copy thereof (Section •800, Lab. C.)' ' Jolicy No. i09 3_7V C pa El� eCertified copy is hereby furnished. Cer[Ified co y filed with the cit But i Ivislo Date _ Applicant r_ EXEMPTION FROM WORKERS' COMPENSATIO DECLARATION (This section need not be completed if the permit is or one hundred ($100) or less). 1 certify that in the performance of the work for which this permit is Issued I Shalt not employ any per;on in any manner so as to become subject to tate ' Workers'. Compensation Laws of California. ._Date. Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this "permit' shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that ther0 is a construct)ori lending agency'for the performance of the work for which this permit is issuod (Section _3097 Civ. C.) Lender's Name Lender's Address i OWNER BUILDER DECttiARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, after, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file asigned statement that he/she is licensed pursuant to the provisions of the Contractor's License i-aw (Chapter 9 (commencing with Section7000) of Dlvlsion 3 of the Business and Professions Code) or that he/she . is exempt therefrom and the basis for the alleged exemption. Any violation -of Section 7031;5 by any applicant for a permit subjects the,applicant to a civil )enalty of not more than five hundred dollars ($500). ❑ I, as owner of the property or my employees vilth wages as their sole i• compensation, ill do the work, and the structure is not intended or offered for sate (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon and who does such work himself/hersalf or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will hhVe the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting, with licensed con- 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 I builds or improves thereon, and _who contracts for such projects with a con- tractor(s) license pursuant Ito the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to 'me. ❑ I am exempt under Section 13• & P. C. for this reason Cr Date Owner I hereby certify that 1 have read this application and state that the above information is ect. ree to cam ly wit II city and county ordinances and state 1a s relaq t building c strut n, and hereby authorize repre- sentatives o 'this ty o enter -uAi t above-mentioned property for inspectlon p r G Signature Date 1::21) So Drivers' License or SS 5872 1/16/85 4.50 I% AF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor TYPE OF CONSTRUCTION El NEW ADD LJ ALTERATION U ❑ CONVERSION ❑ DEMOLISH ❑ OTHER- DESCRIPTION OF WORK/USE OF BLDG. REPAIR q P # Zone S Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL El OTHER E T ,Front Z O A Rear - - N PROJECT DESCRIPTION SQ. FT. OCCUPANCY CON STRUCTfON TYPE VALUATION $ ZONE GRADING CU. YDS. ACRES C Right N S' Left R Ping. Ref. °# Parking Req./Provided E Remarks: Planning Notes: Q' M T S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW -1 50 + KW - ! Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter El up to 100 amps, r ' Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors )Q0.1 HP ❑ 1 34 - 8 pC Floor Drains' Swimming Pool w/SpaF-A-U. Inc. Solar L39-15 HP 1:116-15+ Floor Sinks Urinal - Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors ' Kitchen Sink Water -Heater Water Service Outlets Switches Range Sign Lavatories Auto -Wash Garbage Disposal ;Standing Sections P—Trap Laundry Trays _ Generator El 0-5 KW EJ 5-15 KW Trash Compactor Roof Drains t Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee$15 Issue Fee ± $ 3 Boiler Duct - Under Giound MECHANICAL Hood or Type 1 ❑ Canopy Type I I 11 FEES DEVELOPMENT SERVICES Approved By Building Building Approved By —� Application Issued By REQUIREMENTS: Date __— Data Date L Duct - Structural Refrigeration System 1:30-100,000 BTU 0100,000BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL ' PLAN CHECK 25% $ $ S $ $ $ $ $ SUMMARY OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P,C. $ O0 GRADING $ 50 MICROFILM '$ TOTAL FEE $ uo ` Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers Heating System & Ducting 00-100, 000 BTU Ell 00,000 BT Registers - i 1 Reinspection Fee $15 Issue Fae $ 3 AF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor ;`CONSTRUCTION AND PLANNING APPROVALS Permit # Date I'lnspector POOL & „?A APPROVALS Permit # Date InspPcrnr '.1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55, Electrical Bonding 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUN ITE 7. Footings 58. Electrical Conduit-Undrgrnd. -8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final . 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64, Plumbing System - Final 14. Rough Plumbing 65, Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68, APPROVED FOR PLASTERING 1B. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22.,Ducts, Ventilating .71. Product Piping El Gas 1--) Oil 23. Gas Pipe-Rough & Test 72, Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 84• FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy i 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 1 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 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 CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address t. Bldg. E Unit 4 Applicant's Mailing Address 1 Saticoy St. N . Holl ood, Owner's Name Tro7 Investment Fund Phone 5 49-2988, Address 4321 Birch St. Newport Beach, Ca. T Arch/Eng. Marin J. Rock License No. Address 12881 Knott Ave. S tuie 216 Contracsor's Name Duco Air Condit ionin hone 9821216 Aodress(mailing) 13110 _Saticoy St. N.H011ywood,Ca. City License No. 39925 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing With section 7000) of Division 3 of the Business and Pro sions Code, and my license is in full force and effect. License ICIl��ass Licen 6 2$1 Date�#,f�8�$..�..' Signature WORKERS' COMPENSATION DEC RATION I hereby affirm that I have a Certifica of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) nn- Policy No. __-�WC7-82_4�_ Company , LJ1 eJMa_UJS. eCertified copy is hereby fairnis6ed. . Cert if py is filed with the city Buil g�Drr11"w�}}is��ion' DatApplicant iJL— EXEMPTI Oki FROM WORKtRS' COMPENSATION DELL RATION (This section need not be completed if the permit is for one hundred ($100) or less}. I certify that in the performance of the work for which this permit is issued, f shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: if, after making this declaration, you should become subject to the - Workers' Compensation provisions of the tabor Code, you must forthwith Comply with such provisions or this permit Shall be deemed revoked. - CONSTRUCTION LENDING, AGENCY I hereby affirm that there is a construction lending agency for the Performance of the work for which this permit is - issued (Section 3097 Civ. C.) Lender's Name - Lender's Address OWNER BUILDER DECLAkATION 1 hereby affirm that I am exempt from the Contractor's License Law for tho following reason (Section 7031.5 Business and Professional Code: Any city - county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its Istuance, also requires the applicant for such -permit to file a signed statement that he/She is IIcensed pursuant to the provisions of the Contractor's License taw (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 malty of not more than five hundred dollars ($500). i, as owner of the proberly or my employees with wages as their sale compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code; The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If,however, the building or improvement Is sold within one year of com- pletion, the owner will -have -the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts far such projects with a con- tractor(s) license pursuant 'to the Contractor's License Law). 1 am aware that proof o their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations• PERMIT NO. I TRACT NO. I LOT NO. UNIT NOi Date I hereby certif Information is and *St at0 Et senta[ivesinspection Signature Drivers' Licensf CMF 0865-46. I Yl k b-1 - It-- TYPE OF CONSTRUCTION LJ NEW 0 ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. c}6 DESCRIPTION OF WORK/USE OF BLDG, S Main Buildi E TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL B Rear ❑ -OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K left CONSTRUCTIONTYPE VALVATION $ $ ZONE GRAofNG CU. YOS. ACRES Ping. Ref, # Remarks: Planning Notes: Owner' that I have read this application and state that the above 1 rect. 1 agree to ca ly with all city and county ordinances ating to building struction, and hereby authorize repre- city to en/ter u n the above-mentioned ,property .for C� !t 4� ob r5Sg¢ 10/84 White - Building; Canary Bar Sink Backflow Preventer Backflow Irrigatiori Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Interceptors Kitchen Sink Lavatories P—Trap Roof Drains' Outlets Reinspection Fee 1 S15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG 4k Heating System & Ducting R10.100,000 BTU 0 100,000 BT Reinspection Fee 1 $15 Applicant; Pink - Accounting; Goldenrod - Assessor AGING FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee I - $ 3 FEES Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System 00-100,000 BT U ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 2260 8/03/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Pan F-A.U, Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW 05-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0-1 HP ❑ 1 Y. - 8 inc. Solar 09-15 HP ❑16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 15e50 TL FEES Z 0 N I N G R E Q M T S I I Reinspection Fee I 515 I I issue Fee I S 3 , 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By pato Application Issued By Dat Z SUMMARY OF FEES BUILDING PERMIT $ SMip $ PLAN CHECK S PERMIT PLUMBING S ISSUANCE S PLAN CHECK 25% $ ENERGY P -C. $ ELECTRICAL i GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ no TOTAL FEE $ PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POOL " SPA APPROVALS Permit # Date Inspecror 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 Carnd. 57. APPROVAL TO COVER•GUNITE 1 7. Footings .' S$. Electrical Conduif-Undrgrnd. 8' Foundation i 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House ConnectiQn 62. Backwash & Receptor-Final 12. Sewer Cap ; 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing i 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 14. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24, Roof Framing 73, Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing -39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date 0 - 01 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. P RMIT NO. TRACT NO. LOT NO. U !F NO CIT (.'dSTA M-7SA CQN�STR UCTI N PERMIT 6 f' � G 7 Grp A.P. # Project Address [ �' W' J Applicant's Mallin Address -70 Owner's Name Phone Address Arch/Eng. License No. Address Contractor's Nam Phone Address (mailing) City License No. —_ LICENSED CONTRACTOR DECLARATION I her affirm that I am licensetl untler mmencing with section a Business and Profess[ons Code, and my license is in full d e e License C1a_s License o. Date Signature 'WORKERS* COMPENSATION DEC4-ARATION I hereby affirm that i have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified -copy thereof (Section 0, Lab. C.) ..iicy No. Company eCertified copy is hereby furnished. Certified copy is filed with the city Building Division, Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less) I Certify that in the performance ojftn rk for whI his permit is I�suecl I shall not employ any person in anner so become subject to the Workers,'o�tpensation Laws of Ca. Date // 7 YY�� S€gnatur NOTICE: It, after making this declarat' ou should become subject t Workers' Compensation provisions of a Labor Code, you must forthwith comply with Such provisions or this permit, shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to Construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Profession$ Code) or that he/she is exempt •efrom and the basis for the alleged exemption. Any violation of Section t.5 by any applicant for a permit subjects the applicant to a civil ,Ity of not more than five hundred dollars ($500). u 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an ovvner of a property who builds or Improves thereon, and who does such work nimself/herself or through his or, her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed Con- 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 builds or improves thereon. and who contracts for such oroiects with a con- tractors) license pursuant to the Contractor's License Law). i am aware that pr o their Worker`s Compensation insurance should be provided to me. I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that i have read this application and state that 1he above Information is correct. I agree to comply with all city and county ordinances and state law tAnto ��bbbq wilding ronstructlon, and hereby authorize repre- sentatives t istqenter upon the above-mentioned proyr fpr €nspection oseZ- }� Signature Date Drivers' License -Ar SS TYPE OF CONSTRUCTION LI NEw LJ ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE-OF BLDG— L -01 -ALTERATION LJ REPAIR TYPE OF PERMIT LI GRADING LJ FFDUNDATION LI STRUCTURAL TENANT ❑ ELECTRICAL L`TPLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT./ OCCUPANCY CDN STRUCTION TYPE �I,As yL VALUATION $ ZONE GRADING CU.YDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO =0 - Heating System & Ducting C1 0.100,000 BTU ❑10o,000eT Reinspection Fee 1 $15 0865-46, rev. 5/88 White - Building; Canary - Applicant-, Pink - Accounting: Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Tra4s Issue Fee Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑o-100,000 BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee S Main Building: Accessory Building: E T Front ARear C R ight S , Left Ping. Ref. # Parking Req./Provided Planning Notes: Zone Z O N I N G R E O M T S. ELECTRICAL FEES FEES Automatic Washer Transformer ❑ 15.50 KW Construction Pole Sub. ❑ 50 + KW BUILDING PERMIT $ Cooking Unit Meter Elup to 100 amps $ Dishwasher Meter Cover 100 amps $ Dryers []Gas ❑Electric Sub Panel Fan Motors 00.1 HP Ell %-8 $ F.A.U. Inc. Solar 09.15 HP 016-15+ $ -- Fixtures Microwave $ Device Boxes Pole Light $ Outlets Range $ Switches Sign $ Garbage Disposal Standing Sections $ Generator ❑0.5 KW ❑5.15 KW Trash Compactor $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ Reinspection Fee $15 issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued 8v _ _' B't *S/.✓t_� ns.e / $ 3 FEES Z O N I N G R E O M T S. $ 3 01 00021875-00021898 TOT DATE= 12/12/88 TT"E: 13:31 SUMMARY OF FEES" BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ 5-,00 ISSUANCE $ -- PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ $ 3 01 00021875-00021898 TOT DATE= 12/12/88 TT"E: 13:31 a ,CONSTRUCTION AND PLANNING 'APPROVALS Permit # _ Date Inspector POOL `A 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 ConduitaUr+drgrnd. 1 55, Electrical Bonding 5. Steel'Rei'nforcemert 56. Rough Plumbing & Pressure Test 6 i Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE r 7. Footings, 58. Electrical Conduit-Undrgrnd. f• 8$Foundation 59. Gas Pipe, ❑ Undrgrnd., Test _ is 9r Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structurai Floor System 1 61. APPROVAL TO DECK , 11ltiPraperty Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap , r ; 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 1.4. Rough Plumbing 65. Electrical -Final r: 15. Rough Electrical -Conduit 66. Solar System -Final 1,6. Rough Electric Wiring 67. Fencing & Access Approval 17?. ough Wiring%ign 68. APPROVED FOR PLASTERING 18: Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20, Rough Fapory Fireplace ' 21. Ducts, i�,Structure 70. Underground Hydro 22. Ducts, Ventilating l .i 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & T4$t 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing �. 74. OverHead Hydro 26. T -Bar Ceiling (Structural) &'Monocoat 75. Dry Chemical 27. Ffameand Flashing W 76. Dry Standpipe 28, Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulatyon '� ? 78. FIRE PREV, FINAL 30. Drywall Nailing -. HEALTH DEPT. REQUIREMENT 31l! Plaster Brown Coat 79. FINAL INSPECTION 32: --Electrical Power Meter -Final i 80. -FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test ` L 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 1 40. Gas Service -Final " 41. Solar Domestic -Final ; 42. Backflow Preventer f .. � r 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 ' r / Applicant CITY OF COSTA MESA / SSS ZV to fill in all spaces except those within heavy pc rder lines and sign all appropriate declarations. PE MIT NO. TRACT NO. LOT NO. BLD CONSTRUCTION PERMIT 11096 1 & 2 E LII::; Proj:ctAddress 711 W. 17th Street Applicant's Meiling Address : 7 d 1 ft Ma r A r f- h n r R 1 yd _ , -c' _ D TYPE QFCQNSTAUCTIONI I NEW nADD ALTERATION REPAIR . M .❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. ¢6 2 — 0 C1 1 _ 05 n Lt O 5 a to Zone(r Owner's Neme Troy T a' e c t m e n t Fund hone 549-99 - 8 DESCRIPTION OF WORK_EXteTlOr Alterations S Main Building: Accessory Building: Z Address 4121 R i rr_h St . r NawPnrt- ReachTYPE Arch/Eng.,WTp.._h.. Pereira As' -Q enseNo. Address Mar Contractor's Name Phone Address (mailing► City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I em licensed under provisions of Charter 9 (commencing section 7000) of Division 3 Of the Business and Professions Code, and my license is In full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certiflcete of consent to self4nsure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL [I OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY R-2 CONSTRUCTION TYPE VALUATION $ _7_�r7 A d f1n ZONE GRADING CU.YOS. ACRES - T Front ' N g A Rear I N C Right G & Left R Ping. Ref, 7 Park. Fees $ U Remarks: P#20 -84S' Parking Req./Provided I Use of Building: Rwith E PLUMBING FEES Planning Notes: M E Bar Sink Showers ENT N Backflow Preventer Service Sink T $ 3900, Lab. C.) Backflow Irrigation Sewer Cap ELECTRICAL FEES Policy No. ,52420001683 Company Argonaut 8 Certified copy Is hereby furnished. Bathtubs Sewer Connection Automatic Washer Transformer Cl 15-50 KW Certlf ed c y is filed with the city wilding Divis Data Applicant - Construction Pole Sub. ❑ + KW Clarifiers SoCollectors ler EXEM 10 FROM WORKERS' CO ENSATION DECLARATION {This section need not be completed If a permit is for one hundred (5300) Or Dishwasher Piping Solar Piin Cooking Unit ❑ Meter up t0 100 amps lass). 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 tine Workers' Compensation Law$ of California. Date Signature NOTICE: If,,after making this declaration, you should become subject t0 the Worker$' Compensation provisions of the Labor Code, you must forthwith Drinking Fountains 9 Soler Tank Dishwasher Meter Clover 100 amps Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel Floor Sinks Urinal Fan Motors E10-1 HP [31 Yr - B Gas Service Outlets Water Closet F.A.U. Inc. Solar ❑9 15 HP [:316-15+ comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097 Cly. C.) Interceptors Water Heater Fixtures ' Microwave kitchen Sink Water Service Device Boxes Pole tight Lander's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter Improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provision$ of the Contractor's Ucense 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 Lavatories Outlets Range p-Tre p Switches Sign Roof Drains Garbage Disposal Standing Sections Generator ❑0 5 KW ❑5-15 KW Trash Compactor Reinspection Fee $25 Issue Fee $ 3 7031.5 by any applicant for a permit subject$ the applicant to a civil amalty of not more than five hundred dollars ($500). 1, as owner Of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds Or Improve$ thereon, and who does Such work himself/herself or through his or her own employees, provided that Such Improvements are not intended or offered for sake. 1!, however, the building Or improvement Is sold within one year of com- ptation, the Owner will have the burden of proving he/she did not bulld or Im- Qrove for the purpose of sale). 4Ei I, as owner of the property, am exclusively contracting with licensed con- ractorsto construct the project {Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an Owner of property who : builds or Improves thereon, and who contract$ for such projects with a con- tractor(s) license pursuant to the Contractor's License Law), ❑ I am exempt under Section B. & P, C. for this reason Reinspection Fee S25 Issue Fee S 3 MECHANICAL FEES Boiler Hood or Type I ❑ Canopy Type 11 ❑ Duct - Under Ground PUBLIC SERVICES AEQUIREi1AENT5 C 1� V. 3 1� L Zoning Approved By ate Building Approved By ate Application Issued By ,a�� /�l� net Duct - Structural Refrigeration System Duct - Ventilating ❑alpp,ppp BTU ❑ 100,000 BTU BUILDING PERMIT $ PLAN CHECK $. PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 5046 $ MECHANICAL $ PLAN CHECK 25% $ SUMMARY OF, FEES o '] 3 SMIP $' PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM S TOTAL FEE $ v " Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO + Date 5 owner I hereby certify that 1 have ren Is application and state that the above information Is correct, l agree to comply with all city and county ordinances and State laws relating to building construction, and hereby authorize repre- sentatives Of this city' enter upon the above-m_entloned pr part for = Inspection u oras. Signature Date Drivers' 0anse or SS 91k Heating System & Ducting ❑0100,000 BTU ❑i00,000 Reinspection Fee -� $25 Issue Fee $ 3 i -CONSTRUCTION AND PLANNING APPROVALS Permit #- POOL & SPA Date Inspector APPROVALS ,: Permit:F- Date _ Inspector 1: Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Uncirgrnd. 54: Forms - 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5, Steel Reinforcement 56. Rough Plumbing & Pressure Test-'- 6. Electrical UFER Grnd. 57.' APPROVAL•TO-COVE R-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, ❑'Undrgrnd., Test ' 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd, 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final r 14, Rough Plumbing 65. Electrical -Final 15, Rough Electrical -Conduit 66. Solar System -Final 16. 'Rough Electric Wiring i 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 20. Rough Factory Fireplace FIRE DEPT, REQUIREMENT 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 1 °,•. 24. j„jof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25•- oof Sheathing 74. Overhead Hydro _ 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ; 27. Frame and Flashing �S 76.: Dry Standpipe ' 28. Lathing & Siding h 77.; FIXED SYSTEM FINAL ; 29. Insulation 78. FIRE PREV• FINAL ; 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. Sofar.: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 o. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONST/RUCTION PERMIT Project Addtess �L �' ! 7 PEPIT NO. �3 % TRACT NO � LOT NO. UNI r O. /' - Zone Applicant's Mailing Address _ -_-___ _ ,qQ S� v� = a �,�,�b� Owner's Name Phone }� �- Q,i r ��/ _kZm � � 7 CA - Address �i - TYPE OF CONSTRUCTION NEW ADD ALTERATION ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. REPAIR Arch/Eng, l,dl/lih,'7 �� OM 0t�A License No. Address - Contractor's Nam a j: Phone 6- Ga Address (mailing) — -- -- iYl J TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL ❑ -OTHER PROJECT DESCRIPTION SQ. FT, OCCUPANCY CONSTRUCTION TYPE- VALUATION $ City License No. ZONE GRADING CU.YOS, ACRES Dote LICENSED CONTRACTOR DECLARATION p B A Rear Remarks: .SUMMARY OF FEES N I I hereby affirm that I am licensed tinder provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Cod�nd my license is in full force and effect. yn� License Class License No. / Right $ SMIP Date Signature S PLUMBING FEES WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have d certificate of consent to self -insure or a certificate Bar Sin ) Showers Perking Req,/Provided Backfiow Preventer Service Sink Planning Notes: -if Workers' •Compensation Insurance, or a certified copy thereof (Section WOO, Lab. C.) q Policy No. &ZOOZ6sl 1 Companydcfisle4 r�S• Co , Certified Copy is hereby furnished. Certified op 1 filed with the city Builtling D' l Backflow Irrigation Sewer Cap , GRADING Bathtubs Sewer Connection 50% $ d- Date Applicant ExEMPT N i ROM WORKERS' COMPENSATION DECLARATION (Th issec on need not be completed if the permit is for one hundred ($100) or less I certify that in the performance of the work for which this permit is issued, I shalt not employ any parson in any manner so as to become subject to the Clarifiers _Solar Coflectors - FEES Dishtnsher , Solar Piping Automatic Washer Construction Pole Sub. - Drinking Fountains Solar Tank Workers' Compensation Laws of California. Floor Drains Swimming Pool w/Spa Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must' forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Floor Sinks Gas Service Outlets Urinal _ WaterCtOset Dryers ❑Gas ElElectrie r E hereby affirm that there Is a construction lending agency for the performance Fan Jf of the work for whic(1 ,,,this por�r�i}�f, is i ued (Section 3097 Civ, C.) Landor's Name -------C?- dfly �iw'c�57 mt2l f ^�_ Lender's Address �2_t J •�H &jaL /-A �/ _ Interco tors p Water Heater F.A.U. Kitchen Sink Water Service OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, atter, improve, demolish or repair 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 the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Buslness and Professions Code) or that he/she is exempt herefrom and the basis fpr the alleged exemption. Any violation of Section 731.5 by any applicant for a permit subjects the applicant to a civil analty of not more than live hundred dollars (SS00). I] I, as owner of the property or my employees with wages as their sole Compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a proberty who builds or improves thereon, and who does Such work himself/herself or through his or her awn employees, provided that Such Improvements are not Intended or offered for sale. If, however. the building or improvement is sold within one year of Com- pletion, the owner will have the burden of proving he/she did not build or Im. prove for the purpose of sale), ❑ 1, as owner of the property, am exclusively Contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a can- tractor(s) Ilconsa pursuant -to the Contractor's License Law). I am aware that Proof or their worker's Compensation Insurance should be provided to me, Lavatories Auto -Wash 1P -Trap Laundry Treys Switches Roof Drains Garbage Disposal _ - Reinspection. Fee $15 issue Fee $ 3 - MECHANICAL FEES Trash Compactor Boiler Hood or Type I ❑ Canopy Type I I ❑ , Duct - Under Ground Duct - Structural Refrigeration System 00- 100,000 BTU ❑100,000 BTU Duct - Ventilating Exhaust System 0 Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers ❑ I am exempt tinder Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above Information is correct. I agree to Comply with all city and county ordinances and state laws relating to but ding Co struCtion, and hereby authorize repre- Sontatives of this City tou e above.mentioned pro rty for Inspection purposes. Heating System & Ducting ❑0.100,6]00 BTU ❑iocFooOBT Registers ' - Reinspection Fee $15 Issue Fee $ 3 Signature Date % Drivers' License or SS � CMF 0665-46, rev. 10/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Reinspection Foe 1 $15 Issue Fee $ 3 A P 9W /' - Zone S Main Building: Accessory Building: Date Building Approved By TFront Dote Application Issued By p B A Rear .SUMMARY OF FEES N I C Right $ SMIP N S Left PERMIT G R Ping. Ref. 5#' Perking Req,/Provided $ E Planning Notes: ENERGY P.C. $ ELECTRICAL Q M GRADING S PLAN CHECK 50% $ T S S ELECTRICAL FEES TOTAL FEE Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW 25% $ Cooking Unit Meter ❑up to 100 amps Dishwasher - Meter ❑over i00arnps Dryers ❑Gas ElElectrie r Sub Panel Fan Jf Motors 00.1 HP 011A - B F.A.U. Inc. Solar 09.15 HP ❑16-15+ Fixtures Device Boxes Outlets Microwave Pole Light Range Switches Sign Garbage Disposal ; Standing Sections Generator 00.5 KW 05.15 KW Trash Compactor Reinspection Foe 1 $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Dote Application Issued By _ - Data .SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25%' $ 1,()0 ENERGY P.C. $ ELECTRICAL $ GRADING S PLAN CHECK 50% $ MICROFILM S MECHANICAL $ TOTAL FEE S� PLAN CHECK 25% $ I CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL 'A APPROVALS Permit # Date inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54, Forms 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, D 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-Cdnduit 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas D Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank D 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 ;, J, 79. FINAL INSPECTION 32. Electrical Power Meter -Final' BO. -FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final , 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation r• 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations r 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison v 50. Gas -Release to Southern California Gas Co 51. CERTIFICATE OP OCCUPANCY No. Date y Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. `l CITY OF COSTA MESA co STRUGI10N MIT Project Address • Aeplisant's Mailin dress Owner's Name P e Address Arch/Eng. License No. Address Contractor's Nam one Address (mailingI / City License No. LICENSED CONTRACTOR DECLARATION thereby, affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3,of the Business and Professions Code, and my license Is in f orc0 na ffect. Licens Class License No,L/• Da[e Signature WORKERS' C M SATION LARATION I hereby that I have a certi 'tate of consent to self -insure or a certificate .of Workers' Compensation Insurance, .or a certified copy 'thereof (Section x3800, Lab. C.) Policy No. ' Company eCertified copy Is hereby furnished. Certified copy Is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (5100) or less). I certify, that in the performance Of the work for which this permit is Issued, I shall not employ any person in any ner s s to become subject to the Work Co sat�p�j Laws of Calif rm Oat "o s -X signature 'NOTICE: If, after making this decla� n, fou should become subject to the Workers' Compensation provisions the -Labor Cotle, you must forthwith comply with such provisions or this permit • shall be deemed revoked. CONSTRUCTION LENDING A43ENCY I hereby affirm that there is a'construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. 'C.) Lender's Name Lender's Address _ - OWNER'BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, -also requires the applicant for such permit to file asigned statement that he/she is licensed- pursuant to the provisions of the Can tractor's'License Law (Ch4pter 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 dileged exemption.' Any violation of Section 7031.5 by any applicant for a permit subjects the- applicant to a civil penalty of not more than five hundred dollars ($500). .3 I, as, owner of the property'or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, BUSineS% and Professional Code: The Contractor's License Law does not apply town owner of a property who builds or Improves thereon, and,who does such work himself/herself or through his or her own employees, provided that such irriprovements are not,intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner wlll�have the burden of proving he/she did not build or im- prove for the purpose of sale), ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project ($ection 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a'con- tractor(s) t)cense pursuant to the Contractor's License Law). lam aware that proof at! their Worker's Compensation insurance should be provided to me, ❑ 1 am exempt under Section B. & P, C. for this reason Date I hereby certi information is and state laws sentatives of inspectionIl��t r Signature Drivers' Lic 5 Owner I, have read this application and state that the above Iagree to comply with all city and county ordinances to building construction, and hereby authorize repre- to enter upon the above-mentioned groEerty f r Date .- orSS:* PERMIT NO. (o LOS TRACT NO. LOT NO. UNIT NO, •5865 7/02/85 1 L1e50 1 TYPE OF CONSTRUCTION LJ NEW D ADD LJ ALTERATION ❑ CONVERSION ❑ DEMOLISH ❑ OTHER 'DESCRIPTION OF WORKIUSE OF BLDG. .:REPAIR A.P. # _ Zone $ Main Building: Accessary Building: TYPE OF PERMIT ❑ GRADING El FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRAOING CU,YDS. ACRES E T Front Z O BRear A N I C Right N S I Left G R Ping. Ref. # Parking Req./Provided > Remarks: Planning Notes: - t7 M ' T. S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink 2 Automatic Washer Construction Pole Sub.. Transformer ❑ 15.50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Ciarifiers Sewer Connection Solar Collectors king Unit r� MOwasher Meter Dup to 100 amps Meter Clover 100 amps. _- Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel -- Drinking Fountains Solar Tank Fan Motors E10-1 HP D11/, - 8 Floor Drains- Swimming Pool w/Spa, F.A.U. Inc. Solar 119-15 HP 1:116-15+ Floor Sinks Urinal - Fixtures Microwave Gas Service Outlets. Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash ' Garbage Disposal ; Standing Sections IP—Trap Laundry Trays Generator ❑0-5 KW ❑5.15 KW Trash Compactor Roof Drains IL ReinspectionFee$15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued Byr� a _ Data Boiler Hood or' Type f ElDEVELOPMENT Canopy Type 11 ❑ Duct - Under Ground Duct - Structural Refrigeration System ❑0-100,000 BTU 0100,000BTU E_ Duct - Ventilating - BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% 'SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE $ $ �__ � ENERGY P,C. $ $ _ GRADING $ $ MICROFILM $ $ TOTAL FEE $ I $ �• �� Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO# Fire Dampers' Heating System & Ducting ❑0-100,000 BTU❑100,000BT Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0665-46, rev. 10184 White - Building; Canary - 4pplicant; Pink - Accounting; Goldenrod - Assessor - CONSTRUCTION AND PLANNING �} APPROVALS Permit # Date Inspector rr1 POOL & .,A APPROVALS Permit # Date Inspector ,i. Tgmpo;ary Electrical Service or Pole '� 52. Pool & Equipment Location 2. Soil�Pi0Wndrgr�nd. ' 53. Steel Reinforcement �3! EIect Gal Conduit•�CXility.Undrgrnd6ij, 54. Forms 4 --Electrical Condiyit`.Und grnd. (U 55. Electrical Bonding 5• fSteelfReinforcement', r .s Af �v l R 56. Rough Plumbing & Pressure Test l f1 �6- E ctrital UFER Gr�d: " rf. = �� 57. APPROVAL TO COVER-GUNITE ' /} 7F`ooti" f - �. 58. Electrical Conduit-Undrgrnd. f tib 8.d�Fatron I� 1 41 59. Gas Pipe, ❑ Undrgrnd., Test + rhp 9E W,t rrPi,pe-Ugdr r' d** .> F t1f 60. Backwash Lines, P -Trap, ❑ Undrgrnd. ) •10� Strut rai Flood stem �_. L ,t 1 61. APPROVAL TO DECK rf 1,1. Pr`p'ertY Sewer Line &House Coltne�tion 62. Backwash & Receptor -Final 12. Sewer Cp Loll,I 63. Heater &Vent Final 13. Roof Drains LJ i 64. Plumbing System Final 14. Rough plumbing -� 65. Electrical -Final t� 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 8lectrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, ir) Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final'Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy • 37. Final Factory Fireplace r � 38. Final Plumbing 39. Water Service -Final ,9 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 517 CERTIFICATE OF OCCUPANCY No.Date- " .� Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PFRMl I N(7. I TRACT NO. LOT NO. I t)Ni'T'run CITY OFCOSTA MESA CONSTRUCTION PERMIT Project Address Ji f I K/- �'RS� IYl Applicant's Mailing Address ` Owner's Name 0 r a N Phone Address _ Arch/Eng. License No. Address _ Contractor's Name- M0 W.1 S C L.EC'Trig t G Phone s�-V-hkM Address (mailing) I If '- 13RY6611- LT; ,) L0tr vrJGTnrV X31 City License No. 3 O LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the ess an Prof ssl Code, and my license is in full force and effect License Class '" 10 License 7 Date I—IO— {iS � Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate Of Workers' Compensation Insurance,,or a certified copy thereof (Section 1800, Lab. -C.) Policy No. -70 Co _ a BCertified copy is hereby furnished. Certllfied copy filed With the city uild" ision. Date._t�s' rApplicant EXEMPTION FROM WORKERS' COMPENSATION ECLARATION: (This section need not be c(impleted if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laves of California. F ' Date Signature -NOTICE: If, after making this declaration. you should -become subject to the Workers' Compensation provisions of the Labor' Code, you must forthwith, _ • comply with such provigions or this permit shall' be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constructlon'tending agency for the performance of the work for which this permit is .issued (Section 3097 Civ. C.) Lander's Name Lender's Address OWNER BUILDER pECLARATION •• 1 hereby affirm that I am exempt from the, Contractor's License Law for the ' following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 '031.5 by any' applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). L1 I, as .owner of the property or my employees with wages as their sole compensation, will do the work, and the.structure is not intended or offered for sale (Section 7044, Business and Professional Code: The- Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one yearofcom- pletlon, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of stile). ❑ I, as owner of the property, am exclusively contracting with licensed Con- tractors t6 construct the project (Section 7044, Business and Professions Code: The Contractor's License law does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a con- tractors) Imense pursuarit to the Contractor's License Law). 1 am aware that Proof of their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this appli information is correct. l ee to comply wit and state la Ing uilding con ruC sent atIves of this t enter upo t inspection pu poser Signature Drivers' License or 55 tand state that the above �tI city and county ordinances h and hereby authorize repre- bove-mentioned property for Date TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION 1I REPAIR 1 ❑ ❑ ❑ I Reinspection Fee CONVERSION DEMOLISH OTHER A.P.�h DESCRIPTION OF WORK/USE OF BLDG. DEVELOPMENT SERVICES REQUIREMENTS: - Zoning Approved By Building Approved By Application Issued By ML Date pate pate S, Main Builth BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% = ELECTRICAL ' PLAN CHECK 50% MECHANICAL . PLAN CHECK 25% SUMMARY OF, FEES $ $ $ $ $ $ �-� $ IS E $ $ $ $ $ $ TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ElTENANT [_1ELECTRICAL ❑PLUMBING El MECHANICAL B ❑ OTHER A Rear C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CON STRUCTION TYPE VALUATIONS $ I Left ZONE GRADING CU. YDS. ACRES Ping. Ref. Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks . Gas Service Outlets ' Interceptors Kitchen Sink. Lavatories P --Trap, Roof Drairis Reinspection Fee 1 $15 Boiler - Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust;System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0-100,000 BTU ❑ 100,000 BTi Reinspection Fee 1 $15 CMF 0865.46, rev. 10/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showeri Service Sink Sewer Cap Sewer Connection Solar Collectors ; Solar Piping Solar Tank Swimming Pool vv/Spa Urinal i Water Closet - Water Heater Water Service A uto-Wash Laundry Trays Issue Fee MECHANICAL !'Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System 1:10.100,000 BTU 1:1100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES i Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric t, Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal • Generator 00.5 KW 05-15 K 5873 1/16/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer El15.50 KW 1-150+KW Meter ❑up to 100 amps Meter -Clover 100 amps Sub Panel Motors %J0-1 HP ❑ 1'h 8 Inc. Solar C1 9-15 HP 016-15+ Microwave• Pole Light Range Sign Standing Sections W Trash Compactor 4,50 TL Z O N I N G R E, Q M T S FEES $ 3 11 1 I Reinspection Fee $15 Issue Fee t $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: - Zoning Approved By Building Approved By Application Issued By ML Date pate pate BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% = ELECTRICAL ' PLAN CHECK 50% MECHANICAL . PLAN CHECK 25% SUMMARY OF, FEES $ $ $ $ $ $ �-� $ IS SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTAL FEE $ $ $ $ $ $ $ 3 • CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL - _PA APPROVALS Permit # Date Inspector '.1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. - 57. APPROVAL TO COVER-GUNITE 7, Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test '9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66, Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17, Rough Wiring Sign fib. APPROVED FOR PLASTERING 18, Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd, Storage Tank ❑ Gas ❑ Oil 25. Roof Shesthing 74. Overhead Hydro 26. T -Bar Ceiling {Structural} & Monocoat 75. Dry Chemical 27. Frame and Flashing 76, Dry Standpipe 28. Lathing & Siding- 77. FIXED SYSTEM FINAL 29, Insulation 78, FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT .31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric ' C�-- Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. 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. CEFIT IF.ICATE OF OCCUPANCY I\1o. Date Applicant to fill in all spaces except those within heavy border -lines and sign all appropriate declarations, CITY OF COSTA MESA GONSTR UC i l LU) I'hK 11 I Proje;t Address`� Applicant's Mailing Address - S' 19.M s Owner's Name oY k". T 6-1 Phone75 _4 - A01 Address 11321 GR _ Al-Ipor;t lAencA C4 Arch/Eng. W[ -!•RM Crai rA a License No. CIS -24Y_ Address .t �S�J (�/.'�t/�.'!e tS�l� 1 lie Contractor's Name Phone Address (mailing) City License No. LICENSED CONTRACTOR DEt;'LARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License NO. Date Signature l WORKERS' COMPENSATION ISECLARATION hereby affirm that 1 have a certificate of consent to self -insure or a certificate ' Workers' Compensation Insurance, or a certified copy thereof (Section .800, Lab. �j/] • icy No. LOO 0 6La f Company /-�e� ,&4 Certified copy Is hereby furnished. Certifiod jlb d with the city Building Divi Date p i Applicant EXEMPTION FJiOM WORKER$' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (5100) or less). I certify that in the performance of the work for, which this permit is issued I shall not employ any person In any manner so, as to become subject to tine Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor -Code, you must forthwith comply with such provisions or, this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a COhstruction lending agency for the performance of the work "for_wtoch thi permit., is issued (sec ion 3097 Civ, •C.) Lender's Name Lender's Address Xltt![Tgwk: /2,A CA - OWNER BUILDER DECLARATION ' 1 hereby affirm that I am. exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit to construct, alter. -improve, demolish or repair -any structure, prior to its issuahce, also requires the applicant for such permit 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 "''"ereTrom antl the basis for. the alleged exemption. Any vlolatlon of Section F '��"`r3i.5 by any applicant for a permit subjects the. applicant to a civil +i'�'enalty of not more than five huntlretl dollars ($500). 4—, r LJ I, as owner of the property or my employees with wages as their solo compensation, will do the work, and the structure Is not intentled or offeeed far sale (Section 7044, Business and Professional Cade: The Contractor's License Law tloes not apply to 8n owner of a property who builds or improves thereon, antl who tloes such work hlmseli/herself or through his ,her own fered for employeesI provided that such improvements are not Intended or of sale. If, however, the building or improvement is sold within one year Of com- pletion, the owner will have the burden of proving he/she did not build or. im- Prove for the purpose of Sale). I f ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor($) license pursuarit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner , 'hereby certify that I have r@ad this application -and state that the above Information is correct. I agree to comply with all city and county ordinances and state laws relating to builgin4cons1witt ' I - antl hereby authorize repre- entatives of this city t0 a ter Ybove-mentioned pro rty for Inspection purposes, Signature Date C� Orivers' License or SS a Y3 7 slW e- L= S- TYPE OF CONSTRUCTION EW LJ ADD U ALTERATION L1 REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. ' S Main Buildi TYPE OF PERMIT 1_G R—A—DING ❑ FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ® PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CON STRUCTION TYPE VALUATION $ S I Left ZONE , GRADING CU, YDS. ACRES Ping, Ref. + Remarks: C/�1+ 3�1 (f/ [ 6 /;cyQ Planning Notes: Bar Sink I, Backflow Preventer Backflow Irrigation Bathtubs Clarifiers _ Dishwasher I Drinking Fountains Floor Drains Floor Sinks Gas Service : Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof.Draiits t Reinspection Fee 1 $15 Boiler ' Duct - Undei Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO.# Heating System & Ducting El 0-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink.- Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cep Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa' Urinal ; Water Closet - Water Heater - Water Service Auto -Wash ,•Laundry Trays ' Issue Fee Hood or Type l ❑ Canopy Type ll ❑ Refrigeration System 1:10m100,000BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers , Issue Fee 8551• 6/30%96 BAD TL Zone Accessory Building: Z O N I N G' R Parking Req./Provided E Q r M S ELECTRICAL FEES Automatic Washer,- Construction Pole�Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit' `y Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas-ElElectric Sub Panel Fan `. �I F.A.U. ' Motors ❑0-1 HP ❑1,A - 8 Inc. Solar ❑9 15 HP El 16-15+ Fixtures Device Boxes Outlets { Microwave Pole Light Range Switches Garbage Disposal Sign ! Standing Sections I Generator 00.5 KW ❑5-15 KW Trash Compactor $ 3 Reinspection Fee $15 Issue Fee S 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved ByDate Application Issued By _ Dat SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ 1c i7 ENERGY P.C. S ELECTRICAL$ GRADING $ PLAN CHECK 50% $ MICROFILM S p MECHANICAL $ TOTAL FEE $ �? PLAN CHECK 25% $ $ 3 COWSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL ;PA APPROVALS Permit # Date Inspector 1. 16"emporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd, 57. APPROVAL TO COVE R-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. ' Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19: Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. ,Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43f -,Backflow Irrigation r• 44. -Landscape Irrigation System 45.,Sound Attenuation 46' Handicap Regulations t 47,1, -FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50s,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. -7 A NSTR 11 N PER'MlT PERMIT NO. TRACT NO. LOT NO. UN1T r,13 7-1 . F O CITY Oa I A MESA CO UCT O Project Address _7/f MESR. Applicant's Mailing Address Owner's Name � � l N yESihe(JT Phone _ Address . Arch/Eng. _License No. Address Contractor's Narn RIS `L.EC1_ R IC- Phone!7"6kKa Address imailing) 1��bS RRYA TT ST; gl gfxh trJ G.�l City License No, 0 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 o mencing with section 7000) of Division 3 of t ass and ofessi ns Code, and my license is in full force and effe . License Ciass I O Lrcen Nv. Dale f I-1-- Slgnature WORKERS'COMPENSATION OECLARATIO I hereby affirm that I have a certificate of consent to self -insure or a certificate -)f Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab. C.) Policy No, Co E LEG'r BCertified copy is hereby furnished. Cer lfietl copy l ,filetl with the cit Buil ivlSion, Date I �� Y, Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the -permit is for one hundred ($100)Or less). l I certify that in the performance of the work for which this permit is Issued 1 shall' not employ any person in any manner so as to become subject to tjte Workers' Compensation Laws of California. Date Signature 'NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with • Such provisions Or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) en Lder's, Name Lender's Address _ OWNER BUILbER DECLARATION I hereby affirm that I am exempt from the Contractor's License law for the following reason (Section 7031.5 Business and Professional Code; Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions Of 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 031.5 by any applicant for a permit subjects the applicant to a civil enaity of not more than five hundred dollars ($500). _ 0 1, as owner of the property or my employees with wages as their $016 compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who build$ or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such .improvements are not Intended or offered for sale, If, however, the building or improvement is sold within one year of com- pletion, the ownor will have the burden of proving he/she tlid not build or Im- rove for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- tractors to Coristruct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such projects with a con- - tractor(s) license pursuarit to the -Contractor's License Law'). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I ' hereby cer hat I have, read this InformationAS cor ct. agree to co p and state I s relaP94 Yo building n sentatives t this t to enter or inspection urb Signature Drivers' License or SS ,a, ion and state that the above I.city and county ordinances on, and hereby authorize reore- above-mentioned property for i Date E— TYPE OF CONSTRUCTION U NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER rSE P.+ DESCRIPTION OF WOR KIUSE OF SLOG. Main Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Reor ❑ ,OTHER '4 PROJECT DESCRIPTION SQ. FT. OCCUPANCY T C Right CONSTRUCTION TYPE VALUATION $ 5 Left ZONE GRADINGCU.YDS. ACRES Ping. Ref,$ Remarks: Planning Notes: ar Sink ackflow Pre'venter ackflow Irrigation Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains , PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service 'Auto -Wash Laundry Trays FEES Reinspection Fee I $151 I Issue Fee I $ 3 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepi/Fact. Bit. ICBO 906 Heating System & Ducting El 0-100,000 BTU 0100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor L Hood or Type I ❑ Canopy Typell ❑ Refrigeration System ❑0-100 D00 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES $ 3 5874 1/16/85 Zone _ Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer - Construction Pole Sub. Cooking Unit Dishwasher _-- Dryers ❑Gas ❑Electric Fan ' F,A.U, Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 05.15 KW Transformer ❑ 15.50 KW ❑ 50+KW 4.50 Z 0 N 1 N G • R E Q M T S FEES Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors ®0-1 HP 01h- 8 Inc. Solar 09.15 HP ❑16-15+ Microwave Pole Light Range Sign ! Standing Sections Trash Compactor I I Reinspection Fee 1 $15 1 1 Issue Fee I $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS. Zoning Approved By Date Building Approved By Date Application Issued By —Date >a -Op SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM 5 MECHANICAL $ TOTAL FEE $ Sn PLAN CHECK 25% $ 1 'CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL SPA APPROVALS Permit # Date Inspecanr ' 1. Temporary Electrical Service or Pole 52. Pool.& Equipment Location 2. Sail Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test .6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE -7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation, 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, 0 Undrgrnd, 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit" 66. Solar System -Final :16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18.' Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ID Gas 0Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Rrown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric f +_ Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irriqation System 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49. Electric Release to Edison 50. Gas Rebase to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO.�� TRACT NO. LOT NO. UNIT Project Address 711 W. 17th St. Bldg. (E) Unit 5 1 i I \ s Applicant's Mailing Address 13110 .. Saticoy St. N.H011ywood CWPE OF CONSTRUCTION LJNEw LJADo LJALTERATION LJREPAIR Owner's Name T tment FundPhone 549-2988 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P # DESCRIPTION OF WORK/USE OF BLDG. Address 4321_Birch S -.—Newport Beach, Ca. S Main Building: Arch/Eng.-Maritl---1-. Rnrk License No. TYPE OF PERMIT GRADING 1:1FOUNDATION El STRUCTURAL T Front Address 1288L1to.it_Av.fa.�uite 216 ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING +� MECHANICAL B Rear ❑ 'OTHER Contractor's Name_ uco Ai_r- ConditiQn�gPhone _982--1216 C Right Address imaiiing►1-31-1-0 _Sat_ i r��t.—N-..H allymood. Ca • PROJECT DESCRIPTION SCS. FT. OCCUPANCY K Left CONSTRUCTION TYPE VALUATION S $ City License No. 3M.2.5 - - — -- — -- --- ZONE GRADING CU.YD$. ACRES LICENSED CONTRACTOR DECLARATION Ping, Ret, # I hereby affirm that t am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: N with section 7000) of Division 3 o he Business and P SSIonS Code, and my license Is in full force and effe Zoning Approved By ' License Class G?0 Lice s N „��}.6..25.1 Date �--�y�/j QQ�— Signature _ RATION I hereby affirm that l have a certifof consent to self -insure or a Certificate WORKC4TV 2 ENSAT1 N D71C2... Date Building Approved By PLUMBING FEES Bar Sink Showers Backflow Preventer Service Sink ' -of Workers' Compensation Insur or a certified copy thereof (Section i800, Lab. C.) Backflow Irrigation Sewer Cap Policy No.—____14G9a24Company 1.11mbermanc S eCertified copy is hereby furnished, 1 Certi copy is filed with the city Buildingoiyls(Qp, 1 Bathtubs Sewer Connection S oat e Applicant t� 2-- y - - -- EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers Solar Collectors $ (This section need not be completed if the permit is for one hundred (5100) or less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Dishwasher Solar Piping Drinking Fountains Solar Tank ELECTRICAL Workers' Compensation Laws of California, Floor Drains Swimming Pool w/Spa Signature S .Date NOTICE: If, after making this declaration, you should become Subject to the Workers' Compensation provisions of the Labor Cade, you must forthwith comply with such provisions or this permit shall be deemed revoked. Floor Sinks Urinal Gas Seri ice Outlets Water Closet CONSTRUCTION LENDING AGENCY PLAN CHECK 25% I. hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Lender's Name Kitchen Sink Water Service Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License taw for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any Structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant t0 the provisions of 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 D31.5 by any applicant for a permit subjects the appliCant to a Civil lmalty ofnot more than five huntlred dollars ($500).I,asoner of the property or my employees with wages as their sole pensation, will do the work, and the structure is not Intended or offered for Sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work hlmself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement IS Sold within one year of com- pletion. the owner will have the burden Of proving he/She did not build or Im- Mr ajor the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- Lavatories Auto -Wash ' P—Trap Laundry Trays Roof Drains - Reinspection Fee $15 Issue Fee$ 3 - MECHANICAL FEES Boiler Hood or Type I ❑ Canopy Type 11 ❑ Duct - Under Ground Duct - Structural Refrigeration System tractors tp construct the project (Section 7044, Business and Professions Coda: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuarit'to the ContraCtor's License Law). I am aware that proof or their Worker's Compensation Insurance should be provided to me. ❑0 100,000 eTU ❑100,000 BTU Duct - Ventilating Exhaust System El Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG # Fire Dampers ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read is application and stale that the above Information Is correct. I agree to ply with all city and county ordinances and state law ating to buildi nstruCtion, and hereby authorize repre- sentatives th1 city to a on the above-mentioned property for inspectionurpos s. Signature a e 7 J Drivers' Livens r 55 Healing System & Ducting FX0-100,000 BTU Ell 00,000ST Registers 0 _ , Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor O�r�6 / &/3/IJ a— Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit D ishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW ❑5-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter Clover 100 amps Sub Panel Motors 00-1 HP ❑ 1'r6 - 8 Inc.Solar ❑9.15 HP 016-15+ Microwave Pale Light Range Sign ' Standing Sections Trash Compactor T--ro FEES Z O N I N G R E Q M T S I I Reinspection Fee 1 $15 { 1 Issue Fee I S 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat Z SUMMARY QF FEES BUILDING PERMIT S SMIP $ PLAN CHECK S PERMIT PLUMBING $ ISSUANCE S PLAN CHECK 25% S ENERGY P.C. S ELECTRICAL S GRADING S PLAN CHECK 50% S MICROFILM $ MECHANICAL S 43-. 00 TOTAL FEE $ 115- 5C PLAN CHECK 25% S 7_r,n CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POO. .SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location r 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement . 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement w 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. r` �'� 57. APPROVAL TO COVE R -G UNITE : 7. Footings ! 5B. Electrical Conduif-Undrgrnd. 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. } 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System r 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12, Sewer Cap t1 63. Neater & 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 APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27, Frame and Flashing 76. Dry Standpipe 2B. Lathing & Siding 77. FIXED SYSTEM FINAL 29. insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer r' 43. Backflow Irrigation 144. Landscape Irrigation System 45. Sound Attenuation %46. Handicap Regulations 11 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison '5D. Gas Release to Southern California Gas Co J51, CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those w�order lines and sign all appropriate declarations. y. CITY OF COSTA MESA CON TRU T�QN #a FAIT Project Address 4�• `,'� Aoplilant's Maili A I ress �/ P to 44 1 Owner's Na P ne Address Arch/Eng. License No. Address Contractor's Nam M,a HLT Phone��,21zW Address (mailing) City License No. 21 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in fu1 orce d rect. Ucens Class License No+' 77 42� � Date `F` �Signature WORKERS' COMPENSATION D LARATION I hereby affirm that I have a certi tate of consent to self -Insure or a certificate of Workers' Compensation Insurance,, or a certified copy thereof (Section 3800, Lab. C.) Policy No. Company Certified copy Is hereby furnished. ' Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (5100) or less). 1 certify that in the performance of the work for which this permit 1s Issued, I shall not employ any person In an m nor o as to become Subject to the Worker Co enSat ws of Cal a. Date Signatur •NOTICE: , Witerm m fng this declr 0n, ou should become subject to the Workers' Compensation provision f the Labor Code, you must forthwith comply with, such provisions Or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issue_ d (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of `the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation -of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, 1the owner will have the burden Of proving he/she did not build or im- rove for the purpose of sale).. , as owner of the property, am exclusively contracting with Ilcensad con. tractors t0 construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a con- tractor(s) license pursuant to the ContraGor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. 6 P. C. for this reason Date Owner I hereby certify that I have read -this application and state that the above Information is correct. I agree to comply with all city and county ordinances and stale laws relating to building construction, and hereby authorize repre. sentatives of this city to enter upon the above-mentioned property far. Inspectionr — Signature �� ase-.,.—•., Dal. 1e' Drivers' PE IT NO. TRACTMOW LOT NO. UNIT NO, �� 5866 7/02/85 I Qe5n TYPE OF CONSI El NEW ADD I Al TERA71 )N -❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. • REPAIR A P. # zone S Main Building: Accessory Building: TYPE OF PERMIT ID GRAOING FOUNDATION 11 STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ -OTHER PROJECT DESCRIPTION SQ. FT, OCCUPANCY CON STRUCTION TYPE VALUATION S ZONE GRADING CU. YDS. ACRES T Front O B A Rear N I C Right N S G Left R Ping. Ref. # Parking Req./Provided E Remarks: Planning Notes: -" Q M T S PLUMBING FEES ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50+KW Cooking Unit Meter []up to 100 amps FEES Bar Sink Showers Backflow Preventer Service Sink Z cc Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Meter C3 over 10.0 amps Dishvva§her Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan' , 'Motors ❑O.1 HP ❑1 fr -•S Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP ❑16-15+ Floor Sinks Urinal Fixtures Microwave ' Gas Service Outlets Water Closet Z =0 Device Boxes Pole Light Interceptors' Water Heater Outlets Range Kitchen Sink Water Service Z Switches Sign Lavatories P—Trap Auto -Wash Laundry Trays Garbage Disposal Generator ❑0-5 KW ❑5.15 KW Standing Sections Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Hood or Type I ElDEVELOPMENT Canopy Type It El SERVICES REOUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Date Date. Duct -Under Ground Duct - Structural Refrigeration System ❑0-i00,000 BTU ❑ 100,000 BTU Duct - Ventilating SUMMARY BUILDING PERMIT $ PLAN CHECK $ PLUMBING S _OO PLAN CHECK 2596 S �� ELECTRICAL $ PLAN CHECK 50%. $ MECHANICAL $ PLAN CHECK 25% $ OF FEES SMIP $ PERMIT _ ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ C�,So Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO Fire Dampers Heating System & Ducting ❑Q700,OD0BTU [3 100,000 BT Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - A licant; Pink - Accounting; Goldenrod - Assessor -CONSTRUCTION AND PLANNING APPROVALS Permit # �.t Date Inspector n POOL & SPA APPROVALS Permit # Date I nsperrnr 1. Tempw�ry Electrical Service or Pole r 52. Pool & Equipment Locationkr m(� 2. Soil Pipe-Undrgrnd, I;p 53. Steel Reinforcement �- rr j3. ElecthicaI Conduits Utility-Undrgrnd? --1 i r 1 54. Forms ZElectncal Conduix-thndryrnd. w 55. Electrical Bonding f. 5. Ste6l1linforcement 56. Rough Plumbing & Pressure Test+I ff�.1=lectrical UFER•Grnd. f / �'� 57. APPROVAL TO COVER-GUNITE i f► 7, -Foo ng`s� •4 ✓' 58. Electrical Conduit-Undrgrnd. 8:.Foundationr� �.41 � 59. Gas Pipe, ❑Undrgrnd., Test J 9% Water�Pape Undr$ntl! �{ 60. Backwash Lines, P-Trap, ❑ Undrgrnd. �1 101Str.uct�ij� I Floor Sy em `� + 61. APPROVAL TO DECK 1,1% 'perty Sewer Lineoy& House Cn4ction I62. Backwash & Receptor-Final ~ 12. Sdwert ftp too �� .l 63. Heater & Vent-Final 13. Roof Drains t.r ' {p f+ 64. Plumbing System -Fina[ l' 14. RouPh;3!umbin<. 65. Electrical-Final v 15. F?6&gh Eiectrical'Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69, POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT r APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 4. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 7B. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41, Solar Domestic-Final 42. Backflow'Preventer 43. Backflow'lrrigation 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 ' COSTA MESA BUILDING -SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT 25e 25 TLt P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 X11 RECEI BY PERMIT ', For Applicant to Fill in Completely — Use Ink Only BUILDIN 711 17th A.P. NO. 424-091-04 W. E6 ADDRESBUILDING OWNER OR TENANT Equalean/Wally Wallick ADDRESS 711 W. 17th Street E6 UNIT OR MAILING AODRESS Above SPACE NO. TR,NO. LOT BLK. TEL. CITY NO. NEW ADO ALTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER BRANCH OWNER UAIE ADORESS VALUE USE ❑ Chem System s 1,500. ARCHITECT TEL. OR ENGINEER ADDRESS ZONE TYPE GROUP CONTRACTOR A. F. S : F,, .- APPROV BY GV TE AODRESS P.O. BOX 3158 CITY Ontario �T rTvo`947-6565 STATE pp 020589 APP OVEOSETBACKS LIC. O. LIC. No. SIZE NO.OF BLDGS. IFR M C/L STREET) OF LOT NOW ON LOT RO FT. USE OF EXISTINGBLOG. Industrial/Mf Separate permits are required for L. SIDE T. electric, plumbing and heating work. REAR FT. US OF BUILDI(JG AND WOR TO 13% PERFORMED. PLANNING A ION utomatIC Dr emica Extin - uishing System to be installed. TE APqROVED APPROVED I hereby acknowledge that I have read this application and state that the above information Is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. the State of California Business and Professions Code, Olvision 3, THE AMOUNT SHOWN UNOER VALUATION IS FOR Chapter 9, and th uc licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt fr the pro sionsoi i Siete of Calif a Business end Professf s Code, Div ian 3, Ch Ater 9. VgLUATION PERMIT FEE f 15.00 Signature f /� y LY—'� PLAN CHECK s Permittee $ 1,500• TAX S 12-11-80 .C,O Authorized e TOTAL_ PAID 5 25.2c; COSTA MESA BUILDING -SAFETY DEPARTMENT P,O. BOX 1200 COSTA MESA, CALIFORNIA 92626 2555 11%10/80 66990 sal APPLICATION FOR STRUCTURAL PERMIT RECE BY PERMIT —- No 500-6 For Applicant to Fill in ComBUILDING pletely — Use Ink Only { ?-� ADDRESS 7110,17-0 I / 0 A.P, NO. a , NEN OR � /'?`A � / r �y TENANT TE BUILDING']/` / ADDRESS / i (,�f MAILING ]] ADDRESS t ` y ^ " UNIT N SPACE NO. TR.NO. LOT BLK. /� j� ,[ �/ CITY W S P -/f ! ��/T NOLE'11 T.J�p-1,5 ~�,�y[ CONSTRUCTION''1 NEW ADD LTE R IREPAIR MOVING DEMOLISH LENDER NN BRANCH OWNER ADDRESS •� LUE 7 USE $ J� 7 . ARCHITECT TEL. v7 OR ENGINEER NO, �f MG ADDRESS ZONE TYPE GROUPAP / , -k �/ CONTRACTOR k. 6L `" Si�7 , i2. F'S.<<% aYPROVED DATE ADDRESS/6 GLAAG TE CITY G AAI &0l9 NO`Q y_ j STATE V_5 LIC. NO. 7� (� LICYNODI/S.Zr APPROVED SETBACKS Ajor SIZE NO. OF BLDGS. (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. USE OF EXISTING BLDG, Separate permits are required for L. SIDE FT. electric, plumbing and heating work. REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION �7 � 44S, r5_ E-/ -f Z- DATE ! ' rAPPROVED K%� S y /✓� r� ,(I�GSi_'IUU.C�f APPROVE I I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workmen's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT, the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business and Professions Code, 10 3, Chapter 9. VALUATION PERMIT FEE $ .� ♦� f Signature of /J' � PLAN CHECK $ • �� Permittee EEE JJJ or $/7.r1 TAX r[Jv 0,170 Authorized Agent Date _ � TOTAL PAID $ 6 7 0 OWNER EQUALEAN COMPANY _ DATE 11/10/80 JOB ADDRESS 711 W. 17th Street, #E-6 BUILDING PERMIT NO. 50960 T GENERAL CONTRACTOR L. RlwpkPr Shf Mtl A-, DESCRIPTION of WORK Paint cnrav Rnnth AP No. 424-091-04 LOT It •CT10NS SO. GAS WATER ROUGH PLUMBING PROP. SWR. LINE D HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER ROUGH WIRING TRENCHES IjFORMS STEEL REINF. FLOOR SYSTEM f BEAM {] STEEL REINFORCE [ _ =SHEATHING FRAME AND FLASHING LATHING -- IN OUT --PLASTER. BROWN COAT NSTa,,f:TURAL, FINAL 9HI G. VENT., REFRIG. AND A.C.• FINAL rPLUm SING. FINAL AND GAS TEST ELECTRIC, FINAL RIIIL[]IMG FINAL TRACT FIRE ZONE VALUE Signature I Date 11TYPE GROUP SUBCONTRACTOR (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 711 W 17TH ST Suite No E007 Vicinity: Parcel Nunmber: 93983055 Applicant: NOCK PLUMBING Address: 11612 KNOTT ST SUITE 217 Phone: (714) 895-1246 GARDEN GROVE, CA Zip: 92841 Owner: CASSITY, CHARLES E TR Address 2866 BOA VISTA DR Phone: COSTA MESA, CA Zip: 92626-3550 Contractor: NOCK PLUMBING Address: 11612 KNOTT ST SUITE 217 Phone: (714) 895.1246 GARDEN GROVE, CA Zip: 92841 License: 707775 Arch / Eng : Address: Phone: Zip: License: CHANGE OUT WATER HEATER. QTY SCOPE OF PERMIT FEE SUMMARY AMT ISSUE FEE $23.50 Backflow irrigation $0.00 • Backflow Preventer $0.00 Bathtub $0.00 Clarifier System $0.00 Connect (Ice,Soda,etc) $0.00 Dental Units $0.00 Dishwasher $0.00 Drain, Floor $0.00 Drain, Rainwater 50.00 Drain, Roof $0.00 Drinking Fountain $0.00 Expansion Tank $0.00 Gas Earthquake Valve $0.00 QTY SCOPE OF PERMIT FEE SUMMARY ISSUED AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P -Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Connect $0,00 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Status: ISSUED Applied: 04/01/2004 Issued: 04/01/2004 ISSUED BY: QTY AMT OTY 0 Sump Pump $0.00 0 0 Swimming Pool 50.00 0 0 Trap Primer $0.00 0 0 Urinal $0.00 0 0 Vacuum Brkr Bkflow(1-4) 50.00 0 0 Vacuum Brkr Bkflow(5+) S0.00 0 0 Wash Basin 50.00 0 0 Wash Basin Set $0.00 0 0 Waste and Vent System 50.00 0 0 Water Closet (Toilet) 50.00 0 0 Water Heater / vent $12.30 1 0 Water Piping (Inst or Rep.) $0.00 0 0" Water Re -pipe $0.00 0 0 Water Service $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92.28, § 1, 12-21.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446-46(6M) I DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the — ll'o far which this perrllit Ls issued. 11/ I have and will maintain woriters' oompensatlon insurance, as required by section 3700 of the Labor Code, for the performance of the work for which tints permit is Issued. VVV My w e e tion Insur crier nd Policyumber are: Carrier: Policy Number: (This section need not be completed It the permit Is valued at one hundred dollars (S 100) or less.) ❑ I certify that In the performance of the work for which this permit is Issued, I shall not employ any person In any manner so as to become subject to the workers' compensation taws at California, and agree that it l shoukf become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall torthwith ply th Applicant �lSig atura ,Z,,Dace: LJ_ !1 WARNING; FAILURE TO SECURE WORKERS' COMPENSATI N COVERAGE 15 UNLAWFUL AND SHALL SUBJECT AN EMPLOYOR TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($1 DO,000}, IN ADOMON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am Ilcerl5e d n=rlslnns of apter 9 (commencing with Section 70110) of Division 3 of theBusiness an fp a ions Code, and my license Is in full force and effect. Uc. # Class a S 9_ Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. {Sec. 3097, C(vil Code). Lender's Name: Lenders Address: Signature: _ Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to aonstrutl the project (Sac. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type o1 document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Glp 2, Art 2, Sec. 341, Title 6, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: _ ._ - Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and cerlty a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes Q No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ....—.................---......_....�—... _.�....�........ _........... ........ — _ - 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time hes on hand a quantity of acutely hazardous materiels equal to Or greater than a weight o1 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ......._ _ _...... _.......... ................. _.................................................................................................................... ...—.......... ........ 3 Does or will the applicant or resent or future building occupant need to prepare an RMPP Risk Management and Prevention Program for acute) hazardous materials)? ❑ Yes p NoP 8 P P P ( 9 og Y ) (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. _ ................_.._...................._.........................................................................................................................................__................... — ......._....... 4 It an RMPP is presenily required, has Section 25534 of the California Health and Safety Coda been Iuity complied with? ❑ Yes ❑ No —............... ......... __............... _._--...._......._._..- --------------....--.........__...—...........--.........................._...---..._........_.._..... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication appermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes lJ NO (Section 65850.2 of the California Government Coda requires that the requested information be furnished On applications for non-residential building permits). ............. .............................................................._........................-- 6 Will anrty peof the facility to be constructed under this permit be within 1000 feet from the outer boundarles of a school? ❑Yes El No (It 'res', the lacility must meet the requirement of Sections 25534 and 42303 o1 the California Health and Safety Code). _....---._..... ---...........................------- 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed byCalifornia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No .........—.._......._....... -.........._......................... ....................... ------ ----_...-•----- 8 (It fires", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: 1 cartity that under penalty of perjury the information given above is COroct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cattily under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City Of Costa Mesa to enter upon the above-described property for impaction purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. gnSWPjPt Le a1 Owner(s)8te„!Q AndlOr Authorized Applicant Date CODE r. INSPECTION TYPE DIE INTITIAL CODE f! INSPECTiONTYPE MM 1616 Fixed System Final Fire Prevention 296 Final Mechanical 1266 Pool Spa Final 20B f=inal Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retalning Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy AROJECT A'ShE88: 7 1 1 W• 1 7 T H ST UNIT: F. IL 2 OWNER'SNAME: BERNARD DAILEY ADDRESS: 3792 .HAMILTON ST, C.M. 786--8778 ARCNIENGINEER: REG.NO.: ADDRESS: UNIT: PERMITTEE: BERNARD M DAILY (714)548-9321 ADDRESS: 711 tis 17TH ST E-2 CM CA 92627 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 o1 the Business and Professions Cade, and my license is in full force and effect. CITY LIC.: STATE LIC.: CLASS: Date: Signature: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation insurance, or a certified copy thereof (Section 3800, Lab. C), POLICY NO.: EXP. DATE: 'OMPANY: Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. Dater Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (chis section need not be completed if the permit is for one hundred (111 130) or less). I certify that in the perlormance of the work for which this permit is issued, I shalt not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. 'Date: Signature: NOTICE: If, after maling this declaration, you should become subject to the Workers' Compensation provisions of the Labor Gode, you must forthwith comply with such provisions or this permit shalt be deemed revoked. CONSTRUCTION LENDING AGENCY: ` I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ, C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt tram the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city o1 county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that helshe is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Codd) or that helshe is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not appy to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or ` improvement Is sold within one year o1 completion, the owner will have the burden of proving h0she did not build or improve for the purpose of sale). I, as owner of the Property am exclusively contracting with licensed contractors to construct the project (Section 7044, Business (� and Professions C)de: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurame should be provided to me. d( I am exempt under Section: B P 7 0 4 4 B. a P. C. for this reaWo ALL WORK BY OWNER Date:- b [72! I do hereby certify that I am aware of and understand the requirements of Cafilornia Health and Safety Code ons 25505, 25533, and 25534 and that I or any future building occupant wilUyrill not (circle one) need to comply with said state codes and the requirements for a permit for construellon or modification from the Air Duafity Management District. Residential construction applications are exempt from these previsions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state Laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for Inspection puurrrpposes. ate: (� _zl / Signatu Driver's License or Social Security N: 1641-46 White—Building; Green—Code Enforcement; Canary—Applicant; Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA -- BUILDING PERMIT PERM NO: B 052173 PERMIT NO: B 052473 PLAN' CHECK NO: 02004-91 S GOVT; N SUPP: N CONS'T'RUCTION TYPE: PERMIT TYPE; STR PURPOSE: ALT JOB DESCRIPTION ; CONST WALL TO DIVIDE INTO 2-1600SF UNITS SQ FT; 3,000 CLAIM VALUE: 3,000.00 CALC--VALUE: 3,000,00 GROUP OCC: B-2 / COMMENTS: K lC• �(• �E N• -,f �F # �4 �F •k• 1F a{�E is � � # iE iE �_.� i(• aE !f iiF ->f � ii � �F �F 1F x• TE lF k• 1(• t< � 3( if �• I<• ?,C #(• xk(• .K. 3F �{• ?c a{- i{. �E #F k• tE �- Tti:• Tt3E # at• 3F # ft IE iE if• if• 1t k(• It• ik i{• #(- t{ - Z O N I N G R E Q U I R E M E N T S S E T B A C K S — —--�— MAIN BUILDING------------�-------- ACCESSORY BUILDING --------- F'RNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV; PARCEL: 42409111 `ZNE; MG REF NO: PLANNING N TESI> CONSTRUCT AN IN'T'ERIOR WALL BETWEEN THE WAREHOUSE AREA OF 2 > SUITES, iE TE #4 �F �F •11• at• ,� iF �E �E it• lE i4 iE k �F * fE � * i(• iF 1F iF �b�F iF it iF TE #f• # •)f �F Y ,tiF �(• � �F �F ii• •IF N• dF #F dF ?( 1f ,tiF TF iF # � # 1i• �#F iF -k * 3F 3E #{• iE iF # ,tiF If•'1F iF �F }• iE !✓F iE �f- k R E V E L O _M E N=T-- S E R V I C E S R E Q U I R E M E N __T__S ZONING APPROVED BYE-- DATE • f_,�r BUILDING APPROVED BY : DATE; APPLICATION ISSUED—,BY: DATE: o_6ZtQJ iE iF kE i(- k• # * }(• }F ?i• * If• bF i(• IF !E if i@ if•iE # # is ., x t* x .� x >r rr t. n- # kE � # #� iF # If iF •11• • a �• � #• ,tiF * ,tiF I{• k(• # }F I(• �•'M.- * IF yE * #( MF � t iF YE MF .� # iF ir• iE MF •1!• #F k'• it• ,tiF i(• }i; � * 3E 9(� iE �E #F �P .�(. i{• }F ii• !f k(• �¢ �F * j4• }i; Ik i(� �(• fi#(-li)f• # yE 3i• if• #� T{• �: * Te }t- }F tf # yE � 3E �(• LEGALIZATION:N F` E E S U M M A R Y — STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELF TRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 54,00 SMIP/NON--RES PLAN 35,iU ISSUE FEE .63 BUILDING --DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 54,63 0,00 35.10 85,7:1 89,73 ,00 REVENUE DIVISION TOTALS--> - COLLECTED: 54.63 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 54.00 .63 iF •11• # iF ,tiF #(• # 1F f{• * iF MF it if- tf �F i{• f•4• #(• .� �( }i• 1F TE +F iE * ;id 1F ;P aF * i{• tf � ,f kF � * iE * ,K• +f 1t ?f• * ,k }t• IE #i- iE kE K * *• iF 1t •1!• ?f �• +t• -}F * fs #'r iE #F ' F 1t 1F yE x kF kF i(• kF * * +F I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFC 3000 ALTER BY VALDE COMMERCIAL NOZON£ 1,00 :3,000,00 END OF FEES G] TIC.7 j DATE: G6?24.r4i Ti14,[: ;Go3.i CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POS a SPA APPROVALS Permit # Date Inspector 1, Temporary Electrical Service or Pole 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd. 53, Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. _Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding - 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57, APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd, S. Foundation 59, Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61, APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13, Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15, Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68, APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air. Conditioning FIRE DEPT, REQUIREMENT APPROVALS Permit # 20, Rough Factory Fireplace 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 ❑ 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 PREY, FINAL 30. Drywall NailingaJ ' HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final ' 40, Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irriqation System 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITV0-F CdSTA MESA ' CONSTRUQQN P`E� MIT pFRMIT NO TRACT NO. LOT NO. UNPT N!ti Project AddressLfG �T Applicant's Mailing AdA.�CJ�' Owner's Name honAddress+ Arch/Eng. License No. Address; Contracto"r's Na Phon % _Address {mailing) City License No. I � .1 LICENSED CONTRACTOR DECLARATION 1, hereby affirm that I arrr, licensed under provisions of Charter 9 (commencing With Section 7000) of Division 3 of the Business and Professions Code, and my'licenle is IqnA for" nct effect. LicenClass License NoDat SignatureWORKERS' ENSgTION D RATIONl hereby•affirI have a certifi ate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) ' I Policy No. �..- Company ' Certified copy is hereby furnished. Certified copy Is filed with the'city Building Division. Date Applicant EXEMPTION FROM WORKERS'_COMPENSATION,DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). ' ' I certify that in the performance of the work for,which this permit is'issued, 1 shall not employ any pCrson in any manners as to become subject to the WorkerCo sat- n laws of Cali .Dale - Signature NOTICE: I , after making this decl a on, you should become subject to the Workers' COmpensdtion provisions the Labor Code,youu must forthwith comply with such provisions or this permit shall be'deemed revoked. CONSTRUCTION LENOING':AGENCY. I hereby 'affirni that there is a construction lending agency _far the performance , ofthe work for which this permit is issued (Section 3097 Civ. C.), Lender's .--Name, -- Lender's Address - - OWNER BUILDER DECLARATION 1 hereby affirm.that I am exempt from the Contractor's'License Law for the following reason (Section 7031.5. Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also require$ the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of .the Contractor's License Law (Chapter-9(commencingwith Section 7000) of Division 3 of the Busirress and Professions Code) or that he/she is exempt therefrom and the Basi% for the alleged exemption. Any violation of Section •7031.5 by, any applicant, for a permit subjects the applicant to a civil salty of not more thah five hundred dollars ($500). 'Ias owner of the property.or'my employees wages as their. sole I, will do the work, and the structure is not intended or offered for - sale (Section 7044, Business' and. Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does.such work hlmSelf/herself or through his or her own employees, provided'that such, improvement$ are,not intended or offered for We. If, however, the b4ilding or improvement is sold within one year of com- pletion,'the owner will have the burden of proving he/she did not build or IM - rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who Contracts for -such projects with a con- tractors) license pursuant to'the Contractor's License Law). I am aware that proof of their Worker% Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason , Date Owner I hereby certify that.i have read this application -and 'state that the above information is correct. I agree to comply with all city and county ordinances and -state laws relating to building construction, and hereby authorize repre- sentatives f this city to enter upon the above-mentioned property for inspection e5. Signature Date 5862 . 7/02/-85 ! 040 TL TYPE OF CONSTRUCTION L) NEW LJ ADD LI ALTERATION Li REPAIR CONVERSION ❑ DEMOLISH ❑ OTHERp•p• # Zone DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: E 2 TYPE OF PERMIT GRADING ❑' FOUNDATION STRUCTURAL T Front _ O' ❑ TENANT ❑ ELECTRICAL 1:1PLUMBING ❑ MECHANICAL ' B Rear - N ❑ 'OTHER _ i A PROJECT 1]ESCRIP7 ON S4. FT. OCCUPANCY C Right , ._ N GON STRUCTION TYPE VALUATION $ S Left R • � R. ZONE GRADING CU.YDS. , ACRES— Ping. Ref. # Parking Req./Provided E• Q Remarks: Planning Notes: I M, S r Bar Sink 4 Backflow'Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Interceptors. Kitchen Sink- ' Lavatories. P—Trap Roof Drains Outlets , Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit, ICBG # Heating System & Ducting E-10-1 00,000 BTU I] 100,000 BT Drivers' L nse or,SS 4E Reinspection Fee W GMF 0865-46, rev. 10/84 White ink -Accounting; Goldenrod - Assessor $15 PLUMBING Showers Service Sink Sewer Cap' Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Lauhdry Trays ®�I Z ' 4 " Issue Fee. $ 3 NNICAL FEES ' Hood or Type 1 ❑ Canopy ' Type II ❑ . Refrigeration System 00;100,000 BTU 0 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee I $ 3 ELECTRICAL FEES Automatic Washer_ I Construction Pole Sub. Transformer ❑ 15-50 KW 0 50+ KW Cooking Unit Meter Cup to 100 amps ; Dishwasher _ Meter Dover.100 amps" _. Dryers DGas. ❑Electric Sub Pane( i Fan F.A.U. Motors ❑0-1 HP Ell 'A -,B Inc. So lar EJ 9-15 HP El 16-15+ F ixtures ' ' Microwave Device Boxes `Pole Light t Outlets Range ; Switches Sign I i Garbage Disposal ; Standing�Sections , Generator D0-5 KW 05-15 KW Trash Compactor $ SMIP LReinspection Fee $15 ` 1 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat SUMMARY OF FEES ' BUILDING PERMIT. $ SMIP $ PLAN CHECK $ - PERMIT PLUMBING $ 1 -Lr>o I ISSUANCE $- PLAN CHECK '25% $ L_ Jw ENERGY P,C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% S MICROFILM $ MECHANICAL $ TOTAL FEE $I PLAN CHECK 25% $ CbNSTRUCTION AND PLANNING. T ;f APPROVALa. Permit # . �'• Date Inspector POOL & zWA APPROVALS Permit # Date Inspervnr ' 1. Temporary Electrical Service or Pole' f 52, Pool & Equipment Location+' .2. Sok;Pipe-Undrgrnd.- �,�� 53. Steel Reinforcement l" 3� Electrical ConduitrUtility.-Undrgrnd. 54. Forms. f' 4..•ElectncafConduiiV,ridrgrnd. 55. Electrical Bonding 5. Steel Reinforcement o 56. Rough Plumbing & Pressure Test �i.• `:6• `Electrical UFER �d. ��(r� L.- j� 57, APPROVAL TO COVER-GUNITE y 7 ,Footings r ✓ 58: Electrical Conduit-Undr rnd. 9 -8wFour'cation �- r I ) �f� , � 59. Gas Pipe, ❑ Undrgrnd., Test g� 9. 'Wrer'Pip`e Undrgr d 60. Backwash Lines, P -Trap, ❑ Undrgrnd. irr 10:,Structu5al Floor System j .61. APPROVAL TO DECK 11. Property -Sewer Line & House Co`�n�nection Ai j 62. Backwash & Receptor -Final � 12. Sewer Cap .!'�' "h CA 63: Heater & Vent -Final ' 13. Roof Drains -64, Plumbing System - Final (IV 14. Rough,Plumbing�""y 65.- Electrical -Final r� 15. Rough Electrical -Conduit 66, Solar System -Final 16. Rough Electric Wiring s 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑Gas ❑ Oil •23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 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 i Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood dr Canopy ' 37,. Final Factory, Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRWCTURE & BUILDING 48. Special Requirements Completed .. 49. Electric Release to Edison - - i 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date - ' _L _ ; I Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO- LDT NO. uniiT nlrj Project Address 71 1 17tb St Bld E Unit 1 Applicant's MailingAddves13110 Saticoy St. N.hoilywood, Owner's Name Iroy Investment Fund Phone549 B8 Address4321 Rlx'ih fit-_ Naranort Beach, Ca. Arch/Eng. Barin ,11, Rork —License No. Addres12881 Knorr AvP. Sotto 236 Contractor's NameDlirn—Air__ -nindi ti hili ng—Phone 992-1216 Address (mai('ingl_1311n SaYi rc� it _ N-,Hc�I�1yWOad,ssr� City License No.—3g.Q25 LICENSED CONTRACTOR DECLARATION f hereby affirm that I am licensed under provisions of.Charter 9 (commencing with section 7000) of Division 3 of the Business Professions Code, and my license is in lky vofce and eft 346251 License Class LLUU i n No. pate 4 / 18184 Signaturr wORKERS' COMPENSATION DTI N I hereby affirm that 1 have a certconsent to self -insure or a certificate of Workers' Compensation InSua certified copy thereof (Section 3800, Lab. C.) WC9824 Lumbermans �oiicy No. Company Certified copy is hereby furnished. Certifiep is filed with the city Builcc7 uuFg Division. I C Date Applicant. � _( l EXEMPTION ROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit is for one hundred ($100) or lels). 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 tie Workers' Compensation Laws of California. Date Signature NOTICE_ 11, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or tills permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any City or county which requires a permit to construct, alter, improve, demolish or repair arty 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 the Contractor's License Law (Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that ne/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 71)31.5 by any applicant for a permit subjects the applicant to a Civil 0enalty of not more than five hundred dollars ($500). _1 1, as owner of the property or my employees with wages as their sole ompensation, will do the work, and the structure Is not intended or offered for sale (Section -7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will havelthe burden of proving hejshe did not build or im- prove for the purpose of Sale). ❑ 1, as owner of the property, am exclusively contracting with licensed Con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(sl 1lcense pursuant to the-Contractor3 License Law). t am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date owner I hereby certify that I have rea information is correct. i agree and state j relating to b di sentives taOi his city t ent in5pectio pur oseS. Signature Drivers' Lic se or SS J this application and state that the above comply with all city and county ordinances g construction, and hereby authorize rpre- upon the above-mentioned property for Date � 2257 5/03/65 15480 TYPE OF CONSTRUCTION LJ NEW i__I ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. # Zone S Main Building: Accessory Building: IZ TYPE OF PERMIT In GRADING LJ FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL El .OTHER E T Front O B A Rear N I PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU. YDS. ACRES C Right N KG S Left - R Ping. Ref. # Parking Req./Provided E Remarks: Planning Nates: Q M ' T S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink- Automatic Washer Construction POle Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps Dishwasher Solar Piping r Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0-1 HP ❑ I% - 8 Floor Drains Swimming Pool w/Spa F,A.U. Inc -Solar 09-15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors' Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator 00-5 KW ❑ 5-15 KW Trash Compactor Roof Drains i Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL - FEES Boiler Duct - Under Ground Hood or Type 1 ❑ Canopy Type 11 ❑ pEVELO?HENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By_ —. Data Date pat Z� _ Duct - Structural Duct - Ventilating Refrigeration System ' ❑0-100,000 BTU ❑100,000 BTI) SUMMARY BUILDING PERMIT $ PLAN CHECK $ $ PLAN CHECK 25% $ ELECTRICAL S PLAN CHECK 50% $ MECHANICAL $ 1-3, PLAN CHECK 25% $ OF FEES SMIP S PERMITPLUMBING ISSUANCE $ ENERGY P.C. S GRADING $ MICROFILM $ DO TOTAL FEE $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit, ICBO # Fire Dampers Heating System & Ducting [X()-1 00,000 BTU E31 00,000 BT Registers Reinspection Fee $15 Issue Fee $ 3 — `MF ()865-46 rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS . Permit # Date Inspector POOL h, _.,A APPROVALS Permit # Date Inspector 1, Temporary Electrical Service or Pole 52. Pool & Equipment Location ' 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding i 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ( j 6. Electrical LIFER Grnd. - -z'` 57. APPROVAL TO COVER-GUNITE 7. Footings � 58. Electrical Conduit-Undrgrnd. i B.- Foundation Yr, 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System -i 61. APPROVAL TO DECK 11, Property Sewer Line & House Co4ection 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 APPROVALS. Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 B0, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 1-6--,Y7 LAP) 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co +�51. CERTIFICATE OF OCCUPANCY fir). Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERT NO; 4,9 L= NO. LOT NO. UNIT NO. 7i l ►�/. I ,ST C057fr m SA c r i �7, Project Address .. , TYPE OF CONSTRUCTION 0 NEW ADD 1 1 ALTERATION I I REPAIR Applicant's Mailing Address Owner's Name --l-ROY 1AJYEST 1y7 Arr Phone Address ArchlEng. License No. Address Contractor's Name .40012IQ IL i; CTR 1 C Phone �_?77-6kE' Address (maiiing) MW_.'iliYA11UT ST, k+C MJ(0 6111N X3.0 City License No. 33 '1 CONTRACTOR DECLARATION I hereby affirm that f am licensed under provislons of Charter 9 (commencing with Sectlon 7000) of Division 3 of the n8ue5S and ProfessI s Code, and my license is in full force and effe �, License ��Cla''s,s,, ' gg C~ Licens Date �u�Signature WORKERS' COMPENSATION DECLARATION ' I hereby affirm that I have a certificate of consent to self -Insure or a certificate of Workers' Compensation insurance, or a certified copy thereof (Section '3800, Lab. C.) _ �� G 'olicy No. INC Sl i Q'1 3-711)Com Certified copy is hereby furnished. Certified cop§ i filed with the city uild' vision. Date„ (� I i) J Applicant EXEMPTION FROM WORKERS' COMPENSATION ECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). Icertify that In the performance of the work for which this permit is issued, I ' shall -not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become Subject to the Workers' Compensation provisions of the Labor Code, you must forthwith . comply with Such provisions or - this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the'performance' of the work for which this permit is 'issued (Section 3097. Civ. C.) Lender'S Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the ' following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/She is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is. exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil ,enalty of not more than five hundred dollars (5500). I,as ownnr of the iproperty or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, Provided that such improvements are not Intended. or offered for Salo. It, however, the bullding or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and _who contracts for such projects with a con- tractors) license pursuarit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance Should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby Certify that I have read this ap Information is t. 1' ree to comply and state la relate 9� building const sentatives o this y o enter po Inspection p rp Signature Drivers' License or SS YA ation and state that the above- [ all city and county ordinances on, and hereby authorize repre- above-mentloned property for Date ❑ CONVERSION ❑DEMOLISH ❑OTHER A.P. # DESCRIPTION OF WORKIUSE OF BLDG. 5 Main Building: E TYPE OF PERMIT MGRADING FOUNDATION M STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear ❑ -OTHER PROJECT DESCRIPTION SQ. FT, OCCUPANCY C Right K' CONSTRUCTION TYPE VALUATIONS S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting [DO -100,000 BTU ❑ 100,000 $T Reinspection Fee $15 CMF 0865-46, rev, 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee ' IANICAL Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000 8TU ❑100,000 81 System Repair/Alteration Fire Dampers Registers FEES $ 3 FEES Issue Fee 1 $ 3 5870 I/j6/85 Zone Accessory Building; Parking Req./Provided ELECTRICAL Automatic Washer ' Construction Pole Sub. Cooking Unit ' Dishwasher Dryers DGas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 05.15 KW Transformer ❑ 15-50 KW 050+KW Meter ❑up to 100 amps Meter Cover 100 amps Sub Panel Motors AO -1 HP Eli h - B Inc. Solar 09-15 HP El 16.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor II o 50 TL FEES 0 Z O N I N G R E a M T S Reinspection Fee PLUMBING Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Floor Drains Solar Tank Swimming Pool w1Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors r Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains PERMIT Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting [DO -100,000 BTU ❑ 100,000 $T Reinspection Fee $15 CMF 0865-46, rev, 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee ' IANICAL Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000 8TU ❑100,000 81 System Repair/Alteration Fire Dampers Registers FEES $ 3 FEES Issue Fee 1 $ 3 5870 I/j6/85 Zone Accessory Building; Parking Req./Provided ELECTRICAL Automatic Washer ' Construction Pole Sub. Cooking Unit ' Dishwasher Dryers DGas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 05.15 KW Transformer ❑ 15-50 KW 050+KW Meter ❑up to 100 amps Meter Cover 100 amps Sub Panel Motors AO -1 HP Eli h - B Inc. Solar 09-15 HP El 16.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor II o 50 TL FEES 0 Z O N I N G R E a M T S Reinspection Fee $15 Issue Fee 1 $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat a 1 r SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ CO - GRADING S PLAN CHECK 50% $ SC-) MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ ` CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & -.,A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. -54. Forms .4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVE R-GUNITE -7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59, Gas Pipe, ❑ Undrgrnd., Test :9. Water Pipe Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64, Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar. System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18., Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72, Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 2 Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. 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 1t C CITY OF C®STA ME I.ICON TR 7 3ION PERMIT , Project Address Applicant's Mailing Address m% Owner's Name TAai B ii-0Zq r Phone 5 6 ` 0,/ Address H3 L i/J/-/rte- rrl It/Gu/�O'/ C Arch/Eng. QLLlk,t e, AeCI A License No. � Address ,-G 5-7 . 60:-1 C4rr.L_ he d IA Contractor's Nam CIA Phone Address (mailing) - City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing With section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. License Class --- License No. Date Signature WORKERS' COMPENSATION DECLARATION hereby affirm that I have A certificate of consent to selftinsure or a certiflCate of Workers' Compensation Insurance; or -a -certified -copy thereof (Section - 800, Lab. C.) P Policy No. 'WLKlU (24�� Company Certified copy is hereby furnished. Certified led with the city Building D' Date oY s fApplicant EXEMP ON ROM WORKERS' COMPENSATION DECLARATION (This se ion need net be completed if the permit is for one hundred ($100) or , less). I certify that In the perforrriance of the work for which this permit is issued, I Shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers: Compensation provisions of the Labor Cede, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY. I hereby affirm that there Is a construction lending agency for the performance of the work for whiCp this p rmIt Is Issued (Sectio 3097 Civ- C.) Lender's Name ' (Jim r " t Lender's Address i/� 1k. GH-�Oa�f'-5fj,- 4 14— OWNER BUILDER DECLARATION —� I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 fqr the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, E;usiness and Professional Code: The Contractor's License taw 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the builgjng or improvement is sold within one year of com- pletion,.the owner will have the burden of proving he/she did not build or Im- rOve for the purpose of sale)- 1, as owner of the proporty, am exclusivelY contracting with licensed con- tractors t6 construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who 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 proof of their Worker's Compensation insurance should be provided to me. 0 1 am exempt under seckion B. & P. C. for this reason Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. P MIT NO TRACT NO. LOT NO. UNIT NCC Date Owner I hereby certify that I have read this application and state that the above Information is correct. I agree to comply with all city and county ordinances and -state laws relating t Uilchna, construction, and hereby authorize repre- sentatives of this cit 0 e t t above-mentioned pro rty for Inspection purposes. ,7 / Signature Date L: Drivers' License SS -P TYPE OF CONSTRUCTION LJ NEW ADD ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.E DESCRIPTION OF WORK/USE OF BLDG. ' S Main Building: E TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front- ' ❑ TENANT ❑ ELECTRICAL f LUMBING '❑ MECHANICAL •B Rear - ❑ OTHER A C Right PROJECT DESCRIPTION SQ. FT- OCCUPANCY, K CONSTRUCTION TYPE VALUATION $ S Lett ZONE GRADiNG CU.YOS. ACRES Ping. Ref. 4d' Remarks:�7,Yh -� �' .�� Planning Notes: Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection ' Clarifiers, _ Solar Collectors ' Dishwasher Solar Piping' Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Servic6 Outlets Interceptors Kitchen Sink Water Closet Water Heater - Water Service .Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains Reinspection -Fee 1 S15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑6100,000BTU ❑100,000BTi Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor FEES Issue Fee $ ,3 iANICAL FEE Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑0.100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 6553 030%86 Accessory Building: Parking Req./Provided ELECTRICAL Automatic'Washer Construction Pale Sub. Cooking Unit ri Dishwasher - - Dryers ❑GasElectric Fan y F.A,U, Fixtures Device Boxes Outlets Switches Garbage Disposal Generator E30.5 KW 05.15 KW 6.00 TL Zone Z O N I N G R E Q M T S FEES Transformer ❑ 15.50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0-1 HP ❑ 715 :8 Inc. Solar 09-115 HP 1-116-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor I I Reinspection Fee 1 $15 1 1 Issue FeeI $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By patfo SUMMARY OF FEES BUILDING,PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $�'-- ISSUANCE $ , PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50°% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% S CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOH 6e SPA APPROVALS Permit # Date Inspector 1.• Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3, Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6- Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. .8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 1-6'.' 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 APPROVALS Permit # 20. Rough Factory Fireplace 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 ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33- Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36- Hood or Canopy r 37. Final Factory Fireplace _- 38. Final Plumbing AM 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43.CBackflow Irrigation 44.�jLandscape Irrigation System 45.&und Attenuation i 46. Handicap Regulations 47."FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. teas Release to Southern California Gas Co 51-c -ERTI FICATE OF OCCUPANCY No. Date , Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF WSTA MESA CONSTRUCTION PERMIT PER IT NO. -7 I TRACT NO. LOT NO. UNI�IV Project A0= /�pplicaslt' Mallin A dress � TYPE OF CONSTRUCTION NEW ADD- ALTERATION EPAIR Owner's Nam bile ❑ CONVERSION ❑ DEMOLISH. ❑ OTHER A -p-+ DESCRIPTION OF WORK/USE OF BLDG. Address S Main Building: E Arch/Erig. _ License No.. TYPE OF PERMIT GRADING M FOUNDATION LJ STRUCTURAL T Front Address. ❑ OTHER PROJECT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL_ A Rear Na Pane Contractor's J PROJECT DESCRIPTION Sq. FT. OCCUPANCY C Right Address (mailing) 4L K Left _Z I. CONSTRUCT fON TYPE - VALUATION $ $ City License No_ l ZONE GRADINGCu.YOS. ACRES LICENSED CONTRACTOR DECLARATION - Ping. Ref. �W I hereby affirm that i am licensed under provisions of Charter 9 (commenclnq Remarks: Planning Notes: with section 7000) of Division 3 of the Business and Professions Code, and my license is in fort nd effect. License lass' License No, 34 2.a - date Signature WORKERS' COMPENSATION LARATION I hereby affirm that I have a certi tate of consent to self -insure or a certificate , of WorkersCompensation Insurance, or a, certified copy thereof (Section 1800, Lab. C:) olicy No. Company I}, -I Certified copy is hereby furnished. LJ Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed If the permit is for one hundred ($100) or less). I certify that'in the perforrnanCe of the work for which this permit is Issued, 1 shall not employ any person in any anner so s to become subject to the Worker Com alio s of Call Date a Signature ,'NOTICE: if, sitar making this dottern, you should become subject to the Workers' Compensation provisions the Labor Code, you must forthwith comply with. such provisions or this permit . Shall be. deemed revoked, CONSTRUCTION � LENDING' AGENCY ' I hereby affirm that there IS a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name -- Lander_'s Address T- -- - - -- OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and -Professional Coga: Any city or county which requires a p@fmit to construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 analty of not more than five hundred dollars ($500). I. as owner of the' property or my employees with wages as their sole Compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Ejusiness and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and such work himself/herself or through his or her own employees, provided that SuCh.Improvements are not Intended or offered for sale. If, however, the bunging or improvement is sold within one year of com- pletion, the owner will have the burden Of proving he/she did not build or im- prove for the purpose of sale), ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, a_ nd who contracts for such projects with a con- tractor(s) license pursuarit't0 the Contractor's License Law). 1 am aware that proof of their Worker's Compensation insurance should be provided to me.. ❑ 1 am exempt under Section B- & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information Is correct. I agree to comply with all city and county ordinances and state laws relating to building conatruction,,dnd hereby authorize repre- sentatives of this city tq enter upon the above-mentioned .property for inspectionpu ses. Signature Date Drivers' Li se or SS :01 r I I PLUMBING I FEES I rf 5866_ 7/02/85 Zone Accessory Building: Parking Req,/Provided 10,50 1'L Z O N I N G R E O M T S Bar Sink Showers ` ELECTRICAL FEES ' Backflow-Preventer - -Service Sink Zoc Automatic Washer - Construction Pole Sub. Transformer ❑ 15=50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher _ Meter ❑over 100 amps _ Dishwasher Solar Piping, Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fari Motors 00-1 HP 01'A - B Floor Drains Swimming Pool vv/Spa $ 3 F.A,U. Inc. Solar 09-,15 HP ❑16-15+ Floor Sinks-' Gas Service Outlets Urinal Water Closet Z so Fixtures ` Device Boxes ' Microwave Pole Light Interceptors Kitchen Sink r.. Water Heater Water Service Z 00 Outlets Switches Range Sign Lavatories Auto -Wash Garbe a Disposal 9 q Standing Sections P—Trap Laundry Trays Generator 00-5 KW ❑5.15 KW Trash Compactor Roof Drains Reinspection Fee Boiler $15 11 Duct - Under Giound Ouct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepi/Fact. Bit, ICBO Heating System & Ducting ❑0-100,000 BTU El 100,000 Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor issue Fee IANICAL Hood or Type 1 0 Canopy Type II ❑ Refrigeration System Cao -100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee S 3 Reinspection Fee $15 Issue Fee ' S 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By-_- - REQUIREMENTS: �! 1. Date Date Dai BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 503/6 MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ �`V 41�� $ )-570 $ $ $ $ SMIP $ PERMIT -ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ t 0 - Sd $ 3 NSTRUCTION AMID PLANNING LAPPR'DVALSPermit # Date Inspector - POOL A APPROVALS Permit #Date Inspector mporary Electrical Service or Pole 52. Pool & Equipment Location r ;_2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement •'3.,iEl86trical Conduit, Utility-Undrgrnd. 54. Forms 4: Electrical Conduit-Undrgrnd. ' ' 55. Electrical Bonding ..5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 'f '6. Electrical UFER Grnd. 57. APPROVAL TO COVER•GUNITE 7, Footings 58. Electrical Conduit-Undrgrnd, r , 8: Foundation _ 59. Gas Pipe, ❑ Undrgrnd., Test r 9. Wates Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, ❑ Undrgrnd. 1 10: Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62, Backwash & Receptor -Final ,1 12. Sewer Cap i 63. Heater & Vent -Final 13. Roof Dr&ins , 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. POOLISPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT - APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22• Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Gil 23, Gas Pipe -Rough & Test 72. Underground Flush 24• Roof Framing 73. Undergrnd. Storage Tank O'Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27, Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Mood or Canopy 37. Final Factory Fireplace .38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final '.41-. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. !-Handicap Regulations 47. FINAL STRUCTURE & BUILDING 4S, Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 0 51. CERTIFICATE OF OCCUPANCY No. Date ' with section 7000) of Division 3 of the Business and Professions ode, and my license is in full force and effect License Class icense N Date I - I- i0 -81S Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 have a certificate of consent to self -insure or a certificate of Workers' Compensation insurance, or a certified Copy thereof (Section 1800, Lab. c.) Policy No. WGS� O [ 7_0 C y CO LEC eCertified copy is hereby furnished Certified copy ted with the cit Build- vision r Date ) �I O'- Applicant EXEMPTION FROM WORKERS' COMPENSATION ECLARgTION (ThiSsection need not be completed if the permit is for one hundred ($100) or less).. I certify that in the performance of the work for which this permit is issued I Shall not employ any person in any manner so as to become subject to tke Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provition5 Or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY i hereby affirm that there i%a construction lending agency for the performance of the work for, which this permit is Issued (Section 3097 Civ. C.) Lander's, Name Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the'Conlractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any City Or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions Of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Buslnets 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 ienalty of not more than live hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their sole Compensatlon, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of Selo). ❑ I, as owner of the pioperty, am exclusively contracting with licensed con- 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 builds or Improves therapn, and _who Contracts for such projects with -a con- tractor(a) license pursuant•to the Contractor's License Law). I am aware that proof oftheir Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Date ' Owner I hereby, certify that I nave read this al informatio4wsi t. I ee to comply and -state o uilding corlstrsentat"es y t enter up nInspection Signature Drivers' License or SS pn and state that the above A city and county ordinances and hereby authorize repre- ove-mentioned property for Date1-jp- L45a 1'L Zone Accessory Building: Z O N I N G R. Parking Req./Provided E O M T is Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF -COSTA MESA -7 CONSTRUCTION PERMIT PERMIT II NO. TRACT NO. S r LOT.NO. UNIT NO. Service Sink- Project Address 1 l VV • 17d S'. C a5?� 1)) C .S A Lr l Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Address Address Applicant's MailingEl_ Solar Collectors TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION -❑ DEMOLISH OTHER Dishwasher Meter ❑over 100 amps Owner's Name r N yEST mr Phone DESCRIPTION OF WORK/USE OF BLDG. A.P. 46 Drinking Fountains Solar Tank Address - _ Fan Motors N0.1 HP ❑ 114 - 8 S Main Building: F.A.U. Inc. Solar 09-15 HP ❑16.15+ E Urinal - - Water Closet Water Heater Arch/Eng. -- --- License No, TYPE OF PERMIT GRADING C1 FOUNDATION 13 STRUCTURAL T Front Switches ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Auto -Wash Address _ Contractor's Nam __ E( -'EC R IC Phone r�F OTHER C Rear Ri ht g rrp j' ld-6� &/ AAM & 1 j LOOmL+)67DrL) 1�±6 PROJECT DESCRIPTION SQ. FT. OCCUPANCY ' Address (mailing) . C O N ST RUCTf ON TYPE VALUATION S 3 .Left City License No: �� rI ZONE - G RAOING CU. YDS. ACRES Ping. Ref. . $ 3 LICENSED CONTRACTOR DECLARATION Reinspection Fee I hereby affirm that I am licensed under provisions of Charter 9 (commencing i Remarks: Planning Notes: with section 7000) of Division 3 of the Business and Professions ode, and my license is in full force and effect License Class icense N Date I - I- i0 -81S Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 have a certificate of consent to self -insure or a certificate of Workers' Compensation insurance, or a certified Copy thereof (Section 1800, Lab. c.) Policy No. WGS� O [ 7_0 C y CO LEC eCertified copy is hereby furnished Certified copy ted with the cit Build- vision r Date ) �I O'- Applicant EXEMPTION FROM WORKERS' COMPENSATION ECLARgTION (ThiSsection need not be completed if the permit is for one hundred ($100) or less).. I certify that in the performance of the work for which this permit is issued I Shall not employ any person in any manner so as to become subject to tke Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provition5 Or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY i hereby affirm that there i%a construction lending agency for the performance of the work for, which this permit is Issued (Section 3097 Civ. C.) Lander's, Name Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the'Conlractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any City Or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions Of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Buslnets 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 ienalty of not more than live hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their sole Compensatlon, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of Selo). ❑ I, as owner of the pioperty, am exclusively contracting with licensed con- 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 builds or Improves therapn, and _who Contracts for such projects with -a con- tractor(a) license pursuant•to the Contractor's License Law). I am aware that proof oftheir Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Date ' Owner I hereby, certify that I nave read this al informatio4wsi t. I ee to comply and -state o uilding corlstrsentat"es y t enter up nInspection Signature Drivers' License or SS pn and state that the above A city and county ordinances and hereby authorize repre- ove-mentioned property for Date1-jp- L45a 1'L Zone Accessory Building: Z O N I N G R. Parking Req./Provided E O M T is CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink- Automatic Washer iConstruction Pole Sub. Transformer ❑ 15-50 KW El 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank a Fan Motors N0.1 HP ❑ 114 - 8 Floor Drains Swimming Pool vv/Spa F.A.U. Inc. Solar 09-15 HP ❑16.15+ Floor Sinks Gas Service Outlets Interceptors Urinal - - Water Closet Water Heater Fixtures Device Boxes Outlets Microwave ` Pole Light Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P -Trap Laundry Trays Generator ❑0.5 KW 05.15 KW Trash Compactor Roof Drains ' Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 Boiler MECHANICAL Hood or Type ❑ Canopy Type 11 ❑ FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date _Date f CO Duct - Under Ground Duct - Structural Refrigeration System 00.100,000 BTU 0100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT '$ ISSUANCE $ $ ENERGY P -C. S $ y-.00 GRADING $ $ �.]C� MICROFILM $ $ TOTAL FEE $— $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firep I/Fact. Bl t.( CB O# Fire Dampers Heating System & Ducting ❑0.100,000BTU ❑100,o00BT Registers H Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor v .1 • •- r . . . , r 'CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL t, SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER•GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. S. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16, Rough Electric Wiring 67. Fencing & Access Approval 17.' Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25, Roof Sheathing 74. Overhead Hydro 26, T -Bar Ceiling (Structural) & Monocoar 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 �i e� Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43. 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 ' M U0 `V ±7J Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TflACT NO. LOT NO. UNIT NCI. Project Address — 711 W. 17th SC-_ Bldg. (E) Unit 7 Applicant's Mailing Address 131 IQ Gat i ccly St - N - Hn I l rj Owner's Name T hone 549-798 Address _4321 birch Sr_ Newport Beach, Ca. Arch/Eng, License No. AddressU LKriQU Ave,_ Suite 216 _ Contractor's Name -nitro Air conditioning 'Phone 982-1216 Add ress"(mailing) _L31101 Saticay St, N.H011ywood, Ca. City License No. -3 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing With scctlon 7000) of Divisio "3,pAthe Business and ^ssions Code, and my license is in full force and �Ife 346251License Class C 0 Lice N Date— 4/1,8/84- Signature WORKERS' COMPPNSATION DEC RATION I hereby affirm that I have a certificata of consent to satf-insure or a certificate of Workers' Compensation -Insurance, or a certified copy thereof (Section 1800, Lab. C.) Policy No. Company �,umberti18.17R BCertified copy is hereby furnished, , Certified o y is filed with the city Build yftg QI iy�sj,Qn. ^ Date Applicant lJ t,,�L�� r[ EXEMPTior4 FROM WORKERS' COMPENSATION DECLARA ION (This saction need not be completed if the permit is for one hundred ($100) or less). 1 certify 'that in the performance of the work for which this permit Is Issued t shall not .employ any person in any manner so as to become subject to t6 Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shaff be deemed revoked, CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) Dander's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm th4t I am exempt from the ContraCtor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to Construct, alter, improve, demolish or repair any struCturo, 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 the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prolosslons 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 jonalty of not more than five hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their Sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does hot apply to an owner of a property who builds or Improves thereon, and who does such work himself/hersell or through his or her own employees, provided that such Improvement$ are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im. prove for the purwase of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to Construtt the project [Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improve% thereon, and who contracts for such projects. with a con. tractor(s) license pursuant .to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner Ihereby certify that I have read information is correct, 1 agree t and st40 ate la relating to buil n- 5 entatives f is city to a er inspection krq3se5. Signature Drivers' Licep6e or SS =p AF 0865-46,Fev. 10/84 White this application and state that the above imply with all city and county ordinances Construction, and hereby authorize repre- ipon the above-mentioned property for DateAI-200-e-3� TYPE OF CONSTRUCTION L) NEW LJ ADD LJ ALTERATION LJ REPAIR PLUMBING FEES ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRiPT10N OF WORK/USE OF BLDG. Service Sink Backflow Irrigation Sewer Cap S Main Building: Clarifiers E Dishwasher TYPE OF PERMIT GRADING El FOUNDATION El STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL B Floor Sinks Gas Service Outlets ❑ OTHER A Rear Lavatories Auto -Wash Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K K CON STRVCTION TYPE VALUATION $ S Left ZONE GRAOING CU•YOS• ACRES Ping. Ref. # Remarks: Planning Notes: Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System Cl Multiple ❑ Firepl/Fact. Bit. ICBO =# Heating System & Ducting ❑0-100,000 BTU ❑ 100,000 BTI Reinspection Fee f $15 Building; Canary - Applicant; Pink - ACCotlntln9; Goldenrod - Assessor Issue Fee I $ 3 IANICAL Hood or Type I ❑ Canopy Typell ❑ Refrigeration System 00.100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES $ 3 2263 5/03/55 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas' ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW ❑5-15 KW Transformer 0 15-50 KW ❑ 50 + KW Meter ❑up to I00,amps Meter Dover 100 amps Sub Panel Motors 00.1 HP ❑ 1'f, - 8 Inc. Solar❑9-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 15.50 FEES Z O N I N G R E a M T S I I Reinspection Fee 1 $15 1 1 issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date SUMMAR OF FEES BUILDING PERMIT PLUMBING FEES Bar Sink Showers Backflow Preventer. Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool vv/Spa Floor Sinks Gas Service Outlets Urinal Water Closet Interceptors Kitchen Sink Water Heater Water Service Lavatories Auto -Wash P --Trap Laundry Trays Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System Cl Multiple ❑ Firepl/Fact. Bit. ICBO =# Heating System & Ducting ❑0-100,000 BTU ❑ 100,000 BTI Reinspection Fee f $15 Building; Canary - Applicant; Pink - ACCotlntln9; Goldenrod - Assessor Issue Fee I $ 3 IANICAL Hood or Type I ❑ Canopy Typell ❑ Refrigeration System 00.100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES $ 3 2263 5/03/55 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas' ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW ❑5-15 KW Transformer 0 15-50 KW ❑ 50 + KW Meter ❑up to I00,amps Meter Dover 100 amps Sub Panel Motors 00.1 HP ❑ 1'f, - 8 Inc. Solar❑9-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 15.50 FEES Z O N I N G R E a M T S I I Reinspection Fee 1 $15 1 1 issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date SUMMAR OF FEES BUILDING PERMIT $ SMTP $ - PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ - PLAN CHECK 25% $ ENERGY P.C, $ _ ELECTRICAL $ GRADING $ PLAN CHECK 5096 $ MICROFILM $ MECHANICAL $ —13 00 TOTAL FEE $ 15-50 PLAN CHECK 25% $ ; �• CONSTRUCTION AND PLANNING APPROVALS . Permit # Date Inspector POOL -SPA APPROVALS Permit # Date Insppctnr 1. Temporary Electrical Service or Pole 52, Pool & Equipment Location r ; 2. -Soil Pipe-Undrgrrid, 53. Steel Reinforcement 4 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit•Undrgrnd. 55. Electrical Bonding -5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 4 -6. Electrical UFER Grnd. L 57. APPROVAL TO COVE R-GUNITE ; 7. Footings 58. Electrical Conduit-Undrgrnd, 8' Foundation 59. Gas Pipe, D Undrgrnd„ Test 9. Water Pipe-Undrgrnd. f+% 60. Backwash Lines, P -Trap, D Undrgrnd, 10. Structural Floor System 61. APP ROVALTO DECK 11, Property Sewer Line & House Connectign 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 APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ W 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. F I NA L I NSPECT ION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigatiori 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No, Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MES CONSrT�RUCTIO PER PE MI�NO' 7R 7 NO 1 / LOT NO. L G O.S (vr' Project Addrea3 / J6, L — LS • Appli4 nt's Mailing Addresfsmr Ovyer's Name T Phone4#&F _ Address' Arch/En, HELMt License No. 6:2 E, Address) -r 2A Contractor's Name Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Llcohse Class License No. Date Signature WORKERS' COMPENSATION DECLARATION thereby affirm that I have a certificate of Consent to self -insure or a certificate , Workers' Compensation Insurance, or a certified copy thereof (Section tDp, Lab. C.) 'rlolicy No. Company ® Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed it the permit Is for o e hundred ($100) or less). I certify that In the performance of the Work for whiC his permit is issued, I shall not employ any person in any manner as t ecome subject to the Workers' Co pens tion of Californl Date — _ Signature NOTICE: 11 after making this d8cJarali0u O Com subje t to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Of the work for which this permit is issued (Section 3097 Civ. C.) Le rider's Name - Lender's Address OWNER BUILDER DECLARATION I h9reby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such perrnit to file a signed statement that ha/she Is I)crnsed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt "erefrom and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a permit subjects the applicant to a civil nalty of not more than five hundred dollars ($500). LJ I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License taw does not apply to an Owner of a property who builds or improves thereon, and who does such work himself/herself or thrnugh his or her own employoos, provided that such Improvements are not intended or offered for salg, !f, however, the bulltling or improvement is Sold within pne year of com- pletlan, the Owner will have the burtlen of proving he/aha did not build or im- rpve for the purpose D1 saln}, i, as owner of the property, am exclusively contracting with licensed Con- tractors to construct the project (Section 7D44, Business antl Professions Code: The Contractor's License taw docs not apply to an owner of property who builtls or Improves thereon, antl who contracts for such projects with a con- tractors) license pursuant to {fie Contractor's LI nae Law). l am aware that proof of their Worker's Compensation insuranc should be provided to me, ❑ 1 am exempt under Section B. & P. C. for this reason L Date 6,11-5-LOwner hereDy car fy that I havLd ap a a state that the above ihfprmation is correct. I agrply th all city and county ordinances An Cl state laws relati o bnstruction, and hereby authorize repre- sentatives of thi y oon the above-mentioned prop for insbectlon pure es. Signature Date G L3 Drivers' License o� $S z` - TYPE OF CONSTRUCTION NEW ADD LTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORKWSE OF BLDG. n5 " wp %J& 5 � r�.rV_ S2�2<IfeArf:6---uk PLUMBING FEES Bar Sink A.P. Zone l E Main Building: i Accessory Building: TYPE OF PERMIT lJ GRADING 0 FOUNDATION >STRUCTURAL ❑ TENANT ❑E CTRICAL ElPLUMBING EJMECHANICAL ❑ OTHER /fes-�^^�A PROJECT DESCRIPTION S . FTOCCUPANCY " CON ST UC'rf N TYPE VALUATION S zoy_/_! _ ZONE G RADING CU. YDS. ACRES---t� - T Frorit Solar Collectors Dishwasher B Rear I L- C Right Floor Sinks $ i Left Water Closet Ping. Ret. # Parking Req,/Provided Remarks: Pr -3 .. r 4C_,jte _p s p�1 �,.%� Planning Notes: Lavatories ,P—Trap - PLUMBING FEES Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories ,P—Trap Auto -Wash Laundry Trays Roof Drains Reinspection Fee 1 S15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO =#- Heating Heating System & Ducting ❑ 0-100,000 BTU 0100,00061T Reinspection Fee 1 $15 Issue Fee Hood or Type 1 ❑ Canopy Type 11 ❑ Refrigeration System 00.100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee S 3 FE S 3 ADD -,;t.,350 E LECTRICAL Automatic Washer Construction Pale Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A,U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 1:10.5 KW 05.15 KW Transformer © 15-50 KW ❑ 50+KW Meter LJup to 100 amps Meter Dover 100 amps Sub Panel i Motors ❑0-1 HP ❑1'f, - 8 Inc. Solar 09-15 HP ❑16.15+ Microwave Pole Light 1. Sign Standing Sections Trash Compactor Reinspaction Foe 1 $15 1 1 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By -7 Building Approved By Application Issued 13v — FEES Z O N I N G R E a M T S tilloill"" 5 -rg-K S CMF 0865-46, rev. 10/94 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 00007740-1100077741 TC11 'ST OF FEES BUILDING PERMIT S J!M SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P -C, ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTALFEE PLAN CHECK 25% s FEES Z O N I N G R E a M T S tilloill"" 5 -rg-K S CMF 0865-46, rev. 10/94 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 00007740-1100077741 TC11 CONSTRUCTION ANDTLANNING APPROVALS Permit # Date Inspector POOL &SPA APPROVALS Permit # Date Inspector 1.. Temporary Electrical Service or Pole 52• Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. t- 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement I 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVE R-GUNITE 7. Footings 51T_ 'Z �g p 58. Electrical Conduit-Undrgrnd:- 8. Foundation ' ' 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 4 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 PLAS%ERING ft 18. Rough Electrical -T Bar Ceiling 69, POOL/SPA SYSTEMS FMAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT C. APPROVALS Permit # { ; 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oill 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydra Y� ' 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical J A 3 t ! ' ' 27. Frame and Flashing 76. Dry Standpipe L_ 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 ;f + 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 1� 33, Final Electric Notes: f 34. Final Heating & Air Conditioning /.it odel 35. Final Gas Pipe -Test 36. Hood or Canopy r r" • 37, -Final Factory Fireplace :" E 38. Final Plumbing 39. Water Service -Final + r'i✓l � 40. Gas Service -Final ,� .� � ; • i 41. Solar Domestic -Final 42. Backflow Prbventer t ' 43. Backflow Irrigation r + 44. Landscape Irrigation System 45. Sound Attenuation ' 467Handicap Regulations ; t 47. FINAL STRUCTURE & BUILDING 48. ,Special Requirements Completed o ^ - r 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY 4� No. ' ' ' Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. DriarAiY kin TRACT NO LOT NO UNiT CITY OF COSTA A 6 JSTCTION PERMIT Project Addt,ess 1'7f-- ST: T fE-g'r Appjicant's Mailing Address r"ST Owner's Name ne Address Ill 17� -5T i/N/T 6- �C54S ( Arch/En 121 I=917ifL ._rite 71 License No. Arch/Eng. T' 4� LA• e- Address Contractor's Nam Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license IS in full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate Of consent to self -insure or a certificate ?i Workers' Compensation Insurance, or a certified copy thereof (Section --=�-000, Lab. C.) licy No. Company 8 Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' (This section need not be completed It the permit Is for One hundred ($10D) or less).. - I certify that in the performance of the work for which this permit Is issued I shall' not employ any person in any manner so as t0 becoWe subject lite Workers' m I n Laws of Califorrtty� //• Date Signature a r%- NOTICE: f, Ater making this declaration, you should become subject to the Workers' Compensation provisions of the LattOr.Goda, you must forthwith comply with such provisions or this permit"stialt, be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permlt _ is issued (Section 3097 Civ. C.) Lender's Name. Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code. Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/She Is licensed pursuant to the provisions of 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 r',5A31.5 by any applicant for a permit subjects the applicant to a civil e ally of not more than five hundred dollars ($500). I as owner of the property or my employees with wages as their sole co penSation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have'tho burden of proving he/she did not build or im- Erove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- .. tractorsto construct the project (Section 7044, Business and Professions Code, The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such croiects with a con- tractor(s) license pursuant to the Contractors License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 a exempt under Section B. & P. C. for this ;?son r Hate Owne Ithereby erti that I have rea t is application and state that the above information is correct. I agree to comply with all city and county ordinances and -state laws relating to building construction, and hereby authorize repre- sentatives of t r� city to ent u on t bove-mentioned pr per y for ins)Sectlo es. Slgnatur v Date Drivers' License or SS J `` —7-Z 4— �IO, TYPE OF CONSTRUCTION NEW ADD ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. I. TYPE OF PERMIT GRADINGFOUNDATION 0 STRUCTURAL L1TENANT ❑ ELECTRICAL IkPLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY - CON STRUCTION CCUPANCYCONSTRUCTION TYPE = iN VALUATION S ZONE GRADING CU.YDS. ACRES Remarks: A.P. S Main Building: Accessory Building: E T Front B Rear A C Right S • Left Ping. Ref, c# Parking Req./Provided Planning Notes: Zone O N I N G R E a M T S. 1 I ELECTRICAL I FEES I Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO 46 Heating System & Ducting ❑0-100,000 BTU 0100,00061 Reinspection Fee 1 $15 0665-46, rev. 5/86 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 FEES Hood or Type ❑ Canopy• Type 11 ❑ Refrigeration System ❑0.100,000BTU ❑i00,000BTU !XStelm Repair/Alteration Fire Dampers Registers Issue Fee $ 3 Transformer ❑ 15-50 KW ❑ 50 + KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors 13 0-1 HP El Inc. Solar 09-15 HP 016-15+ Pole Light Range Sign Standing Sections Trash Compactor 1 Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By, SUMMARY O BUILDING PERMIT PLUMBING FEES Automatic Washer Bar Sink � - Showers � Construction Pole Sub. Backflow Preventer Service Sink PLAN CHECK 50% Cooking Unit Backflow Irrigation Sewer Cap PLAN CHECK 25% Dishwasher Bathtubs Sewer Connection Dryers ❑Gas ❑Electric Clarifiers Solar Collectors Fan Dishwasher Solar Piping F-A.U. Drinking Fountains Solar Tank Fixtures Floor Drains Swimming Pool wlSpa Device Boxes Floor Sinks Urinal Outlets Gas Service Outlets Water Closet Switches Interceptors Water HeaterGarbage Disposal Kitchen Sink Water Service Generator ❑0-5 KW 05-15 KW Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO 46 Heating System & Ducting ❑0-100,000 BTU 0100,00061 Reinspection Fee 1 $15 0665-46, rev. 5/86 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 FEES Hood or Type ❑ Canopy• Type 11 ❑ Refrigeration System ❑0.100,000BTU ❑i00,000BTU !XStelm Repair/Alteration Fire Dampers Registers Issue Fee $ 3 Transformer ❑ 15-50 KW ❑ 50 + KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors 13 0-1 HP El Inc. Solar 09-15 HP 016-15+ Pole Light Range Sign Standing Sections Trash Compactor 1 Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By, SUMMARY O BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ 01 00011004--00011005 T O T 10.,%0 DATE: 03/02/88 TIME: 13:25 J CONSTRUCTION AND PLANNING POOL IPA t. APF'ROVALS Permit # Date inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52, Pool & Equipment Location 2. Soil Pipe -_Ur d;grnd. 1k1 53. Steel Reinforcement r'- "3.-Electrical'Conduit Utility-Undrgrnd, f' 54. Forms 4. Electrical ConduitfUndrgrnd. 55. Electrical Bonding 5. Steel�Reinf'v mFnt 56. Rough'Plumbing & Pressure Test 6.. El'ecirical lF_t! rnd. 57. APPROVAL TO COVER-GUNITE 7.. Foo�ings '� { 58. Electrical Conduit-Undrgrnd. � 8.' Foundaf±on-:, ~+ 59. Gas Pipe, ❑ Undrgrnd., Test •� 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10' Structural Floor System 61. APPROVAL TO DECK 11,%Prgpt'riy Sewer Line & House Connection � i% � 62. Backwash &Receptor -Final 12. Sevve� Cap r, r r �� 63. Heater & Vent -Final .r I r 131 Roof lJ ains / 64. Plumbing System - Final i 14:� Rdugh Plumbing 65. Electrical -Final 15. Ro��ugh'Electrical-Conduit 66. Solar System -Final /16" Rough Electric Wiring 67. Fencing & Access Approval i1 7. Rough Wiring Sign 68. APPROVED•FOR;PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL i1<9. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS' Perm;t # (20. Rough Factory Fireplace °f V4 .21•. Ducts, in Structure El] 70. Underground Hydro 22. Ducts, Ventilating N 1 71. Product Piping ❑ Gas ' ❑ Oil 23. Gas Pipe-Rqugh & Test l 72. Upderground Flush ,1 24. Roof Framing 1 r} 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil a 25. Roof Sheathing 74. Overhead Hydro 26. T•Bar Ceiling {Structural) & Monocoat 75. Dry Chemical 27,E -Frame and Flashing , 76.,12xy Standpipe t 28. Lathing & Siding 77.,,PPXED SYSTEM FINAL 29, Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing �• HEALTH DEPT. REQUIREMENT t 1, Plaster Brown Coat 79. ;NAL INSPECTION Electrical Power'Meter-Final 80. FOOD CERTIFICATE ISSUED X32, 33. Final Electric Nates: �s 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 1-4w 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing I L 39, Water Service -Final 40, Gas Service -Final 41. Solar Domestic-Final'tl 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45, Sound Attenuation It 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50, Gas Release to Southern California Gas Co l [ .• 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. -� Clry of cosrA�Esrt CONSUCTION PERMIT r Project P�ddress PE MIT NO. 3�Z TRACT NO. LOT NO. UNI N A.P. zona S Main Building: Accessory Building: TYPE OF CONSTRUCTION NEW ADD ALTERATION ❑ CONVERSION 1:1 DEMOLISH ED OTHER DESCRIPTION OF WORK/USE OF BLDG. REPAIR Applicant's Mallin Atldres5 �� r me Owner's Na ^ eVD 1fk%Phone Address i M V cense No. Arch/Eng. • J ,�Li Address l ��4M'7 ■ `+� •' Contractor's Name Phone Address (mailing) City License No. T Front Q A Rear N C Right N TYPE OF PERMIT GRADING ❑ TENANT ELECTRICAL [:],OTHER PROJECT DESCRIPTION SQ. FT. CONSTRUCTION TYPE ZONE GRADING FOUNDATION STRUCTURAL ❑PLUMBING ❑MECHANICAL OCCUPANCY VALUATION $ CU.YDS. ACRES K g • Left G R Ping. Rei. � Parking Req./Provided E Planning Notes: Q M T 5. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Remarks: 2 ELECTRICAL FEES License Class License No. Date . Signature WORKERS' COMPENSATION DECLARATIONConstruction I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. Company 8 Certified copy is h@reby furnished. Certified copy is filed with the city Building Division. PLUMBING FEES Automatic Washer Transformer ❑ 15-50 KW Pole Sub. ❑ 50 + KW Bar Sink Showers Backflow Preve,�ter . Service Sink Cooking Unit Meter ❑up to 100 amps Backflow Irrigatign Sewer Cap Dishwasher Meter ❑over 100 amps Bathtubs Sewer Connection Dryers ❑Gas ❑Electric Sub Panel -* Claflfiers solar Collectors Fan Motors [10-1 HP Ell % - S Date, Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). Icertify that in the Performance of the work for which this permit is Issued 1 shall not employ any person in any anner so as po become it ct to the Workers' ens lig Laws of Call y DateTa Signature - Dishwasher A solar Piping F.A.U. Inc.Solar 09-15 HP 016.15+ Drinking Fount;ins Solar Tank Fixtures Microwave Floor Drains l Swimming Pool vv/Spa Device Boxes Pole Light NOTICE: If„afte making this deClaratio , you should become subject to the Workers' Compensation provisions of the tabor Code. you must forthwith Comply with Such provisions or this permit shall be deemed revoked. CONSTRUCTION LPNDING AGENCY Floor Sinks Urinal Outlets Range Gas Service Outlets Water Closet Switches sign I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097 Clv. C.) Lender's Name Lender's Address _ — „—, Interceptors Water Heater Garbage Dispose! Standing Sections Kitchen Sink Water Service i. Generator El D-5 KW ❑5.15 KW Trash Compactor OWNER Bu1LDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 Of the B4sineSS and ProfesSldns Code) Or that he/she is exempt Lavatories Auto -Wash i P -.Trap Laundry Trays Roof Drains Reinspection Fee $15 Issue Fee $ 3 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 peal�y of not mare than five huntlred dollars (5500). NOI, as owner of the property or my employees with wages as their sole gensation, will db the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thoreon, and who dges such work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for Sale. If, however, the building or Improvement is sold within one year of com- pletlon, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: rhe Contractor's License Law does not apply to an owner of property who builds or Improves thereon. and who contracts for Such orolects with a con- tractors) license pursuant to the Contractors License Law). I am aware that DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By at --- — — — ReinspectiOn Foe $15 Issue Foe $ 3 :) MECHANICAL FEES Boiler Hood or Type I ❑ Canopy Type 11 ❑ Duct - Under Ground SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ Duct - Structural Refrigeration System ❑0-100,000 $TU 0100,000BTU Duct - Ventilating Exhaust system El Multiple 11 System Repair/Alteration proof of their Worker's Compensation Insurance should be provided to me. ❑ tam exempt under Section B. 8 P. G. for thi eason ' Date Owne I hereb cert y that f have re Is application and state that the above information is correct. I agree to Comply with all city and county ordinances and state laws relating to building Construction, a hereby authorize repre- SentatlV this city to enter n th a mentioned pro rty for Inspection Pu Signature Date Drivers' License or S$ - 0865-46, rev. 5/86 White - Building; Canary - Applicant; Pink - Accounting; ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 2596 $ GRADING $ $ MICROFILM $ . $_ TOTAL FEE $ $ FirepllFact. i31t. ICBG Fire Dampers Heating system & Ducting ❑4100,000 BTU ❑100,00087 Registers ! 01 00012841-00012841 TOT DATE! 08/24/88 TIME: 15:19 19.50 F Reinspadion Fee I $15 l Issue Fee '' 5-�- j ,' Goldenrod - Assessor �, CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date .r: Inspector 1.'Temporary Electrical Service or Pole ��?_ 52. Pool & Equipment Location i- .2. Soil Pipe-Und.07nd. ' �tl 53. Steel Reinforcement ' V. Of, Electr'icail Conduit Utility-Undrgrnd. ,y 54. Forms r 4. Electrical Conduit-Undrgrnd. �1 55. Electrical Bonding 5 Steel' Re; nf 6r`66 ment .. r 56. Rough Plumbing & Pressure Test a r fr'• 6! EI'edtricgl LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 58. Electrical Conduit-Undrgrnd. ! l ` 8Foundat bn';. _ 59. Gas Pipe, ❑ Undrgrnd., Test J 9, W1ter Pipe-Undrgrnd.' '. 60. Backwash Lines, P -Trap, ❑ Undrgrnd, �• ` { 10J�St76ctural Floor System 61. APPROVAL TO DECK 1Propedy Sewer Line & House Connection ,j 62. Backwash & Receptor -Final 12.1 Sewer Cap � 63. Heater & Vert -Final f 1 -')Roof Drains 64, Plumbing System - Final - 14. Rdugh"Plumbing 65, Electrical -Final I y 15. Rough Elect4al-Conduit 66. Solar System -Final ,1.6. Rough Electric Wiring 67. Fencing & Access Approval 147 a , 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 APPROVALS Permit # 20: Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating ' 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 1 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26, T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical i 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:(?-y4_9q- •- (bDo" 14Xff�. 34. Final Heating & Air Conditioning ?/I7 fib/ 1 (4/, 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final - 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System {1 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE& BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ` 51. CERTIFICATE OF OCCUPANCY No. Date i 7 Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MES`A/ %,0INST/HU_ A IUN PE PERMIT NO TRACT NO. LOT NO. UNIT Project Adktress�/ ApRlicarit's Mailin ddre Owner's Name f Phone Address Sr7// Arch/Eng. _ License No. Address Contractor's Nam — P on 9 Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) 4f Division 3 of the Business and Professions Code, and my license iAOMPENSATION ree and effect. License LIc ns DateSignature WORK RS' DECLARATION 1 hereby affirm that I have a certificate of consent to Belt -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. Company BCertified copy is hereby furnished, Certified copy is filed with the city Building Division. pate-._, Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that in th performance of the work for.whlch his mit is Issued I shall not em o n arson in an miner so as to a me subject to lite Workers' en Laws of Ga(itoiir¢. Oat- i Signature iK NOTICE: It' aft r making this declaration, you should become subject to the Workers' Com ansation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION FENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lander's Address - OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter Improve, demolish or repair any structure, prior to its issuance, also requires tke applicant for such permit to filo 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 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 -natty of not more than five hundred dollars ($500). 1, as Owner of the properly or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does nbt apply to an owner of a properly who builds or improves thereon, and who goes Such work himself/herself or through his or her own employees, provide(l that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of Com- pletion, th- owner Will have the burden Of proving he/she did not build or im- prove for the PUYPO%e of sale). , ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon. and who contracts for such oroiect5 with a con- tractors) license pursuant to the Contractor's License law). I am aware that proof of their Worker's Compensation insurance should be provided to me. O 'l am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that i have reap information is Correct. I agree to and state laws relating to buildi sentatives of t tit to e t Inspection pur s. Signature Drivers' License or $S :f 0865.46, rev. 5198 White - E � I S a plication and state that the above ith all city and county ordinances nstr ction, and hereby author( e r pre- m e above-mentioned r r f Date oft E 34 71Q. rB . SW TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR Main Building: �` Accessory Building: IJ CONVERSION ❑ DEMOLISH ❑ OTHER Front DESCRIPTION OF WORK/USE OF SLOG. Rear TYPEOF PERMIT GRADING FOUNDATION STRUCTURAL- C Right ❑ TENANT ED ELECTRICAL ❑ PLUMBING 13 MECHANICAL S Left ❑ .OTHER Ping. Ret. + Parking Req./Provided PROJECT DESCRIPTION SQ. FT. OCCUPANCY Planning Notes: CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YOS. ACRES Remarks: w ELECTRICAL Zone FEES N N G R E Q M T S. Reinspection Fee 1 $15 ng; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee I $ 3 01 00010908-00010909 T O T 42.00 DATE: 08/01/88 TIME: 15:08 PLUMBING FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Bar Sink Showers Backflow Preventer Service Sink Cooking Unit Meter Qup to 100 amps Backflow Irrigation Sewer Cap Dishwasher Meter ❑over 100 amps Bathtubs Sewer Connection dryers ❑Gas ❑Electric Sub Panel Clarifiers Solar Collectors Fen Motors ❑0-1 HP 111''5 - B 3 Dishwasher Solar Piping F.A.U. Inc. Solar 119-15 HP 1116.15+ Drinking Fountains Solar Tank Fixtures Microwave Floor Drains Swimming Pool vv/Spa Device Boxes Pole Light Floor Sinks Urinal Outlets Range . Gas Service Outlets Water Closet Switches Sign t Interceptors Water Heater Garbage Disposel Standing Sections Kitchen Sink Water Service - Generator 00-5 KW E15-15 KW Trash Compactor Lavatories Auto -Wash P—Trap Laundry Tros Roof Drains Reinspection Fee $15 Issue Fee $; DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Data Application Issued By Det - Reinspection Fee $15 Issue Fee S 3 Boiler Duct - Under Ground MECHANICAL Hood or Type t ❑ Canopy Type 11 ❑ FEES SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ �-V GRADING $ PLAN CHECK 50% $ MICROFILM $ �� MECHANICAL $ — TOTALFEE $ PLAN CHECK 25% $ Duct - Structural Refrigeration System 110.100,000 BTU 0100,000 BTU Duct - Ventilating Exhaust System ❑ Multiple ❑ System Repair/Alteration FirepllFact. 81t. ICBO Effi Fire Dampers ` Heating System & ducting ❑0 100,000 BTU ❑100,0008 Registers ' Reinspection Fee 1 $15 ng; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee I $ 3 01 00010908-00010909 T O T 42.00 DATE: 08/01/88 TIME: 15:08 FZ dONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL -SPA APPROVALS Permit # Date Inspector 1 Temporary Electrical Service or Pole ;' 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. i 53. Steel Reinforcement 3.;Electrical Conduit Utility-Undrgrnd. 54, Forms 4. Electrical Conduit.Undrgrnd. r 55, Electrical Bonding 5..•Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFEli Grnd. 57: APPROVAL TO COVER-GUNITE • 7. ,Footings ` 58. Electrical Conduit-Undrgrnd. i8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System I 61. APPROVAL TO DECK 11.• Property Sewer Line & House Connection ! F 62. Backwash &Receptor -Final 12. Sewer'Cap 63. Heater & Vent -Final 13. Roof Drains •I 64. Plumbing System - Final. _ T4. Rough Plumbing ,''' 65. Electrical -Final L 15, Rough Electrical -Conduit 66. Solar System -Final I;6 Rough Electric Wiring - - 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING r18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL i9. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20, Rough Factory Fireplace . 21i. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 FOOD CERTIFICATE ISSUED 33. Final Electric otes: 34, Final Heating & Air Conditioning I 35. Final Gas Pipe -Test I ( 36. Hood or Canopy 37, Final Factory Fireplace 36. Final Plumbing 39, Water Service -Final 40, Gas Service -Final 41. Solar Domestic -Final 42.(Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System I, 1 45. Sound Attenuation 46. Handicap Regulations ==�' 47. FINAL STRUCTURE & BUILDING lU 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date f ? ? ;• ' C Applicant to fill in all CITY QF COSTA MESA CONSTRUTION•PERMIT Project Address Applicant's Mailing AcWress :^�%�Lr _ Owner's Name o_Y-TNUL'Stss -6X —Phb I Address `132i _ I {"' G Arch/Eng. M a!" FF License No. CIS` Z Address lA!/ n' U64 L Contractor's Name ©l� Phone Address (mailing) [LtAl&&7Z City License No. LICENSED CONTRACTOR DECLARATION i -hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Oivision 3 of the Business and Professions Code, and my license is inlfxl,I�f)`a ce and effect, License Class; ✓""v �•�SY -License No,.��-+•^/s/� Date Signature WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure or a certificate rt Workers' Compensation -'Insurance, or a certified copy therepf,(Section Lab. C.) Policy No, j1JarirCompany �i Certified copy is hereby furnished. Sj Certified py is I d with the city Building Division. Date Applicant EXEMPT IQA FR MWORKERS'COMPI:NSATION ECLARAT10— (This secti,dn ON(Thissectidn need not be completed if the permit is for one hundred ($100) or less). I 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner So as to become Subject to the Workers' Compensation Laws of California. ' Date Signature '{NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the tabor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work fo r h thi r}�ermit (s issueq (Section 3097 CIv. C.) L-ender'S Name � �T _ �V-ITm�=n% /=4 A/0 Lender's Address `! 3 21 _ 1— 1 k i1vq" /,>- OWNER BUILOER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit ,to file a signed statement that tie/she Is licensed pursuant to the provisions of .,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 '031.5 by any applicant for a permit subjects the, applicant to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the property or my employcos with wages as their sale compensation, will do the work, and the structure .is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement is said within one year of com- pletlon, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale), ❑ I. as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon ; and 'who contracts for such projects with a can- tractor(s) license pursuarit "to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance Should be provided to me. ❑ I,am exempt under Section I B. & P. C. for this reason Date Owner' — I hereby certify that I -have read this application and state that the above I information is correct. I agree to •comply with all city and county ordinances and state laws relating to, tiding Struc� tion, and hereby authorize repre- sentatives of, this city entgr P n9"la above-mentioned propoty /for inspection purposes. ' Signature ate_ Drivers' License or SS =ht ces except those within heavy border lines and sign all appropriate declarations. A LOT NO rc. i iI J TR CT NO. UNIT NO. Showers TYPE OF CONSTRUCTION L1 KEW LJ ADD LJ ALTERATION El REP"Al R Backflow Irrigation ❑ ❑ DEMOLISH ❑ OTHER Bathtubs Sewer Connection CONVERSION Solar Collectors A.P. DESCRIPTION OF WORKIUSE OF BLDG. Drinking Fountains Solar Tank j Floor Drains Swimming Pool w/Spa Floor Sinks S Main Building: TYPE OF PERMIT 11 GRADING FOUNDATION ❑ STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ® PLUMBING ❑ MECHANICAL B Auto -Wash ❑ ,OTHER Laundry Trays' A Rear PROJECT DESCRIPTION SQ. FT. OCCUPANCY C K Right CONSTRUCTION -TYPE VALUATION$ I S S Left ZONE GRAOINGCU.YCOS. ACRES Ping. Ref. # Remarks: r1 r; # - 4146 7I • MICROFILM Planning Notes: S_3 FEES PLUMBING ^ Bar Sink Showers Backflow Preveriter Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank j Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets 'Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Trap Laundry Trays' Roof Drains $ Da i ISSUANCE $ Reinspection -Fee $ f `D S15 Issue Fee I S MECHANICAL S_3 FEES CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 8554 6%3x/86 Y' 8.D17 Tl. Zone Accessory Building: Z O N, . I J R. Parking)Req./Provided E M T S ELECTRICAL FEES Boiler _ 1 Transformer ❑ 15-50 KW ❑ 50+KIN Hood or' Type I ❑ Canopy Type 11 ❑ Meter ❑up to 100 amps Dishwasher Duct - Under Ground Dryers ❑Gas �,gElectric Duct - Structural Fan ~r Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU F,A,U. Inc.Solar 09-15 HP 016.15+ Duct - Ventilating Microwave Device Boxes Exhaust System ❑ Multiple ❑ Outlets System Repair/AIteration Switches Sign Firepl/Fact. Bit. ICBO # Standing Sections Fire Dampers Trash Compactor $ Heating System & Ducting 0,0.100,000 BTU ❑ 100,000 BT i Registers ) PLUMBING $ Da i ISSUANCE $ PLAN CHECK 25% $ f `D ENERGY P.C. I S ELECTRICAL Reinspection Fee $15 ^a 1 Issue Fee $ 3 �_J CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 8554 6%3x/86 Y' 8.D17 Tl. Zone Accessory Building: Z O N, . I J R. Parking)Req./Provided E M T S ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+KIN Cooking Unit `� Meter ❑up to 100 amps Dishwasher Meter [Dover 100amps' Dryers ❑Gas �,gElectric Sub'Panel Fan ~r Motors 00-11 HP ❑ 1 i4 - 8 F,A,U. Inc.Solar 09-15 HP 016.15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal Standing Sections Generator- ❑0-5 KW 05.15 KW Trash Compactor $ PLAN CHECK i PERMIT ) PLUMBING Reinspection Fee $15 Issue Fee S 3 DEVELOPMENT SERVICES REQUIREMENTS - Zoning Approved By Date Building Approved By Date " Application Issued By -- Dat SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT ) PLUMBING $ Da i ISSUANCE $ PLAN CHECK 25% $ f `D ENERGY P.C. I S ELECTRICAL $ GRADING ^a 1 PLAN CHECK ,50%' $ ; MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ CONSTRUCTION AND PLANNING Date APPROVALS Permit # Inspector POOL ,PA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53, Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54, Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd:. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK , 11 . Property Sewer Line & House Connection 62. Backwash &Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final. 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit �. 66. Solar System -Final - ystem-Final16..Rough 16. RoughElectric Wiring 67. Fencing & Access•Approval 17. Rough Wiring Sign 6B. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar'Ceiling 69. POOL/SPA SYSTEMS FINAL 19. `Rough Heating & Air Conditionirig FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping D Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 r HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat V� 79. FINAL INSPECTION 32. Electrical Power Meter -Finale '• 80. FOOD CERTIFICATE ISSUED 33. Final Electric t, Notes: 34. Final Heating & Air Conditioning; 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing "rJ7/} AW 39. Water Service -Fina! 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer G43. Backflow Irrigation a4. Landscape Irrigation System ,45. Sound Attenuation L46. Handicap Regulations °47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison X50. Gas Release to Southern California Gas Co 61. CERTIFICATE OF OCCUPANCY No. Date Cr Applicant to fill in all spaces except those within heavy -border lines and sign all appropriate declarations, CITY�F COSTA MESA CONSTRUCTION PERMIT PE IT NO TRACT NO. LOT NO. UNIT Nb Pioject'Address P-- ` Applicant's MaHlmg Address r Owner's N e J Address ArchlEng.' License No. Address' Contractor's Nam Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am -licensed under provisions of Charter 9 (commencing with section ,7000) of Division 3 of the Business and Professions Code, and my license is in full rce and of ¢ct, 1 Licen, Class _ ICense No.a6:2'. ,5 Date Signature WORKERS' COMPENSATION O IARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate -of Workers' Compensation insurance, or a certified copy thereof (Section 3800, Lab- C.) Policy No. Company 8 Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION OECLARATION (This section need not be completed if the permit -is for. one hundred (5100) or less). t certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so s to become subject to the Work s' Co ensa n Laws of Call r Date Signatur¢ NOTICE: If, afte making this declar on, you should become subject to the workers' Compensation provisions f the Labor Code, you must forthwith comply with such provisions or this permit shall be doomed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit ,to file i signed statement that he/she Is licensed pursuant to the provisions of 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 t0 a civil enalty of not more than five hundred dollars ($500). I, as. owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Coda: The Contractor's 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 employees, provided that such improvements aro riot Intended Or offered for sale. It, however, the building or improvement is sold within one year of Com- pletion, the owner will have the burden of proving tic/she did not build or im- prove for the purpose of sale). ❑ I, as'owner of the property, am exclusively contracting with licensed con- tractors to construct the proiect (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and _who contra Cts for such projects with a Con- tractor(s) license pursuarit to the Contraitor's License Law). I am aware that proof of/ their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner, I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and 'state laws relating to building construction, and hereby authorize repre- sentative�,3's to enter upon the above-mentioned property for inspectioat y �+ Signature Orivers' Pt Reinspection Fee TYPE OF CONSTRUCTION NEW _ ADD El ALTERATION REPAIR $ 3 ❑ ❑ ❑ OTHER DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By CONVERSION DEMOLISH Date Date Dat A P of DESCRIPTION OF WORK/USE OF BLDG. Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ SUMMARY OF FEES � �— ! •5�� ' S Main Building: Fire Dampers . E TYPE OF PERMIT GRADING FOUNDAT1:1ION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B ❑ -OTHER A Rear - PROJECT DESCRIPTION SQ. FT. OCCUPANCY C K Right CONSTRUCTION TYPE VALUATION S S I Left ZONE GRADING CU.YDS. ACRES Ping. Ref. 9{k Remarks: Planning Notes: I PLUMBING I FEES I Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service J Outlets Interceptors 5 ' Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee' _ $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating ExfiaUSt System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO + Heating System & Ducting ❑0-100:000 BTU ❑ 100,000 BTL Reinspection Fee 1 $15 Showers Service Sink Z Sewer Cap Sewer Connection Solar Collectors - j Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Z Water Heater Water Service Auto -Wash Laundry Trays Automatic Washer Construction Pole Sub. Cooking Unit dishwasher Dryers ❑Gas ❑Electric 5869 7/02/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15.50 KW ❑ 50+KW Fan' F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 110-5 KW 115-15 KW Meter LJup to 100 amps Meter- ❑over -100 amps Sub Panel Motors ❑0-1 HP ❑ 1 A - 8 Inc. Solar 09.15 HP ❑ 16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 10..50 Tl,' FEES Z O N I N G R E O M T S i Issue Fee $ 3 Reinspection Fee S15 1 1 Issue Fee $ 3 iANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Date Dat Hood or Type I El Canopy Type It ❑ Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ SUMMARY OF FEES � �— ! •5�� SMIP s PERMIT ISSUANCE $ ENERGY P.C. $ GRADING S i MICROFILM S TOTAL FEE S L'O 5 System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 AF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor r: ' cCONSTRUCTiON AND PLANNING s ,APPROVALS Permit # Date Inspector r� POOL a SpA APPROVALS Permit # Date Inspector �1. Temporary Electrical Service or Pole -52, Pool & Equipment Location 2. Soil. Pipe-Undrgrnd. '� 53. Steel Reinforcement .3./Ele6trical Conduits Utility-Undrgrnd. r 54. Forms 4. •Electrical Conduit-Undrgrnd. 55. Electrical Banding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ` 6. Elect'rical,UFER -Gr nd. 57, APPROVAL TO COVER-GUNITE f 7. Footings .� 58. Electrical Conduit-Undrgrnd. * i 8.Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe,Undrgr,nd. 60, Backwash Lines, P -Trap, ❑ Undrgrnd. 10.v tructural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 1 ,12. Sevver'Cap 63. Heater & Vent -Final +1 13. Roof Drains r t � i 64. Plumbing System -Final "!- 14. Rough Plumbing_• 65. Electrical -Final YV 15. Rough Electrical -Conduit r 66. Solar System -Final 166. 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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush n 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75, Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78, FIRE PREV, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test I 36. Hood or Canopy 37�, Final Factory Fireplace 38. Final Plumbing _39. Water Service -Final / 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow laigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and Sign all appropriate declarations. CITY OP COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO, Project Address III W- 1 1' SLT Sm Fl �0 E Applicant's Mailing Address Owner's Name fJRDn (111% IJES i t'1'1E N I Phone Address ArchlEng. License No. Address Contractor's Name _/YI OR le KS— PLE= 1 C- Phone 6�b0 Address (mailingl I Sff�� J'?RY6Ar7_ S-1-. :91-DUMI"J TPN ��3f1q City License No. • b LICENSED CONTRACTOR DECLARATION I h0reby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions de, anti my license is in full force and effe Ucense Class I D L censeI Date 1-10� k S Signature lr4a�;C_� I — WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure or a Certificate If Workers' Compensation Insurance, or a certified copy thereof (Section - 800, Lab. C.) rolicy No, VUaj0 i7 y FFLGG eCertified COPY is hereby furnishe Certified copy ed with the ci Ivislon. Date 1� I O s Applicant EXEMPTION FROM WORKERS' COMPENSATIO ECLARATION (Thissection need not be Completed if the permit ls,4or one hundred ($100) or less), I certify that In the performance of the work for which this permit Is issued I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 her@by affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name - Lender's Address OWtgl R BUILDER DECLARATION - I heYeby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/She is licensed pursuant to the provisions of the Contractor's License Law {Chapter 9 (commencing wlth 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 031.5 by any applicant for a permit subjects the applicant to a civil 8ndlty of not more than five hundred dollars ($500). +J I, as owner of the property or my employees with wages.as their sole compensation will do the work, and the structure is not intended or offered for sale (SeC�ion 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon,. and who does such work himself/herSeif or through his or her own employees, provided that such improvements are not Intended or offered for sale, If, however, the building or Improvement Is sold within one year.of corn- pletion, the owner will have the burden Of proving he/she dfd not build or fm- rOve for the purpose of sale). I, asowner of the property, am exclusively contracting with.11censed con- 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 builds or improves thereon, and who Contracts for such projects with a-con- tractor(sV license puts uarit-to the COntra6toi'S License Law). I am aware that ,)Too, Or( their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P: C. for this reason Dat@ Owner I hereby certify. that I�have read this application and state that the above information is c I agree tel comply with all city'and county ordinances and state Iatin to builtl lig co ruction and hereby authorize repre- ' sentattve of cit to en up the abov0-mentioned property for Inspectio r s , Signature Dat*�� (�~ Drivers' License or SS _ 5877 1/16/85 4P50 TL Zone Accessory Building: Z O N I G R Parking Req,/Provided E O M ' T S PLUMBING FEES TYPE OF CONSTRUCTION LJ NEw LJ ADZ), ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. ALTERATION LJ REPAIR A.P.qM, S E T B A Main Build TYPE OF PERMIT GRADING D FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER Front Rear PROJECT DESCRIPTION SG. FT. OCCUPANCY CON STRUGTION TYPE VALUATION $ ZONE GRADING CU.YOS. ACRES C g Right I Left Mrig. Ref. # Remarks: Clarifiers Planning Notes: _ 5877 1/16/85 4P50 TL Zone Accessory Building: Z O N I G R Parking Req,/Provided E O M ' T S CMF 0865-46, rev. 10/94 White - Building; Canary - Applicant; pink - Accounting; Goldenrod - Assessor PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW + KW Backflow Irrigation Sewer CapEl50 Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps' Clarifiers Solar Collectors c Dishwasher Meter El over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan !Motors (NO- 1 HP 0 fi - B 1 � Floor Drains Swimming Pool w/Spa F.A.U.Inc. Solar ❑9-15 HP C116-15+ Floor Sinks Urine) Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories - Auto -Wash Garbage Disposal 9 p ,Standing Sections P—Trap Laundry Trays Generator 00.5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 1 MEMO Issue Fee $ 3 -- MECHANICAL FEES Boiler I Hood or Type 1 ❑ Canopy Type 11 ❑ DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date_ Date Date ,1 Duct - Under Ground Duct - Structural Refrigeration System ❑0.100,000 BTU ❑100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ $`'1_co GRADING' $ $ r50 MICROFILM $ t J $ - TOTAL FEE $ $ Exhaust System 0 Multiple ❑ System Repair/Alteration Firep!/FacL81t.ICBD# Fire Dampers Heating System & Ducting ❑0-100,000 BTU ❑imuoOBT Registers _ - Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/94 White - Building; Canary - Applicant; pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING Date APPROVALS Permit #- - Inspector POOL SPA APPROVALS Permit # Date Inspector 1 . Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd, 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE -7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9, Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10, Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains .64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68, APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation. 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No, Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address -711 W.17th St. Bldg. (E) Unit 8 Applicant's Mailing Address Owner's Name Tray InV _&±Ment F'ttnr3 Phone 949-2988 Address4391 Arch/Eng. License No, Address 12881-KAO-t-t-Ave . Suite 216 - -- Contractor's Name„g Phone -_9Z2_-_1,U6 Address (mailing)131-U--SrLt.i Djr Sty N;HollywODd,C.� Cjty License No. 33g23 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 o the Business and P fessions Code, and my license is in full force and etfe License Class C D LIc N , 346251 Date Signature WORKERS' COMPENSATION DEC RATION' I hereby alfirm that l have a eertifica 'of consent to self -insure or a certificate ,)f Workers' Compensation Insurance, or a certified Copy thereof .(Section aoo, Lab. c.) w c 9824 F Lumbermans Policy No. Company 8 Certified copy is hereby fyrnished. / Certitj,Efl opy is filed with the city Buildir�Dlvi i� an. �/� Date- Applicant U C_r7 6 j EXEMPTION. FROM WORKERS' COMPENSATION DECLARA ION (This section need not be completed if the permit is for One hundred ($100) or less) - I certify that in the performance of the work for'whlch this permit is issued I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature -NOTICE: If, after making this declaration, You should become subject to the Workers' Compensation WOVislons of the Labor Code, You must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDINQ AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ, C.) Lender's Name - Lender's Address OWNER BUILDER DECLARATION I hereby affirm that i am exempt from the Contractor's License Law for,the following reason (Section 7031.5 Businessand Professional Code: Any city or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a slgn6d statement that he/she I$ licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business end Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section '031.5 by any applicant for a permit subjects the applicant to a Civil enalty of not more than llv@ hundred dollars ($500). ❑ I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement Is sold within one Year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale), Cl 1, as owner of the property, am exclusively Contracting with licensed con- tractors t0 construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds o[[ improves thereon, and who contracts for such projects with a con. tractor(si license pursuant•to the Contractor's License Law). I am aware that, proof of! their Worker's Compensation insurance should be provided to me. ❑ ( am exempt under Section B. & P. C. for this reason Reinspection Fee I $15. Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO q{k Date Owner Heating System & Ducting I hereby certify that I havq read this application and state that the above 1 uq0-100,000 BTU El 100,000 BT Informatio%10/84 . l agr@e to comply with all city and county ordinances and stateg to b ins construction, and hereby authorize repre- , sentativesty to en r upon the above-mentioned property for Inspection y �p �J Signature Date Drivers' LReinspection Fee $15 IF 0665-46, rev. White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee S 3 I j 226+ 5/03/65 15ee0 TL TYPE OF CONSTRUCTION NEW LJ ADD L1 ALTERATION LJ REPAIR R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. Zone �ANICAL FEES S Main Building: Accessory Building: Date Date Dat Z TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL ❑ -OTHER E T Front BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% Z O A Rear System Repair/Alteration N PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ . ZONE GRADING CU. YDS. ACRES Right 4-40 N K g Left Issue Fee $ 3 G R Ping. Ref. + Parking Req./Provided E Remarks: Planning Notes: M 1 T $ PLUMBING ; FEES ik ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backffow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors s Dishwasher Meter Clover 100 amps Dishwasher Solar Piping • Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Floor Drains Solar Tank Swimming Pool wlSpa Fan F.A.U. Motors 00-1 HP ❑ 1 Inc. Solar 09.15 HP Ell 6-15+ Floor Sinks Urinal Fixtures Microwave Gas Service . Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Lavatories Water Service Auto -Wash Switches Garbage Disposal Sign ; Standing Sections P -Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee I $15. Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO q{k Date Owner Heating System & Ducting I hereby certify that I havq read this application and state that the above 1 uq0-100,000 BTU El 100,000 BT Informatio%10/84 . l agr@e to comply with all city and county ordinances and stateg to b ins construction, and hereby authorize repre- , sentativesty to en r upon the above-mentioned property for Inspection y �p �J Signature Date Drivers' LReinspection Fee $15 IF 0665-46, rev. White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee S 3 I j Reinspection Fee s15 Issue Fee S 3 �ANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By _ --- Building Approved By Application Issued By Date Date Dat Z Hood or Type I El Canopy Type 11 ❑ Refrigeration System ❑0.100,000 BTU 0100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMM $ S $ $ $ $ $ -- 13.00 $ 2 RY OF FEES SMIP $ PERMIT ISSUANCE S ENEIaGY P.C. $ GRADING $ MICROFI LM $ _ TOTAL FEE $ S(1 -_— 15.50 System Repair/Alteration Fire Dampers Registers 4-40 Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS . Permit# Date Inspector POOL SPA 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 r. 6• Electrical UFER Grnd. f 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduif-Undrgrnd. s i 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. ') 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System �.� f 61. APPROVAL TO DECK 11, Property Sewer Line & House Connectign 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains j 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 APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PR E V. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39: Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43, Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. _ TRACT NO. LOT NO. UNIT NCL Project Address Abplicam's Mailing Address13110 SAtiCOv ,St_, Owner's Name Troy _InveSLMPnC Flinn Phone%49-2488 Address _4321 Birch St Newport ReaCh, Ca-. Arth/Eng. m -7. Rock License No. Address _] 2$81 Knott_A�e.�S.uite� Contractor's Name_—IZItCQ Air Ct-ineii tinni ncPhone ga2-1 21216 Address (mailing) 13110 Satirny StY_.__N ,CA - City License No, '43925 !!11 LICENSEO CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of'C arter 9 (commencing with section 7000) of Division 3 of the Buslness an ofesslons Code, and i my license is in full force and of Litense Class se DateSignature WORKERS' COMPENSATION OE RATION t I hereby afflrm thatv I have a certif' ate of consent to self -insure or a certificate K f Workers' Compensation Incur nee, or a certified copy thereof (Section Lab. C.) Policy No.—ielC�l$2/ter— Company T.nmhPnanc H Certified copy is hereby furnished. Certifi y is filed with the city Buikitfttg p -vision. ^ r Ddte Applicant _- LJu J� v f EXEMPTION FROM WORKERS' COMPENSATION DECLA ATION - (-rhiS Section need not be completed if the permit is for one hundred ($100) Or less), I Certify that in the performance of the work for which this permit is issued, I shall- not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. .Ddte Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with Such provisions or this permit Shall be deemed revoked. CISNSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) I-Oncler's Name L9nder's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for.the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit U) file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Lbw (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 '031.5 by any applicant for a permit subjects the ,applicant to a civil lenalty of not more than five hundred dollars ($500). ❑ 1, as owner of the properly or my employees with wages as their sole Compensation will do the work, and the Structure is not Intended or offered r for Salo {Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that Such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- ' Provefor the purpose of sale). [3 1, as owner of the property. am exclusively contracting with licensed con. tractors to construct the project (Section 7044, Business and Professions Code.- The ode:The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractors) license pursuarit'to the,Contractor's License Law). I am aware that Proof of their Worker's Compensation insurance should be brovlded to me. 1 am exempt under Section B. & P,. C. for this reason Date Owner I hereby certify that I have rea ihformatlon is correct. I agree to and state la relating to buildir sentatives is c)ty to ant ihspectlo pur Ses. signature Orivers' Lice or Ss lh, this application and state that the above )mply with all city and county ordinances (construction, and hereby duthorize repre- ,Pon the above-mentioned property for TYPE OF CONSTRUCTION LJ NEW L_J ADD LJ ALTERATION L-.) REPAIR ❑ ❑ ❑ CONVERSION DEMOLISH OTHER - A.P. 0 DESCRIPTION OF WORK/USE OF BLDG. Zoning Approved By 5 Main Building: Building Approved By Application Issued By TYPE OF PERMIT GRADING FOUNOATfO�}}N�� STRUCTURAL T Front El TENANT ❑ ELECTRICAL 1:1 PLUMBING LJ MECHANICAL B ❑ -OTHER A Rear $ C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Fire Dampers CON STRUCTiONTYPE VALUATIONS $ Left ZONE GRADING CU. YDS. —'ACRES— Ping. Ref. + Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains s Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -=Trap Roof Drains Reinspect ion -Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit, ICBGgV Heating System & Ducting R0-100,000 BTU ❑1oo.000BT Reinspection Fee 1 515 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING , Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee MECHANICA FEES S3 FEES Automatic Washer 2265 5/03/85 Zone Accessory Building: Parking Req,/Provided ELECTRICAL Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F,A,U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 1:10-5 KW 135.15 KW Transformer 15-50 KW ❑ 50, KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors 1:10-1 HP 1:1116 - 8 Inc. Solar'09.15 HP 016-15+ Microwave ' Pole Light Range Sign Standing Sections . Trash Compactor 15.60 TL Z O N I N G R E _ Q M T S FEES Reinspection Fee S15 1 1 Issue Fee I s 3 Hood or Type I ❑ DEVELOPMENT SERVICES REOUIREMENTS: Canopy Type II ❑ Zoning Approved By Date Building Approved By Application Issued By Date Date— Hefrigeration System ❑0-io0,000 BTU 0100,000 BTU BUILDING PERMIT PLAN CHECK SUMMARY OF S S FEES SMTP PERMIT ' $ System Repair/Alteration Fire Dampers PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50%. $ $ $ S ISSUANCE S ENERGY P.C. S GRADING S MICROFILM $ Registers MECHANICAL $ 1 3 - D __ TOTAL FEE $ 19-50 Issue Fee 5 3 PLAN CHECK 25% $ 2.50 CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POOL __ jPA 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 /�t 56. Rough Plumbing & Pressure Test 'y6• Electrical LIFER Grnd, 57. APPROVAL TO COVER-GUNITE r -7. Footings J 58. Electrical Conduit-Undrgrnd. i 8' Foundation 59. Gas Pipe, ❑ Undrgrnd., Test � 9. Water Pipe-Undrgrnd. t 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System f 61. APPROVAL TO DECK 11. Property Sewer Line & House Connectign 62. Backwash & Receptor -Final 12. Sewer Cap J; 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 APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Plough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 %0 ?If 4 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date , Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF, COSTA MESA CONSTRUCTION PERMIT ..Project Address 11 W' IIH COSE ftM ES 11 Applicant's Mail' n Address Owner's Name R 0 ME Phone Address Arch/Eng. License No. Address Contractor's Nam rL e C- Phon Address (mailing) 1 �b-�9 I RgAftY .�• RLDEMIA)d-�rJ =o City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I ani licensed under provisions of Charter 9 ( mmencIng with section 7000) of 13iviskon 3 of th iness and Pr 0,4" Code, and my licbrise is in full forrt•e and effe License Class �-^ icense / Date j� �� Signature WORKERS' COMPENSATION DECLARATION . 1 hereby affirm that I have a certificate of Consent to self -insure or a certificate -)f Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab. _ Policy No. C.} _70 Company EL'S BCertified copy is hereby furnished. Certified co , filed with the city uildi vision. Date?) fl — Applicant EXEMPTION FROM WORKERS' COMPENSATIO?i,-,.this CLARATION (This section need not be completed if the permit is ne hundred (3100) or less). I certify that in the performance of the work for w permit k5 issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California, Date — —Signature 'NOTICE: It, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with Such prpvIsions or this permit shall be deemed revoked._ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) . Lender's Name Lender's Address _ OWNER BUILDER DECLARATION - I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires A permit to construct, alter, improve, demolish or,repa11 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 the Contractor's Llcensg 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 vioiaiion of Section '031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). ❑ 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered forsale (Section 7044, Business and Professional Code: The Contractor's License Law does not appiy to an owner of a property who builds or improves thereon, and who does such work himself/herself or throwgh his or tier own employees, provided that such improvements are not Intended or offered for sale. it, however, the building or Improvement Is sold within one year of Com- pletion, the owner will have the burden of proving he/she did not build or Im- rove for the purpose Of sale). 1, as owner of the property, am excluSively contracting with licensed Con- tractors t6 construct tho project (Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who builds or improves thereon, and who Contracts for such projects with a con- tractors) license pursuariCto the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me, ❑ t am exempt under Section B. & P. C. for this reason Date I hereby certif information is and state 5 sentatives of t inspectiorilp Signature Owner have read this application and state that the above I agree fo comply th all city and county ordinances qo buildinJ cons ctlon, and hereby authorize repre- o enter upo he above-mentioned property for Drivers' License or SS %t Date _(—I() - .J..rfa I/Ib/VC) 4950 7 PERMIT NO. —-J 5-7 TRACT NO. LOT NO. . UNIT NO. E— TYPE OF CONSTRUCTION NEw ADD 0 ALTERATION I JREPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORKIUSE OF BLDG. ' A.P. -0 Zone S Main Building: Accessory Building: TYPE OF PERMIT El GRADING 0 FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ElOTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU. YDS. ACRES E T Front Z O B. A Rear N G Right N S G Left R - Ping. Ref. '# � Parking Req./Provided E Remarks: Planning Notes: M T 5 Bar Sink PLUMBING FEES Showers ELECTRICAL FEES Backflow Preventer i Service Sink Automatic Washer Pole Sub. Transformer ❑ 15-50 KW El 50 + KW Backflow Irrigation Sewer CapConstruction Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors_ Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas UElectric Sub Panel Drinking Fountains Solar Tank Fan Motors 00-1 HP 0114- 8 1 CO Floor Drains Swimming Pool w/Spa F.A.U. Inc.Sotar 119-15 HP 016.15+ Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Urinal Water Closet Water Heater Water Service Fixtures Device Boxes Outlets Switches Microwave Pole Light Range Sign Lavatories Auto -Wash Garbage Disposal ' Standing Sections P --Trap laundry Trays Generator 00-5 KW ❑5.15 KW Trash Compactor Roof Drains , 4 Reinspection Fee $15 Issue Fee $ 3 Reinspoetion Fee $15 Issue Fee $ 3 Boiler Duct - Under Ground MECHANICAL FEES Hood Or Type I ❑ Canopy Type 11 ❑ DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date „ Date�- Duct - Structural Refrigeration System 00.100,000 BTU ❑100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SM1P $ $ PERMITPLUMBING $ ISSUANCE $ $ ENERGY P.C. S $ L+ GRADING S $ SO MICROFILM $ $ TOTAL FEE $ $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firep1lFact. Blt. ICBO # Fire Dampers Heating System & Ducting ❑0.100,000 BTU 0100,000 BT Registers Reinspection Fee$15 1 Issue Fee $ 3 CMF 0865-46, rev, 10184 White - Building,, Canary - Applicant; Pink - Accounting; Goldenrod - Assessor '`-CONSTRUCTION AND PLANNING Date APPROVALS Permit # Inspector POOL _- SPA APPROVALS Permit # Date Inspector 11, ._Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6, Electrical UFER Grnd. 57: APPROVAL TO COVER-GUNITE 7, Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final - 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 16. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd, Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final ��7.�� 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final'Heating & Air Conditioning 35, Final Gas Pipe -Test 36, Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. 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 lam 10 r �r ApOlcanl to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PE 17 NO. TRACT NO. LOT NO. UNIT NO. CITY OF COSTA MESA CONSTRUCTION PERMIT A.P. ,I� 3 Z.. 0 9 .� E/o Project Address Applicant's Mailing Address / a Owner's Name 7 — c�L�Zh m' RllC dot Phone 955'_Q!Z S Address Arch/Eng. License No. Address Contractor's Nam Phone Address (mailing) City License No. LICENSED CONTRACTOR OECLARATI N I hereby.affirr i am licensed un provisions of Charter 9 (commencing with section 7000) o on the Business and Professions Code, and my license is in full force an License Class License N Date signature - - — WORKERS COMPENSATION DECLAR I I hereby affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section i0, Lab. C.) r•olicy No. �� y F Company eCertified copy is hereby furnished, Certifiedopy is filed with the city Building Division. Date �y Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (5100) or less). I certify that in the performance of the work for which this permit Is Issued, t Shall not employ any person In any manner so asp become subject to the Workers' Cq��{nT�gQnsation Laws of Califq�y Date N✓U^ nation Signature NOTICE: if, after making this declaration, you should becoine subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county whlcn requires a permit to construct, alter. Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 •refrom and the basis for the alleged exemption. Any violation of Section 51.5 by any applicant for a permit subjects the applicant to a civil .alty of not more than five hundred dollars (5500). LI 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employeeS, Provided that such Improvements are not intended or offered for sale. It, however, the building or improvement Is sold within one year of com- platlon, the owner will have the burden of proving ne/she did not build or im- prgya4cr the purpose of sate). I, as owner of the property, am exclusively contracting with licensetl con- tractarsto construct the project {Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such oroiects with a can. license pursuant to the Contractor's License Law), I am aware that prAJ" off their Worker's Compensation lnsura ce should be provided t e. I am exem t under Sectlon B. & , for on Date ?17Owner I hereby certify that I have read this application and state that the above Information is correc_ t. I agree to Comply with all city and county ordinances and state laws r to building anstructl hereby authorize repre- sentatives of t Is L0,110 ante n th mentioned prope y for Inspection our I Signature Date fir L.arc• C lfPn CA nr SS �i DE OF CONSTRUCTION NEW ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TERATION LJ REPAIR TYPE OF PERMIT L_J GRADING t -LJ FOUNDATION LJ STRUCTURAL 11 TENANT El ELECTRICAL 5 P ' LUMBING ❑ MECHANICAL ❑ ,OTHER PROJECT DESCRIPTION SCI. FT. OCCUPANCY n �- CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRE$ Remarks: l k "_- 11 1 Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee Boiler $15 Duct - Under Ground Duct - Structural Duct - ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO 4: Heating System & Ducti ❑0-100,000 BTU ❑100,000BT Reinspection Fee 1 $15 0865-46, rev. 5/88 White . Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING I11T Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type 1 ❑ Canopy Type ll ❑ Refrigeration System E10-100,000BTU ❑ 100,000 BTU .System Repair/Alteration Fire Dampers Registers Issue Fee S Main Buiidi E T Front A Rear C Right K Left Ping. Ref. # Planning Notes: Accessory Building: Parking Req./Provided Zone Z N N G R E O M T S. I I ELECTRICAL I FEES 1 FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fen F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW ❑5-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter Uup to 100 amps Meter ❑over 100 amps Sub Panel Motors 110-1 HP 131% - 8 1nc.Solar 09-15 HP 016-15+ Pole Light Range Sign Standing Sections Trash Compactor $ 3 01 00024007-00024007 TOTI 5,00 DATE:01/10/89 71111E: 13:35 Reinspection Fee $15 Issue Fee $ 3 SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Date Date $ 3DEVELOPMENT FEES Application Issued By Dat ! SUMMARY OFrFEF:PF BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT f PLUMBING PLAN CHECK 25% $ 1 '57, 0C) S ISSUANCE S ENERGY P.C. $ ' ELECTRICAL $ GRADING S r v PLAN CHECK 50% I MECHANICAL $ $ MICROFILM TOTAL FEE $ $ PLAN CHECK 25% $ $ 3 01 00024007-00024007 TOTI 5,00 DATE:01/10/89 71111E: 13:35 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL 'A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil PiOe-Undrgrnd. 53. Steel Reinforcement 3'1 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. 8E Foundation 59. Gas Pipe, ❑ Undrgrnd., Test + 9�yWater Pipe-Undrgrnd, 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10.)Structural Floor System 61. APPROVAL TO DECK 114 Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12.-$ewer Cap 63. Heater & Vent-Final [ 13,. Roof Drains 64. `Plumbing System - Final 1,4' dough Plumbil,9 65. Electrical-Final 15. �ougli Electrical-Conduit fib. 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 APPROVALS Permit # 20.1 Rough Factory Fireplace' 21.: Ducts, in-Structure 70. Underground Hydro 22. Ducts, Ventilating �' L' 71. Product Piping ❑Gas ❑Oil 23. Gas Pipe-Rough & Test f 72. Underground Flush 24. Roof, Framing `� 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof. Sheathing. _ '' r 74. Overhead Hydro 26. T-Bar Ching (Structural) Si Monocoat 75. Dry Chemical - 27. Frame and Flashing 76. Dry Standpipe 28.E Lathing,&Siding _ 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30q'Drywall Nailing HEALTH DEPT. REQUIREMENT 31,fPlaster Brown Coat 79. FINAL INSPECTION Lv 3:� Electrical Power Meter-Final 80.o FOOD CERTIFICATE ISSUED 33; Final Electric Notes: y 34. Final Heating & Air Conditioning A elf 35. Final Gas Pipe-Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39, Water Service-Final 40. Gas Service-Final y 41. Solar Domestic-Final �. 42. Backflow Preventer r, - 43. Backflow Irrigation r 44. •Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations r' 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date , " Applicant to fill in all spaces except those within heavy border lines and Sign all appropriate declarations._ PER NO TRACT NO LOT NO. Limit N6 CITY O_P CQSTA MESA C STRU ION PERMIT IT Project Address Applicant's Mailing dress / c Owner'S'Narge 1�f%he F Address Arch/Eng. License No. Address r Contractor's Nam Phone Address (mailing) City License No. 2 LICENSED CONTRACTOR DECL� N i I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in 11 force and effect. Llcens Class — License No. 3ai�O Date - Signature WORKERS' COMPENSATION LARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate ,)f Workers' Compensation Insurance, or a certified copy thereof (Section 800, Lab. C.) dolicy No. Company 8 Certified copy Is hereby furnished, ! Certified copy is filed with the city Building Division. Date Applicant j EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' (This section need not be completed If the permit'is'for one hundred ($100) or less), I I certify:that:in the performance of the work for which this permit is issued, I shall not employ any person in any manner s9fas to become subject to the Workere.Corpp�sa,Si' Laaws of Cali r a•, Date [[O0 vv�� •jj//�� Signature el 'NOTICE: If, after making this decl son, you should become subject to the Workers' Compensation provisionsL4f the Labor Code, you must forthwith comply with such provisions or. this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY _ ' , I hereby affirm that there is a construction lending agency for the performance of the work far which this permit is issued -(Section 3097 Civ. C.) Lender's Name Lender's Address - OWNER BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for,the following reason (Section 7031.5 Business and. Professional Code:'Any city or county which requires a permit to construct, alter, Improve, demolish or repair . any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that *he/she is licensed;pursuant to the provisions of .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 "f31.5 'by any applicant for a permit subjects the applicant to a civil malty of not more than five hundred dollars ($500). J I, as owner of the property or my employees with wages as their sole -compensation, will do the work, and the structure is not intended or offered for sale' (Section 7044, Business and Professional Code: The Contractor's • 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 employees, provided that such improvements are not intended or offered for Sale. If, however, the building or improvement is sold'within one year of com- pletion, the owner will have'the burden of proving he/she did not build or im- rave for the purpose of sale). ' I, as owner of the property, am exclusively contracting with licensed con- , 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 builds or improves thereon, and who contracts for'such projects with a con- tractors) license pursuant'to the,Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me.' ❑ I -am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city andcountyordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this ci to enter upon the above-mentioned property for inspection se Signature Date Drivers' nse or SS � F , PLUMBING FEES Bar Sink Backflow Preventer Backflow Irrigation 1 Bathtubs C Clarifiers Dishwasher Drinking Fountains Floor Drains' Floor Sinks Gas Service 'Outlets ` Interceptors Kitchen Sink Lavatories - P --Trap Roof Drains I Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater .Water Service Auto -Wash Laundry Trays Reinspection Fee ' $15 Issue Fee i $ 3 MECHANICAL- FEES Transformer' ❑ 15-50 KW- ' 50 + KW I i Boiler I Meter Opp to 100,amps I TYPE OF CONSTRUCTION• NEw ADD ALTERATION REPAIR IS ❑ ❑ ❑ Duct - Under Ground CONVERSION DEMOLISH OTHER A p # DESCRIPTION OF WORK/USE OF BLDG. Refrigeration System 1 ' ❑0-100,000 BTU ❑ 100,000 BTU Fixtures - Microwave - Duct - Ventilating Main Buildi FOUNDATION STRUCTURAL TYPE OF PERMIT GRADING El FOUNDATION T Front ❑ TENANT Ll ❑PLUMBING ❑ MECHANICAL. B 1 Standing'Sections ❑ OTHER A Rear Dat C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY Registers CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks: Planning Notes: � F , PLUMBING FEES Bar Sink Backflow Preventer Backflow Irrigation 1 Bathtubs C Clarifiers Dishwasher Drinking Fountains Floor Drains' Floor Sinks Gas Service 'Outlets ` Interceptors Kitchen Sink Lavatories - P --Trap Roof Drains I Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater .Water Service Auto -Wash Laundry Trays Reinspection Fee ' $15 Issue Fee i $ 3 MECHANICAL- FEES Transformer' ❑ 15-50 KW- ' 50 + KW I i Boiler I Meter Opp to 100,amps I Hood or. Type I ❑ Canopy Type I I. ❑ Meter Dover :1.00 amps,.. , Dryers ❑Gas' ❑Electric Duct - Under Ground Fan Duct - Structural F.A.U. Refrigeration System 1 ' ❑0-100,000 BTU ❑ 100,000 BTU Fixtures - Microwave - Duct - Ventilating Pole Light Outlets Exhaust System ❑ Multiple ❑• Switches System Repair/Alteration Garbage Disposal 1 Standing'Sections Firepl/Fact. Bit. ICBG # Trash Compactor Fire Dampers Dat Heating System & Ducting ❑0-100,000 BTU-❑1p0,000BTU SUMMARY OF FEES Registers BUILDING PERMIT - -..-. SMIP IReinspection Fee I $15 AF 01365-46, rev. 10/84 White - Building; Canarypplicant; Pink - Accounting; Goldenrod - Assessor Issue Fee I $ 3 .,F_ - 7 . ! 587E 7/02/85 - Zone Accessory Building:. Parking Req./Provided ELECTRICAL Automatic Washer ' Construction Pole Sub.0 Transformer' ❑ 15-50 KW- ' 50 + KW I i Cooking Unit I Meter Opp to 100,amps I Dishwasher_ Meter Dover :1.00 amps,.. , Dryers ❑Gas' ❑Electric Sub Panel Fan Motors 00-1 HP ❑ 1'h - 8 F.A.U. Inc.Solar 119-15 HP El 16-15+ Fixtures - Microwave - Device Boxes Pole Light Outlets Range I Switches Sign Garbage Disposal 1 Standing'Sections Generator ❑0-5 KW ❑5-15 KW Trash Compactor 10950 TL~ FEES I , O N 1. G R E Q M T S Reinspection Fee $15 Issue Fee' $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ ' PLAN CHECK 25% $ �� _ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE $ n•s—o PLAN CHECK 25% $ CONSTRUCTION',AND PLANNING �PPROV'L-' Permit # Date Inspector POOL .'A APPROVALS Permit # Date Inspertor 1 Temporary Electrical Service or Pole x' 52. Pool &Equipment Location i -.2. Soil Pipe-Undrgrnd. l' �j 53. Steel Reinforcement 3:'I Gondui*lJtility-U, 54. Forms 4 IeciricaPConduit:Undrgrnd. , 55. Electrical'Bonding , 5. Steel Reinforcement _ i x 56. Rough Plumbing & Pressure Test E 6. Electr cal UFERrGrnd. 7 57. APPROVAL TO COVER-GUNITE ` ., 7. -Footings, 58. Electrical Conduit Undrgrnd. f 8. Foundation �� `t 59. Gas Pipe, ❑ Undrgrnd., Test �F 9.,Water Pipe-Undrgrnd! 60. Backwash Lines, P -Trap, ❑ Undrgrnd• 10.`Structu�al Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final rc ,12. Sewer Cap ! I d r 63. Heater & Vent -Final .� 13. Roof Drains S 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 Sign68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace •21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:' 34. Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace ! 38. Final Plumbing " X39. 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 f 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. 'CERTIFICATE O,F OCCUPANCY , No. - Date Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. / ^1 /V) PERMIT NO. r TRACT NO. LOT NO. UNIT N6. ' CITY OF COSTA MESA C NSTR�N IOERMIT Pjoject A1idress Applicant's MlifirIg AddressAlllfs,�17 - J4 J - J,--, V Owner's Na e{ Phone ig�ic Address Arch/Eng. _ License No. Address - Contractor's NamPhone Address (mailing) City ,License No, LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in for nd effect. Ucens Class Ll cense No. �� Date Slgnature WORKERS' COMPENSATION D RATION I hereby'affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof ,(Section 3800, Lab. C.) +olicy No. Company Certified copy is hereby furnished. Certified copy Is filed with the city Building Division. ' Date Applicant EXEMPTION PROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit Is for one hundred (5100) or less). I certify that ih the performance of the work for which this permit is Issued I shall not employ any person in any Tawqr so s to become subject to tNe Workep� Comp 5a jo Laws of Califor Date Si,�—Signature 'NOTICE: If, after making this declarati you should become subject to the Workers' Compensation provisions of me Labor Code,.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a Construction lending agency for the performance of the ,work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby, affirm that I am exempt from the Contractor's License taw for the following reason (Section 7031.5, Business and Professional Code: Any city or county which requires a permit to construct, altar, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signets statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that tishe is exempt therefrom anq the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil jenalty of not more than five hundred dollars ($500). 1 1, as owner of the property or my employees with wages as their sole •ompensation, will do the work, and the structure Is not Intended or offered for sale, (Section 7044, Business and Professional Code: The Contractor's License Law goes not apply to an owner of a property who builds or improves , thereon, and who,does such work hlmself/herself or through his or her own employees, provided that such. -improvements are not intendod or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as.owner of the property, am exclusively contracting with licensed con- tractors to cohstruct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuarh.to_ i:he,Contraitor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section B. d. P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above Information Is correct. 1 agree to comply with ail city and county ordinances and slate laws relating to building construction, and hereby authorize repre- sentatives of thi city tp enter upon the above-mentioned property for Inspection p as. /1 _ Slgnature _ i%JYJJYii"tt tt Dat Ita — Drivers' Lice or SS 0 �(`1 (o-7 PLUMBING Bar Sink Showers d Service Sink TYPE OF CONSTRUCTION 0 NEW L1 ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER C DESCRIPTION OF WORKIUSE OF BLDG. LJ ALTERATION U REPAIR A.P.y S Main Building: TYPE OF PERMIT In GRADING FOUNDATION ❑ TENANT [:]ELECTRICAL- ❑ PLUMBING ❑ -OTHER STRUCTURAL ❑ MECHANICAL _ E T B A Front Rear PROJECT DESCRIPTION SQ. FT. OCCUPANCY CON STRUCTION TYPE VALUATION S ZONE GRADING CU.YDS. ACRES C S Right Left Ping. Ref. # Remarks: Planning Notes; Reinspection Fee . .I $15 Boiler Duct - Under Ground Duct - Structural Duct _Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. 1CBO # Heating System & Ducting 00.100,000 BTU ❑ 100,000 BTL Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - u ng; a nk - Accounting; Goldenroq - Assessor Issue Fee MECHANICAL Hood or Type I ❑ Canopy Type 11 ❑ lll�ll�1 fo Refrigeration System ❑0.100,000 BTU. ❑100,000 BTU System Repair/Alteration Fire Dampers, Registers Issue Fee Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric 5872 7/02/85 Accessory Building: Parking Req./Provided ELECTRICAL Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW ❑5-15 KW IGe50 TL Zone Z O N 1 N G R E' D M T S' FEES Transformer ❑ 15-50 KW ❑ 50+ KW Meter Uup to 100 amps Meter (Dover 100 amps' Sub Panel Motors 00-1 HP ❑ l % - S Inc. Solar 09.15 HP Ell 6-15+ Microwave Pole Light Range ! Stand ing'Sect ions Trash Compactor PLUMBING Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs , Clarifiers Sewer Connection Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains, Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Swimming Pool vv/Spa. Urinal Water Closet. Water Heater { Water Service Lavatories Auto -Wash P=Trap Laundry Trays.- rays.Roof RoofDrains; Reinspection Fee . .I $15 Boiler Duct - Under Ground Duct - Structural Duct _Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. 1CBO # Heating System & Ducting 00.100,000 BTU ❑ 100,000 BTL Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - u ng; a nk - Accounting; Goldenroq - Assessor Issue Fee MECHANICAL Hood or Type I ❑ Canopy Type 11 ❑ lll�ll�1 fo Refrigeration System ❑0.100,000 BTU. ❑100,000 BTU System Repair/Alteration Fire Dampers, Registers Issue Fee Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric 5872 7/02/85 Accessory Building: Parking Req./Provided ELECTRICAL Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW ❑5-15 KW IGe50 TL Zone Z O N 1 N G R E' D M T S' FEES Transformer ❑ 15-50 KW ❑ 50+ KW Meter Uup to 100 amps Meter (Dover 100 amps' Sub Panel Motors 00-1 HP ❑ l % - S Inc. Solar 09.15 HP Ell 6-15+ Microwave Pole Light Range ! Stand ing'Sect ions Trash Compactor Reinspection Fee $15 1 -Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued BY REQUIREMENTS: nate Date Dat BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ 3 $ _ _ $ $ $ $ $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $�' $ 3 CONSTRUCTION AND PLANNINGPOOL APPROVALS Permit #�. .Date Inspector APPROVALS Permit:# Date inspector Tv Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil ,Pipe Undrgrnd. 53. Steel Reinforcement `. 3. Electrical Cornduii Utility-Undrgrnd. 54. Forms , 4. Electrical Conduit=Undrgrnd. 55. Electrical Bonding 5'-Steel Reinforcement 56. Rough Plumbing & Pressure Test 11 -6• Electrical UFER Grnd. *'1 57. APPROVAL TO COVE R-GUNITE 7. Footings' t 58. Electrical Conduit•Undrgrnd. In •-$.�Founda-tio 1'59. Gas Pipe, ❑ Undrgrnd., Test 9.;Water`, Pipe Undrgrnd. 60, Backwash Lines, P-Trap, ❑ Undrgrnd. 10" Structural Floor System 61, APPROVAL TO DECK 11. Property-Sewer Line & House Connection ' 62. Backwash & Receptor-Final 12. Sewer Cap ,'1" 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final i 14. Rough Plumbi4 65. ElectricakFinal 15. Rough Electrical-Conduit '66. Solar System-Final G. 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31! Plaster Brown Coat 79. FINAL INSPECTION 32.' Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace ,38. Final Plumbing l 39. Water Service-Finai 11-Q.�f�� ' 40. Gas Service-Final r ,41. Solar Domestic-Final X42. 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' ' } E 1 Applicant to fill In all spaces except those within heavy border lines and C1TV OP COSTA MESA • CONSTRUCTION PERMIT PERMIT NO TRACT NO LOT N4 3'ro)ect Address 71) W, lY� S'I . C � M a c pr Apblicant's Mailing Address Owher's Name TRn�( 1 NVki4 m; F!V'1' Phone Adclress — Arch/Eng. License No. Address ��{� Contractor's Name aRIeLS ELECT IC—�_Phone Adclress (mailing► I � S 4RPYAAYT si. LQDmrM1)G 7AnD C1a.31(a City License No. .o LICENSED CONTRACTOR DECLARATION I hereby affirm that i am'licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Pr fess ns Code, and MY license is in full force and effect. Ucen Class — D (cense O. Date Y O Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate Of Workers' Compensation insurance, or a certified copy thereof (Section 3640, Lab. C.) Policy No. 0 Com an Ec B Certifled copy is hereby furnlshed. Certifled copy Isjlied with the cit wild' ) Division ,/ ,-_ Date10� Applicant EXEMPTION FROM WORKERS' COMPENSATIO DECLARATION (This section need not be completed If the permit Is for one hundred ($100) or less). I cOrtify that In the performance of the work for which this permit is issued I shallnot employ any person in any manner so as to become subject to tie Workers' Compensation Laws of California. Date. Signature 'NOTICE: If, atter making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY- - I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 30(37 Civ. C.) Lender's Name Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that l am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 natty of not more than five hundred dollars ($500). LJ I, as owner of the Property or my employees with wages as their sole •compensation, will do the work, and the structure I$ not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner Of a property who builds or improves theroon, and who does such work himse(f/herseff Or through his or her own err,ployees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of Com- pletion, the owner will have the burden of proving he/She did not build or im- prove for the purpose of Sala). Q I, as owner of the property, am exclusively contracting with licensed con. tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner Of property who bUildS or improves thereon, and _who contracts for $uCh projects with a con- tractors) i)cense pursuant to the Contractor's License Law). 1 am aware that Proof of their Worker's Compensation insurance should be provided to me. I� I am exempt under Sectiun B. & P. C. for this reason Date Owner I hereby certlfy that I have read this application information Is correct. I agree to comply with a and state la at o buildin/con ructi i Sentatives ! this ity to enter the owinspection ur o Signature Dri.art' License or 55 id state that the above and county ordinances hereby authorize repre- entioned property for Date _ n all appropriate declarations. UNIT NO , PLUMBING Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Hoof Drains Reinspection Fee 1 $15 M Boiler (Duct - Under Ground Duct - Structural Duct - Ventilating Exheust'System ❑ Multiple ❑ Firepl/Fact. Bit, ICBO # Heating System & Ducting 110.100,000 BTU 0100,000BTLI- Reinspection Fee 1 $is CMF 0865-46, rev, 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet r Water Service Auto -Wash Laundry Trays _ Issue Fee •1ANICAL Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000 BTU ❑ 100,000 BT System Repair/Alteration Fire Dampers Registers Issue Feb FEES 5879 1/16/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher r' Dryers QGas ❑Electric T Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KIN 05.15 KW Transformer Li 15-50 KW ❑ 50 + KW Meter ❑up to 100amps Meter ❑over 100amps Sub Panel Motors 0-1 HP ❑ 1 i4 - 8 Inc. Solar 09-15 HP ❑ 16-15+ Microwave Pole Light ,Range I Sign Standing Sections Trash Compactor S 3 Reinspection Fee $15 1 issue Fee FEES DEVELOPMENT SER VICES REQUIREMENTS: Zoning Approved By __ 1 Building Approved By = ) Application Issued By _ �t TYPE OF CONSTRUCTION NEW ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. D ALTERATION REPAIR A P + S Main Buildi TYPE OF PERMIT El GRADING 0 FOUNDATION 0 STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ -OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CON STAUCTION TYPE VALUATION 5 ZONE GRADING CU. YOS. ACRES E T B A C g Front Rear Right Left Ping. Ref. # Remarks: $ 3 Planning Notes: , PLUMBING Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Hoof Drains Reinspection Fee 1 $15 M Boiler (Duct - Under Ground Duct - Structural Duct - Ventilating Exheust'System ❑ Multiple ❑ Firepl/Fact. Bit, ICBO # Heating System & Ducting 110.100,000 BTU 0100,000BTLI- Reinspection Fee 1 $is CMF 0865-46, rev, 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet r Water Service Auto -Wash Laundry Trays _ Issue Fee •1ANICAL Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000 BTU ❑ 100,000 BT System Repair/Alteration Fire Dampers Registers Issue Feb FEES 5879 1/16/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher r' Dryers QGas ❑Electric T Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KIN 05.15 KW Transformer Li 15-50 KW ❑ 50 + KW Meter ❑up to 100amps Meter ❑over 100amps Sub Panel Motors 0-1 HP ❑ 1 i4 - 8 Inc. Solar 09-15 HP ❑ 16-15+ Microwave Pole Light ,Range I Sign Standing Sections Trash Compactor S 3 Reinspection Fee $15 1 issue Fee FEES DEVELOPMENT SER VICES REQUIREMENTS: Zoning Approved By __ 1 Building Approved By = ) Application Issued By _ �t SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% S ENERGY P.C. ELECTRICAL $�`� GRADING PLAN CHECK 50% $ SC? MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ $ 3 S Z O N 1 N G R E 4 M T ` S r FEES $ 3 + .t 'CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspectnr 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5, Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, LJ Undrgrnd., Test 9. Water Pipe Undrgrnd- 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Corinection 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 -/Z Notes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. .Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 4B. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Cb ' 51. CERTIFICATE OF OCCUPANCY No. Date r Ct Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. CITY OF COSTA MESA CO_NSTR UCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO, Project Address • t_ 711'W. 17th. St. -Bldg. (E) 1Q Applicant's Mailing A4111Q Saticoy St. N.Hollywo� Owner's Name Troy Investment Fund Phone. 549=2988 Address 4121 Birch St. Newport Beach, _Ca. • - Arch/Eng, License No. Address 12991 Knat.t_ Ave. Suite 216 Contractor's Name ni,Cn Ai r Condi d 0 Phone 982-1216 Address(mailing) 131-10 gatirny St. N.Hollywood,Ca. City License No. 13925 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of C ter 9 (commencing With Section 7000) of Division 3 of the Business and r fessions Code, antl my license is in full force and effect License Class C 20 Lic s 346251 Date _m41 Signature WORKS/� 7SR $OMPEN5ATION DEC RATION I hereby affirm that I have a certitiC of consent to self -insure or a certificate of Workers' Compensation Insure e, or a certified copy thereof (Section 3800, Labm ca k4824 Company 'ollcy No. -� Company Certified copy Is hereby furnished. Certi fiopy Is filed with the city Buildi Division. /�. Date— �1 ( Applicant �L� f i �� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that In the performance of the work for which this permit is Issued, I shall not employ any per;on in any manner so as to become subject to the Workers' Compensation Laws of California. Date _ -Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply With such provisions or this permit m shall be deemed revoked. CONSTRUCTION LENDING AGENCY{ I hereby affirm that there Is a construction lending agency for the performance' of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name ' - Lender's Address. - OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed Statement that he/she is licensed pursuant to the provisions of 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 tor,the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). - - 1, as owner of the Property or my_employees with wages as their sole ,ompensatfon, will do the work, and the structure Is not intended or offered for sale, (Section 7044, Business and Professional Code: The Contractor's License taw 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 employees, provlded that such Improvements are not Intended or offered for sale, If, however, the building or improvement is sold within one year of com- pletion, the owner will 'have the burden of proving he/she did not build or im- prove for the purpose of sale)- " ❑ 1, as owner of the Property, am exclusively contracting with licensed con- 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 builds or Improves therebn„and who contracts for.such projects with a con-. tractor(s) license pursuant'to the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 ain exempt under Section B. & P. C. for this reason Date Owner I hereby certify' that I have rea, information Is correct.'I agree to and'state la relating to bull sentative his city to e Inspecti pur .ser. Signature Drivers' Lic sc or,55 I this y with all and state that the above 1 � comply with all city and county ordinances ICCs 9 construction, and hereby authorize repre- upon the above-mentioned property fob i_�n_ Q r Bar Sink Backfiow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories - P -Trap Roof Drains Reinspection Fee Boiler $15 Duct; Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Ffrepf/Fact. BI I. ICBG # Heating System & Ducting S [3,p-100,000,BTU ❑100,00013TI Reinspection Fee 1 S15 AF 0865-46, rev. 10/84 Whlte - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor i M PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal. - . I Water Closet Water Heater. water Service Auto -Wash -Laundry Trays Issue Fee Hood or Type I ❑ Canopy Type 11. ❑ Refrigeration System ❑0.100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES 2265 5/03/B5 Zone Accessary Building; Parking Req./Provided , ELECTRICAL Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW H❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter Dover 100 amps Dryers DGas ❑Electric TYPE OF CONSTRUCTION U NEW U ADD LUJ ALTERATION LJ REPAIR Motors ❑0-1 HP ❑ 1'f, - $ F.A.U. ❑ CONVERSION -❑ DEMOLISH ❑ OTHER- Fixtures - A.P. # DESCRIPTION OF WORKIUSE OF BLDG. ' Pole Light Range S Main Building: ; Standing Sections Generator ❑0.5 KW 115-15 KW E TYPE OF PERMIT El GRADING El FOUNDATION LJ STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL B ❑ ,OTHER A Rear Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K K CONSTRUCTION TYPE VALUATION $ Left ZONE GRADING CU. YDS. ACRES-- - Ping. Ref.# Remarks: Planning Notes: I this y with all and state that the above 1 � comply with all city and county ordinances ICCs 9 construction, and hereby authorize repre- upon the above-mentioned property fob i_�n_ Q r Bar Sink Backfiow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories - P -Trap Roof Drains Reinspection Fee Boiler $15 Duct; Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Ffrepf/Fact. BI I. ICBG # Heating System & Ducting S [3,p-100,000,BTU ❑100,00013TI Reinspection Fee 1 S15 AF 0865-46, rev. 10/84 Whlte - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor i M PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal. - . I Water Closet Water Heater. water Service Auto -Wash -Laundry Trays Issue Fee Hood or Type I ❑ Canopy Type 11. ❑ Refrigeration System ❑0.100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES 2265 5/03/B5 Zone Accessary Building; Parking Req./Provided , ELECTRICAL Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW H❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter Dover 100 amps Dryers DGas ❑Electric Sub Panel Fan Motors ❑0-1 HP ❑ 1'f, - $ F.A.U. Inc. Solar•09-15 HP 1:116-15+ Fixtures - - Microwave Device Boxes Outlets Pole Light Range Switches Sign Garbage Disposal ; Standing Sections Generator ❑0.5 KW 115-15 KW Trash Compactor 6 FEES Z O N I N G R E Q M T S $ 3 ' Reinspection Fee $15 Issue Fee' $ 3' FEES DEVELOPMENT SERVICES Zoning Approvad By Building Approved By Application Issued BY REQUIREMENTS: Date Date Dat Z' BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% S ELECTRICAL S PLAN CHECK 50% $ MECHANICAL S PLAN CHECK 25% $ SUMMARY OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROPIt_M $ 13.00 TOTAL PEE $ 2.5 ' 15.50 6 QQ $ 3 CONSTRUCTION AND PLANNING APPROVALS : Permit # Date Inspector POOL & , APPROVALS Permit # Date Inspector { 1 . Temporary Electrical Service or Pole- 52. Pool & Equipment Location 2• •Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd• 54. Forms 4, Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test " 6, Electrical LIFER Grnd.,.' 57. APPROVAL TO COVER-GUNITE - 7• Footings 58. Electrical Conduit•Undrgrnd. '8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. -10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED -FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd, Storage Tank -0 Gas ❑ 0il 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27.. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78, FIRE PREY. FINAL 30.. Drywall Nailing HEALTH DEPT-. REQUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION 32: Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 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 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 Nn. Date Applic3nt't&_"in all spaces except those within heavy border lines and sign all appropriate declarations. CITY 0F•CUSTA MESA CONSTRUCTIONTERMI PERM iT O. TRACT NO. LOT NO. UN1 0. P05; ct Address LeaL,J/�1 Applicant's Mailing Address ' STYPE OF CONSTRUCTION NEw ADD ALTERATIOtJ REPAIR R ��J • L1 CONVERSION ❑DEMOLISH OTHER A.P. Owner's Name Phone ii DESCRIArm 420 �MAL PTION F, W RK/USE OF BLDG. � ^! Address S Main Building: E ArchlEng. License Na .,TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front Address TEN NT 1:1 ELECTRICAL El PLUMBING 1:1 MECHANICAL A Rear -TD OTE4 Contractor's Nam Phone PROJECT DESCRIPTION SQ.,T. 2 -SO OCCUPANCY--- &-! C Right 1= Address (mailing) - ap K f CONST RUCTION TYPE �' VALUATION $ �. S Left City License No. ZONE (� �— ;; GRADING CU.YDS..� ACRES ping. Ref. # LICENSED CONTRACTOR DECL RATION 1 hereby affirm that I am licensed under provisions of 6harterr9 (commencing' Remarks: C �E' 140. C Planning Notes: with section 7000) of Division 3 of the Business and -Professions Code, and Ar my license is in full force and effect.I P.C �. a L' c 3 NER BUILDER License Class License No. $ $ $ $ $ $ $ Automatic Washer- Date Signature ' • WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure or a certificate Bar Sink! ' - Backflow Preventer w of Workers' Compensation Insurance, or a.certified copy Ahereof,(Section 3800, Lab. C.) Backflow Irrigation Fan Policy No. Company - e Certified copy Is hereby furnished. r . a. Certified copy is filed with the city Building Division_.' Date, Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION .Y (This section need not be•completed if the permit is for one hundred ($100) or less).Dishwasher I certify that in the performance of the work for which'this permit is issued, 1 _ shali,not employ any person in any manner so as to become subject to the. 1 Bathtubs Clarifiers Device Boxes ' - - ".,,N Drinking Fountains Outlets Workers' Compensation Laws of California. Floor Drains Date Signature NOTICE: If. after making this declaration, you should become subject to`.the ' Floor Sinks - Generator 1:10-5 KW 05-15 K Workers' Compensation provisions of the Labor'Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY �f Gas Service Outlets 1 hereby affirm that there is a construction lending agency for the performance of the work i for , which this permit is issued (Section 3097, Civ. C.) Lender's Name _ Interceptors. _ Kitchen.Sink _Lender's.Address t ? DECLARATION OW I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories - following. reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair P=Trap I any structure, prior to its issuance, also requires the applicant for such permit _ to fife a signed statement that he/she is licensed pursuant to the provisions of , .I. 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 applicanE to' a civil penglt�of not more than five huntlretl dollars ($540). - • I, as owner of the property Reinspection Fee twill do the work, and the structure is not intendetl or offered for sale (Section 7044, Business and Professional Cade: The Contractor's - License Law does not apply to an owner of a property who builds or improves h' If he self or th ou h his or her own Showers Service Sink Sewer Cap _ Sewer Connection Solar. Collectors Solar Piping Solar Tank Swimming Pool w/Spa ' Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays ; $15 Issue Fee MECHANICAL thereon, antl who does such work imse / r r g employees, prpvitletl that such improvements are not intended or offered for Boiler Hood or Type I ❑ saleIf, however, Lha building or improvement is soltl within one year of com- Canopy Type II ❑ t ! plet. ion, the owner will have the burden of proving he/she did not build or im- Duct - Under Ground - -prove for the purpose of sale). - 0 I, as owner of the property, am exclusively contracting with Licensed con- Duct - Structural Refrigeration System 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- tractor(s) license pursuant to the Contractor's License Law). I am aware that: Exhaust System El Multiple El System Repair/Alteration ff their Worker's Compensation insurance should, be provided to me. exempt under Section B. P. C. for this reason Firepl/Fact. Bit. ICBO =f# - Fire Dampers - 1 Date — Owner Heating System & Ducting Registers I hereby certify that I have read -this ap c ion and state that the above ❑0.100,000 BTU ❑100,000161T FEES' 0120 7/25/66 f Zone Accessory Building:- Parking uilding:Parking Req./Provided f 101.20 ;TL I z O N I N G R E Q M T S ELECTRICAL FEES Transformer '❑ 15-50 KW ❑ 50 + KW. Meter Duo to 100 amps Meter El over 100 amps Sub Pane! i Motors El 0-1 HP Ell '/ - 8 Inc.'Solar E39'15 4:0116-115+' Microwave. ± I ( d Pole Light Range e Sign Standing Sections W Trash Compactor $ 3 ` Reinspection Fee _ $15 Issue Fee I = $ 3 -FEES DEVELOPMENT SERVICES REQUIREMENTS: ! �� Zoning Approved By U`'J-- pate 'Building Approved By Date Application Issued By bataL'—+ information Is correct. I agree to comply all city and county ordinances and state laws relating to building construction, and hereby authorize repre- - • sentaUves of this city to enter upon t above-mentioned property for _ inspection purpose Signature Date 7-7-5'- rivers' License or SS � Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 Whit - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 1 CX P ' BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN,CHECK 50% MECHANICAL PLAN CHECK 25% $ $ $ $ $ $ $ Automatic Washer- $ $ $ $ $ ConstructiowPole Sub. Cooking Unit Dishwasher Dryers.❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes ' 2, Outlets 8 Switches— Garbage-Disposal ; I Generator 1:10-5 KW 05-15 K 101.20 ;TL I z O N I N G R E Q M T S ELECTRICAL FEES Transformer '❑ 15-50 KW ❑ 50 + KW. Meter Duo to 100 amps Meter El over 100 amps Sub Pane! i Motors El 0-1 HP Ell '/ - 8 Inc.'Solar E39'15 4:0116-115+' Microwave. ± I ( d Pole Light Range e Sign Standing Sections W Trash Compactor $ 3 ` Reinspection Fee _ $15 Issue Fee I = $ 3 -FEES DEVELOPMENT SERVICES REQUIREMENTS: ! �� Zoning Approved By U`'J-- pate 'Building Approved By Date Application Issued By bataL'—+ information Is correct. I agree to comply all city and county ordinances and state laws relating to building construction, and hereby authorize repre- - • sentaUves of this city to enter upon t above-mentioned property for _ inspection purpose Signature Date 7-7-5'- rivers' License or SS � Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 Whit - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 1 CX P ' BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN,CHECK 50% MECHANICAL PLAN CHECK 25% $ $ $ $ $ $ $ SUMMARY OF FEES -6$ `i'�•SMIP PERMIT OD ISSUANCE ENERGY P.C. GRADING g7 d MICROFILM TOTTA,L FEE • $ $ $ $ $ +� 'CONSTRUCTION AND PLANNING APPROVALS Permit # o, Date r Inspector POOL & SPA APPROVALS Permit # Date _ Inspector 1 t Temporary Electrical,Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. '' 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd, 54. Forms 4'. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7...F,00tings �' 58. Electrical Conduit-Undrgrnd. �,B..Foundation << •� 59. Gas Pipe, ❑ Undrgrnd., Test 9;.Wat>Pip'e'-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final k 12. Sewer Cap 63. Heater & Vent-Final, 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing q-2-q A "47 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 s 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro . 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush I 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil : 25. Roof Sheathing 74, Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocgat 75. Dry Chemical 27. Frame.and Flashing � jc -P& fw` 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall flailing �f �� HEALTH DEPT. REQUIREMENT f r' 31. Plaster Brown Coat 79. FINAL INSPECTION , '- 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED fy� 33. Final Electric Notes, q : 34. Final Heating & Air Conditioning 35. Final Gas-Pipe-Test' i 7 . e16in 36. Hood or Canopy f 37. Final Factory Fireplace �� v012 5 ~�T7 j - 38. Final Plumbing 39. Water Service-Final LTzu [ r 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 w' 48. Special'Requirements Completed 49.-Electric Release to Edison 50. Gas Release to Southern California Gas Co + 51. CERTIFICATE OF OCCUPANCY r No. ; Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA' CQNSTR IOI[L f�RMIT PERMIT NO. TRACT NO_ LOT NO. UNIT NO. Project Address �.. Applicant's Mail dress Ownbr's Name wo-one Address L ��% 7/�O/R�+ TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. q(k Zone S Main Building:. Accessory Buildirig:, Arch/Eng. - License No. Address TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL -❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SG. FT: OCCUPANCY CONST RUCTION TYPE VALUATION S - ZONE GRADING CU.YDS. ACRES - - _ T U Frbnt. 1 A Rear N Contractor's Na Ph, .)7 Address {mailings City_ Licehse No. • LICENSED CONTRACTOR EC4ARATION 1 hereby affirm that' I am licensed under provisions of Charter 9 (commencing With Section 7000), of Division 3 of the Business and Professions Code, and my license is in f force d ffect. �7 ry Licens Class — License No. hn �-d'J Date Signature K Right G S Left R Ping. Ref. # Parking Req./Provided E Remarks: Planning Notes: O M T S PLUMBING FEES WORKERS' COMPENSATION LARATION I hereby affirm that I have a cert ficate of consent to self -insure or a certificate s ELECTRICAL FEES Bar Sink Showers of Workers' Compensation Insurance, or a certified, copy thereof_ (Section _ 3800, Lab. C.) ; I 1 Polley No. Company BCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Backflow Preventer Service Sink 2 Automatic washer r Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW 1 Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit , Meter ❑up to 100 amps i Date Applicant - EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less)- I certify -that in the performance bf the work for which this permit is issued, I shall not employ any person In any manner so to become subject to the Work e Co ;pp�,_ Its ws of Call Dater r� Signature 'NOTICE: If, after making this decla n, you should become Subject to the Workers' Compensation provisions f •the labor Code, you must forthwith Comply with such provisions or this permit • shall be deemed revoked- CONSTRUCTION. LENDING AGENCY. I hereby affirm that there is a con$truction.lending agency for the performance of the work for which this permit is - issued (Section 3097, Civ. C.) Lender's Name Lender's. Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for�the following reason (Section -7031.5 Business and Professional Code: Any city or county which requires a permit tq construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the -provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the-BusineSS and professions Code) or that he/she is exempt therefrom and the basis for;the Alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). {, as owner of the property or my employees with wages as their Sole compensation, wilt do the work, and the structure is not intended or offered for sale (Section ,7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- - pletion, the owner will have the burden of proving he/she did not build or im- Clarifiers Solar Collectors _ Dishvvasher _ - _ Me_ter ❑aver .100 amps Dishwasher Solar Piping. Dryers ❑Gas ❑Electric Sub Pane! Drinking Fountains Solar Tank Fan Motors ❑0-1 HP ❑I%-�8 Floor Drains Swimming Pool w/Spa F•A•U Inc. Solar ©9.15 HP Ell 6-15+ ; Floor Sinks Urinal - Fixtures' "-' - Microwave Gas Service 'OutletsWater Closet Z CX� Device Boxes Pole Li ht ' g Interceptors Water.Heater _ Kitchen Sink Wates' Service 2 Outlets Range Switches Sign ; - Lavatories. . Auto -Wash Garbage Disposal Standing Sections ' , P -Trap Laundry Trays_ Trays - Generator ❑45 KW 115- 15 KW Trash Compactor ,Roof Drains• ReinSpection,Fee• $15 Issue Fee $ 3 . Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES - Boiler Hood or Type l ❑ Canopy Type I I C1Zoning Duct - Under Ground DEVELOPMENT SERVICES REQUIREMENTS: Approved By Date Building Approved By Date - Duct - Structural Refrigeration System 1:10-100,000 BTU ❑ 100,000 8TU for, the purpose of sale). 1, as owner of the property, am exclusively contracting -with licensed Con- F 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 builds or improves thereon, and who contracts for -such project$ with a con- license pursuan't'to the Contractor's License Law). I am aware thatE tractor(s)ce proof o n theWorker's Compensation insurance should be provided to: me. ❑ 1 am exempt under Section B. & P. C. for this reason Application Issued By Dat Duct Ventilating _ - SUMMARY BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ - PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ OF FEES SMIP $ PERMIT C C� ISSUANCE $ ' SO ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ 1 � • _ xhaust System ❑ Multiple ❑. System Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- Sentatives of this cit to enter upon the above-mentioned property for inspection p es. Signature Date Drivers' nse or SS Heating System & Ducting 0. 100,000 BTU 0100,000 BT Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor _ CONSTRUCTION AND PLANNING .� APPROVALS Permit :# Date Inspector �. POOL & SPA APPROVALS Permit :# Date Inspecror 1. Temporary Electrical Service or Pole 52. Pool &Equipment Location 2. ,Soii,Pipe-Undrgrnd. ._ 53. Steel Reinforcement ip z3�Eleciricai Conduit-Utility-Undrgrnd' 54, Forms 4:5Elect,iccal?Conduit U drgrnd, v 55. Electrical Bonding 5�Steel'Remforcement 56. Rough Plumbing &Pressure Test e •6. Electrical UFERIGrpd. -" i 57._. APPROVAL TO COVER-GUNITE r 7 JFoot�ings � , �. 58. Electrical Conduit-Undrgrnd. `. i E 8. Foundation 0, 59. Gas Pipe, ❑ Undrgrnd., Test 9. WateF Pipe-Undrgrnd, 60. Sackwash Lines, P -Trap, © Undrgrnd. 10. -Struczural Floor System 61. APPROVAL TO DECK 11, Proper{y Sewer Line & House Connection 62. Backwash &Receptor -Final t1 2. Sewer' Cap f , !� 4 � 63. Heater &Vent -Final �• �. 13. Roof Drains 64. Plumbing System - Final 14. Rbugh Plumbing,- 65, Electrical Final r 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. POOLISPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, irr Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil `. 23. Gas Pipe -Rough & Test - 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ 0il 25. Roof Sheathing 74, Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76, Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80.` FOOD CERTIFICATE ISSUED ` 33. Final Electric Notes - 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy )37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 1 49. Electric Release to Edison w t - 50. Gas Release to Southern California Gas Co 51, CERTIFICATE OF OCCUPANCY. No. Date 13 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY O.F COSTA MESA -CONSTR 7 TION PER Project Address Applicant's Mailing Address L Owrier;s NameV yJJ v'� �2) r Phone -5 6 4 Address r Sr` Ale" C r Arch'IEng. i' iAlrl L !�/ Gr/A ,cense No. L 7Z - Address S4' S�r.l f%= "'Z^, Contractor's Name, C) /1 Phone Address (mailing) Q��,A•��-- ✓♦ F^, City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect. License Class License NO. Date Signature WORKERS' COMPENSATION DECLARATION, 1 hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation insurance, or a certified copy thereof (Section 3800, Lab. C.], Policy No. ls-9 Company BCertified copy is hereby furnished. Certified "olied with the city Building Division. Date ' Applicant E%EMP-i ON ROM WORKERS' COMPENSATION DECLARATION (This seclion0'need not be completed If the permit is for one hundred ($100) or less). I certify that in the performance of the work for, which this permit is issued 1 shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you Should become subject to the Workers' Compensation provisions of the Labor Coda, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for this ermlt Is issued (Section .3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, altkr, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file asigned statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption, Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner ,of 'the property or my employees with wages as their Sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply t0 an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/Sha did not build Or Im- prove for the purpose Of sale). ❑ I, as owner of the property, am exclusively Contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law tloes not apply. to an owner of property who builds or improves thereon, and who contracts for such projects with a COn. tractor(s) license pursuant'to the Contractor's Qcense Law). I am aware that proof Of their Worker's Compensation Insurante Should be provided to me. ❑.I,am exempt under Section g. L P. C. for this reason ' Date Owner _ ...._ .. I hereby certify that I have read this application and state that the above information is correct. I agree to comply wish all city and county ordinances and state laws relating to ilding construction, and hereby authorize repre- sentatives of this city enteru i above-mentioned grope y f r inspection purposes. Signature Oate Drivers' License ori s 4 PERM N� /CT NO. L LOT NO. UNIT/ O, G-% B557 C/3fl/B6 p•uu TYPE OF CONSTRI IN W ADD ALTERATION LLJJ REPAIR - ❑ CONVERSION ElOEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A. # Zone S - Main Building: Accessory Building. TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT El ELECTRICAL ® PLUMBING El MECHANICAL ❑ ,OTHER PROJECT DESCRIPTION SQ. FT, OCCUPANCY CON STRUCTION TYPE VALUATIONS ZONE GRADING CU.YDS. ACRES E T Front Z O A Rear N C Right N g G Left � � � R Ping, Ref.# Parking Req./Provided E Remarks: G OZI& Planning Notes: M T S PLUM ING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pole:Sub. Transformer ❑ 15.50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit - Meter ❑up to 100 amps Clarifiers –. Solar Collectors Dishwasher Meter ❑over,100amps Dishwasher t Solar Piping Dryers ❑Gas • CElectric Sub Panel Drinking Fountains Solar Tank Fan -'�. Motors❑41 HP❑18 Floor Drains Swimming Pool vv/Spa F.A.U. Inc. Solar 09-15 HP ❑16-15+ Floor Sinks Gas Service Outlets Interceptors Urinal Water ClosetDevice � Q Water Heater Fixtures Boxes Outlets Microwave Pole Light 1 Range Kitchen Sink '" Water Service, Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator ❑0.5 KW ❑5.15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $.3 Reinspection Fee $15 Issue Fee S 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date_ Application Issued By.—. Date � Boiler Hood or, Type 1 ❑ Canopy ' Type II• ❑ Duct -Under Ground Duct - Structural Refrigeration System 00-100,000 BTU ❑ 100,000 BTU Duct - Ventilating BUILDING.PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT ' $ ISSUANCE $ $ ENERGY P.C. $ $ GRADING I $ $ MICROFILM $ S TOTAL FEE $ $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firep1lFact, Bit, ICBG # Fire Dampers Heating System & Ducting ❑0-100,000BTU ❑100,000BT Registers • Reinspection Fee $15 Issue Fee $ 3 GMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # 7DateIns pector POOL & SPA •APPROVALS Permit # Date Inspector 1, Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil•Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement.' 56. Rough Plumbing & Pressure Test 6, Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 5B. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd, 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63, Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval ,17: Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOLISPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas []Oil 23. Gas Pipe -Rough & Test 72, Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank []Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75, Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power Meter -Final 80. -FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 7 y� 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation r - A4. Landscape Irrigation System ,45. Sound Attenuation ig6. Handicap Regulations W7. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison C50. Gas Release to Southern California Gas Co C51. CERTIFICATE OF OCCUPANCY N0. Date __ l0 Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO Project Address 71.1_x_ 17Th S1-_- Bldg -(Ell -Unit 11 Applicant's Mailing Address 1 , Owner's Name TrgT1n:%XtMQat F,rnrl Phone 549-99 8 Address Arch/Eng.-N;grin T R1r nnLicense No. ��, Address t ]AR1 K„^rp Rr,i f -e 916 Contractor's Name.—DiiZo tioni.ng Phone 982-1216 Address(mailing) 131-10 Saticoy St. N.Hollywood,Ca. City License No. 33925 LICENSED CONTRACTOR DECLARATION [-hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and ofessions Code, and my Ilcense is in full force and off ec 346251 License Class C' LI a o. Dat(4 / 18 /127 Sighature WORKERS'COMPENSATION OEC RATION I hereby affirm that I have 4 certiflqgte of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) WC9824 Lumbermans Policy No. Company Certified copy is hereby furnished• B CertlW fapy Is filed with the city Buildi Division. �1t c, Date— 1 Applicant— EXEMPTION pplicant EXEMPTION FROM WORKERS' COMPENSATION DECLARA ION (This section need not be completed it the permit Is for one hundred ($100) or less). I certify that in the porfortnance of the work for which this permit is issued. I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become sub)ect to the Workers' Compensation provisions of the tabor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the 'work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name - Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repalr 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 the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031,5 by any applicant for a, permit subjects the -applicant to a civil enalty of not more than five hundred dollars ($500). I'as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code- The Contractor's 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 employees, provided that such Improvements are not intended or offered for sake. It, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors 1:6 construct the project (Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant -to the Contractor's License Law), I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for thisreason Date Ihereby certify that I h information is correct.-I'a r nd state I s relating to entattves o this citynspection u oses. Signature Drivers' Li Se or SS iP Owner J this application and state that the above comply with all city, and county ordinances 9 construction, and hereby authorize repre- upon the above-mentioned property for Date -X30--Ar, M( V PLUMBING FEES TYPE OF CONSTRUCTION LJ NEW ADD LJ ALTERATION - REPAI R 515 Issue Fee ❑ CONVERSION +❑ DEMOLISH ❑ OTHER Backflow Preventer A.P. 906 FEES DESCRIPTION OF WORK/USE OF BLDG. Transformer ❑ '15-50 KW ❑ 50+ KW Backflow Irrigation- Sewer Cap Bathtubs Clarifiers Sewer Connection Solar Collectors S Main Building: Dishwasher Solar Piping E Dryers OGas ❑Electric TYPE OF PERMIT GRADING El FOUNDATION 0 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL B Swimming Pool w/Spa ❑ OTHER F.A.U. A Rear Urinal I C Right PROJECT DESCRIPTION 50. FT. OCCUPANCY K Device Boxes CONSTRUCTfON TYPE VALUATION $ S Left ZONE GRADING CU. YDS. ACRES Ping, Ref. Remarks; Planning Notes: 2267 5/03/85 Accessory Building:. Parking Req./Provided Zone 15050 Z O N I N G R E O M T S Reinspection Fee 1 $15 1 Issue Fee MECHANICAL Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG Heating System & Ducting 1 P'0-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 Whlte - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type 1 ❑ Canopy Type II ❑ Refrigeration System 00-100,000BTU 0100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 PLUMBING FEES Bar Sink . Showers ' 515 Issue Fee ELECTRICAL FEES Backflow Preventer Service Sink FEES Automatic Washer Construction Pole Sub. Transformer ❑ '15-50 KW ❑ 50+ KW Backflow Irrigation- Sewer Cap Bathtubs Clarifiers Sewer Connection Solar Collectors Cooking Unit Dishwasher Meter ❑up to 100 amps Meter Cover 100 amps Dishwasher Solar Piping FEES SMIP $ PERMIT 'ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM } $ TOTALFEE $ Dryers OGas ❑Electric ,Sub Panel Drinking Fountains Solar Tank r Fen Motors ❑0.1 HP ❑1 h - B Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP ❑16.15+ Floor Sinks' Urinal I Fixtures - - Microwave' Gas Service Outlets Water Closet Device Boxes Yale Light Interceptors Kitchen Sink Water Heater Water Service Outlets Switches Range Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections "P—Trap Laundry Trays. Generator ❑0-5 KW 05.15 KW Trash Compactor Roof Drains Reinspection Fee 1 $15 1 Issue Fee MECHANICAL Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG Heating System & Ducting 1 P'0-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 Whlte - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type 1 ❑ Canopy Type II ❑ Refrigeration System 00-100,000BTU 0100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 Reinspection Fee 515 Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By — Building Approved By Application Issued By REOUIREMENTS: .—Date _pat Date Z SUMMARY OF BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ 13.00 PLAN CHECK 25% $ 2� FEES SMIP $ PERMIT 'ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM } $ TOTALFEE $ 15.54 $ 3 CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POOL & SPA 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 ' t 5. Steel Reinforcement ,56. Rough Plumbing & Pressure Test r s 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE •7. Footings 58. Electrical Conduit-Undrgrnd. '1 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System ' . - :` 61. APPROVAL TO DECK 11. Property Sewer Line & House Con`ection 62. Backwash &Receptor -Final 12. Sewer Cap 41 63. Heater & Vent -Final 73. ,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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24., Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30.. Drywall Nailing HEALTH DEPT-. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Prevegter 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO I TRACT NO. LOT NO. UNIT NO CITY OG COSTA MESA CONSTRUCTION PERMIT ProjectAddress .1t 111. 1� Cfa.S'rl� Applicant's Mailing Address' Owner's Name 12 U ESTm E7 n1T Phone Address - - Arch/Eng. _ - License No,. Address - Contractor's NameAICIRR L 5 E1.�;C-19 tc- Phone R77 ---611D Address (mailing) L5f 5 BRYAN ST, q9LaDM-ifQ0T()rJ 6QL3I d City License No. LICENSED CONTRACTOR DECLARATION ' 1 hereby affirm that I am licensed under provisions of Charter 9 commencing with section 7000) of Dl vision 3 t usiness and Proles ' ns Code, and my license is in full for and elf t. License Class Licen Mo. 31 Date I~) Sighature WORKERS' COMPENSATION OECLARATIO I hereby affirm that I have g certificate of consent to self -Insure or a certificate „lof Workers' Compensation Insurance„or a certified copy thereof (Section 3800, Lao. C.) ” Policy No, w CSI 0C1 o Co � nY H Certified copy is hereby furnished. Certified copy JS filed with the dty ulld vision. DLie Applicant EXEMPTION FROM WORKERS' COMP N ATION ECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that in the performance of trio work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature ''NOTICE: If, after making this declaration, you Should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with Such provisions or this permit shall be .doemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there I$ a construction -lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm -that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter. Improve; demolish -or repair any structure; prior to Its Issuance, also requires theapplicantfor such permit 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 Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of, the property Or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does SLjCh work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the buliging or improvement is sold within One year of com- pletion, the owner will have the burden of proving he/she did not build or Im- Erove for the purpose of sale}. I, a$ owner of the proberty, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- t on- - tractor{s) license pursuant'to the Contractor's License Law}. I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date . Owner _ I hereby certify that I have read information is correct. I agreeto c and state laws bull ding sentatives of his �Cty enter Inspection p rp Signature Drivers' License or 55 applica ion and state that the above y wi ail city and county ordinances tru an, and hereby authorize repre- e above-mentioned property for ✓fc� Date �l0 TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION "LJ REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. ' S Main Building: E TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ •OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATIONS g Left ZONE GRADING CU. YDS. ACRES Ping. Ref. 911 Remarks: Planning Notes: MEC Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO Heating System & Ducting 00-100,000 BTU 11100,000 BTL Reinspection Fee I $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type 1 ❑ Canopy Type II ❑ Refrigeration System 1:10-100,000 BTU ❑100,000 -BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES Seca_ l i l 6re� + Zone Accessory Building; Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW ❑5-15 KW $ 3 FEES Reinspection Fee S15 Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors90-1 HP 01 !6 - $ 1nc.Solar 09-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor Issue Fee tic 00 TL Z O N I N G R E 0 M T S FEES —T_ $ 3 PLUMBING Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Kitchen Sink. Water Heater Water Service Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains Reinspection Fee $15 Issue Fee MEC Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO Heating System & Ducting 00-100,000 BTU 11100,000 BTL Reinspection Fee I $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type 1 ❑ Canopy Type II ❑ Refrigeration System 1:10-100,000 BTU ❑100,000 -BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES Seca_ l i l 6re� + Zone Accessory Building; Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW ❑5-15 KW $ 3 FEES Reinspection Fee S15 Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors90-1 HP 01 !6 - $ 1nc.Solar 09-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor Issue Fee tic 00 TL Z O N I N G R E 0 M T S FEES —T_ $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building•Approved By Date I Application Issued By{rL— SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P,C. '$ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ .5D MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% .$ $ 3 rr- CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspecinr 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7.'Footings 58, Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, E3 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67, Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping E3 Gas ❑ Oil 23. Gas Pipe -Rough & Test 72, Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY, FINAL 30. Drywall Nailing HEALTH DEPT, REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32, -Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date I "w 7� PROJECT ADDRESS: -11 1 W 1 7TH ST UNIT: E1 2 A DwNEWNENAME: TRISNAN 6 MEARS ADDRESS: 711 W 17TH ST #E12 COSTA MESA CA 92627 ARCHIEN E: (710645-4532 MILAGRA DESIGN REG.HO.: NO ADDRESS: 427 E 17TH ST 127 PERMITTEE: COSTA MESA CA 9 2 62'7 ADDRESS: JOHN C. MEARNS (714)645-4532 (j•71n11 Wfi17TH ST (['``nn 77'�77 E-12 LICENSED CONTRACTOR, CLL'AR1i710HMtYr A affirm that I am licensed under`pfd4isionns�1�1TAp�er 9 {commencing with Section 70001 Of Division 3 of the Business and Professions Code. and my license is in full force and effect. CITY LIC.: STATE LIG.; CLASS.- Date: LASS:Date: Signature: WORKERS' COMPENSATION OECLARATIDN: I hereby allirm that I have a ceniticale of consent to sell -insure or a certificate of Workers' Compensation Insurance, of a certified copy thereof (Section 3800, Lab, Q. POLICY NO.: EXP. DATE: COMPANY: Certified copy is hereby furnished. Q Certified copy is filed with the city Building Division, ate: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed it the perm; is for one hundred (5100) or less). I certify that in the performance of the work fpr which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensadon Laws of California. Date: Signature: NOTICE: If, after making this declaration. you should become subject fo the Workers' Compensation provisions of the Labor Code, you must lorllvMlh comply with such provisions or this perrrrit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: f herNtry affirm that there is a construction lending agency Sot the performance of the work for whim this permit is issued (Section 3097, f.r` v. C), LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that helshe is licensed pursuant to the provisions of the Contractors' Slate License Law (Chapter 9 icommencing with Section 7000) of Division 3 of the Business and Professions Code) or that helshe 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 penally of not more than live hundred dollars ($500}. I, as owner of the property or my empployees with wages as their sole compensation, will do the work, and the ❑ struclme is not intended or offered far sale {Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a properly who builds or improves thereon, and who does such work himsetilherself or through his or her own employees. provided that such improvements are not intended or offered for sale. If, however the buVtding or improvement is sold within one year of Completion, the owner will have the burden of proving helshe dM not build or improve for the purpose of sale), 1• as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business and Professions Code: The ConLractors' State License Law does not apply to an owner of property who builds or improves thereon aria who contracts for such projects with a contractor(s) license pursuant to the Contractors' Slate License Law), I am aware that proof of their Worker's Compensation insurance Should be provided to me. ❑ 1 am exempt under Section: B. & P. C. for this reason: qr Datew• "' a '� /—,� Owner. I do hereby Cerlily that I am aware of and understand the requirements el Cali Ma,Nealth and Safety Code Sections 25505. 25533, and 25534 and that I or any luture building occupant wifUwill not ;circle one) need t comply with said state codes and the requirements for a permit for construction or modification from the An Duahly Manageme I District. Residential ns:ruc tan applications are exempt from these provisions. Date: V Applicant: I hereby certify that 1 have read this application and state that She aba in rmalion is correct. I Wee to comply with all city and county ordinances and state laws relating [o building Construction and hereby ar r e representatives o} 1 ly to pevLlhebovementioned properly for inspection purposes. Date: (_, Signature: — Driver's License or Social Security M: 164r-46 Whne—Suddmg: Green - e Enforcement Canary—Appticant: Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 05319_ ?ERMIT N0; B 053193 PLAN CHECK NO: 02397-91 L GOVT: N SUPP: N :ONSTRUCTION TYPE: PERMIT TYPE; STR PURPOSE: ALT JOB DESCRIPTION ; COMMERCIAL T.I. (OFFICES) SQ FT: 456 :LAIM VALUE: CALC--VALUE: 4,979.52 GROUP OCC: B-2 / "01"IMENTS: I%��-t��F� ��c• ��-� ��-+t•��-�-��#�F;c-��•+�-�+�� ,��•�•>F��''t•*�-�-�•��-��-��c �•�# ��c• � k-�r•*�•�c• � �•��-�c•n*•�• Z O N I N G R E Q U I R E M E N T S S E T B A C K S --------•-----•— MAIN BUILDING ------------ ------- ACCESSORY BUILDING--------- FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT SN DEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ• PROV: PARCEL;•42409111 ZNE- MG REF NO: PLANNING NOTES> INTERIOR ALTERATION FOR A SIGN CONTRACTING BUSINESS— NO > NEW FLOOR AREA ADDED, D E V E L O P M E N T S E R l I C E S R E Q U I R. E M E N T S ZONING APPROVED BY 5c DATE: _,7 J/// BUILDING APPROVED BY ;� L5 DATE: ��- kPPLICATION ISSUED BY: DATE- � � R dE iX #' * * * YF k * �F * �E lc >k i! * iF dE r yc it�rit it iF �E �E is #( �f �r li• �[ iE rr ie )c iE**if'*��E•*****3i•*IFtf*****�(-*>}i•icMF**********ie*iE****.+t*•1T•�{'�iE�ji•lC�aE*iF*MFMF�T4�***#Fit-�it�i4�ji•�***XF :,EGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 72,00 SMI P /NON --RES PLAN 46.80 1.05 ISSUE FEE 3UILDING--DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE, TOTALS-----> 73,05 0.00 46.80 119.85 119.85 ,00 REVENUE DIVISION TO'T'ALS--> COLLECTED: 73,05 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN --CHECK 72.00 1.05 ****K****if'Tf*********KK********'A'*'lk***K**K********** ******,> *******,til*Xi *********** I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFC 456 Or ALTER TYPE III—N --AVER 10,92 4,979,52 t _ END OF FEES EXPIRED mPlete 11"SPCCtk;Ins r - CONSTRUCTION AND PLANNING" Permit # Date Inspector POOL PAAPPROVALS APPROVALS Permit # Date Inspector i. Temporary Electrical Service or Pole 52. Pool & Equipment Location �• ti 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms t 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding - f_ r" 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final -1 12. Sewer Cap 63. Heater & Vent -Final z- 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 or 18. Rough Electrical -T Bar Ceiling 69. POOLISPA SYSTEMS FINAL If I/ 19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25, Roof Sheathing 74. Overhead Hydro 26. T-8ar Ceiling (Structural) & Monocoat 75. Dry Chemical , 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77, FIXED SYSTEM FINAL 29. Insulation `t' • 78. FIRE PREY. FINAL q 30. Drywall Nailing �'{ -� .a HEALTH DEPT. REOUIREMENT..i '- 31. Plaster Brown Coat 1 S 79. FINAL INSPECTION 32. Electrical Power Meter•Finai � % 80. FOOD CERTIFICATE ISSUED ', J 33. Final Electric %�+��' Notes: 34. Final Heating & Air .Conditioning . { J 35. Final Gas Pipe -Test 36. Hood or Canopy ! 0 37. Final Factory Fireplace Iia 38. Final Plumbing it 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. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy T-1der lines and sign'all appropriate declarations. CITY OF -COSTA MESA CONMUCTION PERMIT PER IT'NO. TRACT NO.J ;LOT NO. UNIT NO. ,Project Address --� �L !! Applicant's Mailing Address bQfkli'+aJi a� C. % TYPE OF CONSTRUCTION NEW ADD'>5LALTERATioil LJ REPAIR ism aj '❑ CONVERSION ❑ DEMOLISH OTHAER A.P.#_ A Owner's Name Phone DESCRIPTION OF WORK/USE OF BLDG. � f bo I 1 �t� 2 - Fl -g - a 1 Address — S Main Building: Archilr, ! License No,�ff��'Z TYPE F. PERMIT GRACING. FOUNDATION STRUCTURAL T Front Address 5�)3t 91RG� 11 fbill E3 iGN eA• TENANT ❑ ELECTRICAL 10 PLUMBING ❑ MECHANICAL B Rear Contractor's Name /,� ©r`/�— PhoneijMl� � OTHER I C Right rF cv PROJECT DESCRIPTION` SQ. FST. 245^ C2� OCCUPANCY Address (mailingl' Q [r CH �� + • CONSTRUCTION TYPE 'y*'ry VALUATION $ rT. �uOf�. do $ Left City License No. ZONE MS CU.YDS. ACRES --� �• # LICENSED CONTRACTOR DECLARATION 1 Pill - 1 hereby affirm that, 1 am licensed under provisions of Charter 9 (commencing 'Remarks: �. 5 s Planning N with section 7000) of Division 3 of the Business and Professions Code, and' ..- my license is In full rc and effect. License Class Date Z — Signature 77AX PLUMBING WORKERS' COMPENSATION DECLARATION " Bar Sink Showers I hereby affirm that 1 have a certificate of consent to self -insure or a certificate _ ` Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 00, Lab. C.) r A ,rolicy Not(,y 232 ? Company �$ 1ty` r«"'�+ '- Backflow Irrigation , Sewer -Cap Certified copy is hereby furnished. Certified cop filed with the cityraJ� Ing I a p Bathtubs Sewer Connection Date �� '' Applicant v,�1-• f , ,� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers Sola rs (This section need not be completed if the permit is for one hundred ($100) or - Dishwasher i less). I certify that in the performance of the work for which this permit is issued, I. olar - - -- - shall not employ any person in any manner so as to become subject to the- Drinking Fountain r Workers' Compensation Laws of California. , 1 Date ' Signature Floor inS ing Poo�a NOTICE: If, after making this declaration, you should become subject to the �44BUILDING PERMIT PLAN CHECK Workers' Compensation provisions of the Labor Cade, you must forthwith F12 S� N Urinal comply with such provisions or this permit shall be deemed revoked. coNSTRUCTION LENDING AGENCY Gas er Oter Closet ' I hereby affirm that there is a construction lending agency for the performance IEPLIANCE, of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Interceptors'Water Heater Lender's Address i Kitche VIA Water Service OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law 'for the Lavatories Auto -Wash following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair -permit P—Trap , Laundry Trays any structure, prior to its issuance, also requires the applicant for such MICROFILM to file a signed statement that he/she 101censed pursuant to the provisions of Roof D ns 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 - r - '"ere from and the basis for the alleged exemption. Any violation of Section , )31,5 • by any applicant for a permit subjects the applicant to a civil nasty of not more than five hundred dollars (8500). 1 ❑ I, as-own.r of the property or my employees with wages as their sole Reinspection ,Fee $15 Issue Fee compensation, will do the work, and the structure is not intended or offered ' forsale (Section ;7044, Business and Professional Code: The Contractor's MECHANICAL License Law does not apply to an owner,Of a property who builds or improves thereon, and who does such work himself/herself or through his or her own - Boiler Hood or Type I ❑ employees, provided that such improvements are not intended or offered for sale. If, however, the bullding'or improvement is sold within one year of co Canopy Type 11 ❑ .pletion, the owner will have the burden of proving he/she did not build or im- Duct - Urider Ground , I •prove far the purpose of sale)., - ' ❑ I,.as owner `of the property, am exclusively contracting with Iicensetl con- Duct - Structural Refrigeration System FEES tractors to construct the project(Section 7044, Business and Professions Code. The Contractor's, License Law does not apply to an ownerlof property who Duct - Ventilating ❑0-100,000 BTU 00,000 BTU builds or improves thereon; and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ,❑ system air/Alteration ` proof off their Worker's Compensation insurance should be provided, to me. -. ❑ 1 am exempt under Section B. & P. C. for this reason Firepl/Fact. Bit. ICBG # ire Dampers - Date Owner Heating System & Ducting Registers I hereby certify that I have read this application and state that the above 00-11 '00,000 BTU ❑ _uv BI information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of is city to a er upon the above-mentioned -property for inspection p - /T Signature e l a �� . Drivers' License or 55 einspection Fee , 815 Issue Fee r CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor !11 - FEES 3FEES 7-T X /Ri i►'1C 1 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas DElectric Fan Fixtures Device Boxes I Outlets Switches Garbage Disposal 0642 1/22/87 ,?///S Zone Accessory Building:, Parking Req,/Provided ELECTRICAL S Transformer ❑ 115:50 KW ❑ 50+KW , Meter Cup to, 100 amps Meter Cover 100 amps Sub Panel Motors 00.1 HP aLX2 Inc. Solar ❑9 P Eli 6-15+ Microwaye Generator 110-5 K5-15 KW Range Sign Standing Sections Trash Compactor 65.03 TL Z O N I 'N G Reinspection Fee '$15.1 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMEN 11 II � 4h Zoning Approved By, Date Building Approved By Data Application Issued BY Dat SUM YF .EES �44BUILDING PERMIT PLAN CHECK $ $ -SMTP PERMIT $ PLUMBING, $ IEPLIANCE, _ $ ,. PLAN CHECK 25% $ G Y P. c. $ ELEGTRIGAL $. !&R ING PLAN CHECK 50% $ MICROFILM ? $ MECHANICAL $ �� - i -� TOTAL FEE' $ I PLAN'CHECK 25% $ , 0Z CONSTRUCTION AND PLANNING APPROVALS Permit # pate Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd, 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. 57. APPROVAL TO COVER -GUN ITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. -Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. WateFPipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains - 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit ` 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro r 22. Ducts,'Ventilating 71. Product Piping ❑Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush r 24. Roof Framing 73, Undergrnd. Storage Tank ❑ 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 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 Nates: S% iwco 7A 34. Final Heating & Air�Conditioning 1-i A Com' wOL 35. Final Gas Pipe -Test • 36. Hood or Canopy f 37. Final Factory Fireplace _ t - 38. Final Plumbing 39. Water Service -Final a 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 ' r 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No, Date -, PROJECT ADDRESS: 71 1 17TH 'ST UNIT: E OWNER'S NAME: MESA BUSINESS CENTER ADDRESS: SAME 759-1569 ARCw mmm. WILLIAM SIMPSON REG -ND.: 867 ADDRESS: 2222 NEWPORT BL UNIT: NEWPORT BEACH CA 92663 PERMITTEE: GRAHAM BROTHERS (714)546-1653 ADDRESS: 2952 CENTURY COSTA MESA CA 92626 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 01 the Business and Profession ode, and my license is in full force and elf t. CITY LIC.: 0 0 5 9 6 3 GESTATE LIC.: 8 LASS: C- 2 0 Date: yl-- Signal WORKERS' COMPENSATION DECLARATION: I herebym R-s-e lf-insure or a certificate dt Wokers' Compensation k s -yj 6r 1, 1�� 2,2 &01,�ction 3800. Lab. 68/01/91 POLICY NO.: iiLNNiiIB LIBERTY EXP. DATE: .OMPANY: Certified copy is hereby furnished. L` i C ed Ca th the city Building ion. r Date: ! Applh: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This seclian need not be completed if the permit is for one hundred ($100( or less). 1 certify that in she performance of the work tar which this permit is issued, I shaft not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date: Signature: NOTICE: If. after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: 1 hereby affirm frail there is a construction lending agency for the performance of The work for which this permit is issued (Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance, also requires the applicant for such permit to fife a signed statement that he/she Is licensed pursuant to the provisions at the Contractors' State 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 apfiftant to a civil penalty of riot, more than Live hundred dollars (M). 1, as owner of the property or my employees with wages as their sale compensation, will do the work, and the structure is not intended of offered for sale (Section 7044, Business and Professional Code: The Contractors' State 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 employees, provided that such improvements are not intended or offered for sale. If, however the building of improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve lar the purpose of sale). I, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' Slate License Law does not apply to an owner of property who builds or improves thereon and who Contracts for such projects with a contractors) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. 1 am exempt under Section: B. 8 P. C. for this reason: Date: Owner: I to hereby certify 1hm I am aware of and understand The regrrirements of Catilorn+a Health and Safety Cade Sections 25513,5, 25533, and 25534 and that I or any future building occupant will/will not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District. Residential construction applications are exempt from mese provisions. Date: App' ant: I hereby certify that I have read this applicatia nd state that the above information is ordinances and slate laws relating to building nstruction and prize represent p(operty for inspeClion purpossees. Date: ` Sinal. Driver's License or Social Security p. to comply with all city and to enter upon the above -me 16,41.46 Whne-Building: Green -Code Enforcement: Canarv-Applicarul Pink -Revenue: Goldenrod -Assessor CITY OF COSTA MESA - BUILDING PERMIT : M 05 !!!] PERMIT NO: M 052007 PLAN CHECK NO; N , CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: ALT JOB DESCRIPTION LEGALIZE 485SF IST FL TI, 485SF 2ND FL A SQ FT; CLAIM VALUE: CALC-VALUE: GROUP OCC: B-2 / COMMENTS: 2ND FLOOR REFER TO #BE51395 �*��*��*�*�***��***�**TU TU TFTrrTkTkT6T4TUTUTFT4TtTETUTrr��*�**�*��*TtTU*TrrTfTUT4T4*��TfrTUTkTfTfTrrTrr ,-'ZONING S ZONINGS ERTEBQAUCIKRSE M E,N T S =------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PKING REQ• PROV: PARCEL: 42409111 ZNE: REF NO: ANNING N TES> > �(• aF * * TE TE Tt TE TF Trr. * TE ith TE Tt � �(• Tt• Tt Tt � Tt � If t,4 Tt Tt t,4 Tt TIF TE t,4 Tf Tt Tt -lfr Tt t,4 TE t,4 � Tt Tt Tf �(• TE Tf �(• Tl• TF Tt Tt Tl• TE TE t,4 TE TE TE TIF TF TE TE TE IIF TIF TE t,6 � Tt Tt � �(• TF TF Tf TF TE TE D E V E L O P M E N T S E R V I C E,,S R E. Q U I R E M E N T S� ZONING APPROVED BY DATE: BUILDING APPROVED BY :. _. _ _ ___ DATE: t APPLICATION ISSUED BY: DATEt TIF TE Tt Tt Tf TE Tf TE TE Tt Tt t,6 Tf Tt TE TIF TIF TE T(• Tt TE TE 3f�TF�F�iF'�•� ��iFiE� iF�->� TIF If Tt Tf TE TIF TIF TE TE TIF TE Tf Tf TE TIF TIF TE Tt• TIF TI• TF t,4 TE T<• TE TIF Tt TIF Tf t,6 TIF Tt TF t,6 t,6 Tf TIF TE t,6 t,6 TE TF TIF Tf t,6 t,6 TE Tt Tf Tf Tt Tf Tf TE Tt Tf Tf TIF TIF t,4 Tf TE TIF � II• TIF TN TIF Tf t,6 TE Tf � TE t,4 Tt Tf TE Tt Tt TIF Tf TF TIF TE TE � TE TIF TIF TIF LEGALIZATION:N F E E S U M M -A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMTP/RES GRADING PERMIT 9 00 �5$ SMIP/NON-RES PLAN ISSUE FEE 15.00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID- DUE TOTALS ---- > 9,00 15.00 0.00 24.00 24,00 r ,00 REVENUE DIVISION TOTALS--> COLLECTED: 24,00 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 24.00 ' Tf TE TIF TIF TF TE TIF Tt TIF t,4 TIF TE Tf TE TE t,6 t,6 Tf TE TIF TF TE Tf t,6 kt• TE TF Tf Tf TF TE Tf Tf Tf Tf T[' Tf t,4 t,6 Tf t,4 Tf Tf Tf t,6 Tt TE Tf t,6 Tt TE TE TE Tf Tf Tf TN TE Tf t,6 t,6 TF TF TN Tt t,4 TE TE * Tt TIF TIF TE t,6 TF Tf t,4 Tt Tf I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST MEC 1 REPAIR/ALT COOLING UNIT/SYS W/CNTLS END OF FEES 9,00 9.00 01 GDOP,6 9 90 -CODE &$70 TODD DATE: 05/69/?l TirtF: 14:23 CONSTRUCTION AND PLANNING. PL & SPA . APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector s 1. Temporary Electrical Service or Pole 52• Pool & Equipment Location 2• Soil Pipe-Undrgrnd, u:' 53. Steel Reinforcement - ,7 rr• t • -. •r '3r Electric i;& nduit Utility-U " 54. Forms r8rgrnd' q 4. Electrical Conduit-Undrgrnd." 55. Electrical Bonding 7',5. Steel-Reinforceyment 56. Rough Plumbing & Pressure Test 4 Electric alUFEF; Grhd. 57, APPROVAL TO COVER-GUNITE _ -Z4:7, Footings. a I � � 58. Electrical Conduit-Undrgrnd, ,-8. Foundation h, I .^ 59. Gas Pipe, ❑ Undrgrnd., Test `9. Water Pipe-Undrgrnd. { ± �� 60. Backwash Lines, P-Trap, ❑ Undrgrnd. A 10. Structural Floor System v I 61. APPROVAL TO DECK 11. Property Sewer Line & Hduse Connection 62. Backwash & Receptor-Final Z •* I 12. Sewer Cap 63. Heater & Vent-Final - 13. Roof Drainsc �1 64. Plumbing System - Final M r 14. Rough Plumbing, 65. Electrical-Final 15. Rough Electrical Conduit 66. Solar System-Final i 16. Rough Electric Wiring 67• Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 'APPROVALS =' _ Permit # } 20: Ro-ugh+Factory Fireplace + U_r d _ y s w n i 5• ti' r r s- 21Ducts, in Stcuctu.re. i ..�,• ; :70. Undergr,aund Hydro 22, Ducts, 1/.entilatingr 71. Product'Pping ❑'Gas Coilr r , 23r Gas Pipe Rough &Test ; ; 72. Underground Flush :. 24�. Roof Framing n 73:" Undergrnd. Storage.TankA❑ Gas ❑ Oil 25. Roof Sheathing,,.' '747 Overhead' Hydro'' 26.' T•Bar Ceiling (Structural) &,-'Mono coat - + 75:" Dry Chemical 3 r � , 27;' Frame and Flashing 76, Dry Standpipe i p... 28. Lathing;& Siding,- .: : _ : ,. z • - 77, FIXED SYSTEM-FINAL u '29. Insulation t = ;, '� f � 78: FIRE PREY. FINAL r , 30. Drywall-Nailing , , HEALTH}DEPT.'REQUIREMENT 31. Plaster Brown Coat y ; l; 'a 79:' FINAL it SPECTION -{ ti i, r .32; Electrical Po_ er„Meter-Final -.- 80: FOOD CERTIFJCATE ISSUED 33 Final Electric ' r " 'Notes: s CC r r, i J 34: Final Heating &;Asr Gtonditioning•`- 35! Final Gas Pipe-Test , � I �` ,t �^ + Y a = 36:' Hood or Canopy ,• _ L . n z�., v+ c 37:-Final Factory Firetlace^ ' r 38. Final Plumbing ,�; �, f t * -' a 1 39. Water Service-Final -' # moo- 4 _ * 3 40. Gas Service-Final n. r. �' �� -' _,, `' `ti. r .41. Solar Domestic-Fina!- •1 42:- Backf lowl Prevented 43. Backflow Irrigation w _..-. ti s r 44. Landscape Er'rigation System i „ `, - ti ,3 �� ;.� + ' ,, i ;r 45' Sound • Attenuation �. - YV � - - • - r� r - mss. . u:'.g � 46. Handicap R;gulatiiins ` y ':; �• �' , r 47., FINAL STRUCTURE & BUILDING 48:JIFINAL PLANNINGrr, = 49. Electric Release to.Edison 50.. Gas.Release to Southern California Gas Co '51. URTIFICATE OF, OCCUPANCY No -. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address _ 711 W. 17th St. Bldg.(E) Unit 12 PERMIT NO. k ,?)1 +2— 1 TRACT NO. J LOT NO.UfVIT NO. 2268 5/03/85 1505(] TYPE OF CONSTRUCTION NEW ADD ALTERATION ❑ CONVERSION ❑ DEMOLISH .❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. REPAIR 1.9 f Applicant's Mailing Address - 13110 Saticoy St N.Holnlywood Owner's Name Troy Investment Fund phone 547-2988 Address 21 Birch St. Newport Beach Ca. A.P. Zone S Main Building: Accessory Building: Arch/Eng, Marin J.- ROCk License No. Address Suite 216 TYPE OF PERMIT GRADING El FOUNDATIO�Ng STRUCTURAL El TENANT ElELECTRICAL F-1PLUMBING L7 MECHANICAL El OTHER PROJECT DESCRIPTION SQ, FT. OCCUPANCY CONSTRUCTION T VPE VALUATION $S ZONE - GRADING CU.YDS. ACRES E T Front Z O A Rear N Name. DitrL)Ai r ConditioningPhone 982-121 Contractor's Address (mailing) 131 10 Sniriooy--St -N.HOJJywwood,Ca City License No. ., LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions o arter 9 (commencing with section 7000) of Division 3 of the Business d rofessions Code, and my license is in full fCorc„grtd effe 346251 License Class LL nse o. Date— 4118/84 Sighature C Right N K I Left R Ping. Ref. •# Parking Req./Provided - E Remarks: Planning Notes: a M S PLUMBING FEES - WORKERS' COMPENSATION DE RATION I hereby affirm that I have a certif le of consent to self -insure or a certificate ELECTRICAL FEE Bar Sink Showers ' Backflow Preventer Service Sink --- Automatic Washer � Construction Pole Sub, - - Transformer ❑ 15-50 KW ❑ 50 + KW i ` of Workers' CompensationIncur ce„ or a certified copy thereof (Section 3800, Lab: C.) Policy No. WC9824 Compare Lumbermans Company BCertified copy is hereby furnished. GertlIopy is filed with the city BuVing f sion. /� Date Applicant N4C 7 /Tf EEMPTIO FROM WORKERS' COMPENSATION DECLARATION Ell (This section need not -be completed if the permit Is for one hundred ($100) or less). i I certify that in the performance of the work for which this permit is issued, I shall not employ any parson in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature •NOTICE: If, after making this declaration, you should become subject to the workers' Compensation ptovisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Backflow Irri ation g Sewer Ca P Bathtubs Sewer Connection I Cooking Unit Meter Cup to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric r Sub Panel I Drinking Fountains Solar Tank r Fan MOlOfS ❑41 HP ❑1 %, - 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar C1 9-15 HP Eli6.15+ , Floor Sinks _ Urinal Fixtures Microwave - Gas Service Outlets - Water Closet Device Boxes Pole Light CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Interceptors Water Heater Outlets Range - Lender's Address OWNER BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter. Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement•that he/she Is licensed pursuant to the provisions Of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the. Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031-,5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees -with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the builtling or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale), ❑ 1, as owner of the proberty, am exclusively contracting with licensed con. 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 builds or Improves thereon, and who contracts for such projects with aeon- tractor(s) licenso pursuarit•to'the Contracto'r's Liconse Law). 1 am aware that Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ' 9 P Standing Sections P --Trap Laundry Trays ' Generator 00.5 KW El 5,15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 issue Fen $ 3 MECHANICAL FEES Boiler Hood Or Type 1 ❑ Canopy Type I I E)Zoning Duct - Under Ground DEVELOPMENT SERVICES RECIUIREMENTS: Approved By Date Building Approved By Date Application Issued By Dat 7 Duct - Structural Refrigeration System ❑4100,000 BTU ❑100,000 BTU Duct - Ventilating SUM ARY OF FEES BUILDING PERMIT $ SMIP $ Exhaust System ❑ Multiple ❑ System Repair/Alteration _ proof of their worker's Compensation insurance should be provided to me. D I am exempt under Section B. & P. C. for th(s reason PLAN CHECK PLUMBINGISSUANCE PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% $ PERMIT $ $ $ ENERGY P.C. $ $ GRADING $ $ MICROFILM $ , 13.00 15.50 $ ��_ TQTAL FEE $ $ Firepl/Fact. Elft. (Coo To Fire Dampers Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree comply with all city and county ordinances and state laws relating tO b ng construction, and hereby authorize repre- sentatives this city t4 nt upon the above-mentioned property for inspectlo pu aces. Signature Date �—�`S Drivers' Lice or 55 1 Heating System & Ducting U4100,000BTU 0100,000BT 6 Registers 0 Reinspection Fee $15 Issue Fee $ 3 CMF 0665-46, rev. 10/84 White --Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor - -CONSTRUCTION AND PLANNING APPROVALS . Permit # Date - Inspector POOL & SPA APPROVALS Permit # Date " Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 1 2. "Soil Pipe-Undrgrnd. 53. Steel. Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms .4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing '& Pressure Test 6. Electrical LIFER Grnd. y� 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8: Foundation , 59. Gas Pipe, [3 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60, Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System i 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap f 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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping,C] Gas ❑ Oil 23.'Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ 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 1 �7A,1 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39, Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations , 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date pp""i PROJECT ADDRESS: 711 W 17TH ST UNIT: E 1 2 DwNE NAME: AD TRISNAN & MEARS ADDRESS 711 W 17TH ST #E12 .COSTA MESA CA 92627 ARCH/ENGINEER' (714)645-4532 REG.li ADDREss: MILAGRA DESIGN NONA: 427 E 17TH ST 127 PERMITTEE: COSTA MESA CA 92627 ADDRESS: PARKER PACIFIC WEST INC. (714) 646-5359 497 ABBEY WY (('` JJuud� CA .. 9 2 E�? LICENSED CON TRACTO1f DECLARATION: I hereby affirm that I am licensed under CA of ap er 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. CITY LIC.: 54000 STATE 1 60929 CLASS: Date: Signature: WORKERS COMPENSATION DECLARATION: I hereby affir at I have a ce tilt a of consent to self -insure or a certificate of Workers' Compensation Insurance. or a certified copy thereof (Se:n 3804 Lab. C). POLICY No.: 1137747-91 EXP. GATE: 07/01/92 COMPANY: STATE Certified copy is hereby furnished. Certified copy is filed ith the city Building Di cion. fEXIMITIIN e. "� y+ APPllcant: FROM WORKERS' COMPENSATION DECLARATION: (T section need not be completed if the permit is for one hundred (5100) or less). rtify [hat 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 ject to the Workers' Compensation Laws of California - Date: Signature; NOTICE: If. alter making this declaration, you should become subject to the Workers' Compensation provisionsmf the Labor Cade. you must forthwith comply with such provisions or this permit shall be deemed revoked. ' CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance 6f the work for which this permit is issued (Section 3097. Civ. C)- r LENDER: .r ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who buiids or improves thereon, and who does such work himselllherself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the property, am,exclusively contracting with licensed contractors to construct the project (Section 7044, Business Eland Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or Improves thereon and who contracts fol such projects with a contractor(s) license pursuant to the Contractors' State License Law). 1 am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: - B. 8 P. C. for this reason: Date', owner: I do hereby certify that I am aware of and understand the requirements of California,Health and Safety Code Sections 25505, 25533. and 25534 and that I or any future building occupant willlwill not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Oualdy Management District. Residential construction applications are exempt from these provisions Date: Al I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building Construction and here authorize representatives of this city to enter upon the above-mentioned property far inspection ppurposes. Signature: Driver's License or Social Security ii: 1641-46 White—Building; Green—Coe LnTorceni CaRTr—Applicant: Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: E 053706 PLAN CHECK NO: N CONSTRUCTION TYPE: PERMIT TYPE: ELE JOB DESCRIPTION ; COMMERCIAL T.I. (OFFICES) CLAIM VALUE: CALC—VALUE: PERM NO: E 05370 GOVT: N SUPP: N PURPOSE: ALT SQ FT: GROUP OCC: B--2 / COMMENTS: REF B53193 Z O N I N G S E T B A C K S R E Q U I R E M E N T S MAIN BUILDING ---------- --------- ACCESSORY BUILDING---------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42409111 ZNE: REF NO: PLANNING N TES> > D E V E L O P M E N T S E:•;R V I C E S, R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY DATE: APPLICATION ISSUED BY DATE: p O 1E1E1E********1E*IE�F�F1E�F�F**�F****�F1E1E1EiF1EiEiE#iF**** 9F1E9F1(-l(-*��lE*lE�l(-l(-+li�*****IEIEIE��IE*lE*��**** LEGALIZATION;N F E Ea S M M A R Y STRUCTURAL SEGMENT:N PERMIT BLDG PMT PLUMBING ELEC I5 MECHANIC FIRE SMIP/RES GRADING �0% SMIP/NON--RES PLAN ISSUE FEE 15.00 BUILDING—DIV—> PERMIT IS E PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 26.25 .00 0.00 41.25 41.25 .00 REVENUE DIVISION TOTALS— > COLLECTED: 41.25 OVER/SHORT: .00 BLDG PMT PLUMBIN ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 41.25 *1E*lE-1E1F*�,ie*�iE**�***iE� 9Eik**3E**1F1FiF*iF****iF****lE*lE**IE�FIE*IEiEIEiEiE�lE1(-1(-1(-*IEIE***IEIE*lEiEiEiEiEiElE1(-* I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 20 FIXTURES, LIGHTING 1 ST 20 EA. .75 15.00 ELE 5 FIXTURES LIGHTING ADDITIONAL EA. .45 2.25 ELE 7 RECEPT/06TLET ADDITIONAL EA. .45 3.15 ELE 13 RECEPT/OUTLET ADDITIONAL EA. .45 5,85 END OF FEES 01 00096:112-00096::02 7107 x1.25 DATE: 09/04/91 Tint: 151:52 CONSTRUCTION AND PLANNING # POOL A APPROVALS Permit # Date Inspector APPROVALS Permiit # Date Inspector 1, Temporary Electrical Servi' or Pole 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd. to ' 53. Steel Reinforcement r_ ..let`�iral Cc�.ridility lJndrgrnd E'" 54. Forms �3r7j �4 ;ls�t`triGaL''�ndra2:Undrgrnd. i. 55. Electrical Bonding .r^ �r'�'_e`:'Fgir'ifWeme t 56. Rough Plumbing & Pressure Test , E.6. EffctrivalfilFff>fi[rstnd. q . .,- 57. APPROVAL 70 COVER•GUNITE ° r�1"' _fir, t a 58. Electrical Conduit-Undrgrnd. ul rooti r. n= F_oundat1or 59. Gas Pipe, ❑ Undrgrnd., Test �. 9. Pipe Undvgrnd. 60. Backwash Lines, P•Trap, ❑ Undrgrnd. �V,Vater 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer:tliine-& House Connection 62. Backwash & Receptor-Final 12. Sewer Cap y ! 63. Heater & Vent-Final 13. Roof Drains .�__ ell 64, Plumbing System - Final 14. Rough Plum6rl e 65. Electrical-Final 15. Rough EgctricZConduit 66. Sofar System-Final 16. Rough ElectricWiring 67, Fencing & Access Approval 7, Rough Wir�g S6n 68. APPROVED FOR PLASTERING 18. Rough Electri XT Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 7 v LL, E- LIZ a: E- IT! Lr C,lt'•, 20,'floui Far:torj Firfplace i t:C[T! <"i i C, C+r. r rA;PPR0VA'L�'v.3�errAit �. 1• ix E: Y 5 r t LT'S x. Cu a ""Cr:t-+[� F' rx trt: . :, 21.r uGis, i �tr'ytu r. t ... 2 'i + r r r °7:K _ .�"' Cr3 'k t-1 0. td's ndergr�t�d�-iyoro 22. Ducp, LIh,iPdting�'� "31, ProductiPi s 'g ❑'' ❑pi{ 23.'�as!4A e�Rou &•lest rJ' 2. Under ro fl Flus 24.t$oo�Fram ng� t.rs t ' E- •• r #. 9 y3.ti_lndergrndl'Storaq�e-'tank ©Gas I-] 0;P 25. RociSh�athing Hydro , f , cd "r T4.}verhead J' ;r, 26.WT-BmCeiling (Stri�irral) &i "o-coat *,. rxi [ ;F -r 75.2,v Chemical "7 :r M J E*•r Lr Ix 27.' tame ar.d Flashiii� r �' t : 76.= �]ry Stan,�Iyi" e Cr f~' r i•28.T athing;ik Siding r"I •-? t ul F ••w r 77.L'FIXED S EM'29. Insulati'F`TiVALa triIr 1 78.s�IRE PREY. FII�l j. 0, Drywall lNailing I- IA&ALT 6EPTa�REQW4RE?MEN� 1 Coat 1 1. Plaster Brownoa " "'&,79,-FINAL iN ? CTE '' ? :r >✓r '� ti E 2.}�lectricel Pow>rr M40ec�inal t +: iv * 0.t OOD CERTIF1Q,ar' rIS9UED I�r rw .-� � x• in EleclriC, i ��yy rr o:`tx X33. t=; --"[Z +�-2 "7i} "" Q 4.rFin Heating!r AirConF!itiomi' ;k .,v ti ri;1i .-r �A •F -•� T� r-• 35.inat'Ga• 'Pip-Test " �� a: !l uaa 4� t, F' tZ' t JcD Fa t r"a 4'.CO. i w i-; W 19001, ortganopy :� J s tr i a. .� f•3 Ca x �F 7. inaliFactory Firepf'a& r Wit'' " Ell j x :F- '1-1 C:S r5 7 .. .. s frH cs y .. .. ,`38, Final]Plumbing ,v ! �, r :i: ( T 7r 5 �-+ M rA r :39. Water: Service-Final? r ,. I fit 5_1 4 tTl * hC r ;t tt; }. ;r 41 t r! trl L11 t r X10. Gas Service-Final ; -1 <te E- S 4 :E: 01 f R :. Q� s L4 VJ y6 J .� •• �i1. Solar Domestic•Finat 5 ntn �+ i ��1 ra t .i. E.. C Fl -42.~�ackflow Preventers, N *w ,� K Ur xi �[+ C 43. Backflow IrrRtion"r �5S ;V 'f; Y ,,44. Landscapg Iri?gatioEt SystemWtrlf-, LrM n,' rsruPar+i It :45.50und AttenuationY ' iT' r� �- !"`' r•y E]"'� r-�Q • r x tr; rr, :r � Ex- V tP 6.€�andicap Regulations i C, En -f S Z:1 S Y r tti U� ""j .. 47..-E1l�L STRUCTURE & BWEDING :►• _ , r r rte. �: r 4OWAL PLANNINe, -494le'-ic Release to 8dison Y' I '-: x a: r 't• ' '50.-.Gas,Release to Southern Calif'ornia,Gas Co T. ri C)t-1 t? r •~•�• 1.CERTIFICATE=OF'CY CCUPAN'. rNoDate Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. _. CITY OF COSTA MESA CONS7TiUCTION PERMIT. Project Address 2z/ / / r Applicant's Mailing Address Owner's Name k 37 ' & 'P'yh•�one•: t/ % z Z?FJ Address L rZ r* •/ G / , Arch/Eng. �~ License No. S Address � e2 5- V Contractor's Nam V 0 Phone Address (mailing) -Z D .1/ V ? %7 / City License No.- • LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provision$ of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in fforceenFt•offect. ..? / — Llcens C! Lr CJ LI nse NO. b Dat Signature WOR RS C MPENSATION DEC RATION I,here y affirm that I have a cerlifi a of consent to self -Insure or a certificate ` Workers'- Compensation Insura re, .or a certified copy thereof- (Section 300, Lab. policy No. - S / Company )!Fd i2/9? ��T..DLCr-e BCertified copy ls,hereby furnished. Certified copy IS filed with the city Build' Diylslon_d!l • Date Applicant .. EXEMPTION FROM WORItERS' COMPENSATION OECLARATION _ (This Section need not be completed if the permit IS for one hundred ($100) or less). 1 certify that in the perforMance of the work for which this permlt is issued I shallnot employ any person In any manner $o as to become subject to the Worker$' Compensation laws of California. ! Date Signature 'NOTICE. If, after making this declaration, you should become subject to the Workers' Comoensation•pr4vislons of the-Labor,Code, you must forthwith comply with such provisions or this ,permit shall be deemed revoked. -CONSTRUCTION LENDING AGENCY ' L. , s I hereby affirm that there is a construction lending agency for the performance of the work' for which ,this permit is Issued (Section ,3097 Civ. C.) Lender's Name Lender's Address' ' ` OWNER BUILDER DECLARATION 1 I hereby affirm that I am 4xempt from the Coritractor's License law for the, ' following reason, (Section -7031.5 Business and Professional Code. Any city or county which requires a permit to construct, alter, Improve, demolish or•repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division ,3.of'the Business and Profession$ Code) or that he/she is exempt 'terefrom and the ,basis for the alleged exemption.—Any—violation of Section 131.5 by any applicant fora permit subjects.the,applicant to a civil tnal_ty of not more than five'hundred dollars ($500). ❑ I, as 'owner of the 'property or my employees with, wages 'as their sole compensation, will'do the work, and the structure Is not Intended or offered for sale '(Section 7044, Buslness and Professional Code: The Contractor's ' 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 employeeS, provided that Such Improvements are ,not intended or offered for sale. If however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose Of'sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or'Improves thereon, and 'who contracts for such pro]ects-with a con- tractor(s) license pursuant to'the Contractor's License Law). I am aware that • proof of their Worker's Compensation insurance shoultl be provided t0 me. ❑ I am exempt under Section B: & P, C. for this reason 4 Date Owner — I hereby certify that -I have read, thi information incorrect. hagree to COM and state la s relating to building co Inspect this city to meter u inspection oses. �G/..% Signature Drivers' Lit se or SS 46 )plication and state that the above with all city and county ordinances uctlon, and hereby auth0i repre. :he above-mentioned pr ertY/(o) PERRrMiT NO.� �__TRACT NO. LOT,NC1.,, uN Nct. .3659 I is/U// t)4. I 1.1 o 1,0 TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR [-]'CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. - A.P. Zone 'S Main Building: Accessory Building: TYPE OF PERMIT I GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ -OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU. YDS. ACRES T, Front O B' A Rear N I C Right N S Left G R Ping, Ref. # Parking Req./Provided , E Remarks: _ i Planning Notes: M T S PLUMBING FEES' i ELECTRICAL t FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Waiher Construction Pole Sub. Transformer ❑ 15-50 KW 0 50 + KW ' ' Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Soler Collectors -� Vishwasher ; Meter Dover 100_ amps - Dishwasher , IISolar Piping ' Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank J. i,Fan f Motors 00-1 HP 011A_ B Floor Drains ' Swimming Pool w1Spa tik F.A.U. Inc. Solar 09-15 HPC El 16-15+ Floor Sinks- Urinal ' ' Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors . , - Water Heater _ Outlets Range i Kitchen Sink ` water Service, Switches Sign , Lavatoiiesc ` , Auto -wash, �, Garbage Disposal ; Standing Sections P. -trap Laundry Trays ~ Generator .00-5 KW El 5-15 KW Trash Compactor Robf Drains .- Reinspection Fee $15 Issue Fee j ;r' $ 3 Reinspection Fee $15 Issue Fee $ 3 i I MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By ^ Date Application Issued By - -� ✓}�_ _ _Data Boiler Hood or Type I ❑ Canopy Type 11 ❑ Duct 2 Under Ground Duct - Structural Refrigeration System ! 00.100,000 BTU ❑ i00,000 BTU Duct --Ventilating SUMMA BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ t PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL6q•5�_s�1C'.� PLAN CHECK 25% $ Y OF FEES $MIP $ PERMIT ISSUANCE 1$ ENERGY P.C. $ ! GRADING $ ! MICROFILM $ TOTAL FEE $ Zl,e'� ZE Exhaust System 1:1Multiple ElSystem Repair/Alteration Firepl/Fact. Bit, ICBO # Fire Dampers 2.' Heating System & Ducting ®0-100.000 BTU El 100,000 BT Registers � - '-� i Reinspection Fee $15 Issue Fee $ 3 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting, Goldenrod - Assessor IL CONSTRUCTION AND PLANNING Date APPROVALS Permit # ' . Inspector POOL _- oPA APPROVALS Permit # Date Inspector 1. Temporary•Electrical Service or Pole 52. Pool & Equipment Location 2; Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical,Conduit Utility-Undrgrnd. 54. Forms } " 4. Electrical'Conduit,Undrgrnd. 55. Electrical Bonding , 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test •• 6• Electrical-UFER'Grnd. I 57. APPROVAL TO COVER-GUNITE r :�l , 7, Footings '1 , i, 58. Electrical Conduit-Undrgrnd, B. Foundation 59. Gas Pipe, ❑ Undrgrrid., Test 9. Water.Pipe-Undrgrnd; .. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. ' 3 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 4v 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 APPROVALS Permit # 20. Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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. F.I:RE PREY. FINAL 30., Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating &'Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing ' i 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer _ 43. Backflow Irrigation ; 44• Landscape Irrigation System 45. Sound Attenuation 46. Handicap'Regulations 47. FINAL STRUCTURE & BUILDING- 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PETIT NO. TRACT NO. LOT NO. UNIT NO. CIT.Y'OF COSTA MESA CONSTRUCTION PERMIT 'Project Address t j I P. I� �• C95aill M e SFS , Automatic Washer Construction Pole Sub. Cooking Unit I Z Dishwasher Applicant's Mailing Address Owner's Name ;TROY Lri Ve TniEAr[ Phone TYPE OF CONSTRUCTION NEW El ADD, ALTERATION REPAIR. ❑ CONVERSION ❑ DEMOLISH ❑ OTHER, DESCRIPTION OF WORK/USE OF BLDG. ; Address Fane Motors D(0-1 HP ❑ 1'h - 8 F.A.U. Inc. Solar ❑9-15 HP 1316-15+ 'Fixtures Arch/Eng. License No. Address TYPE OF PERMIT GRADING ❑ TENANT ❑ ELECTRICAL ❑'OTHER FOUNDATION STRUCTURAL ❑ PLUMBING ❑MECHANICAL �' cV-7-6 Contractor's Name_1�`IZg)� EUEC-'rRIC- _Phone V -6rKb G Address (mailing) I�b� ;�`�11F� �i-Da►7llti�a'fD/U n1lb City License No. - 3 n PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION S ZONE GRADING CU. YDS. ACRES LICENSED CONTRACTOR DECLARATION Garbage Disposal ; Standing Sections Remarks: Trash Compactor I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and PERMIT my license is in full,force and effect. License Class -Lice ns No.42 T Date+�` �, Signature ISSUANCE $ PLAN CHECK 25% PLUMBING FEES WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate Bar Sink Showers Backflow Preventer Service Sink - if Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab, C.) _ Policy No. WC.•�I O4 �� pan, �� ' eCertified Copy is hereby furnishe Certified copy is�filed with the cit` ui! i g D Ision- _ Backflow Irrigation Sewer Cap ' Bathtubs t Sewer Connection _1 Date �� tU� 7S S Applicant EXEMPTION FROM WORKERS' COMPENSATION ECLARATION Clarifiers Solar Collectors (This section need not be completed it the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued I shatI not employ any person in any manner so as to become subject to tke Dishwasher Solar Piping Drinking Fountains Solar Tank Workers' Compensation Laws of California. Floor Drains i ' Swimming Pool vviSpa Date Signature •NOTICE: if, after making this declaration, you should become subject to the Floor Sinks _ Urinal - - Workers' Compensation. provisions of the tabor Code, you must forthwith comply with' such provisions or this permit shall` be deemed revoked. Gas Service Outlets Water -Closet' CONSTRUCTION LENDING AGENCY. I hereby affirm that there is a construction fending agency for the performance of the work for which this permit is issued (Section 3097 Clv. C.) Lender's Name _ Interceptors Water'Heater ' Kitchen'Sink - Water Service Lender's,Address _ OWNER BUILDER DECLARATION i hereby affirm that I am exempt from the Contractor's. License Law for the following reason {Section 7031.5 Business and Professional Code: Any city or , county which requires a permit to construct, alter, improve, demolish or repair ` any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 '031.5 by any applicant for a permit subjects the applicant to a civil jenaity of not more than five hundred dollars ($500). ❑ 1,' -as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered ' for sale '(Section 7044, Business' and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- ptetion, the owner -will have the burden of proving he/she did not build or Im- �rove for the purpose of sale). ' l lJ 1, as owner of the property, am exclusiveiy contracting withlicensedcon- 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 builds or improves thereon_ , and who contracts for such projects with a con- _ - Lavatories Auto -Wash P --Trap - Laundry Trays . Roof Drains - - - Reinspection Fae ' $15 Issue Fee $ 3 MECHANICAL FEES goiter ' Hood or , Type I ❑ Canopy Type II ❑ - Duct - Under Ground Duct - Structural Refrigeration System ❑0-100,000 BTU ❑100,000 BTU Duct - Ventilating Exhaust System ❑ Multiple ❑ System Repair/Alteration - tractors) license pursuant to the Contractor's License Law). I am aware that ' proof of their Worker's Compensation insurance should bo provided to me. Firepl/Fact, Bit. ICBO Fire Dampers ❑ l am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this'appiicatlon and state that the above information is Correct. I agree to comply ith all city and county ordinances ti o buildi cons ction, and hereby authorize repre- and state IMIthla sentatives it to entupo the above-mentioned property for -- Heating System & Ducting ❑o-100,000BTU 13 100, 000 BT Registers - ' Inspection s Signature Date �� f far $� Drivers' License or SS Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Seel ! i � 5iE35 A.P. + ' Zone S Main Building: Accessory Building: E T Front B Rear A C R ight K S Left Ping. Ref. dk Parking Req./Provided Planning Notes: ELECTRICAL Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50'+ KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas . ❑Electric Sub Panel Fane Motors D(0-1 HP ❑ 1'h - 8 F.A.U. Inc. Solar ❑9-15 HP 1316-15+ 'Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal ; Standing Sections Generator 00.5 KW 05-15 KW Trash Compactor G.50 ITL. FEES Z O N I N G R E 4 M T S it Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building'Approved By Date Application Issued BY Date ' SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL .$ 4 -rte GRADING $ PLAN CHECK 50% $ SO MICROFILM $ MECHANICAL $ TOTA'L FEE $?� PLAN CHECK 25% $ CONSTSUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL „.-SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location `2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test' 6- Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9• Water Pipe-Undrgrnd. 60, Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63.' Heater & Vent -Final 13. Roof Drains 64, Plumbing System • Final 14. Rough Plumbing 65. Electrical -Final 15. .Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18, Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20.. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43, Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation. 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50, Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY Nn. Date PROJECT ADDRESS: 711 W 1 7TH ST UNIT: E-12 OWNER'S NAME: MESA BUSINESS CENTER ADDRESS: SAME 759-.1569 ARCHIENGINEER: WILLIAM S IMPSON REG.NO.: 8 6'7 ADDRESS: 2222 NEWPORT BL UNIT: NEWPORT BEACH CA 92663 PERMITTEE: JERRY WAYNE HOWARD (213)640-029G ADDRESS: 300 N. CONTINENTAL 320 EL SEGUNDO CA 90245 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 0l the Business and Professions Code. and my license is in full force and effect. CITY LIC.: STATE LIC.: CLASS: -rte: Signature: ORKERS' COMPENSATION DECLARATIDN: I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' ,ompensation Insurance. or a certified copy thereat (Section 3800, Lab. Q. POLICY NO.: EXP. DATE: COMPANY: ❑ Certified copy is hereby furnished. ❑ Certified copy is tiled with the city Building Division. Date: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is lot one hundred (SI O) or less). I certify ttlal in the performance of the work lot which this permit is issued, I shall not employ any person in arry manner so as to become subject to the Workers' Compensation Laws of Cafifornia. Date: Signature: NOTICE: If. alter making this declaration, you should become subject 10 the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there i5 a construction lending agency for the performance of the work lot which this permit is issued {Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' Slate License Law for the :allowing reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct. alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed Pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business ,nd Professions Code) or that helshe is exempt therefrom and the basis for the alleged exenrlftion. Any violation of Section 7031,5 by V applicant for a permit subjects the applicant to a civil penalty o1 not more than live hundred dollars ($500). I 1, as owner of the properly or my employees rwith wages as their sole compensation, will da the work_and and the ❑ structure is not intended or offered for sale iSection 70x1. Business and Professional Code: The Contractors' State Licensa Law does not apply to an owner of a properly who builds or improves thereon, and who does Such work hlmselfihersell or through his or her own employees, provided that such improvements are not intended or offered for sale. Il, however the building or improvement is sold within one year of completion• the owner will have the burden of proving helshe did not build or improve for the purpose at sale). I, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business LSI and Professions Code: The Contractors' State License Lew does not apply to an owner at property who buil or improves thereon and who contracts for such projects with a contractoris) license pursuant to the Con aclorS' State Li 'e Law), I am aware that proof at their Worker's Compensation insurance should be provided to le. ❑ 1 am exempt under Section: B. 8 P. C. for this reasoner Dale: I do hereby certify that l am aware of and understand the requirements III Calilornia,Health and 5a ely Code Sections 25505, 25533, and 25534 ano that I or any future building occupant will/will not (circle one) need to comply with said stale codes and the requirements for a permit for construction or modification from the Au ualsty Management District. Residential construction applications are exempt from these provisions. n Date! Applicant: I hereby cattily shat I have read this application and state that the ab farm . o is r Ct imply ' I city and county ordinances and state laws relating to buitdng construction and here" rize or ,err i his di' enter • e above mentioned properly for rinspection purposes. Date: 3-- ` L / Signature:— _ Driver's License or Social Securily 11541-46 White—Budding; Green—Code Enforcement-. Canary—Applicant•, Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT UNIT COST PERM NO: BE 05139'_ PERMIT NO: BE 051395 PLAN CHECK NO: 00787--91 A GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: ELE STR PURPOSE: ALT JOB DESCRIPTION LEGALIZE 485SF IST FL TI-, 485SF 2ND FL A SQ FT: 970 CLAIM VALUE: 20,000.00 CALC-VALUE: 29,449,0 GROUP OCC: B-2 / COMMENTS: 2ND FLOOR C spa. Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ----------- ---------- ACCESSORY BUILDING---------- FRNT: FT 1N REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42409111 ZNE: MG REF NO: PLANNING NOTES> TI TO AN EXISTING INDUSTRIAL SUITE, TOTAL SQUARE FOOTAGE • > APPROX. 150042�/ #F �E iE -iF # 1E fE 1E � iE it � tf tf +E �(• � �± � �E }� MN iE iE x •1F tf �F IE �f- aE tk •!I . �F +F -iF •)� �(• . � * 1F 3f +E .K. 3f }E• �F . ii• a • � 4r. f• •. +r. * !(• iE-K 1F 3E tf D E V E L O P M'E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: 31tq_ BUILDING APPROVED BY : j\ DATE: 3 !T- APPLICATION ISSUED BY: DATE: 3 It ,r IE ♦!{• iE � }(. �E iF � 3F �+ 1F >~ � � � � IE � #(. � yE !i; � 3F aF � #� #� iE * -1E 9E . !F �- �E � IF •1F -MF �F �E i{• iF �F !E fit• ♦E �:• �F �E 3F -YF � �E 1E a4 �E SF i(• �F fit• �E �E � T4 � }� iF ?E iF � �(• * -1Fif• i(• �[• �¢ � r4 � x• �� iE'}4 ir- � 3F IE �F LF •1F � iF #� #4 #� �(• if +F � i{• a4 * � j4 #R � x �!- �E ♦f LEGALIZATION:Y F E E S U M M R STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANICIRE SMIP/RES GRADING PERMIT 569.00 42 00 �0% SMIP/NON-RES PLAN. 92.46 4,42 ISSUE FEE 15,00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK PAID DUE TOTALS-•---> 615,42 15,00 46 23 676.65 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 63OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE/TUT GRADING PLAN -CHECK 569,00 57,00 4.42 tF a[ IF 1E 4{• K• ai �F �F �F i! �(• X• ?E +E ML ?F iE � �F �(• i*: +F fE � i(• ?f •lE a f a! tf #L � �F i(• ?E if• #E FT v t4 *F !f # � 4F �F if ?!• iF IE +'r �E � iF •1F Y• iF iE +F i(• �• #[• it W � a4 •1F �! +E afi(• iE iF � 3f• � iF �• I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFC 485 OFF -TYPE V -N -AVER 50.60 24,541.00 -S FC 485 OFF -INT. ALTER TYPE V -N -AVER 10,12 4,908,20 ELE 7 FIXTURES LIGHTING 1 ST 20 EA, 5,25 ELE 17 RECEPT/OOTLET 1 ST 20 EA, .75 ,75 12,75 ELE 4 RECEPT/SWITCH 1 ST 20 EA, ,75 3.00 END OF FEES 01 00082461-GGG9296:s TC: DATE: fai/19/S1 TIM: G%:47 0.4:1 V CONSTRUCTION AND PLAM_..,u APPROVALS Permit # DateJInspector POOL jPA 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 Reinforcernent 56, Rough Plumbing & Pressure Test 6. Electrical UFEF1 Grnd. 57, APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undfgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd./� 10, Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor-Finale" f ' 12. Sewer Cap 63. Heater & Vent-Final . 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final f .; 15. Rough Electrical-Conduit 66, Solar System-Final ` 16. Rough Electric Wiring 67. Fencing & Access Approval , 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydra 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ 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 PO. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: , &401 SLOT, L 34. Final Heating & Air Conditioning ! I 35, Final Gas Pipe-Tist 36. Hood or Canopy.- anopy.37. 37.Final Factory Fireplace 1 ' 38. Final Plumbing ti 39. Water Service-Final- 40. Gas Service-Final- ervice-Final41. 41.Solar Domestic-Final 42. Backflow Preventer, 43. Backflow Irrigation 44, Landscape Irriqation System 45. Sound Attenuation 46. Handicap Regulations 'AA If 47. FINAL STRUCTURE & BUILDIIW g •, 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51, CERTIFICATE OF OCCUPANCY No. Date City of Costa Mesa Development Services Department CERTIFICATE OF OCCUPANCY No. Building Safety Division P, O- Box 1200 Costa Mesa. California The Building located at 711 Ra.41•n17t-h . (ini} P..—I2 has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group Ra Occupancy. Use of Building Retail Legal Description 424-091-11 RSee reverse side for Metes and Bounds) Building Permit No BE 451395 Electrical Permit No. BE 051395 Plumbing Permit No Mechanical Permit No. M 052007 Number of apartments and/or guest rooms ISSUED TO: Mesa Business Center 711 East 17th St., Unit E--12 Costa Mesa, Ca 32826 Building Official Toni C'Da Baca r by rr� Ir ��I C-�- Date May 17, 1991 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C. CMF 1015.46 rev. 1/83 White - Owner; Canary • Numerical File; Pink - Bldg. Permit File CERTIFICATE OF COMPLIANCE PAYMENT OF SCHOOL FACILITY FEES NEWPORT -MESA UNIFIED SCHOOL DISTRICT Developer/Applicant: 4, Address: ;c D _ l�( CJW T/Alc-AlT,ej L c Yr7 �%� �i Z�, �C ri��yG�y��C/_� yo Z u, Telephone Number: '? ( -5 —�j yy'-Ci 7- '9"0 Tract/Parcel and Lot Number(s): Location of Project: 2/1 Wx_5,-r Uio sT Number of Square Feet of Residential Space x $1.50 Total' Number of Square Feet of Commercial and ,/ �r- Industrial Space _45 x $0.25 Total Commercial/Industrial Project is: (Check One) Mini -storage Movie Theater Racquet/Health Warehouses Heavy Industrial Regional Shops Light Industrial Motel Bank Neighborhood Shops R & D Hotel Medical Office Office Park Preschool Auto Repair Hospital Large Office Office Bldg. Restaurant Fast Food The provisions of Government Code Section 53080 are not applicable. This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and 65995.' Checks are to be made payable to Newport -Mesa Unified School District. Business Manager Newport -Mesa Unified School District The above representation as to square footage is true. Developer/ Applicant agrees that if it is later determined that such representa- tions are not true then this certificate hal au omat' ally terminate and the appropriate City/County shall be no i . Date: )hq A Developer Applicant (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT ,Job Address: 711 W 17TH ST Status: ISSUED Suite No F Applied: 10/30/2002 Issued: 1013012002 Vicinity: BLDG F (ROOF TOP) �� ✓ V - - Parcel Number: TPN02004 OR, b ISSUED BY: Applicant: WILLIAMS, KIMBERLY Address: 1401 BAXTER ST Phone: (310)253-5229 ANAHEIM, CA Zip: 92806 Owner: MESA BUSINESS CENTER ASSOCIATION Address: 711 W 17TH ST COSTA MESA, CA Contractor. ALASKA AIR Address: 1401 BAXTER ST ANAHEIM, CA Phone: 949-672-9035 Zip: 92627 Phone: (310)253-5229 Zip: 92806- License: 2806License: 574615 SCOPE OF PERMIT BLDG "UNIT F" CHANGE -OUT AND RELOCATION OF A PACKAGED FAU/COMPRESSOR ON THE ROOF TOP OF AN EXISTING INDUSTRIAL BLDG (412,000 TONS; APPLICANT STATED NEW UNIT 1S OF EQUAL WT TO EXISTING). 1 INST FAU < 100K BTU, 1 COMPRESSOR 3-15 HP1500K BTU. NO OTHER WORK AUTHORIZED BY THIS PERMIT. NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned for a period of 160 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2445-d6 (6=) FEE SUMMARY Quantity . Quantity ISSUE FEE $23.50 Repair I Alt Absorbtlon Unit $0.00 0 Inst FAU <100 k BTU $14.80 1- • Repair I Alt Refrigeration Unit $0.00 0 Inst FAU >100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00, 0 Evaporative Cooler $0.00 0 Inst / Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys <100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys X100 k BTU $0.00 0 Compressors / Absorption Systems Gas Piping $0.00 0 Up to 3 hp 1 100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp / 500 k BTU $27.15 1 Hood w/Mech Exhaust $0.00 0 15 To 30 hp /• 1,000 k BTU $0.00 0 VAV Box $0.00' 0 30 To 50 hp 11,750 k BTU $0.00 0 Vent Fan / Single Duct $0.00 0 Over 50 hp I Over 1,750 BTU $0.00 0 Appliance $0.00' "o Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate App] Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers < 10000cfm $0,00 0 30 to 50 hp 50.00 0 Air Handlers > 10000cfm -$0.00 0 Over 50 hp $0.00 0 Floor Fumace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned for a period of 160 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2445-d6 (6=) DECLARAMNS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self- Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' oompensation insurance, as required by section 3700 of the Labor Code, for the performance of he work for which this permit issued. My workers' compensation Insura-gcam and pollcy number are: Carrier: ��e "_W17 Policy Number: ��j (This section need not be completed If the permit is valued at one hundred dollars (S 140) or less.) ❑ I conity that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so es to be ca subject to the workers' compensation laws of California, and agree that If I should become su jBG-lei a workers' compensation provisions of Sect73o7o 00 the Labor Code, I shall forthwith comply with these provisions. ( Applicant Signature: Date; D WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COvEAAGE IS uNLAWFuL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PtNALTIEA AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($1 DDADO). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 370a OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am llcen d TTIlons Df Chapter 9 (commencing with Section 7000) of Divlslon 3 of the Busin r! Professlons Cod , and my license is in full force and effect. Lic, of Class 4 b Contractors Signature: Date: 102- CONSTRUCTION ZCONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aNlrm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec, 7031.5, Buslness and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500),): ❑ I, as owner of the properly, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Coda: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Dete: Owner ID verified by drivers license. Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, Lo. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more then thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, i will not employ anyone to do work which would requlre a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a Hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Deportment by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 (31 the Califomla Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _...........................................—.—_................. --... _................ _..... ..................... _............................................ ..__... ............... ..—....................... --....._.._..—...__._....._ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No Section 25534 of the California Health and Safety Code provides that the Costa Masa Fire Department may require the preparation, corWicatfon and filing with the Fire Department of an RMPP by businesses whlch are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully compiled with? ❑ Yes ❑ No 5 Does or will the applicant or present or tutu re building occupant require for the work which Is the subject of thisa plication a ermit for such Construction or modification from the South Coast Air Quality Management District or tram any other air pollution control district or agency? Byes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 WIN any part of the facility to be constructed under this permit be within 1000 lost from the outer boundaries of a school? ❑ Yes ❑ No (if yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). _ ........................---._...........--- ...._.._..._. _ _..._.._........---._.......................... __.......................... _.............. .................................................................................._ ..... ----- 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safely Code Section 42303 been made? {] Yes ❑ No 6 (If yes", attach certificate of compliance from the appropriate air pollution Control officer). CERTIFICATE OF COMPLIANCE: I comfy that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Dole: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature egalOwner(s) r, And/Or A ihorized cant (� Date CODE INSPECTIONTYPE 2M 1L{]717e4$ CODE f INSPECTION TYPE I2AIE 1616 Fixed System Final Fire Prevention 206 Final Mechanical ha l —oq b,1N 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final BlDcklRataining Wall 212 Flnal Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final She 204 Final Demolition 250 Final BuildinglOccupency 1' COSTA MESA BUILDING -SAFETY DEPARTMENT P_n_ Rnx 7700 COSTA MESA. CALIFORNIA 92626 For Applicant to Fill in Completely BUILDINGpD ADDRESS iL7 OWNER /V MAIL ADDRESS `r LS 7"E O CITY V TEL.NO. -yf CONSTRUCTION LENDERRAI H Q BRANCH ADDRESS ARCHITECT TEL.b 4 Z'54+ OR ENGINEER caul N ADDRESS E D CONTRACTOR ADDRESS G p= b TE L. CITY I NO. -57/�' STATE CITY't LIC. NO. LIC. NO. SIZE NO. OF BLDGS. OF LOT AL'ACR&S NOW ON LOT USE OF L 14H -r 1 )aD 1 S7•RrA-z h-Cj E#WfiT4 G BLDG. �„� fz e I SIZE OF V NO. OF NEW BLDG. O /� Z� ROOMS ZTORI ES Z EXTERIOR WALL ROOF COVERING /V COVERING USE OF BUILDING ANQ WORK TO BE PERFORMED 16 OT An To P,6C. 06-5-1c es I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I em properly licensed as a Contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. Signature of THE -T9a-1I1UUcs7;p+ers.r �uiwo Permittee Authorized Agent PAIEInn(� yy�� ,4AB-i-71ACFicrU� d�2� 77h ft �4.45 PRLICATION FOR BUILDING PERMIT REC I V tY I L TE jREV4V� O TE ISSU ff PEFIMIY NC A.P. NO. _Qq, h7 BUILOING `bU 1 ADDRESS /] �L1Zc:uPor TRACT rnt4d LOT `Jj I BLOC QWNER I� I Z �_.TMAE�i `�%N 1. ! _ VALUE .l _A A_mI FIRE ZONE 41EjD= GROUP APPROVEp.• By DATE THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m ZONE NO. OF PLANS USE OF NEW-tA14eo .1 J BUILDING YARDS APPROVED MAIN BUILDING YARDS APPROVED ACCESSORY BUILDING (FROM C/L ST,REET) / / . REAR DISTANCE BET MAIN SLOGS. VAR. G.U.P. + / APPROVED / FT, BET. MAIN & ACCESS. BLDGS. DATE APPROVED 11 v TAX Co m 600 o SQ FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m VALUATION au PERMIT FEE $ N m E PLAN CHECK $ E H� J LL TOTAL FEE $ ��+ A Z UU UU CL U Z_Q O aCIO J 0 _j fn Q W 00 J m -- Q Ufn ZQ lu q: d l,u LU Z _j0 cc _J= ww 0= ZH U fn � 0 9P. 17 l�ca�U�O 695 G-`- 28t.5� COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 i' PCATION FOR BUILDING PERMIT For Applicant to Fill in Completely BY DATE RECEIVED DATE ISSUED —/ BUILDING L , _ t ADDRESS W [ pi; OWNER !V U UlU D A.P. NO. N905 ¢ MAIL BUILDING / � N S�D�) ADDRESS � ADDRESS ( I/lJ , TEL. CITY NO, TRACT LOT BLOCK CONSTRUCTION EW LENDER BRANCH OWNER U D ADDRESS C VALVE ARCHITECT S TEL. OR ENGINEER FIRE ADDRESS ZONE TYPE'131 GROUP ' APPROV CONTRACTOR BY DAT r -ADDRESS TEL. ZONE NO. OF USE OF NEW CITY NO. PLANS BUILDING STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO.OF BLpCnS. FROM C/L STREET) OF LOT NOW ON LOT ERONT FT. FT. USE OF ExtSTtNG BLDG, R. SIDE FTw F SIZE OF NO. OF NEW SLOG. ROOMS STORIES L. SIDE FT. FT. EX'T'ERIOR WALL ROOF COVERING COVERING REAR FT. FT. ' USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN SLOGS, ACCESS. SLOGS, VAR. 46 DATE C.U.P, # APPROVED APPROVED RX DATF I hereby acknowledge that I have read this application and state f1 that the above information Is correct and agree to comply with �J all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY., am exempt from the provisions of the State of California Business and Professions Cocie, Division 3, Chapter 9. VALUATION PERMIT FEE $ Signature Of Permittee $ PLAN CHECK $ TOTAL FEE $ -Z Authorized Agent i' CITY OF COSTA MESA CONSTRUCTION PERMIT 6 -/3i�"?a Applicant to fill In all spaces except those within heavy bOraai lines and sign all appropriate declarations. Project Address 7 t h s t r e e t Applicant's Mailing Address; 241'8 MacArthur Blvd. . 'C.I Owner's Name TX -0— Tn PstmPnt Fund Phone 549-298E Address 4'421 ; rr-h 8 t reet s New -ort Beach_ ArchlE ng. W m- L- P e r e r a A s s P reense No. Address 2418 MacArthur Blvd., _Corona del Mi Contractor's Name Phone Address (meilingl City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code. and my license Is In full force and effect. License Class License No, Data Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate T' Workers' Compensation Insurance, or.a certified copy thereof (Section �''90, Lab. C.) 11cy No. 5242001683- Company Argonaut eCertified copy Is hereby furnished. Certified copy Is filed with the city Building Division. Clete Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ;This section need not be completed If the permit is for one hundred ($100) or fess); 1 certify that In the performance of the work for whi thispermit Is Issued I shall not employ any person In anmanner so as t'o become subject to tke Worke Co s tion Lows of Caly if n Date L Signature NOTICIEi If, after making this declar t on, you sh uld become subject to the Workers' Compensation provisions the Labor Code, you must forthwith comply with such provisions or this permit -shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097 Civ. C.) Lender's Name Lander's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Codei Any city or county which requires a permit to construct, alter Improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 t erefromyand the basis for the alleged examsubtion. Any violation of Section ^_ Ity of not morethannt for a five hundred r dollars ($500)mit cts the applicant to a civil as owner of the property or my employees with wages' as their sole L compensation will do the work, and the structure Is not Intended or offered for sale. (Seellon 7044, Business and_ Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for ' sale.' If, however, the bulldin(I or Improvement Is sold within one year of com- pletion, the owner will have he burden of proving he/she did not build or Im. ' Te for the purpose of sale). , is owner of the property, am exclusively contracting with licensed can. tractorst6 construct the project (Section 7044, Business and Professions Coda: The Contractor's Llcense Law does not apply to an owner of property who builds or lmproves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Cont,actor's License Law). , ❑ 1 em exempt under Section B. & P. C. for this reason , Date Owner ' l�� 1 hereby certify that I have read 445 application and state that the above Information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of - this, city to enter upon the above-mentioned property for Inspection p poses. Signature Data - Drivers' U4Ase or SS MIT NO. TRACT NO. LOT NO. BLD 11096 • 1 F, 2 B TYPE OF CONSTRUCTION NEW 17 ADD XffALTERATION LJ REPAIR . M .❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK Exterior Alterations - Trash Enclosure TYPE OF PERMIT LJ GRADING LJ FOUNDATION CISTRUCTURAIL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL r ❑ IOTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATIONS 800-00 ZONE GRADING CU.YDS. ACRES Remarks: P. C. #20-84S PLUMBING FEES Bar Sink Showers Backflow Preventer Backflow Irrigation Service Sink Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinkin6 Fountains Solar Tank Floor Drains Swimming Podi w/Spa Floor Sinks Urinal Gas Service -Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories P --Trap Roof Drains Reinspection Fee $25 � Issue Fee $ 3 MECHANICAL : FEES Boller Hood or • Type I ❑ Canopy Type 11 , r Duct 'Under Ground Duct - Structural Refrigeration System ❑Q100,000 BTU C1100,000BTU Duct - Ventilating Exhaust System ❑ Multiple ❑ . System Repair/Alteration Firepl/Fact. Bit, iCSO ## ', -- Heating System & Ducting 00.100,000,BTU ❑ 100,000 EFTL Reinapaction Fee $25 -Issue Fee $ 3 CMF 0865.46 raw. 12/83 White - Buildingl Canary - Applicant; Pink - Acopunting; Goldenrod - Assessor A.P. + L}2j�+— S Main Building: E T Front B Rear A C Right K 5 Lef Ping. Ref, -0 7 Parking Req./Provided Use of Building: Planning Notes: Automatic Washer Construction IRcileSub. Cooking Unit Dishwasher Dryers ❑Gas ®EI= Fen F.A.U. Fixtures Device Boxes 0114 5/1-0/86 Zone Accessory Building: Park. Fees $ ELECTRICAL Outlets Switches Gerbege Dispssdl Generator'10151KW 05-15 KW Reinspection F� Transformer ❑ 15-50 KW ❑ 50 + KW Meter ❑up to 100 amps. Meter Dover 100 amps Sub Panel Motors El 0-1 HP ❑ 1'h - 8 Inc.Salar ❑9.15 HP 016-15+ I Microwave Pole Light Range .Sign' Standing Sections Trash Compactor S25 I Issue Fee PUBLIC SERVICES REQtARFMENTS: Zoning Approved Ift Building ApproleadBy Application Issued) Bt► 8 U I LD I Nle IFIERa41T PLAN CHECK PLUMBING PLAN CHECK 29X ELECTRICAL PLAN CHECK 50'!6 MECHANICAL P I.A N CHECK 25% L SUMMARY OF FEES S ,rte u SMIP' is PERMIT $ ISSUANCE $ ENERGY P.C. S GRADING S MICROFILM S { TOTAL FEE S I5:o: -Ti. Z O N I N G R E O U I R E M E N T FEES $ 3 ' •�CONSTRUCTION-AND PLANNING _ - : ' - - POOL &• �- t :, •� •- a r- • n �;� "APPROVALS Permit # Date - Inspector 7 • -_• APPROVALS ,,: ,Permits# = ;pate iri'sector w Y 1 Temporary Electrical Service or Pole - .52. Pool & Equiprrienf Location - r, z: 4, _ 21 .Soil Pipe-Undrgrnd. - 53. Steel Reinforcement - 3� Electrical Conduit Utility-Undrgrnd, 54. Forms "4:' Electrical Conduit-Undrgrnd:. 55.' Electrical Bonding. _ ; _ nr _ 5." Steel Reinforcement 56. Rough Plumbing'& Pressure Test 6. Electrical LIFER Grnd. r 57; APPROVAL TO COVER GUNI7E:• r 7. Footings' Z �� 58. Electrical Conduit=Undrgrnd. 8. Foundation - 59. Gas Pipe, 0 Undrgrnd Test: 9. WaterPipe-Undrgrnd. 60. Backwash Lines,;P,Trap, 0 Undrgrnd.= t - 10. Structuraf Floor System 61. APPROVAL TO DECK 11. PropertVSewer Line & House Connection 62. Backwash & Receptor Final 12. Sewer Cap _ 63. Heater ,& Vent -Final' . 'r 'T 13. Roof Drains 64. Plumbing System Final Y ? 14. Rough Plumbing 65, Electrical=Final``' 15. -Rough Electrical -Conduit - 1 66. 5olarSystem•Final r -" r- -- - - - - 16. Rough Electric Wiring - - 67,E Fencii,g &Access Approval 17: Rough Wiring Sign' { 68. APPROVED FOR PLASTERING- 18. Rough Electrical -T BarrCeil'ing _ ' 69. POOLISPA SYSTEMS FINAL 19. Rough Heating &Air Conditioning ! FIRE DEPT, REQUIREMENT f APPROVALS, Permit# t ; } 20. Rough Factory Fireplace 21. Ducts, in Structure f ! 70. Underground Hydro~ i' i ix 22. Ducts, Ventilating ! 71. Product Piping 0Gas %rpOil 23. Gas Pipe -Rough & Test = + 72. � Underground Flush 24. Roof. Framing - e 73.' Undergrnd. Storage Tank•❑ Gas ❑;Oil r ` 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 ' t'- 77. FIXED SYSTEM FINAL 29• .frisufation - 1 78. FIRE PREV. FINAL ! 30, Drywall Nailing -;HEALTH DEPT. REQUIREMENT l 31, Plaster Brown Coat 79., FINAL INSPECTION - 32, Electrical Power Meter -Final BUFOOD CERTIFICATE ISSUED i 33, Final Electric Notes: i• 34, Final Heating & Air Conditioning !' 4 35, Final Gas Pipe -Test 36, Hood or Canopy 37. Final Factoryl Fireplace► 38. Final'Plumbing 39, Water Service -Final 40,Gas Service -Final k • � •' -' r 41. Solar Domestic -Fina! 42. Backflow Preventer , s t �+ 43, Backflow Irrigation , 44. Landscape Irrigation System 45. Sound°Attenuation ' ! _ I I ;li �, r ►c- 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed' i I ; " ' 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CER TiFICATEOFOCCUPANCY r 2. No, T Date' - w Applicant to fitl in all spaces except those within heavy border lines and sign alt -appropriate declarations. f CITY OF COSTA MESA CO STF,IIIO�jI PERMIT. P MIT NO TRACT NO. LOT NO. UNIT NO / Project Address % _`r — Applicant's Mailin ddress /6 Owner's Name hone Address Arch/Eng. License No. Address l / Contractor's Nam -_Phone % _ Z� 7 . Address {rnailirlgl City License No.— LICENSED CONTRACTOR DECLARATION !-hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and , my license is in for an eflact. d Licen Class Icense No• Date — Signature 44 WORKERS' COMPENSATION 0 RATION ! hereby affirm that ! have a certi cafe of consent to self -insure or a certificate workers' Compensation Insurance, or a certified Copy thereof (Section Lab. C.) i'%Iicy, No. Company Certified copy Is hereby furnished. Certified copy Is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This sectionneed not be completed if the permit is for one hundred ($100)- or less): I certify that in the performance of the work for which this permit is Issued, I shall. not employ any person In any manner so as to become subject to the Work ery CQrppe ion Laws of F-ft Ia..," Date el�.Jf� 5ignat, 'NOTICE: If, after making this de, ou should become subject to the Workers'. Cornpensalion provisloe Labor Code, you must forthwith , comply 'with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction. lending agency for the performance of tfie work for which, this permit is issued .(Section 3097 Cly. C.) Lender's, Name;_ - Lender's Address OWNER'BUILDER DECLARATION^ I hereby affirm, that I am exempt from the Contractor'S_License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair . any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 herefrm and the basis for the alleged exemption. Any violation of Section J.o r r by any applicant for a permit. subjects the applicant to a civil it -of not more than five hundred dollars (5500). ;.] I, as owner of the property or .my emplovees with wages as their ,sofa compensation, will do the work, and the structure is not Intended or offered for sate (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon,•and _who contracts for such projects with a con- tractors) license pursuant'to the Contractor's License Law). I am aware that proof of their worker's Compensation insurance should be provided to me.' ❑ ! am exempt under section B. & P. C. for this reason , Date Owner I hereby certify that I have read this application and state• lnat the, above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of t s • Ci to enter -upon the above-mentioned roperty ,,for inspection se � Signature , Date4� —2 ffS Drivers' &Q6nse or SS V TYPE OF CONSTRUCTION NEW ADD U ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ' ❑ OTHER A.P. �I DESCRIPTION OF wORK1USE OF BLDG. S Main Building: E TYPE OF PERhll1T GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear ❑ ,OTHER - PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION S SI Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # , Remarks: Planning Notes: FEES 5874 7/02/85 Iq„50 TL Zone Accessory Building: Z O N N G R Parking Req./Provided E Q M. S, Bar Sink, Showers ELECTRICAL FEES — Backflow Preventer Service Sink '2- cc Automatic Washer Construction Pole Sub. '+ Transformer ❑ 15 56 KW r ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors t Dishwasher- Meter ❑over •100 amps _�-• +_. ,_ _ Dishwasher Solar Piping Diyt:rs ❑Gas ©Elec_tric Sub Panel Drinking Fountains Solar Tank Fan Motors 13 0-1 HP Cl 1 h - 8 Floor Drains Swimming Pool vv/Spa F.A;U. Inc. Solar 09-15 HP 016-15+ Floor Sinks -Urinal Fixtures ' Microwave Gas Service Outlets Water Closet Z Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink' ' Water Service 2 Switches Sign Lavatories , Auto -Wash Garbage Disposal ; Standing Sections 0—Trap' Laundry Trays Generator 130.5 KW ❑5.15 KW Trash Coinpactor Roof Drains. Reinspection -Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By v _ _.—Date 771 Boiler Hood or Type 1 ❑ Canopy Type 11 ED Duct -Under Ground Duct - Structural Refrigeration System 130.100,000 BTU ❑ 100,000 BTU Duct - Ventilating SUMMARY QF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ 1_w� ISSUANCE $ PLAN CHECK 25% $ i • 5_0 ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM • $ MECHANICAL $TOTAL FEE $ D. 5D PLAN CHECK 25%, $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit.ICBO# Fire Dampers , Heating System & Ducting 00.100,000 BTU ❑100,00013T Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev, 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNINGPOOL .. APPROVALS Permit # Date Inspector• f 'A APPROVALS Permit # Date , Inspprmr 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.'Electricai,Conduit-Undrgrnd. 55. Electrical Bonding 5.. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grrid. t • 57. APPROVAL TO COVER-GUNITE 7:'Footings 58, Electrical Conduit-Undrgrnd. 8 Foundation �- 59. Gas Pipe, ❑ Undrgrnd., Test 9. fWater,Pipe Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10- Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection ; 62. Backwash &Receptor -Final 12. SewerLCap , 63. Heater & Vent -Final , 13. Roof Drains i 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) 81 Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. 'Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test a 36. Hood or Canopy -37. Final Factory Fireplace 38. Final Plumbing 39, Water Service -Final f9_41- 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 _ (714) 754-5273 - Fax (714) 754-4656 - www.ci.costa-mesa.ca.usING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 711 W 17TH ST Status: ISSUED Suite: F Applied: 05/29/2002 Vicinity:" BUILDING F Issued: 05/29/2002 Parcel Number: TPN02004 Zoning: Applicant: GOMEZ, PAUL _ ISSUED BY: Address: " - Phone: 949-548-1645 Zip: /f Owner: MESX BUSINESS CENTER ASSOCIATION Address 711 W 17TH ST ' Phone: 949-672-9035 COSTA MESA, CA Zip: 92627 "�� /'i `�. �•• A Contractor: P.ETRONELIA.ROOFING 'Address:; 2626 NEWPORT BL ` Phone: "(949) 548-1645 COSTA MESA, CA Zip: 92627/ License: ",460707 Arch Eng: Address: -� �" Add ess:, Phone: . Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING BUILT UP`ROOFING FOR 12 UNITS IN BUILDING FINSTALL BASE = 2 PLY CAP. ASTM D5957. FEE SUMMARY Plan Check: $0.00 Calc Valuation: 535,000.00 Permit: $492.75 - " _ Claim Valuation: 535,000700 SMIP Res: $0.00 SMIP Com: $7.35 Other: $0.00 Inspection: $0.00 Total: $500.10 PLANNING & ZONING SETBACKS- MAIN ETBACKSMAIN STRUCTURE, Front. , 0-,0 Rear 0-0 Left 0-0 Right 0-01, ACCESSORY Front- 0- 0' , Rear 0-0 Left 0-0 Right 0 0 PARKING Existing: ,,,0`: Required: ' � 0 Proposed: 0' ' J NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 44848 (M) WORKERS' COMPENSATION DECLARATION: hereby affirm under penalty of perjury one of the following declarations: have and will maintain a certificate of consent to self. Insure for workers' compensation, as provided for by section 3700 o1 the Labor Code, for the performance of the WC,r,,.*Mr,:0y` k for which this permit is issued. a� ve and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Ade, for the performance of the work for which this permit is Issued. workers' oomph tu.on f+osurence rrier and policy number are: 1 Si"A -' E Y�r d [t,r~l . —r-; s . _ Policy NumW: I �l (This section need not be completed If the permit Is valued at one hundred dollars (S100) or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to became subject to the workers' compensation laws o1 Califomia, a agree that 111 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, i shall forthwith comply with t se provisi s. / Applicant Signalure: Date: �4 WARNING: FAILURE TO SECURE WORK RS' COMPENSATION COVERAGE IS UNLAWFUL ANP SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 570B OF THE LABOR OODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect. Uc. N Class 0 Contractor's Signature: Data: a � — CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency tot the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any qty or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 703t.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Lew does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose a1 sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Dela: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's Ucanse No. Expires: Verification of Ownership by (type o1 document, i.e. - property tax bill or daed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person Is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Tlllo 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet o1 compressed gas at standard temperature and pressure). ...................__._......_......_........................................................................._.—__............................... .. 2 Does Or wi[I the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .......... ...__................_.._..................................................................._.............. ............—........._................_........ ........................................... __.— ........ _..... _......... .—.... _................ _—.............................. 3is or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? es No Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ---......................._............—_._.......................................................----.._._ __.. —............................................. ^-------............................................................ a If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of thisa plication a�ermit for such construction or modification from the South Coast Air Guality Managemont District or from any other air pollution control district or agency/. Eyes L ] No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will an rt of the facrli to be constructed under this rmit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (11 yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application, have allot the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: l certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of penury that I have read this application and state that the information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. atur Of egal Owner(s) C �� AndlQr Odzed Applicant J Date (j CODE t. INAPECT1oN TYPE UU INTITIA CODE;l INSPECDON TYPE U3 It{IQ111L5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pod Spa Final 208 Final Plumbing 200 Final Re -Roof ;7 210 Final Electrical 201 Final BlocklRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Placa 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Buitding/Occupancy CIT#( OF COSTA MESA 1-� ' /3 0 r6— CONSTRUCTION PERMIT Project Address 713 W_ 17th Street Applicant's Mailing Address : 2 4 18 M a r_ A r t h it r- B 1 vd _, C Owner's Name TroW Tnve-tmPnt___Fund hone 544T79$ Address 4321 Birch St. , Newport Beach Arch/Eng. Wm . L . Pereira A S S OPcense No. Address 2418 MacArthur Blvd. , Corona del M Contractor's Name hone Address (mailing) City License No, LICENSED CONTRACTOR CLARATION I hereby affirm that I am licensed under provisions Of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate ,f Workers' Compensation Insurance, or a Certified copy thereof (Section 500, Lab. C.) 01 c No. 524200016B3Company Argonaut eCertified copy is hereby furnished. Cer fl d o y Is filed with the city ullding Dlvis n Date Applicant EXEM TION FROM WORKERS' COM ENSATION DECLARATION (This section need not be completed if—the permit Is for one hundred ($100) or 1055), I certify that in the performance of the work for which this permit ES Issued I shall' not employ any person in any manner so as to become subject to the Workers' Compensation Laws Of California, Date Signature NOTICE: If,iafter making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Comply with such provisions Or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5'Business and Professional Code; Any city or county which requires a permit to construct, alter improve, demoilsh or repair any structure, prior to Its issuance, also require. the applicant for such permit 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 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 131.5 by any applicant for a permit subjects the applicant to a civil salty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to"an owner of a property who bullds or improves thereon,- and -who does such work himself/herself or through his or her own employees, prdvFdod thaE such Improvements are ndt Intended or offered for sale. If, however, the building Or Improvement Is sold wlthln one Year of Com• platten, the Owner will have the burden pf proving he/she did not bu[Id Or Im- rove for the purpose of sale}. I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Busin05s antl PrOfesslon5 Code. The COntracto r. Licari a LdW Oe5 sol apply to an owner Of property who bullds or improves thereon, and who contracts for such projects with a Con- tractort.) Iicen se pursuant to the Con tra Ct OT'. Ll can Se Law), ❑ I am exempt under Sectlon B. & P. C. for this reason Date Owner I hereb certify that I have read i. application and state that the above Informs Ion is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize reore- Sentatives of this city enter upon the above-mentloned property for Inspection u uses, Signature Date ae Drlvars' License or;SS plicant to fill in all spaces except 01M. within heavy border lines and sign all appropriate declaretions. PERMIT NO. TRACT NO. LOT. NO. - BLDG. NO. 11096 1 & 2 1 F TYPE OF CONSTRUCTION NEVJt' A$D LA ALTERATION LJ REPAIR M P CONVERSION ❑ DEMOLISH ❑ OTHER A P y2 - hr� I_ DESCRIPTION OF WDRK V`t IS Main Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear r ❑ •OTHER A PROJECT DESCRIPTION SCI. FT. OCCUPANCY 13-2 C Right CON STRUCTION TYPE VALUATION $ 7 5 F26 4 _ 00 S Left ZONE GRADING CU.YDS. ACRES Ping. Ref, 7— Remarks: — Parking Req./Provided Use of Building: PLUMBING FEES Planning Notes: H Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee S25 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Cl Firepl/Fact. Bit. ICBO qh Heating System & ducting ❑0-100,000 BTU-Cl100,000BT Reinspection Fee 1 $25 CMF 0865-46 rev, 12/83 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Issue Fee Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System 130.100,000 BTU 1:1100,000 System Repair/Alteration Issue Fee 01,_-9 5/In1ill •a=17 st} 06 Zona i✓i � Accessory Building: Z O N I ' N G R E % Park,Fees $ Q U I R E M EOR _ N T ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50.KW ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter Clover 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors 130.1 HP ❑ 114 - 8 F,A.U. 1nc.Soler ❑9.15 HP•016-15+ Fixtures Microwave Device Boxes' - Pole Light . •' 1 Outlets Range • Switches Sign Garbage Disposal Standing Sections -- Generator ❑0.5 KW ❑5-15 KW Trash Compactor S 3 Reinspection Fee $25 ';Issue Fee $ 3 FEES PUBLIC SERVICES REQUI EM(E S: .1 - - Zoning Approved By ,VJ C' Building Approved By, + Date Application Issued By --j at SUMMARY OF FEES'. f - BUILDING%PERMIT $ I1�r0 Sfylp, h"ti '$ i PLAN CHECK $ PERMIT PLUMBING •a'$ '• .ISSUANCE $ PLAN -CHECK •255' $ ENERGY P.C. $ ELECTRICAL '. $ GRADING '$ .PLAN CHECK ' 50%'t$ _ 4MICR0FILM $ MECHANICAL • $ ~ TOTALFEE . $ GG r S 3 PLAN CHECK ':25%.$ t/ V CONSTRUCTION AND PLANNING • APPROVALS Permit #_ Date Inspector POOL & . APPROVALS Permit # Date Inspector 1,- Temporary Electrical Servide or Pale 52. Pool & Equipment Location > 2.. Soil Pipe-Undrgrnd. 53, Steel Reinforcement - 3. Electrical Conduit Utility-Undrgrnd. 54. Forms , 4. Electrical Conduit-Undrgrnd, 55.• Electrical Bonding 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test ; 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE . 7. Footings 58. Electrical-Conduit-Undrgrnd.- - 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. . '10. Structural Floor System 61. APPROVAL TO -DECK -11, Property Sewer Line & House Connection 62. Backwash & Receptor -Final. 12. Sewer Cap 63. Healer & 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/SPASYSTEMS-FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT - APPROVALS Permit # 20. Rough Factory Fireplace 21-f Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush T 24, Rdof Framing - 73. Undergrnd, Storage Tank O Gas' ❑ Oil 25. R�'of Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing �. 76. Dry Standpipe - 28. Lathing & Siding e 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:4 34, Final Heatin-g & Air Conditioning i 1 35. Final,�Gas Pipe -Test 36. Hood br Canopy 4 37. Final'Factory Fireplace 38, Final Plumbing 39. Water�Service-Final y� 40. Gas Service -Final 41. Solar Domestic -Final : 42. Backflow Preventer 43. Backflow Irrigation 44, dscape Irrigation System -7 45. So nd Attenuation 46. Han 'cap Regulations _ 47. FINJL STRUCTURE & BUILDING r t 48. Specia equirements Completed i } 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 1 _ 51. CERTIFICATE OF OCCUPANCY No. Date' , - , 4 -- /ner ll (!�-Z_&C T. Applicant to fill In all spaces except these within heavy border lines and sign all appropriate declarations. LN I Q -r COSTA MASA CON�7RUC�ION rL_K ZT� PERMIT NO. TRACT NO. L07 NO. UN17 NU. "Project Address Applicant's Mailing Address Owner's Name - Phone ^ry Address _ Arch/Eng. License No. Address �,/ Contractor's Nam �' L Phone L_�U Address (mailing) City License No. Ny d LICESED CONTRACTOR OECLARATION I hereby affirm that I am licensed under provisions of -Charter 9 (commencing With section 7000) of Division 3 of the Business and Professions Code, and my license is In full forte and effect. License Class License No. S`S Date 2. Signature WORKERS' COMPENSgTfON DEC RATION I hereby affirm that I have a certifl to of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section '3800, Lab. 'olicy No. C. S -;tCompany p -r Certified copy is hereby furnished. Certified copy Is fil@d_with the city B l ing Division. Date r—:z Applican! ' EXEMPTION FROM WORKERS' COM NSATION DECLARATION (This section need not tie completed If t e permit Is for one hundred {E100) or less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensatiorl Laws of California.' Date _Signature 'NOTICE: if, after making this declaration, you should become Subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY ' I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued .(Section 3097 Civ. C.) Lander's Name _ Lender's Address OWNER BUILOER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of- -Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant- to a civil ,enalty of not more than five hundred dollars ($500). I, as owner of the properly or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and. who dots such work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold Within one year of com- pletlon, the owner will -have the burden of proving he/she did not build or Im- rove for the Purpose of sale), 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for Such projects with a con- tractor(5) 11Cense pursUant*t0 the Contractor's Llcense Law). I am aware that proof of their Worker's Compensation insurance Should be provided to me. ❑ 1 am exempt under Section S. b P. C. for this reason Date Owner. I hereby certify that I have read this application and State that the above information is correct, t agree to comply with all city and county ordinances and state laws relating to building cons ruction, and hereby authorize repre- sentatives of this City to enter up the above-mentioned property for Inspection Purpo-SO.' d � �5 � Signature Date , Drivers' Licen,pI5 or SS TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR Backflow Preventer ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Backfiow Irrigation A.P. 36 DESCRIPTION OF WORK/USE OF 8LDG. Sewer Connection Clarifiers Solar Collectors }, Dishwasher Solar Piping 5 Main Building: Floor Sinks Gas Service Outlets Interceptors Urinal Water Closet Water Heater E Water Service TYPE OF PERMIT Li GRADING FOUNDATION STRUCTURAL_ T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL $ PERMIT ❑ PLUMBING A Rear .OTHER PLAN CHECK 25% C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K S CONSTRUCTION TYPE VALUATION $ S Left ZONE GRAOfNG CU.YOS. ACRES Ping. Ref. # Remarks: ( S0(71_1!!5Planning $ fid" • 00 Notes: $ �- PLUMBING FEES Bar Sink Showers Backflow Preventer Service Sink. Backfiow Irrigation Sewer Cep _ Bathtubs Sewer Connection Clarifiers Solar Collectors }, Dishwasher Solar Piping Drinking Fountains Floor Drains Solar Tank Swimming Pool w/Spa Floor Sinks Gas Service Outlets Interceptors Urinal Water Closet Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains $ Reinspection Fee I $15 I I Issue Fee $ MECHANICAL FEES Boiler Hood or Type 1 ❑ Duct - Under Ground Canopy Type 11 ❑ ' Duct - Structural Refrigeration System CIO-1100,000BTU 0100.000BTU Duct - Ventilating Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG # Fire Dampers Heating System & Ducting El 0-100,000 BTU ❑ 100,000 BT Registers /Lt4 Date Reinspection Fee I $15 •1 1 Issue Fee 1 $ 3 AF 0865-46, rev. 10/84 White - Bullding; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 54133 6/25/85 Zone Accessory Building: Perking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan. F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW ❑5.15 KW Transformer ❑ 15-50 KW ❑ 50 + KW Meter Uup to 100 amps Meter Clover 100 amps /Sub Panel Motors ❑0.1 HP [31% - 8 Inc. Solar ❑9.15 HP 1:116.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 6000 . FEES Z O N 1 N G R E a M T S Reinspection Fee I $15 I I Issue Fee I $ 3 j 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By /Lt4 Date SUMMARY OF FEES BUILDING PERMIT S SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ _J3.00. GRADING S PLAN CHECK 50% $ — S,00 MICROFILM $ MECHANICAL $ TOTAL FEE $ fid" • 00 PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit # r� Date Inspector POOL & i APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53, Steel Reinforcement !' 3. Electrical Conduit'Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE I 7. Footings ` 58. Electrical Conduit-Undrgrnd. 8. Foundation i 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. I' I 60. Backwash Lines, P -Trap, ❑ Undrgrnd. k 10. Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection l 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13, Roof Drains 64, Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final i 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. -Rough Wiring Sign 468. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating I 71. Product Piping ❑ Gas ❑Oil _23. Gas Pipe -Rough & Test 72, Underground Flush 24. Roof Framing 73, Undergrnd, Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: `7 /O 34. Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39, Water Service -Final 40, Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51'. CERTIFICATE OF OCCUPANCY No! Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. TD Ar' Kin I I n -r AIA CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 17th -at, Bldg.CFJ Unit 1 Applicant's Mailing Address 13110 5aftcoy St. N.Hollywood, Owner's NameT Phone 549-2988 Address Arch/Eng. Marin .T - R nek _License No. Address 1-288-1_Knrltt Ave—. --Suite 216 Contractor's NarreDlye-n Air C'.nnrii t•i nni na 98hone 982-1216 Addressimailing)—Z 3110—S-at_i.rnir Sr_ N-Hollyuood,Ca. City License No. 3975 _ LICENSED CONTRACTOR DECLARATION I hereby, affirm that I am licunsed undlr provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Pess Ions Code, and my license is in full force and effec Ucenso Class Llce N Date 4 / 1 R /8A Signature WORKERS' COMPENSATION DEC ATION 1 hereby affirm that I have a certifi of Consent to self -insure or a certificate of Workers' Compensation Insura ca. or a certified copy thereof (Section 31100, Lab. c.) Oollty Na. WC 9824 Company Lumbermans I� Certified copy Is hereby furnished. ❑ Certifie�= Is filed with the city Building Date Applicant EXEMPTION ROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that in the performance of thg work for which this permit Is issued, 1 shall not amploy any person In any manner so as to become subject to the Workers'. Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for. which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address - - -- OWNER BUILDER DECLARATION I hereby affirm that I am exempt frorn the Contractor's•License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to Construct, alter, Improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is klcensed pursuant to the provisions of 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 ienalty, of not more than five hundred dollars ($500). D I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business anq Professional Code: The Contractor's License Law does not apply to an owner or a property who builds or Improves thereon, and who does such work hirnself/herself or through his or her own employees, provided that such- Improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner will•have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractor(s) ilcense pursuarit•to the Contraitor'4 License Law), I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date ' Owner I hereby certify that I have read this application and state that the above 1 information Is Correct. I agree to comply with all clty and County ordinances and state relating to bu Ing construction, and hereby authorize repre- sentative o! his Clty l n r upon the above-mentioned property for inspect) pu dses. SlgnaturF;ft Date Drivers' LI rise or SSS CMF 0865-4 , rev: 10/84 PLUMBING Bar Sink Showers Backflow Preventer Service Sink TYPE OF CONSTRUCTION L1 NEW 0 ADD LJ ALTERATION LJ REPAIR Bathtubs ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Clarifiers A.P. � DESCRIPTION OF WORK/USE OF BLDG. Solar Piping Drinking Fountains Floor Drains Solar Tank Swimming Pool w/Spa Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories Urinal Water Closet Water Heater, Water Service Auto -Wash S Main Building: Roof Drains E TYPE OF PERMIT EJ GRADING 0 FOUNDATION LJ STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 0 MECHANICAL B ❑ -OTHER 4 Rear C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CON STRUCTION TYPE VALUATION S g Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Date ' Owner I hereby certify that I have read this application and state that the above 1 information Is Correct. I agree to comply with all clty and County ordinances and state relating to bu Ing construction, and hereby authorize repre- sentative o! his Clty l n r upon the above-mentioned property for inspect) pu dses. SlgnaturF;ft Date Drivers' LI rise or SSS CMF 0865-4 , rev: 10/84 Reinspection Fee $15 Boiler Duct' Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO �k Heating System & Ducting 90-100,000 BTU 11100,000 BT Reinspection Fee 1 $15 White - Building; Canary - AppllCarit; Pink - Accounting; Goldenrod - Assessor Issue Fee Hood or Type I ❑ Canopy , Type 11 ❑ Refrigeration System ❑0.100,000 BTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES 2269 5103/85 Zone Accessory Building: Parking Req./Provided 15080 ELECTRICAL I I FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers []Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW ❑5.15 KW Transformer 0 15=50 KW ❑ 50+KW Meter L]up to 100 amps Meter Dover 100 amps Sub Panel Motors ❑0-1 HP ❑ 1'h - 8 Inc.Solar 09.15 HP 016-15+ Microwave Pale Light Range Sign Standing Sections Trash Compactor Z O N I N G R E Q M T S $ 3 PLUMBING Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Floor Drains Solar Tank Swimming Pool w/Spa Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories Urinal Water Closet Water Heater, Water Service Auto -Wash P—Trap Laundry Trays, Roof Drains Reinspection Fee $15 Boiler Duct' Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO �k Heating System & Ducting 90-100,000 BTU 11100,000 BT Reinspection Fee 1 $15 White - Building; Canary - AppllCarit; Pink - Accounting; Goldenrod - Assessor Issue Fee Hood or Type I ❑ Canopy , Type 11 ❑ Refrigeration System ❑0.100,000 BTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES 2269 5103/85 Zone Accessory Building: Parking Req./Provided 15080 ELECTRICAL I I FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers []Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW ❑5.15 KW Transformer 0 15=50 KW ❑ 50+KW Meter L]up to 100 amps Meter Dover 100 amps Sub Panel Motors ❑0-1 HP ❑ 1'h - 8 Inc.Solar 09.15 HP 016-15+ Microwave Pale Light Range Sign Standing Sections Trash Compactor Z O N I N G R E Q M T S $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK S PERMIT PLUMBING 5 ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADtNG $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ 1 3 00 TOTAL FEE $ 19-50 ' PLAN CHECK 25% $ Sin. $ 3 CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POOL b _. A APPROVALS Permit # Date Inspecrnr 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd. 53, Steel, Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms T r c-4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding -,5. Steel Reinforcement f 56. Rough Plumbing & Pressure Test I r 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 1: 58. Electrical Conduit-Undrgrnd. 1' ,. ' 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System t 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT% REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32.'.Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer, 43. Backflow Irrigation 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE &BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border Imes and sign all appropriate declarations. CITY_UF COSTA MESA CONSTRUCTION PERMIT ALF �r Project Address 7' ~ PERMIT NO. ssg TRACT NO. LOT NO. UNIT NO. 3737 12/ 1 Qi84 - 33.75 TL Applicant's Mailing Address ' Owner's Na a Pho -••� Address f 1ll/i/ C�-1 r4'er -- F_I ArchlEng.. f/ 4ircerise No. Address A7�� THU —i�y /U� �/� Cont(actor's NamdJ4)A0p/S ��TrPlG _Phone .T �G Address (mailing)X41 City License No. 4�� LICENSED CONTRACTOR DECLARATION 1, I hereby affirm that I am licensed under provisigns of Charter 9 (Commencing With section 7000) of Division 3 of the Busingss and Professions Code, and - my license is in f II force and effect. License lass .41c o Date - Signature TYPE OF CONSTRUCTION NEW ' LJ ADD U ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORKIUSE OF BLDG. - A -P.# Zone S Main Building: Accessory Building: _ . TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE i GRADING CU.YDS. ACRES E T Front Z O A Rear N C Right N K $ Left G R Ping. Ref. # Parking Req./Provided E ' Remarks: Planning Notes: Q M ' r — T S PLUMBING FEES WORKERS' COMPENSATION DEC ATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink � Automatic Washer Construction Pole Sub- ` Transformer ❑ 15.50 KW ❑ 50 + KW ' , of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. /li%� 5�U�374 Company. SE/FC/T eCertified Copy is hereby furnished. Cer i ied cop _1 filed with the city d Sion. Backflow irrigation Sewer Cap iC Bathtubs Sewer Connection ~0 Cooking Unit Meter El up to 100 amps Date �� 7 Applicant _ _ EXEMPTION FROM WORKERS' COMP SATION DECLARATION (This section need not be completed if the permit -is for one hundred (5108) or ILss). I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner s❑ as to become subject to the Workers' Compensation Laws of California. Date Signature _ 'NOTICE: It, after making this declaration, you Should become subject to the Clarifiers Solar Collectors Dishwasher P I Meter' . ver 100 ams Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel , Drinking Fountains Solar Tank Fan Motors ❑0 1 HP El 1 %, - 8 - Floor Drains Swimming Pool w/Spa F.A.U. I Inc. Solar Q9-15 HP ❑16-15+ •� d Floor.Sinks - Urinal 43 q Fixtures Microwave S Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be -doomed revoked. CONSTRUCTION LENDINGAGENCY I hereby affirm that there !s -a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's, Name , _ Gas Service Outlets Interceptors Water Closet Water Heater _ Device Boxes Outlets Pole Light g Range Lender's Address OWNER BUILDER DECLARATION- I hereby affirm that I am exempt from the Cori tractor's'Llcon se Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county wnl.h requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also require% the applicant for such permit 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 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 ienalty of not more than five hundred dollars (E500). as owner of the, property or my employees with wages as their Sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Coder The Contractor's 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 employees, provided that such improvements aro not intended or offered for sale, If, however, the building or improvement Is sold within one year of com- ,the owner, will'have the burden of proving he/she did riot build or IIIDuct for the purpose osale).s owner of the property, am exclusively contracting with licensed con- Fn tractorsto construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who 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 • proof of their Worker's Compensation insurance should be provided tome. I am exempt under Section_ ❑ p — B. & P. C. for this reason Kitchen Sink. Water -Service Switches Sign Lavatories _ Auto -Wash Garbage Disposal ; Standing.Sections -Trap Laundry Trays Generator 00.5 KIN ❑5-15 KW Trash Compactor p Roof Drains - - Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Feb • $ 3 MECHANICAL FEES Hood or T Boiler ype I ❑ Canopy Type II - Under Ground DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Data Z C) Duct - Structural Refrigeration System - ❑0-100,000 BTU ❑100,000 BTU Duct - Ventilating - -. ••-• SUMMARY OF FEES BUILDING PERMIT $ SMIP $ , PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers Heating System & Ducting ❑0.100,000'BTU El 100,000 BT Registers Date Owner.— _ _ I hereby certify that I have read this application and state that the above Information Is correct. 1 agree to comply with au city and county ordinances and state laws relating to building con ruttlon,,and hereby authorize repre- sentatlyes of this city to ewiPr up the above-mentioned property for Inspection '�,,,,��,,�� Signature DateAy// - L Drivers' Llcen r 55 PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% $ ENERGY P.C. $ $ 2Z GRADING $ -5Q $ fry • 2S MICROFILM $ $ TOTAL FEE $ $ Y �• - -' Reinspection Fee $15 Issue Fee $ 3 Goldenrod - Assessor CMF 0865.46, 11?,',. 10/B4 White - Building; Canary - Applicant; Pink - Accounting; `~• +� CONSTRUCTION AND PLANNING r 1 APPROVALS Permit # Date Inspector POOL & _. A APPROVALS Permit # Date Inspecror 1. Temporary Electrical Service or Pole i 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 Grrid. 57. APPROVAL TO COVER-GUNITE 7. Footings' 58. Electrical Conduit-Undrgrnd. 8.'. Foundati on " 59. Gas Pipe, ❑ Undrgrnd., Test 9.'Water Pipe Undrgi nd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10:Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final '12.'sewer Cap 63. Heater & Vent -Final 113. 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd, Storage Tank ❑ Gas ❑ Oii 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 Gar Pipe -Test' . 36. Hood or Canopy 37, Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape irrigation System � 45. Sound Attenuation r 46. Handicap Regulations F 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`in. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY L'FCOSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. (1N1 No. O Project Address -7 1 1 VJ �• C-'�5'! pM Me Applicant's Mailing Address Owner's Name �o� 1 N Vr; STi f1 E AX I phone Add;ess Arch/Eng. License No. Address Contractor's Name �f21S ELI; C I R I G Phone M; b Yko Address (mailing) 119b5' SPYAME-ST. 811-MMfN r-T9fO C1a314o City License No. "i O LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Chart 9 (commencing with section 7000) of DIvls1on 3 f t usiness an Pro Bions Code, and my license is In full force nd effe o License Class - Dat¢ O ' Signature WORKERS' COMPENSATION DECLARA ION I hereby affirm that I have a certificate of consent to self4nsure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 9a00,'Lab. C.) olicy No. 1t��lfl�f x10 Cor pa I�EG L� Certified copy is hereby furnished. r ❑ Certitletl coyyjs filed with the Cit 19 it q ision. Date"f O� 25 S Applicant EXEMPTION FROM WORKERS' COMPENSATION D CLARATION (This section need not be completed If the permit is for one hundred ($100) or less). I certify that In the performance of the work for which this permit is issued. i shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature •NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction tending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 d civil penalty of not more than five hundred dollars (S500). _ I, as owner of the property or my employees with wages as their solo compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements aro not Intended or offered for sale. 11, however, the building or Improvement is Sold within one year of com- pletlon, the owner will have the burden of proving he/she did nut build or lm. S0 for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractors) license pursuarit•to the Contractor's License Law). I am aware that proof of their Worker's Compensation_ insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner ' I herebycertify that I have read this information rr gree to Co pi and state I ws re Ing t building n$ sentatives f th ity o enter on inspection ur Signature Drivers' License or SS = ftion and state that the above all city and county ordinances 3n, and hereby authorize repre- above-mentioned property for Date 5882 1/16/85 4.50 TL 1 . TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 916 Zone DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: E Z TYPE OF PERMIT GRADING El FOUNDATION In STRUCTURAL T Front O ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear N ❑ -OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N CONSTRUCTION TYPE VALUATION $ S Left R ZONE GRADING CU.YDS. ACRES Ping. Ref, # Parking Req./Provided E Remarks: Planning Notes: Q _- M T - - -- S Bar Sink Backflow Preventer Backflow Irribation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap ' Roof Drains Reinspection Foe { $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO 90- Heating #Heating System & Ducting ❑0.100,000 BTU 0100,000BTi Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water -Service Auto -Wash Laundry Trays II Issue Fee MECHANICAL Hood or Type I Canopy Type II ❑ Refrigeration System 00-100,000 BTU 0100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES ELECTRICAL Automatic Washer - Construction Pole Sub, Cooking Unit Dishwasher Dryers []Gas ❑Electric Fan F.A,U, Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW ❑5-15 KW Transformer ❑ 15.50 KW ❑ 50 + KW Meter ❑up to 100 amps Meter Dover 100 amps Sub Panel Motors %A I HP 1:11 h - 8 Inc.Solar 09.15 HP ❑16.15+ Microwave Pole Light Range Sign ! Standing Sections Trash Compactor ,FEES $ 3' Reinspection Fee $15 Issue Fee S 3 FEES r DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date Data(P SUMMARY OF FEES BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ �I•o� _ PLAN CHECK 50% $ Sa MECHANICAL $ PLAN CHECK 25% $ SMIP $ PERMIT ISSUANCE $ ENERGY P -C. $ GRADING S MICROFILM S TOTAL FEE $ $ 3 �rl ,- CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & _. A APPROVALS Permit # Date Insp?rror ` 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54, Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd„ Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System • Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit ��, '�� 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring' Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Strocture 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 []Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydra 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 �- ��i �'�f'.� Nntes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43, 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 Nn. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERF NO.7a 161-26 NOLOT NOU T N Project Address 1 7Syi r + J Applicant's Mailing A dress v TYPE OF CONSTRUCTION _ NEW ADD ALTERATION REPAIR. Owner's Name N z��yr_ f AIl,OPh ne 7SQ J&�� ED CONVERSION ❑ DEMOLISH El OTHER A.P. # t� DESCRIPTION OF WORK/USE OF BLDG. Address �,�,. , _n/ew pAr � S Main Building: Arch/Eng. %�1ay�tLLy_-_�-„ I rLefil�l� Livens/rres No rS �!a TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front Address `� fAS� �✓ i +SAlri'e- I✓Cf., C ❑TENANT ❑ELECTRICAL PLUMBING ❑MECHANICAL B Rear HER A Contractor's Nam Phone ❑ OT y� PROJECT DESCRIPTION SO. FT. OCCUPANCY C Right Address (mailing) wde: 13i�. K CONSTRUCTION TYPE VALUATION $ S Left City ,License No. ZONE GRAOINGCU.YDS. ACRES LICENSED CONTRACTOR DECLARATION / 1 Ping. Ref. 9PI hereby affirm that 1 am licensed under provisions of Charter 9 (commencing Remarks: •/`"Q./"'Mi T 30-�' Planning Notes: with section 7000) of Division 3 of the Business and Professions Cotle, An my license Is in full force and effect. Ucense Class License No, Date Signature WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure or a certificate ,f Workers' Compensation Insurance, or a certified copy thereof (Section 300, Lab. C.) .•olicy No. (i) 600 -SIS' t Company r 8 Certified copy is hereby furnished. Certifietl co y s filed with the city, Qyjj�visipp.�� Date — Applicant, EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (3100) or less). I certify that In the performance of the work for which this permit Is issued t shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or -this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for MLbLCh th it i "Aed etl ectl n �g 7 Civ- C.) 1 � Lender's Name 2 V^' Lender's Ad dress - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 131.5 by any applicant for a permit subjects the applicant to •a civil malty of not more than five hundred dollars ($500). tII, as owner of the property or my employees with wages as their sole mDensation, will d0 the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold,wlthin one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- rOve for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- 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.' builds or improves thereon, and who contracts for such projects with a con. tractors) 11cense pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me.i ❑-I am exempt under Section B. & P. C. for this reason Dat1 Owner I hereby certify that I have read this application and sta a at he above information is correct. ! agree to comply with all city and county ordinances and State laws relating to building construction, and hereby authorize repre- sentatives of this city to enter/Ron the above-mentioned property for inspectionpurpos_9c•— Gr Signature Date J i V Drivers' License or SS =P 00000 - Reinspection Fee $15 1 1 Issue Fee I $ 3 �\CMf= 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting: Goldenrod - Assessor 9I56--7?L35 B5 �epp,.�'1 v Accessory Building: Parking Req./Provided - ELECTRICAL FEES Z O N I N G R E Q M T S Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ' ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps PLUMBING FEES Bar Sink Showers Fan A Backflow Preventer Service Sink Inc. Solar 1:3 9-15 HP 016-15+ Backflow Irrigation Sewer Cap Device Boxes ' Bathtubs Sewer Connection Range Clarifiers _ Solar Collectors Garbage Disposal Dishwasher Solar Piping Trash Compactor Drinking Fountains Solar Tank Floor Drains Swimming Pool vv/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Trap Laundry Trays. Roof Drains ' Reinspection -Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Hood or Type I ❑ Canopy Type I I El Duct - Under Ground Duct - Structural Duct - Ventilating Refrigeration System 130-100,000 BTU ❑ 100,000 BTU Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit, ICBG # Fire Dampers Heating System & Ducting E-10-1100,000 BTU ❑ 100,000 BT Registers Reinspection Fee $15 1 1 Issue Fee I $ 3 �\CMf= 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting: Goldenrod - Assessor 9I56--7?L35 B5 �epp,.�'1 v Accessory Building: Parking Req./Provided - ELECTRICAL FEES Z O N I N G R E Q M T S Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ' ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter Clover 100 amps, Dryers ❑Gas DElectric Suh Panel Fan A Motors ❑0-1 HP ❑ 1 h - B F.A.U. Inc. Solar 1:3 9-15 HP 016-15+ Fixtures Microwave Device Boxes ' Pole Light Outlets Range Switches Sign Garbage Disposal ; Standing Sections . Generator ❑0.5 KW 05-15 KW Trash Compactor Reinspection Fee $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: r Zoning Approved By Date Building Approved By Dater_ Application Issued By Dete r2`f $ 3 RW__W1! s, SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK '25% $ LOD ENERGY P.C. ; $ ELECTRICAL $ GRADING S PLAN CHECK 50% $ MICROFILM S MECHANICAL $ TOTAL FEE $ oQ PLAN CHECK 25% $ &VVU=_ RW__W1! s, CONSTRUCTION AND PLANNING APPROVALS Permit 44 Date Inspector POOL: A APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. V 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; Eiectrical UFER Grnd. 57. APPROVAL TO COVE R-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas'Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60, Backwash Lines, P -Trap, ❑ Undrgrnd, 10, Structur5l 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 66. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas D Oil 23. Gas Pipe -Rough & Test 72:. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas O 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 60. FOOD CERTIFICATE ISSUED 33. 'Final Electric Notes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43. 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 l~ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate deelaratior . CITY OF COSTA MESA CONSTRITION PERMIT PER 111U. U114.11 NO. LOT NO. U114.11NO. i �j Project Address [ Applicant's Mailing rass Owner's Name one Address ' ' Arch/Eng. License No. Address — Contractor's Nam Phoc y, Address (mailing) MOT,:/��}�.11�_ via 9) t - City License No. LICENSED CONTRACTOR DECLARATION I herebyaffirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in f It fo e a d effect. O Licens Class License No. Dat Signature WORKERS' COMPENSATION CLARAi16r I hereby affirm that 1 have a cerUficato of consent to self -insure or a certificate Of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) - , Policy No. Company BCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Date - -- Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or - less). I certify ,that In the performance of the work for which this permit is Issued I shall not employ any person in any manner p'as to become subject to the Worker Cc p sat �ws Of. Ca Ia. Date " Signature 'NOTICt=: lf,after m k ng this de tion, you should become subject to the Workers' Compensation pro visio of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LtNOING AGENCY 1 hereby afflrm that there is a construction lending agency for the performance of the work for Which this permit Is .Issued (Section 3097 Civ. C.) Lender's Name' Lender's Address - — OWNER BUILDER DECLARATION - I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Settlon 7031.5 Business and Professional Code: Any city or county which requiros a permit t0 construct, alter, improve, demolish or repair any Structure, prior to Its issuance, also requires the applicant for such permit Jo file a signed staternent that he/she is licensed pursuant to the provisions of 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 malty of not more than five hundred dollars ($500). ' I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the -structure is not intended or offered for Sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements aro not intended or offered for sale. If, however, thQ building or improvement Is sold within one year Of com- pletion, the owner Will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting'with licensed con- tractors td construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and. who contracts for such projects with a Con- tractor(s) 11cense pursuarit to•ihe.Contractor's License' Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me, 0 1 am exempt and@r Section B. & P. C. for this reason Date Owner I hereby certify that 1 have read thjs applicatlon.and state that the above Information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for inspection se Signature r Date privers' VenSe Or SS :f CMF 0865.46, rev. 10/84 �Q Showers Reinspection Fee $15 1 1Issue Fee $ 3' ELECTRICAL FEES Backflow Preventer Service Sink TYPE OF CONSTRUCTION NEW ADD El ALTERATION REPAIR -Transformer- 0- 15-50 KW ❑ 50 + KW ❑ CONVERSI§N ❑ DEMOLISH ❑ OTHER Bathtubs Clarifiers A.P.=# DESCRIPTION OF WORK/USE OF BLDG. Meter ❑up to 100 amps Meter Dover 100 amps Dishwasher Solar Piping L - Dryers ❑Gas ❑Electric S Main Building: Solar Tank E Motors El G- 1 HP ❑i'fi B TYPE OF PERMIT GRADING FOUNDATION LJ STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Urinal - ❑ -OTHER Fixtures A Rear Water Closet Water Heater i Water Service Z Z co C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY' K Garbage Disposal CON ST RUCTION TYPE VALUATION $ $ Left ZONE GRADING CU. YDS. ACRES Ping. Ref. Remarks: Planning Notes: r PLUMBING FEES Accessory Building:. r Perking Req./Provided Zone Z O N I N G R E O M T S Bar Sink Showers Reinspection Fee $15 1 1Issue Fee $ 3' ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub: -Transformer- 0- 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Clarifiers Sewer Connection Solar Collectors Cooking Unit Dishwasher Meter ❑up to 100 amps Meter Dover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors El G- 1 HP ❑i'fi B Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9.15 HP ❑16-15+ Floor Sinks Urinal - Fixtures Microwave Gas Service Outlets Interceptors Kitchen Sink Water Closet Water Heater i Water Service Z Z co Device Boxes Outlets Switches Pole Light Range Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P -Trap Laundry Trays, Generator 00.5 KW ❑5-15 KW Trash Compactor Roof Drains �• Reinspection Fee j $15 Boiler - Duct= Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Sit. ICBO 9# Heating System & Ducting ❑0.1o0,000 BTU El 100,000 BTL Reinspection Fee 1 $15 nt; Pink - Accounting; Goldenrod - Assessor Issue Fee Hood or Type I ❑ Canopy , Type I I ❑ Refrigeration System ❑0-1 oo,000 BTU 0100,000 BT System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 1 1 ' Reinspection Fee $15 1 1Issue Fee $ 3' FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat ^ SUMMARY OF FEES - _ — BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ �q �i� ISSUANCE $ PLAN CHECK 25% $ 1 -Sc� ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ 10 'SC:� PLAN CHECK 25% $ I $ 3 j CONSTRUCTION AND PLANNING APPROVALS Permit # i� Date Inspector POOL & a:'A APPROVALS Permit #_-.� Date InspPctnr 1. Temporpy Electrical Service or P616 l 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd.� 53. Steel Reinforcement .3� EI ectrical Conduit�Utility-Undr 54, Forms 4 Els rriul, Conduit-Ond`grod. 'Kj 55. Electrical Bonding , e. 5.`Ste§I{Re nforcement-aq � 56. Rough Plumbing & Pressure Test 'Y 6- E ect,trica'I UFER-Grnnd �� 57. APPROVAL TO COVER-GUNITE r -,v 7. Frootings Q ?,1 � r 58. Electrical Conduit-Undrgrnd. 8 Foun*da ion�j 59. Gas Pipe, ❑ Undrgrnd., Test 9, ateerr;Pipe-Undrgrn�d'. i 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 14'SFru Lural Floor•System f' 61. APPROVAL TO DECK 11. Prr perty'Sewer Line,& House Connection 7 W ► 62. Backwash & Receptor -Final %a 12. Se er p V -1./ � ' 63. Heater & Vent -Final � 13, Roof Drains zf '1 64. Plumbing System - Final t ' 14. -Rough Plumbing « 65. Electrical -Final i 15. Rough Electrical'donduit 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 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 NotP_s: 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 7yry. */?Z- 40. Gas Service -Final X41. Solar Domestic -Final 42. Backflow Preventer �Z"g� 01,:f 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 . 0 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA C NSTRyUC.�,ION PERMIT PERMI NO_ , T�� C NO. LOT NO. IT (Yo. ,Project Address �/% . 1 { //J�/ �TYPE OF CONSTRUCTION %A= ADD ALTERATION REPAIR Applicant's Mai-l�n pAAddress--- Owner's Name �/�7 V -Y— - 'r/� hone:Z9 "" MO Address /!/?, ,, Q}}S,, Lc?!/ - -Si: i�L[! fir%-- ArchlEng. LVdh P • License o. r 12 Y Address s� fly$ i rA. �lvc� ZAP_ _, Contractor's Name— Phone Address imailing) City License No: LICENSED CONTRACTOR DECLARATION 1. hereby affirm that I am licensed under provisions of Charter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. Date Signature WORKERS' COMPP,NSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation -Insurance, Or a certified -copy thereof (Section 3800, Lab. C'..))' Policy No. ,f��` /s - Company _�iCti!!L /4Gi 8 Certified copy is hereby furnished. Cer •fi_d copy ped with the, city Buil�tl Davis' n. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This soction need nbt be completed if the permit is for One hundred ($100) or less) . I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. DateSignature NOTICE: If, atter making this declaration, you Should become Subject to the Workers' Compensation provisions Of the labor Code, you must forthwith comply with such provisions Or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm that there Is a construction lending agency for the performance Of the work for thi r t is IMed (Sect on 3097 Civ. C.) Lender's Name Lender's Address 1 �-e A Ct_,. OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the foliowing reason {Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demoilsh Or repair 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 the Contractor's Lltense Law (Chapter 9'(c0mmenci09 with Section 7000) Of Division 3 of the Business and Professions Code) or that he/she Is OXOmpt therefrom and the basis for the alleged exemption. Arly•violation of Section (331.5 by any applicant for a permit subjects the applicant to a civil natty of not mor@ than five hundred dollars ($500). . 1, a5 owner of the property Or my employees with wages as their sole C mpensalion, will do the work, and the structure is not Intended or offered for sale (So 7044, Business and Professional Code: The Contractor's 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 employees, provided that such. improvements are not intended Or offered for safe. if, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/tine did not build or Im- rave for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- teactorsto construct the protect (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an'owner of property who builds or Improves thereon, and 'who contracts for such projects with a con- tractors} license pursuant to the Contractor 'S License Law). 1 am aware that proof a( their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state at the above Information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for Inspection qui Signature Data Drivers' Licens�®r,SS t CMF 0865-46, rev. 10/$4 White - Build 0157 7/25/86 ! ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. qjE, Zone S • Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION 0 STRUCTURAL ❑ TENANT ❑ ELECTRICAL ;9 PLUMBING ❑ MECHANICAL ❑ D-rHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ _ ZONE GRADING CU. YDS. ACRES T Front O A Rear - _ N C Right I N K S Left - - G R Ping. Ref. # Parking Req./Provided E Remarks: Jnr r Planning Notes Q M T, S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Waskt' Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap' Bathtubs Clarifiers Sewer Connection Solar Collectors - Cooking Unit Dishwasher Meter ❑up to 100 amps Meter ❑over -100 amps Dishvvasher ' Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Floor Drains Solar Tank Swimming Pool vv/Spa Fan *� F.A.U. Motors ❑0.1 HP ❑1'%- 8 Inc. Solar 09.15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Interceptors Water Closet Water Heater Device Boxes Outlets Pale Light Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal 'Standing Sections P—Trap Laundry Trays Generator ❑0.5 KW 135-15 KW Trash Compactor Roof Drains i rS Reinspection Fee 815 Issue Fee Reinspection Fee $15 Issue Fee $ 3 Bailer Duct - Under Ground MECHANICAL Hood or Type I ❑ Canopy- Type I I ❑ FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved ByDate Application issued By Date Dat_ Duct - Structural Refrigeration System ❑0 100,000 8TU 0100,000 BTU Duct - Ventilating BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% S MECHANICAL $ PLAN CHECK 25% $ SUMMARY OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG # Fire Dampers Heating System & Ducting 00-100,000 BTU ❑100,000 BT Registers Reinspection Fee S15. Isiue Fee $ 3 Goldenrod - Assessor COWSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL, A APPROVALS Permit # Date Inspector 1."Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Uridrgrnd, 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4..Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER G'rnd. 57, APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural. Floor System 61. APPROVAL TO DECK 11. Property Sewer Line &!-louse 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 APPROVALS Permit # 20. Rough Factory Fireplace 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 r. - 73. Undergrnd. Storage Tank ❑ 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 Noies: 34. Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow P.reventer 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 r 50. Gas Release to Southern California Gas Co X51. CERTIFICATE OF OCCUPANCY No. Date L"� Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. , CITY OF COSTA MESA CONS RUCT Ni PERMIT Project Address' r PE+ ^IT NO, F 4 TRACT NO. LOT NO. UN�7 TYPE OF CONSTRUCTION NEW AQD ALTERATION REPAIR ❑ CQNVERSIDN ❑DEMOLISH ❑OTHER DESCRIPTION OF WORK/USE OF BLDG. •Applicant's Mailing A dress) Owner's Nome. P e Address Arch/Eng. License No.. Address q p [ ' - �_ �U ,76. Zone ' I Oo'0� S Main Building: Accessory Building: TYPE OF PERMIT GRADING -FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑'OTHER PROJECT DESCRIPTION SQ. FT, OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU. VDS. ACRES E T Front = Z O A Rear - N Contractor's Nam P one ' Address (mailing♦ZSU City License No_ � �� LICENSED CONTRACTOR pECLARATION I hereby, affirm that 1 am licensed under provisions of Charter 9 (commencing wlth section 7000) of Division 3 of the Business and Professions Code, and my license is in f forCojarjd effect, �0,� `C 7 L-icens Class c��j ((,�� License No.!:200 'r C Right - N S Left - - R Ping, Ref. # Parking Req./Provided E Remarks: Planning Notes: C11 _ _ S PLUMBING FEES ELECTRICAL FEES Date Signature WOR KERS' COMPENSATION D IIARATION I hereby affirm that I have a certit ate of consent to self-insure or a certificate Bat SinkShowers of Workers' Compensation Insurance, or a certified copy thereof (Section - - '3800, Lab. C.} Backflow Preventer Service Sink Automatic Washer - Trarisformer' ❑ 15-50 KW Backflow Irrigation Sewer Cap , Policy No. Company BCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Construction Pole Sub. j ❑ 50 + KW Bathtubs Sewer Connection Cooking Unit - i v Meter L1 up to 100 amps Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This sectionr need not be completed if the permit Is for one hundred (3100) or- less), I certify that in the performance of the work for which this permit is issued I shallknot employ any person in any anner s as to become subject to the worker Co�p�nsp��qu Laws of Calico Clarifiers Solar Collectors Dishwasher -- ' f Meter ❑aver 100amps ' - Dishwasher Solar Piping i Dryers ❑Gas ❑Electric Sub Panel - Drinking Fountains Solar Tank Fan Motors ❑41 HP ❑ 1 % - 8 i Floor Drains Swimming Pool w/Spa F. A. U- Inc. Solar E19-i5 HP ❑16-15+ Date_y[t!'j�Slgnature ' 'NOTICE: if, after making this declar n, you should' become subject to the Workers" Compensation. provisions the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance - Floor Sinks Urinal '- F' fixtures - - ' Microwave r Gas Service OutleisWater,Closet - - Z00 Device Boxes P ole Light ' Interceptors Water Heater, Outlets Ran e' g of the work for. which this permit is issued (Section _3097 Civ. C,) Lender's Name_ Kitchen Sink Water Service Z Switches Sign Lender's Address OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit-to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division.3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031:5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). J I, as owner of the property ,or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletionthe owner will have the burden of proving he/she did not build or im- , Me for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 on- s or improves thereon, and who contracts for such projects with a con- buiitln tractor(s) license pursuarit to the Contractor's License Law). I am aware that tractor proof of their Worker's Compensation insurance should be provided to me. L� 1 am exempt under Section B. & P. C. for this reason Lavatories, Auto-Wash i Garbage Disposal Standing Sections t P—Trap LaundryTrays y ' Generator ❑0 5 KW ❑5 15 KW Trash Compactor Roof Drains ' - Reinspection Fee _ $15 - Issue Fee i $ .3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Hood or . Type I ❑ Canopy • Type II ❑ i ' ' Duct - Under Ground + DEVELOPMENT SERVICES RED'UIREMENTS' Zoning Approved By nate Building Approved By I Date Application Issued By _- Dat Duct - Structural Refrigeration System Ela-100,000BTU ❑100,000 BTU - - - _ Duct - Ventilating - ... SUMMARY BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ CHECK 25% $ ELECTRICAL $ c _ OF FEES j SMIP S PERMIT t]C7 ISSUANCE $ ENERGY P.C. $ GRADING $ Exhaust System ❑ Multiple ❑ System Repair/Alteration i Firepl/Fact. Bit. ICBO # , Fire Dampers Date owner+ I hereby certify that I,have read this application -and state that the above information is correct. I agree to comply with all city and county ordinances Heating System &Ousting 00.100,000 BTU ❑100,0008T , RegistersPLAN ' and state laws relating to building construction, and hereby authorize repre-PLAN sentatives of is ci y • to enter upon the above-mentioned property or inspection p D. Signature Date r Drivers' Li nse or SS 1 CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ MICROFILM $ _ TOTAL FEE $ �� •`�� Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CdNSTRUCTION AND PLANNING APPROVALS Permit # v Date Inspector POOL _rA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pow { 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. i� L 53. Steel Reinforcement110 v~" 3 Electrical Conduit Ufiliity-Undrgrnd �'� 54. Forms < li�-'Elecfri� Conduit Und grnd. �3 55. Electrical Bonding 4 t 5. Steel rReinforcement . 56. Rough Plumbing &Pressure Test 6• Electrlcjl UFER�Grnd. •, 57. APPROVAL TO COVER GUNfTE -7' ing5 58. Electrical Conduit-Undrgrnd. t �t Foun�d�ion ��ar k ;/ `�4 59. Gas Pipe, ❑ Undrgrnd., Test aN Water. �. pe-Undrg nd, 60. Backwash Lines, P -Trap, ❑ Undrgrnd. �✓ 10 Structur I Floor Sys em a c) 61. APPROVAL TO DECK 1 f .•Property'Sewer Line & House CoAnection ..I� �► 1 j 62. Backwash &Receptor Final n 12, Se'Wer Clp 63. Heater & Vent -Final l�7 13. Roof Drains �E J� n 64. Plumbing System - Final 14.- R** grPlumbing.- 65. Electrical -Final f 15.Rough Electrical=Conduit A 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping f❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test li 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74, Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75, Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78, FIRE PREV. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 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 _ l4 N 171r) CP Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address . Bld F knit 2 Applicant'sMailing Address 11110 Saticoy ST. N.F10llWOOd Owner's Name Phone .549-W Address 1,321 gi re h StNewport- Ra?f-h, Ca- Arch/Erig.ri n T Rnr•1r - __ License No. Address _L2 1 Knott—Av- Suite 216 Contractor's Name Dia— Air Condi ti nn Phone 952-1216 Address (mailing) _.L3J,1,Q__SAtJ coy '3I--_N-Ho11XWnad Ca - City License No. 33225 LICENSED CONTRACTOR DECLARATION I hereby affirm that t am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business an rofessions Code, and my license is in full force and off License Class -20 ns No. 346251 Date 4111 Signature WORKERS' COMPENSATION DE RATION I hereby affirm that I have a certif ate of consent to self -insure or a certificate of Workers' Compensation Insurance, Or a certified copy thereof (Section Policy Lab. c.) Lumbermans Policy Na. WC9824 Company 8 Certified copy is hereby furnished. Certifie py is filed with the city Building -0i Isiar).f Date Applicant Y-,C.-CGf EXEMPTION ROM WORKERS' COMPENSATION DECLARATION (This section need not be completed,if the permit is for one hundred ($100) or less). ' 1 certify that in the performance of the work for which this permit is Issued 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 CIv. C.) Lender's Name - Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit t0 construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 '031.5 by any applicant for a permit subjects the applicant to a civil jenalty of not more than five hundred dollars ($500). ❑ 1, as owner of the property or my employees with. wages as their SOIL compensation, will do the work, and the structure IS not Intended or offered for sale (Section 7044, Business and Professional Coda:' The Contractor's License Law does not apply to an- owner of a property who builds or Improves thereon, and who does such work himselfJhorself or through his or her own employees, provided that such improvements are not,Intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletlon, the owner will have the burden Of proving he/she did not build or Im- prove for tho purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon_ ,'and who contracts for such projects with a con- tractors) license pursuant to the.Contractor'i License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ l am exempt under Section B. & P. C. for this reason Date Owner 1 hereby certify that I have roc this application and state that the above information i orrect. I agree limply with all city and County ordinances and state la s elating to but i construction, and hereby authorize repre- sentatives f t is city to to upon the above-mentioned property for inspection ur Ses. D Signature d Date Drivers' Li se or SS :fiL AF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - TYPE OF CONSTRUCTION LJ NEW L_J ADD LJ ALTERATION U REPAIR Bar Sink ❑ ❑ ❑ Backflow Preventer _ Service Sink - CONVERSION DEMOLISH OTHER Sewer Cap A P. DESCRIPTION OF WORK/USE OF BLDG. Clarifiers Solar Collectors Dishwasher ' Drinking Fodntains S Main Buildi Swimming Pool vv/Spa Floor Sinks , E Gas Service Outlets, TYPE OF PERMIT EIGRADING 0 FOUNDATION LJ STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING © MECHANICAL B Auto -Wash ❑ OTHER Laundry Trays A Rear C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. + Remarks: Planning Notes: Reinspection Fee $15 Issue Foe PF�ES MECHANICAL Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting 1 1&100,000 BTU 0 100,000 BT1 Reinspection Fee , 1 $15 Accounting; Goldenrod - Assessor Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTU ❑100,000 BT System Repair/Alteration Fire Dampers Registers Issue Fee I S 3 2270 5/03/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A,U. Fixtures . Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 05.15 KW Reinspection Fee 1 $15 Transformer ❑ 15-50 KW - El 50 + KW Meter Cup to 100 amps Meter ❑over 100 amps , Sub Panel Motors 00-1 HP ❑ 1 h - 8 Inc. Solar 09.15 HP 1316.15+ - Microwave - Pole Light Range i Sign Standing Sections Trash Compactor Issue Fee DEVELOPMENT SERVICES REOUIREMENTS: Zoning Approved By Building Approved By Application Issued By PLUMBING JFEI Bar Sink Showers Backflow Preventer _ Service Sink - Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fodntains Solar Tank Floor Drains Swimming Pool vv/Spa Floor Sinks , Urinal Gas Service Outlets, Water Closet Interceptors • Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains Reinspection Fee $15 Issue Foe PF�ES MECHANICAL Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting 1 1&100,000 BTU 0 100,000 BT1 Reinspection Fee , 1 $15 Accounting; Goldenrod - Assessor Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTU ❑100,000 BT System Repair/Alteration Fire Dampers Registers Issue Fee I S 3 2270 5/03/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A,U. Fixtures . Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 05.15 KW Reinspection Fee 1 $15 Transformer ❑ 15-50 KW - El 50 + KW Meter Cup to 100 amps Meter ❑over 100 amps , Sub Panel Motors 00-1 HP ❑ 1 h - 8 Inc. Solar 09.15 HP 1316.15+ - Microwave - Pole Light Range i Sign Standing Sections Trash Compactor Issue Fee DEVELOPMENT SERVICES REOUIREMENTS: Zoning Approved By Building Approved By Application Issued By FEES SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTAL FEE Z O N I N G R E O M - - T S FEES ■ r© $ 15.50' SUMMARY OF BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ _13-00 PLAN CHECK 25% $ _ 2.50 FEES SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTAL FEE Z O N I N G R E O M - - T S FEES ■ r© $ 15.50' CONSTRUCTION AND PLANNING APPROVALS • Permit # Date Inspector POOL -. 8PA APPROVALS Permit +_ Date lnspector `, 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 j -6. Electrical UFER Grnd. 57. APPROVAL 70 COVER-GUNITE f 7. Footings 58. Electrical Conduif-Undrgrnd. 8' Foundation 59. Gas Pipe, ❑.Undrgrnd., Test 9, Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd, 10. Structural Floor System ;l 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. Electricai-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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydra 22. Ducts, Ventilating 71. Product Piping []Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29.. Insulation 78, FIRE PREV. FINAL 30., Drywall Nailing HEALTH DEPT% REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF�OCCUPANCY No. Date Applicant to,fill in all spaces except those within heavy border fines and sign all appropriate declarations. CONSTRUCTION PERMIT P9_1 ERT NO. TRACT NO, LOT NO. UNIT O. CITY OF COSTA MESA i 3 fVl g � �'a . ,Project dress / Z/ 4cl- .eApiicant's Mailing Address Owner's Name ��/��'� 1�N ��¢ P h o n a Address Arch/Eng. License No. Address r —,72t1,%7 lav 3^J8 7/0 -1? 720 Contractor's Nam Phone Address (mailing) - City License No, LICENSED CONTRACTOR DEC' ARAT N '106 , I hereby affirm that 1 am licensed under provisions of Charter 9 (co mencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in fuLl for9b and effect. License lass L I is se Date Signature WORKERS' COPAPENSATION DECLARATION I hereby affirm that I nave a certificate of consent to self -insure or a certificate ,f Workers' Compensation Insurance, or a certified copy thereof (Sec ion 300, Lab. C.) �s� #�rt No. ,Lad 2 99��% Company -al/` -/O Z A-2-1 rtified copy is hereby furnished. i I o is filed with the city g DIVISI . ,8 , Date � [��— Applicant ��'-•s EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one nundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance _ of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name .Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 131.5 by any applicant for a permit subjects the applicant to a civil natty of not more than five hundred dollars ($500). J I, as owner of the property or my employees with wages as their sole .compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. 11, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 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 proof of their worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of th' city to enter upon the above-mentioned property for inspection P o s, a_(r Signature 4, Dole l Drivers' License or SS -A' TYPE OF CONSTRUCTION NEW ADD n ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A. P. DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING ❑ FOUNDATION STRUCTURAL T Front ..❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear , ❑ OTHER A PROJECT DESCRIPTION Sri. FT. OCCUPANCY C Right CONSTRUCTION TYPE TYPE VALUATION $ S Left !ZONE GRADING CU.YOS. ACRES Ping. Ref. # Remarks:- Planning Notes: Reinspection ,Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑0-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applic t; Pink - Accounting; Goldenrod - Assessor Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U- Fixtures Device Boxes Outlets 5050 9/1-1/87 Zone Accessory Building: Parking Req./Provided ELECTRICAL Garbage Disposal Generator ❑0-5 KW 05-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100amps Meter Dover 100 amps Sub Panel Motors 1-10-1 HP ❑1%-8 Inc.Solar ❑9-15 HP 016-15+ Microwave Pole Li2t Range Sign Standing Sections Trash Compactor •50&0 TL Z O N I N . G R E Q M T S FEES Issue Fee $ 3 PLUMBING FEES Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor:Sinks,' Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service „r Lavatories A uto-Wash P—Trap Laundry Trays Hoof•Drains Reinspection ,Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑0-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applic t; Pink - Accounting; Goldenrod - Assessor Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U- Fixtures Device Boxes Outlets 5050 9/1-1/87 Zone Accessory Building: Parking Req./Provided ELECTRICAL Garbage Disposal Generator ❑0-5 KW 05-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100amps Meter Dover 100 amps Sub Panel Motors 1-10-1 HP ❑1%-8 Inc.Solar ❑9-15 HP 016-15+ Microwave Pole Li2t Range Sign Standing Sections Trash Compactor •50&0 TL Z O N I N . G R E Q M T S FEES Issue Fee $ 3 ,, Reinspection Fee - $15 Issue Fee $ 3 MECHANICAL FEES Hood or Type I ❑ Canopy Type 11 ❑ DEVELOPMENT SERVICES Zoning Approver! By Building Approved By Application Issued By—,Dat BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% REQUIREMENTS: Date Date SUMMARY OF FEES — S SMTP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. S $�" Wt_! GRADING $ $ MICROFILM $ $ TOTAL FEE $ $ ` - Refrigeration System ❑0-100,000 BTU E1100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit,# Date Inspector POOL &SPA APPROVALS Permit # Date Inspector 1: Temporary Electrical Service or Pole 52, Pool & Equipment Location 2. Soil Pipe-Undrgrnd. r 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit•Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement- 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd, B. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd,• '` 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System" 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 6. Solar System -Final 16. Rough Electric Wiring se O� . 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 APPROVALS Permit # _ ' it 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil -23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof ,Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 26. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 7B. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 8 FOOD CERTIFICATE ISSUED 33. Final Electric tes: Cklftk , ;l rr:A., 34. Final Heating & Air Conditioning i / 35. Final Gas Pipe -Test 36. Hood or Canopy i 37. Final Factory Fireplace 38. Final Plumbing ". , 39. Water Service -Final _ •-40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation - { -44. Landscape Irrigation System " 45. Sound Attenuation S 46. Handicap Regulations _ f 47. FINAL STRUCTURE & BUILDING_ t 48: Special Requirements Completed - 49. -Electric Release to Edison 50. Gas Release to Southern California Gas Co f " 51, CERTIFICATE OF -OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 6177Q�'CQSTA PASA CONSTRUCTION PERMIT, PERMIT NO. TRACT NO. LOT NO. UNIT NO. protect Address '-7-1 I- )VI). �ITW Sf . COS 1 l M E &ft l Applicant's Mailing Address Owner's Name E Phone Address Arch/Eng. License No, Address Contractor's Name MIUR>ZL", GLGGLT - I Cz Phone 9774 Address (mailing) 159 ,ER'lA+'T' ti -1, aLi`(Y) iePG7010 gQILo City License No. 3 '7� `I U LICENSED CONTRACTOR DECLARATION 1 hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Profession Code, and my license is in furl force and effe License Class C— f D License N j Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof _(Section 3800, Lab. C:) Policy No, r1C.S 1 IDS �R � � � ny L.. `G H. Certified copy is hereby furnishes. Certified copy i led with the ci$y B '1 Division. Date t5 Applicant ( EXEMPTION FROM WORKERS' COMPENSATIO DECLARATION (This section need not be completed if the permit is or one hundred ($100)1 or less). I certify that in the performance of the work for which this permit Is Issued, I shall not employ any persori in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workerst Compensation provisions of the Labor Cade, you must forthwith comply with such provisions or this permit shall, be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's' Name T Lender's Address OWNSRPBUILDER DECLARATION I hereby, affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of i Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031,5 by any applicant for a permit subjects the applicant .to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees 'with wageS'as their sole compensation, will do the work, and the Structure is not intended or offered for Sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who'doe% such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). C 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for Such projects with a con-- tractor(s) license pursuarit.to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read 65 pplicatipn an tate that the above information is correct. I a e mpl with I city a d county ordinances and state laws relating t building on ructio , and h eby authorize repre- sentatives of this city t enter the ove- tinned property for inspection Signature Drivers' License or SS �, TYPE OFCUIVSTRUCTION NEw ADD El ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH '❑ OTHER. A P # DESCRIPTION OF WORK/USE OF BLDG, 5 Main Building: E TYPE'OF PERMIT El GRADING FOUNDATION 0 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL_ B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION 5 g Left ZONE GRADING CU.YDS. ACRES Ping, Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains' Floor Sinks. Gas Service Outlets Interceptors Kitchen Sink r Lavatories P—Trap' Roof'Diains Reinspection Fee $15 Boiler. Duct .'Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting El 0-100,000 BTU El 100,000 BT Reinspection Fee CMF 0865-46, rev. l0/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays FEES Issue Fee S 3 MECHANICAL Hood or Type I ❑ t Canopy • Type 11 ❑ Refrigeration System ❑o-100,000 BTL) 0100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan 5683 I/I6/85 i Accessory Building: Parking Req./Provided ELECTRICAL F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 130.5 KIN 05-15 KW .4-50 TL Zone Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter Clover 100 amps Sub Panel Motors K0-1 HP ❑ 1% - B Inc. Solar ❑9-15 HP El 16-15+ Microwave — Pole Light Range Sign Standing Sections Trash Compactor Z 0 N I N G R E Q M T S ' Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS:, Zoning Approved By Date Building Approved By Date Application Issued By' Dat SUMMARY OF FEES BUILDING PERMIT S SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. .$ ELECTRICAL $ OO GRADING, $ PLAN CHECK 50% $ SO MICROFILM $ MECHANICAL $ TOTAL FEE $ 3 PLAN CHECK 25% $ i-_ �� CONSTRUCTION AND PLANNING -APPROVALS Permit # � Date Inspector J POOL &SPA i APPROVALS Permit # Date Inspec?nr I 1. Temporary Electrical Service or Pole 52. Pool &Equipment Location r2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3, Electrical Conduit Utility-Undrgrnd. 54. Forms 4, Electrical Conduit-Undrgmd,- 55. Electricai Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6- Electrical UFER Grnd.' 57. APPROVAL TO COVE R-GUNITE 7. Footings 58, Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65, Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final • 16. Rough Electric Wiring - 1 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 '<r- j c Notes: I 34. Final Heating & Air -Conditioning �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 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 r\in. pate i Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 'ITY+OF COSTA MESA CONSTRUCTION PERMIT tProject Address 7 ! �' Fu Sf r' 2 - Applicant's Applicant's N�piling Address � OWn+Y'S Name�1/ j L L- f ✓�•/"1 P--tSne L `t LOSS yf Address/t— Arch]Eng. License No. Address Contractor's'Na me Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that i am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. License Class ' �'' �'' License No. Date Signature WORKERS' COMPENSATION DECLARATION ' I herebyaffirm that I have a certificate of consent to self -insure or a certificate •f, Workers' Componsationt Insurance, or a certified copy thereof (Section '00, Lab. C.) " Alcy No. ^ -" ' " •Company 8 Certified copy is hereby furnlshed. Certified copy Is filed with the city Building Division. Date - Applicant' EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not bl completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit Is issued, I Shall not employ any person in any manner so as toy ecorn subject to the Workers' Compens 1 ws of Californ' Date Signature ti+ NOTICE: If, after mak ngithis declaration, you shouktl becom subject to the Workers' Compensation provisions of,the Labor Gode; you ust forthwith comply with such provisions or this�permlt shall be d emed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued (Section, 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or County which requires a permit to construct, alter improve, demolish or repair any structure, prior to Its issuance, also requires t6 applicant for such permit 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 Dl vision 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 131.5 by any applicant for a permit subjects the applicant to a civil salty of not more than five hundred dollars ($500). -1 I,, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for We. If, however, the building or improvement is sold within one year of com- pletion 1 , the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale).. , as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). 1 am aware that �proof of their worker's Compensation insurance should be provided to me. tgcL'•I am exempt under Section, % Apad B. & P. C. for this reason Date Owner ! hereby certify that I,have read t 5 application and staIdun that the above 'information is correct. I agree to comply with all city andty.rdinartces and state laws relating to building construction, and herebauthorize repre- sentatives of this city to ente on t e above -menti 0 property -for Inspection purposes. Signature, Data Ir Drivers' License or SS PMIT NO. TRACT NO, LOT NO . UNyj NO 0864 12/114/87 �3o8C TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF W RKIUSE OF Bl rt d ti s 1-0 Cqmt wk a,xn�t A,P, # _ Zone S Main Building: Accessory Building: TYPE OF PERMIT GR ING/,gDUNDATION STRUCTURAL ElTENANTEl ELECTRICAL UMBING ❑ MECHANICAL ElOTHER_ PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE ' -VALUATION $ ZONE .GR DING CU.YDS. ACRES T Front O A Rear N C _ _ _ Right N S Left G R Ping. Ref. # Parking Req./Provided E Remarks: V K& Planning Notes: M T 5 - PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer - Service Sink Automatic Washer Construction Pole Sub. I Transformer ❑ '15-50 KW El50+'KW f - Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit - Meter ❑up to.100 amps ; Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan i Motors 00-1 HP Ell %.-8 Floor brains' Swimming Pool w/Spa ' F.A,U. Inc. So r ❑9-15 HP ❑ 16.15+ Floor Sinks Urinal Fixtures rdwave Gas Service Outlets Water Closet + Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink r Water Service Switches Sign Lavatories Auto•Wash Garbage Disposal Standing Sections P—Trap Laundry Trays Generator 00.5 KW ❑5-15 KW Trash Compactor Roof Drains a Reinspection Fee $15 Issue Fee S 3 Reinspection Fee T$ Issue Fee $ 3 MECHANICAL FEES Milli I SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat BoilerHood or Type I C1DEVELOPMENT Canopy Type 11 ❑ Duct •Under Ground Duct - Structural Duct - Ventilating Refrigeration System f0-100,000 BTU 'Cl 100,000 BTU 4' BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUM $ $ $ $ $. $ S $ Y OF FEES SMIP $ PERMIT C7-0 ISSUANCE •• $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ • G V Exhaust System ❑ Multiple ❑ ystem Repair/Alteration Firepl/Fact. Blt.'ICBO # Fire Dampers R E Heating System & Ducting 1:10-100,000 BTU 0100,000 BTL Registers Pin$ nspeG Ions ' Sig Reinspection Fee $15 Issue Fee $ 3 GMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit #! Date Inspector POOL & SPA 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 6. Electrical LIFER Grnd. 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVE R-GUNITE 7. Footings 58. Electrical Conduit -Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P-Trap, ❑ Undrgrnd, 10. Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater,& Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18, Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL t 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑Oil 23. Gas Pipe:Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25, Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77, FIXED SYSTEM FINAL 29. Insulation 78, FIRE PREV. FINAL ' 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED ' 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test ; 36. Hood or Canopy 37. Final Factory Fireplace 3B. Final Plumbing 39. Water Service-Final. 40. Gas Service-Final , 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape'Irrigation System p 45. Sound Attenuation Ji1coff1pletia Inspector's 46, Handicap Regulations 47. FINAL STRUCTURE & BUILDING -Valer.r 48. Special Requirements Completed 49. Electric Release to Edison 0. r 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date --; l Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. winT -ro Ae• r A1rl I 1 rlT nln I II CITY OF COSTA MESA . CONSTRUCTION PERMIT Project Address h St. Bldg. -_(F Unit 3 Appiiealvt%-NTdiling Address 13100 Sati roy St. N . H011yla0Qd Owner's Name Phone549_298 Address 4321 -$I -r -e— iCts—N8W,PQr_t RL anh, ra . Arch/Eng. Ma -in -7 - Rnrk License No. Address 12881 Knott Ave_, Suite 216 Contractor's Nem Phone 9$2-1? 16 Addressimailing) 13110 Saticoy St- N.Hollywood,Ca. City Licbnse No. 33929 LICENSED CONTRf3CTOR DECLARATION I hereby affirm that Iam licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Busin4anrofessI.ns Code, and my license is in full force and elleinUcehse Class o. _ 346951 Date 4 /18/84 - WORKERS' 18/84 WORKERS' COMPENSATION DE RATION ' I hereby affirm that I have a certif ate of consent to self -Insure or a certificate of Workers' Compensation Insu ante„ or a certified copy thereof (Section Jee(l, Lab: c.) Wc9824 Llmbermans ' +oli4y No. Company H Certified copy is hereby furnished. Certifiedis filed with the city Building t�tn.._[ Date—I _ L4U Applicant __ - EX£MPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (810D) or lass), I certify that in the performance of the work for which this permit is issued 1 shall- not employ any person in any manner so as to become subject to the ' Workers' Compensation Laws of California. Date Signature NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with Such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency -for the performance Of the work for, which this permit is issued (Section 3097 Civ, C.) Lentler'S Name Lender's Address - OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its isSudnce, also requires the applicant for such permit to the a signed Statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 fcommencing with Section 7000) of Division 3 of the Business and Professions Code) or that fie/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars (5500). J I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's Ll Cense Law does not apply to an Owner Of a property who builds or imaroves thereon,' and who does such work hlmself/herself or through his or her own employees, provided that such Improvements are not intended or offered for sa1t1,If, however, the building or improvement Is sold within one year of com- plation, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). , 131, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s) License pursuant to the-Contractor'i License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I'am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have ead this application and state that the above infgrmatlon Is correct. ! agr o comply with all city and county ordinances and state laws relating to ui !ng construction, and hereby authorize repre- sentative this city- a ter upon the above-mentioned property for linsbecti n pur ores. Signatur Datey�J`� Drivers' LiSpfise or SS :P TYPE OF CONSTRUCTION NEW 0 ADD LJ ALTERATION U REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 906 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT = GRADING I FOUNDATIO��Nryry 11 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ED PLUMBING 9) MECHANICAL _ B Rear ❑ -OTHER A PROJECT DESCRIPTION SQ, FT. OCCUPANCY C Right CONSTRUCTION -TYPE VALUATION $ S ILeft ZONE GRADING CU.YDS. 'ACRES Ping. Ref. cift Remarks: Planning Notes: Bar Sink 1 Backflow Preventer PLUMBING Showers Service Sink Backftow Irrigation Bathtubs Sewer Cap Sewer Connection Clarifiers Solar Collectors Dishwasher Drinking Fountains Solar Piping Solar Tank Floor Drains Swimming Pool vv/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater - Kitchen Sink Water Service Lavatories Auto -Wash P—Trap Laundry Trays, Roof Drains , Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. iCBO # Heating System & Ducting 0100,000 BTU ❑ 100,000 BT Reinspection Fee 1 .$15 CMF 0665-4 , rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Aisessor Issue Fee Hood or Type ❑ Canopy Type I I ❑ Refrigeration System ❑0.100,000 BTU ❑ 100,000 BT System Repair/Alteration Fire Dampers Registers Issue Fee FEES $ 3 FEES 5 3 Automatic Washer • 227_1 5/03/85 Accessory Building: Perking Req./Provided ELECTRICAL Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F,A.U, Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW 05.15 KW 15eED FL Zone Transformer '❑ 15-50 KW - ❑ 50+KW Meter ❑up to 100 amps Meter Clover 100 amps Sub Panel Motors ❑0-1 HP ❑1 i5 - B Inc. Solar 119-15 HP El 16-15+ Microwave - Pole Light Range Sign Standing Sections Trash Compactor FEES Reinspection Fee $15 1 1 Issue Fee I S 3 Z O N I N G R E O M T S DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By —Date— ateBuilding BuildingApproved By Date Application Issued By Dat SUMMARY OF FEES -----� BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% S ENERGY P.C. $ ELECTRICAL $ GRADING $ .._ PLAN CHECK SD% $ MICROFILM S — MECHANICAL $ _ 13,00 TOTAL FEE $ 15.50' T PLAN CHECK 25% $ 2.50 CONSTRUCTION AND PLANNING API?ROVALS . Permit # Date Inspector POOL . 'A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ! fi 2: Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms .= 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement _ 56. Rough Plumbing & Pressure Test 6, Electrical LIFER Grnd. % 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. $' Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd, ,. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System '' 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection _ i 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 1$. Rough Eiectrical-T Bar Ceiling 69. POOLISPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Urndergrnd. Storage Tank ❑ 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 PREY. FINAL 30., Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32" Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. .Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. oconni I Ain I TRAr`T Kir-i I nT Nn - i iniir win CITY OF COSTA M SA co srRISTIONPERMIT Project Address (� AppNcant i iUl i!i g Address, ' , Owner's Name 7 Pho � r Address Arch/Eng. License No. Address Contractor's Nam Phone " 2-7 Address imailing) City License No. LICENSED CONTRACTOR DECLARATION I nereby affirm that I am licensed under provisions of Charter 9 (commencing with lection 7000) of Division 3 of the Business and Professions Code, and my Ilcense is in fqlkforce an effect. n Licons Ciass License No��3d`f Date Signature WORKERSCOMPENSATION dkqnR Of; I hereby affirm that l have a cortiflifate of consent to self -Insure or a certificate S1 Workers' Compensation Insurance, or a certified Copy thereof (Section 1800, Lab. C.) Policy No. Company 8 Certified copy Is hereby furnished, 1 Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any man er a5 to become subject to the Werke s' Co penTiLaws of Calif Date Signature NOT CE: If,Jfter'YnXIn9 this deckiwilifTV6. you should become subject to the Workers' Compensation provisions ofVthe Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY. ' I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name Lender's Address _ OWN$R13UILD_ERDECLARATION ' I hereby affirm -that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its.issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 ienalty of not more than five hundred dollars ($500). • .0 I, as owner of the, property or my employeef with wages as their sole Compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sate. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- Irove for the purpose of sale).. - , as owner of the property, am exclusively contracting with licensed con- 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 builds or improve$ thereon, and _who contracts for such projects with a con- tractor(s) Ilcense pursuarit.to the Contractor's Liconse Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I' nave read this appilcatlon and state that, trio above Information is correct. Iagree to comply with all city and county ordinances and state law$ relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentloned property for inspection D Signature Date '— Drivers' en or SS :r . -P. I— TYPE OF CONSTRUCTION 0 NEW 0 AOD LJ ALTERATION 7REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 90 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT El GRADING M FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER - - A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K' CONSTRUCTION TYPE VALUATION S S Left ZONE GRADING CU. YDS- ACRES Ping, Rei. Remarks: Planning Notes: F- 3 Zone Accessory g - Z O N N G R Parking Req./Provided E Q M T S AF 0865-46, rev. 10/84 White - ui ing; nary - pp cant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink- 2 Automatic Washgr - Construction pale Sub. — - Transformer " ❑ 1550 Kw ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers -Solar Collectors Dishwasher r Meter ❑over 100 amps Dishwasher Solar Piping Dryers- ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00.1 HP Ell %- S Floor Drains Swimming Pool w/Spe F.A.U. Inc. Solar 09.15 HP ❑16.15+ Floor Sinks Urinal Fixtures Microwave - Gas Service 1 Outlets Water,Closet Device Boxes Pole Light Interceptors Kitchen Sink Water Heater Water Service Z L Outlets Switches Range Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap '' Laundry Trays. Generator ❑0.5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Foe $ 3 Reinspection Fee $15 Issue Foo $ 3 Boiler. Duct - Under Ground MECHANICAL Hood or Type I ❑ Canopy Type I I El FEES DEVELOPMENT SERVICES REQUIREMENTS: Approved By Building Approved By Building Application Issued By Date Date Dat Duct - Structural Refrigeration System Do- 100,000 BTU El 100,000 BTU Duct - Ventilating BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ SUMMARY OF FEES SMIP $ PERMIT - ISSUANCE $ ENERGY P.C. $ • $ MICROFILM $ TOTALFEE $ _ j O•Sb Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # I Fire Dampers Heating System & Ducting 0¢100,000 BTU ❑100,000 BTGRADING Registers Reinspection Fee $15 Issue Fee $ 3 AF 0865-46, rev. 10/84 White - ui ing; nary - pp cant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING . APfiROVALS Permit # Date Inspector POOL c- _PA APPROVALS Permit # Date Inspector ,1. -Temporary Electrical Service or Pole V 52. Pool & Equipment Location iy 2.ilPi0' 4-Undrgrnd. 53. Steel Reinforcement 3fEfect kcal Cond` i��l?tility Undrgrrid�� 54. Forms 4� EEec tical Conduit U�dgrnd. f 55. Electrical Bonding ;.. teel;Reinforcerrient }. '6'WIect 56. Rough Plumbing &Pressure Test iJ h Dal UFERG?,nnd. ✓ r r: r.1 / .Ji ;� 57. APPROVAL TO COVER-GUNITE tT 7.. Foo�ing's-' 58. Electrical Conduit-Undrgrnd. $ Foundation `� r « r �,.� J' �: �, 59. Gas Pipe, ❑ Undrgrnd., Test rI ?.'ter' Pipe Undrglyd.{ - 60. Backwash Lines, P -Trap, ❑ Undrgrnd. iJ 10� •Structural Floor System l� 61. APPROVAL TO DECK 11. Proper, ewer Line &House Co'n�ction 62. Backwash & Receptor -Fina! 12. Sewer �p 4 63. Heater & Vent -Final 13. Roof Drains ! ,1 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final `r•� 15. Rough ElectrZltonduit J 66. Solar System -Final V 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign fib. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Und@rground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Qrywail Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final '40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. 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 t 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY ' No. Date M Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA M A/ CON/S RUCTION PERMIT 0,-) 'A O.V 5 RAc„+voj LOT NO. UNIT No, Project Address l � + �j[Q Applicant's Mallin Addreu � Owner's Name Address 3gd r Arch1En9, I A-? E� License No. C Address //l��yy r [1 I tIc • _LA h Contractor's Name _LL'rl Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION , 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate Of Consent to self -insure or a certificate I Workers' Compensation Insurance, or a certified copy thereof Section 300, Lab, C.) /_ /1�i ,eTy r Ilcy No. 0U� �(a7 ��+ s - 1-- Company6 Certified copy Is hereby furnished, f Certified CapY Is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if Ina permit is for one hundred ($100) or less), I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. DataSignature NOTICE: 11, after making this declaration, you should become Sublctt to the Workers' Compensation provisions Of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY. I hereby affirm that there is a construction tending agency for the performance of the work for which tris �vers Is d (� tLo�3 ;r Clv. Lender's Name i/ fC (9 - Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file asigned Statement that he/she Is licensed pursuant to the provisions of .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 vlolation-of Section 131.5 by any applicant for a permit subjects the applicant to a civil nalty of not more than five hundred dollars (5500). t L-1 I, as owner of the property Or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for salo (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/horsotf or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale), ❑ 1, as owner 01 the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and who Contracts for such projects with a con- tractor($) license pur$uarit to the' Contractor's License Law), I am aware that proof of their Worker's Compensation Insurance should be provided to me, ❑ 1 am exempt under Section 8. & P. C. for this reason Data Owner' 1 hereby certify that I have read this application and state that the above information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city enter n ih above-mentioned property for inspection purpose Signature Date Drivers' License or SS -r TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAI R �J CONVERSION ❑ DEMOLISH ❑ OTHER A.P. + DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING f�f FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL 4L PLUMBING -1 MECHANICAL A Rear ' El -OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Right K CONSTRUCTION TYPE VALUATION$ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: �y/yJ/ �t �f j37"� Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service . Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Foe Boiler $15 Duct - Under Ground Duct - Structural Duct - Ventilating - Exhaust System ❑ Multiple ❑ Firept/Fact. Blt. ICBO # Heating System & Ducting 00-1 ()0,000 BTU ❑ 100,000 BT I Reinspection Fee 1 $15 CMF 0865-46, rev, 10/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 5037 5/23136 Zone A ccessor y -B u i ld i ng: Parking Req./Provided. MR TL Z O N L N G R E Q M T S IMBING FEES Showers ELECTRICAL FEES Service Sink Automatic Washer` Construction Po le Sub. Transformer ❑ 15-50 KW ❑ 50+ KW Sewer Cap Sewer Connection Cooking Unit Meter ❑up to 100amps Solar Collectors - Dishwasher -- - Meter ❑over 100 amps Solar Piping; Dryers ❑Gas El Electric Sub'Panel Solar Tank Fan �+ Motors 1:10-1 HP 01 1/a - B Swimming Pool w/Spe F.A.U. Inc. Solar ❑9-15 HP Ell 6-15+ Urinal Fixtures Microwave Water Closet 00 Device Boxes Pole Light Water Heater Outlets Range Water Service Switches Sign Auto -Wash Garbage Disposal ; Standing Sections Laundry Trays Generator 00-5 KIN 05.15 KW Trash Compactor Issue Fee S.:3 Reinspection Fee $15 lssuo Fee 5 3 4ANICAL Hood or Typal ❑ Canopy Type 11 ❑ FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date_ Dat Refrigeration System ❑0.100,000 BTU 13100,000 BTU SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK$ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25%, $ 0 ENERGY P.C. S ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM S MECHANICAL $ TOTAL FEE S PLAN CHECK 25% $ �J ou System Repair/Alteration Fire Pampers � Registers Issue Fee S 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL A 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 e r.. 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding' .� 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6- Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE �� [ 7. Footings 56. Electrical Conduit-Undrgrnd. 7 B. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test } 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd, f 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection62 � . Backwash & Receptor -Final i 12. Sewer Cap JS 63. Heater & Vent -Final 'n 13. Roof Drains �'f 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure �► 70. Underground Hydro 22. ducts. Ventilating 71. Product Piping ❑ Gas ❑ Oil x23t;Gas Pipe -Rough & Test 7z' Underground Flush 2 Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing to 74: Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 301Drywall Nailing HEALTH DEPT. REQUIREMENT 31IPlaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 36. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43c=Backflow Irrigation 44A, Landscape Irrigation System 45L.Sound Attenuation 4$n Handicap Regulations 47,!.' -FINAL STRUCTURE & BUILDING 46. Special Requirements Completed 49. Electric Release to Edison 50.Gas Release to Southern California Gas Co 51c:CERTIFICATE OF OCCUPANCY n No. Date I CITY OF COSTA MESA CONS I KUCT101,4 PE 11 Pro fact Address Applicant's Mailing Address Owner's Name 7_`9'&1J0jfLJA Phone Address ArchlEng. License No. Address Contractor's Nam Phone 7_._L-,2" Address(maiiing) 0&1.si City License No.�,� LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in fullce a d effect. License Class License No.� Date Signature WaRKER ' COMPENSATION D LARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate -)f Workers' Compensation Insurance, or a certified copy thereof (Section 800, Lab. C.) Policy No. Company -`-- 8 Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant r EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). r I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner o as to become subject to tyle Work ' Co pens saws of Califia. Date Signatures , 'NOTICE: If, after making this declar on, you should become subjec `fi1the Workers' Compensation provisions f the Labor Code, you must forthwith cornpty with such provistons or this permit shall' be deemed revoked. CONSTRUCTION LENDiNG,AGENCY ' I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OVVNER BUILDER DECLARATION I hereby, affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of ,the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division , 3 of the Business and Professions Code) or that he/sne is exempt therefrom and the basis for the alleges] exemption. Any violation of Section 031.5 by any applicant for a, permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). L1 I, as owner of the property or my employees with wages as their sole cornpensation, will do the work, and the structure i5 not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's LiCense taw does not apply to an owner of a property who builds or Improves thereon„and who does such work himsel(/heraet( or through his or her own employees, provided that such improvements are not intended or offered for sale. if. however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of,proving he/she did not build or im- prOvO for the purpose of sale). . 1 ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who builds of improves thereon, and who Contracts for 5uch projects.with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PE MIT NO. TRACT NO. LOT NO. U iT b Date Owner 1 hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county Ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for inspection pur os Signature Date Drivers' se or SS CMF 0865-46, rev. 10/84 White - Building; -I 9 / / V SUMMARY OF FEES A $ TYPE OF CONSTRUCTION NEW ADD ALTERATION LIREPAIR $ ❑ ❑ ❑ PLUMBING $ CONVERSION DEMOLISH OTHER PLAN CHECK 25% A.P. # DESCRIPTION OF WORK/USE OF BLDG. ELECTRICAL $ GRADING PLAN CHECK 50% S $ Main Buildi S TOTALFEE PLAN CHECK 25% $ TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B [—],OTHER A Rear C R ight PROJECT DESCRIPTION SQ. FT. OCCUPANCY_ K CON ST14UCTION TYPE VALUATION $ $ Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Flour Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee I $15 Boiler Duct = Under Ground Duct - Structural Duct- Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBG # Heating,System & Ducting 00-100,000 BTU 1:1100,000 BT Reinspection Fee 1 $15 Iicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES Showers Service Sink - Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urine( Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee $ 3 MECHANICAL FEES Hood or Type I ❑ Canopy Type II ❑ Refrigeration System 130-100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 9945 3/25/95 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer - Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal .Generator 110-5 KW 05-15 KW Transformer ❑ 15.50 KW ❑ 50 + KW Meter LJ up to 100 amps Meter Clover 100 amps Sub Pane4 Motors Cl 0-1 HP ❑ 1 A - 8 Inc. Solar ❑9-15 HP 1116-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 10450 TL FEES Z O N I N G R E 0 M T S I I Reinspection Fee I $15 I I Issue Fee I $ 3 I 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By - 1 SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% S _ �iS ENERGY P.C. ELECTRICAL $ GRADING PLAN CHECK 50% S MICROFILM MECHANICAL S TOTALFEE PLAN CHECK 25% $ ' ONSTRUCTION AND PLANNING i j Date - �S4PPROVALS Permit # i inspector y - POOL SPA APPROVALS Permit # Date Inspector - 1 y Temporary Electrical Service or Pc. e, .,� 52. Pool '& Equipment Location 2. So±I;Pipe-Undrgrnd. w� 1 53. Steel Reinforcement 3.iElect`rical Conduit`.6tility-Undrgrnd. tv 54. Forms ' !� 4. Elecirical Condui :Undrgrnd. (.�i 55. ElectricahBonding `1 r 51 Ste el'Reinforcertlent' , ^56. Rough,Plumbing &Pressure •Test }•f� 6;, Ele`ctrical UFEFI':Gr+nd. `� �' - r 57. APPROVAL TO COVER GUNITE ' ]'Footings % - 58. Electrical Conduit-Undrgrnd., 8`.` Foundation �� 1 59. ' Gas Pipe, ❑ Undrgrnd., Test 11 j 9 -Water Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, ❑ Undrgrnd. 4y� 10. Structural Floor System 61. APPROVAL TO DECK b1i.,;Property Sewer Line &House Connection 62. Backwash & Receptor -Final {� 12,`• Sewer Cap V I 63. Heater& Vent Final f 13. Roof Drains + • � �- � 64, Plumbing System -Final 1�4, Rough Plumbing- L� 65. Electrical=Final- r 15. Rough Electrical -Conduit 66. Solar System -Final' 16, Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING II& Rough Electrical -T Bar Ceiling 69. POOLISPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit# 20. Rough Factory Fireplace 21. Ducts, in Structure I 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 ❑ Gas ❑ Oil 25. Roof Sheathing 74, Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical - 27. Frame and Flashing r 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY, FINAL 30. Drywall Nailing HEALTH DEPT, REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36- Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing �y 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final - 42. Backflow Preventer 43, Backflow Irrigation F 44. Landscape Irrigation System 45. Sound Attenuation 46, Handicap Regulations ; 47. FINAL STRUCTURE & BUILDING ' 48. Special Requirements Completed 49. Electric Release to Edison - '- t 50. Gas Release to Southern California Gas Co 51. CERTtFICATE'OF OCCUPANCY. No. Date i _ r _ Cr Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA t VNb I KUU I IQ[VPERMIT PERMIT NO. TRACT NO. LOT NO. U T NO, Project Address 1]� St. Bldg_._(D) Unit 6_ O� �b Applicant's Mailing Address_) c ,. C t,; 7' ,, ,� s TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR �ci6e" wt' N Huilyw""" ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Owner'sName Phone 949_2 A.P. � CTr� R' Newport Ren rh (a DESCRIPTION OF WORK/USE OF BLDG. Address 21- Rirch,St.- Diet• S Main Building. Arch/Eng. License No. TYPE OF PERMIT GRADING FOUNOATLON STRUCTURAL T Front Address EJ TENANT ❑ ELECTRICAL F-1PLUMBINGMECHANICAL B Rear ❑ OTHER A Contractor'sNam Ph0ne-9$2__J2a,6 C Right Address imailing) PROJECT DESCRIPTION 5q. FT. OCCUPANCY K Left CONSTRUCTION TYPE VALUATION $ $ City License No. 3992.x_ _ ZONE GRADING CU.YDSr ACRES Ping. Ref. iU LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: with section 7000) of Division 3 of the Business an ofessions Code, and my license is in full force and effec License Class— se d.-346291 Date�W-84 -- Signature WORKERS' COMPENSATION p RATI N 1 hereby affirm that l have a cert) to of consent to self -Insure or a certificate of Workers' Compensation InSu nce,• or a certified copy thereof (Section 1800, Lab.- C.) olicy No. W179A94 Company Certified copy is hereby furnished. Certifi o y "s filed with the City Bui ing DivisionlL, Date Applicant ( I W EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (S 100) or less). I certify that in the performance Of the work for which this permit Is Issued, I shall not employ any person in ahy manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provision; of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address— DWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 4f the Business antl Professlons 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 t0 a civil I alty of not more than five hungred dollars ($500). 1, as owner of the property or my employees with wages as their sola ompensation, will do the work, and the structure Is not intended Or offered for sale (Section 7044, Business and Professional Code: The Contractor's License taw 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 employees, provided that such Improvements are not Intended or offered for sale. It, however, the building or Improvement Is sold within one year of com- pletlon, the own or will have the burden of proving he/she did not build or lm- Eveefor the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project(Section 7044, Business and Professions Code: The Contractor's License Law qes not apply to an owner of property who builds or improves thereon, and Who contracts for such projects wlth.a con- tractors) license pursuarit'to'the Contractor's License Law). I am aware that proof of their Worker's CompenSatlon insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and information is correct. I agree to mply with all city e and State la elating to buil ' construction, and he sentatives f t s city to a er upon the above -me, inspectio pur es Signature Drivers' Lic or SS to that the above county ordinances y authori� reprp- ned tigjlferty Y' Bar Sink Backflow Prevernter Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Interceptors Kitchen Sink Lavatories ' P—Trap Roof Drains Reinspection Fee Boiler Outlets s15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO =# Heating System & Ducting 1 Q0-1 00,000 BTU ❑ 100,000 BT 1 1 Reinspection Fee 1 S15 IF 0865-46, rev. 10/84 White - Bullding; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink - - Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater. Water Service Auto -Wash Laundry Trays Issue Fee IANICAL Hood or Type 1 ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTu ❑1oo,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automatic Washer Construction Pole Sub, Cooking Unit Oishwasher Dryers ❑Gas ❑Electric Fan 1776 4/24/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL 4 Transformer ❑ .15-50 KW ❑ 50 + KW F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 05-15 KW Meter ❑up to 100 amps Meter Dover 100 amps Sub Panel Motors 00.1 HP 0156. S Inc. Solar 09-15 HP 016-15+ Microwave - Pole Light Range Sign Standing Sections Trash Compactor S 3 Reinspection Fee S15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By [ Building Approved By [ Application Issued By 1 SUMMARY OF FEES BUILDING PERMIT $ SM1P PLAN CHECK $ PERMIT PLUMBING 5 ISSUANCE PLAN CHECK 25% $ ENERGY P.C. ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ _23.00 TOTAL FEE PLAN CHECK 25%'$ 2'.50 4 30 S 3 15050 FEES S 3 $ $ 15.50 Z O N 1 N G R E O M T S CONSTRUCTION AND PLANNING APPROVALS . Permit # Date Inspector POOL. A APPROVALS Permit # Date Inspector 1. "temporary Electrical Service or Pole 52. Pool & Equipment Location ' _'2. -Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3 3.. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. -Electrical Conduit-Undrgrnd. 55. Electrical Bonding .• 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test a 6. Electrical UFER Grnd. 57. APPROVAL TO COVER•GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. � 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd, ti 60. Backwash Lines, P -Trap, ❑Undrgrnd. •J 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Conpection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13, Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final '415. 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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23.•Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30., Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40, Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, .Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date �' }•, Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. r CP CITY or- COSTA MESA CONSTRUCTION PERMIT Project Address ~%// C.t % 7 rHs' r C-:•G�� `Pplicart's MailingAddress Owner's Namey/cxr,! i2 sr /r Phone Address , Arckrig. License No. Address Contractor's NamP,olf.-�PJeox G IZel-1Q /C Phone Address (m a i I i n g)/—1 2V& r 4 i f s /6 City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 mmencing with section 7000) of Division 3• of the 13n mess and Pr fessl Code, and my license is in fur force and effect � f License Class License o. Date — Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) re N.AAC'- 1/� `'1,370 Co • % Certified copy is hereby furnished. Cert-fietl copy Is f" d with the city vision. Date 1 O ^E' Applicant EXEMPTION FROM WORKERS' COMPENSATION ECLARATION' (ThiSsection need not be completed if the permit is for one hundred ($100) or less). I certify that In the performance of the work for which this permit is Issued I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with -such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I I hereby affirm that there is a construction tending agency for the performance of the work for which this permit Is Issued (Section 3097 Clv. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 they basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil tnalty, of not more than five hundred dollars (5500). J I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements aro not intended or offered for Sale. If, however, the building or improvement is sold within one year of com- pletlon, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and t_who contracts for such projects with a con- tractor(s)license purSuar 'to'the Contractoi's License Law). I am aware that proof oftheir Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read, this information is c rrect agree to c mp and state I re 9 o buildin con sentatives f this to enter upor Inspection ur Signature Drivers' License or SS lhL 4F 0865-46, rev. 10/84 1 ration and state that tate above i all city and county ordinances on, and hereby authorize relare- above-mentioned property for I Date O -.PS I.n—I. .vv. --1 ,+.... 1 td; it IVY. TYPE OF CONSTRUCTION NEW ADD ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. :0 DESCRIPTION OF WORK/USE OF BLDG. • S Main Building: E TYPE OF PERMIT GRADING 1 FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL 2 PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ $ Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains ' Reinspection Fee $15 Boller Duct - Under Ground, Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting OD -1 00,000 BTU-❑ 100,000 BT Reinspection Fee 1 $15 licant; Pink - Accounting; Goldenrod - Assessor 5863 1116185 14o50 'T1 Zane Accessory Building: Z O N 1 N G R Parking Req./Provided E Q M T S PLUMBING Showers FEES ELECTRICAL FEES ServiceSink- Automatic Washer- Construction Pole Sub. Transformer ❑15-50 KW ❑ 50'+ KW Sewer Cap Sewer Connection Cooking Unit Meter ❑up to 100 amps Solar Collectors I Dishwasher Meter [Dover 100 amps Solar Piping Dryers ❑Gas ❑Electric Sub Panel Solar Tank Fan Motor 0-1 HP ❑1'/ - B tj( Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP ❑16-15+ Urinal Fixtures Microwave Water. Closet Device Boxes Pole Light Water Heater Outlets Range Water Service Switches Sign Auto -Wash Garbage Disposal ; Standing Sections Laundry Trays Generator 00.5 KW ❑5-15 KW Trash Compactor Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Hoad Or Type I El Canopy Type I I ❑ DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Date nate �P Refrigeration System ❑0-100,000 BTU 01100,000BTU SUMMARY BUILDING PERMIT ,$ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ -� PLAN CHECK 50% $ MECHANICAL $ , PLAN CHECK 25% $ OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFI LM $ TOTAL FEE $ L4 <Sn System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 COVSTRUCTION AND�PLANNING -APPROVALS Permit # Date Inspector POOL L- . A APPROVALS Permit # Date InspQctnr 1, emporary Electrical Service or Pole n 52. Pool & Equipment Location 2. Soil.Pipe-Undrgrnd :�' 1 53. Steel Reinforcement 17 _3%Electrical Conduit Ut i`ity-Undrgrnd. ;� %� 54. Forms 47ElectricaI Conduit-Undrgrnd. 55. Electrical Bonding 5, SteelReinforcement t' 56. Rough Plumbing & Pressure Test 6:• Electrical UFER'Grnd. 57. APPROVAL TO COVER•GUNITE 7.' Footings 58. •EiectricaI Conduit-Undrgrnd. 8.' Foundation 59. Gas Pipe, ❑ Undrgrnd., Test -i 9.7Watei•Pipe Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10.,Structural Floor System ^ 61 • APPROVAL TO DECK 1 ] .; Property Sewer Line & House Connection Jr J 62. Backwash &Receptor -Final i 12"Sewer Cap `� 63. Heater & Vent -Final ; 13- Roof Drains �_• 64. Plumbing System - Final 14. Rough Plumbing, t. 65. Electrical -Final t 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 APPROVALS Permit # 20. Rough Factory Fireplace 21- Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 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 Il 01,L Notes: 34, Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36, Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39, Water Service -Final 40, Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43, 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 151. CERTIFICATE OF OCCUPANCY n. Date J Applicant to -fill in all spaces except those within heavy border lines and sign all appropriate deciarations. + TRUCTION PERMIT PERIUIIT NO. TRACT NO., LOT_UO. I UNIT NO. CITY OF 1_05I A MESA CONS Project Address 711 West 17th Street D-6 Applicant's Mailing Address same Owner's Name — Phone631-3227' Address '711 Nest i7t}7 Strt?et D-6 Arch/Eng, License No. Address Contractor's Nam Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. Date. - - - Signature WORKERS' COMPENSATION DECLARATION ! I hereby affirm that I have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section -300. Lab. C.) Aicy No. ,„_ - Company Certified copy is hereby furnished. Certified coot is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Componsation Laws or California. Date Signature NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such Provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a Construction lending agency for the performance of' -the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name -- - --.--- ---- ------ Lender's Address OWNER BUILDER DECLARATION I hereby affirm that_I.am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requireS,a permit to construct, alter, improve, demolish or repair ! any structure, prior to Its issuance, also requires the applicant for such permit - to file a signed statement that he/she is licensed pursuant to the provisions of 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 '031.5 by any applicant for a permit subjects the applicant to a civil valty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the Structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Ico- r e for the purpose of sale). I, as owner of the property, am exclusively Contracting with licensed Ion- a tors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who 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 proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby rti that I have read this ap Iicatlon and state th the above information is correct. I agree to Comply with all city antl Count ordinances and. state laws relating to building construction, and hereby auth rize repre- sentatives of this city to enter upon above-mentioned property for inspectionburp e i Signature D�W ate Drivers' License or SS BF_M Z 9's' o� TYPE OF CDNSTRUCTION LI NEW 4 ADD L ALTERATION LI REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER J]ESCRIPTION OF WORK/USE OF BLDG. >, oom TYPE OF PERMIT GRADING FOUNDATION 11 STRUCTURAL TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 'OTHER PROJECT DESCRIPTION SQ. FT- OCCUPANCY 1 — CONSTRUCTION TYPE VALUATION $ ZONE GRADINGCU.YOS. A( Remarks: 6 PLUMBING FEES A.P. # — S Main Building: E T Front B R ear A C Right K -S Left Planning Notes: 1 , Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers i Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool vv/Spa Floor Sinks Urinal i Gas Service Outlets Water Closet Interceptors Water Heater e. c Kitchen Sink Water Service Lavatories Auto -Wash P—Trap Laundry Trays ' Roof brains — Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple FirepllFact, Bit. ICBG # Heating System & Ducting 00-100,000 BTU ❑100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F,A.U. Fixtures Device Boxes 8025 5/ I.t /87 65er). n Zone Mi" Accessory Building: Z Q d1 y A N Parking ••• ELECTRICAL Outlets Switches Garbage Disposal Generator 00.5 KW 05-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter El up to 100 amps Meter clover 100 amps Sub Panel Motors 00-1 HP ❑ VA - 8n. Inc. Solar El 9-15 HP [J 16-15+ Microwave Pole Light J� Range Sign Standing Sections Trash Compactor Issue Fee $ 3 Reinspection Fee $15 1 Issue Fee $ 3 CHANICAL FEES Hood or Type I ❑ Canopy Type II El DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application issued By REQUIREMENTS:J �j Q to "1 S U Date Dat Refrigeration System 00-100,000 ST El 100,00.0 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ .2 5 4) SMIP $ 6.50 $ �7� PERMIT $ ISSUANCE $ $ � ENERGY P.C. $ $ —d, GRADING $ $ _ 7 0 MICROFILM $ $ _ b . O b _ TOTAL FEE $ 5.O 8 $ 0- -75 System Repair/Alteration Fire Dampers r Registers 0 Issue Fee $ 3 CONSTRUCTION AND PLANNING I APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector I. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53, Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd, 54, Forms s 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 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 & ReceptoryFinal 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 766. 11 Solar System -Final 16. Rough Electric Wiring 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 APPROVALS Permit # 20. Rough Factory Fireplace 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 Cl Oil 25. Roof Sheathing 74, Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing S 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 34 Notes: 34, Final Heating & Air Conditioning 35. Final Gas' Pipe -Test 36. Hood or Canopy 37.. Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final .42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 30 48. Special.Requirements Completed di 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co e 51._CERTI FICATE OF'OCCUPANCY NO.' Date PROJECT ADDRESS: ,• 7111- W 17TH ST UNIT' D__) OWNER'S NAME: ADDaEssSIOK ENG YAO : r_ ' 25 05LDENROD 'CM CA 92714 ARCNIENGINEER: 786-- ,7 7 2 0 REG.NO.: ADDRESS: UNIT: PERMITTEE: S I OK ENG YAO (714)786-7720' ADDRESS: '25 GOLDENROD TRVTNC CA 92714 LICENSEO CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. CfT;Y LIC,: STATE LIC.: CLASS: Date: Signature: WORXERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof Section 3800, Lab. Q. POLICY NO.: EXP. DATE: ,gUMPANY: Certified Copy is hereby furnished. ❑ certified copy is filed with the City Building Division. Date: Applicant: EXEMIRION FROM WORKERS' COMPENSATtON DECLARATION: (This section need not be completed if the permit is for one fill (1100) or less►. I certify that in the performance of the work for which this permit is issued, I shall not empil any person in any mariner so as to become subject to the Workers' La Laws of California Date: a-14— 7r a Signature: , NOTICE: 11, after making this declaration, you should beCo §ulirgt to the Workers' nation provisions of the Labor Code, you must forthwith comply with such provisions o",5! ' permit shall tie deemed yoked. hat � ere CONSTRUCTION LENDING AGENCY: i hereby affirm tis a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ. C), LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter„improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code► or that helshe is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500). I, as owner of the property or my employees with wages as their sole compensation, will, do the work, and the ❑ structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State 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 employees, provided that such improvements are not intended or offered for sale. If, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the propel am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Cade: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' State License Law), I am aware that proof of their Worker's Compensation insurance should be provided to me. I am exempt under Section: 7044 B. d P. C. far this reason: = OWNR DOING WORT, IF NEP. ED Oate: !! ! q 6 Drvrte . ll I do hereby certify that I am aware of and understand the requiremerits of Cali nia Neahh and Safety Code Sec[gn 5505, 25533, and 25534 and that I or any future building occupant will/will not (cirde one) n comply with said stale codes and t requirements for a permit for construction or modification from the Air Duality Management District. Residential construction applica ns are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county Ordinances and slate laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned Property for inspection purposes. Date: � — I "Iio� 7-6 _ Signature: Driver's License or Social Security A: 1641-46 While—Building; Green—Code Enforcement: C4nary—Appbr-ant; Pink—Revernie; Goldenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT PERM NO: 1s” :046120 - PERMIT ,NO:P 046120 JPLAN CHECK NO: N GOVT: N SUPP: CONSTRUCTION TYPE: PERMIT TYPE:. PLU PURPOSE:; 017H JOB DESCRIPTION NEW GAS SERVICE SQ FT: ,CLAIM VALUE: CALC-VALUE:, GROUP OCC: ,B-2 / f COMMENTS: INS'T'ALL GAS METER/PIPING ALREADY IN I�a�-�-��***•��#,�*�e**I�-��->t*•>k*��t#>E•>t��c��•�•��+'r�-�->t�*�-�*�r>f*��r->F�*�*->E->f*��-�r��a-��*��c*�e Z O N I N G R E Q'U -I R E M'E N T S S E T B A C K S ----------- MAIN BUILDING -------- - -- - '--- - ACCESSORY BUILDING ---- --- _ FRNT: FT IN REAR: FT IN FRNT: 'FT: IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN' PARKING REQ: PROV: PARCEL: 00000000 ZNE: REF NO: PLANNING NOTES> .� # dE # •>f 1E 11• ->f # # # le # �E iE # kt # ->f # t# 9t i4 -►(- iF # •?!• # * # •It• i[- iE iF •3t -N- iE il• # �.iw t# # ;IE # -►(- iF # �E # 1E'�E #'# # dt # # # * # fF -►(- # # * �E >7E it• -31- >f iF •K• it• # ?E !I• # # D F V E L O P M E N T' S E R V•"•�; C E S R'E Q U I R'E M E N T S ZONING APPROVED BY __ __-----_ •,' _____ DATE: -- BUILDING APPROVED BY 7777 _ DATE: }_ ' APPLICATION ISSUED BY: `~_ DATE: 1E iE +F # # it• * >t- # * iE ?t-.� iF iE i4- •3E• �[• !E 8E �F• 9k��E 7F• ?'(•�� R• - - #'!f # -)C- 1+: iE dE �E 1E iE i��-N-}�E� iif Tf '![ # .� YE # iF it• iF !I.1E # if 1E �E #[ 1E 1I•. # * if -3t -3t * -N- i4 # iE # # 3E !F �k * # aE TE }E iE -1F i6 # i(• TE d4 •)(• iE iE �E # ie * it- * iS• 3E 31• * # it• •>f # # iF iE iE � # # iE LEGALIZATION:N F E E M A R Y STRUCTUiW, SEGMENT;N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT' 2.00 25e SMIP/NON-RES ,PLAN ISSUE FEE • -'3.00 BUTLDING-DIV--> PERMIT ISSUE PLAN -CHECK 'TOTAL PAID DUE' TOTALS-----> 2.00 3.00 0.00 5.00 5.00 00 REVENUE DIVISION TOTALS---> COLLECTED: s.00: OVER/SHORT: .00 BLDG P14T PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 5.00 'Jf YE -N' # if if * -1F'� if 3t # �(* iE �r ,if # # iF # l+E �F # 1t x in iE # * # #t 1E �£ * •3t -3E 4t # N * iE * iF 3E 3E # * * (E #'Jf 9t ->f jt * >f # * # iE * -3E * * # .N. # if Yf # # �E # # i♦ # )1• iC- I N D T V I -D U A L F E E B R E A K D O W N TY LSE QTY ]D E 5 C R •,T. P '1' T O N UNIT, COST TOTAL COST F -111U 1 GAJ SERVYCE N END OF F EES3 2-00 O1 00054118-00054118 TOT DATE: 02/14/90 TIME: 15:34 2-00 CONSTRUCTION AND PLANNING • APPROVALS Permit # Date Inspector POO .SPA APPROVALS Permit # Date Inspector. 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location i 2. Sail 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-GUNIT,E 7. Footings 58. Electrical Conduit-Undrgrnd, 8. Foundation 59. Gas Pipe, ❑ Undrgrnd•, Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final �'• 12. Sewer Cap 63. Heater & Vent -Final 4 13. Roof Drains 64, Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final i 15. Rough Electrical -Conduit 66. Solar System -Final 1 . 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Efectrical-T Bar Ceiling 69. POOL/SPA-SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT'. REQUIREMENT APPROVALS 'Permit # 20. Rough Factory Fireplace 211.. Ducts, in- Structure 70. Underground Hydro 22. Ducts, Ventilating •71. Product -Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test - 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ 00 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 lRl 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' , - r 35.' Final Gas Pipe -Test 36. Hood or Canopy 3 ' 37, .Final Factory Fireplacef 38. Final Plumbing is Qjj ' 39. Water Service -Final s 40, Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System = ' 45. Sound Attenuation 46, Handicap Regulations - f 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING- LANNING49. 49.Electric Release to Edison 50. Gas Release to Southern California Gas Go r f 51. CERTIFICATE OF OCCUPANCY No. Date _� Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COST;W—A�MrOL:4, UICPE IT PERMIT NO TRACT NO LOT NO. UNI Project Address Applicant's Mail' Address ��v Owner's Name Phone Address Arch/Eng. License No. Address Contractor's Nem JPhone, 7 7 Address (mailingl - 42 City License No. .� LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in full orce and effect License Class License No _79,0).2 ZID'% Date Signature WORKERS' COMPENSATION D RATION 1 hereby affirm that I have a certificate of consent to self -insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab. C.) - Policy No. _ Company l eCertified copy is hereby furnish@d. _ Certified copy Is filed with the city Building Division. Date Applicaht EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that In the performance of the work for which this permit is Issued, I.• shall not *MPIOY any person in any manner as to become subject to the Work Gomp nsa 'on ws of Cel" ia. Date �^ Signature NOTICE: If,af er making this deet t you should become subject to the Workers' Compensation provisions o the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a con$truction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name _ -- Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of theContractor'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 1031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hungred dollars ($500). I, as owner of the property or my empioyees, with wages as their sole compensation, will do the work, and the structure r$ not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion,the owner will have the burden of proving he/she did not build or im- rOve for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and Who contracts for such projects with a con- tractors) license pursuarit to'the Cons tractor'License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section_.-- B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above Information is correct. I agree to Comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city o enter upon the above-mentioned property for inspection Signature Signature Date `—I Drivers' LICe or S CMF 0865.46, rev. 10/84 W Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service i Interceptors Kitchen Sink - Lavatories P—Trap Roof Drains Reinspection Fee Boiler Outlets $15 Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 00-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 Cant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spe Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee IANICAL Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES $ 3 FEES $ 3 9946 3/25/95 Lane Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F•A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW El 5-15 KW Transformer ❑ 15-50 KW ❑ 50 + KW Meter LJup to 100 amps Meter ❑over 100 amps 'Sub Panel Motors ❑0-1 HP ❑ 115 - B Inc. Solar 09.15 HP ❑16-15+ Microwave Pole .Light Range Sign Standing Sections Trash Compactor I❑o50 TL FEES L O N I N G R E Q M T S I I Reinspection Fee 1 $15 1 1 Issue Fee I $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By SUMMARY OF FEES BUILDING PERMIT $ SMIP TYPE OF CONSTRUCTION El NEW ADD ALTERATION LJ REPAIR PERMIT ❑ ❑ ❑ $ ISSUANCE CONVERSION DEMOLISH OTHER $ A.P. # DESCRIPTION OF WORK/USE OF BLDG. $ GRADING PLAN CHECK 50% $ MICROFILM S Main Buiidi TOTAL FEE PLAN CHECK 25% E TYPE OF PERMIT Li GRADING ED FOUNDATION 0 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B ❑ •OTHER A Rear Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K K' CON STRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service i Interceptors Kitchen Sink - Lavatories P—Trap Roof Drains Reinspection Fee Boiler Outlets $15 Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 00-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 Cant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spe Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee IANICAL Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES $ 3 FEES $ 3 9946 3/25/95 Lane Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F•A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW El 5-15 KW Transformer ❑ 15-50 KW ❑ 50 + KW Meter LJup to 100 amps Meter ❑over 100 amps 'Sub Panel Motors ❑0-1 HP ❑ 115 - B Inc. Solar 09.15 HP ❑16-15+ Microwave Pole .Light Range Sign Standing Sections Trash Compactor I❑o50 TL FEES L O N I N G R E Q M T S I I Reinspection Fee 1 $15 1 1 Issue Fee I $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By $ SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.C. ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% . $ $ �A y CONSTRUCTION AND PLANNING r Fr Date " APPROVALS Permit # - Inspector POOH .x SPA . , APPROVALS Permit # Date Inspector 1: Temporary Electrical Service.or Pole 52. Pool & Equipment Location i. Soil,Pipe-Undrgrnd �� 53. Steel Reinforcement Electrical Conduit,'Uti`ty-Undrgrnd. 54. Forms �I Electrical Conduit}tj'hdrgrnd. { .55. Electrical Bonding r if 5 } Reinforcement,- 56. Rough Plumbing & Pressure Test ��i 6- Electrical UFER"Grnd. �� r,'� 57. APPROVAL TO COVER•GUNITE ` + 7,-:" Footings !y+` f' 58. Electrical Conduit-Undrgrnd. 8� Foundation r� r { 59. Gas Pipe, ❑ Undrgrnd., Test fn 9 Water Pipe Undrgrnd. 60, Backwash Lines, P -Trap, ❑ Undrgrnd. -•10. Str tura) Floor System 61. APPROVAL TO DECK ,,Property Sewer Liner& House Cehnyection ! 62. Backwash & Receptor -Final Vt 12'�.Sewer Cap V t 63. Heater &Vent Final t „ 13r:,Roof Drains ` , _ 64. Plumbing System - Final !iRough Plurnbi9g4- C40 65. Electrical -Final 15. Rough Electrical -Conduit j6A. 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 c 19, Rough Heating & Air Conditioning k� FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas, ❑ Oil ' 23. Gas Pipe -Rough & Test 72. Underground Flush 24•. Roof Framing 73. Undergrnd- Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Moriocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe. _ 28. Lathing & Siding I 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster BroWn Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED '33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace ' 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed f 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 151. CERTIFICATE OF OCCUPANCY No. .'Date - ' . - . . ,. . J, - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITYF COSTA MESA - CONSTRUCTION PERMIT )�f1M1T No_ TRACT No LOT NO. UNIT NO. Project Address Applicant's Mailing Address Owner's Name ne 17d�d6"ZSL Lic? Address Oka j Arch/Eng. i. �Y • At a �Li"O k �QQt n ^Ee�nse No 1S-��'Y Address �n `Ei2 CU[11�d�� &o, ,t]- tl - z_4 LI. Contractor's Nam Phone Address (mailing) City License No. - - — LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. , License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION hereby affirm that I have a Certificate of consent to self -Insure or a Certificate Workers' Compensation Insurance, or a certified 'Copy w, thereof ,((Section- ,800, (SSection - 8 Icy Lab. C•- = 6 Ifo Company &912 A". "� • P icy No. 1/GC.f Certified copy is hereby furnished. Certified copy is filed with the city 19uilding Divisio Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This sectlon heed not be completed if the permit is for One hundred ($100) or less). ! certify that In the performance of the work for which this permit is issued, I shall not employ any person in any Manner so as to become subject to the Workers' Compensation Laws of California. DateSignature 'NOTICE: It, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for 1he performance O1 the work for t i gQrlitiI I lsiu cHD Iv, C.) Lender's Name '/111 Z Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License taw for the following reason (sectlon 7031.5 Business and Professional Code: Any City or county which requires a permit to congtruct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a Signed statement that he/She Is licensed pursuant to the provisions Of the Contractor's License Law (Chapter.9 (commencing with Section 7000) of INvlsion 3 of the Business and ProfCtslons Code)• or that he/she is exempt ierefrom and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subjects the_applica_nt- to a Civil Fatty of not more than five hundred dollars ($500).' I. a5 owner of the property or My employees with wages as their sole Compensation, will do the work, and the•structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or impr4voment is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed Con- ' tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property wno builds or improves thereon, and who contracts for such projects with a con- tractof(s) llcense pursuarit to the ContraCtor's License Law). I am aware that proof of their Worker's Compensatioh Insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner 1 hereby certify that I have read thi''l application and state that the above Information is correct. I agree to comply with all city and county ordinances and state laws relating,to building construCtlon, and ,hereby authorize repro- sentatives of this city tqeffNr up t abgve-mentioned properly for Inspection purposes. Signature Dat_ Drivers' License Or SS iP TYPE OF CONSTRUCTION U NE=W LJ ADD LJ'ALTERATION i� REPAIR yj�^j' CONVERSION ❑ DEMOLisH ❑ OTHER A,P. # DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL_ T Front El TENANT El ELECTRICAL PLUMBING ❑ MECHANICAL A Rear El .OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CON STRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ' ACRES Ping, Ref, c* Remarks: vpv3 Planning Notes: 6038 5%23'/96 Zone - Accessory Building: Parking Req,/Provided Z O N I N G R E O M T S GMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Wash' Construction Pole Sub, Transformer © 15-50 KW D 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit .� , ` Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over'100 amps - Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Floor Drains Solar Tank Swimming Pool w/Spa Fan F.A.U. Motors 00-1 HP 01 h - B Inc.Solar ❑9-15 HP ❑16-15+ Floor Sinks Gas Service Outlets Urinal Water Closet 00 Fixtures Device Boxes Microwave Pole Light Interceptors Kitchen Sink Water Heater Water Service Outlets Switchesi Range Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P --Trap Laundry Trays Generator C3 0-5 KW ❑5.15 KW Trash Compactor Roof Drains Reinspection Fee S15 I Issue Fee- 5 3 Reinspection Fee S15 Issue Fee S 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Approved By Date Building Approved By Date Application Issued By _ Date Boiler Hood or Type I ❑ Canopy Type I I El Duct Under Ground I Duct - Structural Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN PLUMBING CHECK ' PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY $ $ $ ----�— $ _ $ S $ S OF FEES SMIP $ p� PERMIT ISSUANCE $ ENERGY P,C. $ GRADING $ ' MICROFILM $ TOTALFEE $ i Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fect.Sit. IC80, Fire Dampers Heating System & Ducting 0()-1 00,000 BTU El 100,000 BTL Registers, I Reinspection Fee S15 Issue Fee S 3 GMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POO. ;PA 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 I 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. f'3� '8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test ✓O� 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. St�� 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection ,� ► n 62. Backwash & Receptor-Final 12. Sewer Cap_ 63. Heater & Vent-Final f 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 ElectricalT Bar Ceilin 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20, Rough Factory Fireplace 21. -Ducts, in Structure 70. Underground Hydro 2 oDucts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23;'Gas Pipe-Rough & Test f. 724 Underground Flush 24 ;Roof Framing r% 73. Undergrnd, Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing f' 74. Overhead Hydro 26. T-Bar Ceiling (Structural) &lMonocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30.JDrywall Nailing HEALTH DEPT. REQUIREMENT 31VPlaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47'•. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed ' 49. Electric Release to Edison 5A Gas Release to Southern California Gas Co �1- CERTIFICATE OF OCCUPANCY No: Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations, CIP,OF COSTA MESA CQNSTRUCTION PERMIJ�J Project Address Applicant's Mailing-!( ss r C;f�- Owner's Name Phone Address Arch/Eng, License No. Address Contractor's Nam Phon Address (mailing) City License No., LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing withsection 7000) of Division 3 of the Business and Professions Code, and my] i cense is in full for and effect. onLicense ass Li o Date' _ Signature WORKERS' COMPENSATIONEC TION i hereby affirm that I have a certi " of consent to self -insure or a certificate f Workers' Compensation Insurance, or a certified copy thereof (Section - 3800, Lab. C.) Policy No. Company e Certified copy is hereby furnished. ; Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for v4aich this permit is issued, I shall not employ any person in any m ner o s com subject to the Work e o e i n Laws of Calii Date r' Signature NOTICE: It, after making this decta ativn you should ecome subject to the Workers' Compensation provisions f Labor Code, you must forthwith comply with. such provisions or permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued r (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER 9_UILDER DECLARATION . I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code.- Any city or county which requires a permit to construct, alter, improve, demolish ourepair 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 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 /031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as theirsole compensation, will do the work, and the -structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sate). 1, as owner of the property, am exclusively contracting with licensed con- tractors to on- tractprsto construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuarit"to the'Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner 1 hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state taws relat" g to'Idi g const uction, and hereby authorize repre- sentatives of is y t upon he above-mentioned ro erty.yfor inspection our Signature Date Drivers' Li nse or SS qp TYPE OF CONSTRUCTION IJ NEW IJ'ADD U ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A. P. # DESCRIPTION OF WORK/USE OF BLDG, S Main Building: E TYPE OF PERMIT El GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT AELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTWER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right KLeft CONSTRUCTION TYPE VALUATION $ S ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: 1 Planning Notes: 8948 9/26/84 16.50 TL Zone Accessory Building: Z O N I N G R Parking Req./Provided _ E M T S. Bar Sink PLUMBING Showers FEES ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pale Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connectiori Cooking Unit Meter Opp to 100 amps Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps Dishwasher Solar Piping f Dryers ❑Gas ❑Electric Sub Panel a Drinking Fountains Solar Tank Fan Motors 0.1 HP tf, B❑k Floor Drains Swimming Pool wlSpa` F.A.U. ; Inc. Solar ❑9-)5 HP ED 16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets -Water Closet � Device Boxes [� Pole Light Interceptors Water Heater 0 Outlets Range Kitchen Sink Water Service Switches Sign Lavatories, Garbage Disposal Standing Sections P—Trap Generator 00-5 KW ❑5-15 KW Trash Compactor Roof, Drains Reinspection -Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Hood Or Type 1 ❑ Canopy Type II ❑ DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REOUIREMENTS: pate Date Dat Duct Under Ground Duct - Structural Refrigeration System ❑0.100,000 BTU ❑ 100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 2596 ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE" $ $ ENERGY P.C. $ $ _ GRADING $ $ MICROFILM $ $ TOTAL FEE $ $ `Sb Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact, Bit, ICBO # Heating System & Ducting 00.100,000 BTU 0100,000 BTU r I Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 4/84t�uiiuin ry - Applicant; Pink - Accounting; Goldenrod - Assessor . ONSTRUCTION AND PLANNING •!APPROVALS Permit # Date Inspector POOL -- 'PA 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 56.56. Rough Plumbing & Pressure Test 6•fElectrical UFER Grnd. j 57. APPROVAL TO COVER-GUNITE ' 7. Footings 58. Electrical Conduit-Undrgrnd. 8' Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd.. , 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. -Property Sewer Line 8i House Connection62. Backwash &Receptor -Final 12„S6;er 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 Heati.P Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70.' Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 /Q v Notes: 34. Final Heating & Air Conditioning " 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. .Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51•. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy'border lines and sign all appropriate declarations. TRAC O LOT NO CITY OF COSTA MESA CONSTRUCTION PERMIT Pi KNIT NO. T N UNIT NO. PrgJect Address T H 42 CI ' Applicant's Mailing Address_ Owner's Name rap J Z -) LI TFS ' 1-44 REJ %— Phone Address Arch/Eng, License No. Address Contractor's Nameff/My V711J' ITC F cT 2K Phone 9' - t Address (mailing ll�J�� S /11 4' F=J T - 13Lol;r1 L ?2ii City License No. 3 .31 9 0 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions ofCha ter 9 (commencing with section 7000) of Division 3 of the B s and P fessi s Code, and my license is in full orce and_effectl C'� License lass 1 "ens No. J Date I Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certifled'copy thereof (Section 3800,Lab. C.} 1oiicy No Lj-L sr/o 93 7o C y ' Z; C 1 ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the cit Bui g rvisiorl. Date �'�d^�; Applicant EXEMPTION FROM WORKERS' COMPE ATIO ECLARATION (Thissection need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I Shall not employ any persori in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm that there Es a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name' Lender's Address , OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil •enalty of not more than five hundred dollars ($500). J I, as owner of the property or my -employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for We. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/She did not build or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuarit'to the Contractor's License Law). i am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I -am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that -I have read this ap information is c c?to ree to comply, and state la relybuilding conssentatives this enter ru o t inspection Signature71 Drivers' License or 5 rev. 10/84 white ajjvon and state that the above YlalI city and county ordinances 66n and hereby authorize repre- above-mentioned property for Date 596[1 r:e60 TL 1 TYPE OF CONSTRUCTION NEW ADD ALTERATION J REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 4A Zone DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: TYPE OF PERMIT Li GRADING E FOUNDATION STRUCTURAL T. Front Z O ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N ❑ OTHER A I PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N CONSTRUCTION TYPE= VALUATION $ g Left R, ZONE GRADING CU. YDS. ACRES Ping. Ref. # Parking Req./Provided E Remarks: Planning Notes: QM T S Bar Sink Backflow Preventer Backfiow Irrigation Bathtubs Clarifiers Dishwasher ' Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P --Trap Roof Drains Reinspection Fee Showers Service Sink - Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet' Water Heater Water Service Auto -Wash Laundry Trays $15 Issue Fee - MECHANICAL Boiler Duct - Under Ground Duct - Structural Duct Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting El 0-100,000 BTU ❑ 108000 BT Reinspection Fee 1 $15 icant; Pink - Accounting; Goldenrod - Assessor Hood or Type I ❑ Canopy Type II ❑ Refrigeration System ❑0-100,000 BTU 01I00,000BTU System Repair/Alteration Fire Dampers' Registers Issite Fee FEES ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter Dover 100amps - Dryers ❑Gas ❑Electric Sub Panel Fan Motors �dD-1 HP ❑ 1 A - B Do F.A.U. Inc. Solar 12 9-15 HP El 16-15+ Fixtures Microwave Device Boxes Pale Light Outlets Range Switches Sign Garbage Disposal ; Standing Sections Generator 00-5 KW 1:15-15 KW Trash Compactor $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: _ _ Date Date Data _ SUMMARY OF FEES BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ OO PLAN CHECK 50% '$ S MECHANICAL $ PLAN CHECK 25% $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & _- A I APPROVALS Permit # Date I nspecm r� 1. Temporary Electrical Service or Pole .w f 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. A� 53. Steel Reinforcement rElec[ricat Conduit �"iffty-Undrgrnd. 54. Forms 4nElectrical Conduit-Undrgrnd. 64 55, Electrical Bonding 5..Steel)Reinforcernerit, ' i 56: Rough Plumbing & Pressure Test 6r Electrical UFER'Gr`nd. 57. APPROVAL TO COVER-GUNITE r' 7.,Footings ' 58. Electrical Conduit-Undrgrnd. 'L 8.1Fou4dation rt M 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water. Pipe-Undrgrnd. 60. Sackwash Lines, P -Trap, ❑ Undrgrnd. 10,,Structural Floor System rr� 61. APPROVAL TO DECK 11 'Property Sewer Line*& House Connection 62. Backwash &Receptor -Final 12'. Sewer Cap �; j r t 63. Heater & Vent -Final r� 13:rRoof 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Rar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frdme and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78, FIRE PREV. FINAL 30.E Drywall Nailing HEALTH DEPT, REQUIREMENT 31 Plaster Brown Coat 79. FINAL INSPECTION 32 Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric ` k �� Notes: 34. Final, Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40, Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System ,x 45. Sound Attenuation , 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING' 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all aparopriate declarations. CITY OF COSTA MESA ' CONSTRUCTION PERMIT Pfoiect Address .-7.11 W_. 17th St. B1d&. (D} Unit 7 Appiicant's Mailing Address 13130 Saticoy N.Hollywoad, Owner's Name T-rlay Tniracrmpnt- Fitn"I Phone 949-2989 Address 4321 Arch/Eng.) License No. Address .]?AR Kn(y1-r Ave_ ,$,Mite — Contractor's Nam Phone 982--121 Address (mailing) -13-L 0 %a Ca. City License No. _39425 LICENSED CONTRACTOR DECLARATION I hereby affirm that I arra licensed under provisions of arter 9 (commencing with section 7000) of 4ivlsion 3 of the Business an rbfessions Code, and my license is in full force and effe License Class - L se o._'i46251 Date4 /19 184- Signature WORKERS' COMPENSATION DE RAT( N I hereby affirm that I have a certif' to of consent to self -insure or a certificate +f Workers' Compensation Insu rice, or a certified copy .thereof (Section 1800, Lab. C.) 4 _ Policy No. WAR94 Company 1.umbermanS eCertified copy is hereby furnished. Certifi � y is filed with the city Building,qusjop. A 1� Date Applicant LLIJ C(__..00 EX£MPTI N FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). t certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date —Signature •NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that therq I$ a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION ' J hereby affirm that i am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter. Improve, demolish or repair any structure, prior to It$ issuance, also requires the applicant for such permit 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 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 1031.5 by any appiic§nt for a Permit subjects the applicant to a Civil )enalty of not more than tive hundred dollars ($500). tiI, a5 owner of the property or my employees with wages as their sole Compensation will do the work, and the structure Is not intended or offered for Salo (Sec{ion 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who build$ or improves thereon, and who does Such work himself/herself or through his or her own employees, provided thtit such improvements are not intended or offered for sale. It, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purposo of sale). ❑ 1, as owner of the Properly, am exclusively contracting with licensed Con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who contracts for such projects with a con- traCtor(s) license pursuant'to the Contractor'i License Law). t am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date - Owner I hereby certify that I have read this application and state that the above Information is correct. I agree t omply with all city and county ordinance$ and• state law Iating to buil n Construction, and hereby authorize repre- sentatives t S city to a upon the above-mentioned pr p rty f inspectio urp as. �7 Signatur. Date J Drivers' Lic or,SS 9 1777 4/24/65 I6e50 TYPE OF CONSTRUCTION, LJ NEW L-1 ADD LJ ALTERATION LJ REPAIR PLUMBING FEES ❑ CONVERSION ❑ OEMOLISH ❑ OTHER A.P. 4- Zone DESCRIPTION OF WORK/USE OF BLDG. $ Main Building: Accessory Building: Backflow Irrigation Sewer Cap Bathtubs E REQUIREMENTS: - - Cooking Unit Z TYPE OF PERMIT GRADING FOUNDATION 11 STRUCTURAL T Front Dishwasher 0 ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL 13 Fire Dampers Dryers ❑Gas' ❑Electric N ❑ -OTHER A Rear Fan+ I Floor Drains C Right F.A.U. N PROJECT DESCRIPTION SO. FT. OCCUPANCY Urinal Water Closet Water Heater Fixtures Device Boxes Outlets G CONSTRUCTION TYPE VALUATION S S Left Switches R ZONE GRADING CU. YDS. ACRES Ping. Ref, # Parking Req./Provided E ;Standing Sections P --Trap Laundry Treys Q Is Remarks: Planning Notes: Roof Drains M T - Reinspection Fee Boiler $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting ®0-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant, Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer. Service Sink $15 Issue Fee Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection REQUIREMENTS: - - Cooking Unit Meter Dup to 100 amps Clarifiers Solar Collectors BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Fire Dampers Dryers ❑Gas' ❑Electric Sub Panel Drinking Fountains Solar Tank Fan+ Motors ❑0-1 HP 1:11 - 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9.15 HP ❑16-15+ Floor Sinks Gas Service Outlets Interceptors Urinal Water Closet Water Heater Fixtures Device Boxes Outlets Microwave Pole Light Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ;Standing Sections P --Trap Laundry Treys Generator 1:1115 KW 05.15 KW Trash Compactor Roof Drains Reinspection Fee Boiler $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting ®0-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant, Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 Reinspection Foe $15 Issue Fee $ 3 iIANICAL FEE$ Hood or Type 1 ❑ Canopy Type II ❑ DEVELOPMENT SERVICES Zoning Approved By Building Approved sy Application Issued fay— REQUIREMENTS: - - Date Date'�� Date_.�..,;_, Refrigeration System ❑0-100,000 BTU 0100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ S $ $ 13,00 $ 2.50 SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ ' GRADING $ MICROFILM $ TOTAL FEE $ 15.50 System Repair/Alteration Fire Dampers Registers ! ls=e Fee $ 3 CONSTRUCTION AND PLANNING Date APPROVALS . Permit # Inspector POOL - SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool-& Equipment Location f 2. -Soil Pipe-Undrgrnd, 53. Steel Reinforcement . 3. Electrical Conduit Utility-Undrgrnd. 54. Forms �- 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding i 5. Steel Reinforcement _ 56. Rough Plumbing & Pressure Test 6. El'ectrical UFER Grnd. r .' n 57. APPROVAL TO COVER-GUNITE r 7. Footings 58. Electrical Conduit-Undrgrnd. ° t 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. ' 10. Structural Floor System - 61. APPROVAL TO DECK 11. Property Sewer Line & House Convection 62. Backwash & Receptor -Final 12. Sewer Cap 't 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76, Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78, FIRE PREV. FINAL 30.. Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79, FINAL INSPECTION 32.- Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 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 iii Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MES A CONS UCXION PERMIT Project Address 11b Applicant's Mailing Address Owner's Name one Address ArchlEng, ense No. Address Contractor's Nam Phone Address (mailing) City License No. LtCEi4SED CONTRACTOR DECLARATION I hereby affirm that i am licensed under provisions of Charter 9 (commencing With section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a' certificate of consent to self -insure or a certificate of Workers' Compensation Insurance,- or a certified copy thereof (Section 3800, Lab. C i- ��QQ Po icy No/1-5 -Company Certified copy is hereby furnished. Certified copy ) %filed with the city Building Dlvision. Date Applicant EXEMPTION FROMWORKERS' COMPENSATION ECLARATION - - (This section need not be completed if the permit is for one hundred ($100) or less), ' l certify, that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to'the Workers' Compensation Laws of California. DateSignature 'NOTICE: If, after making this declaration, you should become subject to'the Workers' Compensation provisions of -the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency fort perfor ante of the work for is is per I is c n 7 C.) Lender's Name p n/� - �- Lender's Address _ J{r in OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License -Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, pHor to its Issuance, also requires the applicant for such permit -to filo 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 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 331.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). - ❑ I'as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale {Section 17044. Business and Professional Code: The Contractor's 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 t employees, provided that such improvements are not intended or offered for sale- If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/sho (lid not build or im- rove for the purpose of sale), I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License -taw does not apply to an owner of property who 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 proof of their Workers Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. i agree to comply with ail city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to r1 up h a gve-mentioned property for inspection purposes. , Signature Date Drivers' License or SS ✓ i u TYP OF CONSTRUCTION LJ NEW, LJ ADD U ALTERATION U.REPAIR- CONVERSION ❑ DEMOLISH ❑ OTHER A.P. fit, DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING ❑ FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL A Rear L-1OTHER!!! PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CON ST_RUCTION TYPE VALUATION $ S Left ZONE GRADING CU. YDS. ACRES _ ping, Ref. 9(t Remarks: Planning Notes: I Bar Sink Backflow Preventer Backflow Irrigation Bathtubs ; Clarifiers _- Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Intarceptors Kitchen Sink Lavatories' P—Trap Roof Drains Reinspection Fee $15 MEC Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact.,Blt. ICBO # Heating System & Ducting ❑ D-100,000 BTU ❑ 100,00D B7 , I + Reinspection Fee I I $15 CMF 0865-46, rev. 10/B4 White - Building; Canary - Applicant; pink - Accounting; Goldenrod - Assessor ABING FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Zone Building: Parking Req./Provided ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construction Pale Sub. ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher �- Meter ❑over 100 amps - Dryers ❑Gas -DElectric Sub Panel Fan 1. Motors ❑0-1 HP U1 V2 '8 F.A.U. Inc. Solar. 09-15 HP 016.15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal ; Standing Sections Generator ❑a-5 KW 05-15 KW� 'Trash Compactor Z ' N I N G JS' R E M T FEES t . Issue Foe $ 3 Reinspection Fee$15 Issue Fee $ 3 4ANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By 1 Building Approved By Application Issued By Date t Date pate !-rood or' Type 1 0 Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU , SUMMARY OF FEES BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ QO PLAN CHECK 25% $ _ _ ELECTRICAL $ , PLAN CHECK ;50% $ I MECHANICAL $ PLAN CHECK 25% $ �y 1 SMIP $ PERMIT , ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE . $ ' ' System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 t CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL ?A 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 �y 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test l �' 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE rY 7. Footings 58. Electrical Conduit-Undrgrnd. k 8. Foundation 59, Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK ' 7 i . Property Sewer Line &House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final .V 13. Roof Drains r 64. Plumbing System - Final `. 14. Rough Plumbing ls 65. Electrical -Final t 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22�Ducts, Ventilating 71. Product Piping El Gas EJ Oil 2�Gas Pipe -Rough & Test721 Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 30.0Drywall Nailing HEALTH DEPT. REQUIREMENT 31.T Plaster Brown Coat 79, FINAL INSPECTION 32' Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer ,43. Backflow Irrigation X94. Landscape Irrigation System ,45. Sound Attenuation fL4 6. Handicap Regulations ,47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 5;1. CERTIFICATE OF OCCUPANCY Date -, Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address �/ 1J)% S - Applicant's Mallin Address Owner's Name Phone Address Arch/Eng. _ License No, Address Contractor's Nam one _Z7 Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I arh licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in ful orce a d ffect. License Class License No, a Date�OENSAT..,Signature WORKERS' DRATION I hereby affirm that I have a certifi&ate of consent to self -insure or a certificate 73f Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. �- Company H Certified copy is hereby furnished. Certified copy is filed with the city Building Division. - Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for One hundred (5100) or less). 1 certify that in the performance of the work for which lhiypermit is issued I . shall not employ any person in any manner So s to become subject to tke Workej�j,,Cofn nsatl_or14aws of Califo Date ^^//�/- ��P—o_� Signature NOTICE: If, after making this declarat , you should become subject to the Workers' Compensation provisions of fhe labor Code, You must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENbING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ, C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law lot the following reason (Sectlon 7031.5 Business and Professional Code: Any city or, county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions Of the Contractor's License Law (Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code) or that he/she is exempt 'herefrom and the Basi% for the alleged exemption. Any violation of Section '031.5 by any applicdnt for a permit subjects the applicant to a civil enalty of not more thary live hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole Compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not abply t0 an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own empioyeeS, provided thdl such Improvements are not intended or offered for Sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale), ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improvos thereon, and _who contracts for such projects with a con- tractors) Ilconse pursuant 'to"the Contractor's License Law). I am aware that proof of their Worker't Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Date Owner 1 hereby certify that 1 have read this application and state that the above Information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city t enter upon the above-mentioned property for inspection pur t - Si nature Date r I Drivers' Licen or 55 ,CMF 0865-46, rev. 10/84 Whi 9947 3/25/85 I0e50 TLi (cant; Pink-- Accounting; Goldenrod - Assessor TYPE OF CONSTRUCTION D NEW 0 ADO L1 ALTERATION 0 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORKIUSE OF BLDG. REPAIR A.P. Zone S Main Building: Accessory Building: TYPE OF PERMIT LJ GRADING LJ FOUNDATION In STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ •OTHEn PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATIONS ZONE GRADING CU.YDS. ACRES E T Front Z 0 B A Rear N I C Right N S Left R Ping. Ref, `>k Parking Req./Provided E Remarks: Planning Notes: O M T S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors El 0-1 HP ❑ 154 - 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar C1 9-15 HP 1:116.15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator 045 KW 05.15 KW Trash Compactor Roof Drains Reinspection Foe $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 Boiler Duct - Under Ground MECHANICAL Hood or Type I C1DEVELOPMENT Canopy Type I I ❑ FEES SERVICES Zoning Approved By Building Approved By Application Issued By . REQUIREMENTS: Date Date �� Dat Duct - Structural Refrigeration System 134100,000 BTU ❑100,000 BTU Duct - Ventilating _ BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ �0 ISSUANCE $ $ - ENERGY P.C. $ $ GRADING $ $ MICROFILM $ $ TOTAL FEE $ $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Blt. ICBO # Fire Dampers Heating System & Ducting ❑4100,000 BTU C1 100,000 BTLJ Registers Reinspection Fee $115 F Issue Fee $ 3 (cant; Pink-- Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING - APPROVALS Permit # 'Date Inspector POOL - SPA :APPROVALS Permit # Date Inspector , r 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location l{ - `,"2, Soirl�Pipe-Undrgrnd. � � 53. Steel•Reinforcement `.:3rEle t ical Conduit-Uti'lity-Undr'ndf 54. Forms 4L.Dectr cal Concluiit;0i7digrnd. (� 55. Electrical Bonding 5r1SteeIfReinforcement-.i �� 56. Rough Plumbing & Pressure Test Y*T� 6•: Electrical LIFER Grrrid. � r 57. APPROVAL TO COVER-GUNITE n T. Footi gs ' �z .y 58. Electrical Conduit-Undrgrnd. 8.* Foundation f 59. Gas Pipe, ❑ Undrgrnd., Test 9'. Water Pipe-Undr`gpd'. �� A 60. Backwash Lines, P -Trap, ❑ Undrgrnd. ;10�' tquctural Floor Sysiem F 61. APPROVAL TO DECK 111Property Sewer Line'& House Co^ndction i 62. Backwash & Receptor -Final 12. "Sewer CapJam/ `� r 63. Heater & Vent -Final " rj 13� Roof Drains r+ 64. Plumbing System • Final s 14:'Rough Plumbing� :S� 65. Electrical -Final to 15. Rough Electrical -Conduit 615. 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 APPROVALS Permit # 20., Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd, Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75, Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29, insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing f ` 39. Water Service -Final 1 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 CITY OF COSTA MESA . CONSTRUCTION PER PrgjechAddress 711 W. 17th' ST.J Bldg. (D) Unit $ Applicant's Mai I ing Address 1311fl_ Saticoy St. N.Hollywood, Owner's Name !Xrglr TnupStmPnt 'F-ttnd JPhone 549-2988 Address 4391 Birch St. Neport, Beach Ga _ Arch/Eng. Main _J_. Rock License No. Address 12881 Knott Ave. Suite 216 Contractor's Nam it Conditioning Phone 982-1216 Address imai(ing0_3110 Sat.COy St. N.Hollywood,Ca. City License No. 39.925 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 Q1 the Business and Professions Code, and my license is in full fold and etf 346251 License Class U� c JsN o. Date8.184 SignaturOlerance, WORKERS' COMPENSATIONTION I hereby affirm that I have a ceronsent to self -insure ora certificate of Workers' Compensation Ina certified copy thereof (Section )ana, Lab. c.) WC91k4 ' Lulnbermans Policy No. Company , eCertified copy is hereby furnished. f Cert'f' c Is iled with the'city BuildirnQvisi n. Date Z' Applicant 1 EXEMPTI N FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less) I Certify that in the performance of the work for which this permit is issued, I shall -not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you Should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply 'with' such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY _ I hereby affirm that there is alconstruction-lending agency for the performance of the work for which' this permit is issued (Section 3097 Civ. C.) Lender's Name _ - Lender's Address OWNER BUILDER DECLARATION _ I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Divisioni 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 '031.5 by any applicant for a permit subjects the ,applicant to a civil enalty of not more than five hundred dollars ($500). -_ 0 I, as owner of the property or -my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered'for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove forr the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- 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 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 proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner 1 hereby certify that I have rea this application and state that the above information is correct. I agree or" ply with all city and county ordinances and state I relatingto bu i construction, and hereby author)� rep - sentativ of is city tp t upon the above-mentioned, yrglimrty IVr inspec ' n Pur oses. Signet Drivers' L' se or SS CMF 0865-46, rev. 10/84 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PE MIT NO. i TRACT NO. LOT NO.IT Nb. TYPE OF CONSTRUCTION LJ NEW jJ ADD LI ALTERATION LJ REPAIR ❑ ❑ ❑ OTHER- Zoning Approved By 1 CONVERSION DEMOLISH ,4 p # DESCRIPTION OF WORK/USE OF BLDG. Building Approved By 5 Main Building: TYPE OF PERMIT ❑ GRAOING El FOUNDATIOJV STRUCTURAL E T Front - ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING Ln MECHANICAL 13 ❑ COTHER - A Rear - $ C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K PLUMBING CONSTRUCTION TYPE VALUATION $ S Left _ ZONE' GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains, Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P --Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct-` Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting R90-100,000 8TU Ell 00,000 BT Reinspection Fee $15 Canary --Applicant; Pink - Accounting; Goldenrod - Assessor FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa . Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee - $ 3 ECHANICAL FEES Hood or Type ❑ Canopy ' Type 11 ❑ Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee I $ 3 1778 4/24/25 Accessory Building: Parking Req./Provided t - ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ©Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator El 0-5 KW C1 5-15 KW 150; 0 TL Transformer 0 15-50 KW ❑ 50+ KW Meter LJup to 100 amps Meter ❑aver 100 amps Sub Panel Motors ❑0-1 HP ❑1'A - 8 .Inc.Solar 09-15 HP ❑16-15+ Microwave Pole', Light Range Sign Standing Sections Trash Compactor FEES z O N I N G R, E a M T S Reinspection Fee 1 $15 1 ' I Issue Fee 1 $ 3 I 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat Z SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.G. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ - MICROFILM $ MECHANICAL $ 11-00 TOTAL FEE $ 1.5. 5Q PLAN CHECK 25% $ 2.50 CONSTRUCTION AND PLANNING APPROVALS • Permit # Date Inspector POOL ,PA APPROVALS Permit # Date Inspertnr r 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location r" 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd.55. Electrical Bonding �s �A, 5. Steel Reinforcement r 56. Rough Plumbing & Pressure -Test �' t 6. ElectricalUFER Grnd. ' ' 57. APPROVAL TO COVER-GUNITE , 7. Footings 58. Electrical Conduit-Undrgrnd. 8: •Foundation f r 59. Gas Pipe, ❑Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Con2ection 62. Backwash & Receptor -Final -12. Sewer Cap ! 63. Heater & Vent -Final 13. Roof Drains 64, Plumbing System -Final ' 14. Rough Plumbing 65. Electrical -Final r 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. REOUIREMENT APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30.. Drywall Nailing HEALTH DEPT% REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION ' 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Fina! Gas Pipe -Test 36. Hood or Canopy 37, Fina! Factory Fireplace 38. Final Plumbing 39, Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. -Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING,, 48. Special Requirements Completed 49. Electric Release,to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY O COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. F C` I ~l I Li- L1 I I I jf1 .rw- Pfoje66-Address ?/I 6.1 J, 77'`�-gr i Applicant's Mailing Address Owner's Name ►'I VIVAZ2211_414. Phone Address Arch/Eng. License No. Address - rl. ._ Contractor's Nam^'a4��r�1�C C�/�—Phone �! Address (mailing)/cy-1P&r4&,-,gr4,T nt't!t�/t+ll�+a�%C J 716 City License No. _—f-7 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (Co mencing with section 7000) of Division 3 of the C s and Pro 6ssio ode, and My license is in full force and effect, License Class ' tensa DateSignature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified Copy thereof (Section 1800, tab- C.) _ Policy Nell} G S 10 13 7", Co BCertified copy is hereby furnished Certified 60p9is ed with the cit B n ivlslon, Date 5 Applicant EXEMPTION FROM WORKERS' COMP NSATIO DECLARATION (Thissection need not be Completed if the permit is for one hundred ($100) or less) . I Certify that In the performance of the work for which this permit is Issued, I shall not' employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE:_ If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance' of the work for which this permit is Issued (Section 3097 Cly. C.) Lender's Name - Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License taw for tha following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the'applicant for such permit to file a signed statement that he/She Is licensed pursuant to the provisions of 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 '031.5 by any applicant for a permit subj"ts the applicant to a civil enalty of not more than five hundred dollars ($$00). C-1 1, as owner of the property of my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements ar@ not Intended or offered for sale. If, however, the building or Improvement IS sold within one year of corn- pletlon, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively Contracting with licensed Con- tractorsto construct the project (Section 7044, Business and Professions Code; The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and _who contracts for such projects with a con- tiactor(s) license pursuarit'to the Contractor's License Law), I am aware that proof of their Worker's Compensation insurance should be provided to me, ❑ ! am exempt under Section B. 8. P. C. for this reason Date Owner — I hereby. certify that I have read this application and state that the above informatioWse ee to comply with all city and county ordinances antl state uilding con tructt antl hereby authorize repre- Sentativesenter uP th . Ave -mentioned property for inspection ��y r'� Signature Date .--d J Drivers' License or SS � 1/16/85 6.50 . TL TYPE OF CONSTRUCTION LJ NEW L! ADD LJ ALTERATION LI REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. # Zone S Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT, OCCUPANCY C 0 N ST RUCTI ON TYPE VALUATIONS ZONE GRADING CU, YOS. ACRES T Front ZO 13 A Rear N C Right N S Left R Ping. Ref. # Parking Req,/Provided E Remarks: Planning Notes: Q M T S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 0-1 HP Ell .S - B Floor Drains Swimming Pool w/Spa F,A.U. Inc. Solar 1:19-15 HP 1:116-15+ Floor Sinks Urinal Fixtures Microwave - Gas Service- Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections P—Trap Laundry Trays Generator 1:10-5 KW 05.15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Hood or Type 1 ❑ Canopy Type II ❑ DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: _ _. Date Date Oat Duct - Under Ground Duct - Structural Refrigeration System ❑Q100,000 BTU ❑ 100,000 BTU Duct - Ventilating SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. S ELECTRICAL �$ q.C)o GRADING $ PLAN CHECK 50% $ �5Q MICROFILM $ MECHANICAL $ TOTAL FEE $ 4-50 PLAN CHECK 25% '$ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Blt. ICBO # Fire Dampers' Heating System & Ducting 00-100,000 BTU 0100,0008 Registers Reinspection Fee S15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING `. `PPROVALS Permit # Date Inspector POOL _iPA APPROVALS Permit # Date InspecTnr 1. Temporary Electrical Service or Pole �� 52. Pool & Equipment Location 2. Soil+•Pipe, -Undrgrnd f) 53. Steel Reinforcement 3!�Ele6rical Conduit Utility-'Undrgrnd. 54. Forms 4"'Ele&Ncal Conduit-Undrgrnd. f1 55. Electrical Bonding 5..Steel'Reinforcement r 56. Rough Plumbing & Pressure Test y 6i Electrical UFER Grnd. j 57. APPROVAL TO COVER-GUNITE 7� Footings 58. Electrical Conduit-Undrgrnd. t. ' $r Foundation �. 59. Gas Pipe, ❑ Undrgrnd., Test 9'Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10.7Structural Floor System •r 61. APPROVAL TO DECK 110Property Sewer Line & House Connection rs h 62. Backwash &Receptor-Final 12w-Sewer Cap f" L, t 63. Heater & Vent-Final 13. Roof Drains r-�' 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 APPROVALS Permit # 20., Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 31i.`Plaster Brown Coat 79. FINAL INSPECTION 32 Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric [( Nntes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39- Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow-Preventer r 43. Backflow Irrigation 44. Landscape Irrigation System k� 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 Ian. Date ,Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations, CIT OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. BLDG. NO: !JMSTRUCTION PERMIT G Z % 9287 7/ 1 8/81. 90e02 Project AddressZJ T PE OF CONSTRUCTION Owner - Phone [:1 ❑ e NEW ADD ALTERATION Address - REPAIR ❑ CONVERSION ❑DEMOLISH ❑ OTHER ZONING REGULATIONS ArchlEng. License No. w A.P. 9P `.. Address DESCRIPTION OF WORK _ ZONE PLNG. REF.:P Con0actor D Phone TYPE OF PERMIT �Rpp INC IPitTLLppY LINE Address r ❑ GRADING (I FOUNDATION C1 STRUCTURAL SETBYARD ACK C/1 -T OBB LICENSED -CONTRACTOR DECLARATION ❑ TENANT )0 ELECTRICAL XPLUMBING �MECHANICA SIpE Y I hereby afflrm that I am licensed under provisions of Charter 9 (Stem- RIGHT me Ong with section 7000) of Division 3 of the Business and OTHER Professions Code, and my license Is In full force and effect,REAR YARD (TO P/L) DESCRIPTION - cense No. License Class License PKC. SPACE REQ. - PROVIDED - Date Signature SQ. FT. STREET WIDTH PARK FEE $ WORKERS' COMPENSATION DECLARATION OCCUPANCY__QONSTRUCTiON TYPE_. I hereby affirm that I have a certificate of consent to self -Insure or a VALUATION �,, ZONE ZONING APPROVED BY DATE r Certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.). GRADING CU. YDS. ACRES SPECIAL CONDITIONS: D+Jicy No, Company :erti(led copy is hereby furnished. REMARKS: ::ertl(led copy Is filed with the city Building Division. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION section need not be completed.if the permit is for one hundred 1This aloaj br less`. Cert ty that n the performance of the work for which this.permit is, _ Issued, I shall not employ any person in any manner so as to become PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK subject to the Workers Compensation Laws of California. .. _ Date Signature BATHTUBS SHOWERS NOTICE: If after making this declaration, you should become subject TOILETS URINALS GENERATOR 0-1 KW 1-10 KW to the Workers' Compensation provisions of the Labor Code, you must TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS APPLIANCE 10-50 KW__..;_50 + KW revoked. - - CONSTRUCTION LENDING AGENCY , _ , KIT. SINKS DISHWASHERS MOTORS 0.1 HP I(INC. _ 1-10 HP I hereby affirm that there is•a construction lending agency for the per- SERVICE SINKS SUMPS - - SOLAR) 10-50 HP 50 + HP formance'ofGthe work for which thlstpe_r,mlt iS`)SSuedl-($eCtion 3097 Clv. C.). Lender's Name FLOOR SINKS FLOOR DRAINS FIXTURES D OUTLETS SWITCHES Lender's Address - <� _ .. .-, ` DRINKING FOUNTAINS GAS TUBE SIGNS r _ OWNER BUILDER DCLARATION_ k` E I herebyy affirm that I am exempt from.the Contractor's License Law for INTERCEPTORS CLARIFIERS POLE LIGHTS SWIMMING POOL P TRAP POLES METERED SUB the fol wing reason (Section 7031.5 Business -and Professions Code: Any city or County which requires a permit to construct, alter, WATER SERVICE ALTERATION -PANELS MAIN SUB Improve, demolish or repair'any structure` prior to Its issuance, also re- quires the applicant for such permit to file a signed statement that he GAS SERVICE OUTLETS SERVICE AMP IS licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the WATER HEATERS BTU OUTPUT r Business and Processions Code) or that he is exempt therefrom and the basls for the alleged exemption. Any violation of Section 7031.5 by SEWER CONNECTIONS applicant for a 'permit subjects the applicant to a civil penalty A more than five hundred dollars ($500). SOLAR TANK COLLECT6RS as owner of the property, or my employees'with wages'as their sole compensation, will do the work, and the structure Is not intended SOLAR PIPING SYS.ISSUE FEE or offered for sale. (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of a property _ ISSUE FEE APPLICATION APPROVED BY DATE who builds or Improves thereon, and -who does such work himself or through his own employees, provided that such Improvements are not MECHANICAL PLAN CHECK SUMMARY OF FEES Intended or offered for sale. If, however, the building or Improvement is sold within one year of.completlon, the owner will have the burden of proving he dip not build or Improve for trio purpose of sale). HEATING SYSTEM 0-100,000 BTU BUILDINGr7 F' PERMIT S 30 • �O SMIP S S� 1, as owner of the property, am axclusivety contracting with Censetl contractors to construct the project (Section 7044, Business AND DUCTING 100,000 + BTU PLAN CHECK $ 2� PERMIT and Professions Code: The Contractor's License Law does not apply to _ ISSUANCE $ an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ tracts from such projects with a contractor(s) Ilcesned pursuant to SYSTEM GRADING $ the Contractor's License Law). 100,000 + BTU PLAN CHECK -s, ❑ 1 am exempt under Section B. & P. C. for this BOILERS f TU ELECTRICAL $ CO $ reason - PLAN CHECK $ MICROFILM $ SYSTEM REPAIR, ALTERATION Date Owner ��JJ � MECHANICAL 'S -/j/ TOTAL FEE $ TOTAL I hereby certify that I have real this application and, state that the above EXHAUST SYSTEM MULTIPLE LESS AD. information Is correct. I agree to comply with all city and county PLAN CHECK $ VANCE PC $_ ordinances and state laws relating to construction, and hereby authorize representatives of this city to enter Pon the above mentioned property for spec n pas =n _ -P Signal ure - FINAL FEE $�_ 1L - Drivers' License or SS :p ISSUE FEE 3 CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector _' { , ;�; _ . , POR L & SPA _ • APPROVALS \y Permit # Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location ' 2. SoilPipe-Undrgrn 44. Steel Reinforcement -- 3. Electrical Conduit;UtilityzUndrgen = _..� 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bonding 5. Steel ein orce 47. Rough Plumbing & Pressure Test 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE 7. Footings 49. Electrical Conduit-Undr rn - 8. Foundation 50. Gas Pipe, ❑ Undr rn, Test 9. Water Pipe-Undrgrn 51. Backwash Lines P-Trap.❑ Undrqrn 10. Structural Floor System 52, APPROVAL TO DECK ` `,Property Sewer'.L'tne,&•House Connection 53. _ Backwash & Receptor-Final 12. Street Sewer Connection 54. Heater & Vent-Final 1.3. Rough Plumbing 14. Rough Electric-Conduit 56. Electrical-Final 15. Rough Electric-Wiring 57. Solar System-Final 16. Rough Heating & Air Conditioning W Fencing & Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING 18. Ducts, Ventilating 60. POOL/SPA SYSTEMS FINAL 19. Gas Pipe-Rough & Test 20, Roof Framing 21. Roof Sheathin NOTES:Z&A�2 22. Frame and Flashing 23. • - Insulation 24. Lathing & Siding !J 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter-Final 28. Final Electric - . (L 29. Final Heating & Air Conditioning S� 30. Final Gas Pipe-Test 3 31, Final Plumbing 32. Water Service-Final 33. Gas Service-Final 34. Solar Domestic-Final 35. - Landscape Sprinkling System 36. Sound Attenuation 37, Handicap Regulations 38. FINAL STRUCTURE; & BUILDING 39. Special Requirements Completed 40, Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42, CERTIFICATE OF OCCUPANCY No Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. C4TY OF COSTA MESA L;UNS 1 KUU 1 IUN VtKIVIL1 RF MIT NO _ _ TRACT Nn LOT NO i mri r sin Project Address 7L(4,/' S - Applicant's Mailing Address Owner's a e one Address Arch/Eng. �j•, (, icense No. Adrfress� Contractor's Name- /J2 Phone Address (mailing) � L City License No, LICENSED CONTRACTOR DECLARATION I hereby affirm that am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect, , License Class License No. Date Signature ' WORKERS' COMPENSATION DECLARATION' I hereby affirm that I have a certificate'of consent to self -insure or a certificate f Workers' Compensation Insurance;L or a certified- copy thereof (Section 800, Lab.rlC A �1 icy No.Lp rf�}r�(0 / Company I�17o5ilCertified copy is hereby furnished. Ll Certified copy Is filed with the city Building Division. ' Date Applicant - EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - (This section need not be completed if the permit is for one hundred ($100) or less). ' I certify that In the performance of the work for which this permit is issued, I Shall not employ any person in any manner so as to become subject to the Workers,' Compen$atlon Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the, Labor Code, you -must forthwith comply with such provisions or this permit shall be' deemed revoked, CONSTRUCTION LENDING AGENCY• I hereby affirm that there is a construction lending age y for the perjormance of the work forr;QN h' i Civ. C-) Lender's Name VVV Lender's Address OWNER BUILDER DECLARATION r ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section -7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair _any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement -that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt erefrom and the basis for, the alleged exemption. Any violation of section - 31.5 by any applicant for a permit subjects the applicant to,a civil lsalty of not mora than five hundred dollars ($500)., _ L.1 I, as owner of the property or my employees with wages as their Sole compensation, will do the work, and the structure is not Intended or offered for sate (Section -7044, Business and Professional Cotle: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who doe$ Such work himself/herself or. through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of Com- pletion, the owner will have the burden of proving he/she did not build or Im- prove fpr the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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. 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 proof of their Worker's Compensation insurance should be provided to me, ❑ I am exempt under Section B. & P. C. for this reason TYP OF CONSTRUCTION, l_J NEW LJ ADD (J ALTERATION I_._I REPAIR CONVERSION ❑ DEMOLISH ❑ OTHER A.P. ESCRIPTION OF WORK/USE OF BLDG. S Main Building: TYPE OF PERMIT GRADING ❑FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICALPLUMBING ❑ MECHANICAL B Rear ❑ -OTHER A PROJECT DESCRIPTION SQ. FT- OCCUPANCY C Right S Left CONSTRUCTION TYPE VALUATION $ ' ZONE GRADING CU. YDS. ACRES Ping, Ref. # , Remarks:IL 3O Planning Notes: PLUMBING FEES Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers e Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service ' Outlets' Interceptors Kitchen Sink - Lavatories ' P—Trap - Roof Drains -. Reinspection Fee Showers Service Sink - Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal -water Closet Water Heater - Water Service Auto -Wash Laundry Trays" $15 1 Issue Fee 5 3 MECHANICAL FEES Boiler i Hood or, Type I ❑ Duct - Under Ground Canopy. Type IIII ❑ Duct - Structural Refrigeration System _- Duct Ventilating - ❑0-100,000 BTU ❑ 100,000 BTU Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers ; Date Owner Heating System & Ducting Registers I "hereby certify that l have read this application and state that the above ❑0.100,000 BTU ❑100,000 BT information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize revre- , sentatives of this city�,ulilbove-mentlonecl . .property forinspection purposes. Signature spection Fee $15 Issue Fee ^� 3 Drivers' License or SS g IF 0865-46, rev. 10/84 White - Building; Canary - Applicant; pink - Accounting; Goldenrod - Assessor ; Zone Accessory Building: Parking Req;/Provided ELECTRICAL Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit I Meter ❑up to 100 amps Dishwasher- - -- Meter ❑over 100amps - Dryers OGas 'QElectric Sub Panel Fan ', Motors 00-1 HP 01'A - 8 F.A•U. Inc. Solar ❑9-15 HP 016-15+ Fixtures , Microwave Device Boxes Pole Light Outlets Range Switches Sign F Garbage Disposal ; Standing Sections Generator ❑0-5 KW 1:15.15 KW Trash Compactor , $ 5 MICROFILM TOTAL FEE Reinspection Fee $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By— L esd0 TL Z O N 1 N G R E Q ` M T S' ' FEES i _■ INEN EN 001iiiiiiiiiiiiii -�-I SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $_ PERMIT PLUMBING $ �'�7 — ISSUANCE S PLAN CHECK 25% $ ENERGY P.C. S ELECTRICAL S GRADING i S PLAN CHECK 50% MECHANICAL $ 5 MICROFILM TOTAL FEE $ $ PLAN CHECK 25% $ 001iiiiiiiiiiiiii -�-I . CONSTRUCTION AND PLANNING Date - APPROVALS Permit # Inspector POOL 'A 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 it 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test tY 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7, Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test l� :n ! 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, ❑ Undrgrnd, U 10. Structural Floor System r 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection f ;%� 62. Backwash &Receptor -Final + 12. Sewer Cap r 63. Heater & Vent -Final �? 13. Roof Drains 1 64, Plumbing System - Final iv 14, Rough Plumbing f 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 Electricai-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditconing FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21, Ducts, in Structure 71 70. Underground Hydro 22Aucts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 234Gas Pipe -Rough & Test I 72:1 Underground Flush 24! Roof Framing 73, Undergrnd, Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing ��. 74, Overhead Hydro 26. T -Bar Ceiling (Structural) & IVlonocoat 75. Dry Chemical 27. Frame and Flashing +fes 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 307Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing -ftJ.F( Awr 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation Landscape Irrigation System 45, Sound Attenuation F46. 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 m No. Date Applicant to fill in all spaces except thole within heavy border lines and sign all appropriate declarations. r... -r — I TG ArT nln I 1 nT fun I i mn war. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address �y ` Applicant's Mailin Address �&*75�d ��- L41 Owner's Name Phone Address — Arch/Eng. License No. Address _ Contractor's Nam,�,,5011� L] _S &.,6 Phone 777Z7 -U/- Address (mailing) ,��7 /_—_ [�� A J �.rl — City License No.— LICENSEO CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is In fu for antl effect. il License Class License No,:5d2, yC r% Date-1�� Slgnature WORKERS' COMPENSATION D RATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate of Workers' Comphnsation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. - Company -� Certified copy is hereby furnished. Certified copy Is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or. less). I certify that -in the performance of the work fOrvwhlCR this permit is Issued, 1`+ shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of Califor(ai Date Signatur NOTICE: If, after nta ing this decla i n, you should become subjeCt to the Workers' Compensation provisions o the Labor Code, you must forthwith comply with such provisions or this permit shall -be deemed revoked. CONSTRUCTION LENDING AGENCY • , I hereby affirm that there is a construction lending agency for the performance of the ,work for which this permit is issued (Section 3097 Civ. C.) Lender's Name - Lender's Address --- OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for,the following reason ($action 7631.5 Business and professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 fonthe alleged exemption. Any violation of Section '031.5 by any applicant for a permit subjects' the applicant to a civil enaity of not more than five hundred dollars ($500). ❑ I, as owner of the property or.my`employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for We (Section 7044, Business and Professional Code: The Contractor's License Law does hot 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 employees, provided that Such improvements are not Intended or offered for We. If, however, the building or Improvement is sold within one year of com- ple tlon, ,the owner will have the burden of proving he/she did not build Or Im- rove for the purpose of sale). ' 1, asiowner of the property, am exclusively contracting with licensed con- tractors tO cohstrutt the project (Section 7044, Business and Professions Code: The ContraCtor's License Law does not apply to an owner of property who builds or improves thereon, and _who contracts far such projects with a can- tractor(s) license Pursuarit'to•the Contractor's License Law). l am aware that proof of their Wgrker•S Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Date Owner 1 hereby certify that I have read this application and state that the above Information is correct. I agree to comply with all City and County ordinances and state laws relisting to building construction, and hereby authorize repre- sentatives Of this city to enter upon the above-mentioned property for InSpeCllon purp Signature Date Z�y�QJ Drivers' Licen or SS # CMF 0865-46, rev. 10/84 -Wh TYPE OF CONSTRUCTION 0 NEW ADD LJ ALTERATION LJ REPAIR -❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TYPE OF PERMIT C1 GRADING M FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ ,OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES-. - Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service r Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural i Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO * Heating System & Ducting ❑ o-100,000 BTU ❑ 1 oo,000 BT Reinspection Fee I $15 M%pli"nt; Pink - Accounting: Goldenrod - Assessor PLUMBING FEES A.P. + S Main Building: E T Front B Rear A C Right K S Left Ping. Ref. Planning Notes: 9948 3/25/85 Zone Accessory Building: Parking Req./Provided 109 !_0 TL Z O N f N G R C E Q M T S Showers ELECTRICAL FEES Service Sink Automatic Washer Construction Pole Sub. - Transformer ❑ 15-50 KW - ❑ 50+KW Sewer Cap Sewer Connection Cooking Unit Meter ❑up to 100 amps Solar Collectors Dishwasher Meter Clover 100 amps_ --� Solar Piping Dryers ❑Gas ❑Electric Sub Panel Solar Tank Fan Motors ❑o-1 HP ❑1 h -•B Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 HP Cl 16-15+ Urinal Fixtures Microwave Water Closet Device Boxes Pale Light Water Heater Outlets Range Water Service Switches Sign Auto -Wash Garbage Disposal ; Standing Sections Laundry Trays Generator 00-5 KW 115- 15 KW Trash Compactor Issue Fee. $ 3 1 ` Reinspection Fee $15 Issue Fee. $ 3 AANICAL FEES Hood or Type I ❑ Canopy Type II ❑ DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date Dat Refrigeration System 00.100,000 BTU ❑100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHI ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY $ $ $ $ $ $ $ OF FEES SMIP, $ , �D PERMIT / ISSUANCE $ C. $ GRADING $ MICROFILM $ TOTAL FEE ) $ / System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 CONSTRUCTION AND PLANNING,, - APPFIOVALS Pale t 4 Dace t, Loj T l ar POOL SPA APPROVALS Pernilt ��. .... - Da% inspector { 1. Temporary Electrical Service or PdI y 52. Pool & Equipment Location ! _ 2, Soli Pipe-Undrgrnd. re 1 53. Steel Reinforcement � ' 3.• ElecOical Conduit,UtiiitV-yndrgind.' ► 54. Forrm 4' Electrical Conduit-Undigrn_d. �'� 65. Electrical Bonding r 5.' Steel Reinforcement � i h 56. Rough Plumbing-& Pressure'Test i '6. Electrical UFER�Gind. k ,y 67.- APPROVAL TO_COVER-GUNITE 7.' Footings ^j 58. Electrical Conduit.Urtdrgrnd. Fo4ndation Lr f, 4 59. Gas Pipe, ❑ Undrgrnd., Test 4 - 9:' Wate? Pipe Undrgrnd, 60. Backwash Lines; P -Trap, ❑ Undrgrnd. ; -10. Si uctural'Floor System - 61. APPROVAL TO DECK '{11Property Sewer Line & House Connection 62. Backwash &Receptor -Final 12, Sdwer Cap ✓ ti 1iri 63. Heater & Vent -Final 13 Roof Drains `,-f .64.. Plumbing System - Final F 14*Rough Plumbingy 65. Electrical -Final w -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 APPROVALS Permit # l '20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 1 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil - 23: Gas Pipe -Rough & Test 72. Underground Flush 24., Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes 34. Final Heating & Air. Conditioning _ 35. Final Gas Pipe -Test 36. Hood or Canopy ' 37. Final Factory Fireplace 38. Final PlumbingAr 39. Water Service -Final i 40. Gas Service -Final 41. Solar Domestic -Fina! 42. Backflow Preventer 43. Backflow Irrigation ' 44, ,Landscape Irrigation System ' 45. Sound Attenuation , + 46. Handicap Regulations 47. FINAL STRUCTURE &,BUILDING = ` 48. Special Requirements Completed F 49. Electric Release.to Edison t 50. Gas Release to Southern California Gas Co i 51. CERTIFICATE.OF OCCUPANCY No Date __� Applicant to fill In all spaces except these within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. a TRACT NO. LQT NO. UNIT NO. Project Address 211 W. 17 Lb. St. Bldg (D) Unit -9_ U Applicant's Mail ingAddress 13114 Saticoy St. N.Hollywood TYPE OF CONSTRUCTION NEWLJ ADD LJ ALTERATION LJ REPAIR Troy Investment Fund 549-2988 1:1 CONVERSION 1:1 DEMOLISH ❑ OTHER A.P. = Owner's Name --Phone DESCRIPTION OF WORK/USE OF BLDG. Address4321 Birch St. Newport Beach, Ca. S Main Building: ArchfEn9. Marin J. Rock _ License fyo. TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front Address12881 Knott a ❑ TENANT ElELECTRICAL ElPLUMBING 91MECHANICAL B Rear Contractor's Name 17nr n Air ('i5nditinninoPhone 98211(�, ❑OTHER C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY Address (mailing) .-_31_J Q Sa,ti i;oyc t . Nt U01111:WAAd CONSTRUCTION TYPE VALUATION S S Left City License li T '49925 a5 _ ZONE GRADING CU.YDS. ACRES Pin Ref. + LICENSED CONTRACTOR DECLARATION 9 I hereby affirm that I am licensed under provisions of Chart 9 (commencing Remarks: Planning Notes: with section 7000) of Division 3 of a Business and Pt slons Code, and my license is in full forwrid effect License Class C—Lice e 349251 Dat4118.19 �_ Signature WORKERS' COMPENSATION DEC RATION' I hereby affirm that I have a certifi a of consent to self -insure or a certificate if Workers' Compensation Insur nce, or a certified copy thereof (Section :600, Lab. C.) Policy No. WC9824 ~ Company Lumbermans eCertified coby IS hereby furnished. teertifieplC�bYis filed with the city Buildirlq D Llsl n- J► %^ Applicant— EXEMPTION f�OfN PROM WORKERS' COMPENSA(�TION DECLARATION (This section need not be completed if the permit is for one hundred (5100) or less). I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner So'as to become subject to the Workers' Compensation Laws of California. Date Signature ' 'NOTICE: If, after making this deClaration, you should become subject to the Workers' Compensation provisions of the Labor Code, You must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Namg Lender's Address .. OWNER BUILDER DECLARATION" I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any City or county which requires a permit to construct, alter improve, demolish or repair any Structure, prior to Its issuance, also requires the applicant for such permit to file a signeq statement that he/she 1% licensed pursuant to the provisions of 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 031.5 by any applicant for a permit subjects' the applicant to a civil m ,enalty of not ore than five hundred dollars ($500). ❑ 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who'bullds or Improves thereon, and Who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of COM- pletion, the owner will have'the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and -_who contracts for such projects with a con- tractors) 1lcehse pursuant to'the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner 1 hereby certify that I have read this application. and state that the above information is correct. I agree to mply with all city and County ordinances and state law Iating to buil ' construction, and hereby authorize repre- sentatives i s city to e r upon the above-mentioned p rty f inspectio lire lip Dat Drivers' Lic se or 5 Reinspection Fee 1 $15 CMF 0865-46, rev, 10/84 PliCAnt,, Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 1779 4/24/85 Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets , Switches Garbage Disposal Generator 00.5 KW ❑5-15 KW Reinspection Fee I $15 15o °Q Zone Transformer ❑ 15.50 KW ❑ 50 + KW Meter Uup to 100amps Meter ❑over 100 amps Sub Panel Motors 00-1 HP Ell 'h - 8 Inc.Solar ❑9-15 HP ❑16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor Issue Fee N FEES $ 3 Z 0 N 1 N G R E O M T S DEVELOPMENT SERVICES REQUIREMENTS: PLUMBING FEES Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Application Issued By Bathtubs Sewer Connection _ Clarifiers Solar Collectors ' Dishwasher Solar Piping SMIP Drinking Fountains Soler Tank $ Floor Drains Swimming Pool w/Spa PLUMBING Floor Sinks Urinal $ = -- Gas Service Outlets Water Closet ENERGY P.C. $ Interceptors Kitchen Sink Water Heater Water Service GRADING Lavatories Auto -Wash $� P—Trap Laundry Trays MECHANICAL Roof Drains TOTALFEE $ 15.50 - PLAN CHECK 25% $ _2.50 _ Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Duct - Under Ground Hood or Type f ❑ Canopy Type II ❑ Duct . Structural Refrigeration System ❑0-100,000 BTU 0100,000BTU Duct - Ventilating Exhaust System ❑ Multiple ❑ System RepairfAIteration Firepl/Fact. Bit. ICBO # Fire Dampers Heating System & Ducting 60-100,000 BTU ❑100,0008T Registers 6 Cfl - ,� Lr nn Reinspection Fee 1 $15 CMF 0865-46, rev, 10/84 PliCAnt,, Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 1779 4/24/85 Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets , Switches Garbage Disposal Generator 00.5 KW ❑5-15 KW Reinspection Fee I $15 15o °Q Zone Transformer ❑ 15.50 KW ❑ 50 + KW Meter Uup to 100amps Meter ❑over 100 amps Sub Panel Motors 00-1 HP Ell 'h - 8 Inc.Solar ❑9-15 HP ❑16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor Issue Fee N FEES $ 3 Z 0 N 1 N G R E O M T S DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By -oat s Application Issued By _Dat _ SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ = -- PLAN CHECK .25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $� MICROFILM $ MECHANICAL $ u -no TOTALFEE $ 15.50 - PLAN CHECK 25% $ _2.50 _ CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POOL ..IPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52.. Pool & Equipment Location �} 1 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement ( �` 3. Electrical Conduit Utility-Undrgrnd, 54. Forms .4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding •f �r 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test > ; A• 6. Electrical UFER Grnd. �� 57. APPROVAL TO COVER-GUNiTE 7• Footings 1 58. Electrical Conduit-Undrgrnd. 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test t ' 9• Water Pipe-Undrgrnd. �/ 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10• Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Conhection 62. Backwash & Receptor -Final A 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro ,22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush .24. Roof Framing 73. Underg rnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydra 26. T -Bar Ceiling (Structural) & Monocoat 75, Dry Chemical 27• Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall {Nailing HEALTH DEPT. REQUIREMENT 31."Plaster Brown Coat 79. FINAL INSPECTION 32.' Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy i 37. Final Factory Fireplace 38, Final Plumbing , 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. .Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING - 48. Special Requirements Completed ; 49. Electric Release to Edison X50. 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. CI'TY OF COSTA MESA CONSTRUCTION PERMIT Project - Project Address 7& W L Z�2--S,A-1 1 - •Stj _ _— Applicant's Mailing Address Owner's Name fyOY xp► sli S, mEs-1T -Phone Address Arch/Eng, License No. Address �y Contractor's Name L1+n- l ' L i I ' i L Phone Address (maiiingl/5 �•'� 74-2--C7- Ra+40/1iftZbe-1 9 Zai, City License No- LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Char er 9 (co encing with section 7000) of Division 3 0 Hess and Pr essions e, and etel my license is in ful orce and effec . License Cl ss License p. Dale — S ySignature WORKERS, COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure or a certificate 1 Workers' Compensation Insurance, or_ a certified copy thereof (Section 180o, Lab. C Policy NoZ� )6.�orjO /.3 7 C "re ac 7� BCertified copy is hereby furnished. Certif-ed copy is fit tl with the Cit Buil ision Date.,. J'_�a i Applicant EXEMPTION FROM WORKERS' COMPE SATIO DECLARATION (Thissection need not be completed if,the permit is for one hundred ($100) or less). I certify that In the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. ' Date Signature 'NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor, Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION 'LENDING'AGENCY ' I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address . OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the , following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair ' any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 'here from 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 jenalty of not more than five hundred dollars ($500). 0 I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code! The Contractor's 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 employees, provided that such improvements are -not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors t6 construct the project (Section 7044, Business and Professions Cade: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contfacts for such projects with a con. r tractos) license pursuant'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me, ❑ i am exempt under Section B. & P, C. for this reason Date Owner - I hereby certify -that 1 have read Information is correct. I ee to c and state taws g/ o b tiding sentatives of his enter inspection pur ses Signature Drivers' License or SS this application and -state that the above imply with all city and county ordinances co�Kstrk4ion, and hereby authorize repre- I)above-mentioned property for n GMF 0865-46, rev. 10184 White - Building: Canary - PERMIT NO. T RACT NO. LU I NU. U IT NO E -1 i4s— TYPE OF CONSTRUCTION El NEW 0 ADD El ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.6 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT El GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL PLUMBING ❑MECHANICAL - B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ g Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: PL ar Sink ackflow Preventer - ackflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Interceptors Kitchen Sink - Lavatories P—Trap Roof Drairis Reinspection Fee $15 l- MEC Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust.System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0-1WOW BTU ❑ 100,000 BT { l I Reinspection Fee $15 nt; Pink - Accounting; Goldenrod - Assessor 5866 1/16/85 Accessory Building: Parking Req,/Provided Le50 + TL Zone Z 0 N 1 N G R E 0 M T S IMBING FEES Showers ELECTRICAL FEES Service Sink ` Automatic Waslier Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 50+KW I Sewer Cap Sewer Connection Cooking Unit Meter L] up to 100 amps Solar Collectors Z Dishwasher Meter Dover 100 amps Solar Piping Dryers ❑Gas DElectric Sub Panel Solar Tank Fan Motors 0 1 HP ❑ 1 f. 8 Swimming Pool vv/Spa F.A.U. Inc. Solar 09.15 HP 016-15+ -Urinal - i Fixtures Microwave Water Closet Device Boxes Pole Light Water Heater Outlets r Range Water Service Switches Sign Auto -Wash Garbage Disposal ; Standing Sections Laundry Trays Generator 00-5 KW ❑5-15 KW Trash Compactor Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ .3 AANICAL FEES_ DEVELOPMENT SERVICES REOUIREMENTS: Zoning Approved By Date Building Approved ByDate Application Issued By— C Date b Hood or Type j ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000 BTU 0100,0.00 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP. $ $ PERMIT $ ISSUANCE S $ ENERGY P.C. $ $ .-y -012) GRADING $ $ Sn MICROFILM $ $ TOTAL FEE $ $ System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 CONSTRUCTION AND PLANNING ' :APPROVALS Permit # Date �J Inspector I POOL -SPA APPROVALS Permit # Date Insp?ctar 1, Temporary Electrical Service or Pole. n 52. Pool &Equipment Location 2. Soil Pipe-Undrgrnn f 53.' Steel Reinforcement 3._�Electrical Conduit Utility-Undrgrnd. 54. Forms 4"Elect�Jcal Conduit-Ur1drgrnd. ;; 55. Electrical Bonding 5,.Steel.Reinforce rnent 56. Rough Plumbing & Pressure Test 6., Electrical UFER'G, nd. 1 57. APPROVAL TO COVER-GUNITE J A -Footings 58. Electrical Conduit-Undrgrnd. ` 8. Foundationtl 59. Gas Pipe, ❑ Undrgrnd., Test P0 9.' Water Pipe Undrgrnd. 60, Backwash Lines, P -Trap; ❑ Undrgrnd. 10 Structural Floor System r., 61.. APPROVAL TO DECK I I AProperty Sewer Line,& House Connection 62. Backwash & Receptor -Final 12.'Sewer Cap T 631. Heater & Vent -Final 13. Roof Drains ! 64. Plumbing System - Final 14. Rough Plumbing. 65. Electrical -Final r~ 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts,'in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION IP 3eElectrical Power Meter -Final v 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas'Plpe-Test 36, Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final _ 42. Backflow Preventer 43, Backflow Irrigation 44. Landscape Irrigation System x 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STFIUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant. to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 71 CITY O5 COSTA ME/S 1A•' C`OjI�ISTRUCTION PERMIT RMIT NO. j TRA T NO LOT NO. UNIT 'Project Address Applicant's Mailing Address TYP OF CONSTRUCTION NEW ADD ALTERATION REPAIR Oj CONVERSION ❑DEMOLISH' ❑ OTHER Owner's Name hone79L 14 _ Address let.lech 9L !l>� G4-, c Arch/En gW �n L' EK. EC P-ALiCense No. 067 Address s CA Contractor's Nam Phone Address (mailing) - - City License No. LICENSED CONTRACTOR DECLARATION l hereby affirm that I am licensed under provisions of Charter 9 (commencing with section '7000) of Division 3 of the Businesg and Professions Code, and My license is in full force and effect. License Class Litense No. Date Signature - -_— WORKERS' COMPENSATION DECLARATION I hereby affirm that f have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance,- or a certified copy thereof (Section 800,Lab. Q ` icy No, Company _J Certified copy Is hereby furnished. Certified copy Is filed with the city Building Division. ' Date - Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). 1 certify that in the performance of the work for which this permit Is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date I Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of -the Labor Code, you must'forthwitri comply 'with such provisions. or this permit shall be deemed rovokedi CONSTRUCTION LENDING 'AGENCY 1 hereby affirm that there is a construction lending agency for the performance ; of the work for hie t is er. 3 is .is e - (Se n 309 Civ. C_.) Lender's Name ✓►�l �k Lender's Atldress .�'� i' / / rC� OWNER BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License taw for the following reason (Section 7031.5 Business and Professional Code: Any city or ' county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of , the Contractor's License Law (Chapter•9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade) or that he/she is exempt therefrom and the basis for the alleged exemptlon. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil snalty of not more than five nundred dollars (5500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section '7044, Business and Professional Code: The Contractor's ' License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employee$, provided that Such improvements are not intended or offered for . sale. If,'however, the building or improvement is $oid:withln one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of Sale), I I,,as owner of the property, am exclusively contracting with licensed con- 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. 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 proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason ' Date Owner _ I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and county ordinances , and state laws relating -to building construction, and hereby authorize repre- sentatives of this city, to r u th0 J64ve-mentioned property for Inspection purposes. SignatureDate Drivers' License or SS :�r _ ESCRIPTION OF WORK/USE OF BLDG. PLUMBING A.P. # S. Main Buildi TYPE OF PERMIT GRADING ❑ FOUNDATION ❑ STRUCTURAL Service Sink T Front ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL Transformer ❑ 15-50 KW El 50 + KW 13 Bathtubs ❑ OTHER A Rear Meter ©up to 100 amps Clarifiers C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY Dishwasher - K Dishwasher ' CONSTRUCTION TYPE VALUATION $ $ Left ZONE' GRADING CU.YDS. ACRES Solar Tank Ping. Ref. # Remarks: If- i Fan ;i Planning Notes: 6041 VNYB6 _ '140 T4 Zone Accessory Building: Z O N N G R Parking Req./Provided E O M T S CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES ELECTRICAL FEE$ Bar Sink , Showers Backflow Preventer" Service Sink Automatic Washer Pole Sub. Transformer ❑ 15-50 KW El 50 + KW Backflow Irrigation Sewer CapConstruction Bathtubs Sewer Connection Cooking Unit �. Meter ©up to 100 amps Clarifiers _Solar Collectors -' Dishwasher - - -Meter Clover 100 amps Dishwasher Solar Piping Dryers ❑Gas L)Electric Sub Panel Drinking Fountains Solar Tank Fan ;i Motors El 0-1 HP ❑l'A- B Floor Drains Swimming Pool vv/Spa F.A.U. Inc. Solar 09-15 HP ❑ 16-15+ Floor Sinks - Urinal ' Fixtures Microwave l Gas Service ` Outlets Interceptors Kitchen Sink r Water Closet Water Heater Water Service 00 Device Boxes Outlets Switches, Pole Light Range Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P -Trap Laundry Trays Generator ❑0-5 KW ❑5.15 KW Trash Compactor -Roof drains Reinspection'Fee $15 •` Issue Fee Reinspection Fee $15 Issue Fee' S 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Data Building Approved By Date Application Issued By Dat _ BoilerHood or Type 1 El Canopy. Type I I ❑ Duct - Under Ground Duct - Structural Refrigeration System •00-100,000 BTU ❑ 100,000 BTU ` Duet - Ventilating—- - - SUMMARY OF FEES BUILDING PERMIT S �T SMTP $ PLAN CHECK $ PERMIT PLUMBING $--7,00 ISSUANCE 1 $ PLAN CHECK 25% $ UO ENERGY P.C. $ ELECTRICAL $ GRAOING J $ PLAN CHECK '5096' $ MICROFILM $ MECHANICAL $ TOTAL FEE S L) PLAN CHECK 25% $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Blt. ICBO # Fire Dampers Heating System & Ducting 00-100,000 BTU El 100,000 BTL Registers i Reinspection Fee S15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor t;ONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & , APPROVALS Permit '# Date Inspector ir. 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 fj , 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical -USER Grnd. 57. APPROVAL TO COVER-GUNITE Z 7. Footings 58. Electrical Conduit-Undrgrnd. e'1 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd, rL}� 10. Structural Floor System% 61. APPROVAL TO DECK ti 11. Property Sewer .Line & House Connection V, 62. Backwash & Receptor -Final l•? 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains i f 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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22rDucts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23?Gas Pipe -Rough & Test 72. Underground Flush V. 24.' Roof Framing -- .�' 73. Undergrnd, Storage Tank ❑ Gas ❑ Oil 2P 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.--4Drywall Nailing HEALTH DEPT. REQUIREMENT 31 ! Piaster Brown Coat 79, FINAL INSPECTION 39Electricai Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning . 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing ,;�D•S4 39, Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 4-B. Backflow Irrigation 41- Landscape Irrigation System 45. Sound Attenuation 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 Q No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PF�tMIT NO. TRACT NO. L07 NO. UNIT AiC1. r Project Addr@ss Applicant's Mailing Address Owner's Nam@ Phone Address Arch/Eng. _ License No. Address Contractor 'sName I1+ Phone,%!j27 Address (mailing) U e,&,y L tr- City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is In full to ce and effect. Licens Class — Llcenso No. � 1 Date Signature WORKERS' COMPENSATION DE RATION 1 hereby affirm that I have a certificate of consent t0 selfinsure or a certificate of Workers' Compensation insurance, or a certified copy thereof {Section 3800, Lab. C,) +Dllcy No, — - Company _ Certified copy Is hereby furnished. Certified copy Is filed with the city Building Division. Date _ Applicant .+ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section heed not be Completed it the permit Is for one hundred (3100) or fess). 1 certify that in the performance of the work for which this permit Is Issued I shall not employ any person in any manner asttD become subject to the Work! s' Com en o Laws of Calif Signature NOTICE: It. diter making this declar n, you should become subject to the Workers' Corapensation provisions O the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirrn that there is a construction tending agency for the performance of the work for which this permit Is issued (Section 3097 CIv. C.) Lender's Namo Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031..5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any slructur4, 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 the Contractpr'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 eny applicant for a permit subjects the applicant to a Civil )enalty of nqt more than five hundred dollars ($500). I, as owner of the properly or my employees with wages as their sole fompensatlon, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code; The Contractor's 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 employees, Il that such Improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletio n, ,the owner will have the burden of proving he/she did not build Or Im- rove for the purpose of sale). i, as owner of the property, am exclusively contracting with licensed con- tractors to cgnstruct the project(Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who contracts for such projects with a con- tractor(s) llcense pursuarit'to the Contractor'i License Law). I am aware that proof of thgir Worker's Compensation insurance should be provided to me. ❑ 1 am exernpi under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above Information Is correct. I agree to comply with all city and county ordinances and state laws relating to building Construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for Inspection Our o s. Signature ` Date Drivers' LiceV or SS U -/81/444C01:Lu_ PLUMBING FEES Showers Backfiow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs TYPE OF CONSTRUCTION NEW ADO ALTERATION REPAIR Solar Collectors Dishwasher ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Drinking Fountains A.P. e DE5CRIPTION OF WORK/USE OF BLDG. Swimming Pool w/Spa Floor Sinks Urinal Gas Service ` Outlets Interceptors Kitchen Sink Lavatories Water Closet Water Heater Water Service Auto -Wash S Main Build Roof Drains E TYPE OF PERMIT D GRADING FOUNDATION EISTRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B ❑ OTHER A Rear C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATION $ $ I Left ZONE GRADING CU. YDS. ACRES Ping. Ref. Remarks: Planning Notes: Bar Sink PLUMBING FEES Showers Backfiow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service ` Outlets Interceptors Kitchen Sink Lavatories Water Closet Water Heater Water Service Auto -Wash P—Trap Laundry Trays Roof Drains Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact, Bit. IC80 Healing System & Ducting ❑ 0. 100,000 B T U ❑ 100,000 BT Reinspection Fee I $15 CMF 0865-46, rgv. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 9949 3/25/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW El 5-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter LJupto100amps Meter ❑over 100 amps Sub Panel Motors ❑0-1 HP Ell 8 Inc.Solar 119.15 HP El 16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor Issue Fee $ 3 Reinspection Fee $15 1 1 Issue Fee -IANiCAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By A, [ Application Issued By _ (!/T__J Hood or Type I ❑ Canopy Type (I ❑ Refrigeration System ❑0.100,1700 BTU 01100,000BTU SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P,C. ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTALFEE PLAN CHECK 25% $ System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 13.53 TL 2 0 N I N G R E Q M T S FEES $ 3 -CONSTRUCTION AND PLANNING_ - 'POOL-& QrA APPROVALS Permit # Dam' Insp�or APPROVALS Fhermit #_...�...-..� Gate inspector n 1 . Temporary Elk frical Service or P61.0 ' �" 52. Pool,& Equipment Location - 2. So�Pipe-Undrgrnd. ; r " i 53: Steel- Reinforcement _. Electrical Comfuit lttili4-Undr6rrid.' �� 54. Forms l'n ' Electrical CondLjt �1ndjWnd. 55. Electrical Bonding = y �i ' ; • 5" Steel Reinforcement •Q f r _ = 5& Rough,Plulnbing & Pressure Test :.6, Electrical OF ER jGr id. � �� ] 57.' APPROVAL TO (OVER-GUNITE r 7; Footings J11 58. Electr-s64 CDndjfjf-Und>Tnd.. L00 Foundation 59. Gas Pipe, 0'-Undrgrnd., Test { Water Pipe-Undn d. .' ip 60. Backwash Lines,�P-Trap, 0 Undrgrnd, " ,r10�Stfuctural Floor Sy0em 61. APPROVAL TO DECK - _I1.' Prgperty Sewer Lind & House (jo�h ection ; 62.. Backwash & Receptor -Final r12<§Mvver Cap t✓ -7/ )l i1 s - 63. Heater'& Vent -Final A. 123 -Roof Drains �� ', r1 -.64. Plumbing System _Final r 14 Rough Plumbing -•l �Ij�'Zb`�i LAW 65. Electrical -Final rV 15:, Rough Electrical-Coriduif - b6. Solar System Final X16. Rough Electric Wiring 67. :Fencing & Access Approval =' e - 17:-1 Rough Wiring Sign 1 68. APPROVED FOR PLASTERING 18.. Rough Electrical T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL = 19: Rough Heating & Air Conditioning ... FIRE DEPT. REQUIREMENT - APPROVALS Permit # - 20.4 Rough Factory Fireplace 21.+ Ducts; in Structure 70. Underground Hydro T.22.. Ducts, Ventilating I 71t Product Piping 0 Gas ❑ Oil 23.; Gas Pipe -Rough & Test:; ' i 72. _Un-d�rgrbund Flush -� ' 24.E Roof'Framing 73. 'Undergrnd.;Starage Tank 0 Gas 0 Oil 25., Roof Sheathing 74. Overhead Hyd {o 26.'T, -Bar Ceiling (Structural),& Monocoat - 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe; 28.1 Lathing&Siding .77. FiXEDSYSTEM FINAL 29., Insulation' 78. FIRE PREV. FINAL r 30.' Drywall Nailing HEALTH DEPT. REQUIREMENT, _ 31.'Plaster Brown Coat 79. FINAL INSPECTION . 32.11 Electrical Power Meter -Final ' 1 80. FOOD CER'TIOICATE ISSUED 33.'Final Electric Notes: 34. Final Heating & Air -Conditioning ' 35. Finai 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 -- - i - 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 1 50. Gas Releas$ to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY jy -•�- -� - -�- NO, .Cl Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CJTYfW�STAMjE�SA CONSTRUCTION PERMIT JA_ Add4s d- 4 L. tV 17,7;Y s% _ 1. as R A„111Pticant's Mailing Address . Owner's Name ?�0 y' - �� ST Phone t Address r r Arch/Eng. -- License No. Address -- Contractor's Name /�10rPiP/S ELCf T�PiG Phone X774, Address (maiiingi b'RYl�NT` `aLV1VZff_A2 /tf TQL City License No. 1313 r1 O— LICENSED CONTRACTOR DECLARATION i hereby affirm that I arty licensed -under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business andProfessio s Code, and my license is in Bull fLAce and effect Ucense Class License o.' Date Signature WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consen to self -insure or a certificate of Workers' Compensation Insurance,,or a certified copy thereof (Section 3olic Na C.) C_5' 10 - Gom ELCG BCertified copy is hereby furnished. Certified copy is ietl with the cit Buil ision, // Date ,—/ �'� ��-- Applicant EXEMPTION FROM WORKERS' COMPENSATIO DECLARATION (This section need not be completed if the permit is for one hundred'($100) or less), I + 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 tie Workers' Compensation Laws of California. Date -Signature NOTICE: If, after making this declaration, you should become subject to the Workers', Compensation provisions_Of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENbING AGENCY •1 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ. C.) Lender's' Name Lender's Address - OWNER BUILDER DECLARATION I hereby affirm -that l atn'exempt from the Contractor's'License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure; prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 basig for the alleged exemption. Any violation of Section 7031,5 by any appticant for 'a, permit' subjects the applicant to a civil enalty of not more thar, five hundred dollars ($500). I, as., of the property or my employees with wages,as their sole compensation, will do the work, and the structure is not Intended or offered for sale;(Section 7044, Business and Professional Code: The Contractor's 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 • employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year'of com- pletion, rthe owner will have the burden of proving he/she did not build or im- ove forr the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 builds of -improves thereon, and _who contracts for such projects with a con- tractor(s) license pursuant'to the Contractor's License Law). 1 am aware that proof off their Worker'% Compensation insurance should be provided to me, ❑ 1 am exempt under Section B. & P. C. for this reason Date I hereby certify that I information is c ct. and state laws'relalrA t sentatives this ty inspection urp Signature Orivers' License or SS qp Owner ve read this application and state that the above reeui to comply w�l all city and county ordinances building c str on, and hereby authorize repre- enter .0 on above-mentioned property for CMF 0865-46, rev. 10/84 White - Building; Canary Date ` O—gG i - r -43e-7 PERMIT NO. TRACT NO. LOT NO. UNIT N(7.�/� V JUQ/ I / l at 0:3 Lo,^i(} I TYPE OF CONSTRUCTION NEW ADD ALTERATION. ❑ CONVERSION ❑ DEMOLISH .❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. ' REPAIR A.P. # Zone S Main Building: Accessory Building: TYPE OF PERMIT ❑ GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ELECTRICAL ❑PLUMBING' ❑MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CON STRUCTION TYPE VALUATION S ZONE GRADING CU.YDS. ACRES E T Front Z O B A Rear N C Right N S Left G R Ping, Ref. # Parking Req./Provided E Remarks: Planning Notes: M T S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer - Construction Pole Sub. Transformer ❑ 15.50 KW 1:1 50'+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection - Cooking Unit Meter ❑up to'100amps. Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel DrinkingFountains Solar Tank � Fan Motors 160-1 HP ❑ 1 K - B Floor Drains Swimming Pool w/Spa F-A,U, inc. Solar ❑9-15 HP ❑16-15+ Floor Sinks Urinal - Fixtures Microwave Gas Service Outlets .Water Closet Device Boxes Pole Light Interceptors Kitchen Sink Water Heater Water Service Outlets Switches Range Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap • Laundry Trays Generator ❑0.5 KW 1:15-15 KW Trash Compactor i Roof Drains Reinspection Fee $15 i Issue Fee $ 3 Reinspection Fee $15 Issue'Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: , Zoning Approved By - Date Building Approved By Date Application Issued By . _ _Dat Boiler Hood or Type I El Canopy Type 11 ❑ Duct - Under Ground . Duct - Structural Refrigeration System ❑0.100,000 BTU ❑100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ $ .��GRADING $ •�!�� $ LJ_- MICROFILM $ $ TOTAL FEE $ $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG # Fire Dampers Heating System & Ducting DO -100,000 BTU ❑100,000 BT Registers Reinspection Fee$15 Issue Fee $ 3 Applicant: Pink -Accounting; Goldenrod - Assessor J (OIJSTRUCTION AND PLANNING = I APFR10VALS Permit # Date ' 1 nspector POOL & SPA APPROVALS Permit # Date Inspector temporary Electrical Service or Pole 52. Pool & Equipment Location 2 moil Pipe-Undrgrnd. 53. Steel Reinforcement 3.,E1ectrical 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 COVE R -G UNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 6. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK * 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap - 63. Heater & Vent -Final 13, Roof Drains 64. Plumbing System -Final 14. Rough Plumbing 65. Electrical -Final 15, Rough Electrical -Conduit 66. Solar System -Final 16, Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 3O. -,Drywall Nailing HEALTH DEPT. REQUIREMENT 311 Plaster Brown Coat 79. FINAL INSPECTION 32.) Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40, Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, .Landscape irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49, Electric Release to Edison ` 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No.,,.,_ Date . I Q N 1 M Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CI�YaOF COSTA MESA CONSTR UCTION PERMIT PERMIT NO. TRACT NO. L07 NO. UNIT NO. Project Address 711- W. 17th -St . Bldg, (D) Unit 10 Applicant's Mailing Address 13110 Saticoy St. N.Hollywood, Owner's Name Troy Investment. Fund _Phone 549-1216 Address4321 Birch St. Newport Beach, Ca. Arch/Eng.—_Mirin J.Rock License No.� Address _UaaL.Knott Ave. Smite 216 Contractor's Name—DU Co—Air Conditioning Phone 982-1216 Address(mailing)_13110 Saticoy St. N.H011 ood Ca. City License No. —39925 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business a Professions Code, and my license is in full force and effe License Class —^G� en No./i�7251 Date -44948.4— Signature VZ WORKERS' COMPENSATION O LARATIO I hereby affirm that I have a cerci ate of consent to self -Insure or a certificate of W6rkers' Combensation Insurance, or a certified copy thereof (Section 3800, Lab, C.) WC9824 Lumbermans 'olicy No. Company Certified copy is hereby furnished LJ Gert - d co y is filed with the city Buil7olll03(I�s,'ron. r i' Date Applicant_- [[JJ r L.J_�_�, EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). ! 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 Ike Workers' Compen%ation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lander's Name - Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's Llcensa Law (Chapter 9 (commencing with Section 7000) of Division 3 of th'a Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not m4re than five hundred dollars ($500). !�. 1, as owner 4f the property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License law doeq not apply to an owner of a property who builds or improves thereon, and'whb does such work himself/herself or through his or her own employees, provided that such improvement% are not Intended or offered for sate. If, however, the building or improvement is Sold within one year of com- platlon, the own@r will have the burden of proving he/she did not build or im- prove for the purpose of sale). - ❑ I, asowner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con. tractors) license pursuant'to the Contractor's License Law). 1 am aware that proof of their Worker's Compensation insurance should be provided to me, ❑ 1 am exempt irider Section B. & P. C. for this reason Date Owner I hereby certify that.l have read this application and state that information is Correct. !agree comply -with all city and county and state law lacing to b � d, g construction, and hereby autM sentatives i s cityo h r upon the above-mentioned inspection urp Signature Dat Drivers' Lic se Z 55 ir AF 0865-46, rev. 1q/84 White - Building; Canary - Applicant; Pink above rances repre- ]L for TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR PLUMBING ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. qjk DESCRIPTION OF WORK/USE OF BLDG. Backflow Preventer Service Sink Reinspectipn Fee S Main Building: Backflow Irrigation Sewer Cap E Sewer Connection TYPE OF PERMIT GRADING M FOUNDATIONSTRUCTURAL_ T Front ❑ TENANT C1 ELECTRICAL ❑ p(J PLUMBING LMECHANICAL Solar Collectors Z ❑ OTHER A Rear Solar Piping C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY Drinking Fountains Floor Drains Solar Tank Swimming Pool w/Spa CONSTRUCTION TYPE VALUATION S S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: 1780 4/24/85 =one Accessory Building: Parking Req,/Provided 15.50 TL z O ff T S Reinspection Fee I S15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # 1 Heating System & Ducting Cko-1 oo,00o BTU 11100,000 BT Reinspection Fee S15 Accounting; Goldenrod - Assessor Issue Fee PLUMBING FEES L; ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Reinspectipn Fee Automatic Washer Construction Pole Sub. Transformer ❑ 15 -50 -KW H❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection FEES Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Z Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Floor Drains Solar Tank Swimming Pool w/Spa Fan F.A.U. Motors ❑Qi HP Di 'S - 8 Inc, Solar ❑9 i5 HP E]16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pale Light Interceptors Kitchen Sink Lavatories Water Heater Water Service Auto -Wash Outlets Switches Garbage Disposal Range Sign ; Standing Sections P—Trap Laundry Trays Generator 00.5 KW 05.15 KW Trash Compactor Roof Drains Reinspection Fee I S15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # 1 Heating System & Ducting Cko-1 oo,00o BTU 11100,000 BT Reinspection Fee S15 Accounting; Goldenrod - Assessor Issue Fee S 3 Reinspectipn Fee $15 I Issue Fee f -M" MECHANICAL Hood or Type I ❑ ' Canopy Type 11 ❑ FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: —Date ^Dat Data Z Refrigeration System ❑o-100,000 BTU ❑100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLANCHECK 2596' ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ S S $ 1"1 nf] $ --- SMIP $ PERMIT ISSUANCE $ P.C. $ GRADING S MICROFILM S TOTAL FEE S 15.50 System Repair/Alteration Fire Dampers RegistersENERGY ,0 Issue Foe S 3 CONSTRUCTION AND PLANNING ' ,APPROVALS - Permit # + Date Inspector POOL & _.,A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location r 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement '7 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding f 5. Steel Reinforcement r 56. Rough Plumbing & Pressure Test r �.A 6. Electrical UFER Grnd. j �✓ 57. APPROVAL TO COVER GUNITE 7. Footings ! 58. Electrical Conduit-Undrgrnd. - 8' Foundation 59. Gas Pipe, ❑ Undrgrnd., Test ' 9. Water Pipe-Undrgrnd. It 60, Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System ; 61. APPROVAL TO DECK 11. Property Sewer Line & House Goriydection 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 Etectricat-Conduit 66. Soiar 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 A. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS. ' Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydra 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Underg rnd. Stdrage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overread 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 l�f 9� 35, Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Fiscal 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 X50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date (714) 754-5273 - Fax (714) 754-4856 - www.ci.costa-mesa.ca-us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 711 W 17TH ST Status: ISSUED Suite No D011 Applied: 12/07/2001 Vicinity: Issued: 12/07/2001 Parcel Nunmber: 93983038 Applicant: JON JONES - - ISSUED BY: S%"\- Address: FEE SUMMARY 41 Phone: 949-574-0609 Quantity - Quantity ' ISSUE FEE 5 Zip: Temp Dist System I Lighting $0.00 0 Temp"service test $0.00 Owner:�JONES, JON R $0.00 0 Res. a/c package $0.00 Standing Section $0.00 0 ' Address 4047 N MEADOWBR00K-ST- 0 $0.00 0 Now Res (3+units) Phone: /. Transformers up to 1 kvalkw ORANGE, CA - Zip: 92865 $0.00 0 .. ...,.up to 10 kvalkw $0.00 �'�,0 Lighting Fixts $0.00 0 ' '' "' .......:.up to 50 kvalkw $0.00 0 Recept Outlets .$5.50 5 .................up to 100 kvalkw $0.00; 0 Switches \ . $0;00 0 .. Contractor: . $0.00 � ' 0 %. - $0.00 Address: Low Voltage Equipment $0.00 0 Res Appl %, $0,00-,", �0 Low Volt Wiring System I Ckt " , $6.60,, 0 Service to 200a $0.00 0 Misc. Conduit $0.00 Service to 1000a', e �� 0' ` Misc. Conductor $0.00 ; : .0 Service over 1000a� , $0.00 %, 0 Circus ( gen or ride) License: Motors to 1 h \ $0.00 r 0 - Circus (mech ride or lights) .$0.00- /0 Motors to 10hp $0.00 A" Christmas Tree Stand, - 50.00 ; '"" 0 - Motors to 50hp SCOPE OF PERMIT -%-' 0 Fireworks Stand- INSTALL 5 OUTLETS, NO OTHER WORK AUTHORIZED BY THIS PERMIT. $0.00 0 ' Other Electrical Fee' COMMENTS 1 SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2aa5-46 (&M) FEE SUMMARY 41 Quantity - Quantity ' ISSUE FEE $23.50 Temp Dist System I Lighting $0.00 0 Temp"service test $0.00 Busway 000 ft ' $0.00 0 Res. a/c package $0.00 Standing Section $0.00 0 ' New Res (1-2 units) $0.00 0 Misc Electrical'Equipment $0.00 0 Now Res (3+units) $0.00 0 Transformers up to 1 kvalkw $0.00 0 , Pool / Spa $0.00 0 .. ...,.up to 10 kvalkw $0.00 �'�,0 Lighting Fixts $0.00 0 ' '' "' .......:.up to 50 kvalkw $0.00 0 Recept Outlets .$5.50 5 .................up to 100 kvalkw $0.00; 0 Switches \ . $0;00 0 .. ..................over 100. kvalkw = . $0.00 � ' 0 %. Non Res Appy $0.00 Low Voltage Equipment $0.00 0 Res Appl %, $0,00-,", �0 Low Volt Wiring System I Ckt " , $6.60,, 0 Service to 200a $0.00 0 Misc. Conduit $0.00 Service to 1000a', ;, " $0.00. �� 0' ` Misc. Conductor $0.00 ; : .0 Service over 1000a� , $0.00 %, 0 Circus ( gen or ride) '.. $0.00' y 0 Motors to 1 h \ $0.00 r 0 - Circus (mech ride or lights) .$0.00- /0 Motors to 10hp $0.00 A" Christmas Tree Stand, - 50.00 ; '"" 0 - Motors to 50hp \ $0.00 -%-' 0 Fireworks Stand- --$0.00 '-" /0 Motors to 100hp $0.00 0 ' Other Electrical Fee' Motors over 1 00h S000- 0 Communication drops $0.00'-,\ -,0' Investigation Fee- - -= $0.00 Sub panel to 200a $0.00 ' 0` Plan Check Fee ' $0.00 Pole Light Pkg $0.00 0 ' Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $29.00 Intermed Pole $0.00 0 COMMENTS 1 SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2aa5-46 (&M) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars ($100) or less.) ❑ I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workers' compensatlon taws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the labor Code, I shall forthwith comply with these provisions. Applicant Signature: Data: WARNING: FAILURE TO SECURE WORKERS' OOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDrn0N TO THE COST OF ODMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37D6 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. p Class 0 Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code), Lenders Namw Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exerpAt under sec Business and Professions Code for this reason: Signature: � Date: Owner ID v6iffad by driv license. M_Yes ❑ No Drivers License No. MPMExpires: 2 Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cenity that no excavation five (5) or more feet in depth into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Califomia Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Data: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ _...._........................................................................................................ ......................................................... _ _..... 2 Does or will the applicant or present or future building occupant need to fits a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ................................................................................................................................................................................................................................................................................................................................................................ _......... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .............._......................._ ...............—......_......._.......—_.....__...._............_..—_............................._........................................................................................................................._................_ 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Coda been fully complied with? [:]Yes ❑ No _........................_ ....._.-...._..__..._._....._....._......._........................................................................................................... _................... --- ..._.. _... -- 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aggermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes LJ No (Section 65850.2 of the California Government Code requires that the requested Information be fumished an applications for non-residential building permits). _......... to ................................................................................................................................................................ ....................._............._..............-- ......... 6 Will any part of the facility be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .......................................... ---........... ...........—......................... _........................ 1 ..........._.......... ..................................................................................................... ................ .... ............................................ ............... __............. _..-........... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by Calitomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ................................... ....---------....---••-•---......................................................................................._.........................11..1..1...................._ .. ........... (lf yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certily that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materiels and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above -des ed properly for i pecu.on purposes. t agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ate- % -i;!-- 7 - d t r� Signature Of Legal Owner(s) Date AndlOr Authorized Applicant Date CODE ►, INSPECTION2AIE INTITIA CODE I INSPECTION TYPE RATE INT177A�$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 248 Final Plumbing _. 200 Final Re -Root 210 Final Electrical 201 Final BlocklRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Sita 204 Final Demolition .250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIH UHIVE, CUS IA nntsA, CJA Wb1b Job Address: 711 W 17TH ST Suite No D011 Vicinity: UNIT D011 Parcel Nunmber: 93983038 Applicant: JONES, JON R Address: 711 W 17TH ST AMT QTY COSTA MESA, CA - Owner: JONES, JON R' Address �711 W 17TH ST. Laundry Tub! Washer UNIT D011 1 COSTA MESA, CA Contractor: OWNER -BUILDER Address: Arch / Eng ; Address: PLUMBING PERMIT Status: ISSUED Applied: 11/27/2001 Issued: 11/27/2001 ISSUED BY: Phone: 949-574-0609 Zip: 92627 Phone: Zip: 92627 Phone: Zip: License: 0 Phone: Zip: License: SCOPE OF PERMIT PLUMBING PERMIT TO ADD A COOKTOP TO A BREAK ROOM IN AN EXISTING INDUSTRIAL BLDG AND TO CHANGE -OUT A WATER HEATER. 1 GAS OUTLET (1.4), 1 WATER HEATERIVENT, NO OTHER WORK WITH THIS PERMIT. �.. FEE SUMMARY NOTICE: The work authorized by this permit S1GIDMI1M AISRtati4lp-M� requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shaWBe-Tticft 44900neftd]i 4SSUOt I } igbWCI�So *} Hgj work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2448-0 (6=) AMT QTY. AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub! Washer $9.80 1 Sump Pump $0.00 0 Backflow irrigation $0.00 .0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P -Trap $0.00 0 Trap'Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00. 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(IA) $0.00 0 Connect (Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Br1 r Bkflow(54) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water -Heater I vent $12.30 1 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas (1-4 outlets) $6.15 1 Sink, kitchen $0,00 0 Water Softener $0.00 0 Gas (Over 4 outlets) $0.00 0 Sink, servicelmop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0.00 0 TOTAL CALCULATED FEES: $51.75 NOTICE: The work authorized by this permit S1GIDMI1M AISRtati4lp-M� requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shaWBe-Tticft 44900neftd]i 4SSUOt I } igbWCI�So *} Hgj work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2448-0 (6=) WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-insure for workers' compensation, as provided for by section 3700 of the labor Code, for the perlormence of the work for which this permit is issued. ❑ I have and will maintain workers' Compensation Insurance, as required try section 3700 of the Labor Code, for the performance Of the work for which this permit Is Issued. My workers' compensation Insurance Carrier and policy number are: Carrier: Policy Number. (This section need not be completed if the permif is valued at one hundred dollars ($ f 00) or less.) ❑ 1 certify that In the performance of the work for which this permit Is Issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Dote: WARNING: FAILURE TO SECURE WORKERS' COMPENtATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($1 OD,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION VW OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I horeby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divlslon 3 of the Business and Professions Code, and my license Is in full force and effect. Llc. 0 Class 0 Contractor's Signature: _ Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signaturo: __ _ Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit t0 construct, alter, Improve, demolish, or repair any structuro, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter g (Commencing with Section 7000) of Division 3 of the Business and Professions Code) Cr that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a perp-P subjects the applicant to a civil penalty of not mora than five hundred dollars (3500).): ©_ 1, as owner of the property, or my employee4 with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License law does not apply to an owner of property who builds Cr Improves thereon, and who does such work himself Cr herself or through his or her own (amployees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did riot build or improve for purpose of sale.). ❑ I, as owner of the property. am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am ex pt under s Business and Professions Code for this reason: Signature: Date: Owner ID rifled by d es license. IZ Yes ❑ No Drivers License N Expires: DZ-07-O 6 Verification of Ownership by (type of document, i.q. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, This 8, California Administrative Code). ❑ As owner-builder, 1 will not employ anyone to do work which would require a permit lrom the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CRFITIFICATEON: 1 Wllt the applicant or present or future bulldinp occupant need to file and certity a Business Pion for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _......................'r'......._.—_...........n.t......._,r.._ento,r._........`b'..............................................................s-r-o......'t-ri-......_...—_.........................._..ar-d-o ......... i'e"Ia"I's"........... _......................................................... _...._. 2 Does or will the appliCeni or present or future building occupant need to file a registration lanm for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code. with some exceptions, requires reglstratlon with the Costa Mesa Fire Department by each business which at any ono time has on hand a quantity of acutely hazardous materials equal to Cr greater than a weight a1 500 pounds, or a volume of 55 gallons, or 200 cubic feat of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ---- ...............—� ......................................�..............................................................................................................� ......................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ................—.-----......_.. ....—..._......._...._...........�...---............_...__............................_............... ........... .............. ........ ... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a rmll for such construction or modification ge from the South Coast Air Quality Management District or from any other air pollution control district or agent)? Yes U No (Section 65850.2 of the California Govemmermt Code requires that the requested Information be furnished on appiicolions for non-residential building permits). B Willon part of the facili to tae constructed under this y ty permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (If yes", the facility must most the requirement of Sections 25534 and 42303 of the California Health and Safety Code). �._.............__......._..._�............... -....._.-.................................. ._..-.-............................... ........ .......... .................. -.............. __ ... -_._......................._ ._......................... ._.................. ............. ...... ................. _--....... 7 If a permit from the South Coast Air Quality Management District or other air pollution Control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8 (If 'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIRCATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certity under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with at] state laws and City ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the atmov scribed pr rty for inspection purposes, I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. _61 61 Signature Of Legal Owner(s) Date And/OT Authorized Applicant Date con 1. INSPECTION TYPE INTMAL$ CODE 1 INSPEC ON TYPE 2= WaALS 1616 Fixed System Final Fire Prevenlion 206 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing �z 200 Final Re-Roof 210 Final Electrical 201 Final B1ocVFIetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place �^ 220 Final Planning Approval 203 Final Sign _ 222 Final Site 204 Final Demolition 250 Final BulldingtOccupanGy 4-• � L . � CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT "• (7i4) 754-5273 • Fax (714) 754-4856 Z ,lob Address: 711 W 17TH ST Suite No D011 ra � Vicinity: Nunmber: 93983038 Applicant: JON JONES Address: e ' Owner: dJONES, JON R' {y Address 4047 N MEADOWBROOK ST ORANGE, CA Contractor: Address: ELECTRICAL PERMIT Phone'. 949-574-0609 Zip: , Phone: Zip: 92865 Phone: Zip: License: (PERMIT NUMBER 77 FAIR DRIVE, COSTA MESA, CA 92626 status: ISSUED Applied: 1)612511999 Issued: 06!2511999 ISSUED BY: I SCOPE OF PERMITi;=:i r'.5>ir . ELECT WORK, INSTALL BFIXTURt=S 60UTLETS,;1SWITCH, 1-200AMP_SERVICE: 1-64� 'MOiTOR; NO ` 1 ,OTHER WORKAPPRQVED � BY THIS PERMIT:ff � �- k V. � h d h,� �� 1.'• �.�-, � j,..�� • >. � ' d .� FEE SUMMARY fig! , r 4 +•n �Yl:fr .J Quantity - = • -e - e+' ,t !Quantity SUE FEES :*'' $22.00 `- Temp Dist System/. Lighting J ; $0.00; mp.service test $0,00 Busway 1100 ltt$0.00!1°'• 0� �1 s. at ro ackage 1% $0.00 Standing Section �� $OAOs; "'0' s {1-2 units) ' ' 3: 54.00 0 Misc laecirical•Equipment • $0.00 �Ii . J0 . $0.00 1 0 Transformers upp to 1 kvalkw pa U " $oA0 o ..... u to 10 kvalkw '$0:00 0'r g Fixts $8.00 8 ...... p to 50 kvalkw $0.000 7 t Out is $6.00 6x`g up to 100 kvaikw• ;, $0.00 I 0 rhes> : '': $1'.00 1 : �i} . .�, I� ..'....... '' ':over• 100 kvalkw $0.,00 0"' 'Gies Ap I r $0.00 r 0 '• t `' ' j Low Voltage Equipment r, r, , .'�� $0.00 0, M�Ppl '� $0.00` i . 0 �t", ,Low Volt Wiring System l CW �;-$4,00,1` 0 f .'- to 200a � $27.25 1 )t � r Misc. Coriduit � ; ! •� $0.04` 0 rpe to 100oa'';. ', $0.00 0 :,:'_ �' ' ' MISC. Conductor'' $0.00.;�� 10 v`Ioe over 1000a $0.00 0 _ { Circus { gen or ride). z, $0.001 0�` :ors to 1 hp $0.00 0 Circus {mach ride or lights) ; ; $0.00. fif O4 ors to 10hp 811.00' f 1 �'' 'Christmas Tree Stand �; .50 .00 ors to 50hp $0.00 0 r Fireworks Stand' �� $0.00' 0 ors to 100hp $0.00. 0 i • , ; 'Other Electrical Feet $0.00 ors ower 100hp so -do 0 nmunication drops $0.00 0 Investigation Fee u $0.40 panel to 240a $4.00 0 Pian Check Feed , $0.00 I.Ught Pkg $0.00 0 Reinspection Fee $0.00 Circuits $0.00 0 1p Pwr Pole $0.00 0 TOTAL CALCULATED FEES $75.25 rmed Pole $0.00 0 COMMENTS 1 SPECIAL CONDITIONS k (NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related {i ' uu181ions. (Ord. No. 92-28, § 1, 12.21-92) 1©(PjRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned ;f6i a perlod of 180 days. +INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all r ulred Inspections and final approval must be obtained, Failure to obtain Inspections and final approval will result in the expiration of this lhsq t� PP P Pp p permit. i" 2E 'FOR INSPECTIONS CALL: (714) 754.5828 T:. . , r. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 1TY O'FCOSTA�7M�ESA CO—}N,SyT'RUCTION PERMIT MIT NO, TRACT NO. LOT Ivo. UNIT NO. Project Address [1 1 tv' 11 h �' _ � "0—// �// Applicant's Mailing Address 5&M rT OF CONSTRUCTION NEW LJ ADD LJ ALTERATION U REPAIR Owner's Nam Phon z�L r 6 Address 7"3a r Arch1Eng... �.I-%1 % I� ��, ��,Lf +�i�Y r License No. 'Address t11p2.! �� r�lll/>r L& A - Contractor's Name Phone Address imai lingi City License No. LICENSED CDNTRACTOR DECLARATION - I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I nave a certificate of consent to self -insure or a certificate -)f Workers' Compensation Insurance, or -a certified copy thereof (Section 3800, Lab. C ! !y� I gl.cy No.1fnl& / Company ��dsonertified copy is hereby furnished. Certified copy is filed with the city Building Olvision. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed it the permit is for one hundred ($100) or less). I Certify that in the performance of the work for which this permit Is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the -Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION' LENDING AGENCY` I hereby affirm that there is a construction lending agency fort performance Of the work f hich� hi� errpit- is u coon - 097 Civ. C.) Lender's Name 7�'"1 Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code; Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its.issuance, also requires the applicant for Such permit , to file a signed statement that he/She is licensed pursuant to.the provisions of the ContrdCtnr'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 '031.5 ,by any applicant for a permit subjects the applicant to a civil anally of not more than five hundred dollars ($500). owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section,7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own employees, provided that such, improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove far the purpose of sale). C3 1,•aS'owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of 'property who builds or improves thereon_ , and who contracts for such projects with a con- tractors) 1)cense pursuarit to the Contractor's License Law). I am aware .that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner 'I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws rela_ting'to building construction, and hereby authorize repre- sentative$ of this city to to upo th bove-mentioned property for inspection purposes. Signature Drivers' License or SS j CONVERSION ❑ DEMOLISH ❑ OTHER ESCR1PTiON OF WORKIUSE OF BLDG. TYPE OF PERMIT GRADING FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY CON STRUCTION TYPE VALUATION S ZONE GRADINGCU.YOS. ACRES_ Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinke' " Gas Service �Outiets Interceptors Kitchen Sink P—Trap Roof Drains Reinspection -Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑ 0-100,000 BTU Ell 00,000 BT' Reinspection Fe S15 GMF 0865-46, rev. 10/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool wlSpa. Urinal Water Closet Water Fleater - Water Service Auto -Wash Laundry Trays FEES A. P. # S Main Building: E T Front A Rear C Right 8 Left Ping. Ref. # Planning Notes: 6042 V23!86 - I Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 54 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher -Meter ❑aver 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors ❑0.1 HP ❑ 1'r4 - 8 F.A.U. Inc. Solar ❑9-15 HP E] 16-15+ Fixtures. Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal ; Standing Sections Generator ❑0-5 KW 05-15 KW Trash Compactor 8'010 .1L FEES Z O N I N G RE Q M T 5 Issue Fee $ 3 Reinspection Fee L $15 Issue Fee $ 3 1ANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By pp Building Approved By Application Issued By— „ _ Date • Date Data Hood or Type I ❑ Canopy Type I I ❑ * Refrigeration System 1__10-100,000 BTU 0110b,000 BTU SUMMARY OF FEES BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50%, S f MECHANICAL ' $ PLAN CHECK '25% $ SMIP $ PERMIT ISSUANCE $ ENERGY'P.C. $ GRADING S MICROFILM S TOTAL FEE $ System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 y CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL . PA APPROVALS Permit # Date Inspector r1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �• 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 5B. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test ti 9, Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. J� 10. Structural Floor System 61. APPROVAL TO DECK i_ 11,, Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap �l� 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14- Rough Plumbing ` : 65, Electrical -Final 15. Rough Electrical -Conduit V 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 APPROVALS Permit # 20. Rough Factory Fireplace 21, Ducts, in Structure / 70. Underground Hydro 22fDucts, Ventilating 71. Product Piping ❑ Gas ❑ 0il 23.�Gas Pipe Rough &Test v 72a Underground Flush 24.:1Roof Framing j 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 29 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 30JDrywall Nailing HEALTH DEPT. REQUIREMENT 314Plaster Brown Coat 79. FINAL INSPECTION 32, Electrical Power Meter-Firial 80. FOOD CERTIFICATE ISSUED 33- Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy . 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43, Backflow Irrigation n 44. Landscape Irrigation System U45. Sound Attenuation 346. Handicap Regulations X47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 851, CERTIFICATE OF OCCUPANCY No. Date Cr CITY GAF COSTA MESA CONSTRUCTION PERMIT Project Address Applicant's Mailing Address Owner's Name- hone Address Arch/Eng. License No. Address Contractor's Nam •✓ Phone ]Z 7-17y Address {mailing) 7 City License No. �sr� LICENSED CONTRACTOR DECLARATION i hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in fuU farce and effect. - A License Class License No. e-3 e, Date — Signature WORKERS' COMPENSATION DEPLARTTION I hereby affirm that 1 have a certif tate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. Company BCertified copy is hereby furnished. f Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section, need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for.whlcfi this permit is issued, h shall not employ any person in any manner so to become subject to the Worker Co p ns�Il qi �. Laws of Calitorn Date rSignature NOTICE: If, after making this declaratl you should become subject to the Workers' Compensation provisions of a Labor Code, you must forthwith comply, with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Adtlross OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section •7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any.5tructure, 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 the Contractor's License saw (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil )enalty of not more than five hundred dollars ($500). 0 1, a$ owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within ono year of com- pletion, the owner Will have the burden of proving he/she did not build or IM 1 - rove for the purpose of sale).. , as owner of the property, am exclusively contracting with licensed con- tractors t6 construct the project (Section 7044, Business and Professions Code: The Contractor's License law does not apply to an owner of -property who builds -or, improves thereon, and who contracts for such projects with a con- tractor(s) llcense pursuant•to'the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason , Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. P MIT TRACT NO. LOT NO. }T Nb Date Owner I hereby certify that i have read this application and state that the above Information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for ' Inspection purvias. SignatureWM&WDate Drivers' Lice a or SS Reinspection Fee /V /.4 c TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q P 4% DESCRIPTION OF WORK/USE OF BLDG. S Main Building: f TYPE OF PERMIT GRADING 0 FOUNDATION D STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY, C Right K Left CONSTRUCTION TYPE VALUATION $ $ ZONE GRADING CU. YDS. . ACRES. Ping. Ref. Remarks: Planning Notes: Reinspection Fee ' I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO =` Heating System & Ducting ❑0.100,000 BTU ❑ 100,000 BT RF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 FEES 9950 3/25/65 Zone Accessory Building: Parking Req./Provided ELECTRICAL Coo" Automatic Washer - Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas []Electric Fan ;r F.A.U. Fixtures. Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW ❑5-15 KW _ Issue Fee I $ 3 MECHANICAL FEES Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU C1100,000BTU System Repair/Alteration Fire Dampers Registers - Issue Fee I $ 3 Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100amps Meter ❑over 100 amps Sub Panel Motors 13D-1 HP D h - B Inc. Solar ❑9.15 HP El 16-15+ Microwave Pole Light Range Sign ! Standing Sections Trash Compactor 10050 TL r� FEES Z O N I N G R E Q M T S I I Reinspection Fee 1 $15 1 1 Issue Fee . I $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Bar Sink PLUMBING Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Drinking Fountains Solar Piping Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains ISSUANCE Reinspection Fee ' I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO =` Heating System & Ducting ❑0.100,000 BTU ❑ 100,000 BT RF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 FEES 9950 3/25/65 Zone Accessory Building: Parking Req./Provided ELECTRICAL Coo" Automatic Washer - Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas []Electric Fan ;r F.A.U. Fixtures. Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW ❑5-15 KW _ Issue Fee I $ 3 MECHANICAL FEES Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU C1100,000BTU System Repair/Alteration Fire Dampers Registers - Issue Fee I $ 3 Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100amps Meter ❑over 100 amps Sub Panel Motors 13D-1 HP D h - B Inc. Solar ❑9.15 HP El 16-15+ Microwave Pole Light Range Sign ! Standing Sections Trash Compactor 10050 TL r� FEES Z O N I N G R E Q M T S I I Reinspection Fee 1 $15 1 1 Issue Fee . I $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Buitding Approved By Date Application Issued By Dat SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ , a O ISSUANCE $ PLAN CHECK 25% $ ,1 •,�� ENERGY P.C. $ ELECTRICAL 5 GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL ' $ TOTAL FEE $ 1G PLAN CHECK 25% $ t CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL sPA APPROVALS' Permit # Date Inspector 1. Temporary Electrical Service or Pole f 52. Pool & Equipment Location 2. Soil Pipe Undrgrnd. f' 53. Steel Reinforcement } Ele t ical Conduit- yti�ty-Undrgrn E. rp 54. Forms ti Eleci�ical Conduit-Und�tjtr,grnd. it 55. Electrical Bonding 5.,Steel'Reinforcemen`t 56, Rough Plumbing & Pressure Test 6' Electrical UFER'G#nd. 57. APPROVAL TO COVER-GUNITE ; �r 7 Fiootings 58. Electrical Conduit-Undrgrnd. 1 w 81 F,oun ation � �'� ,d 59. Gas Pipe, ❑ Undrgrnd., Test Wate"Pipe Undrvgrnd. ,Q 1 v 60. Backwash Lines, P -Trap, ❑ Undrgrnd..• 10 Structural Floor System I v 61. APPROVAL TO DECK 1 <J'Pi'operty Sewer Lined House Connection62. ! / 4 Backwash &Receptor -Final 12o'Sewer Cap i 63. Heater & Vent -Final V` 13,'Roof Drains n i 64. Plumbing System - Final 14,,,.Rough Plumbing# (l ok(A 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 APPROVALS Permit # 26. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts-, Ventilating 71. Product Piping ❑ Gas D Oil 23. Gas Pipe -Rough & Test 72. Ungerground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 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 V Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY QF COSTA MESA CONSTRUCTION PERMIT PERMIT Nf1 TRACT NO. LOT NO. ttNiT Nit Project Address 711 W. 17 th S t. BLDG. (D) 11 " Applicant's Mailing Address 1311f1 Sala coy St _ N.Hol l ywoo l � Owner's Name ,Troy InyestItlp-nt�Fund- Phone549-798 Address 4_191 Rj--ch St_ Ne ort Beach, Ca. _ Arch/Eng, _Ma.Llp -1 - ROCK License No. Address 12881_KnrntY Ave- Sllite_9.1h Contractor's Name—Hurn Air C,=dltJnn i nR Phone-9.SZ f] Address ( mailing) _L3U0_Sa,t_it_O_y_St,—jQ_, n DQd; Ca - City License No. 99-2 LICENSED CONYRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the l3usinoss and fessions Code, and my license is in IuJJ fttrfts o and ef4�J251 License Class LI L/l L e e o. DateL,11884— Signatur WORKERS' COMPENSATION D LARATION I hereby affirm that I have a cer tate Of consent to self -insure or a certificate of workers' Compensation In ranee„ or a certified copy thereof (Section Polio, Lab. c.) Wc9824 Lumbermans Policy No. Company eCertified copy is hereby furnished. Certi i Cp is filed with the city Building Diyi�iQn.� _ /t 1� Date L Applicant out_- ] 7-�f EXEMPTION PROM WORKERS' COMPENSATION DECLARA ION (This section need not be completed if the permit Is for one hundred ($100) or _ less). I certify that in the performance of the work for which this permit Is issued, 1 Shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation previsions of the t_abor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code. Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 '031.5 by any applicant for a! perrnit ,subjects the applicant t0 a civil enalty of not more than five hundred dollars ($500). D I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law dogs not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his ar,her own employees, Provided that such improvements are not intended or offered for sale. It, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale)- ❑ I, as owner of the property, am exclusively cantractlng with licensed Con- 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 builds or improves thereon, and who contracts for such projects with a Con- tractors) license l ursuarit'to the Contractor's License Law). I am aware that proof Of their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION, ❑ DEMOLISH ❑ OTHER Showers A. P. DESCRIPTION OF WORK/USE OF BLDG. Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW El 50 + KW ; Sewer Ca P Sewer Connection S Main Buildi Meter ❑up to 100 amps E TYPE OF PERMIT GRADING FOUNDATIDN STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL_ ❑ PLUMBING G� MECHANICAL Dryers ❑Gas' ©Electric ❑OTHER Solar Tank A Rear Motors Dal HP ❑ 1 K - 8 C Right PROJECT DESCRIPTION SQ. FT, OCCUPANCY K' Urinal CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping, Ref. # Remarks: Planning Notes: Ber Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P --Trap Roof Drains Reinspection Fee S15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System D Multiple ❑ Firepl/Fact. Bit. ICBO # Date OwnerHeating System &Ducting I hereby certify that I have read tnis application and state that the above 1 X-0-100,000 BTU 13 100,000 BT Information is Correct. I agree comply with all city and county Ordinances ' and state law lating to b di C, construction, and hereby auth ze repre- sentatives th s oily to nt upon the above -mentions pert fot— Inspectlo urp eS, S Signa tur Dat Reinspection Fee Drivers' Lice or S CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 1761 4/64/85 zone Accessory Building: Parking Req./Provided 15,50 Z O N I N G R E Q M T S PLUMBING FEES ELECTRICAL FEES Showers Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW El 50 + KW ; Sewer Ca P Sewer Connection Cooking Unit Meter ❑up to 100 amps Solar Collectors Dishwasher Meter Dover 100 amps Solar Piping Dryers ❑Gas' ©Electric Sub Panel Solar Tank Fan Motors Dal HP ❑ 1 K - 8 Swimming Pool wlSpa F.A.U. Inc. Solar 09.15 HP (]16.15+ Urinal Fixtures Microwave Water Closet Water Heater Water Service Auto -Wash Device Boxes Outlets Switches Garbage Disposal Pole Light Range Sign ! Standing Sections Laundry Trays Generator 00.5 KW 05-15 KW Trash Compactor Issue Fee - S 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued 8y pat 2- Hood or Type D Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY $ $ $ $ S $ S 13.00 $ 9 OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C, $ GRADING $ MICROFILM $ TOTAL FEE $ ] 5 , 50 513 System Repair/Alteration Fire Dampers Registers O Issue Fee $ 3 �- CONSTRUCTION AND PLANNING APPROVALS . Permit # Date i Inspector POOL SPA APPROVALS Permit # _ Date Inspertnr 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 r 56. Rough Plumbing & Pressure Test •y,. 6• Electrical LIFER Grnd. il. r" 57. APPROVAL TO COVER-GUNITE 7. Footings r-' 58. Electrical Conduif-Undrgrnd. 8: Foundation 59, Gas Pipe, ❑ Undrgrnd., Test ' l; 9. Water Pipe-Undrgrnd. !' 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System % "" ! 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12, Sewer Cap i 63. Heater & Vent-Final " 13. Root Drains r 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final i 6. 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 0. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS. Permit # 20. Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-8ar 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 L y�/fLQ 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43, Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CIT11INWi A MESA ' CONSTRUCTION PERMIT Applicant's Mailing Address Owner's Name TiPJy f /yyaSi• E/l= Phone Address - Arch/Eng. License No. Address _- - Contractor's Name OR R f 5 � [-b C ?R° f C Phone ?77-6 ? 8D Address Imailing) /-/?4-5�,BRyI N &00M1.1QkMA) q-13!(7 City License No, 33 LICENSED CONTRACTOR DECLARATI4N I hereby affirm that i am licensed under provisions of Charter 9 (c imenctng with section 7000) of Division 3 of the I3uslness and Profession ode, and my license Is in full forceaid effect. License Class c r D cense 3/7 Da to ~ / Signature WORKERS' COMPENSATION DECLAR ION I hereby affirm that I have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. CJ l} Policy No. V✓C 1 O'i `3 _70fl Co LE C- _ H Certified copy is hereby furnished. Certifietlcop 1?Ied with the city r slon. r Date _ Applicant EXEMPTION FROM WORKERS' COMPENSATION ECLARATION (Thissection need not be completed if the permit is for one hundred ($100) or 1 certify that in the performance Of the wgrk for which this permit is issued I shall not employ any person in any manher so as to become subject to tie Workers' Compensation ,Laws of California. Date Signature •NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor- Code, you must forthwith comply with such provisions or this permit shall be deemed revokbd. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit 1% Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code- Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure; prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (CommenCing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she, Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). ❑ 1, as owner of the property or my employees with wages as their, sole compensation, will do the work, and the structure Is not intended or offered for sale,(Section 7044, Business and Professional Code -.The Contractor's License Law does not apply to an owner of a properly who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. 11, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclu"vely contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, arid_who contracts for such projects with a con- tractor(s) license pur$uarit'to the Contraitor's License Law), I am aware that proof 0f their Worker's Compensation insurance should be provided to me, ❑ 1 am exempt under Section _ B. & P. C. for this reason Date — I hereby informatic and state sentative$ inspection Signature Owner that I have read this appl cl. I a req to comply wi tatuiltling coristruqq v enter u n tNe Drivers' License or 55 V1 in and state that the above city and county ordinances and hereby authorize repre- ve-mentioned property for Date 1 -10415 - PERMIT NO. 4 TRACT NO. LOT NO, UNIT NO. D ooiaq I f b/IJO 4a�J(� TYPE OFCONS7RUCTIOfV NEW ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. Zone S Main Building: Accessory Building: TYPE OF PERMIT GRADING C1 FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ -OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CON STRUCTION TYPE VALUATION $ ZONE GRADING CU,YDS. ACRES E T Front Z O B A Rear N I C Right N K S ,Left G R Ping, Ref, # Parking Req./Provided E Remarks: Planning Notes: O M T S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub, - Transformer ❑ 15-50 KW_ ❑ 50 + KW Backflow irrigation Sewer Cap Bathtubs Sewer Connection r Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Soler Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan+ Motors X10-1 HP ❑ 1 /a - S Floor Drains Swimming Pool vvISpa F,A.U, Inc. Solar 09.15 HP El 16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water CloseIt Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Lavatories Water Service Auto -Wash Switches Garbage Disposal Sign ; Standing Sections + P -Trap Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 Boiler Duct -Under Ground MECHANICAL FEES Hood or Type I ❑ Canopy Type I I ElZoning DEVELOPMENT SERVICES REQUIREMENTS: Approved By Building Approved By Application Issued By Date Date Dat Duct - Structural Refrigeration System 00.100,000 BTU 0100,000BTU Duct - Ventilating BUILDING PERMIT $ PLAN CHECK $ PLUMBING S PLAN CHECK 25% S ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL S PLAN CHECK 25% $ SUMMARY OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ _ I-�106 GRADING $ MICROFILM $ TOTAL FEE $4 -50 Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact, Bit. ICBO # Fire Dampers. Heating System & Ducting 00.100,000 BTU 0100,0006T Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10%84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor QONSTRUCTION AND PLANNING POVAPermit # Date Inspectorpate POOL c- _:'A APPROVALS Permit #Temporary Inspector Electrical Service or Pole V2'. 52. Pool & Equipment Location Soil Pipe Undrgrnd. 53. Steel Reinforcement Electrical Conduit Utility-Undrgrnd. 54. Forms Electrical Conduit-Undrgrnd. L4. 55. Electrical Bonding Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE _77. Footings 58. Electrical Conduit-Undrgrnd. '8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15, Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. 'Ducts, in Structure 70, Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 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 Cr Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA• CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. 1iN17 curt _-Pr6jec1'Address j. 911 C06 T& S Applicant's Mailing Address Owner's Name Phone Address Arch/Eng. License No. Address Contractor's Name—/l VRk-1,S TR f C Phone P77-WrO Address (mailing) [�l(�S $RyAn�T,ST RLGomiiti67LrYU 'T.231 16 City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am -licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 he Business and Profess" s Code, and my license is in full, force and effe License Class Licens o. Date^/�` Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of cons op to salt -insure or a certificate of Workers' Compensation Insurancewor a certified Copy thereof (Section 3800, Lab. _C.1f rolicy No. V� c 1 C �-7 Company LEG L� Certified copy is hereby furnished. ❑ Certified cop �fifetl with the cit Bui sion. Date Applicant EXEMPTION'FROM WORKERS' COMPENSATION D CLARATIp (This section need not be completed if the -permit is for ne hundred ($100) or less),- I certify that in the performance of the work for which this permit is Issued I shall not. employ any person in any manner so as to become subject to the Workers' Compensation -Laws of California. ' . Date Signature ' 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this_ permit is issued (Section 3097 Civ, C.) Lender's Name _ Lender's Address . OWNER BUILDER DECLARATION - - 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason -(Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure; prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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-vlolatlon of Section 7031:5 by any applicant for a permit subjects the applicant to a civil salty of not more than five hundred dollars ($500). ` 4, as owner of the property or my emplovees.with wages as their sole _.,mpensation, will do the work, and the structure is not intended or offered . for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/She did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the projectSection 7044, Business and Professions Code: , The Contractor's License Law Res not apply to an owner of property who 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 proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read. this ap informatioAre gree to comply and state t buildingconssentatives enter upotinspectionSignatureDrivers' Li IF 0865.46, rev. 10/84 White - Bull i and State that the above /ity and county ordinances and hereby authorize repre- ve-mentioned property for IL—_ Date 1✓ it �:, ID TYPE OF CONSTRUCTION 0 NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION -❑ DEMOLISH ❑ OTHER A P 46 DESCRIPTION OF WORK/USE OF BLDG. IS Main Building: TYPE OF PERMIT ❑ GRADING _ FOUNDATION STRUCTURAL T Front ❑ TENANT'E] ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 13 Rear ❑ -OTHER A PROJECT DESCRIPTION SQ: FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ S I Left ZONE GRADING CU.YDS. ,ACRES Ping. Ref, # Remarks: Planning Notes: Bar Sink Backflow Preventer- Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories ; P—Trap Roof Drains ( Reinspection Fee $15 Boiler Duct - Under Ground, Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0-100,000 BTU El 100,000 BT , I Reinspection Fee -1 $15 ry - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water-Closat Water Heater Water Service A uto-wash Laundry Trays Issue Fee CHANICAL Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU ❑100,000 BTU System Repair/AIteration Fire Dampers Registers Issue Fee 5869 1/16/85 I Accessory Building: I Parking Req./Provided i4e a0. TL i Zone Z O N I N G R E Q M T S FEES—1 ELECTRICAL FEES Automatic Washer Pole Sub. 'Construction50 Transformer ❑ 15-50 KIN El + KW Cooking Unit Meter El up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors K0-1 HP ❑ 1 h - 8 1 F.A.U. Inc. Solar ❑9.15 HP Ell 6-15+ f Fixtures Microwave Device Boxes Pole Light ; Outlets Range Switches . Sign Garbage Disposal ; Standing Sections Generator ❑0-5 KW 05-15 KW Trash Compactor $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By pate Date Date SUMMARY BUILDING PERMIT '$ PLAN CHECK $ PLUMBING '$ PLAN CHECK 25% $ ELECTRICAL $ •OO PLAN CHECK 50% $ MECHANICAL $ 1 PLAN CHECK 25% $ OF FEES SMIP $ PERMIT ISSUANCE .$ ENERGY P.C. $ GRADING $ �_)o MICROFILM $ TOTAL FEE $� i $ 3 '�ONSTRUCTION AND PLANNING .,APPROVALS Permit # Date Inspector POOL i a . APPROVALS Permit # Date lnspecrnr - 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility,-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 1,2. 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structurg 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 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 f+ �� Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test . 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service --Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. 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 Nn, Date CITY OF 12OSTArJM/E�SAJAI C/O_ Project Address _L LL- L I Applicant's Mailing Address Owner's Name ION PERMIT- - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations r- D .2RMIT N _ A J NQ LOT NO. � I / NO ` TCONSTRUCTION NEW ADD ALTERATION E17R )% TPF ONVERSION ❑DEMOLISH ❑OTHER ApCRIPTION OF WORK/USE OF BLDG, S Main Building: Arch/EngW t•t lilcY� l ► tL icL [iC�License No. _v_ro�� Address � n U2 /A ; Contractor's Name Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license.ls in full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION' L herebyaffirm that 1 have a certificate of consent to self -insure or a certificate { Workers' Compensation Insurance. or a certified copy thereof (Section oo, dlic Nb.,C,.L),§;0 Company 8CAU- � ,i"y , Policy No. Certified copy Is hereby furnished. Certified copy Is filed with the city Building Division. Date Applicant ' EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued I shall not employ any person in any manner so as to become subject to tke Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this tleclaratlon, you should become subject to the Workers' Compensation provisions of the Labor -Code; you must forthwith , comply with Such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending a ency for the performance of the work f w i h i It is Ue (Se ah 13097 Civ. C.) Lender's Name /`� Lender's Atldress OWNER BUILDER C)iECL:ARA1rior4 I hereby affirm that I am exempt fiom the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Codet Any city or county which requIfas a permit to construct, alter, improve, demolish or. repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed Statement that he/she is licensed pursuant to the provisions of .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 '71erefrom and the basis for the alleged exemption. Any violation of section ?�n31.5 by any applicant for a permit subjects the applicant to a civil i.v. y=':`malty of not more than five hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale, If,,however, the building or improvement is sold within one year of Com- pletion, the owner will have the burden ofproving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and who contracts for Such projects with a Con- tractors) license pursuarit to the Contractor's License Law). 1 am aware that proof of their Workers Compensation insurance should be provided to me. ❑ 'I am'exempt under Section B. & P. C. for this reason Date Owner. I hereby certify that I have read this application and state that the above informat!on Is correct. I agree to,Comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter qV01P the ah e- a tinned •property for inspection purposes. ; Signature Drivers' License or SS 9r TYPE OF PERMIT LJ GRADING L-) FOUNDATION LJ STRUCTURAL ❑ TENANT ELECTRICAL PLUMBING ❑ MECHANICAL ❑ •OTHER PROJECT DESCRIPTION SO, FT. OCCUPANCY— CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES Remarks: ,� CMF 0865-46, rev. 10184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor E T Front A Rear C R ight K S Left Ping. Ref. 0 Planning Notes: ' �e6043 6%23%86 Accessory Building: + I Parking Req,/Provided Zone ELECTRICAL Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit . PLUMBING FEES Bar Sink Showers Sub Panel Backflow Preventer Service Sink F.A.U. Backflow Irrigation Sewer Cap Microwave Bathtubs Sewer Connection Garbage Disposal + Clarifiers _ _ Solar Collectors— -- - Trash Compactor Dishwasher Solar Piping PLAN CHECK 50°x, Drinking Fountains Solar Tank $ Floor Drains Swimming Pool vv/Spa Floor Sinks Urinal I $ Gas Service Outlets 1 Interceptors Kitchen Sink 'Water Closet " -Water Heater Water Service PLAN CHECK 2595, Lavatories Auto -Wash C ; P -Trap Laundry Trays Roof Drains Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Hood or Type I ❑ Canopy Type I I ❑ Duct Under Ground Duct - Structural Refrigeration System ❑0.100,000 BTU ❑100,000 BTU Duct - Ventilating Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact, Bit. ICBO # Fire Dampers Heating System & Ducting t E10-100,000 BTU ❑ 100,000 BT - Reg isters Reinspection Fee $15 Issue Fee $ 3 ,� CMF 0865-46, rev. 10184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor E T Front A Rear C R ight K S Left Ping. Ref. 0 Planning Notes: ' �e6043 6%23%86 Accessory Building: + I Parking Req,/Provided Zone ELECTRICAL Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit . Meter Cup to 100 amps Dishwasher - - Meter Oover 100 amps Dryers ❑Gas []Electric Sub Panel Fan Motors 130-1 HP 131 F.A.U. Inc.Solar 09.15 HP ❑16-15+ Fixtures • Microwave Device Boxes Outlets Switches Pole Light Range Sign Garbage Disposal + ; Standing Sections Generator 130.5 KW El5.15 KW Trash Compactor GRADING $ PLAN CHECK 50°x, $ Reinspection Fee ! $15 1 1 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date - I Building Approved By Date— Application Issued By _ Date_ Z Q N . I N G R £. Q M T S FEES $ 3 SUMMARY OF FEES �y BUILDING PERMIT $ SMIP $ 'TJ PLAN CHECK $ PERMIT I PLUMBING $ _L� '� ISSUANCE $ PLAN CHECK 2595 $ �1._.-._.__._ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50°x, $ MICROFILM $ �� MECHANICAL $ TOTAL FEE $ PLAN CHECK 2595, $ C ; CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL ?A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pale 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 5$. Electrical Conduit-Undrgrnd. {l 8. Foundation 59, Gas Pipe, ❑ Undrgrnd., Test '/, 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System �eJ 61. APPROVAL TO DECK F' J� 14. Property Sewer Line & House Connection 62, Backwash & Receptor -Final 12. Sewer Cap ., 63. Heater & Vent -Final r 13. Roof Drains %1 64. Plumbing System - Final 14. Rough Plumbing � 65. Electrical -Final t 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 F INAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory rireplace 21. Duets, in Structure 70. Underground Hydro 2 � JDucts, Ventilating �� 71. Product Piping ❑ Gas ❑ Oil 23Aas Pipe -Rough &Test 72yUnderground Flush 24.)Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydra 26. T -Bar Ceiling (Structural) & Klonocoat 75. Dry Chemical 27. Frame and Flashing ' 76. Dry Standpipe 28. Lathing & Siding L 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30ZDrywall Nailing HEALTH DEPT, REQUIREMENT 31.ePlaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing XO-• 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 w 47? FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co M 51 CERTIFICATE OF OCCUPANCY Nor3 Date '611**0F COSTA MESA CONSTRUQTION PE %T/ Project'Address fz// Applicant's Mailing Address Owner's Name Phone Address Arch/Eng. License No, Address Contractor's Nam Phone Address (mailing) V}" % ' City License No. �5_a LICEN5EO CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is In full f ;we a fact. .f Licervn�6sse7e7 Class Fcense No. 30 13=11! `/-- DatY'-- Signature WORKERS' COMPENSATION DE RATION , I hereby affirm that I have a certifica a of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) t� Policy No. Company _ H Certified Copy is hereby furnished..ti Certified copy is filed with the city Building Division, Date Applicant f EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued f y shall not employ any person in any manner so as to become subject to tire' Worker ' Cam ens tion Laws of Calif Date Signature NO CE: IT. bter acing this declar i n, you shou d ecome subject to the Workers' Compensation provisions o he Labor Code, you must for%pwith comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name - Lender's Address ,f OWNER BUILDER DECLARATIDN I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division, 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of not more than five hundred dollars ($500). 0 1, as owner of the property or my -employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License taw 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractar(s) license pursuarh'to'the Contractor's License Law), I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. a P. C. for this reason Cr Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PE MIT[O8"/a ry TRACT NO. LOT NO. UiVET;i� J.�s /l a 17J1 Date Owner 1 hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this'city to enter upon the above-mentioned property for inspection pujpo es. Signature 1Oate Drivers' Licbhs/or SS V1 4F 0865-46, rev. 10/84 White - Building; Canary - Kpplican TYPE OF CONSTRUCTION LJ NEW ADO LJ ALTERATION Li REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER 7P.+ DESCRIPTION OF WORKIUSE OF BLDG. n Building: E TYPE OF PERMIT EJ GRADING FOUNDATION ElSTRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION S S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer _ Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO Heating System & Ducting ❑0.100,000 BTU E] 100,000 BT Reinspection Fee 1 $15 t: Pink - Accounting; Goldenrod - Assessor PLUMBING FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays 77Uf if Cdr O.! ILID VJ IL Zone Accessory Building: Parking Req,/Provided. , ELECTRICAL Automatic Washer Construction Pole Sub, Cooking Unit Dishwasher Dryers OGas ❑Electric Fen F.A,U, Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 05-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors 00.1 HP ❑ VA - 8 Inc.Solar 1-19-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES Z O N 1 N G R E Q M T S Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 iANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By ' Application Issued By �C, Date Date Dat Hood or Type I ❑ Canopy Type 11, ❑ Refrigeration System 1--10.100,000 BTU ❑ 100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ .-_� / �i� $ $ $ $ SMIP $ PERMIT ISSUANCE $ ENERGA P.C. $ G13ADIh:3 $ MICROFILM $ TOTAL FEE $ System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 ' ;CONSTRUCTION AND PLANNING 'EDate 'APPROVALS Permit•# w �3 Inspector POOL, ,PA -APPROVALS ' Permit # Date Inspector F: Temporary Electrical Service or Poe 52. Pool &Equipment Location 2. Soil Pipe-Undrgrnd. rq �� 53. Steel Reinforcement 3. EIeC[rical ConuitrkJiility Undrtnd. _ � � ,d • � "' 54.. Forms '4Y,Elect_ al Conduit, In4grnd. Gi" 55. Electrical Bonding L, 5. Steel Reinforcerrient'.4 a hh r ;r 56. Rough Plumbing & Pressure Test 'rfr {ht' ricaI UFERSG Ad. 57. APPROVAL TO COVER-GUNITE n -r7f Footings rJ 58. Electrical Conduit-Undrgrnd. I rI! .F ri'dation 59. Gas Pipe, EJ Undrgrnd., Test 9 Water, Pipe-Undryrn . �' G 60. Backwash Lines, P -Trap, C1 Undrgrnd. 10� "Struc ural Floor Sy tem h 61. APPROVAL TO DECK 1Lpert Sewer Line j& House C37nrijection 1 62. Backwash & Receptor -Final 12 .�5ewer Caplj� 63. Heater & Vent -Final i 13' Roo Drains ci r 64. Plumbing System - FinalLj r� 14nRough Plumbinrl L,�-q 65. Electricai-Finat -15. Rough Electrical -Conduit • 66, Solar System -Final 1'6. Rough Electric Wiring 67. Fencing & Access Approval 1-7. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bir Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conaitioning FIRE DEPT. REQUIREMENT .ri. APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. -Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Stdrage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75, Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV, FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79: FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 1-5--0 CZ0 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing �C 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. Handi6ap Regulations .K , 47. FINAUSTRUCTURE & B,UILDING 48, Special Requirements Completed 49. Electric Release,to Edison T 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF,OCCUPANCY No. Date Q N a J ' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Projecl dress 711 W. 17th St Bldg. (D) Unit 12 Applicant's Mailing Address 13110 Saticoy Sy N.H=ood, Owner's Name Troy Investment Fund Phone 549-296d Address 21 Birch St Newport Beach,Ca. Arch/Eng-Mr. J • Rock License No, Address 12881 Knott Ave. Suite _216 Contractor's Name_D (2__Air Conditioning Phone 9821216 Address (mailing) -1311,0 Saticoy St. N.1lollywood,Ca. City License No. ��3925 LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business a rofessions Code, and my license is in fun forgenj effe 346251 License Class C; LV en No. Date4/ 1 8 1 84 Signat WORKERS' COMPENSATION oEPALARATCON I hereby affirm that I have aCertif;Eate of consent to self -Insure or a certificate of Workers' Compens$tion Insurance, or a certified copy thereof (Section 1800, Lab. `[ C9824 Lumbermns Policy I — Company 8 Certified copy is hereby furnished. Cerci i y is filed with the city Buildins on. Date Applicant_,? Ju_ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less) I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation. Laws of California. ' Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers', Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked: CONSTRUCTION LENDING AGENCY I hereby affirm that th@re is a construction lending agency for the performance of the work for which this permit is ISsuetl (Section 3097 Clv. C.) Lender's. Name T __ Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 -of the Business and Professlons Code) or that he/site is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031,5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). J I, as owner of the property Or my employees with wages as their sole Compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or oflered'for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/She did not build or im- Irove for the purpose of sale).. , as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's Licgnse Craw does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a con. tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. _] I yam exempt under Section B, & P. C. for this reason Date Owner I hereby certify that I have rea, Information is correct. I agree t and -State laws.relating,to b.; r sentatives Of is city to t .Inspection rp ses. Signature Drivers' LAG Se Or -S TYPE OF CONSTRUCTION LJ NEW LJ ADD I J ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. y� DESCRIPTION OF WORK/USE OF BLDG. S Mein Building: E TYPE OF PERMIT [11GRADING FOUNDATION LJ STRUCTURAL r T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUM91NG 9 MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SO. FT. OCCUPANCY K Flight K CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU -YDS. ACRES— Ping. Ref. # Remarks: Planning Notes: •A. this application and state that the above _Ply with all city and county ordinances construction, and hereby authorrize rep - upon the above-mention%dy py Pert ar AF 0865-46, rev. 10/84 White - Building; Canary - Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee - Boiler 'J $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO 94E Heating System & Ducting E�0-100,000 BTU ❑ 100,000 BT , I I Reinspection Fee ` $15 Iicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping . Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee MECHANICAL Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System i]0-,100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automatic washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan 1762 4/24/95 15,50 Zone, Accessory Building: Z O N N G - R Parking Req./Provided E O M T S ELECTRICAL I I FEES F,A.U, Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 05-15 KW Transformer -0 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter El over 100 amps Sub Panel Motors 00-1 HP ❑ 1 A - B Inc. Solar ❑9-15 HP Ell 6-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor S Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REOUIREMENTS: Date Dote Dat Z75 BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES S $ $ $ t S S S — 13-.00 $ 2.50 SMTP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING S MICROFILM S TOTALFEE S - 15.50 $ 3 ,CONSTRUCTION AND PLANNING -APPROVALS - Permit # Date Inspector POOL, .PA . APPROVALS Permit # Date Inspector - Temporary Electrical Service or Pole 52. Pool -& Equipment Location �` ! '2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement r. "e 3. Electrical Conduit Utility-Undrgrnd, 54. Forms ` f 4, Electrical Conduit-Undrgrnd. 55. Electrical Bondingi. 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test +, 'A 6. Electrical LIFER Grnd. _ -� 57. APPROVAL TO COVER-GUNITE `► 7, Footings 58. Electrical Conduit-Undrgrnd, 8' Foundation 59. Gas Pipe, ❑ 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 Congection 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ 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 _f/0 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING . 48. Special Requirements Completed 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date' 1 z Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. LOT NO. U T N I Llcen Cia t.r ense o CITY OF COSTA MESA CVIM iy�tvly PERMIT Date Signature Kitchen Sink ' WORK RS' CO PENSATION DE RATION '/-r 1 herebyaffirm that I have a certit to of consent to salt -insure or a certificate Bar Sink: Backflow Preventer 'Of Workers' Compensation Insurance, or a certified copy thereof (Section teoo, Lab, raj �, �1/2 /1 6SiUrcoI ollcy No. Li-_�.._.� Company, Pkojl3cf Address -- - eCertified copy is hereby furnished. Certified copy is filed with the cityBuIldl OIv15Ion. ' AL Bathtubs pate Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers (Th IsSect Ion need no t be completed It the permit Is for one hundred ($100) or" 1 certify that In the performance of the work for which this permit Is Issued I shall notemploy any person In any manner so as to become subject to the Dishwasher Applicant's MailingAddress �,�r��f��r.��/ G�� TYPE OF CONSTRUCTION NEW ADD ALTERATION tREIAl ❑ ❑ ❑OTHER Floor Drains Date Signature ' 'NOTICE: It, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks - Name ate/ Phone+}_�L�LCQ CONVERSION DEMOLISH A.P. -y Generator 00.5 KW 05-15 KW Owner's F/L�y/ 1 IS ET DESCRIPTION OF WORK/USE OF BLDG. S Main Building: ry Address ArchlEng. ) 01tG[ ! License Z r TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ,, Address � /14/25 �f � ❑ TENANT ❑'ELECTRICAL ❑PLUMBING ❑ MECHANICAL ❑ B Rear , GRADING Contractor's Nam U E -'fl Phone Z Z/� 'OTHER C Ri ht g $ Address (mailing) �� J �� G dy N. f / . - PROJECT DESCRIPTION SQ. FT. OCCUPANCY K PLAN CHECK 2596 $s } e—� -3 CONSTRUCTION TYPE VALUATION $ S I Left 'City License No. 3 LICENSED CONTRACTOR DECLARATION ZONE GRAOING CU. YDS. ACRES Pin Ref. + g' I herel y affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: with $CCtI n 7000 of Division 3 of the Business and Professions Code, and my license is Int owe-gnd�Uect. /- 2 z—` I Llcen Cia t.r ense o Gas Service Outlets ' Date Signature Kitchen Sink ' WORK RS' CO PENSATION DE RATION '/-r 1 herebyaffirm that I have a certit to of consent to salt -insure or a certificate Bar Sink: Backflow Preventer 'Of Workers' Compensation Insurance, or a certified copy thereof (Section teoo, Lab, raj �, �1/2 /1 6SiUrcoI ollcy No. Li-_�.._.� Company, Backflow Irrigation eCertified copy is hereby furnished. Certified copy is filed with the cityBuIldl OIv15Ion. ' AL Bathtubs pate Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers (Th IsSect Ion need no t be completed It the permit Is for one hundred ($100) or" 1 certify that In the performance of the work for which this permit Is Issued I shall notemploy any person In any manner so as to become subject to the Dishwasher Drinking Fountains Workers' Compensation Laws of California. Floor Drains Date Signature ' 'NOTICE: It, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks - -comply with Such provisions or this permit shall be deemed revoked. $15 ''CONSTRUCTION LENDING AGENCY C ' I hereby affirm that there is a construction lending agency for the performance of the work for which this Permit' Is Issued (Section 3097 Civ. C.), Undo"S Name Gas Service Outlets ' Interceptors ,. Kitchen Sink I Lender's Address OWNER BUILDER DECLARATION _ I hereby affirm that I am exempt from the Contractor's License Law for the* fallowing reason.(Sectlon 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its 'issuance, also requires the applicant for such Wrnit to file a signed Statement that he/she is licensed pursuant to the provisions of III e Contractor's License; Law (Chapter 9 (commencing with Section "7000) of Oiv[s],n 3 of the Business and. Professions' Code) Or, that he she Is exempt therefrom and the basis for the alleged exemption. Any viola Ion of Section '031.5 by any applicant for a permit- subjects the applicant to a- civil enalty of not- more than five hundred dollars ($500). •� I, as owner of the property or my employees with wages as their solo compensation, will do the work; and the structure Is not Intended or offered for sale '(Section 7044; Business and Professional Code: The Contractor's Lavatories P—Trap Roof Drains Fan 1 ' Reinspection Fee F.A.U. E - License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himsoif/herself or through his or her own I employees, provided that such Improvementsare not Intended or offered for sale. It, however, the building or improvement Is sold within one year of com- pletion, the owner ,will have the burden of proving he/she did not build or Im- prove for the purpose o1 sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors W construct the project (Section 7044, Business and Professions Code - The Contractor's License Law does not apply to an owner of property who builds or, Improves thereon, and _who contracts for Such projects with -a con- traC[er(s) license pursuant *toContractor's License Law). I am aware that proof o • their Worker's Compensation Insurance should be provided to me. Automatic Washer * Construction Pole Sub. I Boiler Cooking Unit , , Duct - Under Ground, t Dishwasher Duct -Structural Dryers ❑Gas ❑Electric Duct - Ventilating ' Fan Exhaust System ❑ Multiple ❑ F.A.U. E Fir epl/Fact, Bit. ICBO ❑ I am exempt under Section B. & P. C. for this reason Date Owner ' I I hereby, certify that-i`have read thls IiCation and slate that the above -` ,information is,correct. I'agree to com Ith all city and County ordinances relng to bull c Str ction, and hereby authorize repre- and state' I ati sontatives f this city to ter n he above-mentioned pro rty for 1 Inspectlon Signature Date< Drivers' LIc se or SS # r' j L:' vHfeating System & Ducting 90-106,000 BTU ❑Iwoo0BTi Outlets + Switches Reinspection Fee $15 GMF 0865-46, rev. 10/84 White - Building; Canary • Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers' Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays e MECHANICAL' Hood or Canopy issue Fere $ 3 • FEES Type I ' ❑ Type II ❑ Refrigeration System ❑o-100,000 BTu E1100,000BTU System Repair/Alteration Fire Dampers ' Registers r • E s Issue Fee $ 3 ' 3559 12/mB4 zone Accessory Building: Parking RecidProvided I1}o!3 TL ELECTRICAL FEES Automatic Washer * Construction Pole Sub. -Transformer' C1 15-50 KW' "- ❑ 50 + KW Cooking Unit , Meter ❑up to 100 amps Dishwasher Meter ❑aver 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors ❑0-1 HP 01 A - B F.A.U. E Inc. Solar ❑9.15 HP 016-15+ Fixtures `I Microwave Device Boxes I Pole Light , Outlets Range Switches Sign Garbage Disposal ' ;Standing Sections Generator 00.5 KW 05-15 KW Trash Compactor PLAN CHECK $ Z O N I N G R E O M T S Reinspection�Reinspection Fee�$15��Issue Fee $ 3�Feee 33 DEVELOPMENT SERVICES'REOUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Data Z SUMMARY OF FEES + BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ i ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. `$ ELECTRICAL 1 1$ GRADING $ PLAN CHECK 50% $ I MICROFILM $ MECHANICALlaq,G TOTAL FEE $ PLAN CHECK 2596 $s } Z1 , (� 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL b, -,,A APPROVALS Permit # Date Inspector '1. Temporary Electrical Service or Pale 52. Pool & Equipment Location f°-�� ,_-•. 2. Soil•Pipe-Undrgrnd. ` 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4• Electrical Conduit-Undrgrnd. r 55. Electrical Bonding 5. Steel Reinforcement,, 56. Rough Plumbing & Pressure Test f 6. Electrical UFER�Grnd. 57. APPROVAL TO COVER-GUNITE , 7. Footings ' 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑Undrgrnd., Test 9. Water Pipe Undrgrnd. 60, Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line;& House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final . 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final -16. Rough ElectricWiring- 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 APPROVALS Permit # , ;20.eRough Factory Fireplace 21. Ducts, in Structure, 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank D Gas D Oil :'25. Roof Sheathing 74. Overhead Hydro 26, T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29, Insulation 78. FIRE PREY..FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79, FINAL-INSPECTION 32. Electrical Power Meter-Final 80. FOOD'-CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning J•7 ",I) 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39, Water Service-Final• 40. Gas Service-Final 41, Solar Domestic-Final 42. Backflow Preventer. 43, Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap*Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date - CITY OF COSTA MESA— /3 7 Q p3 CONSTRUCTION PERMIT t r� Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. 11096 LO Project Address 7-11 W - 17th Street TYPE OF CONSTRUCTION U NEw U ADD Q&1 ALTERATION LJ REPAIR Sewer Connection Applicant's Mailing Address..2 4 18 MacArthur Blvd. , C._D M. ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A. P. 240 _Q T Owner's Name Tr.Qy inyestMent FundPhone 549-298E DESCRIPTION OFWORK F.xtPrinr AltPrationg— Trash Enclosure S Main Building: Address' 4321 Birch Street, Newport -Beach_ TYPE OFPERMIT GRADING FOUNDATION STRUCTURAL T Front Arch/Eng, Wm _ T. - , Pe re irA AS SQC!ioense No. ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Solar Piping Address 2418 MacA thug Blvd. , Carona del_ M r' ❑,OTHER A Rear Solar Tank C Right Contractor's Nam hone PROJECT DESCRIPTION SQ. FT. OCCUPANCY ❑ 1 am exempt under Section B. b P. C. for this reason Dryers []Gass ❑Electric Address (mailing) CONSTRUCTION TYPI; VALUATION $ 800-00 S Left City License No. ZONE GRADING CU.YDS. ACRES PiRef.9 ng, _ ZZ �( LICENSED CONTRACTOR DE LARATION Remarks: P.C. #20r84S Parking Req./Provided I hereby affirm that I am licensed under provisions of Charter 9 (commencing Gas Service Outlets Water Closet with section 7000) of Division 3 of the Business and Professions Code, and F, A. U, Use of Building: my license Is In full force and effect. PLAN CHECK 25% $ ENERGY P.C. License Class License No. PLUMBING FEES Planning Notes: Date Signature Bar Sink Showers Fixtures WORKERS' COMPENSATION DECLARATION Informatlon Is correct. I agree to amply with all city and county or hereby I hereby affirm that I have a certificate of consent to self -Insure or a certificate Backflow Preventer Service Sink Lender's Name ^f Workers' Compensation Insurance, or a certified copy thereof (Section Water Service and state laws relating to building construction, and authorize repre- 10, Lab. C.) Backflow Irrigation Sewer Cap Lavatories Icy No. 52420001683Company Arggnau't _ PLAN CHECK 50% Outlets 0117 5/I0/8t, leen Zone Accessory Building: 2 :3198Ir Park.Fees $ r" i ELECTRICAL ' I I FEES L..i Certified copy Is hereby furnished. Bathtubs Sewer Connection ❑0100000BTU 0100,000BTU Automatic Washer LLJ� Certified copy Is filed with the city Building Division. tractors t+5 Construct the project (Section 7044, Business and Professions Coder The Contractor's License Law does not apply to an owner of property who Duct - Ventilating g ,to Applicant Clarifiers Solar Collectors SUMMARY F FEES L�' Construction Pole Sub. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be Completed if the permit is for one hundred (5100) or Dishwasher Solar Piping Cooking Unit fess). I certify that In the performance of the work for which this permit is Issued I In become subject to the Drinking Fountains g Solar Tank Dishwasher shall not employ any person any manner so as Worke a on Laws of Caiit n ers Floor Drains Swimming Pool w/Spa ❑ 1 am exempt under Section B. b P. C. for this reason Dryers []Gass ❑Electric Date Signature NOTICE- If,iaf er making this doclarat n, you should become subject to the Floor Sinks Urinal Fan Workers' Compensation provisions the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Gas Service Outlets Water Closet - F, A. U, CONSTRUCTION LENDING AGENCY ' PLAN CHECK 25% $ ENERGY P.C. I hereby certify that 'I nava tea his application and state that the above I hereby affirm that there Is a construction lending agency for the performance Interceptors Water Heater Fixtures of the work for which this permit Is Issued (Section 3097 Clv: C.) Informatlon Is correct. I agree to amply with all city and county or hereby Lender's Name Kitchen Sink Water Service and state laws relating to building construction, and authorize repre- Device Boxes Lender's Address OWNER BUILDER DECLARATION Lavatories PLAN CHECK 50% Outlets I hereby affirm that I am exempt from the Contractor's License Law for the p_Tra following reason (Section 7031.5 Business and Professional Code: Any city or p Inspection p rposes. # Switches county which requires a permit to construct, alter improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit Roof Drains MECHANICAL .$ TOTAL FEE Garbage Disposal to fiie a signed statement that he/she Is licensed pursuant to the provisions of Reinspection Fee $25 Issue Fee $ 3 the Contractor's License Law (Chapter 9 (commencing with Section 7000) of $ Drivers' 1_�;iilnse or SS gh Generator 1:10.5 KW 05.15 KW 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 Goldenrod -Assessor —n31.5 by any applicant for a permit subjects the applicant to a civil Reinspection Fee $25 Issue Fee $ 3 alty of not more than five hundred dollars ($500). 1 !, a3 owner of the property or my employees with wages as their sole MECHANICAL Reinspection Fee "Ompensation will d0 the work, and the structure is not intentled or olfered FEES Transformer ❑ 15.50 KW ❑ 50 + kW Meter ❑up to 100 amps Meter ❑over 100 amps; Sub Panel Motors❑0.1 HP ❑1)S - B Inc. Soler'09-15 HP 016-15+ Microwave Pole Light Range Standing Sections Trash Compactor $25 I Issue Fee for sale (Sect'lon 7044, Buslnass and Professional Code: The Contractor's PUBLIC SERVICES REQUIREMENTS: Lice Law does not apply to an owner Of a property who builds or Improves Boiler Hood Or Type I ❑ thereon, antl 'who does such work in or through ds or her own Zoning Approved By employees, provided that such imgrpvements are not intentled or offered for Duct =Under Ground Canopy Type II ❑ sal 1. If however, the building or Improvement Is sold within ono ycar'0 com- - I BuildinglApproved By plotlpn, the ownar will have the burden of proving he/she did not build or Im- rove for the purpose of sale). Duct - Structural Refrigeration System Application Issued By I, as owner Of the property, am exclusively contracting with licensed con- ❑0100000BTU 0100,000BTU tractors t+5 Construct the project (Section 7044, Business and Professions Coder The Contractor's License Law does not apply to an owner of property who Duct - Ventilating g SUMMARY F FEES L�' builds or Improves thereon, and who contracts for such projects with a con- Exhaust System ❑ Multiple ❑ System RepaWAlteretion BUILDING PERMIT $ SMIP tractors) license pursuant to the Contractor's License Law). PLAN CHECK $ PERMIT ❑ 1 am exempt under Section B. b P. C. for this reason Firepl/Fact. Bit. ICBO 91E PLUMBING $ ISSUANCE bate Owner Heating System & Ducting PLAN CHECK 25% $ ENERGY P.C. I hereby certify that 'I nava tea his application and state that the above El 0-100,000 BTU 0100,000 BT I ELECTRICAL $ GRADING Informatlon Is correct. I agree to amply with all city and county or hereby and state laws relating to building construction, and authorize repre- , PLAN CHECK 50% $ MICROFILM sentatives of this city enter upon the above-mentioned property for Inspection p rposes. # MECHANICAL .$ TOTAL FEE Signature Date Reinspection Fee $25 Issue Fee $ 3 PLAN CHECK 25% $ Drivers' 1_�;iilnse or SS gh CMF 0865.46 rev. 12/83 white - Building; Canary - Applicant; Pink - Accounting; Goldenrod -Assessor Z 0 N I N G R E Q U I R E E N T CONSTRUCTION AND PLANNING ' -APPROVALS Permit # Date Inspector P001 & : - - ' ' APPROVALS Permit- # - r- r � - Date � c Inspector I.- Temporary Electrical Service or Pole 52. Pool & Equipment Locationa �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 y 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER•GUNITEr 7. Footings �y s. 58. Electrical Conduit-Undrgrnd: _ 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, C1 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 r 13. Roof Drains 64. Plumbing" System - Final - 14. Rough Plumbing 65. Electrical -Final f 15. Rough Electrical -Conduit -` 66. Solar System-FinaE 16. Rough Electric Wiring 67. Fencing& Access Appjoval- 17. Rough Wiring Sign 68. APPROVED EOR PLASTERING .1 8, Rough Electrical -T Bar -Ceiling 69.' POOLISPA SYSTEMS FINAL s - T. 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # ' _ 20. Rough Factory Fireplace 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 ❑ Gas D'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 PR EV, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test { 36. Hood or Canopy 37, Final Factory Fireplace - 38. Final Plumbing' . 39. Water Service -Final ' 40. Ga's Service -Final 41. Solar- Domestic-Pinai - 42, Backflow Preventer + ' 43. Backffow Irrigation 44, Landscape Irrigation System - 45. Sound Attenuation 46, Handicap Regulations . T 47. FINAL STRUCTURE & BUILDING t 48. Special Requirements Completed t , a 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co y 51, CERTIFICATE OF OCCUPANCY No Date - - - w Applicant to fill in all spaces except those within heavy border line% and sign all appropriate declarations. CIW OF COSTA MESA CONSTRUCTION PERMIT sf r71 PERMIT NO, f TRACT NO. LOT NO. UNIT IVO, Project Address TM S -1! Applicant's Mailing Address Owner's Name , E Phaqe Address. .S Arch/Eng, icense No, U - Address Contractor's Nam P one Address ( mailingl E City License No. LICENSED CONTRACTOR DECLARATION 1 -hereby affirm that I am licensed under provisions of Charter 9 (commencing With section 7000) of Division 3 of the (3uslness and Professions Code, and my license is in II force and effect, , License Clas License No Date Signature WORKERS' COMPENSATION DECL ATION 1 hereby affirm that I have a certificate of consent to salt -insure or a certificate of wdrkers' Compensation insurance, or a certified copy thereof (Section 3900, Lab. C-} d` S�iE� r olicy No. - 509370 Company Certified copy is hereby furnished. Cert--f.{etlFopWlVilod with the city Btri•1 vis' Date- /d `/n'`�s Y Applicant EXEMPTION FROM WORKERS' COMP SATION DECLA ATION (This section need not -be compieted If the permit is for one hundred (3100) or lesg)- 0 I certify that in the performance of the work for,whlch this permit is Issued, I sha)) not employ any parson in any manner so"as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: It, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit 'shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or County which requires a permit to construct, alter, Improve, demolish or repair any Structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provision$ of the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation 'of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Enalty of not more than five hundred dollars ($500). I, as owner of the property or my .employees with wages as their Sole ,ompensation, will do the work, and the structure is not intended or offered for sale (Section •7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale, If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden Of proving he/she did not build or Im- prove for the purpose of sale), 0 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who -contracts for such projects witn a con- tractar(s) license pursuant"ta'the CantraCtor'$ License Law), I am aware that pilroof of their Worker's Compensation Insurance should be provided to me. L,I 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building Construction, and hereby authorize repre- sentaflves of :this city to enter uponabovo-mentioned property for Inspection p Signature Date Drivers' Llcens or SS :f TYPE OF CONSTRUCTION L -I NEW L -J ADD- LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER rE - 46 DESCRIPTIDN OF WORK/USE OF BLDG. Main Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL Front - ❑ TENANT ❑ ELECTRICAL -❑ PLUMBING ❑ MECHANICAL B Rear ❑ -OTHER A PROJECT DESCRIPTION 5Q. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU. YD5. ACRES Ping. Ref. = ' Remarks: [ In P4 Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation I Bathtubs Clarifiers Drinking Fountains Floor Drains ' Floor Sinks Gas Service Outlets Interceptors Kitchen Sink P -Trap Roof Drains Reinspection :Fee $15 Boiler Duct - Under Ground ` Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit, ICBG Heating System & Ducting ❑ o-10%000 B T U ❑ 100,000 BTi Reinspection Fee I $15 CMF 0865-46, rev, 10/84 white - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 3736 12/10/84 I Zone ' Accessory Building: Parking RegJProvided 15.J? TL Z O N 1 N G R E Q M T S issue Fee ? 3 ' C PLUMBING FEES ELECTRICAL FEES Showers Service Sink Automatic Waih&' Construction Pole Sub. Transformer ❑ 15-50 KW El 501+ KW Sewer Cap " Sewer Connection f' Cooking Unit - Meter ❑up to 100 amps { Solar Collectors r Dishwasher Meter Cover 100 amps ' S'�a Solar Piping t Dryers ❑Gas ❑Electric Sub Panel Registers Solar Tank Fan Motors 00.1 HP ❑ 11/. - 8 Swimming Pool vv/Spa F.A.U. Inc.Solar ❑9.15 HP 1:116.15+ z Urinal - - - Fixtures - Microvvai a Water Closet Device Boxes 'Pole Light Water Heater Outlets Range Water Service Switches Sign Auto -Wash Garbage Disposal ; Standing Sections , Laundry Trays Generator 00.5 KW 05.15 KW Trash Compactor Z O N 1 N G R E Q M T S issue Fee ? 3 Reinspection Fee $15 Issue Fee $ 3' -IANICAL FEES Hood or Type 1 - ❑ Canopy Type ll' ElZoning DEVELOPMENT SERVICES Approved 8y Building Approved By Application Issued By. REQUIREMENTS: Date fate Dat { Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU SUMMARY OF FEES BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25%' $ ELECTRICAL $ 11 •oo PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25%' $ SMIP $ PERMIT 1 ISSUANCE $ ENERGY P.C. $ GRADING $ MICRDFILM $ TOTALFEE $ ' S'�a System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 {� CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & :.... APPROVALS Permit # Date Insprcrnr . 1. Temporary Electrical Service or Poie 52. Pool &Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3,•Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5: Steel Reinforcement 56. Rough Plumbing & Pressure Test ' 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE Footings 5B. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash &Receptor -Fina! 12. Sewer Cap 63. Heater & Vent -Final t1,3. 'Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15, Rough ElectricakConduit 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 j �. Notes: 34, Final Heating & Air Conditioning 1 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42, Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING ; 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY . No. Date 3 11A1u 011 COSTA MESA BUILDING-SAFETY DEPARTMENT P,Q. BQX 7200 COSTA MESA, CALIFORNIA 92626 APLIATION FOR BUILDING PERMIT For Applicant to Fill in Completely R E ED Y DATE RECEIVED p TE IS UED BUILDING r '''' tt] r ADDRESS IAV hJL TN OWNER A.P. NO. • MALL - J ADDREBUILDINS�� `f`+ _ ADDRESS fJPC.v CITY v f/V� (/ NO. �� TRACT TRACT�p5 LO BLOCK CONSTRUCTION C- Sv/Ko W ADD LENDER* BRANCH r*;<174 AW OWNER IJ ADDRESS �� (-Yl'S VALUE ARCHITECT TET. S $ OR ENGINEER N Y - p /� y ADDRESS p 33 Del&/L P/C!� y'�� FIRE � ZONE TYPE � GROUP _ / CONTRACTOR 2� Y wv, /�'r%NQ `�s1 %Z APPROV BY DATE , ADDRESS, TEL _, ZONE ZONE NO. OF USE OF NEW/,DZ&5Ty CITY /�iyf/t/�- Z PLANS BUILDING 43 STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO, LIC. NO, MAIN BUILDING ACCESSORY BUILDING SIZE ,Q� y� NO. OF BLDGa (FROM C/L TR ET) OF LOT / V ` /� L� S NOW ON LOT FRONT FT. h, FT, USE O�F��+ .rJ'�JLi� ++�/Vf%✓S'i�=rte / C !�` v. &Mr.BLDG. ilL -' SL" � FT SIZE OF ZOe7 NO. OF 12-61L(/5 X L �f NEW BLDG. ROOMS TORIES L. SI FT. FT. EXTERIOR WALL//�� Co �' ROOF �yy� P COVERING COVERING6M REAR T. a FT. US QF W4JLDING AND WOR TO BE PERFORMED, w DISTANCE BET. BET. MAIN & M FFG oo D G MAIN BLDGS. ACCESS. BLDGS. VAR. # DATE C.U.P. APPROVED / APPROVE / PG- - MOLD FM 5P I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shell not employ 27 any person in violation of the workman's compensation laws of T/U( the State of California, m o I hereby certify that I am properly licensed as a contractor under SQ. FT, the State of California Business and Professions Code, Divisicn 3, THE AMOUNTSHOWN UNDER VALUATION IS FOR Chapter 9, and thpt such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. m am exempt from tl.e provisions of the State of California Business and Professions //D! n 3, C pter 9. VALUATION PERMIT FEE n Signature of Permittee S//A� may/,/ PLAN CHECK $ E Authorized Agent �• TOTAL FEE $ LL Z . Will CL U Z_Q CL In J D J W Q W M J m J Q V cn Z¢ W W CL W —10 M Z J dr W W D= Z � U �° Z Q U_ J CL CL Q O H CAI Z O H U fY Z WE 1 7-741- " OO 694 -t' * *?86.501 ACC -32 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 (CATION FOR BUILDING PERMIT For Applicant to Fill in Completely RE EI BY I DATE RECEIVED L D TE I SUEd BUILDING )' fj�! f ADDRESS / /- PERM T OWNER A.P. NO. MAIL �J j ADDRBUILDESS /II 8' / "" ADDRESS TEL. CITY NO. TRACT LOT BLOCK CONSTRUCTION ADD MQVING LENDER BRANCH OWNER N V ADDRESS VALUE $~� ARCHITECT TEL. OR ENGINEER FIRE ADDRESS ZONE tTYPE MGROUP APPROVE f ' CONTRACTOR BY DATE ADDRESS TE L CITY TE ZONE NO. OF PLANS USE OF NEW BUILDING STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF BLDGS. (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. R. SIDE FT FT SIZE OF NO. OF NEW BLDG. ROOMS STORIES L. SIDE FT. FT. EXTERIOR WALL ROOF COVERING COVERING REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. VAR.* DATE C.U.P. yfa APPROVED APPROVED Ely DATF I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that 1 am properly licensed as a contractor under SQ. FT. THE AMOUNTSHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. am exempt from the provisions of the State of California Business and Professions Cocia. Division 3, Chapter 9. VALUATION PERMIT FEE $ (p Signature of Permittee $ PLAN CHECK $ TOTAL FEE S Authorized Agent / (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 - Eng: BUILDING PERMIT .lob Address: 711 W 17TH ST Status: ISSUED Suite: E Phone: Zip: Applied: 04/11/2005 Vicinity: UNIT E License: Issued: 04/11/2005 Primary Occ: B Eat<501 Office/ Bar<50 Type of Construction: V Parcel Number: TPN02004 Zoning: TEAR OFF EXISTING BUILT-UP ROOFING Applicant: BATIOFF, JOHN ISSUED BY: Address: 17182 ARMSTRONG AVE FEE SUMMARY Plan Check: Phone: 949-260-1900 Calc Valuation: $40,000.00 IRVINE, CA Zip: 92614 Owner: MESA BUSINESS CENTER ASSOCIATION $0.00 Address 711 W 17TH ST SMIP Com: $8.40 Phone: 949-672;9035 COSTA MESA, CA- Zip: 92627 Contractor: \ l DR[ COMMERCIAL Total: $551:65 � ' Address: 17182 ARMSTRONG AVE Phone: 949-260-1900 PLANNING & ZONING I RVI NE„CA SETBACKS Zip: 92614 'License: 818623 Left 0-0 Arch - Eng: Address: Address: Phone: Phone: Zip: License: License: _ SCOPE OF PERMIT TEAR OFF EXISTING BUILT-UP ROOFING & INSTALL NEW BUILT-UP ROOF SYSTEM (UNIT E) - 192 SO. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $40,000.00 Permit: $543.25 - Claim Valuation: $40,000.00 SMIP Res: $0.00 SMIP Com: $8.40 Other: $0.00 Inspection: $0.00 Total: $551:65 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right - 0-10 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right '0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 1546 (WW) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to seti-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: }�� / /� Carrier: �kiV�F� i�1%d��yCl7l��-�Lk Hyl.�}� „(�D. �F !;7>1+�i�j Policy Number.��`t"�f�a �O Z(�Z (This section need not be complefed if the permit isval�one hundred dollars ($100) or fess.) ❑ 1 certify that in the performance of the work for which this permit Is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califo is, and agree that If hould became subject to the workers' compensation provisions of Section 3700 of the Lebor Code, I shall forthwith alply-with.thase provision ApPGcant'Sfgnature: WARNIM: FAILURE TO SECURE WORKERS' COMPFNSATI COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARti ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that 1 am license der provisions of Chapter 9 {commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. # Cla55 # C. re 6F prnanature: r a A `— CONSTRUCTION I -ENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Seo. 3097, Civil Code). Lender's Name: Lender's Address: Signature: _ Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to Construct, after, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year 01 Completion, the owner -builder will have the burden of proving that he or she did not build or improva for purpose of safe.). ❑ I, as owner o1 the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Lew does not appty to an owner of properly who builds Or Improves thereon, and who Contracts for such project with a c0n1raC10T(s) license pursuant 10 the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: _ Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ N0 Drivers License No. Expires: Verification of Ownership by (type 0f document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone t0 do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION.- 1 ERTIFICATION:1 Will the applicant or present or future building occupant need to fila and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Califomia Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity 0f hazardous materials equal to or greater than a weight of 500 pounds, 0r a volume of 55 gallons, or 200 cubic toot of compressed gas at standard temperature and pressure). -..........._.__......................:._...............................-......--__................................ _.................... ....�................ ._......................................---........................... ........ - ....--.._.........._—__ ....... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Cade, with some exceptions, requires registration with the Costa Mese Fire Department by each business which a1 any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .............................:................................................................................................................................................................................... ................................................................................................................................ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Calitomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ...................................................................................................................................................................................................................................................................................................................................................................................... 4 it an RMPP is presently required, has Section 25534 of the California Health and Safety Coda been fully complied with? ❑ Yas ❑ No _ .......... .......—.... ....... ---=- - -._............................ ----- .................. __--..... .........- ................ - ................... ..-_.._.................... ----................. ................. 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication a ermit for such Construction or modification from the South Coast Air Ouafity Management District or from any other air pollution control district or agency? Yes No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). ............... .............. ............................................................................................................. -.-... --------------.........................................-•----------------........................................................................................................................................ 6 Will any part of the facility to be constructed under this permit be within 1000 feel from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 0f the California Health and Safety Code). ......................................................• .....---------.............................................................................. ........................................... .......................................... ,.............................................................. ......-'.................................................. 7 If a permit from the South Coast Air Ouelity Management District or other air pollution control district or agency Is required for the work which is the subject of this application, have all o1 the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ......................................................................................................................................................................................... ................................................ .....-.................................................................. ..................................................... 8 pf "yes",, attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is Correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penally of perjury that I have read this application and state that the information given is Correct. i agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signet f legal er Dat yips An App4icanl.__:77 ,. Cal!---'r_t CODE 1. INSPECTION TYPE IMMIhLS CODE ✓i INSPECTION TYPE QAIE LNTITIAL9 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final BlocklRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building)Occupancy, �I Applicant to f€II In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA/ 1 COIN, STR`-U7CTION PERMIT PEPPT NO. TRACT r� T/�RAC/T NO. LOT NO. UNIT NO. Project Address - 71 / ilV r /dd / `5+r f Y 7 / />r<L%d Applicant's Mailing Address - S /117 (5, Owner's Na1m�e �P�hone 7s6 I9GOt Address /_ /zed C/f _f 7� Arch/Eng. � ` License No, 9 Address -5-6 �d ; 7 Z& ISA. %'G, ��o� 4 A, Contractor's Name— 19 Z22 Phone Address (mailing) City License No. ^LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class _ License No. ,ADate Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section - 3800, Lab. C) / �Pco,.lacy No. �-U�OSPZS_ Q- Company � /y .( Certified copy is hereby furnished. LJ Certifie C pY i fled with the city Buildi 2QLv"lLiap�,r� Date Applicant EXEMPT N F OM WORKERS' COMPENSATION DECLARATION (This section naled not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. ' Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers; Compensation provisions Of the Labor. Code, you must forthwith - comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name 7 DY Ff/D)s Lender's Address �j32 l rlc. Sr C_K C ___ aA elf OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair -, any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code)orthat he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section '031.5 by any applicant for a permit subjects the applicant to a civil nalty of not more than five hundred dollars (5500). 1, as owner of the properly or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for We. If„however, the building or improvement is sold within one year of com. ; plation„tne owner will have the burden of proving he/She did not build or Im- Irove for the purpose of sale).. , as owner of'the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). 1 am aware that proof of their Worker,'$ Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Data Owner 1 hereby certify tnat I have read this application and State that the above information is correct. I agree to comply with all City and county ordinances and state laws relating to bu€Wing cons uctfon, and hereby authorize repre- sentatives of this city to nter up h ove-mentioned pro rty for inspection purposes. X Signature ate Drivers' License or SS ftW ! 6/30/66 6900 TL Ca: - •- -. .. ... TYPE OF CONSTRUCTION ” NEw LJ ADD LJ ALTERATION L_J REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG, A.P. Zone S Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL IS PLUMBING ❑ MECHANICAL ❑ OTHER E T Front - z O B A Rear N I C Right N PROJECT OESCRIPTiON SQ. FT. OCCUPANCY CON STRUCTION TYPE VALUATION $ ZONE GRADING CU.YD5• ACRES S Left G R Ping. Ref. # Parking Req./Provided E Rem r eM O Planning Notes: O PLUMBINk3 FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink r Automatic Washer Construction Pale Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit `r', Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher- Meter Dover 100 amps Dishwasher Solar Piping Dryers ❑Gas .❑Electric Sub Panel Drinking Fountains Solar Tank Fan , ,.n Motors ❑O-1 HP ❑1'r5: g Floor Drains Floor Sinks Swimming Pool w/Spa Urinal F.A.U. Fixtures Inc.Solar ❑9-15 HP 016-15+ Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P -Trop Laundry Trays Generator ❑0-5 KW ©5-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $3 Reinspection Fee $15 Issue Fee S 3 MECHANICAL FEES Boiler ; Hood or Type 1 1:1DEVELOPMENT Canopy Type 11 ❑ SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date ___ �. Dates Duct • Under Ground Duct -Structural Refrigeration System 00-.100,00OBTU ❑100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT S ISSUANCE S $ ENERGY P.C. S S GRADING S S MICROFILM $ $ TOTAL FEE $�..—� $ , — Exhaust System ❑ Multiple 13 System Repair/Alteration Firepl/Fact, Blt. ICBO _ Fire Dampers Heating System & Ducting 00-100,000 BTU ❑100,000 BT Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL r_ APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Poo! & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd, Storage Tank ❑ Gas ❑ Oil 25, Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing��' 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43- Backflow Irrigation r► sr+ 44: Landscape Irrigation System 45: Sound Attenuation 46: Handicap Regulations 474 FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51: CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign ail appropriate declarations. CITY 0'F COSTA MESA CO NS TRUCTIOJERMIT OEW�N�, 1^1 � TRACT NO. LOT NO. UNIT NO. Project Address / Applicant's Mallin Address L Dryers ❑Gas, dDElectric Sub Panel Fan Motors 00.1 HP Ell 'f,-8 TYPE OF CONSTRUCTION NEW ADD ALTERATION ❑ CONVERSION ❑DEMOLISH El OTHER REPAIR Owner's Name ono DESCRIPTION OF WORK/USE OF BLDG. Device Boxes Address Outlets Range Switches Arch/Eng. License No. Address TYPE OF PERMIT In GRADING FOUNDATION El STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL OTHER Contractor's Nam Ph ne VA❑ Generator ❑0-5 KW 05.15 KW Trash Compactor PLAN CHECK CityAddLi ense N g) City License No: f5ai PROJECT DESCRIPTION SQ. FT. OCCUPANCY CON ST RUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR OECLARATION $ CSO ISSUANCE $ Remarks: ' ENERGY P.C. I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and ELECTRICAL $ ' rimy license is in rce and effect. Licen Class license No $ MICROFILM $ MECHANICAL PLUMBING FEES Hate ignature WORKERS' COMPENSATION O RATION I hereby affirm that I have a certif to of consent to self -insure or a certificate Bar Sink Showers Backflow Preventer Service Sink of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, lzb. C.) t Backflow Irrigation Sewer Cep Policy No. Company BCertified copy is hereby furnished. Bathtubs Sewer Connection Certified copy is filed with the city Building Division. , Date Applicant EXEMPTION FROM WORKERS' COMPENSATION OECLARATION Clarifiers Solar Collectors _ (This section need not be completed If the permit is for one hundred ($100) or less): I certify that in the performance of the work for which this permit is issued, I shall- not employ any person in any ye as to become subject to the Work e C ens n Laws of Calif Date +" Signature 'NOTICE: If, ffter ma ling this declar on, you should become subject o the Dishwasher Solar Piping ' - Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa , Floor SiAks Urinal - 2 co Workers' Compensation provisions the Labor Code, you must forthwith comply with such provisions or this permit , shall be deemed revoked. Gas Service 'Outlets L Water Closet _ _ CONSTRUCTION LENDING -AGENCY I hereby affirm that there is a construction lending agency for the performance of the 'work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Interceptors Water Heater Kitchen Sink _ Water Service Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License .Law for the following reason (Section 7031.5 Business and. Professional Code: Any Uty or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for Such permit to file a signed statement that he/she is licensed pursuant to the ProvISIons of the Contractor's License Law (Chapter 9 (commencing with Section 7040) of Olvision 3 of the. Business and Professions Cade) 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 alty of not more than five hundred dollars (E500). YI, as owner of the property or my employees with wages as their solo compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves theroon, and who does such work himself/herself or through his or ner own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com• the owner will have the burden of proving he/she did not build or -lm- prove for the purpose of sale). ❑ I, as owner of the propeity, am exclusively contracting with licensed con- 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 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 proof of their Worker's Compensation insurance should be provided to me. Lavatories Auto -Wash - P—Trap Laundry Trays Roof Drains - - Reinspection Fee $15 Issue Fee $ 3 'MECHANICAL - FEES Boiler Hood or Type I . ❑ Canopy Type 11 C1pletion, , Duct -Under Ground Duct - Structural Refrigeration System ❑0 100,000 BTU 01100,000BTU - Duct - Ventilating Exhaust System C1 Multiple ❑ System Repair/Alteration Firepl/Fact. BIL ICBO # Fire Dampers ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this ci to enter upon the above-mentioned property for inspection p ses Heating System & Ducting ❑0-100,000 BTU ❑100,000 BT Registers Reinspection Fee $15 Issue Fee $ 3 Signature Date •� Drivers' L se 0r SS CMF 0865-46, rev. 10/84 White - Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor A.P. # S Main Building: E T Front A Rear C Right K S Left Ping. Ref. # Planning Notes: 5844 7/02/85 r Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washor . Cdnstruction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit Meter 0 u to 100 amps Dishwasher Meter 0Over 100 amps Dryers ❑Gas, dDElectric Sub Panel Fan Motors 00.1 HP Ell 'f,-8 F.A.U. Inc. Solar El 9-15 HP El 16-15+ Fixtures ' Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal ; Standing Sections Generator ❑0-5 KW 05.15 KW Trash Compactor 10050 FEES Z O N I N G R E Q M T S Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ CSO ISSUANCE $ PLAN CHECK 25% $ • S� ENERGY P.C. $ ' ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ z_ CONSTRUCTION AND PLANNING APPROVALS Permit # r. Date Inspe� r POOL & A APPROVALS Permit # Date Inspector 1-1. Temporary Electrical Service or Po1eo' 52. Pool & Equipment Location �Il /f►� 2. Soil Bipo•Undrgrnd. �-1 n 'i 53. Steel Reinforcement �- �3�ElectniI:Conduit lNtil�y Undrg�rnd:f 54, Forms i 4ttEIectr'ica1 Conduit- drgrnd. 55. Electrical Bonding is 5:.SteeleRe nforcern t, `� 'f 56. Rough Plumbing & Pressure Test �) fl 6 6062 :1 UFER-6rnd+ ' �% 57, APPROVAL TO COVER-GUNITE 7. FoO_t g1 �� A: l 58. Electrical Conduit-Undrgrnd. C` 8. FouncEation it 1,40-« 59. Gas Pipe, ❑ Undrgrnd., Test I{{ 9.;OWtate��Pipe•UndrVrid: y '� 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10�Structugl Floor System f� 61. APPROVAL TO DECK r 1i. Propert�`Sewer Lin &HouseConnelction + ' 62. Backwash & Receptor -Final 12� ewer-C'ip { "' ? 51 t 63. Heater & Vent -Final 13. lioof Drains V�� { 64. Plumbing System - Final 14 7Roug �Plumbing1 1 (�' 65. Electrical -Final N 15. Rough Electrical'Gonduit §.Q. 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72, Upderground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace f-,38. Final Plumbing '39. Water Service -Final 40. Gas Service -Final r 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 e Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 6P.+ CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 711'W., 17th St. Bldg. (E) Unit 6 Applicant's Mailing Address 13110 SaticoySt. N.H011 O Owner's Name Tr0 Investment Fund hone 549-_ 229 4321 Birch St Newport Beach, Ca. PERMIT �I ' ZJ lfJ TRACT NO. LOT NO. UNIT NO. �i0 ,TYPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR El CONVERSION El DEMOLISH El OTHER 8DESCRIPTION OF WORKIUSE OF BLDG.Address Construction Pole Sub. T A C K g Building: Marin I. ROC1c Arch/Eng. License No. Address 12881 Knott Ave Suite 216 TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING IR MECHANICAL ❑ -OTHER PROJECT DESCRIPTION SQ. FT, OCCUPANCY CONSTRUCTION TYPE .VALUATION $ ZONE GRADING CU.YOS. ACRES Front Rear Contractor-s"ame Duco Air Conditioning phone 982-1216 Address imaiiing) 13110 Saticoy St N.Hollywood, Ca. City License No. 33925 - LICENSED CONTRACTOR DECLARATION � , I herebyaffirmthat I am licensed under previsionsof_Charter 9 (commencing ofessians Code, and my license is in full force and efrf�e with section 7000) of Division 3 of the BusinessO.-C License Class C `v Li 346251Datil. !-1Q 84 SignaturePLUMBING ARATION WORKERS' COMPENSATION D/nce I hereby affirm that I have a certife of consent to self -insure or a certificate of Workers' Compensation Insur or a certified copy thereof (Section Right Left Ping. Ref. # Remarks: - Planning Notes: - ATION Clarifiers FEES workers' Compensation provisions of the Labor Code, you must forthwith Bar Sink Showers (Thissection need not be completed if the permit is for one hundred ($100) or less) Dishwasher 3800, Lab, C.) WC9824 Lumbermans Backflow Preventer Service Srnk this application and state that the above Automatic Washer, Policy No. Company Backflow Irrigation Sewer Cap sentatives of his city tp ter Construction Pole Sub. BCertified copy Is hereby furnished. Signature _ ate Drivers' Licelse or SS :P Certifie opy is filed with the city Buil ahpg pJ,vision. Date Applicant J �+ Bathtubs Sewer Connection " F.A.U. , Y Cooking Unit EXEMPTION FROM WORKERS' COMPENSATION DEC LA - ATION Clarifiers Solar Collectors workers' Compensation provisions of the Labor Code, you must forthwith Dishwasher (Thissection need not be completed if the permit is for one hundred ($100) or less) Dishwasher Solar Piping comply with such provisions or this permit shall be deemed revoked. _ - ,' Dryers ❑Gas ❑Electric I certify that in the performance of the work for which this permit is Issued, I , 1 hereby certify that I have read this application and state that the above information is correct. I agree tn shall not employ any person In any manner so as to become subject to the Drinking Fountains Solar TankFan sentatives of his city tp ter r workers' Compensation Laws of California. Signature _ ate Drivers' Licelse or SS :P Date Signature Floor Drains Swimming Pool w/Spa " F.A.U. 'NOTICE: if, after making this declaration, you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets - water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) interceptors Water Heater Outlets Lender's Name' Lender's Address Kitchen Sink Water Service Switches OWNER BUILDER DECLARATION 1 hereby affirm that 1 am.exempt from the Contractor's License Law fpr the Lavatories Auto -Wash Garbage Disposal following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair P -Trap Trays y 'Laundry- Generator E10-5 KW 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 therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil )enalty of not more than five hundred dollars ($500). $ 3 0 I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's •Id s MECHANICAL FEES Reinspection Fee ce 2262 5/03/85 Accessory Building: Parking Req./Provided ELECTRICAL 15 KW $15 i5e50 TL Zone FEES Transformer ❑ 15-50 KW El50+ KW Meter I~ lup to 100 amps Meter ❑over 100 amps Sub Panel Motors E10-1 HP El1''A - 8 Inc. Solar El 9-15 HP El 16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor Issue Fee License Law does not apply to an owner of a property who bur s or improve thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REOUIREMENTS: employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I ❑ sale. If, however, the building or improvement is sold within one year of corn- Canopy Type I I ❑ Zoning Approved By [ pletlon, the owner will have the burden of proving he/she did not build or im- Duct - Under Ground prove for the purpose of sale). Building Approved By [ ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct - Structural Refrigeration System Application Issued By [ 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 SUMMAR OF FEES builds or improves thereon, and _who contracts for such projects with a con- • - tractor(s) license pursuarit to the Contractor's License Law). I 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 0.1 am exempt under Section B. & P. C. for this reason Firepl/Fact. Bit. ICBO # Fire Dampers ISSUANCE PLUMBING 5 Date Owner 1 hereby certify that I have read this application and state that the above information is correct. I agree tn omply with all city and county ordinances' relg to but r and state I atin construction, and hereby authorize repre- sentatives of his city tp ter upon the above-mentioned property for inspectio our o s. Signature _ ate Drivers' Licelse or SS :P Heating System & Ducting C30-1 00,000 BTU Ell w000 BTI Reinspection Fee I 515 aF 0865-46, rev. 10/84 white - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Registers 61001PLAN CHECK 25% 5 ENERGY P.C. ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ 13. 00 _, TOTAL FEE Issue Fee $ 3 PLAN CHECK 25% $ 2.50 S 3 $ Z O N I N G R E Q M T S CONSTRUCTION AND PLANNING APPROVALS Permit #� Date Inspector POOL a .SPA APPROVALS Permit #� Date Insperrnr 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ." 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Urrdrgrnd. 54. Forms J 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding s 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test r 6• El'ectrical LIFER Grind.. 57. APPROVAL TO COVER-GUNITE d 7. Footings 5B. Electrical Conduif-Undrgrnd, B: Foundation 59. Gas Pipe, D Undrgrnd., Test f. 9. Water Pipe-Undrgrnd. ? 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System ' 61. APPROVAL TO DECK 11. Property Sewer Line & House Conn iectign 62. Backwash & Receptor -Final 12. Sewer Cap r 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 16. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT APPROVALS. Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank D Gas D 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 76. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Piaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioriing 91/71W 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40, Gas.Service-Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison '50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date_ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address j 1 �� 171115L, COSTA 6F,511 Applicant's Mailing Address . Owner's'Name 0 U L)e, Phone Address, Arch/Eng. License No Address _ Contractor's Name mOR�IS - 1E� E� 1� 1 G _Phone E71 - Address (mailing) ) 2ghS l3p.',qfln- e,T, BLCtvn,N670>J____�-3, 16 City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 ofa ess and Professlonj Code, and my ticense'is in fury force 1-7 and eBec . License Class C " f jJ icense No Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation insurance, or a certified copy thereof (Section 3800, Lab. C-) C 3�D a EG Policy No. i�C ) Q!q BCertified copy is hereby furnishe Certitled cvp Is}lied with the cit Bu' i"Ision. Date.__jt_^ Applicant EXEMPTION FROM WORKERS' COMPENSATIOq DECLARATION (This section need not be completed Il'the permit Is/Tor one hundred ($100) or less). I certify that In the performance of thin work for which this permit is Issued I shall not employ any person in any manner so as to become subject to tko Workers" Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation .provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTIO94 LENDING AGENCY - I hereby affirm that there Is a constructlon lending agency for ttie performance of the work for which this permit is issued (Section 3097 Civ, C.) Lender's Name --- Lender's Address OWNER BUILDER DECLARATION , I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is Ilcensed pursuant to the provisions of 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 appilcant to a civil enatty of not more than five hundred dollars ($500). ' ' 1, as owner of the property or my.empioyees with wages as their sole compensation, will do the work, and the structure I$ not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improve$ thereon„and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is Sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor'; License Law does not apply to an owner of property who builds or improves thereon, -and _who contracts for such projects with a con- tractors) ilcense pursuaM'tdthe Contractor's Licensrs Law), I am aware that proof o their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt tinder Section B. & P. C. for this reason Date Owner I hereby certify that I have read' this Information I5 ct. ree to camp and State la rgiat t building n sentatives of this y o enter of inspection p rp Signature Drivers' License or SS rf ation and state that the above i all city and county ordinances Do, and hereby authorize repre- above•mentioned property for Date 1-10- $S gA7A I / I r;/oA /- =n PERMIT NO�. E 11 TRACT NO. LOT NO, UNIT NO, l ivy~ t TYPE OF CONSTRUCTION LJ NEW LJ ADD LA ALTERATION LJ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORKIUSE OF BLDG. REPAIR A.P. # Zone 5 Main Building: Accessory Building: TYPE OF PERMIT LJ GRADING FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ -OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY ' CONSTRUCTION TYPE VALUATION S TONE GRADING CU.YDS. ACRES E T Front Z p 13. A Rear N I C Right N S Left G R Ping. Ref. #Parking Req,/Provided is E Remarks: Planning Notes: O M T PLUMBING FEES ELECTRICAL � FEES Bar Sink Showers Backflow Preventer Service Sink - Automatic Washer ' Construction Pole Sub, Transformer ❑ 15.50 KW 0 50+ KW Backflow Irrigation Sewer Cap ' Bathtubs Sewer Connection -r .+ Cooking Unit Meter ❑up to 100amps Clarifiers Solar Collectors i. Dishwasher Meter Dover 100 amps Dishwasher Solar Piping Dryers ❑,Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan I Motors ja0.1 HP [31 'A - B Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09.15 HP 1:3 16-15+ Floor Sinks IUrinal Fixtures Microwave Gas Service, Outlets Water Closet Device Boxes Pole Light Interceptors Kitchen Sink Lavatories + Water Heater Water Service Auto -Wash Outlets Switches Garbage Disposal Range Sign ;Standing Sections P -Trap Laundry Trays Generator ❑0-5 KW 115-15 KW Trash Compactor Roof Drains Reinspection Fee S15 Issue Fee $ 3 Reinspection Fee $15 issue Fee S 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By date Application Issued By Oate _ Boiler Hood or Type 1 ❑ Canopy Type I I ❑ Duct -Under Ground Duct - Structural ' Refrigeration System 00.100,000 81TU ❑ 10 OW BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMITPLUMBING $ ISSUANCE $ $ ENERGY P.C. •$ $ GRADING $ $ 50 MICROFILM $ $ TOTAL FEE $ _4' $ SO - Exhaust System ❑ Multiple ❑ System Repair/Alteration FirepllFact, Bit. ICBO # Fire Dampers Heating System & Ducting ❑0-100,000 BTU❑14D,0006T Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING r-APPROVALS Permit # Date Inspector POOL & aPA APPROVALS Permit # Date Inspector -'i ., Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53, Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding •5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. 57, APPROVAL TO COVER-GUNITE 7. Footings 58, Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sevyer 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas 0 Oil 23. Gas Pipe-Rough & Test 72, Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas 0 Oif 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical f 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric 1 �_ Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40, Gas. Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project'Address arc l� f7 st Applicant's Mailing Address S Roy-11/0e*$Z '4'ff friA'I�Phone_1f� _-0 Owner's Name - - Address z c PERNO. �� TRACT NO. fSl LOT NO. UNIT NU. 1' TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAI R CONVERSION 1:1 DEMOLISH El OTHER DESCRIPTION OF WORK/USE OF BLDG. TYPE OF PERMIT GRADING C1 FOUNDATION STRUCTURAL El TENANT ❑ ELECTRICAL 9 PLUMBING 1-1MECHANICAL ❑ 'OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CO STRUGTION TYPE VALUATION 5 .J Arch/Eng. !.f/iL1•42r4 /r6'�Q- License No. _C1 -S -2z !._.__ G- Com- Address S� 5-7 (-�%,��f'�I: re �lucl--- -- Contractor's Nam Q Phone Address (mailing) 4l .� r �Cl�! _ City License No. ZONE GRADING CU,YOS. ACRES LICENSED CONTRACTOR DECLARATION i hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. Date Signature, Fixtures Microwave Remarks: PCrirr. 30 r SCC /I , r![ Gr4eeI3 Switches PLUMBING FEES WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate Bar Sink Showers Backflow Preventer Service Sink of workers' Compensation Insurance, or -a certified copy thereof,(Sectlon - 3800, Lab. f/C.) //�� S P ticy No. fL/t�40615_4 Company /J��%utr Certified copy is hereby furnished, LL}} Certified o y s filed with the city Build! Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Date Applicant EXEMPT ON ROM WORKERS' COMPENSATION DECLARATION - (This section nted not be completed if the permit is for one.hundred ($100) or less), I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Data Signature NOTICE: If, after making this declaration, you should become subject to,the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such - provisions or this permit shall be deemed revoked. Clarifiers Solar Collectors - - Dishwasher Solar Piping Drinking Fountains Solar Tank ' Floor Drains Swimming Pool w/Spa Floor Sinks - Urinal Gas Service Outlets "' Water Closet CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for yvblch this permit is issued Section 3097 Cly. C.) Lender's Name Lender's Address 3 interceptors _ Water Heater Kitchen Sink Water Service OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the ContraCt4r's License Law for the following reason (Sectlon 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repa11P—Trap 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 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 1031.5 by any' applicant for a permit Subjects- the applicant to a civll enalty of not more than five hundred dollars ($500). Cl I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is"not Intended or offered forsale (Section 7044, Business and Professional Code: The Contractor's ' License Law,does not apply to an owner of a property who builds or imprdve5 thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for It, however, the building or Improvement is sold within one year of corn- the owner will have the burtlen of proving he/she did not build or im- ' prove for the purpose of sale). - 0 I, as owner of the property, am exclusively contracting with licensed con- 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 L builds or Improves thereon, and who contracts for such projects with a con- tractor(s) license pursuarit to the Contractor's License Law). I am aware that of their Worker's Compensation insurance should be provided to me. Lavatories Auto -Wash ' _ Laundry Trays Roof Drains Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES goiter d Hooor Type I Elsate. Canopy Type I I Elpletlon, Duct - Under Ground - Duct - Structural Refrigeration System ❑0 100,000 BTU C) 100,000 BTU Duct —Ventilating Exhaust System ElMultiple ❑ System Repair/Alteration proof ❑ 1 am exempt under Section B. & P. C. for this reason Firepl/Fact. Bit. ICBO # Fire Dampers Date Owner I hereby certify that I have read this application and state that the above Information is correct. I agree to comply with all City and county ordinances and state laws relating to building construction, and 'hereby authorize repre- h or Sentatives of this city tabove-mentioned pro rty o e r Heating System & Ducting ❑D 100,000 BTU 0100,000 BT Registers , u poses. Inspection purposes. Signature Date Drivers' License or SS Reinspection Fee $15 taus Fee $ 3 GMF 0865.46, rev, 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor A.P. S Main Buiidi E T Front ARear C R ight K S Left Ping. Ref, # Planning Notes: Zone Accessory Building; z O N I i" N G R Parking eR q./Provided E O M T S ELECTRICAL FEES Automatic Washer.. Transformer ❑ 15.50 KW ❑ 50+KW Construction Pole Sub. $15 1 1 Issue Fee, Cooking Unit Meter ❑up to 100 amps Dishwasher Meter- ❑over 100 amps. Dryers ❑Gas DElectric Sub Panel Fan Motors C1 o-1 HP 1:11 i4 - B F.A.U. Inc. Solar 1:19-15 HP 016-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal ! Standing Sections Generator ❑0.5 KW 05-15 KW Trash Compactor Reinspection Fee $15 1 1 Issue Fee, $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By I Date Building Approved By Date Application Issued By U V Dat SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $PERMIT -C) — PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. S ELECTRICAL $ GRADING S ' PLAN CHECK '50% $ MICROFILM $ MECHANICAL S TOTAL FEE $ PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL,- A APPROVALS Permit # Date Inspector 1 . Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10, Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16, Rough Electric Wiring 67. Fencing & Access Approval - 417. 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas ElOil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80.- FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation l 46. Handicap Regulations 47. F,INALSTRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and, sign all appropriate declarations. CITY OF COSTA MESA CONS RUCTIW4 PERMIT Project Address Applicant's Mai i Addresg ) VL Owner's Nam Address !� Arch/Eng. License No. Address (f Contractor's Name ) ph... 7� Address (mailing) D City License No.� LICENSED CONTRACTOR DECLARATION I hereby affirm that i am�licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in f fort nd ffect. Licens Class License No. bate t— ignature n; JnaD 10 WORKERS' COMPENSATION E LARATION I hereby:affirm that I have 8 cern icate of consent to self -Insure or a certificate of Workers' Compensation Insurance,, or a certified copy thereof (Section 3800, Lab. C.) ' Policy No. Company eCertified copy is hereby furnished. ' Certified copy is filed with the city Building Division. Date Appiicant ' EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit Is for one hundred (5100) or less). ' 1 certify that ,in the perforrnance of the work for which this permit is Issued, I shall not employ any person in any manner o as to become subject to the Worke Co 6atl ws of Cahf a. Date Signature ^.��, NOTI E: If, < after ma ng this deciar on, you should become suGe—Crto the Workers' Compensation provisions of the Labor Code, -you must forthwith comply with such provisions_ or this permit shall be deemed revoked. CONSTRUCTION. LENDING 'AGENCY . I hereby affirm that there is a construction iending agency for the performance of the work for which this permit is issued (Section 3097 Civ, C.) Lender's. Name _ Lender's Address DWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and' Professional Code: Any city or county which requires a plrmit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License LSw (Chapter 9 (commencing with Section 7000) of , Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant_ to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the, property or my'employees with wages as thelr sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and. Professional Code: The Contractor's 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 employees, provided that Such improvements are not intended or offered for sale. If, however, the builging or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractw(s) license pursuant'to the Contractor's License Law). I am aware that proof o their Worker's (Zompensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date I hereby certify that information is correct and state laws relatin sentatives of this cil inspection p es. Signature Drivers' LlceAse or SS Owner I hove read this application and -state that the above I agree to comply with all city and county ordinances to building construction, and hereby authorize repre- tq enter - upon the above-mentioned prop e ty.for 9RK7 7inn/lai; PER IT NO. 10 TRACT NO. LOT NO. UNIT NO r� ` f 000U TYPE OF CONSTRUCTION LJ NEW LJ ADD U ALTERATION LJ ❑ CONVERSION ❑ DEMOLISH ❑ OTHERA•p, DESCRIPTION OF WORK/USE OF. BLDG. REPAIR " • Zone S -E Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ •OTHER PROJECT DESCRIPTION 'SQ. FT. OCCUPANCv_. CONSTRUCTION TYPE VALUATIONS ZONE GRADING CU. YDS. AtC�RES - T f=ront Z 0 B A Rear N I C Right N $ Left ' G Ping. Ref. # Parking Req:/Provided E Remarks:) Planning Notes: M T S PLUMBING FEES r ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service, Sink 2 Automatic Washer Construction Pole Sub. Transformer D 15-50 KW U-1 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit _ , Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter El over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors E10-1 HP Dim, .8 Floor Drains Swimming Pool w/Spa F•A.U. Inc. Solar 09-15 HP ❑16-15+ Floor Sinks Urinal - Fixtures Microwave Gas Service Outlets Water Closet Z Device Boxes Pole Light Interceptors Kitchen Sink Water Heater Water ServiceSwitches Outlets Range Sign r Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap _ Laundry Trays Generator 00-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee r $15 Issue Fee S 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Approved By Date Building Approved By Date Application Issued By Dat r Boiier Hood or Type I ❑ anopy Type 11 CEl Duct - Under Ground Duct - Structural Refrigeration Systeri'm = 00-100,000 BTU ❑ 100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY S $ $ $ $ $ $ $ OF FEES SMIP :$ PERMIT Lc?�_ ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ oo TOTAL FEE $ --. — Exhaust System ❑ Multiple ❑ System Repair/Alteration Ffrepi/Fact, Bit. FCBO # Fire Dampers Heating System & Ducting ❑0.100,000BTU ❑100,000BT Registers • Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - ApfSiitant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING. " APPROVALS Permit # _�' � Date Inspector � POOL & �ir'A APPROVALS Permit # Date inspector 1 .,Tempof y Electrical Service or Pole rF 52. Pool & Equipment Location 2. So Pipe�Undrgrnd. (�r� r:J 53. Steel Reinforcement 1 3;'01 ctri6FConduit„Jiility Undrgrnd `f �j 54. Forms S i 4!Electr�c�al;Condui't-(j drgrnd. - �f% F� 55. Electrical Bonding 5�S!& enforcement' •5 56. Rough Plumbing & Pressure Test 6�EIedi iQ UFER�Grnd. ,4-�• n 57. APPROVAL TO COVER-GUNITE ,7?F oting5, ;' �r� y 58. Electrical Conduit-Undrgrnd. 8 Foundation r d ,A 59. Gas Pipe, ❑ Undrgrnd., Test 9� �Wa�e�Fipe-Und gond• i+ 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Struc ur Floor Sy tem y 61. APPROVAL TO DECK ' 11. Property sewer Line & House Connection . t �. 1 � 62. Backwash &Receptor-Final 12. Sewer Cf p h f ! JZvi1 63. Heater & Vent-Final 13. Roof Drains `� f 64. Plumbing System - Final , 14. Rough Plumbing.-i ; <<* -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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas [:]Oil 23. Gas Pipe-Rough & Test 72. Ur Cderground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Fina'I plumbing 39. Water Service-Final a 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. CERTiFICATEOF OCCUPANCY Nn. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA— A13 a PERMIT NO. TRACT NO. LOT NO. BLD . CONSTRUCTION PERMIT / 1109HJ,_- ' 1 & 2 E Project Address 711 W. 17th Street TYPE OF CONSTRUCTION LJ NEW ADD X.X ALTERATION REPAIR Applicant's Mailing Address . 9 A 1 R M a A r t- h n r R 1v -r3 - -r C_ D - M.0 CONVERSION ❑ DEMOLISH ❑ OTHER A. P. 0 ?A— C)C1l _ O� Owner's Name Tr -0 Phone_�d9-9c) 8 DESCRIPTION OF WORK F.Xf'Prinr AliQratiQjas S Main Building: 4��1 Ri rrh�t MPw n�t��. Address ��TYPE OF PERMIT - GRADING FOUNDATION STRUCTURAL r Front � Arch/Eng. Wm - L _ _P -P Y•P i r_ a A G S o Qonse No. 11TENANT ElELECTRICAL ❑PLUMBING ❑MECHANICAL B. Rear Address Mar ❑ BOTHER '° PROJECT DESCRIPTION SQ. FT- OCCUPANCY - C Right Contractor's Nem B-2 hone K Address'(mailing) CONSTRUCTION TYPE VALUATION$ 7S 264 - nfi S Left City License No. ZONE GRADING CU.YDS. ACRES Ping. Ref. # LICENSED CONTRACTOR DECLARATION Remarks:P - 2D -$s Parking Req./Provided 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and Use of Building: my license Is in full force and effect. Planning Notes: License'Class License No. PLUMBING FEES Date ISignature 88r Sink WORKERS' COMPENSATION DECLARATION Backflow Preventer I hereby affirm that I have a certificate of consent to self -Ensure Or a certificate f Workers' Compensation Insurance, or a certified copy thereof (Section .800, Lab. C.) Backflow Irrigation PalEcy No. 52420003 683 Company Argonaut 8 Certified copy is hereby furnished. Bathtubs ` Certlf ed c y is filed with the city ullding Divis an pate Applicant Clarifiers F.XEMfTl6F4 FROM WORKERS' CO ENSATION DECLARATION (Thissection need not be completed IfYfie permit Is for one hundred ($100) or Dishwasher Drinking Fountains less). I certify that in the performance of the work for which this permit Is issued I Shall not employ any person In any manner s0'as to become subject to t6 Workers' Compensatlon Laws of California. Floor Drains Date Signature NOTICE: 1f,lafter making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provislons„ or this permit shall be deemed revoked. Floor Sinks Gas Service Outlets CONSTRUCTION LENDING AGENCY Heating System & Ducting Interceptors I hereby affirm that there Is a construction lending agency for the performance of the 'work for which this permit Is Issued (Section 3097 Civ. C.) Kitchen Sink Lender's Name - - Lender's Address OWNER BUtLDER DECLARATION Lavatories I hereby. affirm that 1 am exempt from the Contractor's License Law for the following reason {Section 7031.5 Business and Professional -Code. Any city or county which requires a permit to construct, alter improve, demolish or repair any structure, prior to its issuance, also requlres toe applicant for such permit P - Trap p Roof Drains 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 Olvlslon 3 of the Business and Professions Code) or that he/she' is exempt ,refrom and the basis for the allegedexemption. Any violation of Section 11.5 by any applicant for a permit subjects the applicant to a civil salty of not more than five hundred dollars ($500). Li I, as' owner of the . property "oi• my employees with wages as their sole tlth t I ti t a d if d Reinspection Fee , Date Dat $25 compensatlon, will do the work, an a strut ure s no n on a or o are for sale, (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to'an owner of a property.who builds or improves Boiler thereon,'and who does such work himself/herself or through his or her own employees, provided that such'Improvements are not intentled or pHeretl for If however, the buliding or improvement Is sold within one com- S-3 pact - Under. Gro sale, year'of pletion, the owner will have the burden of proving he/she did not buIltl or im- rove for the purpose of sale). ; Duct -Structural I, es owner of the property, am exclusively contracting with licensed con- ractars,to construct the project (Sectlon 7044, Business and Protesslons Code- Duct Ventilating The Contractor's Llcartse L-awoes not apply to an owner of property who builds or Improves thereon, and who contracts for Such projects with a con- Exhaust System ❑ Multiple ❑ tractor{s) license pursuant to the Contractor's License Ldw). ❑ I am exempt under Section S. & P. C. for this reason Firepl/Fact. Bit. ICBO Data Owner Heating System & Ducting 1 hereby certify that 1 have rea is apocation•and state that the above ❑0.100,ODOSTU Ell 00,000 ST Informa ion Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city' enter, upon the above-mentioned pr pert for i Inspection u ores. Z Signature Data Reinspection Fee $25 Drivers' [ ense or SS me CMF 0865-45 rev. 12/83 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Soul r Coliectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Issue Fee - Hood or Type D Canopy Type 11 ❑ Refrigeration System 1:10-100,000 BTU ❑106,000'BTU System Repair/Alteration i Issue Fee Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers DGas ❑Electric Fan F.A.U. Fixtures i Device Boxes . Outlets Switches Garbage Disposal 0108 5/10/84 DZone 6. ;Accessory Building: Park,Fees $ ELECTRICAL Transformer D 15-50 KW ❑ 50+KW Meter Cup to 100 amps Meter Dover 100 amps Sub Panel Motors 00.1 HP Dl 54 - 8 Inc. Solar 09-15 HP 016-15+ Microwave Pole Light Range Sign - _Standing Sections Genee rator,.❑0.5 KW 1-35;15 KW Trash Compactor $ 3 364".27 TI Z O N I N G R E O U I R E M E N T FEES Reinspection Fee " ' .1-• $25 Issue Fee - S-3 F FEES PUBLIC'SERVICES REQUIREMENTS' V' VL I G ' 21 Zoning Approved By - Date a Busilding Approved By Application, Issued By Date Dat _ BUILDING PERMIT ' r SUMMARY OR $ " FEES SMIP .$'^ " P,LAN CHECK $'--- PERMIT PLUMBING PLAN CHECK ELECTRICALS PLAN CHECK MECHANICAL $ 25% $ $ 50% $ $ ISSUANCE '$ ENERGY P. -C. ,$ GRADING $ MICROFILM $ TOTAL FEE $ !" $ 3 -PLAN CHECK 25% $ • ' CDNSTRUCTION AND PLANNING POOL i -APPROVALS Permit # Date Inspector APPROVALS y. Permit J Date _ Inspector 1, Temporary Electrical Service or Pale 52. Pool & Equipment Location < ,�r 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- •'' . f 6. Electrical UFER Grnd. 57' APPROVALTO_COVER. NITE ; 7, Footings 58. Electrical Conduit-Undrgrnd.- 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrrtd, 1 i 10. Structural Floor System 61. APPROVAL TO DECK ' 11. Property Sewer Line & House Connection 62, Backwash. &-Receptor-Final - i 12. Sewer Cap 63. Heater& Vent -Final y 4 13. Roof Drains •64. Plumbing System - Final - 14, Rough Plumbing - 65. Electrical -Final - 15. Rough Electrical -Conduit 66. Solar System -Final - `"r - - 16. 'Rough Electric Wiring 67. Fencing& Access Approval' 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18.E Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 919 Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT, APPROVALS Permit # _ = C7. i 20. Rough Factory Fireplace i 21. Ducts, in Structure 70. Underground Hydro ' r « i S 22, Ducts, Ventilating 71 . ' Product Piping P Gas' 0 Oil I r 23. Gas Pipe -Rough & Test 72.+ Underground Flush! 24. r of Framing 73. Undergrnd. Storage Tank.❑;Gas ❑ Oil. l ' 25, oof Sheathing74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical r27. Frame and Flashing !S 76.' Dry Standpipe r 28. Lathing &Siding �5- 77.; FIXED SYSTEM FINIAL _ 29. Insulation 78. FIRE PREY, FINAL. i 30. Drywall Nailing I HEALTH DEPT. REQUIREMENT s 31. Plaster Brown Coat r 79. FINAL INSPECTION i 32. Electrical Power Meter Final 80. FOOD CERTIFICATE ISSUED ,33. Final Electric Notes: /ZZP- 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy.. 37. FinakFactory-Fireplace S M 38. Final P1um4ing 39. Wate•r Service -Final l 40. Gas Service=Final 41. Solar.:Domestic Final j)o "r. Au 5(�►{,1f' ; 42. Backflow Preventer ' 43. Backflow Irrigation �I 1 ti - '--r• +: ' 44, ,Landscape Irrigation System i 45. Sound Attenuation �" I 46, Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed f� 49. Electric Release to Edison I 50. Gas Release to Southern California Gas Co I ' 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PE 17 N TRACT NQ. LOT NO. U IT NO. ' CITY OF COSTA MESA CONSTRUCTION PERMIT CR S� �� T 1z Project Address w ° Applicant's Mailing Address - Sif�L� TYPE OF CONSTRUCTION LJ NSW D ADD U ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 90 Owner's Name � ''�c "'L v Phone 601 DESCRIPTION OF WORKYUSE OF BLDG. "^ Address 3 r✓ S Main Building: Arch/Eng, G/� License No. ZZ L_( TYPE OF PERMIT - GRADING FOUNDATION STRUCTURAL T Front Address S /C. ✓r • ❑ TENANT - ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear ❑ OTHER ll! q Contractor's Nam hone C Right Address (mailing! PROJECT DESCRIPTION SQ. FT.." OCCUPANCY CONSTRUCTION TYPE VALUATION $ S Left City License No. ZONE GRADING CU. YDS, ACRES Ping, Ref. # LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed kinder provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect, License Class License No. Date Signature 'WRKERS' COMPENSATION DECLARATION iereby, affirm that I have a certificate of consent to self4nsure or a certificate jf Workers' Compensation Insuraqce, or a certified copy thereof (Section 3800, lab. Policy No. �`-QOD Gr Tt( 2 - Company _ AIAVee- Certified copy Is hereby furnished. Certified c y is d with the city Building Divisi Date Applicant EXEMPTI N F OM WORKERS' COMPENSATI DECLARATION (This section n d not be completed if the permit Is for one hundred ($100) or less). f I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereoy affirm that there is a construction lending agency for the performance of the c$ work for Lhis a rrllt t�ic Lender's Name �f r ^S:t Ned (Seyt�3 3097 Civ. C.) ! MYND- Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 13uslness and Professional Code: Any city or county which requires a permit t0 construct, alter. Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to filo a signed statement that he/the Is licensed pursuant to the provisions of 10 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 ,nerefrom 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 malty of not more than five hundred dollars ($500). ' 1, as owner of the prOverty kir my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Protessional Code: The Contractor's License Law does not apply t0 an Owner of a property who builds or Improves thereon, and who does such worst himself/hersalf or through his or her own employees, provided that such Improvements are not Intended Or offered for sale, If, however, the building or improvement Is sold within one year of com- platlon, the owner will have the burden of proving he/she did not build or. Im- prove for the purpose of sale). - © I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License taw does not appiy.to an.owner of ,property who builds or Improves thereon, and'who contracts for such projects with a con- tractors) license pursuarit'to the Contractor's License Law), f am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that 1 have read this Information ,s correct, I agree to comp and state laws relating,to buI ng con sentatives of this city t nter upot inspection purposes. / Signature Drivers' License Or 5 )plication and state that the above with all city and county Ordinances uction, and hereby authorize repre- , � boovv)e-mentioned .p/�roppo�r. ty/for lLIL� Date Y��lJ� Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0-100,000 BTU ❑100,00013T Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building: Canary - Applicant: Pink - Accounting; Goldenrod - Assessor D g ABING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service .Auto -Wash Laundry Trays Issue Fee MECHANICAL Hood or Type I ❑ Canopy Typell ❑ Refrigeration System ❑0-100,900 BTU ❑100,900 BTU System Repair/Alteration Fire Dampers Registers Issue Fee Pfannina Notes: FEES 18658 6/38/86 �. e. . Accessory Building: l Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit r+ Dishwasher Dryers ❑Gas '❑Electric Fan /•) F,A.U, ' Fixtures ODevice Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 05-15 KW l 1 $3 Zone Transformer ❑ 15-50 KW ❑ 50 + KW Meter LJup to 100 amps Meter Gover 100 amps - Sub Panel Motors 00-1 HP Ell 'A - 8 Inc. Solar 09:15 HP C3 16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor BAD TL FEES Z O N N G R E a M T S Reinspection Fee $15 issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat SUMMARY OF FEES BUILDING PERMIT $ SMTP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ _ �c Q ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM S p. a MECHANICAL S TOTAL FEE $ $ 3 PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector PO �+ SPA APPROVALS Permit # Date Inspector 1 • Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement; 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd, 8. Foundation 59. Gas Pipe, C] 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 1 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 APPROVALS Permit # 20. 'Rough Factory Fireplace 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 ❑ 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 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 a Notes: 34. Final Heating & Air Conditioning, - 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 3B. Final Plumbing 7/m 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43, Backflow Irrigation j 44. Landscape Irrigation System 45. Sound Attenuation = 46, Handicap Regulations r i 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 CITY OF COSTA MESA C NSTRU TION PERMIT Project Address Applicant's Mailing Address 1" Own$r's Noma 1woG Phone Address .. �,a Z / %3;& , 5).' �i • ' &-4• - o t�C� ArchlEng. ZZ ;!gal J=/M '!A License No. C/ -r 2 Z "l —,/,y Address — ��+_s� �%i.%t_/Irl -L.. �%)• — Contractor's Name Phone Address Imailing}— City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 4 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License NO. bate ._ Signature WORKERS' COMPEN5ATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure or a cortificate of Workers' Compensation Insurance• or a certified copy thereof (Section 3800, tab. C/) policy No. r�OO 6OZ S4 Company AAA e'Ctrtified Copy IS hereby furnished. Certiltc y I I ed with the city Building Division. Date Applicant k�:,, EXEMPT].6N F d OM WORKERS' COMPENSATION DECLARATION (Thissec on n enot be completed if the permit is for one hundred (5100) or less). 1 certify that in the performance of the work for which this permit Is issued, I shall not employ any parson In any manner to as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of.tho Labor Code, you must forthwith comply with Such provisions or this permit $hall be deemed revoked. CONSTRUCTION LENDING AGENCY _ - 1 hereby affirm that there is a construction lending agency for the performance of the work for )vtljCh thi Crmt. is Issued (Sect iprt 0 7 Civ. C.) Lender's Name V Lender's Address Z- s1k. �w C OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to filo a signed statement that he/she is licensed pursuant tp-the provisions of the (Contractor's License Law (Chapter 9(commencing with Section 7000) of Divigion 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 131,5 by any applicant for a permit subjects the applicant to a civil natty of not more than five hundred dollars ($500). ' J I, as owner of the property or my'CMPioyees with wages as their soletere Compensation, will do the work, and the structure is not intended or oi11 for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletion, trio owner will have the burden of proving he/she did not bulld or Im- prOVe for the Purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who. builtis or Improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me.. ❑ i am exempt under Section S. G P. C. for this reason Applicant ti) fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERF No. Y3 g Tit%�T iV� LOT NO. UjVI U, Y �� C v Date Owner I hereby certify that 1 have read this application and state that the above information is correct, I agree to comply with all city and County ordinances and state laws relating to building con ruCtldn, and hereby authorize rebre- sent$tives of this City t artier u en t hove -mentioned pr p fly r insp9ction purposes. Signature Date Drivers' License or $S - TYPE OFCONSTRUCTION NEW 1 ADD AN REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P. + DESCRIPTION OF WORK/USE OF BLDG. 5 Main Builth TYPE OF PERMIT GRACING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL J9 PLUMBING ❑ MECHANICAL B Rear O .OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping, Ref. mili, Remarks: "�L # A/ 3o 9L/ Planning Notes: 8556 6%3�/B6 Mo tL Zone - Accessory Building;' • Parking Req,/Provided. Z O N I • N G R E Q M T, S V v PLUMBING t FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Cooking Unit ' r Transformer ❑ 15-50 KW ❑ 50 + KW Meter ❑up to 100 amps Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors _ SUMMARY OF FEES BUILDING PERMIT $ SMIP $ Dishwesl ger — Meter ❑over 100 amps Dishwasher Drinking Fountains Solar Piping Solar Tank PLAN CHECK $ PERMIT ` PLUMBING$ � ISSUANCE $ Dryers ❑Gas ❑Electric Fan Sub Panel Motors 1:10.1 HP 1:11 r4 B Fjoor Drains Swimming Pool W/Spa• F. A. U. fnc.Solar 1:19.15 HP 016-15+ Floor Sinks Urinal Fixtures • Device Boxes Microwave Pole Light Gas Service Outlets Water Closet Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto-Wash Garbage Disposal Standing Sections P—Trap Laundry Trays Generator 00.5 KW 05.15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee — $ 3 Reinspection Fee $15 Issue Fee $ 3 . MECHANICAL FEES Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 1:10. 100,000 BTU ❑ 100,000 BT Reinspection Fee I $15 CMF 0865.46, rev. 10184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type ❑ Canopy Typell ❑ Refrigeration System 130.100,000 BTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee DEVELOPMENT SERVICES REQUIREMENTS. , Zoning Approved By Date Building Approved By Date Application Issued By __.,_ _ _ _ -_Dat _ SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT ` PLUMBING$ � ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE S L $ 3 PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL, A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58, Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64, Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43z Backflow Irrigation 4,4.2 Landscape Irrigation System 450 Sound Attenuation 46.'' Handicap Regulations 47z�, FINAL STRUCTURE & BUI LDiNG 48. Special Requirements Completed 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51� CERTIFICATE OF OCCUPANCY No. Date I? _. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MES_ CONSTFi CTI-O� PERMIT PERM? O. TRACT NO. LOT NO. UNIT N . Z� Project AcWrems _ _ LSU/_ _ _��7-s Data N I N Applicant's Mailing rS �rrf TYPE OF CONSTRUCTION NEW AOD ALTERATION REPAIR El ❑ ❑ OTHER R Parking Req./Provided dAddress Owner's Name rl v , r/VUG— '� `f %� Phone 7�G �( CONVERSION OEMOLISH q p 90 y.32 f 3�' A---C_A DESCRIPTION OF WORK/USE OF BLDG. 5 Main Buildi Address ,� I Transformer El 15-50 KW 4_� PLAN CHECK 25% ❑ 50+ Kw Arch/Eng. ' AM J__1 CrC"114,License No. ,C/5Z 2 `i TYPE OF PERMIT GRADING�f FOUNDATION STRUCTURAL T Front sb-s% lied TENANT ELECTRICAL 4 PLUMBING ❑ MECHANICAL F-1ElI $ MECHANICAL Address — 'f-3n,`C /.S ❑ A Rear Contractor's Nam Phone ,OTHER C Right / PROJECT DESCRIPTION SO. FT. OCCUPANCY K Address (mailing) J� /l/ G7�+� _ _ - __ — P` CONSTRUCTION TYPE VALUATION $ 5 Left City License No. - - -- - — ZONE GRADING CU. YOS. ACRES914- Ping. Ref. 5j� ' LICENSED CONTRACTOR LICENSED DECLARATION i hereby affirm that f am licens@d under provisions of Charter 9 (commencing L Remarks: �� / (] 1 Planning Noes: with section 7000) of Division 3 of the Business and Professions Code, and a. ----- my license is in full force and effect. - License Class_ License No. Date •Signaturq' WORKERS' COMPENSATION 4ECLARATION 1 hereby affirm that 1 have a certificate of consent to self -insure or a certificate of Workers'- Compensation 'Insyrance, or a certified copy thereof (Section - 3800, Lab. C.) Policy No. CUL100 4 Company EA✓� 1i/ Certified copy is hereby furnished. Certifi p y fled with the city Building Oivision. Date Applicant EXEMPT N FROM WORKERS, COMPENSATION ECLARATION - (This sec on need not be completed if the permit is for one hundred ($100) or less). 1 certify that in the performance of the work for which this permit Is issued I shall not employ any person in any manner so as to become subject to toe Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provlsigns of the Labor Code, you must forthwith' - comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there Is a cohstruction lending agency for the performance of the work for h this permit -is issued {Sect on 3097 Clv_, C.) Lender's Name s w e, Lender's Address !/ } Z/ -- %y• r'< .S r _ -�-X00/F_A[c OWNER BUILDER UECLARArI0N - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its Issuahce, also requires the applicant for such Permit to file a signed statement that he/she Is ilcensod pursuant to the provisions of 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 thh alleged exemption. Any violation of Section 131,5 by any applicant for a permit subjects the applicant to a civil jnalty of not more than five hhndred dollars ($500).' ' I, as owner of the Properly or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale {Section 7044, Business and Professional Code: The Contractor's License Law does not apply to do owner of a property who builds or improves thereon, and who does such work himself/herself or through his Or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). © I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the protect {Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who. buildsor improves thereon, and who contracts for such projects with a con. tractors} license pursuant -t0 the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me.- ❑ I' am exempt under Section B. & P. C. for this reason Date Owner — I hereby certify that 1 have r@ad this Information is correct. I agree to comp and statelaws relating to building co sentatives of, this city to nter up i Inspection purposes. Signature Dryers' License or 55 If iplicatlon and state that the above with all city and county ordinances uction, and ,hereby authorize repre- MC above-mentioned propyfty for f 0 Bar Sink Backflow Preventer Backflow Irrigation Bathtubs i Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks , Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains PLUMBRVG Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal ' 2 Water Closet Water Heater Water Service Auto -Wash Laundry Trays Reinspection Fee $15 M Boiler Duct • Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ F irepl/Fact. Bit. I CBO # Heating System & Ducting ❑0.1 o0,o60 BTO ❑ i oo•o6o BT Reinspection Fee 1 $15 ' CMF 0865-46, rev, 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee - Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System 00.100,000 BTU, ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES S 3 FEES S 3 Automatic Washer Construction Pole Sub. Cooking Unit ^ Dishwasher Dryers ❑Gas ❑Electric 8555 6/30/86 6.130 iL Zone Zoning Approved By Accessory Building: Date Z� D Data N I N Dat G SUMMARY OF FEES R Parking Req./Provided E $ 0. S M T 5 ELECTRICAL S=EES Transformer El 15-50 KW 4_� PLAN CHECK 25% ❑ 50+ Kw ENERGY P.C. S Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW 05-15 KW Meter ❑up to 100 amps Meter Dover 100 amps Sub Panel Motors 00.1 HP ❑1'A - B 1nc.Solar 09-15 HP 1116.1 S+ Microwave Pole Light Range Sign Standing Sections Trash Compactor I I Reinspection Fee 1 $15 1 1 Issue Fee I I $ 3 I 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Data Application Issued, By— Dat SUMMARY OF FEES BUILDING PERMIT $ SMIP S PLAN CHECK$ PERMIT PLUMBING $ ate- ISSUANCE 5 PLAN CHECK 25% $ 0 D ENERGY P.C. S ELECTRICAL $ GRADING S PLAN CHECK 50°,6 $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ CONSTRUCTION AND PLANNING ARROVALS Permit # Date Inspector POOL, A APPROVALS Permit # Date Inspector 1, Temporary Electrical Service or Pole 52. Pool &Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd- 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64, Plumbing System - Final 14, Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68, APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19: Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72.' Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ', 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43, Backflow Irrigation 44.'6ndscape Irrigation System 45. Sound Attenuation 46. H$ndicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATEOF_ OCCUPANCY No. Date _- 0 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OE COSTA MESA CONSTRUCTION PERMIT' PERMIT N°' TflacT No. LOT NO. UNIT N" Project Address 911 YJ. ri.r ti, . CaQA" lUESA Applicant's Mailing Address Owner's Name —XRO'( j N uc STm Eftyl Phone Address Arch/Eng. License No. Address Contractor's Name 1v1ZR21S 91EC-FRtL Phone ?77-6, Address (mailing) RYA • _,..Omt�a�� City License No. n LICENSED CONTRACTOR DECLARATION I -hereby affirm that 1 am licensed under provisions of Charter (commencing with section 7000) of Division 3 e Iness and rof ons Code, and my license is in full. force and effe License Class C' 1� icen N f Date I �-I D-- SS Signature FZ WORKERS' COMPENSATION DECLARATION - 1 hereby affirm that I have a certificate of consent to self -insure ora certificate of Workers' Compensation Insurance, or a certified copy thereof (Sectio_ n 3800, Lab. C.) _ - Policy No. 1AJC41o�1 �� a y ELE BCertified copy is hereby furnishe Cel fried cop is'(Iled with the cit B in !vision. Date `It]- S Applicant EXEMPTION FROM WORKERS' COMPENSATtod DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less) 1 certify that in the performance of the work for which this permit is issued I shalt not•employ any person in any manner so as to become subject to the Workers" Compensation Laws of California. Date Signature "NOTICE: It, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY.' I I hereby affirm that there is a construction lending agency for the performance of the work for, which this permit is issued (Section 3097 Civ- C.), Lender's Name '- Lencle"Cs Address , OWNER BUILDER DECLARATION , I hereby affirm that I'am exempt from the Contractor's. License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair ' any structure,, prior to its issuance, also requires the applicant for such permit , to file a signed statement that he/she is licensed pursuant to the provisions of, 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 031.5 by any applicant for a permit. subjects the applicant to a civil enalty of not more than five hundred dollars ($500). ' C I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 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 proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P! C. for this reason Date Owner 1 hereby certify that I have read this application and state that the above information is' torr ree to co ly w th all city'and county ordinances and state laws 'ng to u.".ng nstr ion, and hereby authorize repre- sentatives of thi 'c ty to enter on above-mentioned property far inspection u Signature Date Drivers' ,cerise o SS : TYPE OF CONSTRUCTION I-_1 NEW ' L ADD LJ ,ALTERATION LJ REPAIR - ❑ CONVERSION -❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TYPE OF PERMIT GRADING E FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL -❑ PLUMBING ❑ MECHANICAL B Roar , El OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ g Left ZONE GRADING CU.YDS. ACRES Ping. Ref. + Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains' Floor Sinks Gas Service Outlets Interceptors ` Kitchen Sink' Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground , Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting ❑0-100,000 BTU Ell m000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor FEES Showers Service Sink ' Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee $ 3 HANICAL FEES Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTU D100,000BTU System Repair/Alteration Fire Dampers Registers r Issue Fee I 5 3 5884 1/16/65 Zowe Accessory.Building: 4.50 • TL Z O N N R Parking Req,/Provided E 0 M T S ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 05-15 KW Transformer ❑ 15-50 KW ❑ 50'+ KW Meter ❑up to 100 amps Meter ❑over 100 amps_ Sub Panel Motors %P-1 HP D Y� - 8 Inc.Solar ❑9-15 HP ❑1$-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES I I Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES,REOUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By _—_^ _ Data _ SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ LA -.W _ GRADING. $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE $ Lf��i PLAN CHECK 25% $ _ CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL _,PA APPROVALS Permit # Date Inspector 1! Temporary Electrical Service or Pole 52. Pool &Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding --5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. 57. APPROVAL TO COVER•GUNITE 7, Footings 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16, Rough Electric Wiring 67. Fencing & Access Approval 17. Bough 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 APPROVALS Permit # 20. ' Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 "i Z LQ C Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or'Carlopy 37. Final Factory Fireplace 36. 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 _ ,-! A I Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations, CITY 4F'COSTA MESA I CONSTRUCTION PI=RMIT PERMIT NO. / TRACT NO. L07 NO. UNIT NO. Frojett Address -711 W. 1�T� 5T. )COS Applicant's Mailing Address Owner's Name IN VES-T2L.!�r -Phone Address Arch/Eng. License No. Address Contractor's Name MaRiej.S • E -UEC i? LC_ Phone Rn 6UD Address (mailing) ,RRyariT ST. 2Loarnr4-1 471 -Lw City License No. R13 ri 1) LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3- of the Business and Pr as i ns Code, and my license is in full force and effect. License Class C•f 10 tens o. j Date �' Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section EGA PoI!cy No, y O Company eCertified copy is hereby furnishetl- Certlfietl copy flied with the city ui1 ng O islon. Date +1 f D� k ^. Applicant EXEMPTION FROM WORKERS' COMP SATION E LARATION (This section need not be completed if the permit Is fo one hundred ($100) or less) I certify that In the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. l . Date Signature ' •NOTICE: If, after making this declaration, you Should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENOING AGENCY - I I hereby afflrm that there Is a construction lending agency for the performance of the work, for which this permit is issued(Section 3097 Civ. C.) Lender's Name Lender'S Address OWNER BUILDER DECLARATION' - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also require$ the applicant for such permit 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 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 '031.5 by any applicant for a permit subjects. the applicant to a civil enally of not more than five hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their sole ' compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors tri construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuarit to the'Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I -am exempt under Section B. & P. C. for this reason Date Owner t hereby' certify that I have read this.appi- atiom and state that the above Information i ct. I'agree tXg., Ply hail city and county ordinances and State la s rola wildctlon, and hereby authorize repre- sentatives o this It t ente above-mentioned property for inspectlon p Signature Date �j •' Drivers' License SS CMF 0865-46, rev. 10/84 White - Building; Canary 5885 f/!b/85 ho5Q TL TYPE OF CONSTRUCTION LJ NEW L_J ADD I -I ALTERATION II REPAIR ❑ CONVERSION - ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. # Zone S Main Building: Accessary Building: TYPE OF PERMIT GRADING U FOUNDATION EISTRUCT6RAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ •OTHER - PROJECT DESCRIPTION SQ. FT.OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU -YDS. ACRES E T Front 2 O B A Rear ; N I C Right - N S Left R Ping. fief. # Parking Req. /Provided,' E Remarks: Planning Notes: Q M T S PLUMBING FEES Bar Sink Backflow Preventer Showers Service Sink - Automatic Washer Construction Pole Sub. ELECTRICAL Transformer ❑ 15-50 KW ❑ 50'+ KW FEES Backflow Irrigation Sewer Cap Bathtubs Sewer Connection 'Cooking Unit ;Meier ❑up to'100 amps Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps , Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan t Motors YL0-1 HP ❑ 1% - B Floor Drains SwimmingPool /S a wP F.A.U. Inc. Solar 09-15 HP ❑16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors `' Water Heater Outlets Range Kitchen'Sink, Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections P --Trap Laundry Trays _ Generator 00-5 KWE15-15 KW Trash Compactor Roof -Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler - Hood or Type l ❑ Canopy Type 11 ❑ DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date Dat Duct -Under Ground Duct - Structural i Refrigeration System 00-100,000 BTU 0100,000BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT , $ ISSUANCE $ $ ENERGY P.C. $ $ �-.s� GRADING .$ $ �.� MICROFILM $ $ TOTAL FEE $ $ Exhaust System ❑ Multiple ❑ System Repair/Alteration FirepllFact. Bit. ICBO # Fire Dampers Heating System & Ducting ❑a1 OO,Ooo BTu ❑ 100,000 BT Registers - 1 Reinspection Fee $15 Issue Fee $ 3 Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date "' Inspector POOL .., 5PA APPROVALS Permit # Date _ InspPrtor s 1' Temporary Electrical Service or Pale 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd„ Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap ' 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16, Rough Electric Wiring 67. Fencing & Access Approval 17, Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough ElectricalT bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 -7/4 r05 ` Notes: 34, Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System A5. 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 07 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY,OF COSTA MESA CONSTRICT PERMIT . Project Address Applicant's Mailing dress / Owner's Name i ' Phone Address / Arch/Eng. License No. Address Contractor's Name i Phon Address imailingi City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that•1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my licenie is in f forge nd effect. i License Class ` License No. Date Signature WORKERS' COMPENSATION DFZLAiATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, tab. C.) m Policy No. l Company Certified copy is hereby furnished. i Certified copy Is filed with the city Building Division. , Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit is for one hundred ($100) or ' less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manners as to become subject to the WorkerC rt1Den ti n,Laws of Califoya Date— ns — NOTICE- If, after making this declar n, you should become subject to the Workers', Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is'a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name. r _ Lender's -Address OWNER BUILDER DECLARATION I hereby affirm that I am�exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or, that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I, as owner of the property 'or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale -(Section 7044, Business and' Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner wilt have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractar(s) license pursuarit*to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. , ❑ I.am exempt under Section B. & P. C. for this reason Date Owner, 1 hereby certify that I' have read this application and state that the above information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this -city t0 enter upon the above-mentioned property fOr inspection os Signature Date -' Drivers' Wcense or SS 11 2 TYPE OF CONSTRUCTION L NEW LJ ADD LJ ALTERATION LJ_REPAIR 'I ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A. P. # DESCRIPTION OF WORK/USE OF BLDG.' ITU S Main Building: E TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B, ❑ OTHER A Rear C Right PROJECT DESCRIPTION' SQ. Fr. OCCUPANCY K CON STRUCTION TYPE VALUATION S $ Left ZONE G RAIDING CU. YDS. ACRES Ping. Ref. Remarks: Planning Notes: Bar Sink , Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service J Outlets Interceptors Kitchen Sink ' Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating _ Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 00.100,000 BTU ❑100,000 BT' Reinspection Fee I $15 CMF 0865-46, rev, 10184 White - Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Poo( w/Spa Urinal — Water Closet Water Heater E Water Service Auto -Wash 'Laundry Trays MECHANIC FEES Issue Fee $ 3 Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System E10-100,00OBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee 5878 7/02/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer, Transformer ' ❑ 15750 KW — Construction Pole Sub. El50 + KW Cooking Unit Dishwasher Dryers ❑Gas OElectric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 135.15 KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0-1 HP Ell % - B Inc. Solar ❑9.15 HP ❑ 16-15+ 'Microwave " - Pole Light Range Sign Standing Sections Trash Compactor IOp50 nt Z 0 N I N G R E Q M T S FEES ' FEES 'I Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat ITU SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK S PERMIT PLUMBING $ - ISSUANCE S PLAN CHECK 25% $ t SC7 ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM �$ MECHANICAL $ TOTALFEE i$ PLAN CHECK 25% $ — $ 3 CONSTRUCTION AND PLANNING ` APPROVALS Permit # Date Inspector POOL of SPA APPROVALS Permit # Date Inspectni .I..Tempwary Electrical Service or.Pold ;{' 52. Pool & Equipment Location 2. 5oi��Pipe Undrgrnd.A 53. Steel Reinforcement �EleZiccal Conduit, y-Undrgrnd i� 54. Forms v 4+Ele6thical Condur -Undrgrnd. �a 55. Electrical Bondin 9 5f S'teiflM'6inforce n6nt--' . - .- "i i t. , r r 56. Rough Plumbing &Pressure Test �+ � *- S,6yElectr�ical UFER Gsrrd. to 57, APPROVAL TO COVER GUNITE^� 7�Foo tings 58. Electrical Conduit-Undrgrnd, `8 Foundvion �� `.,�, 59. Gas Pipe, ❑ Undrgrnd., Test ' 1.91 Waite A/ Undrgrnd �{ 60. Backwash Lines, P•Trap, ❑Undrgrnd. V 10 10. Structural Floor System 61. APPROVAL TO DECK 11. PropertylSewer Line& House Co'rtnection ___0 v _ , ` 1 fit. Backwash & Receptor -Final 12. Sewer crap �ii "' � i 63. Heater &Vent -Final 13.• Roof Drains 64. Plumbing System - Final ' 14.'Rough PlurnbingS 65. Electrical -Final t 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 138. Final Plumbing 7 Cz") 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 STFiUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 511.1 CERTIFICATE OF OCCUPANCY Nn. Date Applicant to flit In all spaces except those within heavy border lines and sign all appropriate declarations. + PERMIT NO. i TRACT NO. I LOT NO. I I INiT Nn rowner's ITYlOPCOSTA MESA CONSTRUCTIONPERMIT Project Address C F r Applicant's Mailing Address Name ._7R Dj/ lNU�.tT�-nJ 1 Phone Address Arch/Eng. License No. Address Contractor's Name M!?L'�R ►-5 ELECT'!? LC Phone 1?77-6ky_D Address (mailing) )119k< -6 YRAPrST S -00111I A) 610 113 9231 City License No. 0 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing With section 7000) of Division 3,.oL_tZe_Rj4sIness and Pr fessi ns Code, and my license is in full force and efte License Class____ C–Licens o. f DateSignature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy _thereof (Section 3800, Lab, C.) lollcy No. D Co ny ICE."– Certified I- eCertified copy is hereby furnishetl. Certified cop ,, filed with the city uil rvisio Date �.)�) t?' Applicant EXEMPTION FROM WORKERS' COM ATIO DEC ARAT10N (This section need not be completed if the permit isffor one hundred ($100) or less). I certify that In the performance of the work for which this permit is issued i shall not- employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. . Date Signature 'NOTICE: It, after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION 'LENDING AGENCY ' I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License law for the following reason (Section 7031.5 Business and Professional Cotler Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 2nalty of not more than five hundred dollars (5500). . i I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sectlon 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If,however, the building or Improvement is Sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of Sale). C31, as owner of the property, am exclusively contracting with licensed con- tractors to construct the, project (Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a con- tractnr(s) license pursuant 'to the Contractor's License taw). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date I hereby. Certitl information Is and state law senta lives oil t1 inspection p r Signature Drivers' Ucense Owner that I have read .this a e agree to comply ng building c nsb ty o enter u ation and state that the above I all city and county ordinances on, and hereby authorize repre- above-mentioned property for Date._I O – Vim+ CFI I 1!0.s i I I i_ S TYPE OF CONSTRUCTION El NEW El ADD ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P 46 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING El FOUNDATION 0 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow•Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen ISink Lavatories P–Trap Roof Drains Reinspection Fee PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal FEES Water Closet Water Heater Water Service Auto -Wash Laundry Trays $15 Issue Fee - $ 3 MECHANICAL FEES Bailer Duct -'Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting 12 0-106,000 BTU 0100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 white - Building; Canary - Applicant; pink -'Accounting; Goldenrod - Assessor Hood or , Type i - ❑ Canopy Type 11 ❑ Refrigeration System CIG-1100,00OBTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 5886 1/16/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL 11.50 FEES Z O N I N G R E O M T S Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW H❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter Dover 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors X0.1 FiP ❑134 - S , 'F.A.U. Inc. Solar ❑9.15 HP ❑16-15+ Fixtures Microwave' Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal ; Standing Sections Generator 00.5 KW 05-15 KW Trash Compactor 1. 1 Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building, Approved By Date Application Issued BY Dat SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE S PLAN CHECK 25% $ ENERGY P.C. S ELECTRICAL $ �— GRADING $ PLAN CHECK 50% $ SO MICROFILM $ MECHANICAL $ TOTAL FEE '' rr $ 14 5(!) PLAN CHECK 25% $ CoNSTRUCTION AND PLANNING - APPROVALS Permit # Date Inspector POOL A APPROVALS Permit =F_ Date tnspectnr ' 1 . Temporary Electrical Service or Pole 52. Pool & Equipment Location '2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNiTE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12, Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15, Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67, Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72, Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Piaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric i� Ce Notes: 34. Final Heating & Air Conditioning -41/ 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service - Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape IrrigaFtion 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 00 I Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERT NO. TRACT NO. LOT NO. 1 UN1 NO Project Address 711 W. 17 1h . ST Bld F Unit 5 116 Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors ❑0-1 HP El fr B Applicant's Mailing Address 13110 Saticoy St. N.HOIIywOOd Owner's Name TBQ_�_IIl}Lf'SiXRQJLL�.Pu?!a _ .Phone_-5A�9-8 TYPE OF CONSTRUCTION NEW EJ ADD LJ ALTERATION LJ REPAIR 1:1 CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. Address4391 Ri rrh O%t- . Npwnnrr Rparh , Cn _ Microwave Device Boxes Pole Light Outlets Range Arc WEng, Marin .1. Rork License No. Address Knott AV Gtti to ?16 TYPE OF PERMIT LJ GRADING ❑ TENANT ❑ ELECTRICAL 1:1 OTHER PROJECT DESCRIPTION SQ. FT. CONSTRUCTION TYP$ M FOUNDATION 0 STRUCTURAL ❑ PLUMBING ❑X MECHANICAL OCCUPANCY VALUATION $ „L. road ifin—_*min-Phone 982-121 Contractor's Name mein Adr- Address (mailing)131-LO—Sall rnSt N 1-1n1 1V�.Trlnnra ^7v T�'7-'�� City License No, _ 33925 ZONE GRAOING CU. YOS- ACRES LICENSED CONTRACTOR DECLARATION $ PERMIT Remarks: PLUMBING I hereby affirm that 1 am licensed under provisions of C rter 9 (commencing with section 7000) of Division 3 of the Business an Cessions Code, and $ PLAN CHECK 25% my license is in full force and 4,eife a. License Class Li e o. 346 251 Date+/ L& 84 Signature ENERGY P.C. S PLUMBING FEES WORKERS' COMPENSATION DE RATION I hereby affirm that I have a cort(f ate of consent to sell -insure or a certificate Bar Sink Showers , Backflow Preventer Service Sink .of Workers' Compensation Insurance, or a_certified copy thereof (Section 3800, Lab. C.) Backflow Irrigation Sewer Cap Policy No. WC9824 Company Ltlmhermans eCertified copy is hereby furnished. Certifie py is filed with the city Building OTW'� �(on...J,p �' Bathtubs - Sewer Connection Date Applicant --tt'] 1� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less}. I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Workers' Compensation Laws of California, Date Signature 'NOTICE: If, after making this declaration, you should become Subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Floor Drains Swimming Pool wlSpa Floor Sinks Urinal - Gas Service Outlets _ Water Closet interceptors Water Heater Kitchen Sink Water Service Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am -exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its. Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Oivision 3 of the Ousiness and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil )enalty of not more than (Iva hundred dollars ($500). C1 I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offere- for sale (Section 7044• Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for ,roes. sale. the building or improvement is sold within one year of cam• pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale), ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors t6 construct the protect (Section 7044, Business and Professions Code: The Contractor's License law does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a con- tractor(s) license pursuant -to the Contractor's License taw). I am aware that their Worker's Compensation insurance should be provided to me. Lavatories Auto -Wash P—Trap • Laundry Trays Roof Drains , ReinspectiOn Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Hood or Type I ❑ Canopy Type I I ❑ Duct - Under Ground Duct - Structural Refrigeration System 110-1100,00OBTU 0100,000 BTU - Duct - Ventilating Exhaust System Multiple C3System Repair/Atteration proof of 0 1 am exerApt under Section B. & P. C. for this reason Firepl/Fact. Bit. ICBO # Fire Dampers Date Owner I hereby certify that I have read this application and State that the above information Is correct, I agree t comply with all city and county ordinances and stale I elating to bull g construction, and hereby authorize repre- scntatives fI t is city to e e upon the above-mentioned property for inspection urp ses. Heating System & Ducting 1 �100,000BTU ❑100,000 BT 6 Registers 6 00 - Reinspection Fee $15 Issue Fee $ 3 Signature Date Drivers' Licen or SS - . \CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 2273 5/03/85 A.P. # IZone S Main Building: Accessory Building: E T Front ARear C Right 5 Left Ping. Ref, # Parking Req./Provided Planning Notes: ELECTRICAL y Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 50 + KW a" Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors ❑0-1 HP El fr B F.A.U. Inc.Solar 09.15 HP 016.15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal ! Standing Sections Generator 00.5 KW 05.15 KW Trash Compactor 15.E❑ TL Z O N t N G R - E 0 M T S FEES Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat ___- Z SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% S ENERGY P.C. S ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ 13-00 TOTAL FEE $ 15 -50 - PLAN CHECK 25% $ -__Z CONSTRUCTION AND PLANNING APPROVALS . Permit # Date Inspector POOL - SPA 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 f 6. Electrical UFER Grnd. l f 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, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connectign 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 APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Stdrage Tank El Gas El Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test ,36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irriqation 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 r Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. Ci7Y_QF COSTA MESA UUNSTRUCTIQN PtHMI I Project Address r shy ; Applicant's Mailing Address Owner's Name f U > Phone Address / A:na +tJ - Arch/Eng.' A' License No. t'/S:22- y Address Contractor's Nam e Phone Address (mailing) �.or City License No. LICENSED CONTRACTOR DECLARATION I herebyaffirm that I am licensed Under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in fpil force and effect. License Class - - License No. ' Date Signature v WORKERS' COMPENSATION DECLARATION t hereby affirm that I have a certificate of consent to self -insure or a certificate ,of Workers' Compensation Insurance, or a certified copy thereof (Section 3a00, Lab. C ) Policy No. Company 8 certified copy Is hereby furnished- , Certified c y I fled with the city Building at 7 - �- Applicant 4014 ision. 4N EXEMPTION FROM WORKERS'.COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certlfy that in the performance of the work for which this permlt is issued I shall not employ any person in any manner so as to become subject to tie Workers' Compensation Laws of Chlifornia. ' Date Signature 'NOTICE: If, atter making this decl4ratlon, you should become subject to the Workers' Compensation provisions of, the Labor Code, you must forthwith comply with such provisions or thi$ permit shaff be' deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Of [he work for whi p$ pt it is issued. (Section X97 CIV. C.) AI Lender's Name' Lender's Address A i OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Cade: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior.to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chabter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom, antl the basis for the alleged exemption. Any violation of Section >a 031.5 by any appltcant for- a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). as owner of the property or my employees with wages as their sole 'pensation, will do the work, and the structure isnot Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does Such work himself/herself-or through his of her own employees, provided that such improvements are not Intended. or offered for sale. If, however, the building or improvement is sold within one year of com- pletlon, the owner will have the burden Of proving he/she did not build or Im- prove for the purpose of sale). ❑ I,'as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to.an owner of property who builds or improves thereon, and Who contracts for such projects with a con- tractor(S) license pursuarit 'to the Contractor's License Law). I am aware that proof o their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section _. B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state at the above information I$ correct. I agree to comply with all city and county ordinances and state laws relating to bullding construction, and hereby authorize repre- sentatives of this' city to enter upon the above-mentloned property for Inspection purp ses. _ Signature , IVY Dat Drivers'' License or 55 3¢ icor iw. a�7 i Bar Sink Showers Backflow Preventer TYPE OF CONSTRUCTION LJ NEW 0 ADD L2 ALTERATION LJ REPAIR• ❑ CONVERSION ❑ DEMOLISH El OTHER DESCRIPTION OF WORK/USE OF BLDG. q p # S T B A C S Main Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ® PLUMBING ❑ MECHANICAL ❑ Front Rear -OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CON STRUCTION TYPE VALUATION $ ZONE GRADING CU. YDS. ACRES Right < Left Ping- Ref. Remarks: •Pf-� ddof�J Planning Notes: Floor Sinks Urinal Reinspection Fee , 1 $15 Boiler Duct - Under Ground Duct - Structural Duct-- Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. BIt. ICBO # Heating System & Ducting ❑0-100,000 BTU ©100,000 BT Reinspection Fee I $15 CMF OB65-46, rev. 10/84 White - B4ilding; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor FEES Issue Fee - I $ 3 iANICAL FFI Hood or. Type ❑ Canopy; Type (j ❑ ' Refrigeration System 00-100,000 BTU El 100,000 BTU System Repair/Alteration Fire Dampers Registers 1 0 Issue Fee 1 $ 3 0156 7/25/66 > � 8.00 t - , Zone Accessory Building: Z 0 N I N G R Parking Req./Provided E _ Q M T S ELECTRICAL FEES PLUMBING Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection _ Clarifiers Solar Collectors - k Dishwasher Solar Piping__ Drinking Fountains Solar Tank Floor Drains Swimming Pool vv/Spa Floor Sinks Urinal Gas Service Outlets Z Water Closet Interceptors Water Heater Kitchen Sink Water Service -Lavatories Auto -Wash P—Trap Gundry Trays Roof Drains $ 9, CO ISSUANCE . I Reinspection Fee , 1 $15 Boiler Duct - Under Ground Duct - Structural Duct-- Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. BIt. ICBO # Heating System & Ducting ❑0-100,000 BTU ©100,000 BT Reinspection Fee I $15 CMF OB65-46, rev. 10/84 White - B4ilding; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor FEES Issue Fee - I $ 3 iANICAL FFI Hood or. Type ❑ Canopy; Type (j ❑ ' Refrigeration System 00-100,000 BTU El 100,000 BTU System Repair/Alteration Fire Dampers Registers 1 0 Issue Fee 1 $ 3 0156 7/25/66 > � 8.00 t - , Zone Accessory Building: Z 0 N I N G R Parking Req./Provided E _ Q M T S ELECTRICAL FEES Automatic Washed. Construction Pole _Sub. Transformer ❑ 15.50 KW ❑ 50 + KW Cooking Unit `�}� Meter ❑up to 100 amps Dishwasher - - Meter ❑over)100 amps -� Dryers ❑Gas .DElectric Sub*Panel Fan tia� Motors ❑0.1 HP 01% - B F. A. U, a Inc. Solar ❑9-15 HP C1 16-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal ; Standing Sections , Generator 00-5 KW C1 5-15 KW Trash Compactor Reinspection Fee $15 Issue Fee S 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date ' Building Approved By Date Application lssued By _Date 7:.._ SUMMARY OF FEES , BUILDING PERMIT $ SMIP 5 PLAN CHECK $ PERMIT PLUMBING $ 9, CO ISSUANCE $ ' PLAN CHECK '25% $ ENERGY'P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM S MECHANICAL $ TOTAL FEE $[�_ PLAN CHECK 25% $ I tt r[ a A CONSTRUCTION AND PLANNING APPROVALS Permit � 1 Date Inspector POOL, -A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52, Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNiTE 7. Footings . 58. Electrical Conduit-Undrgrnd. ' 8. Foundation 59. Gas Pipe, O Undrgrnd., Test r 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13, Roof Drains, 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit - 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing.& Access Approval t 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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping OGas 000 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd, Storage Tank O Gas O Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29, Insulation 78. FIRE PREV. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31.,Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36, Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Presenter 43. Backflow Irrigation 44, Landscape Irriqation System 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF Cub I A MESA ONSTR Ll I lO r -n I U PERMIT NO. TRACT NO. LOT NO. UNIT NO, -Pr6iect Address l Applicant's Mailing ress L r Owner's,Na one P , Address Arch/Eng.. License No. Address Contractor's Name �hone�� Address (mailing] City License No, LICENSED CONTRACTOR DECLARATION I hereby'affirm that I am licensed under provisions of Charter.9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license isin f t force and effect. License Cla s — License No. Dat Signature WORKER5' COM ENSATION' LA RATION I hereby affirm that I have a cer ` iCate of consent to self4nsure or a certificate of Workers' Compensation In ranee, or a certified copy thereof (Section 3800, Lab. C.) Policy No, Company ' 8 Certified copy is hereby furnished. Certified copy i$ filen with the city Building Division. Date, __ - Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be Completed if the permit is for one hundred (5100) or less). I certify that in the performance of the work for which this permit is Issued, I shall not emp,lgy any person in any manner so as to become subject to the Werke C $a r w$ of Calif . Date Signature 'NOTE: If, after mak ng this decla , you $hOuld become subject to the Workers' Compensation provisions d the Labor Code, you must forthwith comply with such provisions or is permlt'�shail be deemed revoked. , CONSTRUCTION ,LENDING -AGENCY., I hereby affirm that there is a construction lending agency for the performance, of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit to construct, atter, improve, demolish or repair any Structure, prior to Its issuance, also requires the aPpiicant for such permit ,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 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 ,)enally of not more than five hundred dollars ($500).' ❑ I, as owner of the property or my employees with wages as their sole Compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who'does such work himself/herself or through his or her own employees, prpvided that such Improvements are not Intended or uffered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an Owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractor(s) Iicense pursuant'to the Contractor's License Law). I am aware that Proof of their Worker's Compensation insurance shouid be provided to me. 0 I.am exempt under Section B. b P. C. for this reason Date Owner I herebycertify that I have read this application and state that the above Information Is correct, t agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of 'this 'city o enter upon the above-mentioned property for inspection pu e$. ' Signature Date Drivers' Lic Se or'S5 CMF 0865-46, rev.'10/84 White - Building; Canary - Applicant; Pink - By Zoning Approved By Date TYPE OF CONSTRUCTION NEW ADD I 1AITERATION OREPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Application Issued By A.P. q DESCRIPTION OF WORK/USE OF BLDG. S Main Building: BUILDING PERMIT $ E $ TYPE OF PERMIT GRADING[71 FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B 1 $ ❑ -OTHER $ A Rear C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K PLAN CHECK 50% CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping, Ref. # Remarks: $ Planning Notes: Bar Sink Backflow Preventer. Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks ' Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee f $115 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0.100,000 13TU ❑ 100,000 BT Reinspection Fee I $15 Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping , Solar Tank Swimming Pool w/Spa Urinal Water Closet' -Water Heater Water Service Auto -Wash Laundry Trays Issue Fee MECHANICAL }food or , Type 1 ❑ Canopy Type 11 ❑ Refrigeration System CIO-1100,00OBTU ❑ 100,000 BT System Repair/Alteration Fire Dampers Registers FEES $ 3 FEES Issue Fee $ 3 Zone Accessary Building: z O N l N G R Parking Req./Provided E Q M T ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan r' F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW ❑5.15 KW Transformer -❑ 15-50 KW ❑ 50 + KW Meter LJup to 100 amps Meter Do -ver 100 amps Sub Panel motors ❑0.1 HP❑1A-8 Inc. Solar 139-15 HP El 16,15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES _- I' Reinspection Fee I S15 I I Issue Fee 1 $ 3 i DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By pat SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE 1 $ PLAN CHECK 25% $ C�_ ENERGY P.C. i $ +$ ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM ; $ MECHANICAL $TOTAL FEE $ _! 0 5c� PLAN CHECK 25% $ CONSTRUCTION AND PLANNING ;APPROVALS Permit # `� Date Insp� dor POOL & „PA APPROVALS Permit # Date Inspector 1. Tempary Electrical Service or Pole t 52. Pool & Equipment Location 2. Soil Pipe,'Undrgrnd.-} `f �� 53. Steel Reinforcement 3�, Elect yical Condui[,Utfty-Undrgrnd! 54, Forms l 4.' Elected iaF Con duit'Undrgrnd. 55. Electrical Bonding -5? Steel. Reinforcement 56. Rough Plumbing & Pressure Test J•' 6• !Elect ical UFER.Grn'd h .., F .� i' f .,57. APPROVAL TO COVER-GUNITE 7�'F,o+atii,gs n7� i oil ^ 58. Electrical Conduit-Undrgrnd. Foundation �'. '; �`�1 59. Gas Pipe, ❑ Undrgrnd., Test } �at��:..�pe-Undrdrnd. ;; 60. Backwash Lines, P -Trap, ❑ Undrgrnd. �l 10,St ,uc ural Floor System t, 61. APPROVAL TO DECK 1'1. Pr^operty Sewer Line & House Connction I 62. Backwash & Receptor -Final 12. Sewee Cap ± A t 63. Heater & Vent -Final 13. Roof Drains :�'r r� 64. Plumbing System - Final 14, R,gh mbing,'r � ,% 65. 'Electrical -Final �} 15. Rough Electrica'I-Conduit 66. Solar System -Final 16. _Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electricai-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 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 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace ' 38. Final Plumbing 39. Water Service -Final 140. Gas Service -Final 41. Solar Domestic -Final 42. 8ackflow Preventer 43. Backflow' Irrigation 44. .Landscape Irriqation System 45. Sound Attenuation i 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48. Special Requirernents Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. __ Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA ESACONSTPCTION (P^ERMIT Project Address If `� /7 s.r �(. Applicant's -Ma' ing Address _ 13 � .u— Owner's Namered/F 99110 _e1_0 4 ` J_ 4 3 Phone i Q 4 Address 1/1 'W P7 Zr .Stat*ft. 45-6 ,v�,,�. t'liw.�. ••%v -e 'J�-!t�•7 License No. Address yqt Contractor's Name /il f4: /#>r /1106-e& *� � 1+on �Address (mailing) 13 rv, 1 C L7Z1�� -- v�•• City License No. %- LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000), of Division 3 of the Business and Professions Code, and my license Is in f fart and effect r l% Licensg Class license No 24 6 r � 7 Date /L " J" �' Signature e WORKERS' COMPENSATION DECLARA ION 1 I hereby affirm that I have a certificate of consent to self -insure or a certificate f Workers' Compensation Insurance, or a certified copy thereof (Section 1` liCe d `Policy No. `✓rr �J • / Lb_ ComPanY �4�"i'�hcs..� ,�, •7+� 1 Certified coppYy is hereby furnished. q Btee%�I.d`?Jr is}'fr d wAPgllcanty i1 Id g � EXEMPTION FROM WORKERS' COMPENSA ON DECLARATION (This section need not be completed If the permit is for one hundred (5100) or less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there'is a construction lending agency for the performance ofthe work for which this permit is issued (Section 3097 Clv. C.) La.der's Name Lander's Address - - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt •erefrom and the .basis for the alleged exemption. Any violation of Section 131.5 by any applicant for a permit subjects the applicant to a civil malty of not more than five hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for Sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden Of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 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 proof of their Worker's Compensation Insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above Information is correct. I agree to Comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of is city enter upon the above-mentioned property for inspection pre- S. + Slgnat ure Date Drivers' License or SS PIERMIT NO �j TRACT NO. LOT NO.UNI • 9113 12/22/86 7e00 TYPE OF CONSTRUCTION NEW ADD X1ALTERA7,ON U ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. ' REPAIR A. P, #ZOne S Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING X MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATIONS ZONE GRADING CU. YDS. ACRE5 T Front O B A Rear ' + N I C _ Right N Left g G R Ping. Ref. # Parking Req./Provided E Remarks: Planning Notes: O M T S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer PoleSuh. Transforiner _❑ 15.50 KW ❑ 50+ KW - Backflow Irrigation Sewer CapConstruction Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher + Meter Clover 100 amps Dishwasher - Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00.1 HP ❑1%-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections P --Trap Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee S 3 Reinspectibn Fee $15 Issue Fee S 3 r MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By J Date Application Issued By Boiler Hood or Type I 0 Canopy Type I1 ❑ Duct - Under Ground Duct - Structural Refrigeration System ❑¢100,000 BTU 0100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICALS PLAN CHECK , 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ GRADING $ $ MICROFILM $ $ TOTAL FEE $a $ 0 Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG # Fire Dampers Heating System & Ducting )j0.100,000 BTU 0100,000 BTL Registers r ' Reinspection Fee $15 Issue Fee $ 3 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd, 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd•, Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing 65. Electrical-Final 15, Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 1B. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25, Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocgat 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. F I NA L I NSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning s 67 LW 35. Final Gas Pipe-Test 36. Hood or Canopy` ` 37. Final Factory Fireplace ' 38. Final Plumbing 39: Water Service-Final 40. Gas Service-Final ,4i. 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 t 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA co sT UL,ION PERMIT PERMIT NO. TRACT NO.. LOT NO. UNIT N6. Project Address I Appiicantls Mailing dress Owner's Name % e Address Arch/Eng. License No. Address �7 Contractor's Na hone-�1 6)1 i Address (m.irrtg) 45ty'License No. jif LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in fu orce d feet. Licenspr�01SATION v License No.�:; n� 2 Date WORKEO LARA710N I hereby affirm that I have a terti tate of consent to self -insure or a certificate ,if Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) I Policy No. Company Certified copy is hereby furnished Certified copy Is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' CDMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less) I certify that in the performance of the work for which this permit is Issued, 1 shall' not employ any person in any mann r so to become subject to the Worker Co pensa ton Laws of Califo Date: Signature NOTICE: I , a er ma his declare ,you should become subject o the Workers' Compensation provisions he Labor Cade, you must forthwith comply with such provisions or t is permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY " I hereby affirm that there is a construction lending agency for the performance' of the work for which this permit is issued . (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION ' I hereby affirm that I am ekempt from the Contractor's License taw for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit [o file a signed statement that he/she is licensed pursuant to the provisions of ,to 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 1031.5 by any applicant for a' permit subjects the, applicant to a civil ' A��greore than five huntlred dollars (§500). I of the property or my employees with wages as their soleill do thework, and the structure Is not intended or offered 7044, B45iness and Professional Cade: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work ,himself/herscif or through his or her own employees, provided that s4ch improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one Year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sai4). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractors) license pursuarit'to'the Contractor's License Law). I am aware that proof of their Worker's Cgmpensation insurance should be provided to me. ❑ I am exempt under Sectipn B. & P. C. for this reason r _ Date Owner I hereby certify that I• have read this application and state that the above information is correct. 1 agree to comply wjth all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives XnSe is cit to enter upon the above-mentioned Property for inspection ses. Signaturate Drivers' 'cor S5 CMF 0865-45, rev. 10/84 W ant; Pink - Accounting; Goldenrod - Assessor �Z TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION 0 DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF.WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front -❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear - ❑ OTHER C Right PROJECT DESCRIPTION SQ. FT. 'OCCUPANCY K CONSTRUCTION TYPE • VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Parking Req,/Provided Zone 7 Z O N N G R E O M T S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Z OD Automatic Washei f Construction Pole Sub.. Transformer ❑ 15-50 KW 0 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher A Meter ❑over 100 amps _ Dishwasher Solar Piping ' Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0-1 HP Ell X2 8 Floor Drains Swimming Pool vv/Spa F.A.U. Inc. Solar C-1 9-15 HP 016-15+ Floor Sinks Urinal - Fixtures- -Microwave Gas Service Outlets Water Closet' Z Device Boxes Pole Light ; Interceptors Water'Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays - Generator ❑05 KW ❑5.15 KW Trash Compactor Roof Drains 1 r Reinspection Fee '• $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Data Boiler — Hood or Type I ❑ Canopy Type 11 ❑ - Duct- Under Ground Duct - Structural Refrigeration System ❑0100,000 BTU 01100,000BTU Duct -Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL ' PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP is $ PERMIT $ q -m ISSUANCE i $ SO ENERGY P.C. IS $ �� $ GRADING , $ $ MICROFILM �$ $ TOTAL FEE IS $ Exhaust System © Multiple ❑ System Repair/Alteration FirepllFact. Bit. ICBO # Fire Dampers Heating System & Ducting [30-100,000,13T U ❑100,000 BT Registers Reinspection Fee $15 Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # f^ Date Inspector r) POOL, SPA - APPROVALS Permit # Date Inspector 1. TempoRary Electrical Service or Pole' � 52. Pool & Equipment Location = 2. Soil r Pi& Undr nd. 9f 53. Steel Reinforcement r 3.rElectrica},Conduit'dJti,Fty-Undrgrnd. 54. Forms K eElecw_c-al Conduit'_v�drgrnd. 55. Electrical Bonding 7 r S .o �d, - J i�" - 5:.Steel �Reiriforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFERIGeA'd. ✓r t 57. APPROVAL TO COVER-GUN17E n 7 -Footings - ` ��'� 58: Electrical Conduit-Undrgrnd, 0 Foundafipn 59. Gas Pipe, ❑Undrgrnd., lest 9IN8ter,P1'pa-Undrgrnd. 6(}, F-IaCkwu}I Lin9�r P•7fap, ❑Jndrgrntl. ni •10. Structura,[ Floor System l 61. APPROVAL TO DECK y Z i. Properiy?"ewer Line &House Coni ection62. Backwash & Receptor Final ^ 12. Seer yap . ; 63. Heater & Vent -Final 13.,Roof'Dralns J f� r,� 64. Plumbing System - Final 14. Rough Plumbing le, 65. Electrical Final 15, ,Rough Electhcal-Conduit6 de6. 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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Hoof Framing 73, Undergrnd. Storage Tank ❑ 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 {Votes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace ';38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41 . Solar Domestic -Final 42. Backflow Preventer ` .f 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. CERTI FICATE OF OCCUPANCY No. Date - -- 7� Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTBUCT(O Project Address :ZZZ Ze/ 7 C Applicant's'Mailing Address • r S! L/vfV r!' Owner's Name T T �� ✓mss Addr6w � SA"W) A'chIEng. License No. Address Contractor's Niime Alk it J41 J?11Z Phone;-) 5 Y71-7,�C r Address (mailing)10)J b 7,,5 City License No. AJ / -- - LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provision& of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. / License yCls4. Licen o. Date'. r! Signature WORKE s' OMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate f Workers' Compensation insurance, or a certified copy, thereof (Section 800, Lab. C.) Policy No. 7J!j �� 43 Company _Ir&Z ZDAl Certified copy is hereby furnished. LJ CertiSi d co IS iled with the city Date i+ Applicant EXEMP ION ROMWORKERS'CONVE S ION DECLARATION (This section need not be completed if the permit it for one hundred (§100) or less). I certify that In the performance of the work for which this permit is Issued, I shall not employ any person in anymanner so ds to become Subject to the Workers' Compensation Laws of California. ' DateSignature NOTICE: It, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed ♦revoked. CONSTRUCTION LENDING AGENCY t,; I hereby affirm that there is a construction lending agency for the performance Of the work for • which this permit is issueci (Section 3097 Civ. C.) Dander's Name - - - Lender's Address - -- OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Ldw for the following reason (Section 7031.5 Business and Professional Code: Any city or County which requires a permit to Construct, alter, improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for'Such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade) or that he/she is exempt herefrom and the basis for the alleged exemption. Any violation of Section 731,5 by any applicant for a permit subjects the applicant to a Civil enalty of not more than five hundred dollars ($50o). ❑ 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure I$ not intended or offered for 'sale (Section 7044, Business and Professiohal Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale- If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- rove for the purpose of Sale), 1, as owner of the property, am exclusively contracting 'with licensed con- tractors to construct the projectISection 7044, Business and Professions Code: The Contractor's License Law does not apply tq an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractor(s) imense pursuant to the Contractor's Li Cense Law). I -am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section - :-- B. & P. C. for this reason Date Owner I hereby certify that I have 'read this application and state that the above information is correct. I agree to comply with all city and County ordinances and state laws relating to building c struction, and hereby authorize repre- sentatives of this city to enter u n the above-mentioned property for inspection pur Signature Date—calf e Drivers' Llcedse dr SS 2# k,7964 12/0 i /Rg )BMIT NO. / TRACT NO. LOT NO. U jl r ouu TYPE OF CONSTRUCTION NEW PqADD El ALTERATION 0 REPAIR ❑ CONVERSION. ❑ DEMOLISH LJ OTHER DE�CRIPTI Q F WORK/USE OF BLDG. inirmgc �' A.P. # _ Zone ' S Main Building: Accessory Building: TYPE OF PERMIT GRADINGI� FOUNDATION STRUCTURAL ❑ TENANT ❑ELECTRICAL IL�F�PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CON STRUCTIONTYPE VALUATIONS ZONE GR G CU.YDS, ACRES Remarks: S— T Front O B A Rear N I C Right,'" N S Left R Ping. Ref, # Perking Req./Provided E Planning Notes: Q M '_ owulk I T S f PLUM FEES' ELECTRICAL - FEES Bar Sink Showers, Backflow Preventer Service Sink Automatic Washer l Gonstruction'Pole'Sub, Transformer- 1:1 15-50 KW ❑ 50 + KW Backflow irrigation - Sewer-CapI Bathtubs Clarifiers Sewer Connection Solar Collectors. Cooking Unit Dishwasher Meter ❑up to 100 amps Meter ❑aver 10O. -amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan , Motors 00.1 HP ❑1 h - B Floor Drains Swimming Pool w/Spa F.A.U. Inc. SolarHP Ell 6 15+ Floor Sinks Urinal Fixtures .09-115 Microwave' � Gas Service Outlets Water Closet Device Boxes Outlets Switches P ole Light Range Sign I Interceptors Water Heater 21 Kitchen Sink Water Service Lavatories Auto -Wash Garbage.Disposal Standing Sections P -Trap Laundry Trays Generator 00"5 KW:05-15 KW Trash Compactor Roof Drains SIS Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee S15 Issue Fee $ 3 • MECHANICAL FEES ` DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By " _ mate 'Building Approved By 1 Date Application Issued By Dat Boiler Hood or Type I ❑ Canopy Type I( ❑ Duct - Under Ground Duct - Structural Refrigeration System ❑0.100,000 BTU ❑ 100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK "5096 MECHANICALw PLAN CHECK 25% SUMMARY $ $ $ $ $ $ $ $ ' OF FEES SMIP $ � PERMIT ISSUANCE $' ENERGY P.C. $ GRADING $ MICROFILM- $ �J TOTAL FEE $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG # Fire Dampers Heating System &Ducting El 0-100,000 BTU ❑100,0006 I Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0665-46, rev. 10/84 White - Building; Canary ..Applicant; Pink - Accounting; Goldenrod - Assessor TL CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement' 3, Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding 5. Steel Reinforcement 56. Rough -Plumbing & Pressure -Test 6• Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. -Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access'Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ` 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # i= 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro ! 22: Ducts, Ventilating 71. Product Piping ❑Gas ❑Oil., " 23. Gas Pipe -Rough & Test 72. Underground Flush i 24. Roof Framing 73_ Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro r 26. T -Bar Ceiling (Structural) & Monocoat 75: Dry Chemical - 27. Frame and Flashing 76. Dry Standpipe 'LL' 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 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 45. Sound Attenuation 1 '46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING y. 48. Special Requirements Completed 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co ti, 51. CERTIFICATE OF OCCUPANCY No. Date a' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CO STRI�CTION PERMIT ,Project Address yy//�� Applicant's iUailin Address �Rt[sLrR� rr�/� , Owner's Name �'��` &&ne aL22, Address _ C",_;: I ,A Arch/Eng, r C/ ,'r/ License No. Address bv,•r Contractor's Nam 'kIf Phan, Address (mailing) — City License No: _ LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my IiCense Is In full force and effect. License Class License No. DateSignature WORKERS' COMPENSATION GECLARATfON t' 'hereby affirm that I have a certificate'of consent to self -Insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab. C��ii�� &/. ��S Policy No. &Oven y Company , �+/�' _1 K BCertified Copy is hereby furnished. Cert fled copy Is filed with the city Building Division - Date Applicant %!T (i EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred {3100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner So as to become subject to the Workers'Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith' comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for vtJziypd this ,ggr i� is Issued Section .3097 iv. C.) Lender's Name. - Tlff�ff Y !��//rt// 1 Lender's Address 13 i l 4 &14 L._ OWNER 13UILOF-R DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or County which requires a permit to construct, alter, Improve, demolish or repair any Structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License taw (Chapter 9 (Commencing with Section 7000) of .W.._ Ivision 3 of the Business and Professions Code) or that he/she is exempt g erefrom and the basis for the alleged exemption. Any violation of Section n, f=xl%}31.5 by any applicant for a permit subjects the applicant to a Civil `e onatty of not more than five hundred dollars ($500).,, I, as owner of the property or my employees with wages as their sole mpensation, will do the work, and the structure is not Intended or offered for sale (Section, 7044, Business and Professional Code: The Contractor's License Law does'not apply to an owner of a property who builds or Improves ther(!on, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of Com- pletion, the owner will have the burden of proving he/she did not build or Im- rove for the purpose of sale), - l,as,owner of the property, am exclusively contracting with licensed con- tractorsto construct the project (Section 7044, Business and Professions Code: The Contractor's .License taw does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractor($) 11cense pursuant to the Contractor's License Law), I am aware that Proof of their Worker's Compensation insurance should be provided to me. Cl I am axempt under Section B. & P. C. for this reason Date s owner I hereby Certify that I have read this application and stat at the above information is correct. I agree to comply with all city and County ordinances and state laws relating to building construction; and hereby authorize rebre- sentatives of this city to enter upon the above-mentioned property for inspr:ction pureQs�i�s /'I 7 Signature ////Tli / lJl /, 6.�.4n Date l -23--sr, 1- Drivers' License or SS :pp PERMNQ. v9a]r CP,_. i % I NU. LUI IVU. UN7NCy, TYPE OF CONSTRUCTION LJ NEW 0 ADD Ll ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # Zone DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: E TYPE OF PERMIT 71 GRADING El FOUNDATION 0 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ® PLUMBING ❑ MECHANICAL B Rear - - ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping, Ref. # Parking Req,/Provided Remarks: p�„� /Z / a n 4e- Planning Notes: Reinspection Fee I $15 I I Isiue Fee $ 3 CMF 0865-45, rev. 20/84 White - Building; Canary - Applicant; Pink - ACCounting, Goldenrod - Assessor ELECTRICAL Automatic Washes. Construction Pole,Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan �1 F.A.U. Fixtures Device Boxes Outlets Switches' Garbage Disposal Generator 00.5 KW ❑5.15 KW Transformer 0 15-50 KW ❑ 50 + KW Meter LJ up to 100 amps Meter Clover 100 amps Sub Panel Motors ❑0-1 HP D1%-8 Inc. Solar 09.15 HP016-115+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES Reinspection Fee E $15 1 1 Issue Fee I - $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date PLUMBING FEES Bar Sink Showers SMIP Backflow Preventer Service Sink PERMIT Backflow Irrigation Sewer Cap ISSUANCE Bathtubs Sewer Connection ENERGY P.C. Clarifiers Solar Collectors GRADING Dishwasher Solar Piping MICROFILM Drinking Fountains Solar Tank TOTAL FEE Floor Drains Swimming Poot vv/Spa Floor Sinks t Urinal Gas Service Outlets Water Closet L Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains Reinspection Fee S15 Issue Fee S 3 MECHANICAL FEES Boiler Duct - Under Ground Hood or Type I' Cl Canopy Type I I ❑ Duct - Structural Refrigeration System DO -1 00,000 BTU '0100,000 BTU Duct - Ventilating Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG # Fire Dampers Heating System & Ducting 1:10.100,000 BTU ❑ 100,000 BT Registers Reinspection Fee I $15 I I Isiue Fee $ 3 CMF 0865-45, rev. 20/84 White - Building; Canary - Applicant; Pink - ACCounting, Goldenrod - Assessor ELECTRICAL Automatic Washes. Construction Pole,Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan �1 F.A.U. Fixtures Device Boxes Outlets Switches' Garbage Disposal Generator 00.5 KW ❑5.15 KW Transformer 0 15-50 KW ❑ 50 + KW Meter LJ up to 100 amps Meter Clover 100 amps Sub Panel Motors ❑0-1 HP D1%-8 Inc. Solar 09.15 HP016-115+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES Reinspection Fee E $15 1 1 Issue Fee I - $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date PLAN CHECK 25% $ Z' O N 1 N G R E O M T S SUMMARY OF FEES BUILDING PERMIT 5 SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.C. ELECTRICAL S GRADING PLAN CHECK '50% $ MICROFILM MECHANICAL - $ TOTAL FEE PLAN CHECK 25% $ Z' O N 1 N G R E O M T S CONSTRUCTION AND PLANNING APPRdVALS Permit # Date Inspector POOL ;PA APPROVALS Permit # Date Inspector, 1. Temporary Electrical Service or Pole 52. Poo! & 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 S. Electrical UFER•Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17'. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping El Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. -Roof Framing 73. Undergrnd. Storage Tank ❑ Gas O Oil 25. Roof Sheathing 74, Overhead Hydro 26, T•Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80:' FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO, TRACT NO. LOT NO.UNIT Certifie�� is filed with the city Suilding Qlultio�J IyU. Sewer Connection Project Address 7z 1 W. 17th :ST. _Bldg. (F) Unit 6 Cooking Unit ' { Date, `� T 11 Applicant �� S $ 3 Applicant,,s Mailing Address . HO OOd, TYPE OF CONSTRUCTION NEw ADO ALTERATION 0 CONVERSION 1-1DEMOLISH ❑OTHER REPAIR r3 . t . Oxmers Name TF--,EF-Phone ; OESCRIPTION OF WORK/USE OF BLDG. Dishwasher A P 91# I AddiesS• 4,32 IF, H i rr less). I certify that in the performance of the work for which this permit is issued, 1 S Mein Building: ! Shall not employ any person In any manner s0 as to become subject to the Drinking Fountains Solar Tank ArchlEng..MaHn",J'- Rork License No. TYPE OF PERMIT LJ GRADING 0 FOUNDATION LJ STRUCTURAL Workers' Compensation taws of California. T FrOnt 125-$1- Knntt AVQ;^ Suj tr, 71 N ' ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING Q MECHANICAL Date Signature 8 Rear Address i IA ❑ 'NOTICE: If, after making this declaration, you should become subject to the Contractor's Nam I "Iv,_Phone 4$2_1221 '_� 'OTHER workers' Compensation provisions of the Labor Code, you must forthwith C Ri ht g.( 1 � _ I PROJECT DESCRIPTION SQ. FT- OCCUPANCY comply with such provisions or this permit shall be deemed revoked. It . Address (nailing) y CONSTRUCTION TYPE VALUATION 5 CONSTRUCTION LENDING AGENCY S Left City License NO_ 33925 ZONE GRADING CU.YOS. ACRES 1 hereby affirm that there is a construction lending agency for the performance Ping. Ref. LICENSED CONTRACTOR DECLARATION - of the work for which this permit is issued (Section 3097 Civ. C.) I herebyaffirm that -.1 am licensed under provisions of 'Charter 9 (commencing Remarks: - Planning Notes: with section 7000) of Division 3 of the Business an rofessions Code, and . ro license•is in full force and of 346251 Lender's Address Kitchen Sink - License class • C LI s' b. Switches OWNER BUILDER DECLARATION - Dat 1$�_SL�_� Signature PLUMBING FEES I hereby affirm that I am exempt from the Contractor's License Law for the WORKERS' COMPENSATION DEC RATION Bar Sink Showers Garbage Disposal I hereby affirm that I have a certificde of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified Copy thereof (Section county which requires a permit to construct, alter, improve, demolish or repair 1 I th 11 t f r suchermit P -Trap Laundry Trays 2274 5--- ✓i LV m 1T' + f71 1 c r I Z f Q I rAccessory1B6il8irig_„ f Parkingi Re � � I I I ELECTRICAL �- 1800, Lab. G.) Backflow Preventer Service Sink Automatic Washer Transform I - - -- ? Policy No. 1JC9824 Company Lt1IDtlE?If0i3L1S Backflow Irrigation Sewer Cap Construction Pole Sub I 8 Certified copy is hereby furnished. I C l Application Issued By Date � Certifie�� is filed with the city Suilding Qlultio�J Bathtubs Sewer Connection M Cooking Unit ' { Date, `� T 11 Applicant �� S $ 3 EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers Solar Collectors r3 Dishwasher (This section need not be completed if the permit is for one hundred ($100) or Dishwasher Soler Piping Dryers ❑Gas ❑Electric less). I certify that in the performance of the work for which this permit is issued, 1 i I + KIN ! Shall not employ any person In any manner s0 as to become subject to the Drinking Fountains Solar Tank Fan Workers' Compensation taws of California. Date Signature Floor Drains Swimming Pool w/Spa i F.A.U. 'NOTICE: If, after making this declaration, you should become subject to the 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. CONSTRUCTION LENDING AGENCY Gas Service ,Outlets Water Closet - Device Boxes 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Inierceptors Water Heater - Outlets Lender's flame . Lender's Address Kitchen Sink Water Service Switches OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Aut6-Wash Garbage Disposal following reason (Section 7031.5 Business and Professional Coda: Any city or county which requires a permit to construct, alter, improve, demolish or repair 1 I th 11 t f r suchermit P -Trap Laundry Trays Generator 00.5 KW 05.15 KW any structure, prior to its issuance, a so requ res a app can o P to file a signed statement that he/she is licensed pursuant to the provisions of Hoof 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 '031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). ❑ I as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 l led . I C l Application Issued By Date � Q M S $ 3 r3 r� 1 j FEES r50'KW i I + KIN ! Meter I-Jup td. 100;amps Meter ❑over X100 amps Sub Panel 1 1 Motors ❑0-1 HP C11 i4-'8 Inc. Solar 139-i5 HP 1116-15+ Microwave —(- Pole Light Range Sign I Standing Sections I Trash Compactor compensation, will do the work, and the structure Is not Intended or offered Reinspection Fee $15 Issue Fee for sate; (Section 7044, Business and Professional Cuda: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or Improves thereon; and who tloes such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS' employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for Such projects with a con- tractors) license pursuarit'to'the Contractor's License Law). I am aware that proof o their worker's Compensation insurance should be provided to me. r ❑ 1 am exempt under Section B. & P. C. for this reason = Date Owner I hereby, certify that I have read this application and state that the above --;,1 information is correct. I agree comply with all city and county ordinances and stat ati relng to d ng cons[ructlon, and hereby authorize repre- j sentativ s of his city b to n! r upon the above-mentioned property for inspectsn pur ores. Signator Date_7 - - Boiler ' Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ®0-100,000 BTU E) 100, 000 BT Reinspection Fee Drivers' Licyhse or SS 9. GMF 0865-46. rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Hood or Type ❑ Canopy Type I I ❑ toning Approved 13y Date Building Approved By Date Refrigeration System ❑0-100,000 BTU E1100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee Application Issued By Date SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING$ 'ISSUANCE S PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING S PLAN CHECK 50% $ MICROFILM $ MECHANICAL S 13 00 ; OTAL FEE $ PLAN CHECK 25% $ 2.502 i $ 3 CONSITRUCTION AND PLANNING APPROVALS • Permit # Date Inspector POOL SPA APPROVALS Permit # Date Inspector 1. Te.nporary 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 Testr%- 6• Electrical UFER Grnd, t ; / 57. APPROVAL TO COVER-GUNITE 7.. Footings :' 58. Electrical Conduif-Undrgrnd. 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System j 61. APPROVAL TO DECK -11. Property Sewer Line & House Con nectign 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 APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd, Storage Tank ❑ 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. Piaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas,Pipe-Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. 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 t Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY O'F`COSTA MESA CONSTRUCTION PERMIT Project Address `l/11 Z!, _11�rL• C1aST1n" M E8 Pr - Applicantk Mailing Address Owner's Name -0R1)x 1 d E S?M E A17— Phone Address Arch/Eng. License No. Address Contractor's Name 1h OR R IS ELEC.'i'R I. Phone 778 -6�S Address (mailing) 1 jk65jlAtllT S, �1->a>Jmrn3H7DN ri.�316 City License No. W— LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3_,gL the Business and Prbfesslons de, and rry license is in full force nd ewe t. License Class 1 Icense o. Date Signature WORKERS' COMPENSATION DEC(.ARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab. Policy No. lnlCSl O CI .�� ny BCertified copy is hereby furnished Certified copy is led with the cit Buil vision. Date (� f l7�- -- Applicant EXEMPTION FROM WORKE=RS' COMPENSATION 6ECLARATION (This section need not be completed If the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Coda, you must forthwith comply 'with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING'AGENCY 1 hereby affirm that there Is a construction lending agency for the performance of the work for which ,this permit is issued (Section 3097 Civ. C.) Lender's Name Lencler_'s Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 M31.5 by any applicant for a permit subjects trio applicant to a civil nelty of not more than five hundred dollars ($500). e 1, 'as ownar of the property or my employees with wages as their %*Is compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, 13uslness and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work hlmself/herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such Projects with a con- tractor(s) license pursuant*to the Contractor's License taw), I am aware that Proof o their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have rea information is corre agree to and state la r Ing buildir sentatives o thl _ ity enter inspection rP Signature Drivers' License or SS 1 I this application and state that the above comply �th all city and county ordinances g/const tion, and hereby authorize repre- /upon he above-mentioned property for / Date 1-10—&T f EfiMl i NO. I hAt:l NU. LU I Nu. UNI N�, . Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors TYPE OF CONSTRUCTION L1 NEW ADD LJ ALTERATION 0 REPAIR Solar Piping - ❑ ❑ ❑ Solar Tank CONVERSION DEMOLISH OTHER A.P. fir, DESCRIPTION OF wORK/USE OF BLDG. Urinal Gas Service Outlets " S Main Buildi Kitchen Sink E Lavatories TYPE OF PERMIT EIGRAOING ID FOUNDATION 11 STRUCTURAL T Font ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B ❑ OTHER A Rear C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION 5 S Left ZONE GRADING CU.YDS. ACRES Ping, Ref. # Remarks: Planning Notes: I ' PLUMBING I FEES i Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping - Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater , Kitchen Sink Water Service Lavatories Auto -Wash P—Trap Laundry Treys Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground i Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting Do- 100,000 BTU ❑ 100,000 BT Reinspection Fee $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 5BB7 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic washer Construction Poie Sub, Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan • ' F,A,U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW 05-15 KW Transformer ❑ 15.50 KW ❑ 50 + Kw Meter LJup to 100 amps Meter Cover 100 amps Sub Panel Motors %0-1 HP ❑ 1 h - 9 Inc.Solar 09-15 HP 016.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 4050 ,TL FEES Z O N t N G R E O M T S Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System 00.100,000 BTU E1100,000BTU SUMMARY OF FEES BUILDING PERMIT $ SMIP .$ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. S ' ELECTRICAL $ - 4-�� GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $� PLAN CHECK 25% $ System Repair/Alteration Fire Dampers Registers Issue Fee S 3 CONq-TRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL _SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. 57. APPROVAL TO COVE R-GUNITE 7. Footings 58. Electrical Conduit:Undrgrnd. 8, Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign . 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69, POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas O Oil 25. Roof Sheathing 74. Overhead Hydro 26, T -Bar Ceiling (Structural) & MonocoaL 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 17-1f� 0-0- Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, landscape Irriqation 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 e- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. Ci�Y'OF COSTA MESA CONS R CTIO ERMIT PER T NO. TRACT NO. LOT NO. UNIT NO, Py ,. 00-111-r �o}ect Address Backflow Preventer -y - -.. Automatic Washer ' Applicant's Mailing Address I TYPE OF CONSTRUCTION NEW' ADD ALTERATION -REPAIR T ,� ' Sewer Cap ss_ I ❑CONVERSION. ❑ DEMOLISH ❑ OTHER .• _ ` Bathtubs Owner's N I Phone DESCRIPTION OF WORKIUSE OF BLDG. A.P. , SUMMARY OF FEES Address A6 Sewer Connections S Mairi Building: _ -- - - - - - • - E EXEMPTION'FROM WORKERS' COMPENSATION DECLARATION Arch/Eng.- License fUo. TYPE OF PERMIT GRADING -FOUNDATION STRUCTURAL Dishwasher Font ExhausttSystem ❑ Multiple ❑ r - ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL_ ' B I certify In the performance of the work for which this permit is Issued, I $MIP Addressi , - % ,❑ r ❑ 'OTHER ' , - _ A Rear COntractoPs Nam.Lb+ 'Phone � � C Right PERMIT ' - � PROJECT DESCRIPTION SQ, FT. ° � OCCUPANCY ' Y Firepl/Fact, Bit, IGBO Address (mailing) ' ' • CON STRUCTION TYPE VALUATIONS .K S Left I = ' ISSUANCE _ City License No. �'�i _ ZONE — T GRAt]ING CU. YDS. ACRES Ping, Ref, # s Workers" Compensation provisions of he Labor Code, you must forthwith L'iCENSEO CONTRACTOR DECLARATION FIDOr Sinks ' Urinal — - -T - s - -, Fixtures ' -- I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: _ , , Planning Notes: _ with section 7000y) of Division 3 of the Business and Professions Code, and CONSTRUCTION 'LENDING AGENCY'. n Heating System & Ducting r Gas Service' DutlBFs ,�. my license is in f 1 for d effect. Device Boxes I hereby affirm that there is'a construction -lending agency for the performance' C License pass License No. Q. = I, hereby certify that bhave read application and state that the above-). of the ,work for which this permit is issued (Section 3097 Civ. C.) I ^ Date Signature11' r 1 w PLUMBING FEES Water,Heater Outlets WORKERS' COMPENSATION DE RATION , 1 f Bar Sink Shower`s ' R 1 hereby affirm that i have a Certific of consent to self -Insure or a certlficate ke s' Coensalion Insurance or a certified co thereof (Sectlon f W m Lenders+Address ' i - �3800�Lab:'C:)' -p plicant 0 1, as owner of the property, am exclusively contracting with licensed con- Backflow Preventer -y - -Service Sink - - Automatic Washer Policy No. Company Z 0 N G R E Backflow Irrigation Sewer Cap Construction Pole Sub. t HCertified copy Is hereby furnished. t , .• _ ` Bathtubs I , I i ' Certified copy is filed with the city Building Division, r , ` , SUMMARY OF FEES M T S Sewer Connections Cooking Unit Date f ' Applicant r - _ -- - - - - - • - ` EXEMPTION'FROM WORKERS' COMPENSATION DECLARATION Clarifiers Solar C011ectIrS I Dishwasher (This section need not be completed if the -permit Is for.one hundred ($100) or less). ExhausttSystem ❑ Multiple ❑ Dishwasher Solar Piping _ y Dryers ❑Gast ❑Electric I certify In the performance of the work for which this permit is Issued, I $MIP $ ' proof o their Worker's Compensation insurance should be provided to me_ ,that shall,not employ any person in any ma ner s as to become subject to the Drinking Fountains I ) Solar Tank ; _ Fan. Worker "Co EnsaUon,Laws of Califon' a., PERMIT ' , ' Date. signature } �_� - Firepl/Fact, Bit, IGBO Floor Drains' Swimming Pool vv/Spa 1 F.A.U. 'NOTICE: If, after making this deCla ti n,"you should become subject to the ISSUANCE $ Workers" Compensation provisions of he Labor Code, you must forthwith FIDOr Sinks ' Urinal — - -T - s - -, Fixtures ' -- comply with* such provisions or this- permit 'shall be ,deemed revoked. Date Owner ' CONSTRUCTION 'LENDING AGENCY'. n Heating System & Ducting r Gas Service' DutlBFs ,�. Water Closet r - - Device Boxes I hereby affirm that there is'a construction -lending agency for the performance' C $ = I, hereby certify that bhave read application and state that the above-). of the ,work for which this permit is issued (Section 3097 Civ. C.) I ^ ❑0 -100,000 -BTU ❑l100,000BT InffiYCeptDYS Water,Heater Outlets Lender's, fVame' , r R .this information is correct, 1 agree to comply with all city and county ordinances Lenders+Address ' i - Kitchen Sink' - Water Service Z Switches OWNER BUILDER DECLARATION I hereby affirm that I am -exempt from the Contractor's License Law for the GRADING 1 Lavatories ^• (- Auto -Wash and•state laws relating to building construction,, and hereby authorize repre- ; Garbage Disposal following reason (Section, 7031.5 Business and Professional Code: Any city or PLAN CHECK 50% $ county which requires a permit'to construct, alter, improve, demolish or repair it I also re Mies the a for Such permit $ p-1 raR 'Laundry Treys- S Generator ❑0 5 KW ❑5.15 K any structure, prior to s. ssuance,. q P ;to file a signed statement that he/she is licensed pursuant to the provisions of Roof.Drains , - _ , I the Contractor's License Law (Chapter 9 (commencing•with Section 7000) of r 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- )enalt_y of not more than five hundred dollars ($500). I,' as owner of the property :or, my employees with wages, as their sole I Reinspection Fee $15 1 Issue Fee i ELECTRICAL `' I FEES Transformer 0 15.50 KW , .❑ 50+KW • i Meter ❑up -to' 100 amps Meter El over 100 amps Sub Panel - r 1 ;Motors ❑0,1�HP 0 h • $ ) 'Inc. Solar,❑9;15 HP El 16-15+ '- - Microwave Pole Light Range i Sign Standing Sections W Trash Compactor , comRensation, will do the work, and the'.structure is not intended or offered - MECHANICAL Reinspection Fee $15 Issue Fee for sale (Section 7044, Business and: Professional Code: The Contractor's - i I FEES License Law does not apply to an owner of a property who builds or improves thereon, and who,does such work himself/herself or through his or her own I . DEVELOPMENT SERVICES REQUIREMENTS:' employees, provided that such improvements are not intended or offered,for Boiler_ Hood or Typei ❑ - sale. if, however, the building or improvement Is sold within one year of Com- Canopy ' Type 11 ❑ I I - i Zoning Approired By r will have the burden of proving he/she did not build or im- > Duct = Under Ground ' I ' pletion, the owner P 9 ' rove for the purpose of sale). Building Approved By ; i ' I 0 1, as owner of the property, am exclusively contracting with licensed con- Zone' ' Refrigeration System � y Ssory; MR[ ilrtg� Z 0 N G R E itis} ii Alt tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who .• _ ` Parking Req)Provided % 130A00,600BTU 0100,000 BTU 0 , SUMMARY OF FEES M T S l = ELECTRICAL `' I FEES Transformer 0 15.50 KW , .❑ 50+KW • i Meter ❑up -to' 100 amps Meter El over 100 amps Sub Panel - r 1 ;Motors ❑0,1�HP 0 h • $ ) 'Inc. Solar,❑9;15 HP El 16-15+ '- - Microwave Pole Light Range i Sign Standing Sections W Trash Compactor , comRensation, will do the work, and the'.structure is not intended or offered - MECHANICAL Reinspection Fee $15 Issue Fee for sale (Section 7044, Business and: Professional Code: The Contractor's - i I FEES License Law does not apply to an owner of a property who builds or improves thereon, and who,does such work himself/herself or through his or her own I . DEVELOPMENT SERVICES REQUIREMENTS:' employees, provided that such improvements are not intended or offered,for Boiler_ Hood or Typei ❑ - sale. if, however, the building or improvement Is sold within one year of Com- Canopy ' Type 11 ❑ I I - i Zoning Approired By r will have the burden of proving he/she did not build or im- > Duct = Under Ground ' I ' pletion, the owner P 9 ' rove for the purpose of sale). Building Approved By ; i ' I 0 1, as owner of the property, am exclusively contracting with licensed con- Duct - Structural I Refrigeration System Application Issued By Dat f tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who Duct - Ventilating 130A00,600BTU 0100,000 BTU , SUMMARY OF FEES builds or improves thereon, and contracts for such projects -with a con- _ -- - - - - -- - - •-• -- '- - _who tractor(s) license pursuarit-to the Contractor's License Law), I am aware that ExhausttSystem ❑ Multiple ❑ System Repair/Alteration - BUILDING PERMIT $ $MIP $ ' proof o 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, IGBO Fire Dampers ; - ( C) ISSUANCE $ PLUMBkNG $ -0 Date Owner ' Heating System & Ducting Registers PLAN CHECK 25% $ • .7 ENERGY P.C. $ = I, hereby certify that bhave read application and state that the above-). ❑0 -100,000 -BTU ❑l100,000BT - - -- -- .this information is correct, 1 agree to comply with all city and county ordinances r ELECTRICAL $ GRADING 1 $ and•state laws relating to building construction,, and hereby authorize repre- ; 1F PLAN CHECK 50% $ MICROFILM $ sentatives of his ity, enter upon the above-mentioned property for ' inspection purp s, r , MECHANICAL I 1 _ 1 `� ❑ r $ TOTAL FEE $ Signature Date `� - Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ Drivers' Lice or CMF 0865-46, rev. 10/84 White - Building; a , t; Pink - Accounting,, Goldenrod - Assessor 1 - �.-..�+.�./ y.�J..:_..�ti_.'_'�.,.wn�i.r.�.. _ �.Ye ..A:.^-.�-�.�.w.�+f..r-+-�� +.�+-r.r!T•..-. �-.i-/ CONSTRUCTION ANb PLANNING APPROVALS. Permit +_ .. Date Inspe r `. POOL'& _eA APPROVALS Permit # Date = " Inspector 1. Tempofary Electrical Service or Pole' `� 52. Pool & Equipment Location 2. Soil Pipe Undrgrnd. ��f., - �`T 53:-'SteeI-Reinforcement' 3 ;Electrical Cond itri� ility-Undrgrd dJ 54. Forms 4, ElecirI Conduit Undrgrnd. +t 55. Electrical Bonding X51 l.R6nforceent� =. ;:-.�...:- � :: / m l (- r.. n =.ri' ->,. ,,! y rte. `66:-'AoeeghPlurnbing &Presseere'TeSt' 6Jtlectrical UFER Grrid. y - ^► r i 57. APPROVAL TO COVER-GUNITE !� 7�rFgntiiig5 58. Electrical Conduit-Undrgrnd, = 8.Foundation 59. Gas Pipe, ❑Undrgrnd., Test f f1 8:,,warier'_�lPe•Uttargritd. ? 60. Ww*h Linn. P•Tre , 0 Urdrwnd. v I'5t* uctural Floor System j 61. APPROVAL TO DECK _. � 11. Pro'perr Sewer Line &• House Cir n fiction 62. Backwash & Receptor -Final 12. Sev7 CIp CIL- i 63. Heater & Vent -Final 13. Roof Dr ins ��f {' 64. Plumbing System - Final � 14. Rough Plumbing s 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. POO USPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning -or FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27, Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air. Conditioning 35. Final Gas Pipe -Test -rj. s' 4!� 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 09. Water Service -Final .40. Gas Service -Final 41. Solar Dornestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44, .Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING _ 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA.ME NSTR UC39N PERMIT Project Address PER N�„;o �� Tim=%�� LOT NO. uI�T NO ---- /� Applicant's Mailing Address 7M,_!;, Owner's Name V �1Jf)Phone 7nl-k66 ir Address Sf acf� ' Arch/Eng, License No. ('16-4Z 2 Address rglyd.Z - C Contractor's Nam Phone Address(mailing) Lld-0C &. City License No. LICENSED CONTRACTOR DECLARATION I,hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) -of Division 3 of the Business and Profession$ Code, and my license is in full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' C/Lo'm:pp�enMMsationi` i//ntsurance, or a certified copy thereof (Section-, Policy No. .0 U-.•31 _4?!,J L( Company BCertified copy is hereby furnished. Cer fled opy i fr`Ied with the city 6w Date-, 'T 3 -1W1, Applicant - EX EMPTION pplicant EXEMPTION FROM WORKERS' , COMPENSATION -DECLARATION - (This section need not be completed if the permit is for one•hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, You must fortnwitn comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for'the performance of the work ,_; i this permit � sue (Se Io V 097 Clv, C.) Lender's Name /:uy Lender's Address c ri --rte• % Q+'u _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, atter, improve, demolish or repair any structure, prior to its issuance, also requires, the applicant for such permlt to file a Signed statement that he/she is licensod pursuant to the provisions of 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 '031.5 by any applicant for a permit subjects the applicant to a civil ' IMally of not more than five hundred dollars ($500). 1,' as owner of the property or my employees with wages as their sole Compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale, if, however, the building or improvement Is sold within one year of Com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: ' The Contractor's License Law does not apply to an owner.of property, who builds or improves thereon, and who Contracts for such projects with a con- tractor($) 11Cense pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ ,I am exempt under Section i B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state at the above information is correct, I agree to comply with all city and county ordinances and state laws relating [o building construction, and hereby authorize repre- sentatives of, this city' t, nter upon t e above-mentioned property 'for inspection pur s. Signature A .-� Drivers' License or SS -* 0160 7/25/96 8.00 TL TYPE OF CONSTRUCTION NEW ADD ALTERATION I ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORKIUSE OF BLDG. I REPAIR A P #, Zone S Main Building: Accessory Building: TYPE OF PERMIT ' GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ® PLUMBING ❑ MECHANICAL ❑ ,OTHER T Front' Z. B A Rear N PROJECT DESCRIPTION SQ. FT.11 OCCUPANCY 1 CONSTRUCTION TYPE VALUATION 5 ZONE GRADING CU.YDS- ACRES C Right N S Left _ G R Ping. Ref. # Parking Req./Provided E Remarks:rel-/�1 3U 9S---. Planning Notes: non T S' PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Pole Sub- Transformer ❑ 15-50 KW 0 50 + KW 1 Backflow Irrigation Sewer CapConstruction Bathtubs Sewer Connection Cooking�: Unit Meter ❑up to 100 amps Clarifiers - Solar Collectors - - Dishwasher - Meter Dover 100 amps _ Dishwasher Solar Piping Dryers C]Gas 'ElElectric Sub Panel r Drinking Fountains Solar Tank • Fan r' Motors ❑0-1 HP Q 1'/, - 8 Floor Drains Swimming Pool w/Spa F•A.U. Inc. Solar ❑9-15 HP ❑ 16-15+ Floor Sinks Urinal ' Fixtures' Microwave Gas Service Outlets Water Closet Device Boxes Poie Light Interceptors 'Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal 9 p Standing Sections P -Trap Laundry Trays Generator ❑0.5 KWE15-15 KW Trash Compactor . Roof Drains Reinspection Fee', $15 issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Hood or, Typ e I ❑ - Canopy Type II ❑ - DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By • Application IssuedlBy , Date Date Date _ Duct - Under Ground Duct - Structural Refrigeration System E10-100,000BTU 0100,000BTU Duct - Ventilating SUMMARY BUILDING,PERMIT $ PLUMBING $ PLAN CHECK $ t PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK ,25% $ OF FEES SMIP $ PERMIT ISSUANCE $ --y_if V I ENERGY P.C. $ GRADING $ MICROFILM S TOTAL FEE $ Exhaust System ❑ Multiple ❑System Repair/Alteration Firep1lFact, Bit, ICBO•# Fire Dampers Heating System &Ducting ❑0-100,000 BTU 1:11 od,0,00 BT Registers , Reinspection Fee $15 Issue Fee P 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL L A APPROVALS Permit # Date Inspector 1 . Temporary Electrical Service or Pole , 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms ` 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding ` 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd, 8.' -Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water, Pipe-Undrgrnd. _' 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK '11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final N 12. Sewer Cap 63. Heater & Vent -Final 1 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 APPROVALS Permit # 20: Rough Factory Fireplace 21. 'Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. ,Underground Flush 24.. Roof Framing 73. Undergrnd, Storage Tank D 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT "31. Plaster Brown Coat 79. FINAL INSPECTION 32' Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing -*Pic 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 j 46. Handicap Regulations a 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co o51. CERTIFICATE OF OCCUPANCY No. Date T Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY 0* 'COSTA MESA CONSTRUCTION PERMIT PERMIT NO. -�7 TRACT NO. LOT NO. UNIT.NO.- Proil ct Address 7 L1 W• L Z ST. +� aS i r f �' f Applicant's Mailing Address Own@r's Name 'rRIDY 1IJuEST me nJT Phone Address Arch/Eng.. -License No. Address Contractor's Nom. I^l DRe Is -- FZLFC t l2 i -C- Phone 77-6 Address imai Iing)1� •F3�Y Af+ , i`� J3[CTmlr4? � t1d 16 City License No. _ RZ 9 O _ LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing With section 7000) of Division 3 of uslness and ro�1. ons Code, and my license is in full force and 01fec . License Class ' Id Lice No`s 1 Date Signature WORKERS' COMPENSATION Dfc'CLARATION ' I hereby affirm that I have a certificate of consent tb self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (SOCtldn 3800, lab. C.) _ Policy No. �w1C S1 Or1 ?_7_0 _ Company SELF r~. 8 Certified copy Is hereby furnished. Certified copy filed with the city uitd 9_" Ision, C Date- i�fdr�f� Applicant_ EXEMPTION FROM WORKERS' COMP NSATIDN ECLARATION (This section need not be completed if the permit is for one hundred ($100) or loss). I certify that In the performance of the work for which this permit is Issued I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. ' Date Signature -NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you Must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I her@by affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 - Civ. C.) Lender's Name Lander's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License taw for the following reason (Section 7031.5 Business and Professional Code: Any city or courlty which requires a permit to construct, alter, improve, demolish,or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing'wlth.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 1031.-5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). J I, as owner of the properly or my employees with wages as their sole compensatlon, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Codo: The Contractor's p License Law does not aply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale, It, however, the building or improvement Is sold within one year of com- pletion, the owner wiil have the burden of proving he/She did not build or im- prove for the purpose of sale). ❑ t, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractorsi I%unse pursuant'to the Contractor's License Law). I am aware that Proof of their Worker's Compensation insurance should be provided to me. 0 I -am exempt under Section B. & P. C. for this reason Date Owner I h@reby certify that 1 have read this appllc on and state that the above Information is correct. I agree to comply wit 11 city and county ordinances and state law in building co true n, and hereby authorize repre- sentatives othis y enter up n [ above-mentioned property for Inspection purpose Signature Date Drivers' Licen or SS 5888 1/16/85 Lo5p TL TYPE OF CDNSTRUCTION ' LJ NEW LJ ADD LJ ALTERATION L) REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A,p, 4, zone DESCRIPTION OF WORK/USE OF BLDG. $ Main Building: Accessory Building: TYPE OF PERMIT GRADING 11 FOUNDATION EFSTRUCTURAL I- Front ZD ❑ TENANT El ELECTRICAL. El PLUMBING El MECHANICAL B Reer N ❑ OTHER - A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N CON STRUCTION TYPE VALUATION $ S G Left R ZONE GRADING CU. YDS. ACRES Ping. Ref. -# Parking Req./Provided E Remarks: Planning Notes: O M T _a S FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Pale Sub. Transformer ❑ 15.50 KW El 50 + KW Backflow Irrigation Sewer CapConstruction Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter El over )00 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan , Motors X0.1 HP ❑ 1:4 - 8 1 U Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal 9 q ! Standing Sections P—T rap Laundry Trays Generator ❑45 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee ' $ 3 Boiler Duct - Under�Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting ❑4100,000 BTU ❑ 100,000 BTI Reinspliction Fee 1 $15 CMF 0865-46, rev. 10184 White - Building; .nary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type I ❑ Canopy Type It ❑ Refrigeration System ❑4100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES Reinspection Fee I S15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date T Application Issued By Dat SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% S ENERGY P.C. S ELECTRICAL $ GRADING $ PLAN CHECK 50% $ ` MICROFILM $ MECHANICAL 'S TOTAL FEE $ PLAN CHECK 25% $ S 3 "CONSTRUCTION AND PLANNING APPROVALS Permit # _.• _ Date Inspector POOL ,-- _PA APPROVALS Permit # Date Inspecinr 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd.. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59, Gas Pipe, 0 Undrgrnd., Test 9.. Water.Pipe-Undrgrnd- 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. -Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 C?e Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or"Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46, Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date _. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO r 1 r TRACT Nd. LOT Nd. UNfN�, Project Address Ill w. 17th st- h1r10-9f0 ileit Applicant's Mailing Address ii i 1 1 n Sati C0)Z St- N__ Hol 1 3r ea -ad s Owner's'Name Troy Inyestmiaht Fuel_ Phone. 549-2988 Address, 4321Ri rrh St - Nelrmnrt Rear hs Ca- Arch/Eng. a-Arch/Eng., Marin J_ Rock) License No. Address 19881 Kitt Av-Sid t -p 216 _ Contractor's Name Tlttrn Air COndiLiQ17ing_Phone 982-1216 Addresslmailing) 1311f) SatiSr- N .Hal lywnnd,Ca- City License No. 3 N 2 5 LICENSED CONTRACTOR DECLARATION 1 hereby affirm that -.1 am licensed under provisions of Charter 9*(commencing with section 7000) of Division 3 of the Business and Pr ssions Code, and my license is in full fo_fce and effec 0 346251 License Class C Lice e o Date 4.1 19,184- Signature WORKERS' COMPENSATION DVcce, ATION I hereby affirm that I have a certif consent to setf-insure or a Certificate , of Workers' Compensation Insuor a certified copy thereof (Section 3800, Lab, c,) Policy No. Company WC9824 Lumbermans Policy 8 Certified copy is hereby furnished. Certified co y is filed with the city Building Di Date— -1- -- Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued I shall not employ any person in any manner so as to become subject to t6 Workers' Compensation Laws of California. Date Signature NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith, comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby'afflrm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county whiCh requires a permit to Construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption, Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil )enalty of not more than five hundred dollars ($500). ❑ I, as owner of tate property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale: (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. 11, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- Vrave for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 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 proof of their Worker's Compensation insurance should be provided to me. L7 I am exempt under Section B. & P. C. for this reason Date Owner 1 hereby certify that i have reap information is correct. I agree t and state I relating to bui it sentativhis city to ter insoectiaaaaaafifififififi pur ores. Is application and state that the above-- rplmy with all city and county ordinances struction, and hereby authorize repre- on the above-mentioned.;.00erty fpoyrr�i Date ! 6`"r. TYPE OF CONSTRUCTION LJ NEW LI ADD L_J ALTERATION L..-1 REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. DESCRIPTION OF WORK/USE OF SLOG. " S Main Building: TYPE OF PERMIT GRADING 0 FOUNDATION LJ STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING E� MECHANICAL B ❑Rear OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATIONS S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 0100,000 BTU 0 100,000 BT I Drivers' Lic se or SS IReinspection Fee 1 $15 M moor . . CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type I ❑ Canopy Type II ❑ Refrigeration System ❑Q100,000 BTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES 2275 -5/93/85- :--711-5o50', T �-F w4 t Cooking Unit Meter ❑up to 100Famps I r rr rr f r ? Dryers ❑Gas ❑Electric Sub Panel I ! , Fan Motors 00.1 HP ❑ 115 - B j L I Q Zone! r I r- AccessoryrBuiidi6g:,j ; "7 Device Boxes Pole Light rr = 5 ? $15 Issue Fee Z Garbage Disposal ; Standing Sections Generator ❑0-5 KW 05-15 KW I Trash Compactor FEES N I �' Z. r N BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ S $ $ $ $ 13.01 $ 2.50 lir 15.50 1 I r- r G R) Parking'Req./Provided E',� t I j I J Q M I iF T S ELECTRICAL ` FEES Automatic Washer 'Trarisforrtier ❑-V$ 50 -KW Construction Pole Sub, ILI 50 + KW I � t Cooking Unit Meter ❑up to 100Famps Dishwasher Meter ❑ove_r_,100amps _ Dryers ❑Gas ❑Electric Sub Panel I ! , Fan Motors 00.1 HP ❑ 115 - B j i F.A.U. Inc. Solar 09.15 HP El 16.15+ Fixtures Microwave - 4"-- - — Device Boxes Pole Light Outlets Range $15 Issue Fee Switches Sign Garbage Disposal ; Standing Sections Generator ❑0-5 KW 05-15 KW I Trash Compactor t i $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date Dat } Z BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ S $ $ $ $ 13.01 $ 2.50 SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ 15.50 1 $ 3 ' CONSTRUCTION AND PLANNING : APPROVALS - Permit # Date Inspector' POOL ` _PA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding { 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings d 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 , f 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 j6,. 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 APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25, Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coal 79. FINAL INSPECTION 32, Eiectrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning �•/ �7 i� 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51, CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border tines and sign all appropriate declarations. CITY OF COSTA MEA CONST��CT�ON PERMIT PEPT _ 1 7 �3 T�a1� N° LOT NO. u Ni 1 j V! f" ,(� G r Protect Address Applicant's Mailing Addressrnr'" !' 4 Owner's Name� 1/ hone Address _;J c h �� • 4&4L/19- — Arch/Eng.—IW--L - License No. Address Contractor's Name Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION )ereby affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section _doo, tab. C.) �} Policy No. Company [51li�ricr �J", H Certified copy Is hereby furnished. Certified cop Is filed with the city Building Division. Date — 9Applicant;T Yr/�/.'�C ZWL/l i - 2 EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit'is for one hundred (5100) or less)- I certify that in the performance of the work for which this permit is Issued I shall not employ any person in any manner so as to become subject to tie Workers' Compensation Laws Of California. OatO Signature NOTICE: If, after making this declaration, you should become subject t0 the Workers' CompenSation provisions of the Labor Code, you must forthw(th comply With such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work fortt, this er it is issued (Se lion�3097 Civ. C_.) Lender's Name "C! - LJN Lender's Address C �� OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish Or repair any structure, prior to Its issuance, also requires the applicant for such permit to file asigned statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter -9 (commencing with Section 7000) of �iv)sion 3 of the Business and Professions Code) or that hEjBhe is exempt Irefrom and the basis for the alleged exemption. Any violation of Section J31.5 by any applicant for a permit subjects the applicant to a civil alty of not more than five hundred dollars (5500). en f, as owner of the property' or my employees with wages as their sole coropensatlon. Will do the work, and the structure is not Intended or Offered for sale (Section 7044, Business and professional Code: The Contractor's 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 employees, Provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- ' tractors to construct the proiect (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an.owner of property who builds or improves thereon, and who contracts for Such projects with a con- tractors) 11cense pursuant'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance Should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date — Owner _ 1 hereby certify that I have read this app)icatlon and stat that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- Sentatives Of this city to enter upon the above-mentioned property for inspection purpose Signatui Aw Date I Drivers' License or SS jF 8161 7/25/86 TYPE OF CONSTRUCTION L1 NEW L-1 ADD L.J ALTERATION LJ REPAIR ❑ CONVERSION . ❑ DEMOLISH ❑ OTHER _ — A.P. Zone DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ® PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT, OCCUPANCY C Right K li CONSTRUCTION TYPE VALUATION S S I Left ZONE GRADING CU.YDS. ACRES Ping. Ref. Oji`- Parking Req./Provided Remarks: er �Y},' 2/1 �� Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee PLUMBING Showers Service Sink Sewer Gap Sewer Connection - Salar.Collectors . - Solar Piping Solar Tank Swimming Pool w/Spa FEES Outlets z Water Closet Water Heater Water Service Auto -Wash Laundry Treys 515 Issue Fee $ 3 MECHANICAL FEES Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 00-100,000 BTU 1:1100,000 BT Reinspection Fee 1 $15 65-46, rev. 10/84 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor Hood or Type I ❑ Canopy Typell ❑ Refrigeration System ❑0.100,000 BTU ❑ 100,000 B System Repair/Alteration Fire Dampers Registers Issue Fee I S 3 ELECTRICAL Automatic Washir Construction PbliSub. Cooking Unit d ' Dishwasher Dryers ❑Gas -0E Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Dispdsal Generator 00-5 KW Reinspection Fee lectric 5-15 KW 515 Transformer ❑ 15-50 KW , ❑ 50+KW Meter Ljup to 100 amps Meter ❑over 100 amps Sub Panel Motors❑I}1 HP [31y'.8 Inc. Solar 09-15 HP 1:116.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor Issue Fee 8.80 TL FEES S 3 Z O N 1 N G R E Q M T S DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved Byr/ Data Application Issued By � Date _—Q SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING gISSUANCE � $ PLAN CHECK 25% $ � ENERGY P.C.. $ ELECTRICAL $ GRADING S PLAN CHECK 50% $ j MICROFILM ? $ t MECHANICAL S TOTAL FEE PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POO 3PA APPROVALS Permit # Date Inspector 1.. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2., Soil Pipe-Undrgrnd, 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 5B. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, © Undrgrnd., Test 9.,Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 1B. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22,.,Ducts, Ventilating ` 71. Product Piping © Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 7B. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31 Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80%FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy r 37. Final Factory Fireplace 38. Final Plumbing a' fhi �l 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 4 43, Backflow Irrigation '. 44. Landscape Irrigation System 45. Sound Attenuation r 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co s 51. CERTIFICATE OF OCCUPANCY No. Date _n with section 7000) of Division 3 of the Business and Professions Code, and my license is in f fort an effect. Llcen Class— _License No d pat Signator WORKERS' COMPENSATION ECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or_a certified copy thereof (Section 3800, Lab. C.) Policy No. Company ' Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date -- Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the -permit is for one hundred ($100) or loss). I certify that in the performance of the work for which this permit i5 issued I shall not employ any person In any manner 5 as to become subject to the WOrke Co o.n�s['r��yy.i,—�JL�'.ws of Cali ra. Signature 'NOT.ICEt If, after making this declar on, fou should became Subject to the Workers% Compensation provisions the Labor Code, you must forthwith , comply with such provisions or is permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ, C.) Lender's Name T Lender's AddreSt _ - - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which r@quires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 1031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500), ❑ I, as owner of the property or my-omptoyees with wages as their sole compensatlon, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that Such improvement$ are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, tho owner will nave trio burden Of proving he/she did not build or im. rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s1 license pursuarit'to the Contractor's License Law). I am aware that proof a their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section e. & P. C. for this reason ' Date _ Owner I hereby certify that I have read this application and state that the above Information Is Correct. l agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentative$ of this city enter upon the above-mentloned roperty or Inspection pu s- pate Signature r)rivers' Licsikse nr SS =9 CMF 0865-46, rev. 10/84 W Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations, CITY�OF COSTA MESA CONSTRUCT ON URMIT PE IT NO. TRACT NO. LOT NO, UNIT NO. Bathtubs Project Address Clarifiers Dishwasher Solar Piping Drinking Fountains Floor Drains Solar Tank Swimming Pool w/Spa ' Applicant's Mailing Address Urinal - TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑,CONVERSION ❑ DEMOLISH ❑ OTHER Water Closet Water Heater Water Service Auto -Wash P—Trap Owner's Name P ne DESCRIPTION OF WORK/USE OF BLDG. A. P. + Pole Light Range Sign I ; Standing Sections Reinspection Fee $15 Address + S Main Building: $ 3 E ArchlEng, License No. TYPE OF PERMIT 11 GRADING 0 FOUNDATION STRUCTURAL ❑ ❑ ❑ PLUMBING ❑ MECHANICAL T B Front DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved sy Application Issued By Address Contractor's Na a. r* TENANT ELECTRICAL ❑ TOTHER 'a' C Rear Phone7T z-?7U,(s� Right PROJECT DESCRIPTION SD. FT. OCCUPANCY K Address imailing) CONSYRUCTlON TYPE VALUATION $ S Left 11.1 City License No. 2s` ' ZONE GRADING CU.YDS. ACRES Ping, Ref. . _ LICEN5EO CONTRACTOR DECLARATION I hereby affirm that t am licensed under proviSlons of Charter 9 (commencing Remarks: Planning Notes: with section 7000) of Division 3 of the Business and Professions Code, and my license is in f fort an effect. Llcen Class— _License No d pat Signator WORKERS' COMPENSATION ECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or_a certified copy thereof (Section 3800, Lab. C.) Policy No. Company ' Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date -- Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the -permit is for one hundred ($100) or loss). I certify that in the performance of the work for which this permit i5 issued I shall not employ any person In any manner 5 as to become subject to the WOrke Co o.n�s['r��yy.i,—�JL�'.ws of Cali ra. Signature 'NOT.ICEt If, after making this declar on, fou should became Subject to the Workers% Compensation provisions the Labor Code, you must forthwith , comply with such provisions or is permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ, C.) Lender's Name T Lender's AddreSt _ - - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which r@quires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 1031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500), ❑ I, as owner of the property or my-omptoyees with wages as their sole compensatlon, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that Such improvement$ are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, tho owner will nave trio burden Of proving he/she did not build or im. rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s1 license pursuarit'to the Contractor's License Law). I am aware that proof a their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section e. & P. C. for this reason ' Date _ Owner I hereby certify that I have read this application and state that the above Information Is Correct. l agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentative$ of this city enter upon the above-mentloned roperty or Inspection pu s- pate Signature r)rivers' Licsikse nr SS =9 CMF 0865-46, rev. 10/84 W Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firept/Fact. Bit. ICBO 7W Heating System & Ducting ❑ 0- 100,000 BTU ❑ 100,000 BTL Reinspection Fee ' 1 515 nt: Pink - Accounting; Goldenrod - Assessor ANICAL Hood or Type I ❑ Canopy Type II ❑ Refrigeration System 00-100.000BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee OP f17 /.9Zone n ar+ Accessory Building: O Z 7N N G R_ Parking Req./Provided E O M T S FEES PLUMBING Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Floor Drains Solar Tank Swimming Pool w/Spa Floor Sinks Urinal - Gas Service Outlets Interceptors I Kitchen Sink Lavatories Water Closet Water Heater Water Service Auto -Wash P—Trap Laundry Trays Roof Drains Z i Pole Light Range Sign I ; Standing Sections Reinspection Fee $15 Issue Fee Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firept/Fact. Bit. ICBO 7W Heating System & Ducting ❑ 0- 100,000 BTU ❑ 100,000 BTL Reinspection Fee ' 1 515 nt: Pink - Accounting; Goldenrod - Assessor ANICAL Hood or Type I ❑ Canopy Type II ❑ Refrigeration System 00-100.000BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee OP f17 /.9Zone n ar+ Accessory Building: O Z 7N N G R_ Parking Req./Provided E O M T S FEES ELECTRICAL FEES — Automatic Washe)', Construction Poli _sub. Te=ansfbrmer ❑ 15-50 KW ❑ 50+KW z � Cooking Unit « " Meter ❑up to 100 amps Dishwasher Meter El over 100 amps Dryers ❑Gas ,©Etectric Sub Panel Fan F.A.U. Motors ❑O-1 HP 0 fi - 8 Inc. Solar,09-15 HP 016-15+ Fixtures Microwave Z Device Boxes Outlets Switches Garbage Disposal Pole Light Range Sign I ; Standing Sections Generator El 0-5 KW 05-15 KW Trash Compactor $ 3 Reinspection Fee 515 Issue Fee.. $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved sy Application Issued By No Date Date -711 _ Data BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ SUMMARY OF FEES SMIP $ PERMIT 0� ISSUANCE $ _ I ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # A Date Inspector - POOL . ?A APPROVALS Permit # Date Inspecsnr 1. TempoFary Electrical Service or Pole , J 52. Pool & Equipment Location 2. SoilPipe-Undrgrndy . J- fn �n r 53. Steel Reinforcement/Jr a eElecy�cal� Conduitj'L tili y-Undrgrnd. 54, Forms 4Electicap Cond -Cod grnd. 55. Electrical Bonding 5�Steel�R&inforcern2ntt j J 56. Rough Plumbing & Pressure Test _ 6•; Electrics{ UFER�Grnd. �' rn n ; 57. APPROVAL TO COVER-GUNITE F�o`irigs, ✓� 58. Electrical Conduit-Undrgrnd. 'r 8: Foundation ';�j A,r1R hwf� ws �� 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water`Pipa Undrgrnd. i; 60. Backwash Lines, P-Trap; ❑ Undrgrnd. 10JStructu al Floor System ` 1� 61. APPROVAL TO DECK v 11t.'Proper'ry Sewer Line1& House C6nnectian li / , „ t 62. Backwash & Receptor-Final n .12. Sewer Cap :� 63. Heater & Vent-Final 13. Ro Vf rains A 64. Plumbing System -Final , 14, R6u gh,Plumbingj{ 65. Electrical Final YJ 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35, Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39: Water Service-Final 40. Gas Service-Final 141, Solar Domestic-Final .42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51, CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations, MEMO CITY OF COSTA MESA CONSTRUCTION PERMIT PERMlT NO TRgCT NO LOT NO UNIT N Project- Address . 711 W 17th St. Bldg. M Unit 8 Applicant's Mailing Address H 1l OOd , Owner's Name Troy TnVegtmant Fond Phone 549-2989 Address _—(FN] . irch Ct -- Newipart-BeArb, Ca,. Arch/Eng. fir+^U T—License No. Address 1.2$$1 Vime t-f-AveI G.LI]_f P 21 6 – Contractor's Name_Dug0_}1,1,.r__JConditiQZl. -g,--Phone __C182_–__L21_6 Address imailing) 131 1 fl1 1 gn f-4 any City License No.---vu-9?5 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provislonsof Charter 9 (commencing with section 7000) of Division 3 of the Business 4.14 otesslons Code, and my license is in full force and effe License Class 20 Llc 346251 Date 418184 Signature WORKERS' COMPENSATION DEC RATIO t hereby affirm that I have a certific a of consent to self -insure or a certificate of Workers' Compensation Insura ce, or a certified copy thereof (Section 3800, Lab. C.) Policy No. WC9824 Company Lumbermans BCertified copy is hereby furnished. Certifiee� p is filed with the city Buildirla��rrvisi Date J ' Applicant r ; EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performanco of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature •NOTICE: If, atter making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with Such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY _ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor'$ License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, Prior to Its Issuance, also requires the applicant for such permit to file a signed Statement that he/she Is licensed pursuant to the provisions of 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 031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). ❑ 1, as owner of the properly or my employees with wages as their sole compensation, will do the work, and the Structure is not intended or offered for sale (Section 7044, Business and professional Code: The Contractor's 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 employees, provided that Such Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of Com- ptetion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who 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 proof oft their Worker's Compensation Insurance should be provided to me, ❑ 1 am exempt under Section B. a P. C. for this reason Date Owner 1 hereby certify that I have read information correct. I agree to and state s elating to buildi _ so tatives of t is city to en r inspection ur ses. Signature Drivers' Lice#fe or 55 :IF s application and state that the above-. my with all city and county ordinances i$tructiorl, and hereby authorize repre- n the above-mentioned property for [ Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P–Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG 20 Heating System & Ducting I ED0-100,000 B T u ❑ 100,000 BTi Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor ABING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee IANICAL Hood or Type ❑ Canopy Type II ❑ Refrigeration System 00.1100,000BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES S 3 FEES $ 3 2276 5/43/85 15.50 TL Zone. Accessory Building;` Z – O N i G I R; Perking' Req./Provided E'- 1 – M i i T S I ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas CElectric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 05.15 KW - Tonsforrner`ID-15=50-KW 7 ID 50+KW Meter Elup to 100;amps Meter ©over 100 amps Sub Panel I Motors 00-1 HP ❑ 1'h - B Inc. Solar ❑9-15 HP El 16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES i I I Reinspection Fee 1 $15 11 1 Issue Fee I S 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ ❑ ❑ Application Issued By---__ _ _ CONVERSION DEMOLISH OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. SUMMARY OF FEES I BUILDING PERMIT S SMIP S Main Building: S PERMIT E PLUMBING TYPE OF PERMIT GRADING1:1 FOUNDATION 0 STRUCTURAL T Front ❑ TENANT 1-1ELECTRICAL ❑ PLUMBING E MECHANICAL B S ❑ OTHER $ I A Rear MICROFILM S C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K S CONSTRUCTION TYPE VALUATION 3 S Left ZONE GRADING CU.YD5. ACRES Ptng. Ref. 516 Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P–Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG 20 Heating System & Ducting I ED0-100,000 B T u ❑ 100,000 BTi Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor ABING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee IANICAL Hood or Type ❑ Canopy Type II ❑ Refrigeration System 00.1100,000BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES S 3 FEES $ 3 2276 5/43/85 15.50 TL Zone. Accessory Building;` Z – O N i G I R; Perking' Req./Provided E'- 1 – M i i T S I ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas CElectric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 05.15 KW - Tonsforrner`ID-15=50-KW 7 ID 50+KW Meter Elup to 100;amps Meter ©over 100 amps Sub Panel I Motors 00-1 HP ❑ 1'h - B Inc. Solar ❑9-15 HP El 16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES i I I Reinspection Fee 1 $15 11 1 Issue Fee I S 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By---__ _ _ —DataZ SUMMARY OF FEES I BUILDING PERMIT S SMIP $ 1 PLAN CHECK S PERMIT I PLUMBING S ISSUANCE $ PLAN CHECK 25% S ENERGY P.C. S ELECTRICAL S GRADING $ I PLAN CHECK 5096 $ MICROFILM S 13.00 k IS MECHANICAL S TOTAL FEE S •S� _ T PLAN CHECK 25% $ 2.50 CONSTRUCTION AND PLANNING APPROVALS - Permit =#;- Date Inspector POOL 6PA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location � J 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms. 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding , 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. i �1� 57. APPROVAL TO COVE R-GUNITE 7. Footings 58. Electrical Conduif-Undrgrnd. ' 8: Foundalion ` . 59. Gas Pipe, ❑ Undrgrnd., Test %, 9. Water Pipe=Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 1.0. 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. POO USPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS. Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ 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 PREY, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning V0La% !� 35, Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY, No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. Cl7Y Uf' COSTA MASA CONSTRUCTION PERMIT PERT NO. TRACT NO: LOT NO. -UNlf NO. --rLi i Project Address j C ° E � - Applicant's Mailing Address Owner's Name � `� I YJ V RI -SI— r1 E Phone Address Arch/Eng. License No. Address / Contractor's Name Y U 1. Q I-� C-1- C- C-7jR 1 C_ Phone-b�� Address (mailing) LI�� RRYAAYT ST. �iyrn ),067bA) /s4o)b City License No. 3a LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of thea sines and Profess. ns Code, and my license is in full force and effect. License Class ID Licens No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof_ (Section 3800, Policy No. wC`1 )C1 Ci ;R Co n SE LG,C.T S BCertified copy is hereby furnished. i Certified copyois f'fed with the city uil vision Date r Applicant EXEMPTION FROM WORKERS' COMPENSATION 6ECLARATION (This section need not be completed if the permit is for:one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not. employ any person in any manner so as to become subject to the Workers' Compensation Laws of California., Date Signature 'NOTICE: If, after making this declaration, you should -become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit ,shall' be deemed revoked. CONSTRUCTION LENDING'AGENCY - - I hereby affirm that there is a construction lending agency for the performance ofthe work for which this permit is issued (Section .3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby'affirm that I am-ex'empt from the Contractor's License Law for the following reason (Section- 7031.5 Business and Professional Code: Any city or ' county which requires a permit to construct, alter, improve, demolish or repair ,any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with -Section 7000) of - Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit -subjects the applicant - to a civil penalty of not more than five hundred dollars ($500). , ❑ I, "as owner of the property or my. employees with, wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The. Contractor's 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 employees, provided that such improvements are'not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not bull(] or im- prove for the purpose of, sale), ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 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 proof of their Worker's Compensation insurance should be provided to me. , ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby+ certify that 1 have read this -a information is c gree to comply and state laws elat t0 building oust sentatives of his i t enter Pon inspection p Signature Drivers' License or S 4, ration and state -that the above i all city and county ordinances on, and hereby authorize repre- above-mentioned property for r Date I C•` �� i TYPE'OFCONST 01 I NF1 NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER- A.P. # - DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T. Front ❑ TENANT ❑ELECTRICAL ❑PLUMBING El MECHANICAL B Rear ❑ BOTHER A PROJECT DESCRIPTION SQ. FT. ,OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS: ACRES-' Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑ 0-100,000 B T U - ❑ 100;000 BT' Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection k Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash . - Laundry Trays Issue Fee Hood or Type ❑ Canopy Type I I • ❑ FEES Refrigeration System ❑0-100,000 BTU E1100,000BTU System Repair/Alteration Fire Dampers�� Registers Issue Fee 1 $ 3 Automatic Washer 5889 1/+6185 1 Accessory Building: I Parking Req./Provided a 4'50 T1 Zone Z O N . I N G R E Q M T S ELECTRICAL Transformer ❑ 15-50 KW Construction Pe Sub. ❑ 50 + KW Cooking Unit Dishwasher Dryers ❑Gas❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5KW El 5-15 KW Meter EI up to 100 amps Meter ❑over 100 amps Sub Panel MotorsNO-1 HP 1:11 fS - 8 Ine.Solar 09-15 HP ❑16-15+ Microwave Pole Light Range Sign ; Standing Sections Trash Compactor FEES Reinspection Fee $15 I Issue Fee , $ 3 DEVELOPMENT SERVICES. REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.0 ELECTRICAL $ `i C.yCJ GRADING PLAN CHECK 50-A S i MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% S ' CONSTRUCTION AND PLANNING APPROVALS Permit # • Date Inspector POOL & SPA 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 1 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings -58. Electrical Conduit-Undrgrnd, B. Foundation 59, Gas Pipe, ❑ Undrgrnd., Test 9. Water'Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10, Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13, Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15, Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 HEALTHbEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric �� Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. 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 I\o. Date Applicant to fill in all spzJes within heavy border lines and sign all appropriate declarations1l �! CITY OF COSTA MESA PER rT NO. CONSTRUCTION PERMIT TRACT NO. LOT NO. BLDG. N Project Address (J !1+SV, TYPE OF CONSTRUCTION 1081 T_ 1121182 5.00 TL - OwnerZ�UpPra Gc� ,per hone ❑ NEW ❑ ADD ❑ ALTERATION Address - - ❑ REPAIR ❑ CONVERSION❑DEMOLISHL --ZONING ❑ OTHER REGULATIONS, Arch/Eng, License N0. A. P. DESCRIPTt QF WO Address UZONE PLNG, REF. = Contracto Ph6ne-&>feaif, rl EOF'PERMIT ��BUILDING -Address f i ❑ GRADING ❑-FOUNDATION • ❑ STRUCTURAt SETBACK T. !DE YARD F OPERTTY LINE LICENS CONTRACTOR DECLARATION ❑ TENANT ❑ ELECTRICAL PLUMBING ❑MECHANICA I hereby affirm thiA I am licensed under provisions of Charter 9 (com- -7000) ❑ S IG HT mencing- with section of Division 3 of the Business and Professions Code, and y license Is In full force an effect. r - �r r�' _ OTHER PROJECT DESCRIPTION' REAR YARD (TO P/L) " 4:::- �'OfIF License ClassLice �No. PKG. SPACE REQ. PROVIDED Signatue6r,SQ, FT. - WORKERS' COMPENSATIONRATION. OCCUPANCYCONSTRUCTION TYPE_ STREET WIDTH PARK FEE.$ hereby affirm that I have a te of consent to self-insureor a VALUATION' ZONEcertificate ZONING APPROVED BY DATEI of Workers' Compe -Insuran e, o a c rtifledopy thereof (Section 3800, Lab C.). - GRADING CU, YDS. ACRES SPECIAL CONDITIONS: Policy NO.'—Company ; El Certified copy is hereby furnished,.. .REMARKS: Certified copy is filed with the city Building Division. _ ' EMPTION FROM WORKERS' COMPENSATION DECLARATION his section neednotbe completed if the permit Is for one hundred 100) or less )..n - _ certify that.ithe performance of the work for which this permit_Is, Issued, I shall not employ any person in any manner so as to become PLUMBING PLAN CHECK - ELECTRICAL PLAN CHECK subject to the Workers. Compensation Laws of California. - _ . Date Signature : BATHTUBS SHOWERS NOTICE: If atter. making this declaration, you should become subject TOILETS , - —.URINALS - GENERATOR 0-1 KW 1 -10 -KW --` - to the Workers' Compensation provisions of the Labor Code,'you must iTRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS APPLIANCE '10-50 KW,_50+ KW ) revoked. CONSTRUCTION LENDING AGENCY _ KIT, SINKS - DISHWASHERS MOTORS - 0.1 HP 1-10 HP I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS ? j ', SUMPS - (INC. SOLAR) - 10-50 HP 50 +-HP - ' y -•r formance of the work for which this permit is Issued (Section 3097 Civ, C.).- - Lender's Name FLOOR SINKS FLOOR DRAINS I' FIXTURES -' OUTLETS SWITCHES'" ' _ _ Lender's Address DRINKING FOUNTAINS- - GAS TUBE SIGNS-- - • - - -• OWNER BUILDER DECLARATION - - I hereby affirm that I am exempt from the Contractor's License law for INTERCEPTORS CLARIFIERS POLE LIGHTS PTRAP ' the following reason -(Section 7031.5 Business and Professions Code:SWiMM1NG'POOL Any city or county which requires a permit to construct, alter, POLES METERED sue WATER SERVICE ALTERATION-- - PANELS MAIN SUB Improve, demolish'or repair any structure, prior to its,lssuante, also re-- quires the ap, Ilcant for such permit to file a signed statement that he GAS SERVICE OUTLETS SERVICE - - AMP Is -licensed pursuant to the provisions of the Contractor License Law, [Chapter 9 {commencing with Section 7000) of Division 3 of the WATER HEATERS BTU OUTPUT ' - Business and Professions Code) or- that - tie is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by - SEWER CONNECTIONS.- "' - - - ---- - - any applicant for a- permitsubjects 'the applicant to a -civil penalty- of not more than five hundred dollars ($500). r, SOLAR TANK COLLECTORS,' as owner of the property, or my employees with wages as their compensation, will do the work, and the structure is not intended _ SOLAR PIPING SYS ^ ISSUE FEE offered for sale. (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of a property, _ ISSUE FEE APPLICATION APPROVED BY -- DATE - - who builds or improves thereon, and who does such work himself or through.his.own employees, provided that such improvements are not MECHANICAL PLAN CHECK" SUMMARY O_F FEES Intended or offered toe sale. if, however, the building or Improvement Is sold-within..one year of completion, the owner will have the burden of proving tie did not build or improve for the purpose of sale). the HEATING SYSTEM 0-100,000 BTU :BUILDING - PERMIT $ SMIP" $ I� as -owner -of property, am exclusively contracting with --AND DUCTING _ - -- — -- - ' -- — •- - I--• - - ---�- - ----•� - - •. - _ { licensed contractors to Construct the project (Section 7044, Business 100,000,+ BTU PLAN CHECK $ PERMIT and Professions Code: -The Contractor's License Law does not apply to - - - ISSUANCE $ an owner of property who builds or improves thereon, and who con- REFRIGERATION 0.100,000 BTU I IPLUMBING $ tracts --from- such projects with -a contractor(s)•licesned pursuant to License Law), - SYSTEM - - - 100,000,+ BTU ; _ _ _ PLAN CHECK --:GRADING_:3 L the Contractor's $Ch am-exe-mpt under Section'— B. & P. C. for this BOILERS BTU t ELECTRICAL $ " $ reason-'^ - 'PLAN CHECK $ - MICROFILM,$' I Date. Owner SYSTEM REPAIR,ALTERATIDN TOTAL FEES I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE � MECHANICAL $ � 'LESS AD- - Information is correct. I agree to comply with all city and county" ! •,PLAN CHECK -$ - - VANCE•PC $- " ordinances and_state laws rel to construction, and hereby authorize I " " 'i 1 representatipe of this c• o enter upon the above mentioned' •-f property fd _t_I p p es. �—� f FINAL FEE $ % Signature Date L.Drivers' tic• se or SS ISSUE FEE —•- -- ,_- _ -Assessor CMF 0865-46 W lite-Bullding; Canary -Applicant; Pink -Accounting; Goldenrod CONSTRUCTIONAND PLANNI APPROVALS Permit # - Date : `= --�� Inspector POOL & SPA - .APPROVALS Permit # - " ' Date. _ Inspecior 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location ---- - 2. _ Soil ipe-Undrgrn _ 44, Steel Reinforcement _ 3. -Electrical Conduit.Utility.-Undrgrn 45. -Forms, .4.. Electrical Conduit_Undrgrn .46. -Electrical Bonding_. _ - - 5. _ tee em orce _ 47. Rough Plumbing & Pressure Test 6. Electrical LIFER Grn _ 48: APPROVAL TO COVER-GUNITE - 7 7.. _Footings _ _ 49. Electrical Conduit-Undr rn -8. Foundation. 50., Gas Pipe, D.Undr rn, Test ' -9_. .Water Pipe-Undrgrn 51. Backwash Lines P-Tra ZQ' ndr rn - 10. _Structural Floor System- , 52. • APPROVALTO DECK` - - 11. Property.Sewer Line-&.House:Connection - _ 53.- Backwash & Receptor -Final -12..--Street Sewer Connection ' - _ 54. Heater & Vent-Finai. 13... Rough Plumbing - - ' 14. Rough Electric -Conduit - -56. Electrical -Final 15. Rough Electric -Wiring - - 57. -Solar System -Final 16. Rough Heating & Air Conditioning- - b8. Fencing & Access Approval 17.- Ducts in Structure`. APPROVED FOR PLASTERING 18. -Ducts, Ventilating _ 60. POOL/SPA SYSTEMS FINAL - 19. Gas Pipe -Rough & Test _ _ _ 20. Roof Framing 21. Roof'Sheathin NOTES: 22. Frame and Flashing 23.-- Insulation s 24. Lathing & Siding - 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter -Final `. 28. Final Electric - 29. Final.Heating & Air Conditioning _ 30. Final Gas Pipe -Test - 31. 32. Final Plumbing Water Service -Final 33. Gas Service -Final 34. Solar Domesiic•Fihal 35. Landscape Sprinkling S stem 36. Sound Attenuation 37. Handicap Regulations - 38. FINAL STRUCTURE & BUILDING '• 39. Special Requirements Completed _ 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. - 42. CERTIFICATE OF OCCUPANCY No._ - Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations - CITY OF COSTA MESA CONSTRUCTIOW PERMIT Project Address - :2f C S� _ Applicant's Mailing Ad Owner's Name '7 O y -xNO S ITnf ��-6 L^Phone ,V32 Address i �c GvtW Arch/Eng. _ r r e/ /A� I !cerise No, �'S?' Address G . 7 Lrir a✓� its !t , /&-, / L Contractor's Nam O b —Phone Address (mailing) City License No- LICENSEO CONTRACTOFt; DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect, , License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION 1 I hereby affirm that I have 4 certificate of consent to self -Insure or a certificate f Workers' Compensation Insurance, or a certified copy thereof (Section 800, Lab.C.I. ��G./1e qWr,- Policy No. , ..J�a�ra ,�� Company �J eCertified copy Is hereby furnished. CertJd S� Is filed with the city Building Dlvlsioi�f,w� Date a Applicant�P•�f� 1�'•U�� •^�A"n' EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be cgmpleted if the permit Is for one hundred ($100) or less). I certify' that in the performance Of the work for which this permit is issued I shall not employ any person In any manner so, as to become subject to tke Workers' Compensation Laws of California. Date Signature 'NOTICE: 11, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING. AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for v this p Is iss d 5 ttlo Civ. C.) Lender's Name iii Lender's Address e-=144.4 - - OWN6R BUILDER DECLARATION' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit t0 construct, alter,,improve, demolish or repair any structure, prior t0 its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of .the Contractor's License Lzw (Chapter g (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt '•erefrom and the basis for the alleged exemption. Any violation of Section ' 131.5 by any applicant for a permit subjects the applicant to a civil alty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves therenn, and who does such work himself/nerself or through his or her own employees, provided that such improvements are not intended or offered for sale. if, however, the builuing Or Improvement Is sold within one year of com- pletion, the owner will, nave the burden of proving he/she did not build or Im- prove for the purpose of $410), ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuarit•to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date 7�ZC' (° Owner 09 1 hereby certify that I have read this application and stfife that the above information is correct. I agree to ,comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of tnis city to enter, upon the above-mentioned property for inspection pur se r Signature . Date Drivers' License or SS V� PE IT NO,? � T ACT NO . LOT NO. U {� Q TYPE OF CONSTRUCTION LJ N ADD LJ ALTERATION El REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. Y DESCRIPTION OF WORK/USE OF BLDG. 5 Main Building: E TYPE OF PERMIT GRADING1:1 FOUNDATION El STRUCTURAL T Front , ❑ TENANT ❑ ELECTRICAL K PLUMBING ❑ MECHANICAL A Rear El OTHER PROJECT DESCRIPTION SQ. FT, OCCUPANCY C K Right CON STRUCTION TYPE VALUATION $ S I Left ZONE GRADING CU.YDS. ACRES Ping. Ref. °# Remarks: -��_� /�� 7/'j Q \� Planning Notes: or Sink ackflow Preventer ackflow Irrigation Dishwasher Drinking Fountains Floor Drains Floor Sinks ` Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Rainspeclion Fee Boiler Duct - Under Ground Duct - Structural PLUMBING FEES Showers Service,Sink Sewer Cap Sewer Connection Solar Coffectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays , $15 Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO 9 Heating System & ducting . ❑0.100,000 BTU 1:1100,000BTt Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Automatic Washer: Construction Pole Sub. Cooking Unit, �o Dishwasher Dryers ❑Gas JJElectric Fan F.A.U. Fixtures Device Boxes 0162 7/25%86 Accessory Building: Parking Req./Provided ELECTRICAL Outlets Switches Garbage Disposal Generator 00-5 KW 05.15 KW l 8000 TL Zone Z O N I N G R E M T S FEES Transformer ❑ 15-50 KW ❑ 50+KW Meter El up to 100 amps Meter ❑over 100 amps Sub Panel Motors 00.1 HP [:]I 'f, - 8 Inc. Solar 09-115 HP E]16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor Issue Fee $ 3 Reinspection Fee$15 Issue Fee $ 3 4ANICAL FEES Hood or Type I ❑ Canopy Type II ❑ DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: n Date Date Refrigeration System ❑0.100,000 BTU 0100;000 BTU BUILDING PER PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK .50% MECHANICAL PLAN CHECK 25% T SUMMARY DF FEES $ $ $ISSUANCE $ t� $ $ $ $ SMIP $ ' PERMIT $ ENERGY P.C. 5 GRADING $ MICROFILM S TOTAL FEE $ ' Q System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL 'A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole L 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 Grrnd. 57, APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd, 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOLISPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22.'Ducts, Ventilating 71. Product Piping ❑ Gas ❑Oil 23. Gas Pipe -Rough & Test ,• 721 Underground Flush 24. , Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED • 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing V// oil 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44;j Landscape Irrigation System 45.. Sound Attenuation 4p, Handicap Regulations 47� FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49, Electric Release to Edison 50.,Gas Release to Southern California Gas Co 517.CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY -OF -COSTA MESA CONSTRUCTION PERMIT PER IT O TRACT NQ LOT NO. UNIT NO Project Address Applicant's Mailing Address i Owner's Name Ph Address Arch/Eng. License No. Address Contractor's Na —9 Phone7..,��A Address (mailing) City License No, LICENSED CONTRA_ CTOR DECLARATION I. herehy affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in f fort deflect. Licens Class — License No, �j r Date %Signature WORKERS' C_6MAIIISATION D st RON ( hereby affirm that l have a certificdto of consent to self -insure or a certificate .of Workers' Compensation Insurance, or a certified, copy thereof (Section_ 3800, Lab. C:) - policy No. Company BCertified copy is hereby furnished. Certified copy Is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit Is issued, I Shall' not employ any person in any man_ ner so a to become subject to the Workers' Compensation Laws of Califore� Date -� Signature 'NOTI _ : 1 , of er mAitfq this declare i , you s ould become subject to the Workers' Compensation provisions he Labor Code, you must forthwith comply with such provisions or his permit :shall be deemed revoked. CONSTRUCTION'L'ENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address . OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 -Business and Professional Code: Any city or county whichrequires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the'applicant for Such permit to file assigned statement that he/she Is licensed pursuant to the provisions of 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 1031,5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars (17500). 0 1, as owner of the, property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: Thu Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who doessuch work hlmself/herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. 11, however, the building or improvement Is'sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuarit to the Contractor's License taw). I am aware that proof off their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Date 1 hereby certify information is ci and state laws r sentatives of th inspection pmV Signature Drivers' Li Owner that I have read this application and state that the above - rect. I agree to comply with all city and county ordinances ating to building construction, and hereby authorize repre- city o enter upon the above-mentioned roperty for or TYPE OF CONSTRUCTION NEW LJ ADD ALTERATION LJ REPAIR '❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. + DESCRIPTION OF WORK/USE OF SLOG. S Main Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 13 Rear ❑ -OTHER: PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION S 5 Left ZONE GRADING CU.YOS. ACRES Ping. Ref, q1E Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Interceptors' Kitchen Sink ' Lavatories P—Trap Roof Drains Reinspection Fee Boiler Outlets PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays 4 $15 Issue Fee Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑G-100,000.BTU ❑100,000ST Reinspection Fee i I $15 CMF 0865.46, rev. 10/84 White Building; Canary pp cant; Pink - Accounting; Goldenrod - Assessor Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0-1o0,000BTU ❑100,000BT System Repair/Alteration Fire Dampers Registers laue Fee FEES F- Zone Accessorx Buitdi amu^ ue u.r tuou� Z O N I N G R Parking Req./Provided E Q M T S ELECTRICAL Autbmatic Washer r Construction Pale Sub. Cooking Unit D iihwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW ❑5-15 KW �� Transformer El15-50KW —•� ❑ 50 + KIN Meter LJup to 100 amps Meter (Dover 1_00 amps 'Sub Panel Motors ❑0-1 HP ❑1 % - 8 'Inc.Solar 09-15 HP ❑16.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor , FEES .1 $ 3 Reinspection Fee $15 Issue Fee $ 3. FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date -71 Data SUMMARY OF FEES BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ 00 _ PLAN CHECK 25% $ 50 ELECTRICAL $ PLAN CHECK 50% , $ MECHANICAL , $ PLAN CHECK 25% $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ $ 3 CONSTRUCTION AND PLANNING '- APPROVALS Permit # _ Date Inspector POOL _ ,PA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Poi 52. • Pool & Equipment Location r f r'2. Soil n a Pi -Undr rd. L {�P, g t �� 53. Steel�Reinforcement 3�Electhcal Cond�ut� filitY Undrgrnd % rct 54. Forms ! ,y 4. EleccriWConduif-Undrgrnd. f 55. Electrical Bonding 5*+Steel?Relhforcemeht 56. Rough Plumbing & Pressure Test 6�Electricdl LIFER Grid. + I� 57. APPROVAL TO COVER-GUNITE i 7 lFootings -I I - ivy, 1/ 58. Electrical Conduit-Undrgrnd, i �� BFound mon t `� ` �� ( 59. Gas Pipe, ❑ Undrgrnd., Test 9Wat'e=Ppe Undrtjr'yd 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Str"P�tural Floor System a �, �' , 61. APPROVAL TO DECK {✓ 11. Pi�pes<Q;Sewer Lines& House Connection 62. Backwash & Receptor -Final 12. Sewer cep t/ a 63. Heater & Verit•Final 13. Roof Drains Yl � � ;,Q � _ 1 64. Plumbing System -Final � 14. 666gh PIumbing�� "� 65. Electrical -Final -0 15. Rough Electrical -Conduit 6. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 1B. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 7B. FIRE PRFV, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 139. Water Service -Final 40. Gas Service -Final 41. Solar Domestic-Finai /'42. Backflow-Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In ail spaces except those within heavy border tines and sign all appropriate declarations. EMV CITY OF•COSTA MESA CONSTRUCTION PERMIT PERMIT NO._ _ TRACT NO. LOT NO. UNIT Nom. Project Address Applicant's Mailing Address 13110 Std cny St- N _ Bol l Wi7inri s Owner's Name Troy. Investment Fund Phoine_ 49-29$8 Address 437 L Ri rch St_ N w ort Beach, Ea_ ArchlEng. Marin, J. Rock License No. Address e 9 1F Contractor's Name_-DUe,, n; r r•.,.,.1; r;gFk4:lagPhone -9.&2-4-2-16 Address (maiiingl �� }_ASII i-eo.J r1,r`_.,uoll lyw d. GA._ ( City License No: — 339 LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing Nwith section 7000) of Division 3 of the Business an 0fessions Code, and t my license is in full force and effe License Class' Lit e 346951 Dat Signature WORKERS' COMPENSATION DE RATION 1 hereby affirm that I have a cerlifi to of consent to Wf-insure or a certificate of Workers' Compensation Insur ce, or a certified copy thereof (Section 3800, Lab. C.) Policy No. Company �LtlmhermanS Certified copy is hereby furnished. Certlfigd icppY is filed with the city BuildipgLs�iv�n Date_ mt 11 i tJ (� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permtt is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued. I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compens4tlon previsions of the Labor Code, you must forthwith comply with such provisions or this permit shaft be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ, C.) Lender's Name Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm th4t 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/She Is licensed pursuant to the provisions of 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 trio basis for the alleged exemption. Any violation of Section '031.5 by any applicant for a permit Subjects the applicant to a_ civil enalty of not more than five hundred dollars (5500). L� 1, as owner Of the property or my employees with wages as their sole compensation, will do the work, and the Structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does Such work himself/hersolf or through his or.her own employees, provided that Such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im. Prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed Con- 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 builds or improves thereon, and _who contract% for such projects with a con- tractors) license pursuarit 'to the Contractor's License Law). I am aware that proof of their Worker's Cnmpensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above. information is correct. I agree to comply with all city and county ordinances and State I relenting to build; onstruction, and hereby authorize repre- sentatives f is city to en r pen the above-mentioned property for inspectio purp ses. Signature Date Drivers' Lice or SS CMF 0865.46, r v. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor TYPE OF CONSTRUCTION LI NEW LJ ADD LJ ALTERATION L._3 REPAIR $ 3 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 4t. DESCRIPTION OF WORK/USE OF BLDG. $15 Issue Fee $ 3 MECHANICAL Hood or Type I D Canopy Type 11 D S Main Building: REQUIREMENTS: E TYPE OF PERMIT GRADING LJ FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING n MECHANICAL B SMIP $ PERMIT ISSUANCE $ ENERGY P.C. S GRADING $ MICROFILM $ TOTAL FEE $ 15.50 ❑ ,OTHER System Repair/Alteration A Rear Fire Dampers C Right PROJECT DESCRIPTION SO. FT. OCCUPANCY K 00 CON STRVCTION TYPE VALUATIONS S Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks: Planning Notes: ( PLUMBING ( FEES I Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. lCBO # Heating System & Ducting C;P1 BTU ❑ 100,000 BTI Reinspection Fee 1 $15 Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Automatic Washer Construction Pofe Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes I Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer -D-15=50 KW ❑ 50 + KW Outlets Switches Garbage Disposal Generator 00-5 KW 05.15 KW Meter Uup to 100 amps Meter Dover 100 amps Sub Panel Motors ❑0-1 HP 01A -8 Iric.Solar ❑9-15 HP C1 16,15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor /,[-- J -D Z O N I N G r R 4ES r Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL Hood or Type I D Canopy Type 11 D FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date Det L Refrigeration System ❑0-100,000 BTU 0100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ $ $ -13..-o0 $ 9.-,n SMIP $ PERMIT ISSUANCE $ ENERGY P.C. S GRADING $ MICROFILM $ TOTAL FEE $ 15.50 System Repair/Alteration Fire Dampers 6 Registers 6 00 4 00 _$_3 Issue Fee ` CONSTRUCTION AND PLANNING APPROVALS. Permit # Date Inspector POOL ,PA APPROVALS Permit # Date Inspector ' 1. Temporary Electrical Service or Pole i 52. Pool & Equipment Location Y 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement r 3. Electrical Conduit Utility-Undrgrnd. 54. Forms A. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd, 57. APPROVAL TO COVER-GUNITE - r 7. Footings i' 58. Electrical Conduit-Undrgrnd. i1 B. Foundation 59. Gas Pipe, D Undrgrnd., Test � r 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, D Undrgrnd. 10. Structural Floor System : 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection f 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 APPROVALS" Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas D Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank D Gas D Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning V//Flo 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer p3, Backflow Irrigation 4r4. Landscape Irrigation System `45. Sound` Attenuation _'46. Handicap Regulations . FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49, Electric Release to Edison ,50. Gas Release to Southern California Gas Co _q1. CE RTI FICATEOF OCCUPANCY Na. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CAT,Y 9P -COSTA MESA I CONSTRUCTION PERMIT PERMIT NO- TRACT NO. LOT NO. UNIT NU_ Project Address -711 Iry • 1 -Et' S-1. COSTA - 1 F&0.-__ Applicant's Mailing Address Owner's Name ::fft!!` !J UENl Phone Address Arch/Eng- License No. Address Contractor's Name- _.Q C- (Ec—T R iL Phone 77-6 Address (mailing) bJ Ry 6pir , _ mirtif?a/li rf_?311� City License No. _ R - 5 n - LICENSED CONTRACTOR DECLARATION - I hereby affirm that 1 am licensed under provisions of Charter (commencing with section 7000) of Dlvlsion 3 of t ess and Pref si ns Code, and my license is in full force and effect License Class O - teen Date Signature WORKERS' CDMPENSATION DECLARATIDN - I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab.C.}C I ;gu7 s,e Policy No. 8 Certified copy is hereby furnished Certi!fied cop i`filed with the cit Buil Ision. c Date I�[L� Applicant EXEMPTION FROM WORKERS' COMPENSATION CLARATION (This section need not be completed If the permit is for one hundred (SI 00) or less). I certify that in the performance of the work for which this permit is issued I Shall" not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, atter making this declaration, you shoultl become subject to the Workers' Compensation provisions of the, Code, you must forthwith comply with such provisions or this permit 'shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is -issued .(Section 3097 Civ. C.) Lender's Name Lender's Address OWNER,BUILDER DECLARATION T I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 '031.5 by any applicant for a' permit subjects the applicant to a civil enalty of not more than five, hundred dotlars ($500). - .L� I, as owner of the proprty or my employees with wages as their sole compensation, will -do the work, and the structure is not intended or offered for sale .(Section 7044, Business and Professional Code: The Contractor's , 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im• prove for the purpose of sale). ' ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon_ ; and who contracts for such projects with a con- tractor(s) license pursuant to the -Co ntractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ ram exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is cerrec I agree to camply w all city and county ordinances and state I _ Pr ng o builtlin constru on, and hereby authorize repre- sentatives f tity to enter upon t at,ove-mentioned property for inspection urp S' t Date ! bJ G 1 1 •, Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date t]rL _ TYPE OF CONSTRUCTION NEW 0 ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # 7B.ildmg; DESCRIPTION OF WORK/USE OF BLDG. 5, Mai TYPE OF PERMIT GRADING ❑ FOUNDATION El STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B ❑ OTHER A Rear C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CON ST RUCTION TYPE VALUATION $ S Lefi ZONE GRADING CU.YDS: ACRES Ping, Ref, # Remarks: Planning Notes: Bar Sink Backflow Preventer - Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks - L Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains PLUMBING FEES Showers Service Sink ' Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa : Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays ' 1 Reinspection Fee I 115 1 1 Issue Fee ' . I $ 3 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # _ Heating System & Ducting ❑0-100,000 BTU 0100,000BT :Drive,ure Reinspection Fee Drivers' License or SS I I + CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor $15 MECHANICAL Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System CIO-100,00OBTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers. Registers Issue Fee 5890 1/16/85 Zone Accessory Building: Parking Req./Provided , ELECTRICAL Automatic Washer Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes i Outlets Switches Garbage Disposal Generator 1110-5 KW 1:15.15 KW Transformer ❑ 15.50 KW ' ❑ 50 + KW Meter LJup to 100 amps' Meter Dover 100 amps Sub Panel Motors 0-1 HP Ell 'h - $ 1nc.Solar 09.15 HP ❑16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 4050 TL FEES Z O N I N G R E Q M T S FEES r Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date t]rL _ SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ 4�co GRADING $ PLAN CHECK 50% $ fr-) MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% •,$ S 3 _ CONSTRUCTION AND PLANNING ;,APPROVALS Permit # Date Inspector POOL - SPA I APPROVALS Permit # Date w 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. Electricai,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 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13, Roof Drains 64, Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPASYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test . 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25, Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - - 50. Gas Release to Southern California Gas Co 51, CERTIFICATE OF OCCUPANCY. No. Date , Applicant to 1111 In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA M-EESlA CONSTRjUCTI=ON PERMIT PERPT N� � TRACT NO. _ LOT NO. Ua IITN O, 110 /Project Address _ -f—1 1 f v Applicant's Mailing Address Owner's Name _7XVy xrjy eS &7 w-% Phone 21 -q6 a1 Address 13 G Arch/Eng. {- �/L •� Licensie No. /1 /C-.2 2 Address Contractor's Nam © Phone Address (mailing) - -- City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class` _- _- _ - - License No. Date Signature WORKERS' COMPENSATION DECLARATION ' hereby affirm that I have a certificate of consent to self -insure or a certificate ' Workers' Compensation Insurance, or a Certified copy thereof (Section Lab. C.) Policy No. ��0 - �� y ComPo^Y A610464- Certified copy is hereby furnished. DateCer fed p! is I ed with the city Bulldln ivI ion. Applicant • �A� , EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permlt 1$ for one hundred ($100) or l"s). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation laws of California., Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be. deemed revoked, CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for wh)ttis permit I issued (� ctIon.._3097 Civ. C.) Lender's Name TTRR ,F Ki ty I F Lender's Adtlress �_-3 ��C .1 OWNER BUILDER DECLARATION I hereby affirm that I am exempt from thO Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, after, Improve, demolish or repair any structure, prior to its Issuance, also reClulres the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions Of the Contractor's License law (Chapter 9 (c(3mmencing with Section.7000) of Division 3 of the Business and Professions Code) or that he/she )s exempt 'herefrom 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 ge ally of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole t mpensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, BuslnesS and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work hlmSelf/herself or through his or her own emplo(ees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of Proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively Contracting with licensed con- 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 , builds or Improves thereon, and who contracts for such projects with a con- tractor(s) license pur$uant'to the Contractor's License Law). I am aware that proof of their Worker's Compensation in$urance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date - owner t hereby certify that I have read this application and state that the above information is correct. I agree to comply wlth all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of, this city to enter upon the above-mentioned property for inspection purp S. �; �} Signature�ff°/�" ��/G�%//�� " Date / �l S Drivers' License or SS # TYPE OF CONSTRUCTION NEW ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. D ALTERATION H REPAIR FEES A P. O S T g A C g Main Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL 19 PLUMBING ❑ MECHANICAL ❑ OTHER Front Rear PROJECT,DESCRIPTION SQ. FT. CONSTRUCTION TYPE VALUATION ZONE GRADING CU. YDS. OCCUPANCY S ACRES Right I Left Ping. Ref. Remarks: A.4 4/3 /70 Cooking Unit Planning Notes: , 0163.-7/25/86 Zone Accessory Building: Parking Req./Provided Z O N 1 N G R E O M T S CMF 0865-46, rev. 10/84 White - Building: Canary - Applicant; Pink '- Accounting: Goldenrod - Assessor PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backfiow Preventer Service Sink Automatic Washer,. - Construction Pole'Sub. Transformer ❑ 15-50 KW E]50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors - Dishwasher - Meter Cover 100 amps Dishwasher I Solar Piping Dryers ❑Gas GElectric Sub Panel Drinking Fountains Solar Tank Fen �� Motors 00.1 HP ❑ 1''A - B Floor Drains Swimming Pool w15paF.A.U. Inc. Solar ❑9-15 HP C3 16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet l / !� Device Boxes . Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto Wash Garbage Disposal Standing Sections P -Trap Laundry Trays Generator ❑0.5 KIN ❑5.15 KW Trash Compactor Roof Drains Reinspectipn. Fee $15 Issue Fee S 3 Reinspoction Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler � Dull •Under Ground Hood or Typel' ❑ Canopy Type 11 ElZoning DEVELOPMNT SERVICES E Approved By Building Approved By Application Issued. By REQUIREMENTS: Date Date Dat__ _p Duct - Structural Duct - Ventilating Refrigeration System ❑0-100,000 BTU 13100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK ,25% . SUMMARY OF FEES $ SMIP $ $ PERMIT - $ ISSUANCE $ -�c�� $ /I UQ ENERGY P.C. $ $ GRADING 5 $ MICROFILM $ $ TOTAL FEE $ IF,� $ , Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. iCBO =#Fire Dampers Heating System &Ducting 0, 100,000 BTU ❑ 100,000 BT Registers Reinspection Fee $15, Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building: Canary - Applicant; Pink '- Accounting: Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit Date Inspector POOL .%A 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: ElectricalUFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings' 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10, Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap • 63. Heater & Vent -Final 13, Roof Drains, 64. Plumbing System - Final 14. Rough Plumbing 65, Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 Dotes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing Y� 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY -QF COSTA MESA CONST�QHi TION PERMIT MIT NO. TRACT NO. LOT NO. UNIT NO. Project Address Appl,icant's Mailing Address Owner's Name % ho Address M Arch/Eng. — License No. Address Contractor's Nam Phone Address {mailing) �� -• City License No. ' LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of oChartar 9 (commencing with section '7000) of Division 3 Of the Business and Professions Code, and my license is in fa for ante effect. - License Class�F-. — _._Li se No. • y� Da[e.� Signature gggggg,,,,,,►►►►►► WORKERS' COMPENSATION OECIJi�TION I hereby affirm that I have a certificate consent to self -insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section 800, Lad. C•) ' Policy No. Company 8 Certified copy is hereby furnished, . Certified copy Is filed with the city Building Division. Date Applicant EXEMPTION,FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit Is for one hundred ($100) or less). - I certify that in the performance of the work for which this permit is issued, ( shall not employ any person in any manner so as to become subject to the Workeg& Co a�nnsa i n Laws of Callfor Date Signature 'NOTICE: If, after making this cleclaratlgV. you should become subject to the , Workers' Compensation provisions - of he Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirrn that there is a construction lending agency for the'performa rice of the work for which, this permit is Issued (Section 3097 C(v. C.) Lender's Narne ---- - -- Lender's-Address - OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit,to construct, alter, improve, demolish or repair any structur4, 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 the Contractt)r'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 8ny applicant for a permit subjects the applicant to a civil penalty of npt more than five hundred dollars ($500). ❑ 1, as owner of the property or my employees with wages as their Solo compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will 'have'the burden Of proving he/she did not build or Im- rove for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- tractors to cpnstruct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and _who contracts for such projects with a con- tractors) llcense pursuant to the Contractor's License Law). I am aware that proof of their Worker's CompenSation insurance should be provided to mo. ❑ 1 am exempt under Section B. & P. C. for this reason TYPE OF CONSTRUCTION LJ NEW❑Lj ADD LJ ALTERATION LJ REPAIR I ',F-'J_D ❑ CONVERSION ❑ DEMOLISH OTHER A P # DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TYPE OF PERMIT GRADING 0 FOUNDATION 71 STRUCTURAL ET Front ElTENANT ElELECTRICAL ❑ PLUMBING —1 MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SO. FT. OCCUPANCY C Right K CON STRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountairis Floor Drains' Floor Sink& Gas Service' Interceptors Kitchen Sink Lavatories. P—Trap Roof Drains ' 1 Reinspection Fee Boiler PLUMBING FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal - Outlets Water Closet Water Heater Water Service Auto -Wash Laundry Trays , $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Date Owner Heating System &Ducting I hereby certify that I have read this application and state that the above - ❑4100,000 BTU ©100,O0p8T Information is correct, I agree to comply wltn all city and county ordinances and state laws relating to building construction, and hereby authorize repre- , sentatives of this city to enter upon the above-mentioned property foL� inspection pur Sipnature Date_ Drivers' Lice ' e or 'SS � Reinspection Fee CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas• ❑Electric Fan F.A.U. Fixtures ' Device Boxes 5884 7/02/85 Zane Accessary Building: Parking Req./Provided ELECTRICAL 4— _ Transformer ❑ 15 50 KW ❑ 50 + KW Outlets Switches Garbage Disposal Generator 00.5 KW 05-15 KW Meter Cup to 100amps Meter El over 100 amps - Sub Panel Motors 00.1 HP ❑115 8 Inc. Solar 09.15 HP 1116.15} Microwave Pole Light Range Sign Standing Sections Trash Compactor 10x50 TL FEES s Z O N I N G R E 4 M T S Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Hood or Type I ❑ Canopy Type II ❑ DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By I REQUIREMENTS: Date Date Dat -711 Refrigeration System ❑0.100,000 BTU ❑100,000 BT;U BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ $ $ $ SMIP $ PERMIT ISSUANCE • $ ENERGY P.C. $ GRADING S MICROFILM $ TOTAL FEE $ i System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 CONSTRUCTION AND PLANNING Date APPROVALS Permit # _ e < Inspector n POOL iPA APPROVALS Permit # Date Inspector 1Temporary Electrical Service or Pole' 52. Pool & Equipment Location t :'2. Soilt'Ripe�Undrgrnd. /_1 , { p 53. Steel Reinforcement ,J 3; Electrical Conduit,&gity•Undrgend? .�� 54. Forms . Electhcal?Conduit•Undagrnd. s� 55. Electrical Bonding s 5.',Stee'I-Reinforcement t' 56. Rough Plumbing & Pressure Test !nd. 6Electr,ical UFERJ:Gr 57. APPROVAL TO COVER-GUNITE ''0 7� Fob[in'gs `� n `f'� 5B. Electrical Conduit-Undrgrnd. T� BFouncfation 59. Gas Pipe, ❑ Undrgrnd., Test .; 9.+Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, ❑ Undrgrnd. i0`.'St ructural Floor System 61. APPROVAL TO DECK 11,P.r6perjyjSewer Line &House Corinection 62. Backwash & Receptor -Final 101, 1-2.'Sewer Cap :� 63. Heater & Vent -Final 4 13. Roof Drains �#' j 64. Plumbing System - Final 14. Rough Plumbing= l 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 .r FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Urtiderground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas C)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 Nntes'. 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace �38. Final Plumbing ' 39. Water Service -Final 40. Gas Service -Final -41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irriqation System 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF,OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. CiTY OF COSTA MESA CONSTRUCTION PERMIT Project Addrest Applicant's Mailing Address _13110 Sar•irnV St, N-Hn1Tn0 Owner's Name1fr_0y__J41V,e&,t Phone— 49�_,�-9-988 Address �t ;7,r1—$ifs=j�SL. idp,Gl*+nrr ugu�ll7—(;a. Arch/Eng. Marin J. RQck License No. Address 12881 Knott AM—e. Suite 216 Contractor's Name Dura Air Conditioning Phone_ 982 1216 Address (mailing)_I-il It) 5atJrOy tit= N -HDI lyWCJ0n,t:r1. City 'License N_o. N LICESED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and rofessions Code, and my license is in full force and effec 346251 License Class LI n e Dat4l18184�� Signature WORKERS' COMPENSATION DEC RATION I hereby affirm that I have a certifi a of consent to self -insure or a certificate if Workers' Compensation Insura re. or a certified copy thereof (Section 800, tab. C.) Policy No. _ Wr 9994 - _ Company _ tumb ermans 8 Certified copy is hereby furnished. Certifie piy is filed with the city Buildin^Qlvisio Date Applicant— EXEMPTION PROM WORKERS' COMPENSATIONDE�TION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit Is Issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date — Signature NOT ICE: If, alter making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with Such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Of the work for which this permit is Issued (Section 3097 Civ. C.) binder's Namg Lender's Address OWNER BUILDER DECLARATION I hereby affirM that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to Construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signeq statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031:5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred collars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who bullels or Improves thereon, and Who does such work himself/herself or through his or her own employees, provided that such improvements aro not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion r , the Owner will have the burden of proving he/she did not build or im- ove forr the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractors) license pursuariCto the Contractor's License Law). I am aware that proof of their Worker's Compensatlon insurance should be provided to me. D I am exempt under Section B. & P. C. for this reason Date Owner — i hereby certify that I have read this information is correct. I agree to camp and statela elating to build' con Sent atives [ s city to en r upOi inspection rpo s. Signature Drivers' pplication and state that the above with all city and county ordinances ,uction, and hereby authorize repre- the above-mentioned property for ate PER IT NO. TRACT NO. LOT NO. UNIT NO, 2278 5/03/85 15o5D T TYPE OF CONSTRUCTION 0 NEW 0 ADD LJ ALTERATION LJ REPAIR s ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. Zane S Main Building: Accessory Building: TYPE OF PERMIT El GRADING M FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL ❑ -OTHER PROJECT DESCRIPTION SQ, FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $$ ZONE GRADING CU.YOS. ACRES E T Front Z 0 B A Rear N l C Right N K Left G R Ping. Ref. # Parking Req,/Provided E Remarks: Planning Notes: O M T S PLUMBING FEESiL ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ SO + KW - Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0-1 HP Ell 'A - 8 Floor Drains Swimming Pool w/Spa F,A,U, Inc. Solar 119.15 HP El 16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Kitchen Sink Water Heater Water Service Outlets Switches Range Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator 00.5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 Boiler Duct - Under Ground MECHANICAL FEES Hood or Type f ❑ Canopy Type 11 ❑ DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Date —DateLZ� Duct - Structural Refrigeration System 00-1100,00OBTU ❑ 100,000 BTU Duct - Ventilating SUMMARY BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ __1 3,0.0— PLAN CHECK 25% $ 9 OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ i MICROFILM $ TOTAL FEE $15.50 50 Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers 1 Heating System & Ducting �1a100,000 BTU ❑1001000 BT Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, ref 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POOL,.. SPA APPROVALS Permit # Date Inspector 7, Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5.' Steel Reinforcement 56. Rough Plumbing & Pressure Test ' -6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE ' 7. Footings 58. Electrical Conduif-Undrgrnd. B: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. r ► 60. Backwash Lines, P -Trap, 0 Undrgrnd. ' 10. .Structural Floor System %; 61. APPROVAL TO DECK 11. Property Sewer Line & House Conr ectign 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 APPROVALS. Permit # 20. Rough Factory Fireplace • 21. Ducts, in Structure 70. Underground Hydra 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank D 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. Piaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning y6 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Finai 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 F X50. Gas Release to Southern California Gas Co '51. CERTIFICATE OF OCCUPANCY No. - Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF -COSTA MESA CONSTRUCTION PERMIT Projecr Address .7f ! Int, < /-fTll ,Ci• 08 S?R 7k6A Applicant's Mailing Address — --- — Owner's Name _J Rb`l 1111 UE. f1'1 F/lJr phone Address Arch/Eng., License No Address Contractor's Nem,_hnp R PI.pS 1 -LEFT= RIG Phone 7-aY Address (mailing) {rl-h5 �R`!A`��34tYy7ttrl}F3��IJ R�316 City License No. 3 3 Ci c, LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of C arter' {commencing with section 7000) of Division 3 o ess and rofe i ns Code, and my license IS lir full force and effect License Class — /� - 7Icen a No. bate 0— Signature WORKERS' COMPENSATION DECLARATION . I hereby affirm that I have a certificate of consent IL self -insure or a certificate -)f Workers' Compensation Insurance, or a certified copy thereof (Section 800, Lab. C.) dollcy No. a Co pa LE 8 Certified copy is hereby furnished. C Certified copy is iced with the CIt 4 vision. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION ECLARATION (This section need not be completed if the permit is for one hundred ($100),Or less). I I certify that in the performance of the work for which this permit Is issued I shall'not employ any parson In any manner so as to become subject to t6 Workers' Compensation Laws of California. Pale Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' COmpehsation provisions of the Labor Cotle, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance' of the work fbr which this permit Is ,Issued (Section 3097 Civ. C.) Lender's Name Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Cotle: Any city Or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the'prOvlslons of the Contractor's License taw (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or, that he/she is exempt therefrom and the basis for the alleged exemption: Any violation of Section 7031.5 by any applicant for a permit -subjects the applicant to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are' not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/sic did not build or im- prove for the purpose of sale). , ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or impfOVes thereon, and _who contracts for such projects with a con- tractor(S) Ilcensk pursuanl'to the Contractor's License Law), I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I'am exempt under Section B. & P. C. for this reason Date I hereby certify that Information Is c rreyt and state 1 s re sentaiives t this c' Inspection r Signature Drivers' License or $$ Owner ve read this app11 ton and state that the above ree to co ply wi all city and county ordinances building c nstruc n, and hereby authorize repre- enter u On t above-mentioned property for Date1—JO— �J PERMIT NO. TRACT NO.LOT NO. UNIT NO. 5E191 1/16/85 4050 T E7, -7 — r o TYPE OF CONSTRUCTION NEW ADD El ALTERATION LJ REPAIR A.P. # Zone ❑ CorVVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. • - S Main Building: Accessory Building: E Z TYPE OF PERMIT GRADING El FOUNDATION LJ STRUCTURAL T Front 0 '❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 13 ❑, ,OTH E R A Rear � C Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY S Left G R CONSTRUCTION TYPE VALUATION $ Ping; Ref, Parking Req./Provided E ZONE GRADING CU.YDS. ACRES Remarks: Planning Notes: Q M T S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW d 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection t Cooking Unit Meter ❑up to 100 amps Clarifiers l Solar Collectors Dishwasher Meter Dover 100 amps Dishwasher Solar Piping r Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors XD -1 HP ❑ 1 Y, • 8 (� Floor Drains, Swimming Pool vv/Spa F.A.U. Inc. Solar 09.15 HP ❑16.15+ Floor Sinks Urinal — Fixtures Microwave - ` Gas Service- Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater I Outlets Range Kitchen Sink _ f Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator ❑0.5 KW ❑5-15 KW Trash Compactor Roof,Drairis - Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee 515 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Boiler Hood or Type I El y Canopy Type 11 ❑ Zoning Approved By Date Duct - Under Ground Building,Approved By Application Issued By Date Date { 1/40 Duct - Structural Refrigeration System 100,100,0008TU ❑ 100,000 SITU Duct - Ventilating SUMMARY BUILDING PERMIT $ PLAN CHECK $ PLUMBING$ PLAN CHECK 25% $ OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. S Exhaust System ❑ Multiple ElSystem Repair/Alteration Firopl/Fact. Bit. ICBO 9k Fire Dampers Hosting System & Ducting Registeri 00.100,000 BTU•0100,0006 ELECTRICAL S PLAN CHECK 50% $ GRADING 5 �— �] MICROFILM 5 ! MECHANICAL , S TOTAL FEE $ �d Reinspection Fee $15 Issue Fee 5 3 PLAN CHECK 25% $ CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting, Goldenrod - Assessor +- CONSTRUCTION AND PLANNING , PPROVALS Permit # Date . Inspector POOL &sPA APPROVALS Permit # Date Inspector ` 1 ! Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4, Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL_ TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10, Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15: Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL_ 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72, Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74, Overhead Hydro 26, T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29, Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 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 Nn, Date �- Applicant to fill in all spaces within heavy border Imes and sign all appropriate declarations. CITY OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. BLgr,, NO. CONSTRUCTION PERMIT t I D IQ88 !/21/8.2 B.QO Address P,�CL) ' TYPE OF 50NSTRUCTION f " �- pp ❑ NEW DO ❑ ALTERATION s Z ❑ REPAIR ❑ CONVERSION ❑DEMOLISH ❑OTHERDESCRIPTION ZONING REGULATIONS r License No, OF WORKe'P's FAdd ZONE PLfVG: REF.,ctor �t p� PhoneTYPE OFPERMIT ACK PlekFING•SET s ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL- I YARD OP Y LINE ED CONTRACTOR DECLARATION ❑ TENANT'ELECTRICAL ❑PLUMBING ❑MECHANIC SppRD affirm th t I am licensed under provlslons of Charter 9 (tom- 3of ❑ RIIGHTA with section 7000) of Division the Business and Professions Code, land my license is in full force and effect. OTHER REAR YARD (TO P/L) - -' PROJECT DESCRIPTION License Class License No. _ PKG. SPACE REQ. PROVIDED ' Date - - Signature SO.FT. - _ _ `STREET WIDTH PARK FEE $..• ' WORKERS' COMPENSATION DECLARATION OCCUPANCY—CONSTRUCTION_ TYPE I hereby affirm that I have a certificate of Consent to self -insure or a VALUATION ZONE _ ,ZONING APPROVED BY - DATE Certificate of Workers' Compensation insurance, or a certified Copy thereof (Section 3800, Lab. C.). GRADING CU. YDS. ACRES SPECIAL CONDITIONS: P- 'Icy No. Company- Utified copy I$ hereby furnished. . _ REMARKS: ertified copy is filed with the city Building Division. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' (This section need not be completed if the permit Is for one hundred !$100) or less). ff certify that In the performance of the work for which this permit I$ Issued, I Shall not employ any person in any manner so as to become PLUMBING'', PLAN CHECK- ELECTRICAL - PLAN CHECK subject to the Workers' Compensation Laws of California,' _ BATHTUBS SHOWERS Date _Signature NOTICE: If after making this declaration, you should become subject TOILETS. - URINALS _ GENERATOR 0-1 KW 1-10 KW - to the Workers' Compensation provisions of the Labor Coda, you must TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS - APPLIANCE - - 10.50 KW 50 + KW revokeq. CONSTRUCTION LENDING AGENCY KIT. SINKS DISHWASHERS MOTORS 0-1 HP 1:10 HP t hereby affirm that there Is a construction landing agency for the per- SERVICE SINKS SUMPS -- • (INC, SOLAR) 10.50 HP--_- 50 + HP' formance Of the work for which this permit Is Issued (Section 3097 �� Cly. C.), - -- -' - FLOOR SINKS FLOOR DRAINS' - -' FIXTURES _ OUTLETS SWITCHES - - Lender's Name _ Lender's Address DRINKING FOUNTAINS -- "' - GAS TUBE SIGNS - OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS •` POLE LIGHTS - - I hereby affirm that I am exempt from the Contractor's License Law for - the following reason -(Section 7031,5 Business and -Professions Cade: SWIMMING -POOL-' - 'PTRAP - Any city or county which requires a permit to construct, alter, POLES METERED SUB Improvq, demolish orrepairany structure, prior to its Issuance, also re- WATER SERVICE - ALTERATION - tPANELS MAIN - Sue -" - quires the api IlCant for such permit to fila a signed statement that he is licensed pursuant to the provislons of the Contractor's License Law GAS SERVICE OUTLETS t SERVICE AMP (Chapter 9 (Commenting with Section 7000) of Division 3 of the - Business and Pro4esSions Code) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT I - - basis for the allagod exemption. Any violation of Section 7031.5 by applicant for a -permit subjects the applicant to a civil penalty SEWER CONNECTIONS- ot more than five hundred dollars ($500). 4. as owner of the propeity, or my employees with wages as their* SOLAR TANK COLLECTORS- '1 "-•-- w -- - - — - - _ _ sole Compensation, will do the work,. and the structure is not intended _ or offered for safe. (Section 7044,'Business and Professions Code: The SOLAR PIPING S1'S. - ` •• -ISSUE FEE' - - - - - - Contrattor's License Law does not apply, to an_owner of a property who builds or improves thereon, and who does such work himself or ISSUE FFE ,APPLICATION APPROVED-BY-DATE,F` - -- - through his -own, employees, provided that Such improvements are not Intended or offered for sale. If, however, the building or Improvement MECHANICAL PLAN CHECK _ - SUMMARY OF FEES ' is sold within one Year of completion, the owner will have the burden of proving he did not build or Improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTU iBUILDING PERMIT E _. ) »$ I, as-ownerof the property, y contracting with y, am exclusive) - ANDDUCTINGI ` SMfPl. censeu Contractors to construct the project (Section 7044, Business 100,000 +BTU PLAN CHECK $ PERMIT and Professions -Code: The Contractor's -License Law does not apply to - - - - - ISSUANCE 5 an owner of property who builds or improves thereon, and who Con- REFRIGERATION 0-100,000 BTU PLUMBING 5 tracts- from such -projects with a. contractor(S) - licesned -pursuant to SYSTEM - - - - I -PLAN GRADING . $ the COhtractor's License Law). 160,000`t BTU CHECK E ❑ I am exempt under Section' - -"B. & P. C:'for this - BOILERS BTU - ELECTRICAL " $ :] reason - PLAN CHECK E MICROFILMS ` - _ Date — Owner SYSTEM REPAIR, ALTERATION , 'MECHANICAL I -TOTAL FEE $ ' ertify that I have read this application and state that thI EXHAUST SYSTEM MULTIPLE . $ LESS AD- Information ion Is correct. I agree to comply with all city and �PLANCHECK$ -- ___ VANCE PC $ _ and state laws relating to construction, and hereby a atives O this- City t ente upon the" above me for cctio pttr L 1 FEE ateISSUE rFINAL $ _icense or SS FEE - CMF 0865-46 While -Building; Canary -Applicant; Pink-ACcounting; Goldenrod -Assessor CONSTRUCTION AND PLANNING Y. APPROVALS Permit # E-,�4q5 Date Inspector POOL,& SPA APPROVALS, Permit # - Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location 2. Soil Pipe -Un -rgrn _ r 44.' Steel Reinforcement 3. Electrical Conduit •Utility-Undrgrn _ 45. Forms - - 4.. Electrical Conduit-Undrgrn _ _ 46. Electrical Bonding. - - - 5. '. Steel Reinforce 47. 116ugh'Plu'rnbing & Pressure Test - 6. Electrical UFER Grn _ 48: APPROVAL TO COVER-GUNITE - - 7•.Footings _ _ 49. EiectPical Conduit-Undr rn 8. Foundation' ' 50. Gas Pipe, ❑ Undr rn" Test 9. -Water Pipe-Undrgrn 51. Backwash Lines P -Trap.' 0 Undrgrn 10. Structural Floor System . 52. APPROVAL TO DECK _ 11. Property Sewer Line &.House Connection 53. Backwash & Receptor -Final 12. Street Sewer. Connection. --54. Heater & Vent -Final 13. Rough Plumbing - - - 14. Rough Electric -Conduit 56, Electrical -Final 15. Rough Electric -Wiring 57. Solar System -Final 16. Rough Heating '& Air Conditioning- - - encing & Access Approval 17. Ducts in Structure _ _39 -- APPROVED FOR PLASTERING 18. -Ducts, Ventilating 19. Gas Pipe -hough &Test , 20. Roof Framing i 60. POOL/SPA SYSTEMS FINAL 21. 22. Roof Sheathin Frame and Flashing - NOTES: 23. insulation - 24. Lathing & Siding - - -- - 25. Drywall Nailing 26. Plaster Brown Coat 27' Electrical Power Meter -Final r_ 28: -Final Electric - 29, Final Heating & Air Conditioning _ " - 30. Final Gas Pipe -Test - 31. Final Plumbing ' 32: Water Service-Final- ervice-Finan33. 33. -Gas Service -Final - 34, Solar Domestic -Final, 35. Landsca e Sprinkling System ' 36. Sound Attenuation 37. Handicap Regulations - 38. FINAL STRUCTURE & BUIL-DING 39. Special Requirements Completeci 40, Electric Release to Edison 41. Gas Release -to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No. Date COSTA MESA BUILDING—SAFETY DEPARTMENT ' "" P.O. Box 1200 Costa Mesa, Califonlia rl `yam 1 � W Q ~ \ a 0 Q } J IZ W 0. O cc a Z w 2 Ir W 0. Ir O } fA fA 2 F- 19533 12/15/81 � ` � ' Contractor C. C. Cole Plumbing& Heati TRACT X0. 'EC -0 BY 6- LOT NO. BUILDING USE Industrial PERMIT H0. Cd AddICsB 2280 Ne=art DATE ISSUED �f City Costa. -Mesa Ca Zip Code 2627 State License.No. :275585 Class. $-1 BUILDING AODRESS 1L' w. 17th St. Suite F--12 City License No. Tel. No —116 COSTA MESA, CALIFORNIA NO. ITEM EACH FEES NEAREST CROSS.ST. Pomona Avenue FA U. Wall, or Gray. Furn. Incl. Ducts and Vent3 t0 100 .000 BTU - Y OWNER MAIL �7yA� 1St, C�+a ADDRESS 711 W. .111 Ui , Slee F-12 over 100,000 BTU .1 CITY COsta ;1e$a� Ca. TEL. NO. 645-1501 Vent Jif not incl. above} ��y I hereby acknowledge that 1 have read this application -u and `state that the above is correct and agree to comply n a �, ,-wyth all City Ordinances and State Laws regulating Heat - tng; Ventilating, Refrigeration and Air -Conditioning. I certify that I possess the above valid State of Calif - ornia classification or 1 am the legal owner of the single family residential propert des bed above. Ll{.FX! Signature of permittee 1 'Suspended Heatef Alter'or Replace Appliance l ver I eel o gas Piping . BOILERS OR COMPRESSORS 4 g Y 'Y ' 3`H.P. or less Over 3 H.P.to 15 H.P. S �` lam, t Vent Fan—Single, Duct` - REMARKS: frt '� �' Ventii+lating�Hood M t,l U APPROVALS INSPECTOR DATE Ducts Underground Mutts in Structure Ducts Ventilating Heating — Rough Hoods Refrigeration Lines Pressure Test Sub -Total Air -Gond. Final Reinspection Fee Ventilating Final Heating Final T_ Processing Fee y Refrigeration Final Fina! Gas Test TOTAL FEES Utility Co. Notified CMF 0449-4 BLDG. PERMIT NO.�� , Applicant to fill in 311 spaces except those within heavy border lines and sign all appropriate declarations. CITY OF, COSTA MESA CONSTRUCTION PERMIT PERMIITT NO. TRACT NO. LOT NO. UNIT NO. Project Addre?s C rE: I::-- 1 1 t f l Applicant's Mailing Address Owner's Name �TRa`l f NVEN _4 m If fj l hone Address Arch/Eng. License No. Address G' Contractor's Nam Phone Address (mailing).. 1 �6!� BRYAAT ST, - 0.-Dryn1Nk7jn� S1-fL City License No. NI: LICESO CONTRACTOR DECLARATION 1 hereby affirm that 1 -am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 Inessje� •d Pr ssions Code, and MY license is in full force and effe L, License Class C' Lice Date is s10— - Signature WORKERS' COMPENSATION DECLARATIO ' h@reby affirm that I have a certificate of consent to self -Insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section 3940, Lab. yC.,) Policy No. T ['_ -/ j 3�� L.J G eCertified copy is hereby furnished Certified cop is filed with the cit B in Divisi Date LSAT Applicant EXEMPTION FROM WORKERS' COMPENSATICA DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that In the performance of the work for which this Permtt is issued 1 shall not employ any person in any manner so as to become subject to lie Workers' -Compensation Laws of California. pate Signature 'NOTICE: If, after making this declaration, you should become Subject to the Workers' Compensation• provisions of the Labor Code, you must forthwith cornply with such provisions or this permit Shall be deemed revoked, CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.). Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the ' following reason (Section 7031'.5 Businoss and Professional Code: Any city or county which requires a permit to construct, after, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file asigned statement that he/she is licensed Pursuant to the Provisions of the Contractor's License Law (Chapter 9 (commencing'with Section 7000) of Division 3, of the 'Business and Profession$ Code) or that he/she Is exempt therefrom and the baSfs for the affeged exemption. Any violation of Section 7031.5 by any 'applicant for a permit subjects the applicant to a civil nnafty of not more than five hundred dollars ($500), I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does riot apply to an owner of property who 1 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 proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exembl under Section B. & P. C. for this reason Date Owner I hereby certify that I have reap information I agree to and state la s rel -ng o build sentatives o thi , ity to ente Inspection p . rpo s ) u this a lication and state that theabove :ompI ith all city•and county ordinances I cons r ction, and hereby authorize repre- upon he above-mentioned property for Date TYPE OF CONSTRUCTION U NEW U ADD- i~1 ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. # S Main Building: TYPE OF PERMIT 0 GRADING -0 FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ -OTHER E T B A Front Rear PROJECT DESCRIPTION SQ, FT, OCCUPANCY CONSTRUCTION TYPE VALUATION SS ZONE GRADING CU. YDS. ACRES C Right Left Ping. Ref, 9{6 Remarks: Planning Notes: ar Sink ackflow Preventer ackflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating ' Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 00.100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev- 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spe Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays FEES Automatic Washer Construction Pole Sub. CookingUnit Dishwasher Dryers ❑Gas QElec Fan 'F.A.U, Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW [ 5892 1/16/85 Zone Accessory Building: Parking RegJProvided ' ELECTRICAL Transformer ❑ 15-50 KW ❑ SO+KW Meter ❑upto,i00amps Meter Cover 100 amps is Sub Panef 5-15 KW Motors R�p-1 HP 01'%-8 Inc. Solar E19 -15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 4050 FEES Z O N I N G R E O M T S Issue Fee $ 3 Reinspection Fee $15 Issue Fee S 3 iANICAL FEES Hood or Type 1 ❑ Canopy Type 11 ❑ DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: _. ._Date Date Date—__ Refrigeration System [__)0.00,00OBTU 0100,00OBTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES S S $ S r $ t4_ (DO $ 5O $ $ SMIP S PERMIT ISSUANCE S ENERGY P.C. S GRADING $ MICROFILM $ TOTALFEE A_ -'EO System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 r F` CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit 46- Date Inspecsnr 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3, Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding _5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57, APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. '8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, © Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66.- Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas 0011 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73, Undergrnd, Storage Tank ❑ 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 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 cc Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40, Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preveoter 43. Backflow Irrigation 44. Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirernents Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY Nn. Date Is s I Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Addrets —] 1 1 —GI_ I Zrh—St . Bldg (F) Un -i t f 1 Applicant'sMailing Address 13110 Saticoy St. N.HollYwOod, Owner's Name Troy Investment Fund Phone _-5G —2988 Address 4321 Birch St. Newport Beach Ca. Arch/EngMarip J. Rock —License No. — Address 12881 Knott Ave. Suite 216 Contractor's Name Duco Air Conditioning Phone 982-1216 Address lmailing).13110 Saticoy St. N.Hollywood;C&_ City License No. 39925 LICENSED CONTRACTOR DECLARATION I hereby affirm that i am licensed under provisions of Charter. 4 (commencing with section 7000) of Division 3 of the Business and Cesions Code, and my license is in full force and effect. License Class/o Lit 5�.-- Date4J_18_ Signature WORKERS' COMPENSATION DEC AT10N hereby affirm that I have a certifica of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, -Lab. C.) WC9824 Lumbermans Policy No- Company eCertified copy is hereby furnished. Certifi y is filed with the city Bui��crt7n �i sion. Date— Applicant— EXEMPTION ��" `—� EXEMPTION FROM WORKERS' COMPENSATION DECLA ATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, t shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature -NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the tabor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there IS a construction lending agency for the performance of the work fqr which this permit Is Issued (Section 3097 Civ. C.) Lender's Name — Lender's Address OWNER BUILDI~R DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which re4uires a permit to Construct, alter, improve, demolish or repair any structure, Prior to Its issuance,'also requires the applicant for such permit to file a signed Statement that he/she is licensed pursuant to the provisions of the Contractor's License taw (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 clvll enalty of not Moro than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Buslness and Professional Code: The Contractor's License law does not apply to an owner of a property who builds or Improves thereon, and who tloes such work himself/herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement Is sold within one year of corn- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- traCtor(sl license pursuant to the Contractor's License Law). I am aware that proof of{ their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason 2279 5/03/135 15, SO TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A_P_0 Zone DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: E Z TYPE OF PERMITGRADING 0 FOUNDATIO��Ntt 17 STRUCTURAL T Front O E3 TENANT 0 ELECTRICAL ❑ PLUMBING Y_'MECHANICAL A Rear N E3 OTHER PROJECT DESCRIPTION 54. FT. OCCUPANCY C Right N CONSTRUCTION TYPE VALUATION $ S Left R R ZONE GRADING CU.YDS. ACRES Ping. Ref. # Parking Req./Provided E Remarks: Planning Notes: (Qj� T S Reinspection Fee Boiler $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG Date Owner Heating System & Oucting I hereby certify that I have read this application and state that the above 1 a0-100,000 BTU ❑1w000BT information i prrect, I agree to amply with all city and county ordinances and state I s lating tp build construction, and hereby authorize reore- sentatives 1 th s city to en r upon the above-mentioned property for inspection rp es,.r Signature Date Drivers' Lice or SS Reinspection Fee GMF 0865-46, v. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Issue Fee Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0100,000 BTU 01100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 PLUMBING FEES ELECTRICAL FEES Bar SinkShowers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Date Date i Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors SMIP $ PERMIT ISSUANCE $ ENERGY P.C. S GRADING $ MICROFILM $ I TOTAL FEE $ 15, 50 Dishwasher Meter Dover 100 amps Dishwasher Solar Piping 6 Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00.1 HP ❑ 1 X - B Floor Drains Swimming Pool vv/Spa ' r F.A.U. Inc. Solar 09-15 HP Q16.15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Lavatories Water Service Auto -Wash Switches Garbage Disposal Sign Standing Sections P—Trap Laundry Trays Generator 00.5 KW 05.15 KW Trash Compactor Roof Drains Reinspection Fee Boiler $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG Date Owner Heating System & Oucting I hereby certify that I have read this application and state that the above 1 a0-100,000 BTU ❑1w000BT information i prrect, I agree to amply with all city and county ordinances and state I s lating tp build construction, and hereby authorize reore- sentatives 1 th s city to en r upon the above-mentioned property for inspection rp es,.r Signature Date Drivers' Lice or SS Reinspection Fee GMF 0865-46, v. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Issue Fee Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0100,000 BTU 01100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 Reinspection Fee $15 Issue Fee S 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: —Date.Z" Date Date BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ $ $ 13.-00 $ 9-50 SMIP $ PERMIT ISSUANCE $ ENERGY P.C. S GRADING $ MICROFILM $ I TOTAL FEE $ 15, 50 6 00 S 3 CONSTRUCTION AND PLANNING APPROVALS . Permit #- Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1., Temporary Electrical Service or Pole 52. Pool & Equipment Location -Soil Pipe-Undrgrnd. 53. Steel Reinforcement s _ - 3. Electrical Conduit Utility•U;)drgrnd. 54. Forms ' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding j 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. r 57, APPROVAL TO COVER-GUNITE 'r 7. Footings ;~ 58. Electrical Conduit-Undrgrnd. ------------- 8: Foundation i 59. Gas Pipe, ❑ Undrgrnd., Test ' 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System ' fit. 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 APPROVALS. Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 76. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT, REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final B0, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning ��/ . 1 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43. Backflow Irrigation 44. Landscape Irritation 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 CITY -OF COSTA MESA - CON TR CTIO,1 PERMIT Project Addr6ss Applicant's Mailing Address WAC2F ei 4e Owner's Name Phone Address % {��5•,: C Arch/Eng. License No. Address Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. _ TRACT NO. LOT NO. UNIT NO, Contractor's Na r� - Phone / Vh Address (mailing) - City License N_o. LICENSED CONTRACTOR DECLARATION - I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in fu fort and effect. Ucen Class l License No �2�, Date 1'— " it Signatur .4Z dzc I" WORKERS' COMPENSATION DE RATION zl� I hereby affirm that 1 have a certificate of consent to Self -insure or a certificate of Workers' Compensation Insurance, or a certified Copy thereof (Section 3800, -Lab. C.) Policy No. Company 8 Certified copy Is hereby furnished. , Certified copy is filed with the city Building Division. Date Applicant,-, EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is forone hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shail'not employ any person in any manner s as to become subject to the Workers' C m ensatkon Laws of Callfocnld. Date - Signature ,/*gam 'NOT CE: f, fter making this geclar t n, ou should became sublet the Workers' Compensation provisions O the Labor Code, you must forthwith Comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit i$ issued (Section 3097 Civ, C.) Lender's Name .� Lender's Address OWNER BUILDER DECLARATION ' 1hereby affirm that I am exempt from the Contractor's License Law for the following rreason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the BusIne$A and Profession$ 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 malty of not more than five hundred dollars ($500). 1, as owner of the property or .my employee$ with wages as their sole , compensation, will do the work, and the Structure is not intended or offered forsale (Section 7044, Business and Professional Code: The Contractor's , License law does not apply to an owner of a property who builds or improve$ thereon, and who does such Work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- • 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 builds or improves thereon, a_hd who contracts for such projects -with a Con- tractor( ilcense Pursrlant't0 the'Contractor'i License Law), I am aware that , proof off their Worker's Compensation Insurance_ should be provided to me. G I am exempt under Section B. & P. C. for this reason Date Owher 1 hereby certify that I have read this application and state that the above Information Is correct. I agree to comply with all city and county Ordinances and state laws relating to building construction, and hereby authorize repre. sentatives of this city to enter upon the above-mentioned property for Inspection pu es, Signature A Db[e Drivers' tic se or SS :01 - /;I-- - // TYPE OF CONSTRUCTION LI NEW LJ ADD L.! ALTERATION L! REPAIR ❑ CONVERSION ❑ DEMDLISH ❑ OTHER A.P, 9116 DESCRIPTION OF WORKIUSE OF BLDG. 5 Main Building: E TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL_ B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right SLeftCONSTRUCTION TYPE VALUATION $ ' ZONE GRADING CU. YDS. ACRES Ping. Ref. Remarks: Planning Notes: PLUMBING FEES Bar Sink Backflow Preventer -- Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service / Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains , Reinspection Fee I .$15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Sit, ICBO # Heating System a Ducting 00- 100,000 BTU ❑ 100,000 BTL Reinspection Fee 1 $15 GMF 0865-46, rev. 10/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Poo) vv/Spa Urinal - Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type I ❑ Canopy Type ll ❑ Refrigeration System ❑o-100,000 BTU 01100,000BTU System Repair/Alteration Fire Dampers Registers 5865 7/02/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer - Construction Pole Sub. Cooking Unit Dishwasher _ Dryers ❑Gas ❑Electric Fan F.A.U. / Fixtures cc Device Boxes Outlets O C Switches Garbage Disposal Generator 00.5 KW 1:15-15 KW $ 3 Reinspection Fee $15 FEES Issue Fee I $ 3 Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors 00.1 HP Ell 'A - 8 Inc. Solar E39-15 HP 1316-15+Microwave - - Pole Light Range Sign' Standing Sections Trash Compactor Issue Fee 10,50 TL Z O N I N G . R E O M T S FEES $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ 9, cc ISSUANCE $ PLAN CHECK 25% $ IG 0_ _ ENERGY P.C. S ELECTRICAL $ GRADING S PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ CONSTRUCTION AND PLANNING _ APPROVALS Permit # ` • Date - Inspector POOL & SPA APPROVALS Permit #�___ Date Inspectnr 1. Temporary Electrical Service or Pole 52. Pool& Equipment Location 2. Soil Pipe Undrgrnd. , ; f 53. Steel Reinforcement •v '3/Electncaff Cond6it Iitiliiy-Undrgrnd. r .t "' 54. Forms 4�Elect�icaljConduii=U;d Agrnd. art 55. Electrical Bonding 5JStee,Feihforcemer0/ 56. Rough Plumbing & Pressure Test P1 Cf E�ect�ical UFER(Grnd. �% ` : 57, APPROVAL TO COVER-GUNITE •.7 7g�F, obti 5 58. Electrical Conduit-Undrgrnd. � 1 deFouLndation << < t 59. Gas Pipe, ❑ Undrgrnd., Test -9�,Viati4r,Pipre -UndrgS'ndf „ 60. Backwash Lines, P-Trap, ❑ Undrgrnd. .10.. tructural Floor System 61. APPROVAL TO DECK 11;",Property�Sewer Line& House ddAnection r� f, _� 62. Backwash & Receptor-Final ,1.,S6ver Capp 1 _ 63. Heater & Vent-Final I RRoof Drains �� y J 64. Plumbing System - Final ;n 14r<Rpugh Plumbing •7 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final " 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 6B. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19: Rough Heating & Air Conditioning t FIRE DEPT, REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. 'Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Hough & Test 72. Underground Flush -24, Roof Framing 1 73. Undergrnd, Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74, Overhead Hydro 26. T-Bar Ceiiing (Structural) & Monocoat 75, Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Nates: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy r37. Final Factory Fireplace i 38. Final Plumbing 139. 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 150. Gas Release to Southern California Gas Co 51, CERTIFICATE OF OCCUPANCY Nn. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations, CITYOF COSTA MESSACONSTRU5TION PERMIT Project Address 721 Applicant's Mailing Address � Owner's Name tl�f`er1 h Phone7s '-1?6+g1 Address/j�Z �p�rc-li f;• /�/2i{�C>0/� Arch/Eng, ri��t/�fjM /rr eLl License No. -CIS -21 Address W' I 13&,C1 < Contractor's NamPhone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION i hereby affirm that t am licensed Under provisions of Charter 9 (commencing withsection 7000) of Division 3 of the Business and Professions Code, and my Il cense is in full force and effect. License Class - - - License No. Date Signature YORKERS' COMPENSATION OECLARATION hereby affirm that I have a'certificate of consent to self -insure or a certificate ,)f Workersr Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C�.}�-� ? ?elAlAr Policy No. /'y Company s RC1 B 'f` Cert�ied co�yC'IL�s hereby furnished. f ledwiththecity Buildl I islon. ^Z.S®� Applicant �% EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred (5100) or less). Icertify that In the performance Ot the work for which this permit is Issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of COiifornia. Date Signature 'NOTICE: If, after making this decl0ration, you should become subject to 4he Workers' Componsation provisions of the tabor Code, you must forthwith Comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for whi Pftrmlt is issued Section 3U91, iv. C.) Lender's Namer•S'f^/Ji��7� Lender's Address _ -3Z L ik ii OWNER BUILDER DECLARATIQIv I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to flee a signed statement that he/the is licensed pursuant to the provisions of the Contractor's License taw (Chabter 9 (commenCing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property 4r my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of,a property who builds or improves thereon, and Who does such woriz himself/hersell or through his or her own employees, provided that such imbrovements are not Intended or Offered for sale. If, however, the building or Improvement is sold within one year of com- ptetlon, the owner will have the burden of proving he/she did not build or im- va for the purpose of sale). ro leas owner of the property, ant exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors license pursuant t0 the Contractor's License Law), I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section -- B. & P. C. for this reason Date Owner I hereby certify that I have read this application and stafia that the above information Is correct. Iagroe to Comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives Of this City to enter upon the above-mentioned property for inspection purpo es, Drivers' License or 55 9F PER NO. 9o't�0 X� NO, LOT NO. UNILNO� Q 1 64 7/25/86 8600 TYPE OF CONSTRUCTION NEW 0 ADO LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A,P,+ Zone S Main Building: Accessory Building: TYPE OF PERMIT GRADING pFOUNDATION STRUCTURAL ELECTRICAL Lel PLUMBING ❑ MECHANICAL ElTENANT-❑ gr ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES T Front O B A Rear N C Right N g I Left R R Ping, Ref. # Parking Req./Provided E Remarks: r �/ />i i l�V $ Planning Notes: M T S. PLUMBING -FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Poie'Sub. Transformer 0 15-50 KW 0 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit ; Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasl er Meter El over 100 amps Dishwasher Solar Piping Dryers ❑Gas'❑Electric Sub Panel Drinking Fountains Solar Tank Fan 71 Motors❑0-1 HP❑1)4-8 Floor Drains Swimming Pool w/Spa F,A,U. Inc. Solar ❑9-15 HP 046-15+ Floor Sinks Urinal Fixtures Microwave � Gas Service ' Outlets Interceptors Kitchen Sink Water Closet Water Heater Water Service Device Boxes Outlets Switches' Pole Light Range Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator 00.5 KW 135.15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee S 3 Reinspection Foe515 Issue Fee 3 3 Boiler Duct -Under Ground MECHANICAL - FEES Hood or Type I ❑ Canopy Type II El DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application. Issued By Date Date Data Duct - Structural Refrigeration System E10-100,000BTU ©100,1)00 BTU Duct - Ventilating BUILDING PERMIT S PLAN CHECK S PLUMBING S PLAN CHECK 25% S ELECTRICAL S PLAN CHECK 50% S MECHANICAL S PLAN CHECK 25%, S SUMMARY OF FEES SMTP $ PERMIT c ISSUANCE $ ENERGY P.C. $ GRADING S - MICROFILM Sp TOTAL FEE S Ot� Exhaust System ❑ Multiple ❑ System Repair/Alteration Firep1lFact. Bit. ICBG Fire Dampers Heating System & Oucting El 0-100,000 BTU E] 100,000 BT Registers Reinspection Fee S15 Issue Fee S 3 CMI= 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POU SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2.+ Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Cond•ulit 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 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, J 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas O Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating &,Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System t45. Sound Attenuation :46. Handicap Regulations ,447. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co r- 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in ail spaces except those within heady border onas and sign all appropriate declarations. r 't 1 OF COSTA MESA CONSTRUCTION PERMIT. ; = PERMIT NO. TRACT LOT NO. UNIT NO. r B� 34bZ25 109 Project Address -11-1 Applicant's Mailing Address ��' L1M .- TYPE OF CONSTRUCTION LJ NEW LJ ADD ALTERATION LJ REPAIR Owner's Name t7AZ/ Phone ❑CONVERSION ❑DEMOLISH ❑OTHER A.P. # DESCRIPTION OF WORK/USE OF B DG. Address + 0 ' 'r rch ng. _ �� _ License No. Contractor's Name f hone t7, Address (mailing) City License No. L/ It LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) o1 Division 3 of the Business and Professions Code, and My license is in fu 1 force and effect. Date 92 #0 Signature WORKERS' COMPENSATION D CLARATION ' hereby affirm that I have a certificate of consent to self -Insure or a certificate Workers' Compensation Insurance, or a certified Copy -thereof (Sectlon ,00, Lab, C.) r Policy No. Company _ BCertified copy is hereby furnished. - - Cert fled copy is filed with the city Building Division, Date Applicant ' EXEMPTION FROM WORKERS' COMPENSATION DECLARATION �. Thissection need not be completed if the permit is for one hundred ($100) or 55). 2 -.0 I certify that in the performance of the work for which this permit Is issued, 1y shall not employ any person in any n so as beo a subject to the Work e %m 5p 'vn Laws of Cali�� Date Signature —y NOTICE: If, a ter making this declare n, you sWOuld become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ, C.) Lender's Name ` Lender's Address r OWNER BUILDER DECLARATION I hereby affirm that ,l'am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to,its issuance, also requires the applicant for such permit to file a signed statement that he/She Is licensed pursuant to the provisions of 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 -p "'031 5 by any applicant for a permit subjects the applicant to a civil 'b . enalty of not more than five huntlretl dollars ($500), ©© I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) cense pursuant to the Contractor's License Law), I am aware that proof of thheir Worker's Compensation insurance should be provided to me. ❑ I am exempt under,Section B, & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct, l agree to Comply with all City and County ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of ci to a er p n the above-mentioned property for inspection p pos Signature Date Drivers' License or SS %k 4l S Main Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ® ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B ElOTHER � A Rear OZ PROJECT DESCRIPTION SQ. FT. l� OCCUPiYNCY C Right CONSTRUCTION TYPE V IV VALUATION 9r I IOU> T 5 Lef ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: +7Planning gNotes; 4:Z S,C � -7 C - rt_! h i Bar Sink Backfiow Preventer U al Backflow Irrigation Water Closet Bathtubs Water Heater Clarifiers Water Service Dishwasher Auto -Wash Drinking Fountains Laundry Trays Floor. Drains REQUIREMENTS: Floor Sinks Date -/ Date Dat Gas Service Outl Interceptors SUMMARY OF FEES $ $ it 'h 3 S $ $ O S ¢Q_ $ - -1 00 $ 7 - onD Kitchen Sink _ Lavatories r' P—Tap .� Roof Drai Reinspection Fee PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swim ' g Pool w/Spa Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 1:10- 100,000 BTU ❑ 100,000 ST Reinspection Fee I S15 CMF 0865-46, rev. 10/84 White --Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0.100,000 BTU ❑ 100,000 BT System Repair/Alteratiori Fire Dampers Registers Issue Fee FEES 5207 9/14/87 Zone Accessory Building: i Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator El 0-5 KW ❑5-15 KW Transformer ❑ 15.50 KW ❑ 50 + KW Meter L1 up to 100 amps Meter ❑over 100 amps Sub Panel Motors E10-1 HP ❑ 1 %h - 8 Inc. Solar 09-15 HP ❑16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 123083 TL FEES Z O N I N G R E O M T S U al Water Closet Water Heater _ Water Service $ 3 Auto -Wash ' Laundry Trays �C REQUIREMENTS: Date -/ Date Dat S15 Issue Fee MECHANICAL Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 1:10- 100,000 BTU ❑ 100,000 ST Reinspection Fee I S15 CMF 0865-46, rev. 10/84 White --Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0.100,000 BTU ❑ 100,000 BT System Repair/Alteratiori Fire Dampers Registers Issue Fee FEES 5207 9/14/87 Zone Accessory Building: i Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator El 0-5 KW ❑5-15 KW Transformer ❑ 15.50 KW ❑ 50 + KW Meter L1 up to 100 amps Meter ❑over 100 amps Sub Panel Motors E10-1 HP ❑ 1 %h - 8 Inc. Solar 09-15 HP ❑16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 123083 TL FEES Z O N I N G R E O M T S Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date -/ Date Dat BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ it 'h 3 S $ $ O S ¢Q_ $ - -1 00 $ 7 - onD SMIP S PERMIT ISSUANCE S ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL F.2E'$ 14 ".0— LS$3 J _ D ac $3 . CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1,TTernporary Electrical Service or Pole 4 52. Pool & Equipment Location ' - 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Hlectrical Conduit Utility-Undrgrnd. r 54. Forms .-'4:;Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd; B. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 6. Solar System -Final 16. Rough Electric Wiring Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 7 . POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Condition) FIRE DEPT. REQUIREMENT APPROVALS Permit # _ r 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72, Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil ' 25. Roof Sheathing 74. Overhead Hydro 26.•T-Bar,Ce-ssling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 40 1Q Af 76. Dry Standpipe I ` 213. Lathing & Siding 77, FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL , I 30. Drywall Nailing HEALTH DEPT: REQUIREMENT a 31. Plaster Brown Coat 79. FINAL INSPECTION ' 32. Electrical Power Meter -Final FOOD CERTIFICATE ISSUED + 33. Final Electric s: 10 (,f�� 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy a� 37. Final Factory Fireplace T- / 9 38. Final Plumbing �B~4S7 t 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final �. rh�VT f� 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 I r} 51. CE RTIFICATE OF OCCUPANCY No.� Date CITY OF COSTA ME Project llddress Arplicant's Mailing Adc Owner's Name ' Address 21 Arch/Eng. Zig 1� Address �s Contractor's Name Address (mailing) Applicant to fill in all spaces except those within heavy border lines and, sign all appropriate declarations. CONWR � 7I PFS MI, Q W - hone 7,J v` lll��/� —Phone - Phone City License No. LICENSED CONTRACTOR DECLARATION I herebyaffirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. , License Class g kyt_J9.2&4&4�t�License N Date Signature WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self4nsure or a certificate of WorkersCompensation insurance, or a certified copy thereof (Section 3800, Lab. J�C.000 Policy No. �/�� 7- Company��5 ' Certified copy is hereby furnished. Certified ap is filed with the city Bui'�,�eqy�nfrga Divi on 1010 Date Applicant //C��i' EXEMPTION FROM WORKERS' COMPENSATION DECLAR ION (This section need no be completed if the permit is for one hundred ($100) or less). I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws oftCalifornia. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit snail be, deemed revoked. CONSTRUCTION LENDING- AGENCY - I hereby affirm that here is a construction lending agency for the performance of .the. work Lender's "Name Lender's h jt� .p it is ed ctygn 3097T Civ. C.) Lender's Address�— OWNER BUILDER DECLARATION I hereby affirm that Pam exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or, county which requires a permit to construct, alter improve, demolish or repair any structure, prior to Its issuance, also requires ire applicant for such permit to fiie 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 Division 3 of -the Business and Professions Code) or that he/she is exempt therefrom and the basis.for the alleged exemption. Any violation of Section 7031.5 by any applicant -for a permit subjects the applicant to a,civil penalty of not more than five hundred dollars ($504). I, as owner of the property or my employees with wages as their' sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, Provided that such improvements are not Intended or offered for Sale. If, however, the building or improvement is sold within one year of com- pletion the owner will have the burden of proving he/she did not build or im-, rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con-' tractors t6 construct the project (Section 7044, Business and Professions Code: The -Contractor's License Law does not apply to an owner of property who builds or Improves tnereon, and who contracts for•such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason . Date A96 Owner I hereby certify that I have read this application and ate that the above Information is correct. I agree to comply with all city and county ordinances, and state laws relating to building construction, and hereby authorize repre ' sentatives of this city to enter upon the above-mentioned property for Inspection Aur os. 7/rryp Signature Date Drivers' License or SS 1775 8/21/85 4!1075 T�' P MIST' NO, TRACE O. LOT NO, U IT NJ / TYPE OF CDNSTRUCTION LJ NEW ADD ALTERATION LJ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG.' s s ^!d FS REPAIR A.P. qjE r Zone Main Building: -Accessory Building: TYPE OF PERMIT GRADING FOUNDATIO STRUCTURAL ENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL OTHER (� 't� PROJECT DESCRIPTION SQ. FT.CC ANCY CONSTRUCTION TYPA A i�N $ E ZONE GRADING CU.YDS. ACRES T Front B A Rear N C Right _ N, K S L G R Ping. Ref. # Parking Req./Provided E Remarks: U Planning Notes: gg M C Orr/ C l!r4 T S Bar Sink PLUMBING Showers FEES ELECTRICAL FEES , Backflow Preventer Service Sinkc,,, - -- Automatic Washer Construction Pole Sub. Transformer 15-50 KW ❑ 50 W I Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter Dup to 100 amps Clarifiers Solar Collector$ Dishwasher Meter El over 100 amps Dishwasher Solar Piping] ; Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank -S+- ; , + Fan Motors 00.1 HP 01 K 8 Floor Drains Swimming Pool w/Spa '' F.A.U. Inc. Solar ❑9-15 HP❑16-15+ Floor Sinks - Urinal - - Fixtures Microwave - Gas Service Outlets Water Closet _ Device Boxes Pole Light Interceptors Water Heater ' Outlets Range Kitchen Sink Water Service Switches Sign Lavatories L� Auto -Wash Garbage Disposal Standing Sections P -Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor Roof Drains t Reinspection Fee $15Issue Fee S 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler ' Hood or Type I C1DEVELOPMENT Canopy Type I I ❑ SERVI E Zoning Approved By Building Approved By Application Issued By dUIREMENTS: Date { Date ` Dat Duct - Under Ground Duct -Structural Refrigeration System E10-1 00,000 BTU ❑100,000 BTU _ _ _ Duct-'Ventilatin 9 �_ BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES , $ a'S' Od SMIP $ $ - _ I G Zr` PERMIT $ ISSUANCE $ $ ENERGY P.C. $ $ 'GRADING $ $ MICROFILM $ $ TOTAL FEE $ $ . rd Exhaust System El Multiple El System Repair/Alteration FirepllFact. Blt. IC80 # Fire Dampers Heating System & Ducting ❑0-i00;000BTU ❑100,000BT Registers - Reinspection Fee$15 Issue Fee $ 3 CMF 0865-46, rev. 10184 White - Bullding; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor CCI)NSTRUCTION AND PLANNING 1 - AfPf OVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # date Inspector i.Temporary Electrical Service or Pole 52. Pool & Equipment Location 2.•- Soil Pipe-Undrgrnd. 53. Steel Reinforcement '3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grind. 57. APPROVAL-TO COVER-GUNITE 7. Footings , 58. Electrical Conduit-Undrgrnd. 8. Foundation a 59. Gas Pipe, ❑ Undrgrnd., Test 9.- Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Stluctural Floor System ; r ' _ 61•- APPROVAL TO DECK, 11. Property Sewer Line &'House Cormection 62. Backwash& Receptor'Fin3I , 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 1.6. Rough Electric Wiring 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 APPROVALS Permit # 20. Rough Factory Fireplace _21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe=Rough-& Test 72. Underground-Flush 24. Roof Framing ' 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25.';Roof Sheathing , -- 74. Oyer4god Hydro 26, T-Bar Ceiling (Structural} & Monocoat 75. Dry Chemical 27. Frame and Flashing U 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. Elecfrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38., Final Plumbing 39. Water Service-Final 40. Gas Service-Final. - 41. Solar-.Do I mestic-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 t Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PEM T�O.� a J RACT�NO. LOT NO. UNIT NO. IF'Proj4� Address r 7 S .41 Applicant's Mailing Address • d �/ Owner's Name V one Address Z3 I'�P/�GG�` /��✓ 7— Arch/Eng. License No. Address Contractor's Nam `� �.r 'Phone Address (m ailing) -- City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under prov slons of Charter 9 (commencing with section 7000), of Divisl of the B iness and Professions Code, and my license is in fu dye an eff t. License CIa55 Llcen pate, C-- S/ -M- SI nature r WORKERS' COMPENSATION DECLARATION—./ hereby affirm that I have a certificate of consent to self -insure or a certificate ' Workers' Compensation Insurance, or a cer fled copy thereo Section 'a iGGa �:s� 'p AJC Policy No. —��© ,� Corn pan ` J GertiTietl copy is Tiletl with the city Buil n Dlulslon. � ate_ �' 3' 9(� Applicant c ^ EXEMPTION FROM WORKERS' COMPENSATION D CLARATION (This section need not be completed If the permit Is f ne hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, iyou should become subject to the Workers' Compensation provisions of the Labor Cade, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY ' I hereby afflrm'that there Is a COnstructlOh lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name _ Dander's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt fromtheContractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for Such permit to fire a signed statement that he/she it licensed pursuant to the provisions of the Contractor's License Law (Chapter y (commencing with Section 7000) of .Division 3 of the Business and Professions Code) or that he/she is exempt �S_Iherefrom and the basis for the allegeq exemption. Any violation of Section 1-.,77031.5 5 by any applicant for a permit subjects the applicant to a civil r L1penalty of not more than five hundred gollars ($500). I, as owner of the property or my' employees with wages as their sole compensation, will do the work, and the structure Is not'intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If,however, the building or lmprovnment is sold within one year of com- pletion, the owner will have the burder, of proving he/she did not build or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am oxtluslvvly contracting with licensed con- 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 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 proof of their Worker's Cg rrpensatlon insurance should be provided to me. ❑ 1 am exempt under Sec�jn B. & P. C. for this reason Date wner 1 hereby certify that- h ve read thi application and slate that the above InformaLIOn Is correct gree to Com ly ith all city and county ordinances and state laws relati g building c s ction, and hereby authorize repre- sentatives of this t to enter u t 0 above-mentiOned properly for inspection purpos 7�✓ Signature Date.7 /sem Drivers' License or SS =tl TYPE OF CONSTRUCTION LJ NEW LJ ADD ' ALTERATION 7 REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 9MECHANICAL A Rear El OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY—,C Right �� K CONSTRUCTION TYPE VALUATIONS S t Left ZONE GRADING CU.YDS. ACRES Ping. Ref. SSI Remarks a I Planning Notes: Bar Sink Backflow Preventer $ackflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 M Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑f 1 Firepl/Fact. Bit. ICBG -# Heating System & Ducting ❑0.100,000 BTU ❑ 100,000 BTI;' Rainspection. Fee i , S15 CMP 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service A uto-Wash Laundry Trays FEES 246E •9/03/06 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A,U, Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW 05-15 KW Transformer ❑ 15-50 KW ❑ 50+ KW Meter ❑up to 100 amps Meter ED over 100 amps Sub Panel Motors 00.1 HP ❑ 115 - 8 Inc.Sotar ❑9-15 HP 016.15+ Microwave ` Pole Light Range Sign Standing Sections' Trash Compactor 13.00 YL FEES Z O N N G R E Q M T S issue Fee 5 3 'f Reinspection Fee $15 Issue Fee S 3 tANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: El:- Hood � Type or I Canopy Type 11 ❑ •- Zoning Approved By Date Building Approved By Application Issued By �( .C�, bate Dat Refrigeration System 00.100,000 BTUs ❑100,000 BTU BUILDING PERMIT PLAN CHECK SUMMARY OF FEES $ $ SMIP PERMIT $ System Repair/Alteration Fire Dampers PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% $ $ $ $ ISSUANCE $ ENERGY P.C. $ GRADING i $ MICROFILM + $ Registers o t w' MECHANICAL $ TOTAL FEE $ �? Issue Fee $ 3 PLAN CHECK 25% $ �. CONSTRUCTION AND PLANNING VPROVALS Permit #� Date Inspector POO SPA APPROVALS Permit # Date Inspector 1� Temporary Electrical Service or Pole 52, Pool & Equipment Location 1. Soil Pipe Undrgrnd. v 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 9. Water. Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System • Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 60. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:Jr &dlg 34, Final Heating & Air Conditioning y11 "- 35. Final Gas Pipe-Test 36. Hood or Canopy 37, Final Factory Fireplace 36. Final Plumbing 39, Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42, Backflow Preventer 43, Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49, Electric Release to Edison 50., Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No, Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. f YOFCOSTAMSA// CONSTRJUC IrONPI_R-MIT ENR r�� T _ LOT NO, U t_NQoject Address W • / _7 _ _ e� Q S TVPFOFrnPISTRlIrTION NEW ADD ALTERATION REPAIR N_ Applicant's Mailing�lA.ddress y. /7%-1i� Owner's Name Address 21 574- CtV^ P -- Arch/Eng. + Creil029--License No.CIS- 2 Z Address rli'_ riL/i ��h.%� /-?/,C/ZA l�I� Contractor's Name 0 / Phone Address RmailingI f 6 City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I arty licensed under provisions of Charter 9 (commencing with section 7000) of -Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class _ License No. Date Signature _ WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate -i Workers' Compensation Insurance, or •a certified copy thereof (Section 00, Lab. C �eg-�6 �lii:y No. t Company Certified copy Is hereby furnished. Cer i ed copy I fg' ed with the city Buil In ivlsia n� d ite ,moi S V —Applicant _- M `r 1re-/z EXEMPTION FROM WORKERS' COMPENSATION OECLAR ION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the Perfryrmance of the work for which this permit I$ issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date — —Signature 'NOTICE: 11, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions_ or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for this peiTit, is i su (Sectlbn�3097 Clv. C.) Lender's Name �-�VfJ Lender's Address _ _3 2 1 OWNER BUILDER DECLARATION I hereby affirm that I arc, exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter. Improve, demolish or repair any structure, prior to its issuance, also requires the applltant for such permit to file a signed statement that he/site is licensed pursuant to the provisions of 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 '131.5 by any applicant for a permit subjects the applicant to a civil ,laity of not more that} five hundred dollars (5500). 4 I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work hlmself/herself or through his or her own employees, provldod that such improvements are not Intended or offered for sale. It, however, the building or Improvement Is sold within one year of com- pletlon, the owner will have the burden of proving he/she did not build or im- , prove for the purpose of sale). © 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's Lican%e Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuarit-to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Stiction B. & P. C. for this reason Date _74Owner '22; WZ004111G, 1 hereby certify that I have read this application and stat that the above Information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives Of this city to enter upon the above-mentioned property fo inspection put i Signature Drivers' License or SS 1f, " CONVERSION LJ DEMOLISH LJ OTHtH A.P. 46 DESCRIPTION OF WORK/USE OF BLDG. 5 Main Building: E TYPE OF PERMIT GRADING p{ FOUNDATION STRUCTURAL T Front El TENANT El ELECTRICAL 4�1 PLUMBING ❑ MECHANICAL B Rear ❑ -OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: elfir�. B 13 p 95- Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trop Roof,Drains Reinspection Fee Boiler PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays $15 1 j Issue Fee MECHANICAL Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting ❑ 0- 100,000 BTU ❑ 100,000 BT Reinspection Fee I S75 GMF 0865.46, rev. 10184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type 1 ❑ Canopy Type I I ❑ ' Refrigeration System 00-100,000BTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes 0165 7/25/86 Zone Accessory Building: Perking Req./Provided ELECTRICAL , Transformer ❑ 15-50 KW 4__� ❑ 50+KW Outlets Switches Garbage Disposal Generator ❑0.5 KW ❑5-15 KW Meter I Jup to 100 amps Meter Dover 100 amps Sub Panel Motors 00.1 HP 01 'A - 8 Inc.Solar ❑9.15 HP 016.15} Microwave Pole Light Range Sign Standing Sections Trash Compactor $ 3 Reinspection Foe s15 I I Issue Foo FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By [ SUMMARY OF FEES BUILDING PERMIT S SMIP PLAN CHECK S PERMIT PLUMBING S ISSUANCE PLAN CHECK 25% $ r ENERGY P.C. ELECTRICAL S GRADING PLAN CHECK 50% S MICROFILM MECHANICAL ' S TOTAL FEE PLAN CHECK 25% $ S 3 8.00 TL Z O N I N G R E O M T S FEES S 3 S s 5 S S _ �VCONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL t APPROVALS Permit+' Date , Inspector 1. Temporary Electrical Service or Pale 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Farms 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 9: Water Pipe-Undrgrnd. 60, Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough,Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Duets, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 76. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing f T47 cAV') 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 5). CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines andsignall appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PER PERMIT IVO. TRACT NO. ; LOT NO. UNIT NO. - Projgct Address Applicant's Mailing A ress - /t -J TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR �� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER.- my license is in fu force and effect. A.P.# Owner's Name Phone -DESCRIPTION QF WORK/USE OF BLDG. _ , WORKERS' COMPENSATION DE LARATION m I hereby affirthat I have a certificate of consent to self -Insure or a certificate + ` Bar Sink Showers Address— rt Backflow Preventer - - - ° Service Sink Z of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) S Main Building: Policy No. Company i BCertified copy is hereby furnislied. Certified copy Is filed with the city Building Division. Bathtubs Sewer Connection , Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION E _ Arch/Eng. License N -. TYPE OF PERMIT 0 GRADING 'FOUNDATION STRUCTURAL , Drinking Fountains Solar Tank T Front Floor Drains Swimming Pool w/Spa PLAN CHECK 25% ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL Floor Sinks + Urinal B '� Gas Service Outlets.Water Closet - -. - Address 1 hereby affirm that there is a construction lending agency for the performance of the work for which this- permit is issued_ (Section 3097 Civ- C.) Lender's Name' Lender's Address_ - ❑ $ A Rear Contractor's Name hone 2.71-1 OTHER + P --Trap Laundry Trays C Right - - PROJECT DESCRIPTION SQ. FT. OCCUPANCY , Reinspection Fee $15 1 Issue Fee $ 3 Address (mailing)Aldi FEES CONSTRUCTION TYPE VALUATIONS - Boiler S Left City License No. :7� — ---T• LICENSED CONTRACTOR DECLARATION ZONE GRADING GU.YDS. ACRES Duct - Under Ground I Ping. Ref. # Duct - Structural i hereby affirm that t am licensed under provisions of Charter'9 (commencing Remarks: J Planning Notes: with section 7000) of Division 3 of the Business and Professions Code, and my license is in fu force and effect. - Llcense Class License No. Date Signature e PLUMBING FEES , WORKERS' COMPENSATION DE LARATION m I hereby affirthat I have a certificate of consent to self -Insure or a certificate + ` Bar Sink Showers Application Issued By rt Backflow Preventer - - - ° Service Sink Z of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Backflow Irrigation Sewer Cap SUMMARY OF FEES Policy No. Company i BCertified copy is hereby furnislied. Certified copy Is filed with the city Building Division. Bathtubs Sewer Connection , Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers Solar Collectors _ (This section need not be completed if the permit is for one hundred ($100) or less), r 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 tete - Dishwasher Solar Piping , Drinking Fountains Solar Tank $ -OO Workers' mpe ati a_i—vs of Caiifor Date �� Signature } Floor Drains Swimming Pool w/Spa PLAN CHECK 25% NOTICE: If, atter making this declarat n, you should become subject to the Workers' Compensation provisions o the Labor Code, you must forthwith comply with such provisions or is permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY " Floor Sinks + Urinal ELECTRICAL '� Gas Service Outlets.Water Closet - -. - 2 0 1 hereby affirm that there is a construction lending agency for the performance of the work for which this- permit is issued_ (Section 3097 Civ- C.) Lender's Name' Lender's Address_ - Interceptors • _ Water Heater $ Kitch_e_n'Sink, -Water Service Z OWNER BUILDER DECLARATION - - - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repalr 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 '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 peof not more than five hundred dollars ($500). , . I, as, owner of the property 'or •my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered + for sale' (Section 7044, Business and Professional Code:' The. Contractor's 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 employees, provided that such improvements are not intended or offered for If, however, the building or Improvement is sold within one year, of com- + pletlon, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). LJ 1, as owner of the property, am exclusively contracting. with licensed con- ' 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 bunds or improves thereon, and who contracts for such projects with a con- tractors) license pursuan't•to'the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. Lavatories - - Auto -Wash ' - + P --Trap Laundry Trays ' PIAN CHECK 25% Roof Drains. . - - , , Reinspection Fee $15 1 Issue Fee $ 3 MECHANICAL FEES - Boiler Hood or; Type I Elsale. Canopy Type 11 ❑ - , Duct - Under Ground I Duct - Structural Refrigeration System ❑0-100,000 BTU 01100,000BTU Duct - Ventilating _ Exhaust System 0 Multiple ❑. System Repair/Alteration Firepl/Fact. Bit. ICBQ # Fire Dampers ❑ i•am exempt under Section B. & P. C. for this reason Date Dwner I hereby certify that. I have read this application and state that the above information is correct. I agree to Comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of 't is `cit to enter upon the above-mentioned property for inspection pur ses.' Signature Date_ r Drivers' Li se or SS Heating System & Ducting Registers ❑ 0-100,000 BTU 0100;000 BT Reinspection Fee 1 $15 CMF 0865-46, rev, 10/84 White - Building; Canary -'Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee j $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas• ❑Electric i Zone Accessory Building: Z O N N G R Parking Req./Provided E- a M T I S ELECTRICAL 4 Transformer El15=50 KW :-AlE]50 + KW F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator C1 0-5 KW El 5-15 KW Reinspection Fee 1 $15 Meter LJup to 100 amps Meter. E) over 100 amps 'Sub Panel Motors 00-1 HP ❑1%- B Inc. Solar 09-15 HP 016.15+ Microriave — Pole:Light Range Sign' Standing Sections Trash Compactor Issue Fee' FEES i I .S 3 DEVELOPMENT SERVICES. REQUIREMENTS. EQUIREMENTS:Zoning ZoningApproved By Date Building Approved By Date Application Issued By Date,___ _77 SUMMARY OF FEES BUILDING PERMIT $ SMIP i $ PLAN CHECK $ PERMIT PLUMBING, $ -OO ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C• $ ELECTRICAL $ GRADING S PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE $ �•�'�� ^ ' PIAN CHECK 25% $ CONSTRUCTION AND PLANNING A?PROVALS Permit # Date Inspector POOL &SPA APPROVALS- Permit # Date Inspector i.Jemporary Electrical Service or Pole 52. 52. Pool & Equipment Location A "2. Soil P+ JUndrgrnd. rf ,� 53. Steel Reinforcement r 3.Electrical Condui) Utilii y-Undrgr�rd:� 54.. Forms n i IectArical Conduit-Und �grnd. r 55. Electrical Bonding j 5. Steel�Reinforcernent .% n r �- 56. Rough Plumbing & Pressure Test 61"ctriC's l UFER•Grnd. o r , 57, APPROVAL TO COVER-GUNITE ( 7!Foo fines rd r �!' �• 58. Electrical Conduit-Undrgrnd. 8�, Foundation �� % 59. Gas Pipe, I] Undrgrnd., Test � n� 9. ,Water'N`pe-Undrgrnd. ;' 60. Backwash Lines, P -Trap, © Undrgrnd• 10. Structural Floor System 61. _APPROVAL TO DECK 11. Property,,Sewer Line & House Connection 1 62: Backwash & Fleceptor-Final 12. Sewer Vp �� y 1 f as 4 63. Heater & Vent -Final 13. Root Drains t,(t �i 64. Plumbing System - Final 14. Rough Plumbing;" 65. Electrical -Final • t 15, Rough Electrical -Conduit - r 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 ,r, FIRE DEPT. REQUIREMENT APPROVALS- Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping © Gas 0 Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank l] Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydra 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32, Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Nr)tes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy X37. Final Factory Fireplace 138. Final Plumbing 139. Water Service -Final 40. Gas Service -Final /41. Solar Domestic -Final 1142. Backflow Preventer.��, 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL' STRUCTURE & BUILDING 48, Specigi Requirements Completed 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Ca 51. CERTIFICATE OF OCCUPANCY Vin. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTIQ&PERMIT ' PERM` NO. TRACT NO. LDT NO. r :UNIT N6. 35OQ, 12/07�6u r M I k • �� ProjdFt Address G �t<� Applicant's Mailing Address r' ��T� �� Y V i TYPE QF.CDNSTRUCTION ❑,CONVERSION '❑ DEMOLISH NEW ADO ALTERATIDN� REPAIR ❑ OTHER ! F G� y„ Owner's Name Phone ��J A. -Zone � .Z C+ DESCRIPTIDN_DF WORK/USE OF,BLDG. _- ;S;'- Main Building: ` Accessory Building: . Address Arch/Eng. O (' License No. - _ TYPE OF PERMIT GRADING ❑ FOUNDATION ❑STRUCTURAL T. Front - _ O D ' �'� U'� Z 0 a Address ❑ !TENANT, El ❑PLUMBING MECHANICAL Rear; i d N L Contractor's Nam �-� �� Phone 25 i Z%�� 'L/7 ❑ ',OTHER * _ A" C Right -• N / G d PROJECT DESCRIPTION , SQ. FT, OCCUPANCY K 1 C' .1 Address (ImaiIino) •__ = City License No. CONSTRUCTION TYPE ' ' VALUATION $ S Left ' - R. _ _ 1 CONTRACTOR DECLARATION •- ZONE - GRAOING CU. YDS. 11CRES - r r Ping.'Ref.;# ,. ; ' Parking Req./Provided . E ; ;LICENSED ' I hereby affirm that I-am licensed under provisionsof Charter 9 (commencing s ' Remarks: , r _ 4 r Planning Notes': - - -- ' Q' 'M , with section 7000)' of. Division 3 of the Business and' Professions Code, and ` - I `my license is_ in full f rce and ffect. t ` j I f ' t i �_ , i +% ! S O , License I Lice No c J Datef Signature i 1 j I ; PLUMBING r FEES, v ;WORK RS' OMP NSAN TIODEC LA ATION ! �. - I 'l hereby affirm that;I have a certific%te f consent to self-insure:or a certificate Bar'1 i ! Showers ( r ? ' I ELECTRICAL i FEES •. ofn _Workers' CompensatioInsurance 'or_a`certified copy thereof_ Section ( Backflow Preventer Service Sink-'-' f� I_. _ Automatic Washer .° ;' Transformer ❑J15-50 KW��' _ _ 3800, Lab,-4 Policy No. S ! Company Policy Backflow Irrigation Sewer Cap i ❑ 50 } KW ' 1 ,Construction Pole Sub, ' ❑ Certified copy is hereby furnished, i ❑ Certified cdpy is'filed with�the city Build' g O�i'v on I( l ; i •-! , Bathtubs j ;Sewer Connection'? ;Cooking Unit ' I ( Meter, ❑up to 100 amps. ! j ` 'Date i ! Applicants t v EXEMPTION_ FROM WORKERS' COMPENSATION pECLARATION! ' j Clarifiers ' Solar Collectors ! h + __Dishwasher �. Meter ED over 100 amps r _ (Thlssection need not-be;completed'if'the permit;is•for'one hundred ($100) or "'k less), ! - - - - Dishwasher - - - Solar Piping i t - !+l' Dryers ❑Gas ,❑Electric , Sub Panel I i ' l cert-sfy that in the performance of the'work for which this'permlt is issued, 1 shall -not employ any person in any manner so as to become subject to the Drinking Fountains i I Solar Tank ' Fan ! 1 i , ` Motors ❑0-1 I-!P ❑1%z-8 , 'Workers' Compensation Laws'of California. r ` , Date, Signature 1 j Floor Drains i Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 HP 016-15+ 'NOTICE:'If, after making this tleclaration, you should become subject to the •Workers'.-Compensation7provisions.-of the. Labor_,Codeyouu must forthwith _ Flobr-Sinks - -- )- - - 1' -• -- -• ' Urinal •-, -'-�--'" -�i•-- '�'t °�.i ' ! - Fixtures w � _ • Microwave - - - comply with ,suchl provisions or, this permit shall, be deemed revoketl, i CONSTRUCTION LENDING 'AGZNCY'': �`, ,- ,. •� i rr; ': _ z:. , - '+ r" Gas Service: Outlets - - '•' �^ : re, " Water.ClosetDevice e I Boxes i , Pole Light, I hereby affirm that there is a constrUction fending agency for the performance ! ,of the work for which..-this permit .is Issued (Section 3097_ Civ. C.). i `' �' Interce tors '`' p. .,, Water.Heater ` '��"' Outlets i Range ; ! Lender's Name' i. Lender's Address '-= r » "- - r - .. Kitchen Sink' _ - ' �. •- - L WaterService _ ! Switches . 'Sign Si n, ' OWNER BUILDER DECLARATION r t - 4 , _ 1 hereby affirm that I am exemptifrom the Contractor's-License Law for the _ ; �'r 1 t Eavatoriest� } �' I Auto-Wash. ' i ( Garbage Disposal r Standing Sections i following reason, (Section .7031:5 5usiness and'Professional Code: Any city;or_ 1 county which requires a permit.to;tonstruct; alter, improve,' demolish orrrepair j ! p-Trap i i T. ; _ j L"aundry Traysa," ' l' t Genefator�❑0-5 KW ❑5-15 KW Trash Compactor ; r any structure,' prior to its issuance, also requires the applicant'fw such permit_ ; ' j ! to file a signed statement that he/she is licensed pursuant to the provisions ofr,� of= _* Roof Drains •-- ,' r •+;, , t the Contractor's License' Law'(Chapter 9 (commencing with Section 7000) ! Division 3 -of', the Business and Professions Code) or.that heyshe- is ,exempt ! - + =-! -- i r therefrom and the basis for the„alleged exemption.+Any violation of5ection ; _ - _” _= ; r ( '� , } ' ' 17031:5 by. any; applicant for._a permit •,subjects the ;applicant _tor a; civil of not more than fivelh'undred dollars ($500). ; i ! ( y i •` i i penalty �.' 1, as owner of'the property army employees'-with wages as their sole r .Reinspection F-ee ! "Y $15 f issue Fee 1 $ 3' ° ` ; compensation; will do the work; and.the structure is not intended or.offered for sale .(Section 7044, Business, and 'Professional "Code: 'The !Contractor's i 1:7 c ' MECHANICAL, ' " - - FEES, Reinspection Fee $15 - Issue Fee $ 3 ' License Law does not apply to an Owner of a property who builds or improves thereon, and who such:w_ork himself/herself or through his or her own ' -. - Boiler r„ ,Hood OY Type I : ❑ , DEVELOPMENT SERVICES REQUIREMENTS: ,,employees, provided that such improvements are`not intended or offered for - sale, If, however, the building or irhprovement is sold within oneiyear,of com- , - !Canopy Type 11 ' ❑ _ � I ' Zoning Approved By ! Date ! ! j p}etion, the owner will have the burden of proving he/she did not build or im- Duct°-'Under Groundl ,_- ' ° Building-Approved By Date Qrove fortthe purpose of'sale): I ! Lj I, as owner of the property, am exclusively contracting ,with acon- Duct - Structural System Refrigeration Syste Application Application Issued By Dat 1 tractors to construct the prosect (Section 7044, Business and Professions Code: - who jm ' - r - ED 6-1 BTU 11100,000 BTU --- --- — • •••• The Contractor's License Law dots not apply to an owner of property - -' Duct= Ventilating . - `- _ - "-'_- SUMMARY OF, FEES builds vr,'improves.thereon, and _who contracts for such projects with a cont^ License,that n - • BUILDING PERMIT SMIP r �$ ` • tractors) license pursuant to;the a ontractor's Law). I am.aware Exhaust�System ❑ Multiple ❑ System Repair)Alteration f •$ + proof of, their Worker's Compensation` insurance should be provided to me. , ; PLAN CHECK $ • - , 1 PERMIT i ❑ I am exem t under Section- --- B. & P. C. for this reason Fire I/Fact. Bit. ICBG # p Fire Dam ers ; , p ( k ` $ { i PLUMBING, $ ISSUANCE i Date Owner Heating System & Ducting ❑100,OOOBT i Registers I - -^, I PLAN CHECK 25% ;$ ' ENERGY P.C. �$ ($ ! I hereby certify that -ilhave`read= this -application and state that'the above f 96-100,000 BTU Cil ELECTRICAL !$ GRADING information is'correct. I,gree to ply with all.city and county ordinances I I � ,and state, I s relating to buildi nstruction, and hereby author'- rep re- �inspectio pu poses. +1MECHANICAL�f•S_ sentatives o this 1ty o e t an the above-mentioned pro ty r+�R I I l $ 1 MICROFILM $ ! PLAN CHECK 50% '$Signature Is Date (r r r , ! TOTAL FEE ' Drivers' Li se or SS #. ins eetion Fee P $15 Issue Fee i $ 8 I I , r PLAN CHECK 25% $ �' Z } CMF 0865-46, rev, 10/84 - White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit,#�; Date Inspector POOL & SPA APPROVALS Permit# Date Inspector 1.iTemporary 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. 1 - 55. Electrical Bonding 5. 'SteelReinforcement ! .r 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. ' i 57. APPROVAL TO COVER-GUNITE 'T. Footings I 58. Electrical Conduit-Undrgrnd. � 8. Foundation`, i 59. Gas Pipe, P Undrgrnd., Test s 9. Water Pipe-Undrgrnd, rr ' 60. Backwash Lines, P Trap, ❑Undrgrnd. i •' 10. Structural Floor System, { Y61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer ,Cap { t 63. Heater & Vent -Final 13. Roof Drains I 64. Plumbing System - Final 14. Rough Plumbing, 65. Electrical -Final 15. -Rough Electrical -Conduit J 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 p: 69. POOL/SPA SYSTEMS FINAL 19. Rough' -Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure -70. Underground Hydro 22• Ducts, Ventilating 71. Product Piping ❑ Gas' ❑ Oil t, 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing v 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil a 25. Roof Sheathing 74. Overhead Hydro 26, T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL -29. Insulation 78. FIRE PREY. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED (' 33. Final Electric Notes: 34. Finai.Heafing & Air Conditioning' 35. Final Gas Pipe -Test 36. Hood or Canopy' 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final s . 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 t . 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. uNIT N Project Address ' ' 711 w. 17th St. Bldg. (F) Unit 12 Applicant's Mailing Addrest 13110 Saticoy St. N.Hollywoo Owner's Name Troy 1Nvestment Fund hone 549--298 Address 4321 Birch St. Newport Beach, Ca. Arch/Eng. Marin J. Rock License No. Address 12881 Knat_t Aye.__Stuie 216 Contractor's Name DijrQ Air Condit i nin Phone 982-1216 Addressimaiiing) 131 10 Saticoy--S.L. N.HollyWood,Ca. City License No. X1925 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am, licensed under provisions of Char r 9 (commencing with section 70001 of Division 3 of the Business and Pr ssions Code, and my license is in full for nd effe 346251 License Class C LU Licen o. Date 4/ 19/84._.: Slgnature WORKERS' COMPENSATION DEC ARATION I hereby affirm that 1 have a certifI a of consent to self -insure or a certificate of Workers' Compensation InSur' ce,, or a certified copy thereof (Section 3800, Lab. C"WC9824 Lumbermans Policy No. Company H Certified copy is hereby furnished. Certifi ❑py is filed with the city Bui Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that ;in the performance of the work for which this permit is issued I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. I Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers'- Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY, - I hereby affirm that there is a•construction lending agency for the performance of the .work for which this permit is 'issued (Section 3097 Civ. C.) Lender's Name Lender's Address _ OWNER BUILDER DECLARATION .. ! I hereby affirm that I am'exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a pgrmit to Construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for Such permit to file a. signed statement that'he/she is licensed pursuant to the provisions of ,the Contractor's -License Liaw (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 fbr'the alleged exemption. Any violation of Section 7031.5 by any applicant- for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, l3usiness and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale, if, however, the builging or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or lm - rove for the purpose of sale), 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractors) license pursuarit_ to'the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ lam exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to omply with all city and county ordinances and state la relating to bull construction, and hereby authorize repre- sentatives is city t4 en r, poo the above-mentioned property for inspection urp ses.� ly Signature Date_ Drivers' Lice or SS l s TYPE OF CONSTRUCTION NEW I I ADDL1ALTERATION El REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL B Rear ❑ ,OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ $ Lefi ZONE GRADING CU.YOS. ACRES Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains, Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap' _ Roof Drains, PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Soler Piping. Solar Tank Swimming Pool w/Spa Urinal Water -Closet Water Heater Water Service Auto -Wash Laundry Trays Reinspection Fee$15 ME Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple El I Firept/Fact. Bit. ICSO q- Heating System & ducting 1 [90-100,000 BTU ❑100,000BT1 Reinspection Fee { $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee Hood or Type I ❑ Canopy ! Type I I ❑ Refrigeration System ❑¢100,000 BTu E3100,000 BTU System Repair/Alteration Fire Dampers Registers Z=EES 2280 5/03/85 Zone Accessory .Building: Parking Req./Provided ELECTRICAL Automatic Washer �. Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F, AV Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW ❑5-15 KW $ 3 Reinspection Fee $15 FEES FA r Issue Fee $ 3 Transformer ❑ 15.50 KW ❑ 50 + KW Meter ❑up to 100 amps -Meter Clover 100 amps Sub Panel Motors El 0-1 HP ❑ 1'h 8 Inc.Solar'❑9.15 HP El 16-15+ Microwave Pole Light Range Sign ! Standing Sections Trash Compactor Issue Fee 1 5a 50 TL FEES $ 3 z O N I N G R E a M T S DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By —Date Building Approved By Date ' Application Issued By SUMMARY OF FEES BUILDING PERMIT $ SMIP $ ' PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. , $ ELECTRICAL $ GRADING $ PLAN CHECK 50°% $ MICROFILM $ MECHANICAL $ 11-00 TOTAL FEE $ 15.50 PLAN CHECK 25% $ 5C) ' CONSTRUCTION AND PLANNING APPROVALS . Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1.:Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ; 6. Electrical UFER Grnd, 57., APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 1 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test ' 9, Water Pipe-Undrgrnd. .:' 60. Backwash Lines,'P-Trap, ❑ Undrgrnd. 10. Structural Floor System . 61, APPROVAL TO DECK " 11. Property Sewer Line & House -Connection 62. Backwash &Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rougo 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 APPROVALS Permit # 20. Rough Factory Fireplace 21.. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. G1TY DF COSTA: MESA CONSTRUCTION PERMIT Projvct.Address 7l1 VV, 1� - •_- CQi i pr -1'n Sg - Applicant's Mailing Address Owner's Name f N 1/Es-rYl'1 ii ATT Phone Address Arch/Eng. - License No. Address Contractor'sNami., MbiRRis Fl..1=CTf?„iC_ Phone 6ffM Address imailingl 1ST- 14) City License No. �_ 33 15 Z LICENSED CONTRACTOR DECLARATION I hereby affirm that I'am licensed under provisions of Charter 9 commencing with section 7000) of Division 3 B Hess and rofes o s Code, and my license is in full, force and effec . License Class I C' f Licen .7 No. S Date —i�L Signature WORKERS' COMPENSATION DECLARATION - I hereby affirm that I have a certificate of consent to seifansure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) — Policy No. WC- !s 109 -7 0 C pa BCertified copy is hereby furnished. Certified cop isfi]ed with [he Cit i ivisio Date 1—ifl- 5 Applicant EXEMPTION FROM WORKERS' COMPENSATIO DECLARATION (This section need not -be completed if"the permit Is or one hundred ($100)'or less). I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date _ Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with suth provisions or this permit shall be deemed revoked. CONSTRUCTION ,LENDING AGENCY I hereby affirm that there Is a construction lending agency for the.performance of the work for which this permit is issued (Section 3097 Civ. C.). Lender's Name Lender's Address' OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or County which requires a permit to construct, alter, improve, demolish or repair any Structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 0 enalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License taw 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 employees, provided that such Improvements are not Intended or offered for safe. if, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or jm- prove for the purpose of sale). C1 1, as owner of the property, am excluslvely contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who builds or, Improves thereon, and who contracts for such projects with -a con- tractor(sj license pursuant to the Contractor's License Law). I am aware that proof o their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby cert! information is and state Ir f inspection kWJ Signature Drivers' License or SS I have read this appation and state that the above gree tompiy Ipd all city -and county the buildin Constr c bn, and hereby authorize repre- o enter upon h above-mentioned property for Date1—(0— 85 PERMIT NO. C TRACT NO. LOT NO. UNIT NO. 5893 / E/8rJ ba 50 TYPE OF CONSTRUCTION NEW IJ ADD LJ ALTERATION U ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. REPAIR A. P. 916 Zone 5 Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ -OTHER ' PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION 5 ZONE GRADING CU.YDS. ACRES E T Front Z O 9 A Rear - N I C Right N S Left G R Ping. Ref, # Parking Req./Provided E Remarks: Planning Notes: O M T S PLUMBING FEES I ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink c Automatic Washer Construction Pole Sub. -Transformer Q 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Clarifiers Sewer Connection Solar Collectors _ Cooking Unit Dishwasher Meter ❑up to 100'amps Meter. ❑over 100 amps Dishwasher Solar Piping ' Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Floor Drains r Solar Tank Swimming Poo) vv Fan F.A,U. Motors o-1 HP Ell 'A B Inc. Solar 0$-15 HP ❑16 15+ Floor.Sinks Gas Service Outlets Interceptors Kitchen Sink, Lavatories Urinal Water Closet Water Heater Water Service Auto -Wash Fixtures Device Boxes Outlets Switches Garbage Disposal Microwave Pole Light Range Sign ;Standing Sections P—Trap Laundry Trays Generator ❑0.5 KW ❑5-15 KW Trash Compactor Roof Drains r Reinspection Fee $15 Issue Fee S 3 Roinspection Fee $15 Issue Fee $ 3 Boiler Duct - Under Ground MECHANICAL Hood or Type I ❑ . Canopy Type 11 ❑ FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date Detn 1-1 I _ Duct - Structural Refrigeration Systerr'i ❑o•loo,000 BTU ❑ 100,000 STU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ $ x,(5[7 GRADING $ $ -StO MICROFILM $ $ TOTAL FEE s $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG # Fire Dampers Heating System & Ducting ❑0-100,000 BTU [1100,OOOBTL Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor _ WNSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1 i 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. t 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6, Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water. Pipe-Undrgrnd. 60. Backwash Lines. P -Trap. ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection, 62. Backwash & Receptor -Final 12. Sewer Cap 63. Healer & 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 Wiring67. 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 Z Notes: 34. Final Heating & Air Conditioning' 35, Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. 8ackflow Preventer 43. Backflow Irrigation 44. .Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regutations 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed ` 49. Electric Release to Edison 50. Gas Release to Southern California Gas CD 51. CERTIFICATE OF OCCUPANCY No. _ Date „ __, Cr Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITYOFCOSTA+�MESA :CONSTRUCTION PERMIT o-/t5/2 Prect Address 1 1 � ST L1+'V 1% 1 f t5/ Z Costa Mesa !22-<.z7 Applicant's Mailing Address Owner's Name %; Phone 4 S A OLSO Address _i`�1nZ o AGAM6�l° 17.? 13. �[_ 4z1o�4 Arch/Eng. License No. Address Contractor's Nam one Address (mailing) City License No LICENSED CONTRACTOR DcCLARATF6N I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and,Professlons Code, and my license is in full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION ' I hereby affirm that I have a certificate of consent to self -Insure or a certificate -f Workers' Compensation Insurance, or a certified copy thereof (Section 100, Lab. C.) olicy No. Company eCertified copy Is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued, 1 shall not employ any person';,, any ma so as me subject to the Workers' Co pegs7ti-on Laws o! Cal' Date , 7�,( �Signaturcc- r1�� NOTICE: lf, after making this declaratIon,.y uIc1 become subject to the Workers' Compensation provision$ Of the Labor Code, you must forthwith comply with such provisions or this permit shall . be deemed revoked, CONSTRUCTION LENDING AGENCY /� I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name Londer's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License .&w for the following. reason (Section 7031.5 Business and Professional Codet Any city'or county which requires a'permlt to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed Statement that he/she Is licensed pursuant to the provisions of 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 131.5 by any applicant for a permit subjects the applicant to a civil nalty of not more than five hundred dollar$ ($500). .J I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is net Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner Of a property who build$ or Improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for safe, lf,.however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or�Improves thereon, and who contracts for such projects with a con- tractor(s) ucense pursuant to the Contractor's License Law), I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relat Pbuilding construction, and hereby authorize repre- sentatives of t l0 ente the above-mentioned property for inspection p os Signature Dat Z Drivers' L nse or 5 :�"c--�,-�14<1 TYPE OF CONSTRUCTION LJ NEW LJ ADD Al ALTERATION LJ REPAIR ELECTRICAL FEES ❑ ❑ ❑ OTHER Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub... ❑ 50+ KW CONVERSION OEMOLISH A.P.# DESCRIPTION OF WORK/USE OF BLDG. Cooking Unit Meter ❑up to 100 amps Clarifie7s Solar Collectors Dishwasher - Meter ❑aver 100 amps Dishwasher Solar Piping S Main Building: Drinking -Fountains Solar Tank E Floor Drains Swimming Pool vv/Spa TYPE OF PERMIT 0 GRADING{ El FOUNDATION STRUCTURAL T Front ❑ T,ENANT ❑ ELECTRICAL DI PLUMBING ❑ MECHANICAL B Device Boxes Pole Light ❑ OTHER I A Rear Switches Sign C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Generator 00-5 KW ❑5-15 KW Trash Compactor • CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: $ 3 Planning Notes: FEES Zone Accessory Building: Parking Req./Provided Z O N I N G R E O M T S ,I 8ar'Sink I Showers' QC% ELECTRICAL FEES f Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub... ❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifie7s Solar Collectors Dishwasher - Meter ❑aver 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking -Fountains Solar Tank Fan Motors 1:30.1 HP ❑ 1 h - B Floor Drains Swimming Pool vv/Spa F.A,U, Inc. Solar El 9-15 HP El 16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections P—Trap) Laundry Trays Generator 00-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 • MECHANICAL FEES Boiler Duct - Under Ground Hood or Type 1 ❑ Canopy Type II ❑ DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved BY Date Building Approved By Date Application Issued By rn flat r Duct - Structural Refrigeration System ❑0-700,000 BTI.) 0100,000 BTU Duct - Ventilating SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% S ENERGY P.C, $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFI LM $ MECHANICAL $ TOTAL FEE S PLAN CHECK 25% $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers Heating System & Ducting ❑0-100,000 BTU ❑ 100,000 BT Registers Reinspection Fee S15 Issue Fee $ 3 AF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57, APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe.Undrgrnd. 60. Backwash Lines, P-Trap, © Undrgrnd. 10. Structural Floor -System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16, Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18, Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping © Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24, Roof Framing 73, Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat : 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace •38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final .42. Backflow Preventer i •43. Backflow Irrigation '44. Landscape Irrigation System 45. Sound Attenuation ' 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No• Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. TI CITY of COSTA MESA ' CONSTRUCTION PERMIT PERMIT NO. _ TRACT NO. LOT NO. UNIT N0. Project Address 7/EJ. 11THS—, Ck:i4 28 M ESA Applicant's Mailing Address Owner's Address Arch/Ent 1� Address ,.�.; Contracti Address I City Lice LICENSED CONTRACTOR DECLARATION I hereby affirm that t am licensed under provisions of Charter 9 (commencing with section 7000) Of Division 3 of the Business and Professions Code, and My license is in Il force and effect. License Class Date - Signature WORKERS' COMPI_NSATION DEC RATION I hereby'affirm that I have a certi(IC to of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified -copy thereof (Section_ 1600, Lab. C . ,olicy No. w•C �. —1a!F3 � Company r /�(!: r J 8 Certified copy it hereby furnished. Certjf�,ed Tp filed with the city sio . Date �r�[� Applicant EXEMPTION FROM WORKERS' CO PE ATION DECLARATION (This section need not be completed if th&Fpermit IS for one hundred'($100) or less). I certify that in thiI performance Of the work for which this permit is Issued I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California.: pate ' Signature 'NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a constructlon lending agency for the performance of the work for which this permit is :Issued (Section 3097 Clv. C.) Lender's Name - Lender's Address I OWNER BUILDER DECLARATION ' I hereby affirm thgt I am exempt from the. Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or County which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit -to file a signed statement that he/she Is licensed pursuant to the provisions of '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 1031.5 by any applicant for a permit subjects the applicant to a civil •nalty Of f not more than five hundred dollars ($500). / J i, as owner of the property or my employees with wages as their $ole Compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and: Professional Code: The Contractor's License _Law does not apply to an owner Of a properly who•bullos or Improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement Is'sold within one year of com- pletion, the owner will have the burden Of proving he/she did not build or Im- prove for the purp6so of sale). i ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and who contracts for such projects. with a can- tractor(s) license bursuarit-to the Contractor's License Law). I am aware that proof off their WOrker's Compensation insurance should be provided to me. ❑ I am exempt under Section S. & P. C. for this reason TYPE OF CONSTRUCTION " NEW lJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMDLISH ❑ OTHER A.P. 916 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING El FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING El MECHANICAL B Rear ❑ -OTHER '4 PROJECT DESCRIPTION' SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ Left S ZONE GRADING CU.YDS. ACRES PIng. Ref, # Remarks: InjAnP 6,, Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service, Interceptors Kitchen Sink Lavatories , P -T rap Roof Drains Reinspection Fee Boiler i $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Flrepl/Fact. Bit. ICBO # Date Owner Heating System 8i Ducting I hereby certify that .I- have read this application and state that the above - ❑0.100,000 BTU 0160,00013T Information is correct. 1 agree to Comply with all city and county Ordinances ' and state laws relating to building con ruction, and hereby authoriXe repre- sentativesof thls Ci to enter up the above-mentioned property for Inspection p -7 Signature / 7i Oale DD tf Y Drivers' Lice or 55 Reinspection Fee CMF 0865-46, rev. 10184 White - Building, Canary - Applicant: Pink - Accounting; Goldenrod - Assessor $15 PLUMBING -, Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type I ❑ Canopy Type II ❑ ` FEES 3738-12/10/84 Zone Accessory Building: Parking Req,/Provided ELECTRICAL Refrigeration System ❑ 0.100,000 BT U ❑ 100,000 BT System Repair/Alteration Fire Dampers Registers - r - Issue Fee Transformer ❑ 15-50 KW ❑ 50+ KW -Meter ❑up to 100 amps Meter Dover 100 amps Sub Panel Motors ❑0.1 HP ❑ 15S - 8 Inc.Solar 119-15 HP El 16-15+ Micro"ve Pole Light Range Sign Standing Sections Trash Compactor 13.0'0 TL Z O N N G R E Q M T S FEES FEES 'Automatic Washer - Construction Pole Sub, Cooking Unit '1 Dishwasher REQUIREMENTS: -- Dryers ❑Gas' ❑Electric nate Date Dat Fen F.A.U. Fixtures Device Boxes SUMMARY OF FEES BUILDING PERMIT $ PLAN CHECK $ _ PLUMBING $ i PLAN CHECK 25% $ ELECTRICAL $ 1 {-Od PLAN CHECK 50% $ ' MECHANICAL - $ PLAN CHECK 25% $ Outlets i Switches Garbage Disposal Generator 00.5 KW 05-15 KW Refrigeration System ❑ 0.100,000 BT U ❑ 100,000 BT System Repair/Alteration Fire Dampers Registers - r - Issue Fee Transformer ❑ 15-50 KW ❑ 50+ KW -Meter ❑up to 100 amps Meter Dover 100 amps Sub Panel Motors ❑0.1 HP ❑ 15S - 8 Inc.Solar 119-15 HP El 16-15+ Micro"ve Pole Light Range Sign Standing Sections Trash Compactor 13.0'0 TL Z O N N G R E Q M T S FEES FEES Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: -- nate Date Dat SUMMARY OF FEES BUILDING PERMIT $ PLAN CHECK $ _ PLUMBING $ i PLAN CHECK 25% $ ELECTRICAL $ 1 {-Od PLAN CHECK 50% $ ' MECHANICAL - $ PLAN CHECK 25% $ SMIP $ PERMIT , ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ i $ 3 �) ,CONSTRUCTION AND PLANNING I APPROVALS Permit # Date Inspettor POOL . A APPROVALS Permit # Date Inspecror 1 • Temporary Electrical Service or Pole 52. Pool &Equipment Location ,.2. • Soil Pipe-Undrgrnd. 53. Steel Reinforcement j 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 9. Water-Pipe-Undrgrnd. # 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. -'Structural Floor System F 61. APPROVAL TO DECK 11 • Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12; Sewer Ca'p 63. Heater & Vent -Final ill 3. Roof Drains 64. Plumbing System - Final '14, Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit -66. Solar System -Final 1,6.) 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 APPROVALS Permit # 20. -Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 JJ 12 Notes: 34. Final Heating & Air Conditioning 35. Final'Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irriqation System 45. Sound' Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed t 49. Electric Release to Edison - 50.'Gas Release to Southern California Gas Co , 51. CERTIFICATE OF OCCUPANCY No. Date ? 035 _ 'W--1-�4WOO o13* *** 126.51 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 AP LICTION FOR BUILDING PERMIT For Applicant to Fill in Completely RE EI ED Y T R I D DATE ISSUED BUILDING r7�� J -T �I ADDRESS l PERMtTdPt5rj OWNER A.P. NO. 4 MAIL �S Z D[J�:y/�+ IJ2 . BUILDINGI �']+ 11 ADDRESS rsr Z ADDRESS CL U Y/N� TELLL p P3J �/�� TRACT�� LOT�p% BLOCK Z Z Q CITY NO. CONSTRUCTION C WEPAIR MOVING O f S LENDER CL In J O BRANCH 5&9{./ %'4 /V¢ Er>A N DUST12J A z AP-r— r J (n OWNER r' M J ADDRESS _ f�Nl VALUE J <OR ARCHITECT TEL. US E U ENGINEER .00,7Z.% N r �UN7L �" EL� a 3 3 FIRE ZONE fTY4<M GROUP �_Z W cc ADDRESS " /_/V. a w'YfJ�YrWv � /c r�&�T ,vp APPROVED f f� - DATE y J O °0 Z CONTRACTOR 21') Z_ ,7 al*A1 j D2 . BY J fZ UJ ltd ADDRESS ZONE NO. OF USE OF NEWx�j Z� TEL,p c� CITY .�2V1�f� No.v33�/�� PLANS BUILDING O STATE CITY YARDS APPROVED YARDS APPROVED LU U7 Q LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING 7 O SIZE ``,, nn!! NO.OF BLDGS '7"� (F ROM C/ STREET) OF LOT /p�� NOW ON LOT RONT FT. FT. USE OF L EXISTING BLDG. F SIZE OF �fJ}(�I/�� No.) y STORIES �d Z NEW BLDG. vv F� /� L. SID Q EXTERIOR WALL ROOF >oS" AQ G1 COVERING • COVERING REAR FT. i J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & a E1. MAIN BLDGS. ACCESS, BLDGS. VAR, yW DATE O C.U.P. + APPROVED F" APPROVE ,0,1 N r z HOLD FOR SPECIA REQUI UI hereby acknowledge that I have read this application and state ! that the above Information is correct and agree to comply with ry all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of 41 the State of Celifornla. m '4 z I hereby certify that I am properly licensed as a contractor under So. FT. O THE AMOUNTSHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force end effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; a am exempt from itie provisions of the State of California Business and Protesslon5 C I Division 3, hepta: 9 It M N A V�� /7TION PERMIT FEE $ lyi� /7r / (f 7 Signature of Permittee $� PLAN CHECK $ E o` Authorized Agent TOTAL FEE $ COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely BUILDING -- �� / / 7��r` _ 1 ADDRESS w` i �!/ OWNER I CaY- I N y ' �� MAIL ADDRESS CITY CONSTRUCTION LENDER BRANCH ADDRESS ARCHITECT OR ENGINEER TEL. NO. TE L. NO. `•"R 17-7LtPtir00i0 697 -Uj** r , c.., Z3,�i.50 �PWIIfATION FOR BUILDING PERMIT E DATE RECEIVED ITTIE FIRE PE NO. ZONE BUILDING -,.,I APPROVED CONTRACTOR [ADDRESSLI TRACT LOT ADO AER REPAIR MOVINQ_ ZONE NO. OF CITY ��jVVALUE PLANS STATE CITY $ I hereby acknowledge that I have road this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of GROUP �� 1 DATE 9j/ —I USE OF NEW BUILDING YARDS APPROVED, ACCESSORY BUILDING FT. BET. MAIN & ACCESS, BLDGS. DATE APPROVED the State of California. m 1 hereby certify that I em properly licensed as a contractor under SQ. FT. o the State of California Business and Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: o am exempt from the provisions of the State of California Business and Professions Cocie, Division 3, Chapter 9. VALUATION m PERMIT FEE $ rV Signature of m Permittee I I PLAN CHECK $ E I w p. , O Authorised Agent / i4Y LL TOTALFEE $ ///VVV JJJ � FIRE ADDRESS ZONE APPROVED CONTRACTOR BY ADDRESS TEL. ZONE NO. OF CITY NO. PLANS STATE CITY YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING (FROM C/L STREET) SIZE NO. OF BLDGS OF LOT NOW ON LOT FRONT FT. USE OF EXISTING BLDG. R. S SIZE OF NO. OF NEW BLDG. ROOMS STORIES L. SIDE FT. EXTERIOR WALL ROOF COVERING COVERING REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. MAIN BLOGS.. VAR, C.U.P. APPROVED I hereby acknowledge that I have road this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of GROUP �� 1 DATE 9j/ —I USE OF NEW BUILDING YARDS APPROVED, ACCESSORY BUILDING FT. BET. MAIN & ACCESS, BLDGS. DATE APPROVED the State of California. m 1 hereby certify that I em properly licensed as a contractor under SQ. FT. o the State of California Business and Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: o am exempt from the provisions of the State of California Business and Professions Cocie, Division 3, Chapter 9. VALUATION m PERMIT FEE $ rV Signature of m Permittee I I PLAN CHECK $ E I w p. , O Authorised Agent / i4Y LL TOTALFEE $ ///VVV JJJ � ?036 - ' COSTA ME$A BUILDING -SAFETY DEPARTMENT P.O. SOX 1 00 COSTA MESA, CALIFORNIA 92626 Z d U F Z _Z < O 0 CL In J=)J to Q 1.11 M J In J Q U ch Za UJ a w W Z J 0 CO Z J jr W W 0:[ Z_ w0 to Cr 0O H Z Q U_ J IL IL Q O Cl) Z 0 H U Ct) Z fI \f co ca O i IL m N m E 0 u. I A LI ATION FOR BUILDING PERMIT For Applicant to Fill in Completely R cE Y DATE RE Iv D � D E ISSUED ' * ADIDRESS I W a S OWNER tU 11eS7A AJT U A.P. NO. 9 %U RMI N �'-'S MAIL BUILOING j lel' f AODRE552,� Z U 8Al%, Z.03 ADDRESS j Vii ` AfwJ 4 TEL. CITY ( Lr- NO. _q(�? TRACT LOT BLOCK CONSTRUCTION C� SVT/j0 N W ADD ALTER LENDER OWNER BRANCH AAjq ADDRESS VALUE r I �t.+'4n1 T3�-�7 ARCHITECT OR ENGINEER AsD�So NE !3 S #. �7 FIRE +�'��' ADDRESS ��3 ZONE YPE i � GROUP CONTRACTOR �/Ij (� C1 ti� CL.WC_ i, Ig APPROVE BY 1W DATE ADDRESS Z(,sZ U.V&LrT TEL.�+.� ZONE NO. OF USE OF NEw CITY NO. l�3.7• y% PLANS BUILDING STATE CITY YARDS APPROVED YARDS APPROVE LIC. NO, LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF SLOGS _41;_ � (FROM C/LSTREE7, ) r OF LOT S NOW ON LOT RONT T. FT. USE OF EXISTING BLDG. R SI FT. SIZE OF f l NO. OF NEW BLDG. 80 ! 3 ROOMS STORIES Z L. SIDE FT. l% EXTERIOR WALL ROOF COVERING COVERING C0 REAR D F FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN SLOGS. ACCESS. BLDGS. VAR. * DATE LIE C, -r or-?=(Jcey C.U.P. * APPROVED APPROVEBY 4DZ P /FOR HOLD SPEC AL N I hereby acknowledge that I have read This application and state the[ the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SO. FT, THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION and Professions Code, Division 3, Cha feU9e5j-^.C-rU� �ri [ PERMIT FEE $ ` 7F)6 Tq +sY 1 Signature of. Permittee PLAN CHECK $ TOTAL FEE $ Authorized Agent fI \f co ca O i IL m N m E 0 u. Z W W CL U I.—Z Za fl � 0. to J D J to aLU to J J CO _a U � Z< LUIr CL IL W Z Jp C13 J CC LULU d= Z� LU0 [n M DO Z a V CL CL a O I- N Z O U Ir ffj z COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALI FORN4A 92626 IN I rp"J 237.50 AP LI ATION FOR BUILDING PERMIT For Applicant to Fill in Comp! ly C BY GATE RECEIVED DATE ISS%UED _// BUILDING ST ADDRESS* P R T N Q, ^ OWNER >i...i A.P. NO. It MAIL BUILDING // r�Z Ael Sr / ADDRESS ADDRESS /` / TEL' CITY NO. TRACT LOT BLOCK CONSTRUCTION NFW I ADD A LENDER BRANCH OWNER ADDRESS VALUE USE F Ca $ ARCHITECT TEL. OR ENGINEER N FIRE � ADDRESS ZONE TYPE ROUP APPROV E �jj L CONTRACTOR BY DAT ~ ADDRESS TEL. ZONE NO, OF USE OF NEW CITY NO. PLANS BUILDING STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING (FROM C/L STREET) SIZENO. OF BLDGS. OF LOT NOW ON LOT ERONT FT. FT. USE OF EXISTING BLDG. H. SIDE F1, FT SIZE OF NO. OF NEW BLDG_ ROOMS STORIES L. SIDE FT, FT. EXTERIOR WALL ROOF COVERING COVERING REAR FT, FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN Si MAIN BLDGS. ACCESS. SLDGS. VAR.* DATE C.U.P.:0 APPROVED APPROVED DATE r I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shell not employ any person in violation of the workman's compensation laws Of the State of California. I hereby certify that 1 am properly licensed as a contractor under SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business end Professions Code, Divisicn 3, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. am exempt from the provisions of tfieState of California Business 9. VALUATION S and Professions Code, Division 3, Chapter PERMIT FEE $ ✓ og; Signature of Permittee PLAN CHECK $ Authorized Agent TOTAL FEE $ rw Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. MMV CITirOF COSTA MESA CONSTRUl, IQIV MIT PERMIT NO._ �, TRACT NO. LOT NO. UNIT NO. Ftioject Andress V - Applicant's Mailing A dress Owner's Na one Address Arch/Eng. License No. Address Contractor's Nam ne Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION i hereby affirm that 1 am licensed under provisions of Charter 9 (commencing With section 7000) of Division 3 of the Business and Professions Code, and my license is in t 14orce nd effect. Licens Class V License No Date natureWORKERS'COMION LARATION I hereby'affirm that I have a cerci tate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section_ 800, tab. C.) - Jollcy No. Company BCertified copy it hereby furnished. Certified copy it filed with the city Building Division. Date— Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' (This section need Plot be completed if the permit is for one hundred ($100) or less). I certify _that in thk performance of the work for which this permit is Issued, t shall -not employ any person In any m er so s to become subject to the Worker,WCort Laws of Call r a. Date s r Signalur 'NOTICE: If, after rnaklng this declar on, ou should become subject to the Workers' Compensation provisions Of the Labor Code, you must forthwith comply ,with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY. ' I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 CIV. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the fallowing reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish -or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file asigned statement that he/she Is licensed pursuant to the provisions of -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 1031.5 by any applicant for a permit subjects the applicant, to a civil malty of not more than five hundred dollars ($500). .3 I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 amplayees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of Com- pletion, the owner will have the burden of proving he/she did not build or Im - rove farr the purpose of sale). I, as owner of the property, am exclusively contracting with licensed Con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor($? license pi ursuarit'to'the'Contractor'LlCense.Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. L P. C. for this reason Date _ Owner. I hereby certify that I have read this application and state that the above information IS Correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentativesIs ci to enter upon the above-mentioned property for inspection p ses Signature .L» Date 4r { Drivers' VnSO or SS :p G- / TYPE OF CONSTRUCTION L_J NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER FEES A.P. p(F DESCRIPTION OF wORK/USE OF BLDG. Q Autoriiatic Waiher Construction Pole Sub. Transformer ❑ 15-50 KW' 0 50.+ KW Sewer Cap S Main Building: Cooking Unit -. Meter ❑up to 100 amps E Solar Collectors TYPE OF PERMIT 11 GRADING EI FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Dryers ❑Gas IIElectric Sub Panel ❑ OTHER Solar Tank Swimming Poo( w/Spa A Rear Motors 00-1 HP E111%-8 Inc. Solar 09-15 HP El 16-15+ C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY - Water Closet CONSTRUCTION TYPE VALUATION $ 5 IlLeft ZONE GRADING CU.YDS. ACRES ` Ping. Ref: # Remarks: Range Sign ' Standing Sections Planning Notes: Bar Sink Backflow Preventer - - Backflow Irrigation Bathtubs Clarifiers Dishwasher ' Drinking Fountains Floor Drains Floor Sinks Gas Service. Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee s15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact Bit. ICBO # Heating,System & Ducting , ❑ 0-100,000 BTU ❑ i 00,000 BT Reinspection Fee 1 S15 CMF 0865-46, rev. 10/84 White - Building; Canary -Applicant: Pink - Accounting; Goldenrod - Assessor 5887 7/02/85 Zone Accessory Building: Parking Req./Provided 10050 % Z O N I N G R E- Q M T S PLUMBING FEES ELECTRICAL FEES Showers Service Sink Q Autoriiatic Waiher Construction Pole Sub. Transformer ❑ 15-50 KW' 0 50.+ KW Sewer Cap Sewer Connection Cooking Unit -. Meter ❑up to 100 amps Solar Collectors Dishwasher Meter ❑over 100 amps Solar Piping Dryers ❑Gas IIElectric Sub Panel Solar Tank Swimming Poo( w/Spa Fan F.A.U. Motors 00-1 HP E111%-8 Inc. Solar 09-15 HP El 16-15+ Urinal Fixtures Microwave - Water Closet Device Boxes Pole Light Water Heater Water Service Auto -Wash Outlets Switches Garbage Disposal Range Sign ' Standing Sections Laundry Trays Generator ❑0.5 KW 135-15 KW Trash Compactor Issue Fee s 3 Reinspection Fee $16 issue Fee $ 3 ECHANICAL Hood or T I Ype I ❑ Canopy Type I I ❑ FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By - Application Issued By REQUIREMENTS: ; Date Date spat Refrigeration System 0& 100,000 BTU 0100,00.0 BTU SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK S PERMIT PLUMBING $ ) q ISSUANCE $ PLAN CHECK 25% $ f - $-Z} ENERGY P.C. $ ELECTRICAL S GRADING S PLAN CHECK 50% ' $ MICROFILM $ MECHANICAL $ TOTAL FEE S PLAN CHECK 25% $ System Repair/Alteration Fire Dampers Registers + Issue Fee $ 3 RCONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL. ,.,A APPROVALS Permit # Date Inspector ,i. Tempoo�aYy Electrical Service or Po!'e 52, Pool & Equipment Location 2, Sail Pipe`Undrgrnd..__� �v 53. Steel Reinforcement �',Elec"tnl,cLl Con6i fGti$i y-Undrgrnd�' " � 54. Forms L �, 4'.'Elect�ical ConduitUnbrgrnd. ' �n 55. Electrical Bonding , 5rySt el,'R forcenlAnt . s 56. Rough Plumbing & Pressure Test +j 6• 'ectrical UFER,Gr^d. 57. APPROVAL TO COVER-GUNITE 7. 0ootings� ; j ;' f! ,� 58. Electrical Conduit-Undrgrnd. ; 8. -,Foundation •'l ' 59. Gas Pipe, ❑Undrgrnd., Test 9`f Wate �Piae,Undrgrnd}. 60. Backwash Lines, P Trap, ❑Undrgrnd. h 1 NStructural Floor System , 61. APPROVAL TO DECK 11. Property Sewer Line &House Connection 62. Backwash & Receptor -Final 12, Sewer Ea4p �- I 1 63. Heater & Vent -Final 13. Roof Drains /� ` �r 64. Plumbing System - Final h,Pmbin-Q 14.'Rou {u qg � � 65. Electrical -Final t �l 15. Rough Electrical -Final 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36.'Hood or Canopy, 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irriqation 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 f No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITS/ OF COSTA PfSA CONSTRU TON PE MIT P IT � �� TRACCT�O. LOT NO. UNIT NO, Project Address G •! U l Applicant's Mail in Address Owner's Name l ^� ne _ pl Address`•' Arch/Eng L LiCen�e No Address �� Contractor's Nam 6 Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Olvislon 3 of the Business and Professions Code, and my license is in full farce and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate f Workers' Compensation Insurance; or a certified copy thereof (Section 100, Lab._ C isom_ T r Icy No. /4�D�l7mY�7�/%; 1�Gk 4LT Coml. pan_ Certified copy is hereby furnished. Certif' •co s filed with the city Bp , DateApplicant- I- x Emp pplicant I-xEMP i0 FROM WORKERS' COMPENSATION DECLARATION - (This section need not be completed if the permit is for one hundred ($100) or less). 1 certify that In the performance of the work for which this permit is Issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become Subject to the Workers' Compensation provisions of the Labor Code, you' -must forthwith' comply with such provisions or this permit' shall be deemed revoked. CONSTRUCTION LENDING AGENCY t I hereby affirm that there is a ConstruCtion lending agency for the performance of the work this i I su cti 09 Clv C.] Lender's Name Lender's AddreSs OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor'$ License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 , 131.5 by any applicant for a permit subjects the applicant to a civil nalty of not more than five hundred dollars (5500). LJ I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within one year of Com- letion, the owner will have the burden of proving he/she did not build or Im- ove for the purpose of Sale). I. 'as owner of ;the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who Contracts for such projects with a con- tractors] license pursuarit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. 17 I am exem t under Section B. P, C. for this reason y' Date Owner !' 1 here4 ertify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to (ding construction, and hereby authorize repre- sentatives of this' city en r/�l�p] e above-mentioned prop rty for inspection purposes.Jj�irri/�� Signature t Drivers' License or SS jr- TYI�E-OFCONSTRUCTION 41!7NEW U ADD ALTERATIONREPAIR FEES !lX CONVERSION ❑ DEMOLISH ❑ OTHER A.P. -0 DESCRIPTION OF WORK/USE OF BLDG. Showers ELECTRICAL FEES - Service Sink S Main Building: ' Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection TYPE OF PERMIT GRAOING�j FOUNDATION1:1 STRUCTURAL •1• Front, ELERICAL PLUMBING ❑ TENANT ElCT ❑ MECHANICAL' G Dishwasher- ❑ •OTHER Dishwasher A Rear Dryers ❑Gas ❑Electric Sub Panel C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY Motors E10-1 HP ❑1:4 B Floor Drains C U N ST RUCTI ON TYPE VALUATION S 5I Left ZONE GRADING CU.YDS. ACRESPing. Ref. 59k Remarks: 3o g�D Fixtures Planning Notes: Gas Service Outlets' / rA/ 54 - Zone Accessory Building: Z' O N I N G R Parking Rey./Provided E Q M S I , I Reinspection Fee I $151 I Issue Foe I $ 3 I I Boiler Duct - Under Ground Duct - Structural , Duct - Ventilating Exhaust System ❑ Mul rple ❑ Firepl/Fact, Bit. ICBG # Heating System & Ducting ❑ 0-100,000 BTU ❑ 100,000 BTi Reinspection Foe I $15 CMF 0665-46, rev. 10/64 White - Building; Canary - Applicant; Pink - Accounting; Goldonrod - Assessor I- I FEES Hood or Type 1 ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU 111100,000BT System Repair/Alteration Fire Dampers Registers Issue Fee I Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washdr• Construction Poie Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit - j Meter ❑up to 100 amps Clarifiers Solar Collectors - Dishwasher- Meter ❑over 100 amps ` Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors E10-1 HP ❑1:4 B Floor Drains Swimming Pool w/Spa F.A-U. Inc.Solar 09.15 HP ❑16.15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets' Water Closet Device Boxes Pole LigF t Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories ' Auto -Wash Garbage Disposal ; Standing Sections —Trap P Laundry Trays Generator ❑0.5 KW ❑5.15 KW Trash Compactor oof Drains I , I Reinspection Fee I $151 I Issue Foe I $ 3 I I Boiler Duct - Under Ground Duct - Structural , Duct - Ventilating Exhaust System ❑ Mul rple ❑ Firepl/Fact, Bit. ICBG # Heating System & Ducting ❑ 0-100,000 BTU ❑ 100,000 BTi Reinspection Foe I $15 CMF 0665-46, rev. 10/64 White - Building; Canary - Applicant; Pink - Accounting; Goldonrod - Assessor I- I FEES Hood or Type 1 ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU 111100,000BT System Repair/Alteration Fire Dampers Registers Issue Fee I Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ _ PERMIT PLUMBING $ r00 ISSUANCE $ ' PLAN CHECK 25% $ A S O ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM S MECHANICAL $ TOTAL FEE $ ` O• �0 PLAN CHECK '25%, $ $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL A 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 fteinforcement 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 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof grains 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 APPROVALS , Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro' 22. Ducts, Ventilating 71. Product Piping © Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32, Electrical Power Meter -Final 80., FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape irrigation System 45. Sound Attenuation 46. HandicIP Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50, Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. Automatic Washer JCITY OF COSTA MI=SA CONSTRUCTION PERMIT Project Address 711 14 -17th St.Bldg() Unit I _ PERMIT NO. TRACT NO. LOT NO. Bathtubs Sewer Connection _ Cooking Unit Applicant's Mailing Address X3110 Saticn3�t-__N-iin1l3ui•no Owner's Name `rrajC _FnV_CS>�IIl-ent Fundi Phone 549-2988A.P, Address .__4- 91 Ri rrh St- NPw)art Bench,_Ca. _ 11 ALTERATION REPAIR s ❑CONVERSION ❑ TYPE OF CONSTRUCTION NEW ADD DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. OO EXEMPTIO FROM WORKERS' COMPENSATION DECLARATION S E T Q A C S 4ain Building: Arch/Eng,-MaS'1lL_ I ROCk License No. Address 12Knntf- Ay__ Sttite 216 _ 1 P TYPE OF PERMIT 0 GRADING ED FOUNDATION ED STRUCTURAL ❑TENANT ❑ ELECTRICAL 1:1 PLUMBING 91 MECHANICAL OTHER PROJECT DESCRIPTION SQ- FT. OCCUPANCY CON STRUCTION TYPE VALUATION $ Front Rear Contractor's Name—Dttc'o-- it COItionLd ,ing_Phone 9$2-1216 Addressimaiiing) 13110 Satifi.O�St. N.HollywQod, Ca, Right Left City License ' — LICENSED COONTRACC TOR DECLARATION ZONE GRADING CU.YDS. ACRES - Ping. Ref. Remarks: Planning Notes: I hereby affirm that 1 am licensed under provisions of C arter 9 (commencing with section 7000) of Division 3 of the Business an fessions Code, and Floor Drains Swimming Pool vv/Spa F.A.U. my license is in full forCce�rlp elf e 346251 License Class UU Li a se Date -4/_1 /-8-4— Signature PLUMBING FEES WORKERS' COMPENSATION DE ARATION I hereby affirm that I have a certifi ate of consent to self -Insure or a certificate I W k s' C t' I s ranee a certified co y thereof (Section Floor Sinks Urinal Bar Sink Showers ' 2281 5/03/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL 0 or er ampensa on n u or P 3800, Lab. C.) Backflow Preventer Service Sink Automatic Washer Backflow irrigation Sewer Cap Construction Pole Sub. WC9824 Policy No. - - Company Lumbermans BCertified coby is hereby furnished. Bathtubs Sewer Connection _ Cooking Unit Certif• o y is filed with the city Buil �g v sSion. Q_ pate Applicant_ �^+-�� r upon the above-mentioned property for OO EXEMPTIO FROM WORKERS' COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher (This section need not be completed if the permit is for one hundred ($100) or Dishwasher Solar Piping Oryers ❑Gas ❑Electric less). I certify that In the performance of the work for which this permit is issued, I f Drinking Fountains Soler Tank Fan shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature Floor Drains Swimming Pool vv/Spa F.A.U. 'NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Lender's Name Lender's Address Kitchen Sink Water Service Switches 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 P—Trap Laundry Trays Generator 00-5 KW 05-15 KW county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signeq 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 )enalty of not more than five hundred dollars ($500). ❑ t; as owner of the property or my employees with wages as their soleReinspection'Fee $15 Issue Fee $ 3 compensation, will do the work, and the structure is not intended or offered Reinspection Fee for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES t who builds or improves Transformer ❑ 15-50 KW ❑ 50+KW Meter Uup to 100 amps Meter Dover 100 amps Sub Panel Motors 00.1 HP D yr - 8 Inc.Solar 09-15 HP 1-116-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor $15 1 1 Issue Fee License Law does not apply to an owner of a proper y t o h his or her own DEVELOPMENT SERVICES REOUIREMENTS: thereon, and who does such work himself/herself or hi r ug employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the burpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 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 proof of their Worker's Compensation Insurance should be provided to me, ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above Boiler Duct - Under Ground Duct - Structural Duct - Ventilating, Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICSO Heating System & Ducting ® 0-100, 000 B T U 0 100,000 BT Information is correct, I agree comply with all city and county ordinances Application Issued By Date `.2 SUMMAR OF FEES — _ -- BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING S ISSUANCE $ PLAN CHECK 25% S ENERGY P.C. S ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICRDFILM $ MECHANICAL $ TOTALFEE S15-50 PLAN CHECK 25% $ i rp and state S relating to bu' 1 g construction, and hereby authorize repre- sentativ of this city to t upon the above-mentioned property for OO inspecti pu poses. ate y�3a X Signature Reinspection Fee Drivers' LIC se or SS CMF 0865-46, rev, 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Hood or Type ❑ Canopy Type 11 ❑ Zoning Approved By Date Building Approved By Date Refrigeration System ❑ai00,000 BTu ❑100,o00 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 15.50- TL Z O N I N G R E O M T S FEES $ 3 Application Issued By Date `.2 SUMMAR OF FEES — _ -- BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING S ISSUANCE $ PLAN CHECK 25% S ENERGY P.C. S ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICRDFILM $ MECHANICAL $ TOTALFEE S15-50 PLAN CHECK 25% $ i rp 4 OO 3 CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POOL w _r'A APPROVALS Permit :# Date Inspecror 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd, 54, Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. _r�� 57. APPROVAL TO COVER-GUNITE t 7. Footings j 58. Electrical Conduit-Undrgrnd. t 8' Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. I 60. Backwash Lines, P -Trap, D Undrgrnd. j 10. Structural Floor System -Z 61. APPROVAL TO DECK '11. Property Sewer Line & House Connectign s 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 0. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24.. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling {Structural► & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 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 rr- GlTY OP'COSTA MESA CONSTRUCTION PERMIT Project Address (I w- 1 77N S I C OS7i9Y M I S R Applicant's Mailing Address Owne'r's Name FJ V E S`�:]rn E ti`IPhone Address ArchiEng, License No, Address / �i{� Contractor's Nam 30 �j 1PG I � r4Phone - 6 Address (mailing) E Si�� RRVAA�f:_ 5L_ ,t LLXMj111627dn) S]3b City Licensu No.33 �1 D LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Chart9 (commencing with section 7000) of Division 3 of the Business antl Prof s ions Code, and my license is in full force and effec 15 1 License Class Lice so No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that i have a certificate of consent 11 self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section '800, Lab. C.) ` r.- F olicy No.10r _Z70 C;ijldj]�Sion.' Certified copy is hereby furnishetl.Certifiedcop i filed with the city Date�� Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for ne hundred ($100) or less). 1 certify that in the performance Of the work for which this permit is Issued, I Shall not employ any person in any manner so as to, beCome subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: It, after making this declaration, You should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall' be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit ,is Issued (Section 3097 Civ. C.) Lender's Name _ Lender's Address, OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031'.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the -applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's -License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the .Business and Professions Code) or that he/she'ls exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars (5500). I, as'owner of the property Or my employees with. wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such -improvements are not intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/site did not build or Im- ro ve forr the purpose of sale). i I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- - tractnr(s) license pursuant'to the Contractor's Llcense Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date owner I hereby certify that I have read this ap lication and state that the above information is agree to comply h all city and county ordinances and state la s r a 9 building c ns uc 'on, and hereby authorize repre- sentatives f thi c' y enter u on th above-mentionetl property for inspection rpos i i . Signature Oate Drivers' License or S cant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO..7 TRACT NO. LOT NO. UNIT NO, TYPE DF CDNSTRUCTION 11 NEW LJ ADD Ll ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. DESCRIPTION OF WORK/USE OF BLDG. IS Main Building: E TYPE OF PERMIT U GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ SI Left ZONE GRADINGCU.YDS. ACRES - Ping. Ref. + Remarks: Planning Notes: Bar Sink Backflow Preventer — Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains' Floor Sinks Gas Service Outlets Interceptors Kitchen Sink, Lavatories P—Trap Roof'Drains Reinspection Fee ' $15 Boiler ; Duct - Under Ground Duct - Structural Duct - Ventilating, Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 1:10- 100,000 B T U ❑ 100,000 BT Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 5694 I/16/65 Zone Accessory Building: . Parking Req./Provided 4050 TL Z O N I N G R E O M T S Issue Fee - $ 3 PLUMBING FEES ELECTRICAL FEES Showers Service Sink Automatic Washer- Construction Pole Sub. Cooking Unit Transformer 0 15-50 KW ❑ 50 t KW Meter ❑up to 100 amps Sewer Cap / Sewer Connection' i Solar Collectors A Dishwasher Meter Dover _100 amps Solar Piping Date Date Dat,--[-- ( Dryers ❑Gas ❑Electric Sub Panel' Solar Tank r ' Fan Motors R0-1 HP ❑ 1)4 - S Swimming Pool w/Spa Fire Dampers F.A,U. Inc.Solar ❑9-15 HP 016-15+ Urinal Fixtures ""' Microwave Water Closet Issue Fee $ 3 Device Boxes Pole Light Water Heater Outlets Range Water Service Switches Sign Auto -Wash Garbage Disposal ;Standing Sections Laundry Trays Generator ❑0.5 KW 1:15-15 KW Trash Compactor Z O N I N G R E O M T S Issue Fee - $ 3 Reinspection Fee $15 Issue Fee $ 3 L: 1ANICAL FEES Hood or Type El Canopy ' Type Il ❑ - DEVELOPMENT SERVICES Zoning Approved By Building Approved -By Application Issued By REQUIREMENTS: Date Date Dat,--[-- ( Refrigeration System ❑0-100,000 BTU 0100.000 BTU BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $.00 PLAN CHECK 50% )$ MECHANICAL $ PLAN CHECK 25% 1$ SUMMARY OF FEES 'SO SMIP $ PERMIT ISSUANCE S ENERGY P.C. $ GRADING $ MICRDFILM $ TOTAL FEE $' SU - System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL t- ,-A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2,- Soil Pipe-Undrgrnd, 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test -6- Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. `8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Corinection 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 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 Nntes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy' 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. 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 E\in. Date (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT .lob Address: 711 W 17TH ST Suite: G Vicinity: UNIT G Primary Occ: B Eat<501 Officel Bar<50 Type of Construction: V Parcel Number: TPN02004 Zoning: Applicant: BATIOFF, JOHN Permit: $401.85 Address: 17182 ARMSTRONG AVE SMIP Com: $5.46 Other: $0.00 Phone: 949-260-1900 IRVINE, CA Zip: 92614 Owner: MESA BUSINESS CENTER ASSOCIATION Address 711 W 17TH ST Phone: 949-672-9035 COSTA MESA, CA, Zip: 92627 Contractor: DRI COMMERCIAL Address: 17182 ARMSTRONG AVE Phone: 949-260-1900 IRVINE, CA Zip: 92614 License: 818623 Arch : Address: Eng: Address: Status: ISSUED Applied: 04/11/2005 issued: 0411 112 00 5 ISSUED BY: AJ Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING BUILT-UP ROOFING & INSTALL NEW BUILT-UP ROOF SYSTEM (UNIT G) - 97 SO. Plan Check: $0.00 Permit: $401.85 SMIP Res: $0.00 SMIP Com: $5.46 Other: $0.00 Inspection: $0.00 Total: $407.31 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existing: 0 NOTES: FEE SUMMARY Calc Valuation: $26,000.00 Claim Valuation: $26,000.00 PLANNING & ZONING Rear 0-0 Left 0-0 Right 0-0 Rear 0-0 Left 0-0 Right 0-0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 44n -4U truw7 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: �f Carder: Policy Number: W G 2�� r 6 2-- (77115 sec !on need not be Completed ii the pemtll fs valued at one hundred dollars IS f 00) or less. ❑ I cavity that in the performance of the wo for which this permit Is Issued, l shall not employ any person in any manner so as to become subject to the workers' compensation lawV1,V4-0 llfomia, and gr that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comp with thesens. App !22n ore: e e WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE (St 00,OM), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PPOVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licans under provisions of Chapter 9 (commencing with Section 7000) o1 Division 3 of the Business apd Professions Code, and my license is in full force and effect. Lic. a ?J Class a ___.. C 7of1 is Hallo ' rE=> / dK CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued, (Sec. 3097, Civil Code). Lender's Name: Lender's Address; Signature: Date; OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or cotinty',wn1ch_ requires a permit to construct, eller, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement 1t+at,heor sho s licensed pursuant to the procti visions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code);& that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty 0f,nof more than live hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK• and the structure is not intended or offered for sale (Sec, 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through h -Is or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sate.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a confractor(s) license pursuant to the Contractors License Laws.). ❑ f am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verif€ed by driver's license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, Le. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth Into which a person Is required to descend, will be made in connecfion with work authorized by this permit, and that no building structure, scaffolding, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) feel high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan toy emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Calitomia Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materiels equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or w€ll the applicant or present or future building occupant need to file a reglstrallon form for acutely hazardous mater€acs? I] Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume o1 55 gallons, or 200 cubic feel of Compressed gas at standard temperature and pressure). ...... _.-..................... __..............:--.._._......-....---....._ _....................... ._........................ ....................................................................................... ,,,._.......................... __�- 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. _ ....................-._....- • •.....-..�..........._... r.._........_.....—................ -.................... ................................................ ..... .......... ..................-.-.... ---.............. ..----....--- 4 11 an RMPP is presently requ€red, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication agermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 15 No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applicatlons for non-residential building permits). ....................._..................._._.__.................._......................._. __...................._................................. ................ .. - --- ....... ............. _ ............... _ .... 6 Will any part of the tac€lily 10 be constructed under this permit be within 1000 teat from the outer bowVdaTieS 01'a School? ❑Yes ❑ No (If 'fres", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .................. .......... _...... ................ -................................................................... ,....................... ......................................... .................................................................. .........-..................................... _................................................ _.. 7 H a permit from 1he South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 a ❑ N0 -_._..._._........._........--- ............................ .................................. ............................._........._.............................. -.---......... .........._-................ 8 (It "yes", attach certificale of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above Is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and dry ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. t agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. azure Of Le4dl Owner(s) Date WWII! S<Iahw� irdlCifAZ or 'Applicaht CODE I SECTION TYPE Q&U IN II16L5 CODE! INSPECTION TYPE RAM INTITIAL3 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Fina! Electrical 201 Final Block/Retainirng wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Silo 204 Final Demolition 250 Final Building/Occupancy 10 PROJECT ADDRESS: UNFT: OWNER'S NAME: 1W 17TH ST G-2 ADDRESS: G G AYNOR „`;AME REG.NO.: UNIT: • PERMITTEE: ADDRESS: GENE GAYNOR (714)548-1255 M711 W 17TH ST G-2 LICENSED CONT RACTD(` DENMTION: I hereby affirm trial I am licensed un4;"h9p5r 9 (commencing with Section 7000) of Division 3 al the Business and Professions Code. and my license is in full force and effect. CITY LIC.: STATE LIC.: CLASS: [)ate: Signature: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance. or a certified copy thereof (Section 3800. Lab. C). POLICY NO.: EXP, DATE: COMPANY: ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. ate: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (ft n not be completed it the permit i5 for one hundred (SIOD) or less). I certify that in the performance df the work for which 1hEs permit . , I shall not employ pe n in any manner so as to become subject to the Workers pensaiien Laws of Caritomia. %T Date:[_, ` z, Z— 7Z Signature: NOTICE: If, after making this declaration• you should become subject to the Workers' CompensaliqXrovisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for this performance of the work for which this permit is issued (Section 3097. Civ. Q. v LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for tre following reason {Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, aller, improve, demolish, or repair any structure, prior to its issuance. also requires the applicant for such permit to file a signed statement that helshe is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code► or that helshe is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). I, as owner o1 the properly or my employees with wages as their sole compensation, will do the work, and the ❑ structure is not intended oe oflered for sale (Section 7044, Business and Professional Code: The Contractors' Slate License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himseltlherself or through his or her own employees• provided that such improvements are not intended or offered for sale. If, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve Ior the purpose of sale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractoris) license pursuant to the Contractors' State License Law). I am aware trial proof of their Worker's Compensation insurance should be provided to me. ❑ I exempt under SerJion: B. 8 P. C. `J farr this reason: py Date: C,- -Z2 / �— Owner. I do hereby certify that I am aware of and understand the requirements of Califomia Health and Safety Code 5 ions 25505, 25533, and 25534 and that I or any future building occupant wilUv ill not (circle one) need to comply with said state codes and the requirements Ior a Permit for construction or modification from the Air ably Management District. Residential construction applications are exempt from Ihese provisions. Date: Applicant: I hereby certify that I have teas this application and slate trial to bone information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction and he a ' representativeSib)� 1y to enter upon the above•mentioned property r inspection purposes. 7 ![�XLY Date: y Signature: Driver's License or Social Security C 164146 White--Buiidinq; Pink—Revenue: Goldenrod—A4%Psgor CITY OF COSTA MESA — BUILDING PERMIT t PERM NO: P 05788 PERMIT NO: P 057880 PLAN CHECK NO; N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE; PLU PURPOSE: OTH JOB DESCRIPTION : INSTALL PREFABRICATED SHOWER SQ FT: CLAIM VALUE: �.CALC—VALUE: GROUP OCC: / COMMENTS: NO OTHER WORK PERMITTED ->E�-�-�->F->F-�->F->F>E->Fr�*x��**�->F�-�***->Fr�x��-��x��-x�r*>f***�+-►+-�*��r*-��aE****�-I�->F->F**-�->F*-��*+��+�� Z 0 N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- ---------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING R£Q• PROV: PARCEL: 00000000 ZNE: REF NO: PLANNING NOOTES> D E V E L O P M E N T S E R V I C E R E Q U I R E M E N T S ZONING APPROVED BY �%' DATE: BUILDING APPROVED BY : t DATE: APPLICATION ISSUED BY: 'f DATE; � 9l• 1F 1f �f �f * * •li it• iI• it• Xt �f �f ->F �i it• it it �t �t � � �t � � •1i 1F * � * •1F � � � 1F iF �f �4 �f 1F 1F •li it• •If #E �f * * �E it• Xt iE #E �f �f �f Xt Xt �f �f �f �f if iE iE �i �t �t �t �t •If � * * * � � � iE � 94 iT• 1F � MF 1F � � � � * �t � i4 fiF * * it �t �F �E it it it• �t �E }(• •1F 1F 1F � LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 2200 SMIP/NON—RES PLAN ISSUE FEE 3.00 BUILDING—DIV--> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS-----> 2.00 3,00 0.00 5,00 5,00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 5,00 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -HECK 5.00 i!i!�k �k � �F � i!� if �F �F 1F * iE if it• �f �f �f �f �F �i it• � �t ii * •1i it• Xt 91• �F 1F �F 1F �E Xt it• �t 1F it• it• it• � Xt Xt � •If �F •1F � 94 � � it Xt � iF 1F �E •1F �t � � � �F iF � iE � * •1i Xt it• Xt � iE it• I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLU 1 SHOWER END OF FEES 2.00 2.00 CONSTRUCTION AND PLANNING APPIR IALS Permit # Date Inspector POOLE APPROVALS Permit # __ Date Inspector 1. TempR,'xary Electrical Service or Pole 52. Pool & Equipment Location 7. Sa j Pipe-Undrgrnd, QZ La�l� 53. Steel Reinforcement ',•Electrical Conduit Utility-Undrgrnd. 54. Forms -4k 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 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12, Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing L R,D 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 APPROVALS. - Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure F 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test _ 72. Underground Flush 24. foot Framing. 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Piaster Brbwn-Coat j 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes, 34. Final Heating & Air Conditioning 35. Final Gas,Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace r 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 -_ 46.1 Hand icap,Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to edison 50. Gas Release to Southern California Gas Co j I 51. CERTIFICATE OF OCCUPANCY' No mate Applicant to fill In all spaces except those within heavy border lines and sign ail appropriate declarations. PFRMIT Nf) _ - TRACT NO_ I LOT NO. I IINIT Nil CITY OF -COSTA MESA CONST TION PERMI I )'PFO10ct Address 14 Applicants Mailin Address Owner's Nam P ne Address ` Arch/Eng. License No. Address Contractor's Nam 01411 P ne Address (mailing) t City License No. LICONSED CONTRACTOR DECLARATION I hereby affirm that I- am licensed under provisions of Charter 9 (commencing With section 7000) of Division 3 of the Business and Professions Code, and MY license is In A force and 1 ffact. Licens Class — License No Oat r Signature WOFZKERS' COMPENSATION ARATION I hereby affirm that I have a cert'f ate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) � - PoliCy No. Company H Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Data Applicant EXEMPTION'FROM WORKERS' COMPENSATION DECLARATION (This section need -not be completed If the permit Is for one hundred ($100) or - less). ' 1 certify that in the performance of the work for which this permit is issued, I shalt -not employ any person in any er so as to become subject to the Work C pens _ Laws of Calif rn' Dat f Signature NO E: , a !er ak ng this peeler on, o should become subject to the Workers' Compensation provisions the Labor Code, you must forthwith . comply with suCh provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING 'AGENCY, I I hereby affirm that there is a construction lending agency for the performance Of the work for which this permit is issued (Section 3097 Clv, C.) Lender's' Name Lender's Address OWNER BUILDER DECLARATION I h@reby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or County which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant"for such permit to Tile 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 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 -e•,natty of not more than five hundred dollars ($500). I-� I, as owner of the property or my employees with wages as their sola cornpensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code- The Contractor's 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 Zml,p provided that such Improvements are not Intended or offered for If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- r4ve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 buildsorimproves thereon, and who Contracts for such projects with a con- tractor(sl Ilcense pursuant -to -the Contractor's License law). I am aware that prgof o their Worker's Compensation insurance should be provided to me. ❑ I yam exempt under Section B. & P. C. for this reason Date Owner I Hereby certify that I have read this application and state that the above information is correct. Iagree to comply with all city and county ordinances antl state laws relating to building construction, and hereby authorize repre- sentatives of this •cit to enter upon the above-mentioned property or Inspection ses- TYPE OF CONSTRUCTION LI NEW LJ ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. Lf ALTERATION LJ REPAIR - FEES A P. S E T 8 A K Main Building TYPE OF PERMITGRADING FOUNDATION ElTENANT D ELECTRICAL ❑ PLUM13ING 13,0 HER PROJECT DESCRIPTION SQ. FT, CONSTRUCTION TYPE - VALUATION ZONE GRADING CU.YDS. STRUCTURAL 0 MECHANICAL OCCUPANCY $ ACRES Front Rear r Right Leit Ping. Ref" Remarks: Cooking Unit Planning Notes: i Solar Collectors BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% i -5888 7/02/85_ I0e50 TL Zone - Accessory Building: Parking Req./Provided Z 0 N I N G R E Q M T S Reinspectjon Fee I $15 Boiler Duct - Under -Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ F irupl/Fact. Sit. I CBO # Heating System & Ducting ❑ 0- 100,000 B TU ❑ 100,000 BT Signature / Date' ' ense or 55 Reinspection Fee $15 Drivers CMF 0865-46, rev- 10/84 white - Building; cant; Pink - Accounting: Goldenrod - Assessor Issue Fee $ 3 PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer - Service Sink - $15 Issue Fee Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW 0 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Date Date _ Dat Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% Dishwasher - Meter Dover 100 amps ' Dishwasher Solar Piping Fire Dampers Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Soar Tank Fan Motors 110.1 HP 01 'A - 8 Floor Drains Floor Sinks Gas Service f Outlets Swimming Pool w/Spa Urinal Water Closet Q F, A. U. f=ixtures Device Boxes Inc, Solar 09-15 HP 0I6-15+ Microwave ' Pole Light Interceptors Kitchen Sink Water Heater Water Service QO Outlets Switches Range Sign t Lavatories Auto -Wash Garbage Disposal ! Standing Sections P -Trap Laundry Trays _ Generator 00-5 KW 05-15 KW Trash Compactor Roof Drains Reinspectjon Fee I $15 Boiler Duct - Under -Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ F irupl/Fact. Sit. I CBO # Heating System & Ducting ❑ 0- 100,000 B TU ❑ 100,000 BT Signature / Date' ' ense or 55 Reinspection Fee $15 Drivers CMF 0865-46, rev- 10/84 white - Building; cant; Pink - Accounting: Goldenrod - Assessor Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 - -IAN(CAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Date _ Dat Hood or Type I ❑ Canopy Type II ❑ Refrigeration System ❑0.100,000 BTU ❑100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ o $ L- --•C7) $ $ $ $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ IQ System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 i oCONSTRUCTION AND PLANNING APPROVALS Permit # _i Date Inspe 1 r POOL & SPA APPROVALS Permit # Date Inspector .f1. Temporary Electrical Service or Pole 52. Pool &Equipment Location t ,. -2. Soil e-Undrgrnd.^ ! ?! ! 53. Steel Reinforcement 1-oElectrical Conddit Utflify-Undrgrnd'.! ' l7 rte' N 1 4 54. Forms 1 f� 'eElectr'ic �iConddit-1 '11 g nd. CI1 .r-. t a•. . 55. Electrical Bonding, 9 r 5,!,1rzt'e.,1 56. Rough Plumbing & Pressure Test 6• Electj'i� I UFJ=R j Grnd. L'� /•� � f r �h ♦• 57. APPROVAL TO COVER-GUNITE F 7,400tfngsr `�'I v 58. Electrical Conduit•Undrgrnd. 9f Foun} ation !� , ` 1 � _ 59. Gas Pipe, ❑ Undrgrnd., Test ; yl - 1 ;e91 4 ?Pipe Undrg'}nc . '1 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. St ucttg, l Floor System ! # 61. APPROVAL TO DECK 11. Property Sewer Line & House Co vection • I - t .� j 62. Backwash & Receptor -Final 12. SewerCad ✓ 4 l I �/� �-> +� 63. Heater & Vent -Final {J 13. Rfbrains 64, Plumbing System - Final 14. �R�ugh,Plumbin�y s1 65. Electrical Final i l y 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 19. Hough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank []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. F I NA L I NSPECT ION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy �. 37•.'Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40'. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer Z 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 CITY OF COSTA Project Address Applicant's Mailinc Owner's Name'v Address q3_ Z ArcWEng. Address _=11G�. Contractor's Name - Add ress ame_Address {mailing) TION PERMIT Applicant -to fill in all spaces except those within.heavy border lines and sign all appropriate declarations. City License No. LICENSED CONTRACTOR DECLARATION ' I hereby affirm that I am licensed under provisions of Charter 4 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. Date ' Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate' of consent to self -Insure or a certificate of Workers' Compensation Insurance, -or a certified Copy thereof. (Section I 3800, Lab. } ��+�n C Icy No. Company�,� Certified copy is hereby furnished. Certs ' c Is filed with the city Buil ¢+ I i4 Date Applicant EXEMP i16+4—FROM WORKERS' COMP SATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person In any manner so•as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to'tho Workers: Compensation provisions of -the -Labor Coda, you must forthwith comply with such provisions or tnis permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I ' I hereby affirm that there is a construction lending agency for the perf ante of the work fo�-_t+fti�,pC4M �"i f e t 7 .G�l Lender's Name /1�i�Y �I\f - I�}(� Londer's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or County which requires a permit to Construct, alter, improve, demolish or repair any structure, prior to its issuance,'also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 ��malty of not more than five hundred dollars ($500). I, as owner of the property or my employee$ with wages as their sole . compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for sate. It, however, the building or improvement is said within one year of com- etion, the owner will have the burden of proving he/she did not build orArn- Ove_ for the purpose of sale). I, as owner of the property, am exclusively contracting witli licensed Con. Tact lors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law docs n_ot apply -to an owner. of property who 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 ' proof of their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Date Owner I h-ereb c tify that I'have read his application and state that the above informatio is correct. I agree to cpmply with all city and'county ordinances and state laws relating to building constr (tion, and hereby authorize repre- sentatives of this city enter a above-mentioned prop rt for inspection purposes. Signature t7 p t0 Drivers' License or SS - P�MIT� [F-/ � J?A / T f10.� LOT NO. IJIyi,T N6. p/�-/ I TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR - r�(�� CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. - A.P. qje Zone S Main Building: Accessory Building: TYPE OF PERMIT GRADING��ggqlllEl FOUNDATION STRUCTURAL ❑ TENANT'❑ ELECTRICAL Jif PLUMBING ❑ MECHANICAL ❑ -OTHER / PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU. YDS. ACRES T Front 0 B A Rear N I C Right N K S Left = G R' Ping. Ref.# Parking Req:/Provided E Remarks: j' Planning Notes: M S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink I ' Automatic Washer' Construction Pale Sub- Transformer ❑ 15.50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap' Bathtubs Sewer Connection Cooking Unit Meter []up to 100 amps Clarifiers _ Solar. Collectors _ _ Dishwasher - Meter ❑over 100 amps - - Dishwasher Drinking Fountains Solar Piping Solar Tank Dryers ❑Gas OElectric Fan Sub'Panel Motors 00-1 HP ❑ 1 K 8 Floor Drains Swimming Pool W/Spa F.A.U. Inc. Solar IJ 9.1.5 HP EJ 16-15+, Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Bp Device Boxes Pole Light , Interceptors Water Heater Outlets Range Kitchen Sink Water Service r Switches' Sign ; Lavatories Auto -Wash 9 Garbage Disposal ;Standing Sections P—Trap Laundry Trays Generator ❑0-5 KW 115.15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENTSERVICESREQUIREMENTS. Zoning Approved By Date Building Approved By Date ` Application issued By Date,r Boiler Hood or T Type I • ❑ '. - Canopy' Type If ❑ Duct - Under Ground Duct - Structural Refrigeration System i ❑0.100,000 BTU E3100,000BTU - 1 Duct - Ventilating BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ SUMMARY OF FEES ' SMIP $ PERMIT .Op ISSUANCE $ 1 S`�O ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ Or Exhaust System El Multiple ❑ System Repair/Alteration Firepl/Fact. Blt. ICBO # Fire Dampers I Heating System &Ducting 00-100,000STU❑100,OOOBT Registers Reinspection Fea$15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA 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. Hough 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 9. Water Pipe-Undrgrnd. , , 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash &Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16, Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 6B. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19,. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20: Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydra 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Rrown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing CJPO 39. Water Service -Final 40, Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43, Backflow Irrigation ' 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ,Applicant to fill in ail spaces except those within heavy harder lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address _71 -LW, lith St- Bldg. (C,) U131 t- 7 PERMIT NO.!r [3V 5�0 TRACT NO. LOT NO. UNIT NO. C� TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG, Applicant's Mailing Address 13110 Sat1 my St. N.$031,arao0 Owner's Name hone -549-2988 Address4321 Bi rrh St _ NP.Wport APAch. CA_ Rear N Arch/Eng, �.yn_.T- RDrJ License No. Address _L2881—KnQt-a"Ave. Suite X16 _ Contractor's Name-DAIC 3-A3i-CAO-Ltd7-it-op i p n Phone—_9$-2,-1,216 At L7n1 1 Address (mailing)�3-�1�-SgtTGO-S �.--.--�..�=jzL�d3Ad�-�a.- TYPE OF PERMIT GRADING FOUNDATION ❑ STRUCTURAL ❑ TENANT ❑ EL-ECTRICAL ❑ PLUMBING ® MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ City License No. —X39-2.5 LICENSED CONTRAC_TOR DECLARATION ZONE GRADING CU.YDS. ACRES Remarks: SLeft I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business an ofessions Code, and G R Ping, Ref. Parking Req./Provided my license is in full force and efle License Class C 0 Lic se 346251 Date 1-1.818L� Signaturerce, Planning Notes: is PLUMBING FEES WORKERS' COMPENSATION DTION I hereby affirm that I nave a certiconsent to self -insure or a certificate of Workers' Compensation Insua certified copy thereof (Section 3800, Lab. C.) Policy No. WC9824 Company Lumber -mans BCertified copy is hereby furnished. Certltl.d copy is filed with the city Bullr�ptn�{g Division. Q- 1I Date I Applicant ��13�C + v r EXEMPTION FROM WORKERS' COMPENSATION DECLA ATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance Of the work for which this permit Is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Ca p Bathtubs Sewer Connection Clarifiers Solar Collectors pishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENOING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Floor Sinks - Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior t0 its issuance, also requires the applicant for such permit 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 Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more tttan five hundred dollars ($500). I, as, owner of the property or my employees with wages as their sole •ompensation, wilt do the work, and the structure is not intended or offered for sale (Section 70A4, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for Sale. If, however, the building or improvement is sold within one year of corn- the owner, will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractoT(s) license pursuarit'to'the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. Lavatories AUtO-Wash P -Trap _ Laundry Trays . Roof Drains - Reinspection Fee $15 Issue Fee $ $ MECHANICAL FEES Boiler Hood Or Type I ❑ Canopy Type 11 Elpletion, Duct - Under Ground Duct - Structural Refrigeration System ❑0 100,000 BTU ❑ 100,000 BTU Duct - Ventilating Exhaust System El Multiple El System Repair/Alteration Firepl/Fact, Bit. ICBG # Fire Dampers ❑ I am exempt under Section B. & P. C, for this reason Date — Owner I hereby certify that I have rea this appliCation and state that the above information is correct. I agree t c mply with all city and county ordinances and state la relating to but Ing onstruction, and hereby authorize repre- Sentatives f t is city to ter pon the above-mentionedproperty for Inspection urp ses. DateY 1•�� O J Signature e a Drivers' Licor SS 1P 1 Heating System & Ducting 100,000 BTU ❑100,OOOBT Registers 4 00 ol Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 2282 5/03/85 i5. 80 T A.P. # Zone S Main Building: Accessory Building: Transformer © 15-50 KW ❑ 50 + KW 7 Front U B Rear N A Motors El 0.1 HP 131%-8 I C Might N SLeft Pole Light G R Ping, Ref. Parking Req./Provided E Planning Notes: is O M Standing Sections T ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer © 15-50 KW ❑ 50 + KW Cooking Unit Meter El up to 100 amps Dishwasher Meter El over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors El 0.1 HP 131%-8 F.A.U. Inc. So lar El 9-15 HP El 16-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal Standing Sections Generator 00-5 KW 05-15 KW ` Trash Compactor Reinspection Fee $15 Issue Fee S 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By pat BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL 5 PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ SUMMARY OF FEES SMIP $ PERMIT - ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ 13.00 TOTAL FEE $ 1 5 50 �n 1'0%� CONSTRUCTION AND PLANNING APPROVALS . Permit # Date Inspector POOL & S. - APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement ,r 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. i• 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduif-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 11 ZZ 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10, Structural Floor System �. , ,rl 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 APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24" Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Fina+ 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 V 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. G1TY OF'COSTA MESA CONSTRUCTION PERMIT P1 RMIT "n. TRACT NO. LOT NQ. UNI f NCI. Project Address 7 t I tIV, ii 7V1,CT. COSTA /n ESA Applicant's Mailing Address Owner's Name ✓U�►� Phone Address Arch/Eng. License No.' Address Contractor's Nam 12 L�t� Phone Address Imailing) 1JL6,5'RRYANTSI ,QLAW77iN671)10 �(o� 13 City License No.3 LICENSED CONTRACTOR DECLARATION I hereby'affirm that I am licensed under provisions of Charter 9 commencing with section 7000) OT Division 3 r7715,P s and Pr fess- s Code, and my license;is in full force and effect License Class (� enseo. S Date k—f�- 8--= Signature WORKERS' COMPENSATION DECLARATION , I hereby affirm that I have a certificate of consent to self -Insure or a certificate of Workers' Compen%ation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. _7D Com uFC_ , eCertified copy is hereby furnished. ' Certifted copy -filed with the city uil g vision, Oat ei`I [�� Applicant EXEMPTION FROM WORKERS' COM PENS TION CLARATION (This section need not -be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued r shallnot employ any person In any manner so as to become subject to t6 WorkersCompensation Laws of California. Date Signature NOTICE: If, after making this declaration, you shoulo,become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such brovisions or this permit .shall be deemed revoked. CONSTRUCTION LENDING AGENCY - - , , I hereby affirm that there Is a construction lending agency for the performance of the work for Which this permit is issued (Section 3097 Civ. C.) Lender's Name -- - Lender's Address. OWNER BUILDER 4ECL-ARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (SeCtlon 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve; demolish or repair any structure, prior to its; issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the, provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the BUsiness and Professions Code) Or that he/she is, exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a Civil enalty of not more than five hundred dollars (3500). I, as•owner Of, the property or my employees with wages+as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business antl Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himsetf/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of -com- pletion, the owner will have the burden of proving he/she did not build or Im- rove for the purpost of sale), 1, as owner of the property, am exclusively contracting with licensed con- 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 builds -or improves thereon, and _who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby_ certify that I have read this Information is COrrellt, I'agree to ompl and state law ang o buildi cons sent lives o is ity to ente upon inspection p r Signature V'�-' Drivers' License or SS rlication and state thdt the above rith all clty,and county ordinances ction, arnq hereby authorize repre- �e above-mentioned property for Date I— 0— V5 G- 5845 / f 6/95, - 111050 . TL TYPE OF CONSTRUCTION Ll NEW LJ ADD LJ' ALTERATION " REPAIR ❑ CONVERSION [11 DEMOLISH El OTHER DESCRIPTION OF WORK/USE OF BLDG. - A.P. # Zone S Main Building: Accessory Building: TYPE'OF PERMIT GRADING: FOUNDATION' STRUCTURAL ❑TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER EZ T Front 0 N A Rear B PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ' ZONE - GRAOING CU.YDS. ACRES C , Right N 5 Left r G R _ Ping. Ref. Parking Req -/Provided - E _ Remarks: Planning Notes: Q M ' T S PLUMBING FEES ; - ELECTRICAL FEES Bar Sink Showers ' Backflow Preventer - Service Sink - Automatic Washer Construction Pole Sub, Tran;former ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap- Bathtubs Sewer Connection ; Cooking Unit Meter ❑up to 100 amps. Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan MotorsA0-1 HP ❑ 1% - 8 ' Floor Drains Swimming Pool w1spe F.A.U. Inc. Solar 09-15 HP EJ 16-15+ Floor Sinks Gas Service Outlets Interceptors Urinal - Water.Closet Water Heater - Fixtures Device Boxes Outlets Microwave Pole Light Range Kitchem$ink Lavatories Water Service Auto -Wash Switches Garbage Disposal Sign ; Standing Sections P—Trap Laundry Trays Generator E10-5KW ❑5-15 KW Trash Compactor Roof•Drains Reinspection Fee $15 Issue Fee $ 3 ' Reinspection Fee $15 Issue' Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By ` Date ' Building Approved,By Date Application Issued By _ Date_ ��{ Boiler- Hood or Type 1 ❑ Canopy Type I I • ❑ ; Duct_ Under Ground Duct - Structural 1 Refrigeration System - ❑0-T00,000 BTU ❑ 100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% '$ ELECTRICAL PLAN CHECK 5096 MECHANICAL PLAN CHECK 25% SUMMARY $ $ $ $ K:4 Am $ $ s OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $^ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact_ Bit. ICBO # Fire Dampers Heating System & Ducting ©0-100,000 BTU 0100,009 BT Registers Reinspection Fee $15 Issue Fee $ 3 , CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor ' CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector ' i. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. E=lectrical 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 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12, Sewer Cap 63- Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17, Rough,Wiring Sign 68. APPROVED FOR PLASTERING 18,'Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑ Oil 23, Gas,Pipe-Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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. Insuiation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32, Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45, Sound Attenuation' 46- Handicap Regulations , 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Cb, 51. CIsRT1FICATE OF OCCUPANCY No. � Date + o Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. CITY OF 490STAMESA C NST t, TION PERMIT PERMIT NO TRACT NO. LOT NO. UNIT Nis_ . Project Address ++r�ii'SJ' Applicant's Maiii Address r Owner's'Namei h Address Arch/Eng. License No. Address, Contractor's Name "& Phone Aadress (mailing) i City License No. LICENSED CONTRACTOR DECLARATION I�hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in fu orce and effect. Licens Class License Nn.J?.�.• Date Signature WORKERS' COMPENSATION DRATION ' 1 hereby affirm that 1 have a Certif ate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section i800, -tab. C.) ` 'olicy No. Company Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be Completed if the permit is for one hundred ($100) or •, less). I certify that in the performance of the work for which this permit is issued 1 . shall -not employ any person in any so as to become Subject to tie Worker; ' Compensation laws of Cali DateSignat2e_ .'NOTICE: If, a ter ma ting this declal7tion, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this - permit shall be 'deemed revoked. CONSTRUCTION 'LENDING AGENCY - 1 herebyaffirm that there is a construction,lending agency'for the performance of the work for which_ this permit is issued (Section 3097 Civ. C.) Lender's Name. Lende`r's Address - OWNER BUILDER DECLARATION ' I hereby affirm that i am ekempt from the Contractor's License Law for the following reason (Section •7431.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its, issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 by any applicant` for a, permit subjects the applicant to a civil i ,r<enalty of not more than five hundred dollars ($500). I , as owner of the property or my.employees with wages as their sole 'compensation, will' do the Work, and the'structure is not intended or offered , for sale' (Section 7044, Business and, Professional Code: The Contractor's 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 employees, provided that s4ch improvements are not intended or offered4or sale. If, however, the building or improvement is sold within one year, of com- pletion, the owner will have,the burden of proving he/she did not build or im- prove far the purpose of sale), ❑ I, as'owner of the property, am exclusively contracting' with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License i-aw does not apply to an owner of property who builds or improves thereon,, and who contracts for such projects with a con- tractors) license pursuarit to the Contractor's License Law). I am aware -that proof of theirr Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that -t' have read this application and state that the above information is correct. F agree to comply with a!! city and county ordinances and State laws relating to building construction, and hereby authorize repre- sentatives of this ,cit r to enter upon the above-mentioned property for Inspection p es.. i Date G TYPE OF CONSTRUCTION LJ NEW r ADD LJ ALTERATION LJ REPAIR T - -❑ CONVERSION ❑ DEMOLISH ❑ OTHER • A. P. DESCRIPTION OF WORK/USE OF BLDG.' •- S Main Building:, TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE ,VALUATION $ S Left ZONE GRADING CU, YDS. • IACRES Ping. Ref- # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains' Floor Sinks _. R Gas Service ' Interceptors r utlets Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct- Undendiound Duct - Structural Duct - Ventilating _ Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting El 0-100,000 BTU El 100,000 BT S gnature I Drivers' Li se or'SS Reinspection Fee CMF 0865-46, rev. 10184 icant; Pink - Accounting; Goldenrod - Assessor $15 PLUMBING Showers ' -Service Sink - Sewer Cap I Sewer Connection r Solar Collectors Solar Piping ; Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays - FEES • 2 5689 7/02/85 10.51! TL Zone Accessory Building: IN Parking Req./Provided Automatic Wastier -- Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas. ❑Electric Fan ,F.A.U. Fixtures U Device Boxes Outlets d Switches Garbage Disposal Generator ❑0-5 KW 1:15-15 K ELECTRICAL FEES ,Transformer 1-1 15_50•KW J ❑ 50'+ KW Meter ❑up to 100 amps f Meter ❑over 100 amps . .Sub Panel Motors E-10-11HP❑1%-8 Inc. Solar L19-15 HP El 16-15+ ' Microwave- _ - Pole Light Range Sign Standing Sections W Trash Compactor Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3' JIECHANICALFEES DEVELOPMENT SERVICES REQUIREMENTS: Approved By Building Approved By Application Issued By —' - Date Date Date—& _ s T Hood orType I ❑ Canopy Type I I ; ElZoning Refrigeration System ❑0-100,Oo0 BTU ❑100,000 BTU BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $TOTAL PLAN CHECK 25% $ SUMMARY OF FEES 1 N-UU . §MIP $ r PERMIT ISSUANCE $ ENERGY P.C. . $ GRADING $ MICROFILM $ FEE $ 'S'D System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # _, Date Inspector POOL t A APPROVALS ' Permit # Date Inspector 1.. TempgAr ry Electrical Service or Pale u? 52. Pool & Equipment Location , .i 2. Soil 6p'"g-Undrgrnd.M ! 53. Steel Reinforcement " `3!E!e trical Cond'uiL Uti�ify Undrgrndll �i 54.. Forms i 4. Ele. It a? Conduit i1�d}grnd, t1 - 55. Electrical Bonding 5-9&e. e. %Re'lnforce"1, 56. Rough Plumbing & Pressure Test 6.�`ElectricaI UFERtGP�d. �. 57. APPROVAL TO COVER-GUNITE �N 7,.Footi'ngs rj `r 58. Electrical Conduit-Undr rnd. Foundation f- :� 1 59, Gas Pipe, 0 Undrgrnd., Test �1 R ' • .r4 ;9rJWater Pipe A-Undrgrnd. '' 'll 60. Backwash Lines, P-Trap; [IUndr rnd. 10.�tru�tural Floor System _ 61. APPROVAL TO DECK .r 11. Pro'perty�Sewer Line,OHouseConniction 62. Backwash & Receptor-Final Z) 12, 5ev'ver Cap 'Y ,P 63. Heater & Vent-Final { 13. Roof'Dreins .� 64, Plumbing System - Final 7 14. lough Plumbing y 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16.•Rough'ElectricWiring 67. Fencing & Access Approval 17.-Rough Wiring Sign 68. APPROVED FOR PLASTERING 18, Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19, Hough'Heating & Air Conditioning �. FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Hough Factory Fireplace 21. ducts, in Structure 70: Underground Hydra 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Hoof Framing 73, Undergrnd. Storage Tank []Gas ❑ Oil 25. Hoof Sheathing 74, Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29..Insulation 78. FIRE PREV. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe-Test �. 36. Hood or Canopy 37. Final Factory Fireplace T 38: Final Plumbing (x-9 39. Water Service-Final of 40. Gas Service-Finai 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. ,Landscape Irrigation System 45, Sound Attenuation 46. Hand icap,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 n€q, Date _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations, - - - CITY OF COSTA MEA CONSTRUCTION PERMIT PE IT 6 Seo T ACT. NO, LOT_NO. �.8 N6. SMIP Project Address ZZ w. X17 PLAN CHECK Duct - Structural PERMIT Refrigeration System 00-100,000BTU ❑ 100,000 BTU PLUMBING TYPE F CONSTRUCTION NEW ADD ALTERATION REPAIR ISSUANCE 11 VApplicant's Mailln Address CONVERSION ❑ DEMOLISH ❑ OTHER A.P. Owner`sNam°ne Address T r► ESCRIPTION OF WORK/USE OF BLDG. S Main uilding: Arch/Eng i nnlie No. ��+ TYPE OF PERMIT ❑ GRADING❑ FOUNDATION ❑ STRUCTURAL y T Front 6:7 ❑ TENANT ❑ ELECTRICAL 'I-� PLUMBING ❑ MECHANICALS, - B $ Addressle _ ❑ / A Rear Contractor's Name Phone BOTHER C Right , PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Address (mailing) _ -- - CON STRUCTION TYPE VALUATION $ S Left City License No. _ ZONE GRADING CU.YDS. ACRES - Ping, Ref. LICESEO CONTRACTOR' DECLARATION N I hereby affirm that' I am licensed under provisions of Charter 9 (commencing AL Remarks:A3.1-3 Planning Notes: ' with section 7000) of Division 3 of the Business and professions Code, and ' my license is in full force and effect, - License ClassLicense No. Date ° _ '!Signatures WORKERS' COMPENSATION OECLARATION Bar Sink I hereby affirm that I have a certificate of consent to self -insure or a certificate �f Workers' Compensation Insurance, or -a certified copy thereof (Section Backflow Preventer 300, Lab. y , olicy No. Company Backflow Irrigation Certified copy is hereby furnished. 'Certfiled with The city Buil i _& �- - Bathtubs Date Applicant - EXEM 10 FROM WORKEIRS' COMPENSATION DECLARATION - Clarifiers. _ - {Thi;5tctiufi need not be completed if the permit is for one hundred ($100) or less). Dishwasher ' ' 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 i Drinking Fountains Workers' Compensation Laws of California. Date Signature 1 Floor Drains j 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provl510ns of the Labor -Code, you, must'forthwith , - -'- FloorSinks " comply with such provisions_ or this. permit' Shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets 1 hereby affirm that there is a construction lending agency for the performance of the work f Cpl ti 097 Civ. C.} Interceptors Lender's Name _ V Lender's Address Kitchen Sink OWNER BUILDER DECLARATION _ I hereby affirm that I am exempt from the Contractor's License Law for the J Lavatories following reason (Section 7031,5 Business and Professional Code: Any city or - county which requires a permit to construct, alter, improve, demolish or repair P—Trap _ 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 ' . therefrom and the basis for the alleged exemption. Any violation of Section 131.5 ,by any applicant for a permit subjects the applicant to a civil nalty of not more than five nundred dollars ($500). - _J I, as owner of the property or my employees with wages as their sole ' Reinspecticm-Fee compensation, will do the work, and the structure is not intended or offered for sale {Section 7044, Business and Professional Code: The Contractor's , License Law does not apply -to an owner of a property who builds or improves - Showers Service Sink Sewer Cap Sewer Connection - Solar Collectors. -- Solar Piping' Solar Tank Swimming Pool vv/Spa Urinal Water Closet -Water Heater Water Service A uto-Wash Laundry Trays $15 Issue Fee S 3 MECHANICAL FEES thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building Or improvement is sold within one year of Com- Apletion, the owner will have the burden of proving he/she did not build or im- for the purpose of sale).I, as owner of,the property, am exclusively contracting with licensed con- ' ctors to construct the proieC.t (Section 7044, Business and Professions Code: The Contractor's License .Law does not apply. to an owner of property who 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 of their worker's Compensation insurance should be provided to me.. SUMMARY OF FEES - Boiler BUILDING PERMIT ; Hood or; Type I' ❑ . Canopy Type 11 ❑ SMIP Duct - Under Groundove PLAN CHECK Duct - Structural PERMIT Refrigeration System 00-100,000BTU ❑ 100,000 BTU PLUMBING Duct - Ventilating ISSUANCE $ _ Exhaust System ❑ Multiple ❑ $ r S`?7 System Repair/Alteration proof ❑ 1.am exempt under Section B. 8 P. C. for this reason ELECTRICAL Firepl/Fact. Bit. ICBO`9 GRADING Fire Dampers PLAN CHECK 50% Heating System & Ducting MICROFILM Registers t Owner' Da e I hereby c tify that I have read this application and state that the above ❑0-100,0006TU C:) 106,000 BT{ informs ion is correct. I agree to comply with all city and County ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city enter p the above-mentioned prop rty, for inspection purposes. ' Signature Reinspection Fee S15 Drivers' License or SS _ CMF 0865-46, rev. 10/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor I ' Issue Fee ( $ 3 Automatic Washer Construction Pole Suh, Cooking Unit Dishwasher ' ry Dryers ©Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets ' Switches Garbage Disposal Generator 00-5 KW 05-15 K 5a2, ref]L'r Zone Accessory Building: Parking Req,/Provided ELECTRICAL W Transformer ❑ 15-50 K ' ❑ 50 + KW Meter ❑up to 100 amps Meter Dover 100 amps-- — - Sub!Panel Motors 00-1 HP E)1'h 8 Inc, Solar 09-1115 HP Li 16-15+ Microwave Pole Light ; Range Sign Standing Sections , W Trash Compactor ' Reinspection Fee $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Z O N N' G R E Q M T S FEES T� SUMMARY OF FEES BUILDING PERMIT $ SMIP S PLAN CHECK $ PERMIT PLUMBING $ (96 ISSUANCE $ PLAN CHECK 25% $ r S`?7 ENERGY P.C. $ ELECTRICAL $ GRADING $ ' PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE rn t $ �rJ✓ PLAN CHECK 25% $ I T� CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL i 4 APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool &Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. 57. APP ROVAL TO 'COVE R -G UNITE 7, Footings 58. Electrical Conduit-Undrgrnd. S. Foundation 59. Gas Pipe, ❑ Und.rgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap F 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 APPROVALS Permit # 20,• Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro = 22. Ducts, Ventilating 71. Product Piping ❑Gas OOil 23. Gas Pipe -Rough & Test 72: Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 7.9. FINAL INSPECTION 32. Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning ' 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing S(o-�6 L't/9 39. Water Service -Final 40, Gas Service -Final 41, Solar Domestic -Final 42, Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation , 46. -Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT "°. TRACT NO. LOT No. u"I N Project Address _711--U-0-Thi ST BLDG--_ (G) IInit 3 Applicant's Mailing Address -11110 Saticoy St. N;Hollywood Owner's Name Trnl- Tnver;tMP_nt Ftinei _Phone 549-2988 Address 4321 Ri-rch - Ste,—NPwpnrt Beach s Ca. Arch/Eng. License No. Address 128$1 KT1Qtt Amp_ Gr1i to 216 Conlractor's Nanle._DUC Ai r- ('.nnd i t7i- o i f' Phone 982 -,1 2 6 Address'linailing) 131.10�&�_ir•n3r Sfi_ N Holl)Lwoo ,Ca- City,License No. LICENSED CONTRACTOR DECLARATION - I hereby affirm that I am licenged under provisions of Ch r 9 (commencing with section 7000) of Division 3 of the Business and o ssions Code, and my license is in full force and effec License Class Lice e o 6251 Date4/18/-84- Signature WORKERS( COMPENSATION DECLf RATION I hereby affirm that I have a certificare of consent to self -insure or a certificate of Workers' Compensation Ingurance, nr a certified copy thereof_ (Section 3800,' Lab. 'C.) ` 2ollcy No. — WC;94924L_ Company LUMberrrianS eCertified copy is hereby furnished. - Certifi opy is filed with the city Build Ixision. Date___ _ Applicant W EXE=MP+IO FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less;. I Certify'that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. . Date Signature NOTICE: If, after making this declaration, you Should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with, such provisions or this permit • shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a cgnstruction lending agency for the performance of the work -for which this permit is issued (Section 3097 Civ. C.) Lender's, Name Lender's Address OWNER BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or.repair any structure, prior to it$ issuance, also requires the applicantfor such permit to file a signed statement that:he/she is licensed pursuant to the'pivvisions of 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 -enally of not more than five hundred dollars ($500). 1, as, owner of the property or my employees with 'wages as their sola Compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Busihess and. Professional Code:. The Contractor's 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 employees,. provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner•will have the burden of proving he/She did not build or,irn 5 rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the prole�t (Section 7044, Business and Professions Code: The Contractor's License Lata does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with.a con- tractor(s) license pursuaht to'the.Contractor's License Law). I am aware that proof of, their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section S. & P. C. for this reason Date Owner I hereby certify that I have-rea, information is correct. I agree to and state la relating to bulld• sentat Ives is city to e r inspection urp ses. Signature this application and State that the above �-I with with all city and county ordinances constructlon, and hereby authorize repre- ipon the above-mentioned `property for 7 Date �a — rn��b5 PLUMBING_ FEES Bar Sink Showers - - TYPE OF CONSTRUCTION I I -NEW I I ADD 11 ALTE=RATION LJ P 41 R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Backflow Irrigation A.P. # DESCRIPTION OF WORKIUSE OF BLDG. S Main Building: TYPE OF PERMIT Ll GRADING 0 I=OUNDATI?31:1 STRUCTURAL ❑ TE=NANT El ELECTRICAL ElPLUMBING rL?J9 MECHANICAL C1 OTHER E T' A Front Rear PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE �.. VALUATION $ C K $ Right Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Reinspection Fee $15 Issue Fee MECHANICAL Boiler = Duct-- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICSO # Heating System & Ducting 1 90-100,000 BTU [3100,060 BT Reinspection Fee Drivers' Lice Se or SS CMF 0865-46 ev. 10184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Hood or Type I ❑ Canopy Typell ❑ Refrigeration System Do-100,00OBTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers. Registers Issue Fee 2263 5/03/65 -'Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F. A. U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator El C-5 KW El 5-15 KW Zone Transformer ❑ 15.50 KW ❑ 50+KW' Meter ❑up to 100 amps Meter Dover 100 amps Sub Panel Motors ❑0-1 HP ❑ 1'/z - 8 Inc. Solar 09.15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 15.50 TL FEES Z O N t N G R E Q M T S. S 3< PLUMBING_ FEES Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping ' Drinking Fountains Floor Drains Solar Tank Swimming Pool wlSpa ' Floor Sinks Gas Service . Outlets Interceptois- Kitchen Sink Urinal Water Closet Water Heater Water Service Lavatories Auto -Wash P—Trap . Laundry Trays Roof Drains Reinspection Fee $15 Issue Fee MECHANICAL Boiler = Duct-- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICSO # Heating System & Ducting 1 90-100,000 BTU [3100,060 BT Reinspection Fee Drivers' Lice Se or SS CMF 0865-46 ev. 10184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Hood or Type I ❑ Canopy Typell ❑ Refrigeration System Do-100,00OBTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers. Registers Issue Fee 2263 5/03/65 -'Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F. A. U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator El C-5 KW El 5-15 KW Zone Transformer ❑ 15.50 KW ❑ 50+KW' Meter ❑up to 100 amps Meter Dover 100 amps Sub Panel Motors ❑0-1 HP ❑ 1'/z - 8 Inc. Solar 09.15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 15.50 TL FEES Z O N t N G R E Q M T S. S 3< Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date Dat BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ $ _ _ $ � T $ e„ SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTAL FEE $ $ $ S $ Sj S 50 6 0 4 0 S 3 CONSTRUCTION AND PLANNING . APPROVALS - Permit# Date Inspector POOL & .,A APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement " 3. Electrical Conduit Utility-Undrgrnd. 54. Forms � 4. Electrical Conduit-Undrgrnd, 55, Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. s ' -- 57. APPROVAL TO COVER-GUNITE J t 7. Footings 58. Electrical Conduif-Undrgrnd, f ' 8: Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. ; ' 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61, APPROVAL TO DECK 11, Property Sewer Line & House Con6ectign 62. Backwash & Receptor -Final 12. Sewer Cap f. 63. Heater & Vent -Final 13. Roof Drains t 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 APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ID Gas D Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank EJ Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame 2nd Flashing 76, Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Piaster brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 8D. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or. Canopy 37. Final Factory Fireplace 38. Final Plumbing 39, Water Service -Final 40, Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. 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 051. CERTIFICATE OF OCCUPANCY No, Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. LOT NO. UNIT NO. , CITY OF•COSTA MESA CONSTRUCTIONPERMIT Project Address ] I N% • I��' �i ��S { m 5-f - Applicant's Mailing Address _ Owner's Name T2DY V 5 1 MENyl Phone _7 Transformer 0'15-50 KW_ ❑ 50 + KW Cooking Unit G� TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. Address Dryers ❑Gas ❑Electric Sub Panel Fan Motors I,$[0-1 HP ❑1'f, - 8 F.A.U. Arch/Eng, License No. Address Contractor's Nam ;7 LeGT2 i C- Phone Ss77-I��M I �l $6S $iQ1JA VT- S'T. IN 6TOr) Ga311, Address Imaiiingj, _ + G City License No. �A -1 a TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ETPLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION Device Boxes Outlets Pale Light flange ' Remarks: Sign I hereby affirm that I am licensed under provisions of Charter 9 commencing ' with section 7000) of Division 3 0ness and Profes o s Code, and Generator ❑0-5 KW 05-15 KW Trash Compactor my license is in full force and effe License Class 0— fD Lice s No. Date I �l U-� � S Signature S WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 have a certificate of consent t self -insure or a certificate SUMPWARY OF FEES PLUMBING FEES Bar Sink Showers Backflow Preventer Service Sink - of Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab. C.) " 'olicy No. () Co G eCertified copy is hereby furnished. Certified copDy� flletl with the city uil - ivisio Backflow Irrigation Sewer Cap Bathtubs K Sewer Connection Date�� {t`+' s _Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that In the performance of the work for which this permit is Issued, I 'ha 11 not employ any person in any manner so as to become subject to the CEarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation previsions of the Labor Code, you must forthwith comply with' such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there Is a construction lending agency for the performance of the work. for which this permit is issued (Section 3097 Civ. C.) Floor Drains Swimming Pool w/Spa Floor Sinks .} - - - - Urinal - - Gas Service 'Outlets Interceptors Water Closet Water Heater Lender's Name - - Lender's Address - Kitchen Sink Water Service Lavatories Auto -Wash OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031`.5'Buslness and Professional -Code: Any city or county which requires a permit to Construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with'Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). 3 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and tha structure Is not intended or offered for sale (Section 7044, Businoss and ProfeSsional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale, It however, the building or Improvement is Sold within one year of Co...- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project tSectlon 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds of 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 proof of their Worker's Compensation insurance should be provided to me, P—Trap Laundry Trays Roof Drains Reinspection Fee _ $ a $15 Issue Fee _ MECHANICAL FEES Boiler Hood Or Type I ❑ Canopy Type II ❑ Duct •Under Ground Duct - Structural - Refrigeration System ❑0.100,000 BTU ❑100,000'BTU Duct - Ventilating _ Exhaust'System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Blt. ICBO # Fire Dampers ❑ I am exempt under Section B. & P. C. for this reason Date I Owner l hereby certify that I have read this a Iication and state that the above information is cor 1 agree to com_pl th all city and county ordinances g building n ru tion, and hereby authorize repre- sentatives y enter o t o above-mentioned property for and state l&R, inspection �fC'` Heating System & Ducting ❑0.100,000 BTU Dioo,000BTL Registers Reinspection Fee $15 Issue Fee $ 3 Signature Date Drivers' License or 55 CMF 0865.46, rev, 10194 white - Building; Canary - Applicant; Pink . Accounting; Goldenrod - Assessor A.P. W S Main Building: E T Front B Rear A C Right SLeft Ping. Ref. �k Planning Notes: 5896 1/16/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub. Transformer 0'15-50 KW_ ❑ 50 + KW Cooking Unit Meter Cup to,10bamps Dishwasher Meter Dover 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors I,$[0-1 HP ❑1'f, - 8 F.A.U. Inc. Solar ❑9-15 HP ❑16.15+ Fixtures- Microwave Device Boxes Outlets Pale Light flange ' Switches Sign Garbage Disposal !Standing Sections Generator ❑0-5 KW 05-15 KW Trash Compactor 6050 TL Z O N I N G R E Q M T S FEES I Reinspection Foe $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By _: Dat SUMPWARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $I ENERGY P.C. $ ELECTRICAL •$ , 0 `T GRADING $ PLAN CHECK 50% 1$ - MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ CONSTRUCTION AND PLANNING :' APPROVALS Permit # Date Inspector POOL & _.,A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pale 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. ' 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6- Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58, Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, ❑ Undrgrnd, 10. Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electricai-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 i 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. ,Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preveoter 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 4B. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. •TS lLa1l A MESA PE.RVIT NO. TRACT NO. LOT NO. SLOG. NO. CONSTRUCTION PERMIT IV -1:21501 Own -The Common Sense Press Phone 2_04r Address 11W. 17th St. Ste G-4 Costa Mesa Arch/Eng. License No. Address Contractor Graham Brothers, Inc. Phone -1 5 -- Address 2252 Century PL. Costa Mesa . Ca - LICENSED CONTRACTOR DECLARATION I hereby affirm that t am licensed under provisions of Charter 9 (Com- mencing with section 7000) of Division 3 of the Business and Professions Codi d y license is In full force }�s}I effect. Ucense Class "-1`��`{mlicese No24"b04"- Date I— Z 7—A :2- Signature _ WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of Consent to self -insure or a certificate of Workers' Compensation Insurance, or a Certified Copy thereof (Section 3 00 C.y. �t •"y No. Gr{��L I — CA mpany — gA�Ins 16rtifted Copy Is hereby furnished. -;ertified Copy is filed with the city Building DivlSlon. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed -If the permit Is for•one hundred $1001 or less). cert fy that n the performance of the work for which this permit is Issued, I shall not employ any person In any manner so as to became subject to the Workers' Compensation Laws of California.• Date Signature NOTICE: If after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this perrrllt shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a constructionlending agency for the per- formance Of the work for.which this "permit is islued (Section 3097 Cl V. C.). Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professions Code: Any city or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also re- quires the applicant for such permit to fife a signed Statement that he Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he Is exempt therefrom and the r for the alleged exemption. Any violation of Section 7031.5 by pplicant for a permit subjects the applicant to a civil penalty : more than five hundred dollars ($500). as owner of the property, or my employees with wages as their sole'oompensation, will do the work, and the structure is not intended or offered for sale. (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an OWner of a property who builds or improves thereon, and who does such work himself or through his own employees, provided that such Improvements are not intended Or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner will have the burden of proving he did not build or improve for th6 purpose of safe). '❑ I, *as owner of the property, am exclusively. Contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereOn, and who con- tracts from such projects with a contractor(s) Il6esned pursuant to the Contractor's License Law). ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have road this application and State that the above information is correct. I agree 10 comply with all city and County ordinances and state laws relating to construction, and hereby authorize representatives of this city to enter upon the above mentioned property for pection purposes. Signature 4::Z,:7 Date Drivers' License or SS 9F TYPE OF CONSTRUCTION ❑ NEW ❑ ADD ❑ ALTERATION Q REPAIR ❑ CONVERSION El DEMOLISH 0 OTHER DESCRIPTION OF WORK TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRU,.�C,TUU AL ❑ TENANT ❑ ELECTRICAL ❑PLUMBING L}y0[ECHAN ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION ZONE GRADING CU, YDS, ACRES REMARKS: ,' , 1.497 2/01./82 I ZONING REGULATIONS A.P. 5F ELECTRICAL ZONE PLNTG.. REF..: AN NG SETBACK C/1- ST- 'IRTDVNLINE PRbP YARD L5i REFRIGERATION DFE�YA RIGHT URINALS DOUBLE LAVS REAR YARD (TO P/L) 0-1 KW 10-50 KW PKG. SPACE REQ. PROVIDED STREET WIDTH PARK FEE $ ZONING APPROVED BY DATE SPECIAL CONDITIONS: _ PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK BATHTUBS SHOWERS PERMIT 100,000 + BTU REFRIGERATION TOILETS LAVATORIES URINALS DOUBLE LAVS GENERATOR TRANSFORMER APPLIANCE 0-1 KW 10-50 KW 1-10 KW 50 + KW - KIT. SINKS SERVICE SINKS DISHWASHERS SUMPS MOTORS (INC. SOLAR) 0-1 HP P 10-50 HPL 1-10 HP 50 + HP FLOOR SINKS FLOOR DRAINS FIXTURES OUTLETS SWITCHES DRINKING FOUNTAINS $ GAS TUBE SIGNS PLAN CHECK $ MICROFILM INTERCEPTORS CLARIFIERS POLE LIGHTS C. $ SWIMMING POOL P TRAP POLES METERED SUB WATER SERVICE ALTERATION PANELS MAIN SUB ' GAS SERVICE OUTLETS SERVICE AMP WATER HEATERS BTU OUTPUT SEWER CONNECTIONS SOLAR TANK COLLECTORS SOLAR PIPING SYS. ISSUE FEE ISSUE FEE APPLICATION APPROVED BY DATE MECHANICAL PLAN CHECK HEATING SYSTEM 0-100,000 BTU AND DUCTING PERMIT 100,000 + BTU REFRIGERATION 0-100,000 BTU SYSTEM 100,000 +BTU BOILERS BTU SYSTEM REPAIR, ALTERATION EXHAUST SYSTEM MULTIPLE f F CMF 0865.46 White -Building; Canary -Applicant; Pink-cCOunting; Goldenrod -Assessor G M NO* FINAL FEE $ SUMMARY OF FEES BUILDING PERMIT S _ SMtP E PLAN CHECK g PERMIT ISSUANCE $ PLUMBING $ GRADING $ PLAN CHECK $ ' ELECTRICAL $ $ PLAN CHECK $ MICROFILM $ I dO TOTAL FEE E MECHANICAL $ LESS AD- PLAN CHECK S VANCE PC $ FINAL FEE $ CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector -a POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location 2. Soil Pipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bonding 5. Steel ein orce 47. Rough Plumbing & Pressure Test 6. Electrical U ER Grn 48. APPROVAL TO COVER-GUNITE 7. Footings 49. Electrical Conduit-Undr rn B. Foundation 50. Gas Pipe, ❑ Undr rn, Test 9. Water Pipe-Undrgrn 51. Backwash Lines P-Trag, ❑ Undrqrn 10. Structural Floor System 52. APPROVAL TO DECK 11. Property Sewer Line & House Connection 53. Backwash & Receptor -Final 12. Street Sewer Connection 54. Heater & Vent -Final 13. Rough Plumbing 14.' Rough Electric -Conduit 56. Electrical -Final 15. Rough Electric -Wiring 57. Solar System -Final 16. Rough Heating & Air Conditioning bEl. Fencing & Access Approval 17. Ducts in Structure 59. APPROVED FOR PLASTERING 18, Ducts, Ventilating 60. POOL/SPA SYSTEMS FINAL 19. Gas Pipe -Rough & Test 20. Roof Framing 21. Roof Sheathing NOTES: 22. Frame and Flashing 23. Insulation 24. Uthing & Siding 25. Drywall Nailing 26. Plaster Brawn Coat 27. Electrical Power Meter -Final' - 28. Final Electric 29. Final Heating & Air Conditioning 30. Final Gas Pipe -Test X- 31. Final Plumbing + 32. Water Service -Final 33. Gas Service -Final 34. Solar Domestic -Final 35. Landscape rinklinq System 36. Sound Attenuation 37. Handicap Regulations 3B. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No __ Date ti4 City of Costa Mesa Development Services Department Building Safety Division P. O. Box 1244 Costa Mesa, California The Building located at CERTIFICATE OF OCCUPANCY No. Q0.1"S'21 711 W. 17th Street G4 has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B--2 Occupancy. Use of Building Industrial Legal Description 424-091-03, 011, 05, OG {See r?verse side for Metes and Boundsl Building Permit No B13086,B130991actrical Permit No X7176 Plumbing Permit N-1?19692,P23651 Mechanical Permit No. M18758 Numb apartments and/or gues rooms'? � ISSUED TO:'\ Building Official7.�.i` /� .� Troy Investment Fund 4321 Birch Street by ► Newport Beabb, CA Date This Certificate of Occupancy SHALL BE posted in a conspicuous place on tfie premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. GMF 1015-45 rev. 1/83 White . Owner; Canary - Numerica: File; Pink - Bldg. Permit File CITY OF COSTA MESA 13 Q CONSTRUCTION PERMIT F✓ I Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO TRACT NO. LOT NO. BLDG. 11096 1 & 2 G Project Address —7 1 1 W- 1 2 t h, f r t- P t- Applicant's Mailing Address ; 2 41 8 M a c A r t- h 11r R 1 17 fi - Owner's Name Trr)y TnvpStmRnt Fund hone- 549-2 8 Address 4121 Bir -Ch St_- r NO -WPO -rt B-f?e'i_e Arch/Eng. WM - T. - Pa rPNo. Address M Contractor's Name Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section 00, Lab. C.) 0 c No. T S 2 4 2 n n n 1 6 21 Company A r n n a n t eCertified copy Is hereby furnished. Cer filed cop s f ed with the clty Hullding Olv Date Applicant EXEMION OROM WORKERS' C PENSATION DECLARATION (This section need not be completed i the permit Is for one hundred ($100) or less). I certify that In the performance of the work for which this permit Is lssuetl I Shall not employ any person in any m ner so as t Come subject to the Works p n a i n Laws of Califo a Date15TSignature NOTIE: If, fter aking this declare I , you should become subject to the Workers' Compensation provislons,o he Labor Code. you must forthwith comply with such provisions or this, permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I herebyaffirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to fila 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 Division 3 of the Business and Professions Code) or that he/she is exempt 4rafrom and the basis for the alleged exemption. Any violation of Section 1.5 by any applicant for a permit, subjects the applicant to a civil slty of not more than five hundred dollars (5500). I, as' owner of the property or my erriployees with wages' as their sole compensation will do the work, and the structure Is not Intended or offered for sate (Sec{lon 7044, Business and Professional- Code: The Contractor's 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 empi0yeas, provided that such Improvements are not intended or offered for sale. If however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting iiirawith licensed con- Ctorsto construct.the.praject iSectlon 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Lawl. ❑ 1 am exempt under Section B. & P. C. for'thls reason Date 9 Owner I hereby car ify that I have read Is appllcation-and state that the above Information Is correct. I agree to mply with ail city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for Inspection rposes. Signature Date Drivers' L se or SS TYPE OF CONSTRUCTION Li W ADD U ALTERATION LJ REPAIR MP CONVERSION ❑ DEMOLISH VOTHER A.P. -0 DESCRIPTION OF WORK S Main Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑.MECHANICAL 13 A Rear Y ❑ -OTHER , PROJECT DESCRIPTION OCCUPANCY R-2 C Right__P� K CONSTRUCTION TYPE VALUATION 5 •tA�l 7? Cly- S Left ZONE GRADING CU.YDS. ACRES Ping. Ref.+ ZC gon Remarks: P. C, # 2 0– 8 4S Park ing-Req•/Provided Use of Building: PLUMBING FEES Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $25 Boiler Duct - Under.Ground Duct - Structural Duct_ Ventilating Exhaust System ❑ M'ultiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting 00-100,000 BTU 11100,00013T Reinspection Fee I $25 CMF 0865- 6 rev, 12/83 White -Building; Canary -Applicant; Pink - Accounting; Goldenrod -Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool wlSpa . Urinal Water Closet Water Heater Water Service Issue Fee I $ 3 '_CHANICAL FEES Hood or Type ❑ Canopy Type tI El Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU System Repair/Alteration i Issue Fee $ 3 Automatic Washer Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures r Device Boxes t ` Outlets Switches a Garbage Disposal 01 ID ..5/ 10/Ba 00 Zone G Accessory Building: Park. Fees $ ELECTRICAL Transformer ❑ 15-50 KW 4___�1]50+KW l Generator 010=5 KW LJ5-15 KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0-1 HP ❑ 1'f, - 8 Inc. Solar 09.15 HP 1__116-15+ Microwave Pole Light i Range Sign Standing Sections Trash Compactor 2..16u 17' T1 FEES O N I N G R E a U I. R E M E T i Reinspection'Fee $25 Issue Fee $ 3 — PUBLIC SERVICES REQUIREMENTS: r�.~Z Zoning Approved By ' • ' S ' L Date -7 ' Building Approved By? Application Issued' BY ` Date ata t - $ SUMMARY OF FEES SMIP $ iBUILDING-PERMIT PLAN CHECK $ PERMIT PLUMBING' r `:$ r PLAN CHECK .25% $ f' ELECTRICAL ' . $ PLAN CHECK_ 50%-$ r ISSUANCE :$ ENERGY P.C. '$ GRADING $ MICROFILM $ ` MECHANICAL $ TOTAL FEE $ �! L PLAN CHECK e25% $ i CONSTRUCTION AND PLANNING APPROVALS Permit # r Date Inspector POO L,& - -APPROVALS Permit# ' y Date Inspector 1. Temporary Electrical Service or Pole F 52:- Pool & Equipment Location 2.. Soil Pipe-Undrgrnd. 53. Steel Reinforcerrient 3. Electrical Conduit Utility-Undrgrnd. 54. Forms _ c 4. Electrical Conduit-Undrgrnd. 55. Electrical8c,4ng_ 5. Steel Reinforcement 56. Rough Plumbing & PressurejTest & Electrical LIFER Grnd. 57. APPROVAL TO-COVER-GUNITE_ , ,7. Footings 58. Electrical-Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑`Undrgrnd.; Test F .-9• Water Pipe-Undrgrnd.60. Backwash.Lines, PTrap,'❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 1. Property Sewer Line & House Connection 62. Backwash &Receptor- Final r -12, Sewer Cap 63. Heater &'Vent -Final ' L 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 ' I APPROVALS Permit,# 20. Rough Factory Fireplace .21. Ducts, in Structure 70. Underground Hydro ; 22. Ducts, Ventilating 71. Product Piping ❑Gas ❑Oil ' 23. Gas Pipe Rough &Test 72. Underground Flush 24. foof Framing f 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. ,00f Sheathing ,• . 74. Overhead Hydro 26.'T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27• Frame and Flashing ��i�j �YVi 76. Dry Standpipe , 28. Lathing & Siding �� . 77.' FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywaff flailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 3 79.• FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning # • . 35. Final Gas Pipe -Test 36. Hood'or Canopy_ 37. Final'Factory'F.ireplace 38. Fina4lumbirig 39, Water Service -Final 40. Gas Service -Final' ' 41. Solar Domestic -Final R' ` 42. Back#low Preventer 43. Backfiow Irrigation 44. .Landscape Irrigation System i 'r 45. Sound Attenuation - 46. Handicap Regulations ` 47. FINAL STRUCTURE & BUILDINGVC 48. Special Requirements Completed r ' 4 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CER l��T OF OCCUPA 1Vo. Date ; " ' �- � , CITY OF COSTA MESA --/3 CONSTRUCTION PERMIT Applicant to fill In all spaces except those within heavy border tines and sign all appropriate declarations. Project Address r t L V - J_ ' "I Applicant's Mailing Address :2418 MacArthur Blvd -C.D. Owner's Name Tr2Y investment Fund hone 549-298 Address 4321 BirCh Street.Newport Beach Arch/Eng.WM.L- Pereira AS�oOoenseNo• Address 2418 Mac Arthus- Blvd. , Corona del M Contractor's Name Phone Address (mailing) City License No, LICENSED CONTRACTOR DiCLARATION 1 hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 70001 of Division 3 of the Business and Professions Code, and my license Is In full force and affect. Ucehse Class - License No. nate Signature )RKERS' COMPENSATION DECLARATION ereby affirm that I have a certificate of consent to seif-Insure or a certificate of Workers' Compensation Insurance, or' a,.cartified copy thereof (Section 3800, Lab. C.) Policy No, 52420001-683Company Argonaut BCertified copy Is hereby furnished. Certified copy Is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit IS for one hundred ($100) or less). I Certify that in the performance of the work for which this permit Is Issued I Shall not employ any person in any manner so as become subject to the workerj' A s t on Laws of if rn Date ignatura NOTIC : If,la ter making this deCla on, you should become subject to the Workers' Compensation provlslons f the Labor Code, you must forthwith comply with Such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY I horeby affirm that there Is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Clv. C.) Lantter's Name Lender's Address OWNER BUILdER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the 10114wing reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, after Improve, demolish or repair any structure, prior to Its Issuance, also requlres the applicant for such permit 10 file a signed statement that he/she Is licensed pursuant to the provisions of 9Contractor's License Law (Chapter 9 (Commencing with Section 7000) of ,,,Sion 3 -of the Buslnass and Professions Code) or that he/she Is exempt ,erefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects ,the applicant to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the' property or -my employees with wages as their sole Compensation will do the work, and the structure Is not Intended or offered for sale (Secilon 7044, Business and Professional Code: The Contractor's UC4nse 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 employees, provided that such Improvements are not Intended or offered for Sale, If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- rove fort he purpose of sale). I, as owner of the property, am exclusively contracting, with licensed con- traCtorst6 construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for Such projects with a con- traQtor(s) license pursuant to the Contractor's License Law). ❑ I am exempt under Section B. & P. C. for this reason Oats Owner I herebyy certify that I have read Kl% application and state that the above WOrmatlon Is correct. I agree to cornaly with all city and county ordinances and state laws relating to building construction, and hereby euthorize repre- sentatives of this city t enter upon the above-mentioned property for InaDectlon rPoses. Signature Date Drivers' L) nse or SS 11096 1 1 & 2 G TYPE OF CONSTRUCTION LJ NEW LJ ADD M ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK EXtErior Alterations - $ 3 01 1 B .5./10/84 15017, T!_ A.P. 916 42_ _ 0W—o Zone 5 Main Building: Accessory Buiitling: IG TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL r .❑ OTHER PROJECT DESCRIPTION S4. FT. OCCUPANCY CONSTRUCTION TYPE VALUATIONS 8nn _ 00 ZONE GRADING CU.YDS. ACR E$ E T Front 4ANICAL A Rear 3 / ❑ C Right 7 Approved BY K S Loft Z L ! Date Ping, Ref. F* �.— Z Park. Fees $ Remarks: _ 8 Building Building Approved BY Application Issued By Parking Req./Provided W% J Date at G Refrigeration System Use of Building: PLUMBING FEES Planning Notes: Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 50 + KW System Repajr/Altarafjon Clarifiers Solar Collectors Dishwasher Drinking Fountains Floor Drains Soler Piping Solar Tank Swimming Pool wlSpe Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Meter Cup to 100emps Meter Cover 100 amps Sub Panel Floor Sinks Urinal Fan Motors 00-1 HP 0 h - 8 Gas Service Outlets Water Closet F.A.U. Inc.Solar ❑9-15 HP 016-15+ Interceptors Water Heater Fixtures Microwave Kitchen Sink Water Service Device Boxes Pole Light Lavatories Outlets Range TOTAL FEE P—Trap Switches Sign Issue Fee Roof Drains _ Garbage Msposal Standing Sections Generator El 0-5 KW 1:15.15 KW Trash Compactor Rsinspertion ;Fse I - $25 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust' System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # , Heating System & Ducting 00.100,000 BTU ❑ 100,00013T Reinspection Fee k - '$25 CMR 0865=46 raw. 12183 White - u ng; plicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 ' Reinspection Fee $25 Issue Fee $ 3 4ANICAL FEES ' PUBLIC SERVICES REQUIREMENTS: ❑ Hood or Type I Canopy Type I I 13 Approved BY r Q)KG Date Z — � Building Building Approved BY Application Issued By W% J Date at G Refrigeration System 00-100,000 BTU 0100,0.00BTU r BUILDING PERMIT PLAN CHECK $ $ SUMMARY OF FEES / 0— SMIP PERMIT $ 6 System Repajr/Altarafjon PLUMBING $ ISSUANCE $ PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% $ $ $ ENERGY P.C. GRADING MICROFILM $ $ $ MECHANICAL $ TOTAL FEE $� Issue Fee $ 3 PLAN CHECK 25% $ r� CONSTRUCTION AND PLANNING 1.1 Date ''APPROVALS Permit # Inspector - POC SPA APPROVALS Permit Date . - Inspector `r f. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2.. Soil Pipe-Undrgrnd. 53: Steel Reinforcement • r - 3: Electrical Conduit Utility-Undrgrnd. 54. Forms 4:. Electrical Conduit-Undrgrnd. 55.E Electrical Bonding 5:• Steel ReinforcementL/C-- 56.+ Rough Plumbing.& Pressure Test 6.' Electrical LIFER Grnd. 57. APPROVAL TOCOVER-GUNITE, 7. Footings YE- 5B. Electrical Conduit-Undrgrnd,- _ B. Foundation 59, Gas Pipe, 0 Undrgrnd.', Test : = 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P,Trap, Q 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 _1 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro .22. Ducts, Ventilating 71. Product Piping ❑ Gas' . ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush ~- 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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: (jam dpj� N b,tf� 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test _ 36. Hood,or Canopy 37. Final•Factory Fireplace 38. Final_Plumbing 39. Watef Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation s 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING [/C/ 48. Special Requirements Completed =' I i i 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY, No. Date -- I _ - Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. _ • CITY OF COSTA MESA CONSTRUCTION PERMIT PEFjmIT NO. TRACT NO. LOT NO. UNIT NO, , Project Address '111 j w . 1�TFF sT, Cos -TA- ME sft Applicant's Mailing Address Ownei's Name �L`tr wVC-_ST_ &^. J ( Phone Address — Arch/Eng. -- License No. Address Contractor's Name -MERL3l , EU C -TIS tC_ Phone 7-6kSZ> Address (mailing) �(0'5 R s! • Rlpbm 10 Ii+O (o City -Eicense No. LN ICESED CQ NTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter (commencing with section 7000) of Division 3 h siness and rofes 1 ns Code, an my license is in full for a and effe Ucense Class ' ID Lice a tato. S Date —t11�' Signature WORKERS' COMPENSATION DECLARATION ' I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance. -or a certified copy thereof (Section 3800, Lab. C.) _ Policy No. ssc.�l O �_ 0 C BCertified copy is hereby furnjshe,d Certified cryp is sled with the city Build g visio l ga � � Date I - Applicant EXEMPriON FROM WORKERS' COMP S iQN ECI_ARATION (This section need not be completed If the permit IS -f0 one hundred ($100) or less). 1 certify that In the performance of the work for which this permit Is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date __ _Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there Is a construction lending agency for the performance - of the work for which this permit Is Issued (Section 3097 Civ. C.) Lender's - Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reaWn (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter improve, demolish or repair any structure, prior to Its' issuance, also requlres t6o applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Sect(on'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 byany applicant for a permit subjects the applicant to a civil ,enalty of not more than five hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their solo compensation, will do the work, and the structure is not intended or offered for sale (S"tion 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or Offered for sale. If, howrfver, the building or improvement Is Sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of Sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con. 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 builds or improves thereon, and who'eontracts for such projects with a con- tractor(s) lic@nse pursuarit 'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section r B. & P. C. for this reason Date - - Owner — 1 hereby cert I.have read this information correct. I,agree to omp and State I re Ing to build' con sentaiives o this ity to enter upOr Inspectlo, pu Signature Drivers' License or SS =h� ication and state that the above th all city and county ordinances tion, and hereby authorize repre- above-mentionotl property for 1 1 Date O-- 8S- 5697 1/16/85 4050 1 TL Boiler Duct 'Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & ducting ❑ 0. 100,000 BTU ❑ 100,000 BT Reinspection Fee I $15 CMF 0865.46, rev, 10)84 White - Building; Canary - Applicant; pink . Accounting; Goldenrod - Assessor IANICAL FEES Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System E)0.100,0'00BTU 0100,000'BT.0 System Repair/Alteration Fire Dampers Registers Issue Fee I $ 3 Reinspection Fee 1 $15 1 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved'By TYPE OF CONSTRUCTION NEwLi ADO LJ ALTERATION - REPAI R Application Issued By Dat ❑ CONVERSION ❑ OEM OLISH ❑ OTHER A.P. 30 Zona $ DESCRIPTION OF WORK/USE OF BLDG. $ PLAN CHECK $ PERMIT PLUMBING $ S Main Building: Accessory Building: $ ENERGY P.C. $ ELECTRICAL E GRADING S PLAN CHECK 50% Z TYPE OF PERMIT GRAOING FOUNDATION STRUCTURAL T Front $ TOTAL FEE O ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B N ❑ OTHER A Rear I C Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY G CONSTRUCTION TYPE VALUATION S S Left R ZONE GRADING CU.YDS. ACRES Ping. Ref. 5 Parking Req./Provided E O Remarks: Planning Notes: M T - S PLUMBING FEES Bar Sink Showers ELECTRICAL ' FEES Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW Backflova Irrigation Sewer Ca pConstruction Pole Sub. El 50+ KW Bathtubs I Sewer Connection Cooking Unit Meter ❑up to 100amps' Clarifiers Solar Collectors '. Dishwasher Meter El over 100 amps - Dishwasher Solar Piping Dryers OGas ❑Electric Sub Panel Drinking Fountains Solar Tank r Fan f Motors Cg¢1 HP Ell 55- 8 1 Floor Drains Swimming Pool w/Spa F,A.U. Inc. Solar 09-15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water.Closet - Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink ' _ Water Service r Switches Sign Lavatories Auto -Wash Disposal Garbage Dis g p ,Standing Sections P -Trap• Laundry Trays Generator 00.5 KW 05.15 KW Trash Compactor Roof 1) oins Reinspection Fee 1 $15 1 Issue Fee $ 3 Boiler Duct 'Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & ducting ❑ 0. 100,000 BTU ❑ 100,000 BT Reinspection Fee I $15 CMF 0865.46, rev, 10)84 White - Building; Canary - Applicant; pink . Accounting; Goldenrod - Assessor IANICAL FEES Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System E)0.100,0'00BTU 0100,000'BT.0 System Repair/Alteration Fire Dampers Registers Issue Fee I $ 3 Reinspection Fee 1 $15 1 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved'By pate Application Issued By Dat SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $-00 GRADING S PLAN CHECK 50% $ SU MICROFILM $ MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL � _PA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52, Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4, Electrical Conduit-Undrgrnd, 55, Electrical Bonding •5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8, Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P•Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16, Rough Electric Wiring 67. Fencing & Access Approval 17, Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 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 C� Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43. 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 E`in. Date ` ' Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT Nn. Project Address 711 W._1.7 th S t . Bldg (G) Unit 4 Applicant's Mailing Address 111 10 Sap roy St. N. 1401 1 Y. Owner's Name —TrnPhone C/��88 Address 43 }i Gas — Arch/Eng. Marin—, —Rock License No, Address 12$81_KJ3r1t- .Ve___Su"s 916 - Contractor's Nume4).UCo— i-r--{,ga(i-it4.04}}+ig—Phone 982 121 Address(mailing) 13110__Saticoy St_ N1 Hn14—ad Ca. City License No. - _ LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisio4Ch 9 (commencing with section 7000) of Division 3 of the Businesions Code,andmy license is in full force and effect License Class L Dat4'118 84 Sl gnat. WORKERS' COMPENSATION DEC RATION I hereby affirm that I have a certilicffle of consent to self4nsure or a certificate of Workers' Compensation Insur ce, or a certified copy thereof (Section 3800, Lab. C.) Policy No, WC4824 Company LumhermanS _ BCertified copy is hereby furnished. CertifiFtl- opy is filed with the city Building Ision, J� _ Date L) Applicant PIZ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION .(This section need not be completed if the permit Is for one hundred ($100) or toss). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: 11, after making this declaration, you should become subject to the Workers'. Compensation provisions of the Labor Code, you must forthwith comply with, such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCV I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Buslness and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Businass 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 lenalty of not more than five hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's Liconse 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 employyees, provided that such lmpravamenis ora not Intended or offered for sale. I1, however, the building or Improvement Is sold within one year of com- pletlon, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for Such projects with a con- tractof(s) license pursuant'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section S. & P. C. for this reason Data Owner PLUMBING I hereby certify, that 1 have read this application and state that the above information is correct. I agree to omply with all city and county ordinances and state la relating tv buil construction, And hereby authorize repre- sentat€vas 's city to er upon the above-mentioned property for inspection urpo es. to y��` Signature Dishwasher Drivers' Llce or SS :i.' Drinking Fountains TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATtON LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.+ DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING 0 FOUNDATION 11 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION S S Pt ZONE GRADING CU.YDS. ACRES Ping. Ref. ik Remarks: Planning Notes: Reinspection Fee $15 I I Issue Fee PLUMBING Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories P—Trap Auto -Wash Laundry Trays Roof Drains Reinspection Fee $15 I I Issue Fee MECHANICAL BUILDING PERMIT Boiler PLAN CHECK Hood or Type I ❑ Canopy Type 11. ❑ PLUMBING Duct - Under Ground PLAN CHECK 25% Duct - Structural ELECTRICAL Refrigeration System ❑0-100,000 BTU ❑100,000 BTU PLAN CHECK 5096 Duct - Ventilating MECHANICAL $ 1 .i. OC} TOTAL FEE Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact• Olt. ICBO 9� Fire Dampers 1 Heating System & ducting ®0-100,000BTU.❑1o0,000OT' 6 Registers Reinspection Fee E $15 1 1 Issue Fee CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor FEES S 3 FEES $ 3 2264 5/03/55 16.50 Zone Accessory Building: Z O N �N G R Parking Req./Provided E Q M T S ELECTRICAL Automatic Washer Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures - Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 05-15 KW Transformer ❑ 15.50•KW ❑ 50+KW Meter ❑up to 100 amps Meter Dover 100 amps Sub Panel Motors ❑0-1 HP ©1'1A-8 Inc. Solar ❑9-15 HP 016-15+ Microwave Pole Light Range Standing Sections Trash Compactor FEES I I Reinspection Fee 1 $15 1 I Issue Fee I $ 3 1 I DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By nwtw PLAN CHECK 25% $ 2._�Q._ SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.0 ELECTRICAL $ GRADING PLAN CHECK 5096 $ MICROFILM MECHANICAL $ 1 .i. OC} TOTAL FEE PLAN CHECK 25% $ 2._�Q._ CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POOL - _PA APPROVALS Permit # Date InspP,ctnr 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement l �. 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 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System r' Y 61. APPROVAL TO DECK 11. Propefty Sewer Line & House Connectign 62. Backwash & Receptor=Final 12, Sewer Cap j 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. Plough 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 APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 Coal 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning Zyfs,` 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Sefvice-Final 41. Solar Domestic -Final 42, Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51, CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CO STRUCTIO� P RM17 PERMIT NO. TRACT NO.. LOT NI}. UNIT NO. rroject Address �r Applicant's Mailjn ddress Owher's Name AO J Phan Address Arch/Eng. License No. Address Contractor's Name_ .. Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION ' I N@reby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is In f orc an-etTact. tJcert Class License NO3 a.1 Oat Signatur WORKERS' COMPENSATION CL1— -hON I h@reby affirm that I have a cer fiGate of consent to self -insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab, C.) Policy No. Company BCertified copy fs hereby furnished. , Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit Is far=one hundred (5100) or less). I certify that In the performance of the work for which this permit Is issued I shall,not employ any person in any manner so as to become subject to the Worker Com ensatton Laws of Calit Date• Signature 'NOTICE: I , a er ma Zing this declar on, you should become subject to the Workers' Compensation provisions f the Labor Code, you must forthwith cornply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a const ruction- lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name - Lehdi;r's Address . OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Sectlon 7031,5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file asigned statement that he/she I$ licensed pursuant to the provisions of 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 affeged exemption. Any vlofation of Section 7031.5 by any •applicant for a, Perm it• subjects the -applicant to a Civil f5nalty of not more than five hundred dollars ($500). - ' I, as owner of the property or- my employees with wages, as their solo Compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code:. The Contractor'$ License Law does not apply to an owner of a property who builds or improve% thereon, and who -does such work himseff/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of Com- Plet(on, the owner wilt have the burden of proving he/she did not build or im- prove,for the purpose of sale). El I, as owner of the property, am exclusively contracting, with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon, and _who Contracts for such projects with a con- tractor(s) license pursuarit'to'the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner ' I hereby certify that I have read this application and state that the above Information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre. sentatives of this cif to enter upon the above-mentioned property for inspection pur es. Data r r Signature Drivers' Li se or SS :`- TYPE OF CONSTRUCTION LJ NEW L.J ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCR IPTION OF WOR K/USE OF BLDG. LJ ALTERATION LJ REPAIR A.P. 46 S Main Building: TYPE OF PERMIT LJ GRADING LJ FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ -OTHER _ E T a A Front Rear PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONST RUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES C r, Right 1 Left Ping. Ref. 0 Remarks: Planning Notes: Bar Sink Backflow Preventer Backffow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap. ' Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Uuct - ventrtating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 00-10},000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 W pplicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee IANICAL Hood or Type l ❑ Canopy Type 11 ❑ Refrigeration System 00�100.600BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES 0 Automatic Washer ' Construction Pole Sub, Cooking Unit Dishwasher Dryers QGas ❑Electric Fan ' F.A-.U. Fixtures Zone Accessory Building: Parking Reg./Provided ELECTRICAL 4 Transformer ❑ 15'50 KW ❑ 50'+ KW Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW C-15-15 KW Meter Llup to 100 amps Meter Dover 100 amps -Sub Panel Motors 00-1 HP ❑1 h B Inc. Solar 09.15 HP 1116-15+ Microwave Pale Light Range Sign Standing Sections Trash Compactor Z o N ' I N Ga R E O' M T S FEES $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date Date ]azarr BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ g _�C 00 S SD_ $ $ $ $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ $ 3 . .CONSTRUCTION AND PLANNING APPROVALS Permit :# ^ A. Temporary Electrical Service or Pole Date Inspecto r � POOL,.. SPA APPROVALS Permit # 52. Pool & Equipment Location Date Insppctnr t, 2. Soil .1 pe-Undrgrnd. �iy 1 53, Steel Reinforcement >�• r ;'r+' EI cFG Conduit Utility Undrgrnd'. !il 54. Forms 4 -Electrical Conduit-Undrgrnd. �„ _ 9 55. Electrical Bonding ; 5 �Styee1-YR6inforcement ;- 56. Rough Plumbing & Pressure Test 6�Electrica'l UPER Grnd. 57. APPROVAL TO COVER-GUNITE -7,-F6otings j" 58. Electrical Conduit-Undrgrnd. uq' ation j :ar .yam ' 59. Gas Pipe, ❑ Undrgrnd., Test :3 , 9. 1ate6`01pe Undrgrnd, 60. Backwash Lines, P -Trap, ❑ Undrgrnd. f 10 Structural Floor System ' Z 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash &Receptor -Final 12. SevverllCap -4 63. Heater & Vent -Final 13.,Raof!'DrAins E� 64, Plumbing System - Final ry"� 14.Roug`,Rlumbing 65. Electrical -Final r" 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank © Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final iLS Si ,40. Gas Service -Final 41. Solar Domestic -Final 42. Back flow. Preventer 43, Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No, Date -- _ -� Applicant to till in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CO f 7 IJCTIQ PERMIT Project Address --' Applicant's Maili ddress Owner's Name f] Address qy J15 AAi Arch/Eng, icense Np. AdoressBlzite L Contractor's Name Q 4 1 t2 Phone Adtfress (maifing) -- City License No, LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. - Date Signature„ - WORKERS' COMPENSATION DECLARATION I htreby affirm that I have a certificate of consent to selfdnsure or a certificate ,f Workers' Compensation Insurance, or a certified copy thereof (Section - 3800, Lab.) icy No. 00 "� l Company "U U P— Certified copy Is hereby furnished. Certilledop I filed with the city Buildj vis' Dake Applicant EXEmpi FROM WORKERS' COMPENSATION OECLARATiON (This sectionFneod not be completed if the permit is for one hundred (5100) or les$). I certify that.in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. iCONSTRUCTION LENDING AGENCY. I hereby affirm that there is a construction lending agency fo the p rmanC of the work t W13i js t. f ssleo d 3 v. Lender's Name Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Coda: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to•Its Issuance, also requires the applicant for such permit to Ilia 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 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 031.5 by any applicant for a permlt subjects the applicant to a civil malty of not more than five hundred dollars (5500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Isnot Intended or offered for sale (Section. 7044, Business and Professional Code: The Contractor's 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 ner own ernployees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement Is sold within one year of Com- pletion, the owner will have the burdan of proving he/she did not build or Im- ve fof the purpose of sale). 1, as owner of the property, am exclusively Contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not_aPPIY to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). i am aware that Proof of their Worker's Compensation insurance should be provided to me. L,] f am exe •p under Section a. P. C. for this reason Date Owner I here rtify that i have road this application and state that the above informatl is Correct. 1 agree to comply with all City and county ordinances and state laws relating t build, co truction, and hereby authorize repre- senfaflves of this c! o on r the above-mentioned pro a y for Inspection Purposes. 1 Signature QrNerS' License or SS _ TY,M,OF CONSTRUCTION NEW ADD CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. ALTERATION TYPE OF PERMIT L) GRA4ING� FOUNDATION LJ STRUCTU LJ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 50. FT._ _ OCCUPANCY CONSTRUCTION TYPE - VALUATION $ ZONE GRADING CU -YDS. ACRES - Remarks: ' Roof Drains LJ REPA I R RAL FEES Reinspection Fee $15 Issue Fee $-3 Boiler Duct - Under Ground Duct - Structural Duct • Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit, ?CBO # Heating System & Ducting ❑ 0-100,000 BTU ❑ 100,000 BT IANICAL Hood or Type C ❑ Canopy Type If ❑ Refrigeration System [30-1()(),000BTU 11100,00013T System Repair/Alteration Fire Dampers Registers A.P. S Main Building: E T Front B Rear A C Right SI Left Ping. Ref. Planning Notes: Automatic Washef Zone Accessary Building: Parking Req./Provided ELECTRICAL Construction POIeSub. Cooking Unit 'r Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 05-15 KW ' I Reinspection Fee ! S15 FEES Fleinspection Fee I $15 I I Issue Fee I $ 3 CMF 0865-46, rev. 10/84 White Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor Transformer ❑ 15-50 KW ❑ 50 + KW Meter LJup to 100 amps Meter ❑over -Wo amps Sub,Pbnel Motors ❑0-1 HP ❑ 1'h - B Inc.Solar 119_15 HP 1116.15+ !Microwave Pole Light Range Sign Standing Sections Trash Compactor Issue Fee FEES $ 3 Z O N I N G R E 0 M T S DEVELOPMENT SERVICES REQUIREMENTS: PLUMBING Bar Sink Back flaw Preventer Showers Service Sink Backflow Irrigation Bathtubs Sewer Cap Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool vv/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories P -Trap _ _ Auto -Wash Laundry Trays Roof Drains LJ REPA I R RAL FEES Reinspection Fee $15 Issue Fee $-3 Boiler Duct - Under Ground Duct - Structural Duct • Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit, ?CBO # Heating System & Ducting ❑ 0-100,000 BTU ❑ 100,000 BT IANICAL Hood or Type C ❑ Canopy Type If ❑ Refrigeration System [30-1()(),000BTU 11100,00013T System Repair/Alteration Fire Dampers Registers A.P. S Main Building: E T Front B Rear A C Right SI Left Ping. Ref. Planning Notes: Automatic Washef Zone Accessary Building: Parking Req./Provided ELECTRICAL Construction POIeSub. Cooking Unit 'r Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 05-15 KW ' I Reinspection Fee ! S15 FEES Fleinspection Fee I $15 I I Issue Fee I $ 3 CMF 0865-46, rev. 10/84 White Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor Transformer ❑ 15-50 KW ❑ 50 + KW Meter LJup to 100 amps Meter ❑over -Wo amps Sub,Pbnel Motors ❑0-1 HP ❑ 1'h - B Inc.Solar 119_15 HP 1116.15+ !Microwave Pole Light Range Sign Standing Sections Trash Compactor Issue Fee FEES $ 3 Z O N I N G R E 0 M T S DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By_..__Data SUMMARY OF FEES BUILDING PERMIT g SMIP $ PLAN CHECK $ PERMIT PLUMBING S ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL g GRADING $ PLAN CHECK 50% S MICROFILM $ MECHANICAL $ TOTAL FEE $ r Orr PLAN CHECK 25% $ CONSTRUCTION AND PLANNING • APPROVALS Permit # Date Inspector POOL SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment. Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd-, Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final .� 12. Sewer Cap 63. Heater & Vent-Final r 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 66. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24.. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 76. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer ' 43. Backflow Irrigation -' 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. _ (;ITY OF COSTA MESA CONSTRUCTION PERMIT : Project Aclaress -7 -7 S r = C S {f /1'1IRS-ft Applicant's Mailing Address Owner's Name-`TRUy SIV J E ST IiJE/l )� -Phone Address - - ArchlEng. _ License No.' Address nr� Contractor's Name MOR I- - Li_&RIC- Phone i�-77 6,$Cb Address Imaiiing) • g25 NK Sre ELMMIQN !b City License No. LICENSED CONTRACTOR DECLARATION ' 1 hereby affirm that Tam licensed under provisions of Charter 9 (commencing withsection 7000) of Division 3 of the Business and Profess s Code, and my license is in full force and effect � License Class 15 Licens o.,!�0-5211 Date---L�Signature WORKERS' COMPENSATION DECLARATION 1 hereby affirm that t have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified_ copy theieof (Section )0, Lab. C!} , ' olicy No. I C E� O cy---7 D Compan L �C BCertified copy is hereby furnishe r Certificop i filed with the ci Bu' n lvision. Date (` ed d� Applicant s ---w EXEMPTION FROM WORKERS' COMPENSATION ECLARATION (This section need not be completed if the permit Is for'one hundred ($100) or I Certify that in the perforrnance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation ILaws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor. Code, you must forthwith _ comply with such provisions or this permit shall be deemed revoked._ CONSTRUCTION LENDING AGENCY - I hereby affirm that there I5 a construction lending agency for the performance of the work for which this permit is Issued (Section r 3097 Civ. C.) Lender's Name -- Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's Llcense Law for the following reason (Section '7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 031.5 by any applicant for a permit Subjects the applicant to a civil salty of not more than five hundred dollars ($500). ❑ I, as owner of, the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, l3usiness and Professional Code: The Contractor's 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 employees, provided that such'! mprove ments are not intended or offered for sale. If, however, the building or improvement is sold within one yeariof com- pletion, the owner will have the burden of proving he/she did not build or im- rove forr the purpose of sale). r I, asowner of the pioberty, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a -con-` tractors) license pursuant'to the Contractor's Llcense Law), 1 am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C, for this reason Date Owner I hereby. certify that i have read this application and state -that the above Information is corre agree to • mpIy h all city and county ordinances and state laws ng t buikdin const ion, and hereby authorize repre- sentatives Of this Ity q este upon a above-mentioned property for Inspection p rp Signature Date1`JU� - Drivers' Licens c S5 PQ$MIT NO. TRACT NO. LOT NO. :] UNIT NO. 584$ ! / 1. 6/65 TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORKIUSE OF BLDG. - - A. P. # Zone S _ Main Building: Accessory, Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL- - ❑ OTHER _ _ _ PROJECT DESCRIPTION SQ. FT. OCCUPANCY • CONSTRUCTION TYPE - VALUATION $ ZONE GRADING CU,YDS. ACRES _,. T Front p B A Rear N C .- Right N S' Pft G R. Ping. Ref-# Parkirig Req./Provided E. Remarks: Planning Notes: Q M T S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink ' " - Automatic Washer - Construction Pole Sub. Transformer' ❑ 15-50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection -^;y Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher ; Meter Clover 100 amps Dishwasher Solar Piping - Dryers []Gas ` ©Electric Sub Panel Drinking Fountains Solar Tank Fan Motors D(0 1 HP ❑ 1 %: • 8 co Floor Drains' Swimming Pool vv/Spa F.A.U. Inc.Solar 09.15 HP ❑16-15+ Floor Sinks .. Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink, Water Service Switches Sign Lavatories Auto -Wash, Garbage Disposal ; Standing Sections P -Trap Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor Hoof Drains Reinspection Fee .$15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 r MECHANICAL FEES SERVICES REQUIREMENTS: Approved By Date -Date Building* Approved By Date Application Issued By Data -((o Boiler t Hood or Type I ElDEVELOPMENT Canopy Type I I El Duct - Under Ground Duct -Structural Duct --Ventilating Refrigeration System 130_100,000 BTU 0100,000 BTU SUMMARY BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ �-C.``O PLAN CHECK 50% -S _ MECHANICAL $ PLAN CHECK 25% $ OF FEES SMIP $ PER MJT ISSUANCE $ ENERGY P,C. $ GRADING $ SO MICROFILM $ TOTAL FEE S SQ Exhaust System ❑ Multiple ❑ ;System Repair/Alteration Firepl/Fact. Bit. ICBO # 11 Fire Dampers Heating System & Ducting Registers E3 0-100,000 BTU❑100,OOOBT Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Bulldtng; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL - .PA APPROVALS Permit # Date Inspecrnr `1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd. 53. Steel Reinforcement *3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7, Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor•Final 12. Sewer Cap 63. Heater & Vent -Final 13, Roof Drains 64, Plumbing System - Final 14, Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66, Solar System -Final 16, 'Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydro " 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ 0il 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 40 Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39, Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. 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 Nr), Date � - A Applicant to till in all spaces except those within heavy border lines and sign all appropriate declarations. OF COSTA MESA NSTF,_I C I N PERMIT PERMIT NO. TRACT NO. LOT NO. UiV T NO -- CITY �- ProJect Aiidress,� [� Applicant's Mail- Ver. / t Owner's Name ne Address Arch/Eng. License No. Address Contractor's Nam hone Address Imailing) City License No. !ys .ci ! _ __- LICENSED CONTRACTOR DECLARATION I hereby affirm that l am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and MY license Isin Lull ce d ffect.� Zi n Licens C15ss Ll cense No. Date Signature WORZE': S' COMPENSATION p 12ATFON hereby affirm that I have a certifi ate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section 600, Lab. C.) Policy No. Company 8 Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit isforone hundred (S10D) or less), I certify that in the performance of the work for which this permit is Issued I shall not employ any person in any manner so as to become subject to tile Worker ' Com ens (Ion Laws of Calif ia. Date Signature NOY E: er mak ng this declar n, you shou d become subject to the Workers" Compensation provisions the Labor Code, you must forthwith comply with- such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY . I hereby affirm that there Is a construction lending agency for the performance of the work Tor• which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's. License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit .to file a signed Statement that he/she is licensed pursuant to the provisions of thQ Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption, Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a. civil `penalty of not more than five hundred dollars ($500). �J I, as owner of they property ,or my employees with wages as their sole Compensation; will do the work, and the structure is not Intended or offered for sale (Section •7044, Business and professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for We. If, however, the building or Improvement is sold within ono year of com- pletion, the owner will have the burden of proving he/she did not build or im- prgve fpr the purpose of sale). ❑ I. as owner of the property, am exclusively contracting with licensed Con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who builds or improve$ thereon, and _who contracts for such projects with a con- tractor(s) 1lcense purSuarit'to the Contraitar's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and Slate that the above information Is correct. I agree to comply with all city and county ordinances ana state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for Inspectlon� Ose SiynaturP V /r _-- _ — Date Drivers' 16Cense or SS %* _ TYPE OF CONSTRUCTION NEW 0 ADD LJ ALTERATION El REPAIR DEVELQPMENT SERVICES REQUIREMENTS: ELECTRICAL FEES ❑ ❑ ❑ OTHER Service Sink L-) CONVERSION DEMOLISH Transformer I] 15-50 KW* ❑ 50 + KW A.P. Bathtubs DESCRIPTION OF WORK/USE OF BLDG. =_ - Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors S Main Building: Meter ❑over 100 amps Dishwasher E SUMMARY OF FEES $ $ TYPE OF PERMIT GRADING El FOUNDATION 0 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Floor Drains Floor Sinks ❑ OTHER $ t%• d0 $ $ $ A Rear !� Gas Service _Outlets Water Closet C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K MECHANICAL . CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Trash Compactor Roof Drains PLUMBING FEES r I i 5991 7/42/95 10.50 TL Zone Accessory Building; Z O N I N G R Perking Req./Provided E 0 M T Is Bar Sink Showers DEVELQPMENT SERVICES REQUIREMENTS: ELECTRICAL FEES Backflow Preventer Service Sink L-) Automatic Washer Construction Pole Sub. Transformer I] 15-50 KW* ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Refrigeration System Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping SUMMARY OF FEES $ $ Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan' Motors E10-1 HP 01h-13 Floor Drains Floor Sinks Swimming Pouf jnrf5pa Urinal $ t%• d0 $ $ $ F.A.U. Fixtures Inc. Solar 09-15 HP 016-15+ Microwave !� Gas Service _Outlets Water Closet Device Boxes Pole Light Interceptors' Kitclien Sink Water Heater Water Service MECHANICAL . Outlets Switches Range Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P -Trap Laundry Trays Generator 00.5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 I Issue Fee $ 3 MECHANICAL FEES Boiler Duct'- Under Ground Duct - Structural Duct - Ventifating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Oucting 00.100,000 BTU ❑ 100,000 BT Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type 1 ❑ DEVELQPMENT SERVICES REQUIREMENTS: Canopy Type II ❑ Zoning Approved By Date Building Approved By Application Issued By 444 Date Date- �7ZZ �J Refrigeration System ❑0.100,000 BTU ❑ 100,000 BTU BUILDING PERMIT PLAN CHECK SUMMARY OF FEES $ $ SMIP PERMIT $ System Repair/Alteration Fire Dampers' PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% $ t%• d0 $ $ $ ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ Registers MECHANICAL . $ TOTAL FEE $ ,(. O Issue Fee $ 3 PLAN CHECK 25% $ 'CONSTRUCTION AND PLANNING APPROVALS Permit # _ Date Fu Inspector POOL ae SPA APPROVALS Permit # Date Inspector i-. Temporary Electrical Service or Pole M �v1 52. Pool & Equipment Location 2. Soil Pip :Undrgrnd. .� 53. Steel Reinforcement 3r � rical Conduit' /'il^ty-UnArnd. �. 54. Forms " J 401 lett r4r�a�, Conduit;UAdr 55. Electrical Bonding <� 5!}Steel Reinforcement y 56. Rough Plumbing & Pressure Test 6.41 ctrical UFERtGCod. j 57• APPROVAL TO COVER-GUNITE ; t 7�,,doings 'f �"� 58. Electrical Conduit-Undrgrnd. $�Founda.on 59. Gas Pipe, ❑ Undrgrnd., Test Yj 9' ateape Un¢�gFnd. r a f y ; 60. Backwash Lines, P-Trap, ❑ Undrgrnd. , 10. S6uctural Floor System 4 +� 61. APPROVAL TO DECK 11. Property'Sewer Line-Sr House Connection r_ � u i 62. Backwash &Receptor Final 12. Sewer C? p 14 F 63. Heater & Vent-Final � 13. •Roof Drains t'r 64• Plumbing System - Final' 14. Rough Plumbing�a .� 65. Electrical-Final 15. Rough Electrical-Conduit r 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd, Storage Tank ❑ 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. Piaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing l��91 �� 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 61. CERTIFICATE OF OCCUPANCY . . € Nr1. Date Yid Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. epIT NO. Project Address 711 . 17th St . Bldg({;) Unit�, S Applicant's Mailing Address 1- TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR Owner's Nam eirl])l TrtvestMPUt Fund phone 54 —2988 Address 4321 Birch St. Newport hn>1 TCa . Arch/Eng. Marin. Rock License No. Address 19881 Knott- AVP- Sttite 216 Contract'or's Name..._ Dorn _ hone -.82-1216 Address (mailing) 13110 Sati roar Sr- N -Nal 1 ywand, Ca. City.License No. 39.9.25 LICENSED CONTRACTOR DECLARATION I hereby affirm that t am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business an rofessions Code, and my license is in full force and effe 346251 License/Class a se o. Da44-JR 84 Signature WORKERS' COMPENSATION DEC RATION t hereby affirm that I have a certifi to of consent to self -insure or a certificate I Workers' Compensation Insu nce, or a certified copy thereof (Section alio, Lab. c.) WC9824 Lumbermans Policy No. Company HCertified copy is hereby furnished. certifi y is filed with the city BuildipIg\ Div isr - Date Applicant -Y1-1 y -- - EXEMPTION FROM WORKERS' COMPENSATION DECLA ATION (This section need not be completed If the permit is for one hundred ($100) or less). ' I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to t(re Workers' Compensation Laws of California. Date Signature 'NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this -permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address DWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.S Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of trio 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 nenalty of not more than five hundred dollars ($500). I, as. owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 empluyaes, Provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will -have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project(Section 7044, Business and Professions Code: The Contractor's License Law docs not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con. tractor(s) license pursuarit•to the'Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. (� 1 am exempt under Section B. & P. C. for this reason Date Owner 1 hereby certify that Ihave rea informatio"SSP ree t andrstate buil r sentatives er inspection Signature Drivers' Li this application and state that the above mply with all city and county ordinances )]construction, and hereby authorize repre- pon the above-mentioned �prroperty for Date ❑ CONVEASION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. I Reinspection Fee $15 1 1 Issue Fee $ 3 FEES 5 Main Building: Date Date Dat Z E TYPE OF PERMIT Li GRADING 0 FOUNDATION LJ STRUCTURAL SUMMARY OF BUILDING PERMIT $ PLAN CHECK $ PLUMBING s PLAN CHECK 25% 5 ELECTRICAL s PLAN CHECK 50% s MECHANICAL $., PLAN CHECK 25% $ T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING G MECHANICAL B ❑ O'r H E R 4 A Rear $ 3 C Right PROJECT DESCRIPTION SCI. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATION S _ g Lefi ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service, Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Ouct . Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO -* Heating System & Ducting 1 0.100,000 BTU 0 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTU 0100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric 2285 5/03/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Fan F-A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 05.15 KW Meter I Jup to 100 amps Meter Dover 100 amps Sub Panel Motors ❑0-) HP ❑ 1 h - 8 Inc. Solar 09-15 HP 1316-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 15.5© TL FEES Z O N I N G R E O M T S $3 W I Reinspection Fee $15 1 1 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By. Date Date Dat Z SUMMARY OF BUILDING PERMIT $ PLAN CHECK $ PLUMBING s PLAN CHECK 25% 5 ELECTRICAL s PLAN CHECK 50% s MECHANICAL $., PLAN CHECK 25% $ FEES SMIP $ PERMIT ISSUANCE S ENERGY P.C. 5 GRADING $ MICROFILM $ TOTAL FEE s 1,5 5n 4 00 $ 3 CONSTRUCTION AND PLANNING APPROVALS . Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 1 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. i,i' 57. APPROVAL TO COVER-GUNITE - 7. Footings 58. Electrical Conduif-Undrgrnd. f 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor Sysfem 61. APPROVAL TO DECK 11. Property Sewer Line & House Conr ectiQn 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 116. 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 APPROVALS. Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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. Piaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning �Yy 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40, Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ' CITY OF COSTA MESA -CONSTRUCTION PERMIT Project Address 711 _ ,"Applicant's Mail' n Address +�= Owner's Name ne ?6D1 Address ArchlEng, icense No. Address Contractor's Nam Phone Address Imaitingl _ City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect. License Class License No. Date Signature' WORKERS' COMPENSATION DECLARATION ereby affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified -copy thereof (Section _d00, Lab. r ,�( PPvrj(cy No. Company ; A—V-0- �N S 9 IZ Certified cop is hereby furnished, ' Certified o ! filed with the city Builtlin i 1 Date — Applicant EXEMPT FROM WORKERS' COMPENSATION DECLARATION (This sect on ped not be completed if the permit is for one hundred ($100) or less). 1 certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California, Date Signature 'NOTICE: If, after making this declaration, you should become subject to the , Workers' Compensation provisions of the Labor Code; you must forthwith comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY } - I hereby affirm that there is a construction lending agency for th erforma ce of the work In f?I t�I s�e ( ti 7 Lender's Name \\ Lender's AdtlresS % - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, after, improve, demolish or repair -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 theContractor'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 7031.5 by any applicant for a permit subjects the applicant to • a civil enalty of.not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's Licen6e.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 of her own employees, provided that such Improvements are not intended or offered for sale. If„however, the building'or improvement is sold within one year of com- pletion,.the owner will; have the burden of provinghe/she did not build or Im- , ve fpr the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- ractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property .who builds or improves thereon, and'who contracts for Such projects with a con. tractors) license pursuarit*to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ tam eoempt4nd'er Section B. P. C. for this reason Date Owner, 1 hereby ce ify that I have read this application antl state that the above information is correct. I agree to comply with all city and -county ordinances and, state laws relating'tgbi Oand hereby authorize repre- sentatives of this city ve-mentioned pro er y for inspection purposes. C Signature V 3plicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. rIT N Aj NCO% LOT NO. TY�OF CONSTRUCTION L1 NEW LJ ADD LJ ALTERATION LTREPAIR CONVERSION . ❑ DEMOLISH ❑ OTHER A.P. DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL' II PLUMBING Cl MECHANICAL B Rear ❑ •OTHER 1 ` A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATIONS S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks+/p l :k n V( I Planning Notes: Bar Sink Backflow Preventer Backflow irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains ~ Reinspection Fee I S15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0.100,000 BTU ❑ 100,000 BTI s . Reinspection Fee Drivers' License or,SS NJ I CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 IMBING FEES SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK S PERMIT ' PLUMBING S —1_ a0 ISSUANCE PLAN CHECK 25% $ /� Sit, ENERGY P.C. ELECTRICAL $ GRADING PLAN CHECK 50% S MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK ,25% $ Showers Service Sink Automatic Washer' Sewer Cap Construction Pole Sub. , Cooking Unitt Sewer Connection ' _ Solar Collectors r . - Dishwasher - » Solar Piping Dryers ❑Gas ❑Electric Solar Tank Fan Swimming Pool w/Spa F A U Urinal Fixtures . Water, Closet ate Device Boxes Water Heater Outlets Water Service 2 Switches, Auto -Wash Garbage Disposal Laundry Trays Generator ❑0-5 KW ❑5.15 K I Issue Fee S 3 Hood or_ Type 1 ❑ Canopy Type II El Refrigeration System ❑0.100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES Reinspection Fee . 1 $15 DEVELOPMENT SERVICES REGI Zoning Approved By Building Approved By Application Issued By Zone - I Accessory Building: Parking Req./Provided , ELECTRICAL Transformer El 15-50 KW El 50 + KIN !Neter ❑up to 100 amps Meter -Dover 100 amps Sub Panel Motors 130-1 HP ❑ 115 - B Inc. Solar 1:19-15 HP 016.15 Microwave Pole Light Range Sign Standing Sections t W Trash Compactor Issue Fee REMENTS: I ^, 'I Z O N . 1 N G R E O M T S S $ $ SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK S PERMIT ' PLUMBING S —1_ a0 ISSUANCE PLAN CHECK 25% $ /� Sit, ENERGY P.C. ELECTRICAL $ GRADING PLAN CHECK 50% S MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK ,25% $ $ 3 I ^, 'I Z O N . 1 N G R E O M T S S $ $ CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL SPA 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 USER Grnd, 57. APPROVAL TO COVER-GUNiTE 7, Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation �. 59. Gas Pipe, ❑ Undrgrnd., Test 9, Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd, 10. Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final •" ' .f 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 APPROVALS Permit # 20. •Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31; Plaster Brown Coat 79. FINAL INSPECTION 32, Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning ' 35. Final Gas Pipe -Test 36, Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing "r7 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43. Backflow Irrigation 44. Landscape Irriqation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE &BUILDING 48. Special Requirements Completed 49. Electric Release to Edison t, 50. Gas Release to Southern California Gas Co r 51. CERTIFICATE OF OCCUPANCY No. Date , n CITY OF COSTA MESA CPNSTRUCTION PERMIT �risji�ct Address Applicant's Mallin ddressif- Owner's Na a one Address ZIR Arch/Eng. License No. Address Contractor's Nam Phone Address (mailing) City License No, LICENSED CONTRACTOR DECLARATION I Hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.O 1� License Class License No.... _ Date Signature WORKERS' COMPENSATION D CLARATION I hereby affirm that I have a Car Irate of consent to self -Insure or a certificate 'Nf Workers' Compensation Insurance, or a certified copy thereof (Section Boo, Lab. C.) - Policy No. Company BCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (SIDO) or less). I ee)Aify that in the performance of the work for which this permit is Issued I shall not employ any person In any manner so s t0 become subject to tike Worker ' Co nsati n laws of Callfor DineSignature NOTI i f, after making this declara you should become subject to the Workers' Compensation provisions olkThe Labor Code, You must forthwith comply with such provisions or' this' permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the•performanCe Of the work for which this permit is issued (Section 3097 Civ. C,) Ufinder's Name, Lender'S Address -- OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the fallowing reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuanCe, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Icommencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). c !J I, as owner of the property or my employees with wages as their sole Compensation, will do the work, and the structure is not intended or offered for sale l5ection 7044, Business and Professional Code: The Contractor's License Law does not apply loan owner of a properly who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale, If, however, the building or Improvement is sold within one year of com- pletion owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). 0 I, as owner of the property, am exclusively contracting with licensed Cdn- tractors to construct the project{Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of proporty who 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 broof of their Worker's Compensation Insurance should be provided to me. 0 I am exempt under Section B. & P. C. for this reason Applicant to fill in all spaces except those within heavy border line$ and sign all appropriate declarations. pgBMIT NO. _ ' TRACT NO. LOT NO. UNIT r9o. Date Owner _ — — t hereby certify that I have read _this'application and state that the above information is correct. I agree to Comply with all city and county ordinances and state taws relating to builtling construction, and hereby authorize repre- sentatives of th s cit to enter 'upon the above-montionecl property for Inspection p ses Signature Date brivers'i nse or SS CMF 0865-46, rev, 10/84 White - Building; Canary - Applicant; Pink - Accounting G- /::� TYPE OF CONSTRUCTION ❑ NEW ❑ ADD U ALTERATION u REPAIR - AP02 7 11+] QC; i n cri ❑ CONVERSION ❑ DEMOLISH '❑ OTHER A.P. _ Zone - DESCRIPTION OF WORK/USE OF BLDG. Main Building: Accessary Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL FrontOZ ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear N ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N CONSTRUCTION TYPE VALUATION ar Left G R. ZONE' - GRADING CU.YDS. ACRES Ping. Ref. # Parking Req./Provided E Remarks: Planning Notes: Q M T S Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets PLUMBING .I FEES Showers Service Sink - Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Interceptors Water- Heater Kitchen Sink Water Service Lavatories P—Trap Auto -Wash Laundry Trays Roof Drains - Dryers ❑Gas Electric Reinspection ,Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Facf. Bit. ICBO # Heating System & Ducting ❑0-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 ; Goldenrod - Assessor ' Issue Fee - $ 3 IANICAL FEES Hood or Type 1 ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas Electric Sub Panel Fan Motors 00.1 HP ❑ 1 F.A.U. Inc. Solar ❑9-15 HP 1:116-1 S+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal Generator 00.5 KW ❑5-15 KW ; Standing Sections Trash Compactor Reinspection Fee $15 1 1 Issue Fee I $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By P-�p Data SUMMARY OF FEES BUILDING PERMIT $ SMTP $ PLAN CHECK $ PERMIT PLUMBING S ISSUANCE $ PLAN CHECK 25% $ I '_SU ENERGY P.C. S ELECTRICAL $ GRADING S PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ �CPNSTRUCTION AND PLANNING 4' Date APPROVALS Permit # 1 Inspector `-t POOL c� sr'A APPROVALS Permit # Date Inspectnr i.. Temporary Electrical Service or Pale fIj 52. Pool & Equipment Location +�! A , Soil P*A -Undrgrnd.+ v 53. Steel Reinforcement 3 Elecirical Conduit,-.Utility '� 54. Forms �- 4. Elect i Conduit'nd grnd. V + 55. Electrical Bonding r � 5`,Steei'Re" forcernAt � r 56. Rough Plumbing &Pressure Test . n fI, 6:,Electrical UFER Grnd, L i 57. APPROVAL TO COVE R-GUNITE 58. Electrical Conduit-Undrgrnd. n 8Fo s dation ; �04 � ' i� 59. Gas Pipe, ❑ Undrgrnd., Test 1, 9. Wate%ry pe-Undrgr6d. i 60. Backwash Lines, P Trap, ❑Undrgrnd. 10. StN ciLvjI Floor System 61. APPROVAL TO DECK 11. Property Sewer Lin -e'& House Connection r -.e n 11 i 62. Backwash & Receptor -Final !, 12. Sewer'Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough PlumbAq 65. Electrical -Final J 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test Ave 36. Hood or Canopy 37. Final Factory Fireplace •38. Final Plumbing 39, Water Service -Final 1;2�y'�� 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46, Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date - Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MES11bA'' 1 7C-+ ON, STRUCTION PERMIT P IT NO. TRACT N LOT NO. U T NO. Project Address _711' Ii- ! 1' 5+ - Applicant's Mail in Address Owner's Namea D L> ne s Address Arch/Eng. r cense Na. ea` Address Contractor's Name Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is In full force and effect. License Class— __ - „_,License No. Date Signature WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to soil -Insure or a certificate ' Workers' COmbensation Insurance, or a certified copy thereof (Section 300, Lab. /fin (J �-/1,1�s-, dam►,, P licy No. ,f 12f70 �a�J�7 Companyj??C Zk' Certified COPY is hereby furnished. Certi ' c 2y Is filed with the city Buildin vis Date Applicant— -- EXEM t N FRgM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred {x100) or less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to,the workers' Compensation Laws of California, Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY ' I hereby affirm that there Is a construction lending agency for the performance of thework to ryi r -IFAe t I ��n 3 7 Cly. 'C.) Lender's Name 1 Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000) of Divisian 3 of th@ Business and Professions Code) or that he/she is exempt 'ierefrom and the basis for the alleged exemption. Any violation of Section )31.5 by any applicant for a permit subjects the_ applicant to a civil -nalty of not mgre than five hundred dollars (5500). L1 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law doe% not apply to an owner ol'a property who builds or improves . thereon, and who does such work himself/herself or through his or her own employees, pravi()ied that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year Of com- pletion, the owner will have the burden of proving he/she did not build or Im- P90,vfor the purboso of sale). 'e.0towner of the property, am exclusively contracting with licensed con - tom construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of propertY who builds or Improves thereon, and who contracts for such projects with a can- tractor(s) license pursuarit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am ex P kinder Section B. & P. C. for this reason Date Owner _ I here rtffy that I have read t )is application and state that the above infor ti n is correct. I agree to comply with all city and county ordinances and stat laws relating to b •lding construction; and hereby authorlZe repre- sentatives Of this city enter n t e above-mentioned prop ty r Inspection purposes. Signature _ at Drivers' License kir SS qr 23 f3 Iag6. SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK S PERMIT PLUMBING S 1,00 ISSUANCE PLAN CHECK 2596 $ + ENERGY P.0 ELECTRICAL S GRADING PLAN CHECK 50% S MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ TYPE OF CONSTRUCTION NEW I J ADD 7 ALTERATION LJ REPAIR CONVERSION ❑ DEMOLISH ❑ OTHER A.P. =906 DESCRIPTION OF WOR KIUSE OF BLDG. S Main Building: E TYPE OF PERMIT 0 GRADING0 FOUNDATION 0 STRUCTURAL T Front EJTENANT ElELECTRICAL 5rPLUMBING ❑ MECHANICAL Rear ❑ -OTHER A C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATION $ S I Left ZONE GRADING CU. YDS. ACRES Ping. Ref, # . Remarks:. Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection 'Fee PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wast, Laundry Trays- . s S15 1 Issue Fee Boiler . Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting [--10-100,000 BTU ❑ 100,000 BT I Reinspection Fee J $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type I ` ❑ Canopy ' Type 11 ❑ -I FEES M� ■_ EM E® _on= Refrigeration System 00a100,00013TU 0100,o0oBTU System Repair/Alteration Fire Dampers Registers Issue Fee t Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer., Construction Pole'Sub, Cooking Unit Dishwasher - - Dryers ❑Gas I]Electric Fan F. A:. U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 05.15 KW Reinspection Fee 1 $15 Zone Transformer © 15-50 KW Q 50+KW Meter Dup to 100 amps Meter Dover 100 amps Sub Panel Motors E70-1 HP Ell i5 - B Inc. Solar 09.15 HP 016.15+ Microwave Pole Light ' Range Sign :Standing Sections FEES Trash Compactor Issue Fee 1 $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Z' O N I N G R E Q M T S SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK S PERMIT PLUMBING S 1,00 ISSUANCE PLAN CHECK 2596 $ + ENERGY P.0 ELECTRICAL S GRADING PLAN CHECK 50% S MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ 3 Z' O N I N G R E Q M T S CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL 'A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pale _ 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, El Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final ' 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit - 66. Solar System -Final 16, Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18, Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23; Gas Pipe -Rough & Test 72: Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank '0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning , 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing '6S6-'36 LEO 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 4B. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51, CERTIFICATE OF OCCUPANCY No. Date J Applicant to fill in all spaces except those ithin heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTR llC I ION PERMIT PERMIT NO. TRACT NO. LOT NO. uNt7 nth Project Address —711 [d'_ _17th St. 131 dg - (G) Unit 6, Applicant's Mailing Address d Owner's Name Troy Tr1yestmPnt• FiIQd____Phone 549-2988 Address 4191 RJrCh St- Newport Beach, Ca- ArchIE-g. Martin .T-Rntrk _License No. Address 19PAI Knott Ave , Suit -e 916 Contractor's Name- nl]C.CI AJ—r CUadi-t-iol±i Tig_Phone 989-1216 Address (mailing)�311(� Sat�ia;d3�St...Lu.Hc�113�aood,�Ca.— City License No. _ 33995 — LICENSED CONTRACTOR OECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business andofessions Code, and my license is in full force and eff n e License Class 0 Li . 346251 IAP/e 4/18/84 Signature WORKERS' COMPENSATION DEC ARATION I hereby affirm that I have a cart lli to of consent to self -insure or a certificate V Workers' Compensation Insur nce, or a certified copy thereof (Section alio, Lab. c.) WC9824 Lumbermans Policy No. Company H Certified copy is hereby furnished. Certified py is filed with the city Buil d�wSg� Di�vision. a j Date Applicant MIR, EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued, I Shall not employ any person In any manner so as to become subject to the Workers' Compensation laws of California. Date Signature 'NOT,ICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a'cohstruction lending agency for the performance of the work for which this permit is . issued (Section 3097 Civ. C.) Lenger's Name Lencler's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7004) 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 eenalty, of not more than five hundred dollars (5500). .❑ I, as owner of the property or. my employees with wages as their safe compensation, will do the work, and the structure is not intended or offeretl for sale (Section 7044, Business and Professional Code, The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale, If, however, the building or improvement is sold within one Year of com- pletion, the owner will.have the burden of proving he/she did not build or Im- prove for the purpose of sale(. ❑ I. as owner of the property, am exclusively contracting with licensetl con- tractorsto construct the protect (Section 7044, Business and Processions Code* The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a can- trattor(s1 license pursuarit't0 the Contractor's License Law). I am aware that proof o their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner i hereby certify that l have read this application and state that the above information is correct. I agree to mply with all city and county ordinances and state Ia sting to buil construction, and hereby authorize repre- sentatives thi city, to er upon the above-mentioned property for ingnatur -- .6 s. Signature _ __ [)rivers' Lic22! or SS L Co TYPE OF CONSTRUCTION NEW El ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. DESCRIPTION OF WORK/USE OF BLDG. IS Main Buildi E TYPE OF PERMIT LJ GRADING LJ FOUNDATION ❑ STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ _ 5 Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Boiler Duct - Under Ground Duct - Structural Duct - Ventijating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # 1 Heating System & Ducting X0.100,000 BTU ❑ 100,000 BT Reinspection Fee I $15 CMF 0$65-45, rev. 10/84 White - Building; Canary - Applicant, Pink - Accounting; Goldenrod - Assessor Hood or' Type I ❑ Canopy - Type I I ❑ Refrigeration System 00.100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 4 $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes O utlets i Switches 1 Garbage Disposal r, Generator 00.5 KW ❑5-15 K Reinspection Fee i $15 2266 5/03/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50 + KW Meter 1Jup to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑Q1 HP❑1''A-B Inc. Solar.09-1$ HP 0i6-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor Issue Fee 15o50 TL FEES $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By —Date Z O N I N G R E Q M T S PLUMBING FEES Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Drinking Fountains Solar Piping Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories P—Trap Auto -Wash Laundry Trays Roof Drains S i MECHANICAL r. Reinspection Fee 1 1. - I $15 Issue Fee 3 — MECHANICAL FEES Boiler Duct - Under Ground Duct - Structural Duct - Ventijating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # 1 Heating System & Ducting X0.100,000 BTU ❑ 100,000 BT Reinspection Fee I $15 CMF 0$65-45, rev. 10/84 White - Building; Canary - Applicant, Pink - Accounting; Goldenrod - Assessor Hood or' Type I ❑ Canopy - Type I I ❑ Refrigeration System 00.100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 4 $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes O utlets i Switches 1 Garbage Disposal r, Generator 00.5 KW ❑5-15 K Reinspection Fee i $15 2266 5/03/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50 + KW Meter 1Jup to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑Q1 HP❑1''A-B Inc. Solar.09-1$ HP 0i6-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor Issue Fee 15o50 TL FEES $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By —Date Z O N I N G R E Q M T S PLAN CHECK 25% S SUMMAR OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% S ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50°A $ MICROFILM S i MECHANICAL S TOTALFEE S 15.50 PLAN CHECK 25% S CONSTRUCTION AND PLANNING APPROVALS - Permit# Date Inspector POOL __SPA APPROVALS Permit# Date Inspec_rnr 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location 2. -So'sl Pipe-Undrgrnd. 53. Steel Reinforcement 3., Electrical Conduit Utility-Undrgrnd. 54, Forms 4• Electrical Conduit-Undrgrnd. 55. Electrical Bonding ;l 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test '6. Electrical UFER Grrnd. i 57. APPROVAL TO COVER-GUNITE } 7. Footings '. 5$. Electrical Conduit-Undrgrnd, $' Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9- Water Pipe-Undrgrnd. ' 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System - ' ;i 61. APPROVAL TO DECK 11. Property Sewer Line & House Conflection 62. Backwash & Receptor -f=inal 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. POOLISPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS. Permit 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25, Roof Sheathing 74. Overhead Hydro 26, T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76, Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 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 with section 7000) of Division 3 of B Css and Profess) Code,and my Itcense is In full folrS1e and effect ; License Class `-` icense Date (-ID-Z ks Signature WORKERS' COMPENSATION DECLARATION I nereby affirm that I have a certificate of consent to self -insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section yz.'Lab. C:) c - e - Lab. No. Z"tC? 1 O 53 a C��;-,C,!,)g 8 Certified copy is hereby furnishetl.( Certified co y is flied with the cit D vision. Da f`-i-� - Applicant EXEMPTION FROM WORKERS' COMPENSATION ECLARATION (This section need not be completed if the permit is fo 'one hundred (5100) or less). I certify that in the performance of the work for which this permit Is issued, I ' shall not employ any person In any manner so as to become subject to the Workers' Comp,nsation'Laws of California.' Date Signature ' 'NOTICE: If, after making this declaration, you should become Subject to the Workers' Compensation provisions of the LaborCotle, you must forthwith comply with such provisions or this permit •shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ- C.) Lender's Name - - --- _ - - -- Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt' from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county whien requires a permit to construct, alter, improve, demolisn or repair 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 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 8nd the basis for the alleged exemption. Any violation of Section '031.5 by any applicant for a permit subjects the applicant to a civil ,enalty of not more than five hundred dollars ($500). ❑ E, as -owner of the r property or my .employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and. Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for We. If, however, the building or Improvement is sold within one year of com- pletion, thq owner will have the burden of proving he/she did not build or im- prove for the purpose of sale), ❑ I, as owner of the property, am exclusively contracting with licensed con. 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 builds of Improves thereon, and who contracts for such projects with a con-- tractor(sj license pursuant'to the Contractor's License Law), I am aware that proof o[f their Worker's Compensation insurance should be provided to me. ❑ 1 am ext-mpt under Section B. & P. C. for this reason Date Owner I hereby' certify that I have read information is r . I agree to c and state Ia s rel ng o buildinc sentatives t $ ' ity to enter inspection rpo SI nature pplication and state that the above - with all city and county ordinances ruction, and hereby authorize repre- the above-mentioned property for Date 1--10- ES Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains 1 Reinspection Fee Boiler t PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors ' Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water, Closet Water Heater Water Service Auto -Wash Laundry Trays $15 Issrie Fee Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0-100,000 BTU El 100,000 BT g Reinspection Fee $15 Drivers' Litense or SS i CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting-, Goldenrod - Assessor Hood or Type 1 ❑ Canopy , Type 11 ❑ Refrigeration System ❑0-100,000 BTU C1100 000 B - System Repair/Alteration Fire Dampers Registers Issue Fee • 5899 1/16/85 4,50 TL • Zone Accessory Building: Z O N N G R Parking Req./Provided E _ Q M T S FEES Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PER PE•RRMIT NO. G ` -1 TRACT NO. LOT NO. UNIT NO. -� Project Address -711 W • I JT44 17 _ � � Yn E SS Pr — Meter ❑up to 100 amps t Dishwasher Meter ❑over_100 amps_: _ Applicant's Mailing Address Dryers ❑Gas ❑Electric TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAER _ ❑ .❑ DEMOLISH ❑ OTHER Fan F.A.U. Owner's Name TRn`f r �N-ul✓� {i11� Phone CONVEASION DESCRIPTION OF WORK/USE OF BLDG, A.P. 90 Microwave - Pole Light Range Address Sign S Main Building: ; Standing Sections Generator 1:10.5 KW ❑5-15 KW Trash Compactor E Arch/Eng. License No. TYPE OF PERMIT 171 GRADING 1:1FOUNDATION STRUCTURAL T Front $ 3 _ _ ❑ TENANT ❑ ELECTRICAL El PLUMBING ❑ MECHANICAL B $15 Issue Fee $ 3 FEES Address DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Application Issued By—_ ❑ OTHER ° A Rear, ' - BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF, FEES - $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ $ L4 _00 GRADING $ $ X70 _ MICROFILM Is u $ - TOTAL FEE ,$ I `fid $ Contractor's Nam t��l�-bs� hone _� - C Right G Address (mailing] 1 f0� Rj�Ifiwr g, atLY' ,r,)67mj - 5� PROJECT DESCRIPTION SQ. FT. OCCUPANCY K $ 3 CONSTRUCTION TYPE VALUATION $ $ Left City License No. ;�G O I ZONE GRADING CU.YDS. ACRES ,Ping. Ref. # _ .� LICENSED CONTRACTOR DECLARATION I nereby affirm tnat I am licensed under provisions of Charter 9 ( ommencing Remarks: Planning Notes: with section 7000) of Division 3 of B Css and Profess) Code,and my Itcense is In full folrS1e and effect ; License Class `-` icense Date (-ID-Z ks Signature WORKERS' COMPENSATION DECLARATION I nereby affirm that I have a certificate of consent to self -insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section yz.'Lab. C:) c - e - Lab. No. Z"tC? 1 O 53 a C��;-,C,!,)g 8 Certified copy is hereby furnishetl.( Certified co y is flied with the cit D vision. Da f`-i-� - Applicant EXEMPTION FROM WORKERS' COMPENSATION ECLARATION (This section need not be completed if the permit is fo 'one hundred (5100) or less). I certify that in the performance of the work for which this permit Is issued, I ' shall not employ any person In any manner so as to become subject to the Workers' Comp,nsation'Laws of California.' Date Signature ' 'NOTICE: If, after making this declaration, you should become Subject to the Workers' Compensation provisions of the LaborCotle, you must forthwith comply with such provisions or this permit •shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ- C.) Lender's Name - - --- _ - - -- Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt' from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county whien requires a permit to construct, alter, improve, demolisn or repair 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 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 8nd the basis for the alleged exemption. Any violation of Section '031.5 by any applicant for a permit subjects the applicant to a civil ,enalty of not more than five hundred dollars ($500). ❑ E, as -owner of the r property or my .employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and. Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for We. If, however, the building or Improvement is sold within one year of com- pletion, thq owner will have the burden of proving he/she did not build or im- prove for the purpose of sale), ❑ I, as owner of the property, am exclusively contracting with licensed con. 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 builds of Improves thereon, and who contracts for such projects with a con-- tractor(sj license pursuant'to the Contractor's License Law), I am aware that proof o[f their Worker's Compensation insurance should be provided to me. ❑ 1 am ext-mpt under Section B. & P. C. for this reason Date Owner I hereby' certify that I have read information is r . I agree to c and state Ia s rel ng o buildinc sentatives t $ ' ity to enter inspection rpo SI nature pplication and state that the above - with all city and county ordinances ruction, and hereby authorize repre- the above-mentioned property for Date 1--10- ES Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains 1 Reinspection Fee Boiler t PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors ' Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water, Closet Water Heater Water Service Auto -Wash Laundry Trays $15 Issrie Fee Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0-100,000 BTU El 100,000 BT g Reinspection Fee $15 Drivers' Litense or SS i CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting-, Goldenrod - Assessor Hood or Type 1 ❑ Canopy , Type 11 ❑ Refrigeration System ❑0-100,000 BTU C1100 000 B - System Repair/Alteration Fire Dampers Registers Issue Fee • 5899 1/16/85 4,50 TL • Zone Accessory Building: Z O N N G R Parking Req./Provided E _ Q M T S FEES ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50'KW ❑ 50 + KW -� Cooking Unit Meter ❑up to 100 amps t Dishwasher Meter ❑over_100 amps_: _ Dryers ❑Gas ❑Electric Sub Panel i Fan F.A.U. Motors X,0-1 HP ❑ 1'r4 - 8 Inc. Solar ❑9.15 HP 016.15+ Fixtures Device Boxes Outlets Microwave - Pole Light Range Switches Sign Garbage Disposal ; Standing Sections Generator 1:10.5 KW ❑5-15 KW Trash Compactor $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Application Issued By—_ REQUIREMENTS: Date Date— _ Dattt_ U BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF, FEES - $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ $ L4 _00 GRADING $ $ X70 _ MICROFILM Is u $ - TOTAL FEE ,$ I `fid $ - $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL ,....SPA APPROVALS Permit # Date Insper.Fnr `1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd, 54, Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59, Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electric2l-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 f 3 Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. 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 Cil 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. LOT NO. UNIT NO. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 711 W- 17th _St, _Bldg, (g) Unit 7 Applicant's Mailing Address 11110 Saticoy St. N -Hollywood, Owner's Name Trr)y T��y,Pgi-mPn it- Fund Phone -4.59--?9A Address ivPwnnrr rsPacn s t -a - Arch/Eng. Aarl11 T Rock -License No, Address e- 9411 to 916 Contractof's Nar pDUCO Air Conditionin Phone982-1216 Address (mailing) 13110 Saticoy St,N,Hollvwood,Ca_ City License No, X9925 _ LICENSED CONTRACTOR DECLARATION I hereby affirm that i am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business an ofesslons Code, and my license is in full force and effe License Class C 20 L e b 346251 Date 4 11 4 Signature WORKERS' CDMPENSATION DE7CA RATION I hereby affirm that I have a certifiof consent to self -insure or a certificate �f Workers' Compensation Insur, or a certified copy thereof (Section 900, Lab. C.) WC9824 Lumbermans dolicy No. - - Company eCertified copy is hereby furnished, - Certifi�e-d-, '�f,O y is filed with the city Buildin ivisign c, Date - s � -- Applicant C--L� - _ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for ane hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with sucn provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ- C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reaton (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter. Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signkd statement.that he/she is licensed pursuant to the provisions of the COntrnCtOr's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars (E500). 1, as owner of the property or my employees with wages as their sole Compensation, will do the wnrk, and the structure Is not intended or offered for sale (SKtion 7044, Business and Professional Code: The Contractor's 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 employees, Provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the Owner will nave the burden of proving he/she did not build or im- prove for the purpose of Salo), ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 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 proof off their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date — I hereby cert information Is and stateCPur sentative inspectiv Signature GMF 0865.46,Ofev t16_ TYPE OF CONSTRUCTION aNEw LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMDLISH ❑ OTHER A.P. + DESCRIPTION OF WORKIUSE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING El FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL BRear E—]OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes; Owner _ that I have read this application and state that the above 1 rect. iagree t comply with all city and county Ordinances lacing t0 but i g construction, and hereby authorize repre- city to t upon the above-mentioned property for Ds. iorSS 10/84 ar Sink ackflow Preventer ackf low Irrigation athtubs Clarifiers Dishwasher Drinking Fountains Floor Drains. Floor Sinks Gas Service Outlets interceptors Kitchen Sink Lavatories P --Trap Roof Drains , Reinspection Fee I $i5 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System 0 Muitiple ❑ F irepl/Fact. Bit. I CBO +# ating System & Ducting 0-100,000 BTU 0 100,000 BT Reinspection Fee I $is White - Building, Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 2287 5/03/85 Zone Accessory Building: Parking Req./Provided 15950 TL Z O N I N G R E Q M T S PLUMBING I FEES ELECTRICAL FEES Showers Service Sink Automatic Washer Construction Pole Sub. Transformer I] 15-50 KW ❑ 50 + KW Sewer Cap Sewer Connection Cooking Unit Meter Cup to 100 amps Solar Collectors Dishwasher Meter Cover 100 amps Solar Piping Dryers ❑Gas ❑Electric Sub Panel Solar Tank r Fan Motors ❑0.1 HP ❑ 1'h - 8 Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP 016-15+ Urinal Fixtures Microwave Water Closet Water Heater Device Boxes Outlets Pole Light Range Water Service Switches . Sign Auto -Wash Garbage Disposal I Standing Sections Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor Issue Feo S 3 Reinspection Fee $15 Issue Fee S 3 MECHANICAL Hood or Type 4 ❑ Canopy Type 11 ❑ FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By _ REQUIREMENTS: Date Date _ net Refrigeration System 00.100,000 BTU F_11100,000BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY $ $ $ $ $ $ $ 13.00 $ 7 Sn OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM S TOTALFEE $ I5-50 — System Repair/Alteration Fire Dampers Al Registers Issue Fee $ 3 CONSTRUCTION AND PLANNING ' APPROVALS - Permit # Date 1, Temporary Electrical Service or Pole Inspector POOL of SPA APPROVALS Permit # 52. Pool & Equipment Location Date Inspecrnr 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 At. 6. Electrical LIFER Grnd. t .'� 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd, 8' Foundation ;� 59. Gas Pipe, ❑ Undrgrnd„ Test 9. Water Pipe-Undrgrnd. 60, Backwash Lines, P -Trap, ❑ Undrgrnd. 10, Structural Floor Sysiem 61. APPROVAL TO DECK 11. Property Sewer Line & House Con`nectign 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 APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush X24. Roof Framing 73. Undergrnd. Stdrage 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31'. Plaster Brown Coat 79. FINAL INSPECT4ON 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40, Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. 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 C? 51, CERTIFICATE OF OCCUPANCY No. Date r Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PrOhAIT Nnl I TRACT mn LOT NO_ I tiful ntr� CITY OF COSTA MESA CONSTRICTION PERMIT Protect Address Applicant's IVr3tG1t dress Owner's Name one Address Arch/E ng. License No. Address Contractor's Nam hone Address (mailing) City License No. LIC6iSED CONTRACTOR OECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing , with section 7000) of Division 3 of the Business and Professions Code, and My license is In full rce nd effect. Licgnse C1a- License N Date -'Signature WORKERS' COMP— -lVSATION D RATION , I hereby affirm that I have a certificate of consent'to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 9800, Lab. C.) - olicy No. - Company Certified copy is hereby furnished. Certifiedcopy is filedwith the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (5100) or less). I certify that in the performance of the work for which this permit is issued, I shall -not employ any person in any manner as to become subject to the Worker =nstpogi Laws of Calif r. Date'. Signaturevoes 'NOTICE: , a er ;Tia ung this declar n, you should become subject to the Workers' Compensation provisions the Labor Code, you must forthwith Comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the ContraCtpr's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of thq Contractor's License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the ,Business and ProfeSSlonS Code) or that he/she Is exempt th@refrorn and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a. permit subjects the •applicant to a civil )enalty of not more than five hundred dollars (5500). 2 I, as owner of the property or my employees with wages as their sole Compensation, will do the work, and the structure Is not intended or offered for We (Section 7044, Business and Professional Code: The Contractor's 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 employees, provlded that such improvements are not Intended or offered for sale. It, however, the building or Improvement Is sold within one year of com- Pletion, the owner will have the burden of proving he/She did not build or im- rave for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- 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 byllds or improves thereon, and who contracts for such -projects with a con-• tr�ctor(s) license pursuarit to the Contractor's License Law). I am aware that proof at( their Worker's Compensation insurance should be provided to me. ❑ Parn exempt under Section B. & P. C. for this reason Date Owner I hereby certify that l have read this application and state that the above information is correct. iagree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this c y to enter upon the above-mentioned property for Inspection pure ses Signature A6 Date Drivers' Li nse or SS :i TYPE OF CONSTRUCTION LJ NEw LJ ADD L ALTERATION WIREPAIR ❑ CONVERSION -❑ DEMOLISH ❑ OTHER -- A.P. 0 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT In GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K' CON STRUCTIDN TYPE VALUATION $ S Left ZONE GRADING Cu. VDS. ACRES Ping. Ref, Remarks: Planning Notes: " r% 5993 7./02/85 ' Zone Accessory Building: Parking Req,/Provided Reinspection Fee I s15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & ducting [:10,100,000 BTU ❑ 100,000 BTi Reinspection Fee I $15 CMF 065-46, rev. 19/84 W licant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 IANICAL FEES Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑0.100,000 BTU E1100,000BTU System Repair/Alteration Fire Dampers Registers Imue Fee I $ 3 10o50 TL Z O N I N G R E 4 M T S FEES I Reinspection Fee I S15 I I Issue Fee I $ 3 l 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By _....., _ .. Date Application Issued By. AA- Date PLUMBING FEES ELECTRICAL Bar Sink Showers Backflow Preventer - - Service Sink (j Automatic Washer - - Construction Pole Sub.' Cooking Unit Transformer ❑ 15-50 KW ❑ 50 + KW Meter C] Lip to 100 amps Backflow Irrigation Sewer Cap Bathtubs i Sewer Connection Clarifiers Solar Collectors $ Dishwasher Meter ❑over 100_ amps Dishwasher Solar Piping J ENERGY P.C. Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains SoJar Tank s Fan Motors Do -I HP ❑IK -9 Floor Drains Swimming Pool w/Spa MECHANICAL F.A.U. - Inc.Solar 119-15 HP El 16-15+ Floor Sinks Urinal S Fixtures Microwave Gas Service .Outlets Water Closet Q Device Boxes Pole'Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Q Switches Sign Lavatories P—Trap Auto -Wash Laundry Trays Garbage Disposal Generator ❑0-5 KW ❑5-15 KW Standing Sections Trash Compactor Roof Drains Reinspection Fee I s15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & ducting [:10,100,000 BTU ❑ 100,000 BTi Reinspection Fee I $15 CMF 065-46, rev. 19/84 W licant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 IANICAL FEES Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑0.100,000 BTU E1100,000BTU System Repair/Alteration Fire Dampers Registers Imue Fee I $ 3 10o50 TL Z O N I N G R E 4 M T S FEES I Reinspection Fee I S15 I I Issue Fee I $ 3 l 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By _....., _ .. Date Application Issued By. AA- Date SUMMARY OF FEES BUILDING PERMIT $ SMIP s PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ J ENERGY P.C. $ ELECTRICAL $ GRADING s PLAN CHECK 50% $ r _ MICROFILM $ MECHANICAL S TOTAL FEE S PLAN CHECK 25% S I •CONSTRUCTION AND PLANNING APPROVALS Permit # r Date Inspor POOL & --A APPROVALS Permit # Date Inspector 1.. Terr+pw1ry Electrical Service or Pole oyr 52. Pool &Equipment Location 2. ?,�ilFPipe Undrgrnd. "+y 53. Steel Reinforcement " Ir 3.' E-etrical Conduit//lJtil ty-Undrgrnd:! 54. Forms 4. Etectrrcal•Condusf=Unc�r�grnd.+ 55. Electrical Bonding i S.�Steel,Reim nforceen> r n < . 56. Rough Plumbing & Pressure Test :0 6. Electrical UFER,Grnd. 57. APPROVAL TO COVER-GUNITE 7: Fooii'ngs t. 58. Electrical Conduit-Undrgrnd. 8f Four'ldation �� jP 59. Gas Pipe, ❑ Undrgrnd., Test IJ 9. YWater Pipe-Undrgrnd►. 1 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10� Structural Floor System 61. APPROVAL TO DECK 11, Pr 'VIrty Sewer Line(& HouseCoAnection 'Oper, 62. Backwash & Receptor -Final 12• Sewer Cap c 63. Heater & Vent -Final JI 13. Roof Drains 64. Plumbing System - Final , 14. Rough Plumbingr 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. POO USPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test �'-If- 36. Flood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final , 41 , Solar Domestic -Final 42. Backflow Preventer � � A "�' 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.00CUPANCY Nn. Date CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address Applicant's Mailing Address _ Owner's Name U e Address LT ` Arch/Eng. L A-icense No - Address Contractor's Name_h —Phone' Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect, Ll cense Class License No. Date ' Signature WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure or a certificate -f Workers'' C)fo/m�pfe/n}sation Insurance, or a certified copy thereof (Section r00y No. I.N-LL—" , Company [.Jl "6:yE%t'ertified Copy is hereby furnished. ert if €e "s sled with the city 8uilcling sio , Date _ Applicant._-..� EXEMPT N 4P ROM WORKERS' COMPENSATION DECLARATION - (This section need not be completed If the permit is for one hunared ($100) or less). f Certify thatin the performance of the work for which this permit is issued, I shalt not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California - Data Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or, this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY, - I hereby affirm that there is a construction lending agency for the performance of the work forthvnlrh�-this)DaLmJt��i-ssyled65 Cg tion 13097 Clv. C.) ' Lender's Name V ,%�1 Yr�h! F�YtT T t•��VtGC./ Lender's Adores _ OWNER BUILDER DECLARATION t I hereby afflrmrthat I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any City Or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 ,,Xherefrom and the basis for the alleged exemption. Any violation of Section V'-031.5'by any applicant for a permit subjects the applicant to a civil �%nalty of not more than five hundred dollars ($500). J,u I, as owner of the properly or my employees with wages as their sole Compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the buiiding'or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- ve for the Purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- ractors'to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who Contracts for such projects with a con- tractors) license pursuant"to the'Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me.l ❑ I am'e.empt under Section P. C. for this reason Date Owner I heeeb' ce ify that I have read this application and state that the above informs €on €s correct. I agree to comply with all city and county ordinances and statelaws rel ting to builcling construction, and,hereby authorize repre- sentatives of city e_, upon b ve- property for inspection pur �s Signature Drivers' License or. SS :hL pllcant to fill in all spaces except those within heavy border tines and sign all appropriate declarations PE IT NO. `� LOT NO. NIT -7 NU.' ' � 17 -e Backflow Irrigation Sewer Cap TYPE QF CONSTRUCTION LJ NEW LJ Apo LJ ALTERATION LJ REPAIR Sewer Connection CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. Solar Piping- I I Drinking Fountains � 5 Main Building: ' Floor Sinks E Gas Service Outlets TYPE OF PERMIT 17 GRADING ETFOUNDATION STRUCTURAL T Front 1:1TENANT 1:1ELECTRICAL XPLUMBING ❑ MECHANICAL Water Service Lavatories I ❑ OTHER A Rear Roof Drains C Right PROJECT DESCRIPTION SQ, FT. OCCUPANCY K $15 CONSTRUCTION TYPE � VALUATION $ $ Left ZONE GRADING CU. YDS. ACRES Ping. Ref. R-rn.rk#p 130 Planning Notes: -_ -- rrr S0 Refrigeration System ❑I}100,000 BTU ❑100,000 BTU V , U PLUMBING FEES Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors-, - Dishwasher Solar Piping- I I Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet " Interceptors Water Heater ' Kitchen Sink Water Service Lavatories I Auto -Wash P—Trap ; Laundry Trays Roof Drains t PLAN CHECK $ Reinspection -Fee $15 Issue Fee - € $ 3 MECHANICAL FEES Boiler ISSUANCE Hood or Type I' ❑ . - Canopy Type I I El Duct - Under Ground Duct - Structural -_ -- rrr S0 Refrigeration System ❑I}100,000 BTU ❑100,000 BTU Duct - Ventilating $ Exhaust System ❑ Multiple ❑ GRADING System Repair/Alteration Firepl/Fact, Bit. ICBO # $ Fire Dampers Heating System & Ducting t ❑ 0-100,000 BTU ❑ 100,000 BTL S Registers $ I Reinspection Fee 1 $15 I I Issue Fee , I $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Zone Accessory Building:' Parking Req./Provided ELECTRICAL Automatic Washers Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW Cooking Unit . `, Meter 0 u to 100 amps Dishwasher Meter ❑over 100 amps - Dryers ❑Gas ❑Electric Sub'Panel Fan Motors 00.1 HP 01 h {8 F.A.U. Inc. Solar El 9-15 HP El 16-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches + I Sign Garbage Disposal ; Standing Sections Generator 00.5 KW ❑5.15 KW Trash Compactor FEES Z D N G R E Q M T S Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved ByL9 Date Application Issued By V 7�Datft SUMMARY OF FEES BUILDING PERMIT $ SMIP $ t PLAN CHECK $ PERMIT ' PLUMBING $ q� Cd _ ISSUANCE ! $ PLAN CHECK 25%' $ -_ -- rrr S0 ENERGY P. C. $ ELECTRICAL $ GRADING S PLAN CHECK 50% $ MICROFILM S MECHANICAL $ TOTAL FEE $ r / 0• -0 PLAN CHECK 25% $ i CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL, A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole '.' 52. Pool & Equipment Location 2• Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement , 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding , 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 5B. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test ` 9. Water' Pipe-Undrgrnd. 60, Backwash Lines, P -Trap, ❑ Undrgrnd• .10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final r 14. Rough Plumbing 65, Electrical -Final 95, 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72.' Underground Flush 24. Roof Framing 73. Undergrnd• Storage Tank ❑ 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 PREY. FINAL 30.• Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning , 35. Final Gas'Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing zf_(,f�(, LIEU 39. Water Service -Final (Service 40. Gas -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 With section 7000) of Division 3 of the ness and 7essio�Cocle, and my license is in full ( ce and effec . License[ Class � (� icense � f DateSignature WORKERS' COMPENSATION DECLARATION ' I hereby affirm that I have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof_ (Section '800, Lab.'-C'.)^-� ' oliCy No. t., 1 fJ�l 37 f� C - -- — BCertified copy is hereby furgished. Certified copy s led with the cityQVi7. Date ' l Applicant EXEMPTION FROM WORKERS' COMP NSATION 6ECLARATION (This section need -not be completed if the permit is-fef one hundred ($100) or less)., I certify that In the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to tke Workers'. Compensation Laws of California. Date' Signature "NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING rAGENCY I hereby affirm that there Is a c6nstruction lending agency for the performance ofthe work for which this permit is -issued (Section 3097 Civ, C,) Lender's Name Lender's Address r -- - OWNER BUILDER DECLARATION I hereby afflrm' that i am exerript from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or. County which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issu8nce, also requires the applicant for such permit 'to file asigned statement that he/she is licensed pursuant to the Provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) 311, , 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 . Ienalty of not more than five tiundred dollars ($500). ❑ I, as owner of the properly or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that suchimprovementsare. not Intended or offered for sale. If, however, the budding or improvement is sold within one year of Com- pietion the owner oill have ale}the burden of proving he/she did not build or Im- SDve f�r the I, as owner of the property, am exclusively contracting with,licensed con- tractors to construct the protect (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves -thereon, and who contracts for suen-projects with a.con- 1 tractor(s) license pursuarit to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section S. & P. C. for this reason Date Owner t hereby certify that I;have, read this a informatioqa . 1 agree to c mply and state ting o building const sentatives city to enter uponinspections.SignatureDrivers' Lir SS ation and state that the above -• I all city and county ordinances on, and hereby authorize repre- above-mentioned property for Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OE COSTA MESA CONSTRUCTION PERMIT Backflow Preventer - TRACT NO. L07 NO. UNIT NO,Project �~Applicant's Bathtubs Sewer Connection CO Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Address Swimming Pool vv/Spa FPERMITO. - Urinal - water Closet Water Heater Kitchen Sink Water Service ONSTRUCTION NEw ADD ALTERATION REPAIRr—NVERSION Auto -Wash Mailing Address LaundryTrays- '❑ DEMOLISH ❑ OTHER A.P_+ Switches Owner's Name TQC UES MEArI ---Phone IPTION OF WORK/USE OF BLDG. issue Foe r ❑0-5 KW 05-15 KW Trash Compactor S Main Building: Address $ E $ yn 5U Arch/Eng, License No. TYPE OF PERMIT El GRADING Li FOUNDATION STRUCTURALT Front 25% $ ❑' TENANT [I ELECTRICAL El PLUMBING El MECHANICAL B Address MaRf°tS ❑'OTHER Rear �• / U4 C M Contractor's Name _L -F -'c Phone!5 6 io PROJECT DESCRIPTION 5Q: FT. OCCUPANCY C C K Right Address imailingl r0i CONSTRUCTION TYPE VALUATIdN 5 $ Left City License No. - - d ZONE GRADING CU.YDS. ACRES Ping. Ref, LICENSED CONTRACTOR D$CLARATION I hereby affirm that I am Ilcen;ed under provisions of Charter 9 (commencing I Remarks: Planning Notes: With section 7000) of Division 3 of the ness and 7essio�Cocle, and my license is in full ( ce and effec . License[ Class � (� icense � f DateSignature WORKERS' COMPENSATION DECLARATION ' I hereby affirm that I have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof_ (Section '800, Lab.'-C'.)^-� ' oliCy No. t., 1 fJ�l 37 f� C - -- — BCertified copy is hereby furgished. Certified copy s led with the cityQVi7. Date ' l Applicant EXEMPTION FROM WORKERS' COMP NSATION 6ECLARATION (This section need -not be completed if the permit is-fef one hundred ($100) or less)., I certify that In the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to tke Workers'. Compensation Laws of California. Date' Signature "NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING rAGENCY I hereby affirm that there Is a c6nstruction lending agency for the performance ofthe work for which this permit is -issued (Section 3097 Civ, C,) Lender's Name Lender's Address r -- - OWNER BUILDER DECLARATION I hereby afflrm' that i am exerript from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or. County which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issu8nce, also requires the applicant for such permit 'to file asigned statement that he/she is licensed pursuant to the Provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) 311, , 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 . Ienalty of not more than five tiundred dollars ($500). ❑ I, as owner of the properly or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that suchimprovementsare. not Intended or offered for sale. If, however, the budding or improvement is sold within one year of Com- pietion the owner oill have ale}the burden of proving he/she did not build or Im- SDve f�r the I, as owner of the property, am exclusively contracting with,licensed con- tractors to construct the protect (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves -thereon, and who contracts for suen-projects with a.con- 1 tractor(s) license pursuarit to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section S. & P. C. for this reason Date Owner t hereby certify that I;have, read this a informatioqa . 1 agree to c mply and state ting o building const sentatives city to enter uponinspections.SignatureDrivers' Lir SS ation and state that the above -• I all city and county ordinances on, and hereby authorize repre- above-mentioned property for Date Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ 0-100,000 BTU ❑ 100,006 BT Reinspection Fee $15 CMF 0865-46, rev. 10/84 White _ Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 5900 1/16/85 Zone Accessory Building: Parking Req./Provided FEES PLUMBING Bar Sink Showers Backflow Preventer - Service Sink Backfiow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains 11 Swimming Pool vv/Spa Floor Sinks. Gas Service Outlets Interceptors - Urinal - water Closet Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Trap - LaundryTrays- Roof Drains Switches Sign Reinspection Fee $15 issue Foe Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ 0-100,000 BTU ❑ 100,006 BT Reinspection Fee $15 CMF 0865-46, rev. 10/84 White _ Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 5900 1/16/85 Zone Accessory Building: Parking Req./Provided FEES DEVELOPMENT SERVICES REQUIREMENTS: ELECTRICAL - Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit Meter El up to 100 amps Dishwasher _ Meter ❑over 100 amps-. Dryers ❑Gas ❑Electric Sub Panel Date Date -- Fan Motors)F�0-1 HP ❑ 1 X - 8 00.100,000 BTU ❑ 100,000 BTU F.A.U. inc. Solar 09-15 HP 016.15+ - - Fixtures - Device Boxes Outlets Microwave Pole Light Range Switches Sign Registers ffarbDisposal ; Standing Sections r ❑0-5 KW 05-15 KW Trash Compactor $ 3 Reinspection Fee $15 Issue Fee FEES U-50 TL Z O N I N G R E Q" M T S $ 3 Head or Typal ❑ DEVELOPMENT SERVICES REQUIREMENTS: , Canopy Type 11 ❑ Zoning Approved By Date Building Approved By Application Issued By " Date Date -- Refrigeration System 00.100,000 BTU ❑ 100,000 BTU BUILDING PERMIT $ PLAN CHECK .$ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% IS SUMMARY OF FEES y •a!) SO SMIP $ l PERMIT ISSUANCE $ 1 ENERGY P.C. $ GRADING $ MICROFILM S System Repair/Alteration Fire Dampers Registers MECHANICAL $ TOTAL FEE $ yn 5U Issue Fee $ 3 PLAN CHECK 25% $ CONSTRUCTION AND PLANNING _ APPROVALS Permit # Date Inspector POOL & �r1A APPROVALS Permit # Date Inspector 1:- Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms .4, Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. -•8. Foundation 59. Gas Pipe, O Undrgrnd., Test .9. Water Pipe-Undrgrnd. 60, Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final '12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66, Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18, Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating' 71. Product Piping ❑ Gas ❑ Oii 23, Gas Pipe•Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 3 Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. 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 a ADDRESS OF 61gLp°'11, 711 W 17TH ST OYYIIER'S"w"'IOIdiNif FONTES APPRAISALS 4011" 711 W 17TH ST #G-8 COSTA MESA,CA 92627 APDL. "UNG ADDRM AfiCHITECT OR ENOOIEPR: ARCH OR M'S AOORESS: UNT: G-8 LIC. NO.: OfR: =m+AtiO"NkV-' R M H ELECTRIC (714)646-7378 GONTRACTORt1 MXUPM 165 23RD ST AODRESS COSTA MESA CA ur-flo•: 325738 92627 UNIT: 2 UCENSED CONTRACTORS DECLARATION: I hereby affirm under penalty of parjwy that I am Scamed wrier provisions of Chapter 0 (oommer>eng with Section 7000) of Division 9 d the &Mbm= and Profesaklm Code, end my I - - - is In rug force and ~, crry uc. No.: 0 2 4 0 14 LIC. CLASS: C 10 LIC• N r 3 2 3 B X R• 12/96 bats: Z Contract DWNER BUILDER DECLARATION: I hereby elfirm u We d perjury that I atempt ban the COnrsdat License Ler Ta the folowrrg reason [Semon 7091.5 Business and Prod- in - Cade: Any city or oonty whk h mcp*es a Permit to oxstruM Ober. improve, dentalah, a repel arty structure. prior to is issuance, also requ fret the applicant for such panne to Ste a signed statement that he or she +licensed pursuenl to The provisions of the Cordradors Lioanse Lew [Chapter 9 (oprrimenaeq with Sedlon 7000) Of Owision 7 of the minesa and projeniors Codal or the he or she is exampt therehom and the basis for the alleged exemprbn. Arry voletion of Section ,031.5 by any apokard for a point subjects IM applicant to a avis penalty of not more then five hundred doom ( KOD, . _ El I, as owner of the Property or my errgibyeas with -epee as their sole mmpergsmon. will do the work. and the stnubaa is not Wei or offered for sale (Section 7044, Bt*ress and Profess'oos Code: The COrdrapors Lie Law does not apply to en owner of property who builds or improves thereon. and who does such woric haosdf or herself a through his or Mer, own employess, presided that such improvements are not amended or offered for sale. 1, hhmwwer, the budding or improvement is sold wbhin one yew d apmPlelion, Yy ownerbutlder will have the burden proving he a she did not build improve la the purpose d rale). ❑ d pre 1. as owner of the prsPer7, ern axokpivaly contracting with [ceased centrettors 10 uorrinM the PipJed (Section 7044: Business and Pnofepsiom Code: The Contractors Losruse Law does not apply to an owner of property who buiida or i iprovos threat and who mwaicw for arch projeds with a mrtmctor(s) licensed pursuant to The Contractors License Law). I am wwmpi urder Section: B. 8 P.C.. for this reason: , Date: ownw. I do hereby certify that I am aware d and wnderaueramd tand the nreenb Cafionte Health and Safety Cods Sectors 25.506.25593. and 25594, and that I or arty haus budding ocwpard will! will not (cweb one) need to candy with said age codes and Tisa requiramersd fa s prmB fa ommutrddiion m rrodilKmmn heat the Ai ' rrmoom re l7i>arid. Rssidanitisl oonetrctdion 0Ppioations ere avant nom ewe prvrairlm. Date: AppkA t: WORKER'S COMPENSATION DECLARATION: I hereby affirm under Penalty of prj"ori of the ldlowi ntl dadratbru: Q 1 have and will maintain a certificate of carts Io sel4sure la workers' canprrafim, m Provided la by Section 9700 of the Labor Cods. for the perfornwhce d the work for which this perms is issued. 1 have and wit nm&aain wmlkan' oonpemmin 4o ranta, as regLfu by Sed'oh 3700 of the Leber Code. for the pManancs of Ifs work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carie: Policy Number, e asdion need not be completed t the pert a for arc huarded dollars (srmJ or tawj I wally that in The petormence d the work for which this Permit is hared. I shy not ernploy any person in any mrnr so as to become subject to the workers' oompemNion laws of Cefdo mia. and agree their if l should became aAjed to the woriosn' Cornpen tion p vision d Sadiron 3700 of The Labor Code, ; shall orthwilh coTpkyb Cross Data: Z Applicerd: Iyamingr Fahyum to secure wortsra' Cmrmprssthtn Cpvenpa 1 a+W 1 an employer m oirnlrul pwXas and Clip lMss tQ to ons hu citnid thousand deitam (V0g0WA In, addition to Cha Cost o1 congian"No 4 omegas as prodded far In Ssctlm 3708 of do Labor Co* lnterwt, thrid aftrn a fees, CONSTRUCTION LF?IOINO AGENCY: I hereby ether under psnehy of puxkay that threat in a oorrerRrdion kMeq Ogancy for the perlmnanoe d the work la which Ihls permit is 'sacred (Sedbn 9097, Civ. C). LENDER'S NAME: LENDER'S ADDRESS: I citify lhr I have read this application rho are that Thy above information is cored. I agree to comply with all my and county ondinarhon end stale in" refatnp 10 building omftudion and hereby authorize represenimMea d This Lily to enter upon the abwa4mmicned property for inspection purposes. ROBERT HOGIaINT) Date: Z Z7- (alsi-46.WP) Whirs" Bhddiy 6 Salary: Grsen-FOO: Canary-Appioa t: Pink-Revesa: Ooldenrad-Assessor CITY ,OF'COSTA MESA — BUILDING PERMIT '' PERM NO: E 08299 PERMIT NO: E 082999 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH JOB DESCRIPTION : ADD ELECTRICAL OUTLETS SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: / COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT Z O N I N G R E Q U I R E M E N T S S E T B A C K S -------------- MAIN BUILDING ----------- --------- ACCESSORY BUILDING---------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN PARKING RE& PROV: PARCEL: 00000000 ZNE: REF NO: PLANNING N TES> > sv # 1E f+b it it !( it it iI- iI- iE # �- # !(!I-lI-lI-1E 1E iE iI- iI-!E if !I -')t iI-1E iE iE iI-lI-1(• �' if iE i(-')IiI- iE iI- iE i!- if if !( it 1E iE iE f+b if iE iE iI-1E if if !(iE iE # f+b if it• if iI- !I- if if iE iE iE l(l(iE f+b �- D E V E L O P M E N T S E,'R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY _ DATE: BUILDING APPROVED BYDATE: APPLICATION ISSUED BY: Sid DATE: 7 LEGALIZATION:N F E/�E') S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 18.00 50% SMIP/NON-RES PLAN ISSUE FEE 22,00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 18,00 22.00 0.00 40,00 40.00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 40.00 OVER/SHORT: .00 BLDG AMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 40.00 iE iE !E !t• !t•')t )IiE #F #F iE iE i6 �E iE i( -1E !f frE !E !f if it• it• it• 1F iE iE it• 1E !f 1E !f !f if if if if i[• iE iE iE i6 iE iE i6 iE 1(• !f !t• !t• it !E it• !E 1F !E �E iE iE it � it if i{. iE # !E !E !E 1E i6 iE it !t• � !t !t ri- I N D I V I D U A L F E E B R E A K D O W N y TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 18 RECEPT/OUTLET 1. ST 20 EA. 1.,00 END OF FEES 18,00 05-21-1997103:38 PHA40.00 RCP10:01—ME652 PERMIT:O82�"gq CONSTRUCTION AND PLANNING Date APPROVALS Permit # Inspector POOL 'A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59, Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60, Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62, Backwash & Recepior-Final 12, Sewer Cap 63. Heater & Vent -Final 13. Roof Drains r 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit Solar System -Final 16. Rough Electric Wiring �. 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 APPROVALS Permit # 20. Rough Factory ! ireplaee 21, Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O -Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd, Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & MDnocoat 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, REOUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power Meter -Final Q`1. FOOD CERTIFICATE ISSUED 33. Final Electric �% _ �N tes; 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Firial 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. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. Y' ON PERMIT CITOF COSTA MESA %-Z PfjRMIT NO. TRACT NO. LOT NO. UNIT NO. . r, Aadress Sub Panel F Fan Motors ❑0.1 HP 01'12 - B F,A.U, Inc, Solar ❑9.15 HP 1316-15+ Fixtures TYPE OF CONSTRUCTION LJ NEw LJ ADD LJ ALTERATION LJ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER- REPAIR 1�pp cant's Maili g Addres Owner's,Name P ne DESCRIPTION OF WORK/USE OF BLDG. Switches Address Garbage Disposal ; Standing Sections Generator ❑0.5 KW 05.15 KW Trash Compactor SM(P $ PLAN CHECK Arch/Eng. License No. Address Contractor's Na Phone TYPE OF PERMIT OGRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHAN)CAL ❑ -OTHER _ - - - Address (me iling] [ Ir City License No. 7so7% - PROJECT DESCRIPTION SO. FT. OCCUPANCY C O N STRUCTION-TYPE VALUATION $ ZONE GRAOINGCU. YOS. ACRES $ 9•CJO LICENSED CONTRACTOR DECLARATION $ PLAN CHECK 25% $ — f --S'D Remarks: - ELECTRICAL $ I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and $ PLAN CHECK 50% $ rrrY license is in fel for a and affect. - L cegSe Cas ls License No. ' MECHANICAL PLUMBING FEES Date Signature WORKERS' C M ENSATION D R TION I her@by affirm that I have a certif to of consent to self -insure or a certificate Bar Sink Showers Backflow Preventer Service Sink - %f Workers' Compensation Insurance, or a certified copy thereof (Section 900, -Lab. C.) Backflow Irrigation Sewer Cap Policy No, Company - HCertified copy is hereby furnished. Certified copy Is filed with the city Building Oivision, Bathtubs Sewer Connection Date---:-- Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers - Solar Collectors (This section need not be completed if the permit is for one hundred ($100) or less). I certify that In the performance of the work for which this permit is Issued, I shall not employ any person in any manner &o as to become subject to the Dishwasher Solar Piping , Drinking Fountains Solar Tank Worker C pen tion ws of Cali a. ' Date, ,��j- Slgnature Floor Drains Swimming Pool w/Spa *NOTICE: If, after making this decla on, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith compiy with such provisions or this permit . shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency-fdr the performance of the work for which this permit is Issued (Section 3097 Civ, C.) Lender's Name 1 Floor Sinks - Urinal - - Gas Service Outlets Water Closet JU Interceptors Water Heater Kitchen Sink' Water Servicerl Lender's Address OWNER BUILDER DECLARATION I hereby affirm that t am exempt from the Contractor's License Law for the following reason (Section 7031.5'Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit ,to file a signed statement that he/she is licensed pursuant to the provision& of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/She is exempt _` erefrom and the basis for the alleged exemption. -Any violation of Section 31,5 by any applicant for a permit Subjects the -.applicant to a civil n4ity of not more than five hundred dollars ($500). J I,' as owner of the property or, my employees with wages as their sole compensation, will do the work, and the Structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who,bullds or improves thereon, and who does such work himself/horself or through his or her own employees, provided that such Improvements are not intended or offered far sale, If, however, the building or improvement is sold within one year of Com- - pletlon, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). LJ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves there(3n, and _who contracts for Such projects with a con- - Lavatories Auto -Wash - P -Trap „ - Laundry Trays Roof Drains " ' Reinspection Fee " S15 Issue Fee $ 3 MECHANICAL Boiler Hood or Type I C] Canopy Type 11 ❑ . Duct -Under Ground FEES Duct - Structural - Refrigeration System ❑0 100,000 BTU 0100,000BTU Duct- Ventilating Exhaust System El Multiple C] System Repair/Alteration tractor(s) license pursuant 'to the Contractor's License Law), 1 am aware that Proof of their Worker's Compensation insurance should be provided to me, Firepl/Fact. Bit, ICBO'ilk Fire Oampers ❑ I am exempt under Section s B. & P. C. for this reason Date Owner I. hereby certify that I have read this application and state that the above information is correct. t agree to comply with all city and county ordinances and state law$ relating to building construction, and hereby authorize repre- sentatives of this city o enter upon the above-mentioned property for inspectionpu S. Signature Drivers' Lic or SS Heating System & Ducting ❑0.100,000 BTU 0100,000 BT Registers r •\ Reinspection Fee $15 Issue Fee $ 3 CMF 0965-46, rev. 10/94 W Ink - Accounting; Goldenrod - Assessor A.P. # 5694 U d Ia Zone S Main Building: Accessory Building: TFront U ARear - N C R ight N ' SI Left G R Ping, Ref. Parking Req./Provided E Planning Notes: QM is T ELECTRICAL FEES Automatic Washer Construction Pole Sub. Cooking Unit Transformer ❑ 15.50 -KW ❑ 50 + KW Meter dup to 100 amps Dishwasher v Meter Clover 100 amps Dryers ❑Gas ❑Electric Sub Panel F Fan Motors ❑0.1 HP 01'12 - B F,A.U, Inc, Solar ❑9.15 HP 1316-15+ Fixtures Microwave - Device Boxes Pole Light ' Outlets Range Switches Sign Garbage Disposal ; Standing Sections Generator ❑0.5 KW 05.15 KW Trash Compactor Reinspection Fee $15 Issue Fee' $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat SUMMARY OF FEES BUILDING PERMIT $ SM(P $ PLAN CHECK $ PERMIT PLUMBING $ 9•CJO ISSUANCE $ PLAN CHECK 25% $ — f --S'D ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ CONSTRUCTION AND PLANNING PROVALS Permit #„V Date Inspector en POOL PA- APPROVALS Permit ,# I Date Inspector 1. Temporary Electrical Service or Poi� It52. Pool & Equipment Location r• 2. Soil P,i �e-Undr rind. F.� pr 9 '� 53. Steel Reinforcement ' 3Elecir�ic"al Conduit Utility Undrgrnd 54. Forms 4 Elect_�r'ical'Conduif-Udgrnd. 55. Electrical Bonding i AS`eel�Re forcerrrent 56. Rough Plumbing & Pressure Test .� 6ctricaI LIFERR Grnd. 57. APPROVAL TO COVER-GUNITE +� 4 cjot ngs ,,j I 1 5B. Electrical Conduit-Undrgrnd. Fouvniion 59. Gas Pipe, ❑ Undrgrnd., Test 1 �] rUatePipe Undrgrnd. y 60. Backwash Lines, P-Trap, ❑ Undrgrnd. Fw 10 ,St�rNcturaal Floor System 61. APPROVAL TO DECK 11. Pro Pie r~ty"Sewer Line &House Connection 62• Backwash & Receptor-Final 12. Sewer Cap r f � 63. Heater & Vent-Final 13. Roof Drains t X, a 64. Plumbing System - Final 14.,R ygh Plumbing-s 65. Electrical-Final 1v 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 1SSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 35. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STIRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COST CONSTRUCTION ,CONTRUCTION PERMIT Project Addressml- _ � �.,,� � Applicant's Mailing Address SeT YI E - Owner's Name Phone 1 Zi2 Address Arch/Eng Address Contractur's Nam Phone Address (mailing) City License No. _— LICENSED CON7RAC70R DECLARATION I,hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that i have a certificate of consent to self -Insure or a certificate e Workers' �Coomm�p/e�nssation Insurance, or a certified copy thereof (Section ' 300, Lab..( ,iI� P icy No.( Gompan +� L Certified copy I$ her@by furnished. Certifie f lett with the city Building uio Date Applicant ��_ EXEMPTI N OM WORKERS' COMPENSATION DECLARATION (This section need not be completed it the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to Ike Workers' Compensation laws of California. Date Signature 'NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of'the-Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked, CONSTRUCTION LENDING. AGENCY I J I hereby affirm that there Is a construction lending agency for the performance of the work which Is per i is Su tion 3 97 Civ. C:) Lender's Name �7t%%��,�f7� 1 - Londer's Address i�[G;6) /— OWNER BUILDER DECLARATION I hereby affirm that 18m.exempt from the Contractor's License Law for the fallowing reason (Section 7031.5 Business and Professional Code. Any City or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of nlvision 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 1.5 by any applicant for a permit subjects the applicant to a civil ,alty of not more thhn five hundred dollars ($500). LJ I. as owner of the property or my employees with wages as their sole Compensation, will do the work, and the structure Is'not intended or offered _. for sale (Suction 7044 Business and Professional Code- The Contractor's 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 awn employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold Within one year of com- pletion, the owner will have the burden of proving he/She did not build or im- ave for the purpose of sale). I, as,owner of the property, am exclusively contracting with licensed can- ractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law coos not apply to an owner of property who builds or Improves th@reon_ , and who contracts for such projects with a con- tractor(s) license purs4ant to the Contractor's License law). I am aware that proof of their Worker's Compensation insurance Should be provided to me. ❑ I,am exempt under Section B. & P. C. for this reason Date Owner I hereby c lily that I have read this application and state that the above informs io Is correct. I agreeto comply with all City and county ordinances _ and- state laws relating to b (ding construction, and hereby authorize repre. sentatives of this city enter upon e a eve -mentioned property for inspection purposes. e'� Signature G Drivers' License or SS 66-�- - IdG- Bar Sink Showers 1, 16:41, Service Sink TYWOF CONSTRUCTION LJ NEW LJ ADD CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. 0 ALTERATION LJ REPAIR A.P.,# S E T B A Main Building: TYPE OF PERMIT 0 GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL PLUMBING El MECHANICAL ❑OTHER Front Rear PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION S ZONE GRADING CU.YDS. ACRES C K S Right Left Ping. Ref. # Remarks: _7 13Q16 FEES Planning Notes: / ' (/ PLUMBING FEES Bar Sink Showers Backflow Preventer Service Sink Backflow irrigation Sewer Cap Bathtubs Clarifiers. ,. Sewer Connection -Solar Collectors Dishwasher Solar Piping Drinking Fountains Floor Drains Solar Tank Swimming Poot w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet BUILDING PERMIT Interceptors Kitchen Sink Lavatories Water Heater Water Service Auto -Wash $ PERMIT ' P --Trap Laundry Trays PLAN CHECK 25 Roof Drains ELECTRICAL $ GRADING PLAN CHECK 50% S MICROFILM MECHANICAL Reinspection Fee $15 Issue Fie- $ 3 MECHANICAL FEES Boiler Duct - Under Ground Hood or Type 1 ❑ Canopy Type li ❑ Duct - Structural Refrigeration System 00-100,000 BTU- ❑ 100,000 BTU Duct - Ventilating Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICSO # Fire Dampers Heating System $I Ducting ❑0-100,000 BTU ❑ 100,000 BT Registers Reinspection Fee I 115.1 L. Issue Fee I $ 3 GMF 0865-46, rev. 10/84 White - Building; Canary • Appl Accounting; Goldenrod - Assessor 4507 Accessory Building: Zone Z O N G R Parking Req./Provided E _ Q M T Is ELI_CTRICAL Automatic Washei Construction Pole Sub. Cooking Unit' Dishwasher Dryers ❑Gas ❑Electric Fan F.A;U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 1:10-5 KW 1:35.15 KW Transformer El 15-50 KW 50 + KIN Meter Dup to 100 amps Meter Dover 100 amps - Sub Panel Motors ❑0-1 HP 0111h- 8 Inc. Solar ❑9-15 HP 1:116-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES Reinspection Fee $15 issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By — . _ _Date l �' PLAN CHECK 25% $ $ $ S S SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT ' PLUMBING $ , QO ISSUANCE PLAN CHECK 25 ENERGY P.C. ELECTRICAL $ GRADING PLAN CHECK 50% S MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ $ $ S S CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL 'PA 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 S. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. s 57, APPROVAL TO COVER-GUNITE !7. Footings _ 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor $Vstem 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑Gas EJ Oil 23, Gas Pipe -Rough & Test 72.' Underground Flush " 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas O 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 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 ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 46. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. _ - Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. MWEV CITY 01; COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT,NO, UNIT NO. Project Address 71/ LA) - 11T04 51. CD 5 r A- m O,�+ Applicant's Mailing Address Owner's Name ::r ROY tj UE,j'M'�_nj� Phone Address Arch/Eng. _ License No.' Address _ Contractor's Name -_A1 olbe S GUecTe- >r Phone 1�6- c Address (mailing),I -�kiX" RY Ln: ST- �j 11`0 -TbA.> 16 City License No. .33 "I LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Char r 9 (commencing with section 7000) of Division 3 t incss a Pr slons Code, and my license is in full for and eff t. Ucense Class Lice se N Date Signature WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I nave a certificate of consen to self4nsure or a certificate Of Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab. C.) , PalIcy No. tr y E Certified copy is hereby fu rnishetl Certified copy filed with the cit Bull Liv on l L Date 1 Applicant EXEMPTION FROM WORKERS' COMPENSATION ECLARATION (Thissection need not be completed it the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit Is Issued, I shall not employ any person in any manner so as to become Subject to the Workers' Compehsatlon Laws of California. Oate Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this hermit shall be deemed revoked, CONSTRUCTION LENDING AGENCY , I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name ` Lender_'s Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance,,also requires the applicant for such permit to file a -signed Statement that he/she is licensed pursuant to the provisions of 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 31,5 by -any applicant for a permitsubjects the applicant to a civil falty of not more than five hundred dollars ($500). r I'as owner of the property or my employees with wages,as their sole compensation, will do trio work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Coder The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year'of com- pletion, the owher'wilt have the burden of proving he/she did not build or im- prove for the purpose Of sale). ❑ I, as owner of the property, am exclusively contracting with,Iicensed con- 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 builds of Improves thereon, and who contracts for Such projects with a con- tractor(S) license pursuartit'to the Contractor's License Law"), I am aware that proof of. their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner _ I hereby, certify that I have read this Information I. 1 agree to mp and state s 'ti to buildin con sentative of 't cit to enter upoi signature'L-iti�� s! Drivers' License or SS CMF 0865-46, rev. 10/84 :atlon and state that the above i all city and county ordinances on, and hereby authorize repre- above-mentioned property for Date 1 -ID- C{ IBD ELECTRICAL SUMMAVY OF FEES BUILDING PERMIT 5 SMIP, PLAN CHECK S PERMIT PLUMBING, $ r ISSUANCE PLAN CHECK 25% $ ENERGY P,C ELECTRICAL $ L{ Li0 GRADING PLAN CHECK 50% $ SO MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ .Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ID 50+ KW TYPE OF CONSTRUCTION NEW ' ADD _❑ CONVERSION ❑ DEMOLISH ❑ OTHER_ DESCRIPTION OF WORK/USE OF BLDG, ALTERATION REPAIR 1- A.P. `!�, S T- B A Main Buildi TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER _ _ _ _ _ _ _ _ _ _ Front Rear PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE � VALUATION S _ ZONE GRADING CU. YDS, ACRES C KLeft $ Right Ptng. Ref, Remarks: Garbage Disposal ;Standing Sections Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service -Outlets interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under'Ground Duct - Structural Duct - Ventilating . Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting 00-100,000 BTU ❑ 100,000 BT II Reinspection Fee $15 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor P Showers Service Sink Sewer Cap Sewer Connection i Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal - Water Closet Water Heater Water Service Auto -Wash Laundry Trays II issue Fee MECHANICAL Hood or Type I ' ❑ Canopy Type 11, ❑ Refrigeration System '—,00-100.00OBtu ❑100,000'BT System Repair/Alteration Fire Dampers Registers Issue Fee 5901_ 1/16/85 4050 TL Zone Accessory Building: Z O N I N R Parking Req./Provided E Q M T Ell S FEES ELECTRICAL SUMMAVY OF FEES BUILDING PERMIT 5 SMIP, PLAN CHECK S PERMIT PLUMBING, $ r ISSUANCE PLAN CHECK 25% $ ENERGY P,C ELECTRICAL $ L{ Li0 GRADING PLAN CHECK 50% $ SO MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ .Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ID 50+ KW Cooking Unit Meter ❑up to 100 amps 1 Dishwasher Meter ❑over,100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors -f HP ❑ 11A - $ F.A.U. Inc. Solar 09.15 HP ❑16.15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal ;Standing Sections Generator ❑0.5 KW 05.15 KW Trash Compactor r $ 3 Reinspection Fee S15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Bu)iding'APproved By Date— Application Issued By SvAct, Date_ FEES $ 3 SUMMAVY OF FEES BUILDING PERMIT 5 SMIP, PLAN CHECK S PERMIT PLUMBING, $ r ISSUANCE PLAN CHECK 25% $ ENERGY P,C ELECTRICAL $ L{ Li0 GRADING PLAN CHECK 50% $ SO MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ $ 3 FEES $ 3 CONSTRUCTION AND PLANNING 3. APPROVALS Permit # Date inspector POOL 'A APPROVALS Permit # Date InspPcto: 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Sail Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd, 54, Forms 4. Electrical Conduit-Undrgrnd. 55, Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6- Electrical LIFER Grnd. 57. APPROVAL TO COVE R-GUNITE 7. Footings 56. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer One & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap f 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, POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ 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 76. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric `�� Notes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46, Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY NO. Date ' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA. CONSTRUCTION PERMIT Project Address 711 _ W. 17th St. Bldg (Q,. Unit -8 Applicant's Mailing Address 13110 Saticoy St. N.Hollywood, Owner's Name TrnY Iny3i�� S —St—Rn t Phone—54-9-298j Address 4191 Birch—St. Newport Reach, Ca � Arch/Eng. Marin J. ROCK License No. Address 12BB Krintt A3ze Sili tP 716 Contractor's Name—firm Air C:nnrli tinning Phone 982-1216 Address imailing)131 (1 Ca ti coy St N . 1101 13amnrl _ r:'a _ City'License No. -4'1974_ LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of rter 9 (commencing with section 7000) of Division 3 of the Business a ofessions Code, and my license is in full force and effe License class 20 rise p. 346251 Date 411R. %�4— Signature WORKERS' COMPENSATION DE RATION . I hereby affirm that I have a certif ate of consent to self -insure or a certificate It workers' Compensation Insurance, or a certified copy thereof (Section Palin, Lab. c.) WC9824 Lumbermans Policy No. Company BCertified copy is hereby furnished. Certifi o y Is filed with the city Suitdipry Divi 1r. M Date Applicant -(J �1 ---- EXEMPTION FROM WORKERS' COMPENSATION DECLAR TION (This section need not be completed -if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers'. Compensation Laws of California, , Date Signature 'NOTICE: If, after making this declaration, you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance, of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address ; OWNER BUILDER DECLARATION I hereby afflrm that I am exempt from the Contractor's License Law for -the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file asigned statement that he/she is licensed pursuant to the provisions of 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 by any applicant for a permit subjects the applicant to a civil malty of not more than five hundred dollars ($5001. ....Y I, as owner of the properly or my employees with wages as their sole CC mpensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale, If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove,for the purpose of sale). 13 I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractors) license pursuant 'to' the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date mrorman and state sentatives inspectio Signature Drivers' Li CMF 0865-46, Owner certify that I have read this application and state that the above on Is correct. I agree t limply with all city and county ordinances la lating to buil n construction, and hereby authorize repre- th s city to` ter upon the above-mentioned `property for purp es. /1 �.� de.— �r� Iva a orSS:# 10/84 2288 5/03/85 15.50 TL PERMIT NO. I FiAI I NU. Lv I Ivv. UNI TYPE OF CONSTRUCTION 0 NEW LJ ADD ALTERATION U ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. REPAIR A.P. # Zone S Main Building: Accessory Building: TYPE OF PERMIT El GRADING ❑ FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ .OTHER E T Front Z O B A Rear N C Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION 5 ZONE GRADING CU. YDS. ACRES K S I Left G R Ping. Ref. + Parking Req./Provided E Remarks: Planning Notes: a' M! T- S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers ' Backflow Preventer Service Sink- Automatic Washer Construction Pofe Sub, Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap1 Bathtubs Sewer Connection ^ Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00.1 HP Ell 14 - B Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 1:19-15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Lavatories Water Service Auto -Wash Switches Garbage Disposal Sign ; Standing Sections P—Trap Laundry Trays Generator 00.5 KW 05.15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS; Zoning Approved By - Date Building Approved By Date Application Issued By ____Dat �fZ Boiler Hood or Type I ❑ Canopy Type 11 ❑ ` Duch- Under Ground Duct - Structural Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMITPLUMBING $ ISSUANCE $ $ ENERGY P.C. $ $ GRADING $ $ _ MICROFILM $ $�Q— TOTAL FEE $ 1 5 r SD $ Z �SUU Exhaust System ❑ Multiple ❑ System Repair/Alteration Firep1lFact. Bit. ICBG # Fire Dampers Heating System &Ducting 1 R10-100,000 BTU _❑100,000BT Registers t 6 00 4 00 Reinspection Fee $15 Issue Fee $ 3 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POOL ;PA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool &Equipment Location . f { 2. -Soil Pipe•Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 1 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding { 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test i 6. Electrical UFER Grnd. _ .- 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduif-Undrgrnd. 8' Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. '4 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing 65, Electrical•Final 15. Rough Electrical -Conduit 66, Solar System -Final i 6. 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 APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas D Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning ¢(� 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. iFinal Plumbing 39. Water Service -Final 40. Gas Service -Final 41.:Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48 -Special Requirements Completed 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51.'CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. �. %i CITYOF COSTA MESA • CONSTB-tJCTION PERMIT Ptoject Ad'dress' ?applicant's Maili�ddre Owner's Name d ho Address Arch/Eng. License No. Address Contractor's Nam I 1 LS Phone y,✓� Address (mailing) City License N_o.t2—f LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing With section 70001 of Division 3 of the Business and Professions Code, and my licenRaffirm 91haVe Eacer ifica�teof , Ucense License No. Date WORKERATION ` I hereby consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy lheieof (Section •3800, Lab. C.) Policy No. Company 8 Certified copy is hereby furnished. ' certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit -is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued, I Shall, not "employ any person in any manner s ,as to become subject to the Workers'' Co R sa ws of Calif o Date, Signature 'NOTICE: If, aftTr making this declara n,, you should become subject to the Workers' Compensation provisions the tabor Code, you must forthwith comply with such provisions or this permit shalt be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there It a construction lending agency for the performance Of the work for which this permit Is Issued (Section 3097 Civ. C.) Lender's Name ,�- Lender's Address OWNER BUILDER DECLARATION I hereby affirm -that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any slructura, 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 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 ienalty of not more than five hundred dollars ($500). ,D I, as owner of the' property or .my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an'owner of a property who builds or improves thereon, and who does such work hlmself/herself or througn his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion , the owner will have the burden of proving he/she did not build or Im- rove forr the purpose of s81e). I, as owner of the property, am exclusively contracting with licensed con- 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 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 Proof orf their Worker's Compensation insurance should be provided to me. I❑ 1 am exempt under Section B. & P. C. for this reason Data Owner ' I hereby certify that I have read this application avid state that .the above information Is correct. Iagree to comply with all city and county ordinances and state laws rolating to building construction, and hereby authorize repre- sentatives of thisity to enter upon the abovo-mentionatl roperty for Inspectio pos s' Signature Date 4. Drivers' Lslcense or SS �& P RMIT N TRACT NO. LOT NO. UJ> TNIft J ! 5895 7/02/85 TYPE OF CONSTRUCTION El NEW MOD ALTERATIONS ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG, REPAIR A.P. # Zone S Main Building: Accessory Building; TYPE OF PERMIT 0 GRAOING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION S4. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION ZONE GRADING CU. YDS. ACRES E T Front Z O B A Rear N I C Right N g G Left R Ping. Ref. Parking Req./Provided E Remarks: Planning Notes: O M T S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer. Construction Pole Sub. Transformer ❑ 15.50 KW El 50 + KW T Backflow Irrigation Sewer CapQ Bathtubs Sewer Connection Cooking Unit . Meter yup to 100 amps Clarifiers Solar Collectors DishwasherMeter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electr,ic Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0.1 HP ❑1 f, . 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Sol _r.09-115 HP ❑16 15+ Floor Sinks Gas Service Outlets Urinal Water Closet Fixtures Device Boxes Microwave Pale Light Interceptors KitcHen Sink Water Heater Water Service Outiets Switches Range Sign Lavatories Auto -Wash Garbage Disposal ' Standing Sections P—Trap Laundry Trays ' Generator ❑0-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee S15 Issue Fee $ 3 - Boiler Duct - Under. Ground MECHANICAL Hood or Type I ElDEVELOPMENT Canopy Type it ElZoning FEES SERVICES REQUIREMENTS: Approved By Building Approved By Application Issued By _... Date Date Duct - Structural Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU Duct - Ventilating SUMMARY BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 2596 $ ELECTRICAL $ PLAN CHECK 50%6 $ MECHANICAL $ PLAN CHECK 25% $ OF FEES SMIP $ PERMIT ISSUANCE $ ' f S`O ENERGY P.C. $ GRADING $ MICROFILM $ TOTALFEE $ _ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. (CBO # Fire Dampers Heating. System & Ducting ❑0.100,000 BTU ❑100,000BT Registers l .. Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor _ •CONSTRUCTION AND PLANNING -APPROVALS Permit # ' Date Inspector Al POOL 6 -,,A APPROVALS Permit # Date Insppctnr 1., Temporary Electrical Service or Pole'y 52. Pool & Equipment Location , Sohl P-Undrgrnd. r �;� tp 53. Steel Reinforcement Electfical Condbd.Wfil4y-Undr9rnd 54. Forms 4^ElectriCond6it-,Jndrgrnd. ; y 55. Electrical Bonding •I�, 5 +Ste! Reinforcement 56. Rough Plumbing & Pressure Test 4 -'Electri�.UFER Gid. ,�� a10 57. APPROVAL TO COVER-GUNITE 7._ Footings y.`_ 58. Electrical Conduit-Undrgrnd, 8. Foundation lI y 59. Gas Pipe, 0 Undr rnd., Test 't r,Pi�e-Und g nd. * 60. Backwash Lines, P -Trap, 0 Undrgrnd. { f 10. Strutu al Floor System f 61. APPROVAL TO DECK 11. Pro pert (Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap C{ 63. Heater & Vent -Final ` 13. Roof Drains 64. Plumbing System -Final 14. Rough Pli�mbingy '� 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23, Gas Pipe -Rough & Test 72. UrLderground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT ,31.'Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final .40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. 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 r- CITY OF COSTA MESA CO/NSTRUCTION PERMIT Project Address / + �t� Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. PE IT NO. T ACT N LOT NO. UN NO. Applicant's Mailing Address ", Owner's N--- F'u Phone S Address 60WS Arch/Eng. �• License No. Address 3'�• • Contractor's Nam�t� Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, anq my license is In full force and effect, License Class ---Licenso No. Date. Signature _ WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a Certificate of consent to self -Insure or a certificate ofWorkers' Compensation Insurance, or a certified copy thereof (Section 800, Lab. C.) �licy No. Company _ — 4$ Certified copy Is hereby furnished. LLJJ Cert c y is filed with the city Buil,- i Date Applicant A2 '06 EXEM l FROM WORKERS' COMPENSATION DECLARATION (This ction Hood not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit Is issued, I Mall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date - Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of, the Mbar Code, you must forthwith comply with such provisions or this permit shall ,be deemed revoked. CONSTRUCTION LENDING AGENCY I • i I hereby affirm that there is a construction lending agency for the performance of the work for whi h this P rmit is issued (Sectio 3097 Civ. C.) Lender's Name Al Lender's Address / OWNER BUILDER DECLARATION i hereby affirm that I am exempt from the Contractor's License Law for the following reason (Suction 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that, he/she Is licensed pursuant to the provisions of .the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cotle) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section -131.5 by any applicant for a permit subjects the applicant to a civil atty of.not more than five hundred dollars (5$00). i,I, as owner of the property or my 0MPloyeeS with wages as their sole ..umpensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- _ ve for the purpose of Sale). I, as owner of the property, am exclusively contracting with licensed con- rat to construct the projectISectlon 7044, Business and Professions Code: The Contractor's license Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- i tractor($) license PUrsuarit'to the Contractor's License Law). Iam aware that Proof of their Worker's Compensation insurance Should be provided to me. ❑ 1 am exempt un4or Section& P. C. for this reason Oat Owner I hereby C tlfy that I have read this application anq state that the above tnformat on Is correct. I agree to comply with all city and county ordinances and state laws relating, to llding construction, and hereby authorize repre- sentatives of this ci o en u the above-mentioned property for inspection purposes, Signature G F3 Drivers' License or SS :ir [-1-1f366-9 r Bar Sink G Backflaw Preveriter TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR Backflow Irrigation -CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 0 DESCRIPTION OF WORK/USE OF BLDG. Dishwasher Solar Piping Drinking Fountains Floor Drains S Main Building: Urinal vLWater Closet Interceptors Water Heater TYPE OF PERMIT GRAOING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL, P -•Trap Laundry Trays ❑ A Rear -OTHER C Right PROJECT DESCRIPTION SCS. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION S S Left ZONE GRADING CU.YDS. ACRES - Ping. Ref, 9)6 Remar `� Planning Notes; ! PLUMBING ' Bar Sink Showers Backflaw Preveriter Service Sink Backflow Irrigation Sewer Cap Bathtubs Clarifiers Sewer Connection Solar Collectors Dishwasher Solar Piping Drinking Fountains Floor Drains Solar Tank Swimming Pool w/Spa Floor Sinks Gas Service Outlets Urinal vLWater Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P -•Trap Laundry Trays Roof Drains Reinspection Fee $ 3 $15 Issue Fee Bailer Duct . Under Ground Duct - Structural Duct - Ventilating - Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO + Heating System & Ducting ❑0.100,000 BTU ❑ 100,000 BTI Reinspection Fee I $15 CMF 0665-46, rev. 10/84 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor -IAN It. AL I. Hood or Type 1 ❑ Canopy Typell ❑ Refrigeration System ❑0-100,000 BTU ❑.100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES 4.508 /1_1� #. c, ., Zone Accessory Building: Z N 1 N G R Parking Req./Provided' E Q ' M T S ELECTRICAL Automatic Washer. Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ©Electric Fen F.A.U. Fixtures, r - Device Boxes Outlets Switches 2 O Garbage Disposal Generator ❑0-5 KW 05-15 KW Transformer ❑ 15-50 KW r ❑ 50+KW Meter ❑up to 100 amps Meter Clover 100 amps Sub Panel Motors 00-1 HP ❑ IA . 8 Inc.Solar 09-15 HP 016-15+ Microwave Pale Light Range Sign Standing Sections Trash Compactor FEES $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date Dat 4- BUILDING PERMIT PLAN CHECK PLUMBING l PLAN CHECK '25% ELECTRICAL - PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ OD $ $ $ $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING S MICROFILM 1 $ TOTALFEE $ M's� $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & 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. Efectricaf Conduit-Undrgrnd. 55. Electrical Bonding 5. Steiel Reinforcement 56. Rough Plumbing & Pressure Test i 6• Electrical LIFER Grnd. 57, APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd, 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection i 62. Backwash & Receptor -Final 12, Sewer Cap 63. Heater & Vent -Final 13. Roof Dr2ins 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 129. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: • ' 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43, Backflow Irrigation 44. Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49. Electric Release to Bdison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PE MlT PERMIT N TRACT NO. LOT NO. UNIT NO. Project Address S •# G Applicant's Mail- n Address Owner's Name EVIG / Phone Address Arch/Eng, License No, Address -- Contractor's NamPS)C1$'//C0� 6_110 7`J L Phone—v3! lJ ��0 AddressI ailing) �,S' 6- S• �� 5"_A City License No. [Zed/ 9g LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and ` my license is In full f r� end effect. License Classes LI e ru , _ 3�39� 3 Oatc�? Signature - WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificbte of consent to self -Insure or a certificate \ of Workers' Compensation Insurance, or a certified copy thereof (Section 800, Lab. c.) alley No. A% �� (.IIp� Compan Certified copy is hereby furnished. Certifle co ' filed with the city Bui Division. �• �.-�-sy ate Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that In the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the - Workers' Compensation provisions of the Labor Coda, you must fortnwlth comply with such provisions or this' permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued (Section, 3097 Civ. C.) Lender's Name Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 031.5 by any applicant for a permit subjects the applicant to a civil nalty.of not more than five hundred dollars ($500). I, as•owner of the property Or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for solo. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the -purpose of sale). ❑ I, as owner of the property, ani exclusively contracting with licensed con- 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 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 proof of their Worker's Compensation insurance should be provided to me, ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that 1 have read this application and state that the above Information Is correct. I agree to comply with all City and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of is city to eyer_�poZ the above-mentioned property for Inspection ptW ��C�'.( � / Date Signature l /J�C�'y � Drivers' License or SS � 1- o-I&g 34v TYPE OF CONSTRUCTION LJ NEW EJ ADD1�4 ALTERATION L1 REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. DESCRIPTION OF wO K/USE OF�LDG. G S Main Building: IV 4 E TYPE OF PERMIT Ll GRADING LJ FOUNDATION 0 STRUCTURAL T Front ❑ TENANT ;�l ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Roar ❑ OTHER I I A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES . Ping. Ref. 9 Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains F1oor'Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 4. $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 00.100,000 BTU ❑ 100,000 BT' Reinspection Fee I $15 1, CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor FEES Showers Service Sink. Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee 1 $ 3 Hood'or Type ❑ Canopy 'Type 11 ❑ Refrigeration System E1&100,000BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee Automatic washer Construction Pole Sub. Cooking -Unit Dishwasher. Dryers ❑Gas EaElectric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 1:10-5 Kw E_ 0173 1/13/87 Zone Accessory Building: Parking Req./Provided ELECTRICAL ___4Transformer ❑ 15-50 Kw '050 + KW Meter ❑up to 100 amps Meter' ❑over -100 amps Sub Panel Motors 00.11 HP❑1%-8 Inc. Solar 09-15 HP 016-15+ Microwave Pole Light Range Standing Sections 5-15 KIN I I Trash Compactor Reinspection Fee $15'1 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application issued By - Data J l SUMMARY OF FEES BUILDING PERMIT $ SMiP- PLAN*CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN•CHECK 25% $ ENERGY P,C ELECTRICAL $ GRADING ' PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ S 3 $ 6.40 TL Z O N I N G R E Q M T S ee■e CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL &SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soif 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 COVE R-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd, 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 6B. APPROVED FOR PLASTERING 18, Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # - 20. Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ 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 Failing HEALTH DEPT, REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric �!-No tes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37- Final Factory Fireplace J- 38. Final Plumbing 39: -Water Service -Final ti 7 40. Gas Service -Final 41. Solar Domestic -Final y _• •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 C1 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 711- 14 _ 17th_St. Bldg. (G) Unit 9 Applicant's MailingAddress13110 Saticoy St. N.HDl.lywood, Owner's Name . Troy. p_Yestment Fund -Phone 549-2988 Address 4-37] —Birch St,_ N_ ewnort Beach, Ca. Arch/Eng. Ma -l:1 in J - RpCk License No. Address 12$81 Knntt Ave- SUj to 21b Contractor's Name Duco Air Conditionila hone- _-982-1216 Address (mailing) 13 11 1 n C;a t i raw St _ N14al 1 trwood s Ca _ City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 t the Business a rofesslons Cade, and my license is in full force and eft License Class C 20 s Nd. 346251 DatelR�j�L Slgnature 040 WORKERS' COMPENSATION DE RATION t hereby affirm that I have a cert!(! to of consent to salt -insure or a certificate of Workers' Corn6ensation Insur nce, or a certified copy thereof (Section 3800, Lab. C.) olicy No. - WC9824 Company Lumber -mans Certified copy is hereby furnished. Certifie c y Is filed with the city Build!{1 v ion. Dated Applicant }.,ewe -o & EXEMPTION FROM WORKERS' COMPENSATION DECLA ATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit Is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become Subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with Stich provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code., Any city or county which r@quires is permit to construct, alter, improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 violatlon of Section 7031.5 by any applicant for a permit subjects the applicant to a civil ,nalty of not more than five hundred dollars (5500). I, as+ owner of the property or my employees with wages as their sole ,mpensation, will do the work, and the Structure is not intended or offered For sale (Section 7044, Businoss and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/harsetf or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rdve forr the purpasa of Sala), 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractorlsl license pursuant'to the ContraCtor's License Law). I am aware that proof off their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have rea information is correct. I agree and state fa acing to but it sentafives "Y' Inspectl purSignatureDrivers' L!c this application and state that the above omply with all city and county ordinances construction, and hereby authorize repre- upon the above-mentioned property for ate 7 5 -,u Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Cl Firepl/Fact. Bit. ICBO # 1 Heating System & Ducting 90-1()0,000 BTU ❑100,00013T Reinspection Fee 1 $15 AF 0855-46, rev. 10/84 White - Building; Canary - Applicant; Pink • Accounting; Goldenrod - Assessor . Issue Fee PLUMBING FEES ELECTRICAL FEES 2269 5/03!65 15054 TYPE OF CONSTRUCTION 0 NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. -0 Zone S Main Building: Accessory Building: Transformer Cl 15-50 KW ❑ 50+ KW TYPE OF PERMIT GRADING El FDUNOATIONSTRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING Q MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CON STRUCTION TYPE VALUATION S ZONE GRADING CU.YDS. ACRES E T Front Z O B A Rear N I Solar Collectors Right N K Left G R Ping. Ref, # Parking Req,/Provided E Remarks: Planning Notes: O M , Fan T S Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Cl Firepl/Fact. Bit. ICBO # 1 Heating System & Ducting 90-1()0,000 BTU ❑100,00013T Reinspection Fee 1 $15 AF 0855-46, rev. 10/84 White - Building; Canary - Applicant; Pink • Accounting; Goldenrod - Assessor . Issue Fee PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink $15 Issue Fee Automatic Washer Construction Pole Sub. Transformer Cl 15-50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection REQUIREMENTS: Cooking Unit Meter ❑up to 100amps Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel prinking Fountains Solar Tank , Fan Motors 00-1 HP 0 ti<, - 8 Floor Drains Swimming Pool w/Spa F,A,U- Inc. Solar ❑9-15 HP 016.15+ Floor Sinks Gas Service Outlets Urinal 'Water Closet Fixtures Device Boxes Microwave Pole Light Interceptors Kitchen Sink Water Heater Water Service Outlets Switches Range Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator ❑0.5 KW 1:15-15 KW Trash Compactor Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Cl Firepl/Fact. Bit. ICBO # 1 Heating System & Ducting 90-1()0,000 BTU ❑100,00013T Reinspection Fee 1 $15 AF 0855-46, rev. 10/84 White - Building; Canary - Applicant; Pink • Accounting; Goldenrod - Assessor . Issue Fee 5 3 Reinspection Fee $15 Issue Fee $ 3 AANICAL Hood or Type I Cl Canopy Type I1 ❑ FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date Dat Refrigeration System ❑0.100,000 BTU 0100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ $ $ 13.00 $ 2, 50 _ _ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ 15.50 System Repair/Alteration Fire Dampers Registers 6 00 Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POOL i APPROVALS Permit # Date Inspector 1 Temporary Electrical Service or Pole 52. Pool & Equipment Location t 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement r' f 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. f 57. APPROVAL TO COVER-GUNITE 7'. Footings 58. Electrical Conduit-Undrgrnd., 8; Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10.. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Conigectign 62. Backwash & Receptor -Final .12. Sewer Cap t>` 63. Heater & Vent -Final 13. Roof Drains 4 64. Plumbing System - Final 14, Rough Plumbing 65. Electrical -Final 15. Rough electrical -Conduit fib. 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 APPROVALS- Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72, Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 7B. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT .31. Plaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51: CERTIFICATE OF OCCUPANCY No. Hate Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY Of COSTA MESA CONSTRUCTION PERMIT P IT NO. TRACT NO. LOT NO. UNIT N0. Project Address "71! w IIT'rL, �i]d Applicant's Mailing Address Owner's Name T�aY - r�� ESTmry_ Phone Address Arch IE ng. License No. Address Contractor's Name Mg)PLOS F1 -f Q(L Phone Ob Address (mailing) 1'26T sitafur sm alit a City License No, ', 3 G3 f t> — - - — LICENSEO CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 4 (commencing with section 7000) of Division 3. ess a d Prot Ions Code, and my license is in full force and Off License Class ice se No + Date Signature WORKERS'COMPENSATION D£CLARATIO I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance. or a certified copy thereof (Section _ 800, Lati. C.) olicy No. Certified copy IS herebyfurnished Certified copy isfrfed with the cit Buil ' ilio r-- Dat e�11 O� �� Applicant ++t�- EXEMPT.ION FROM WORKERS' COMPENSATION ECLARATION (This section need not be completed If the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued i shall not. employ any person in any manner so as to become subject to the Workers' Compensation ,Laws of California. , Date Signature NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation, provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is ,issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit -to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 nasty of not more than five hundred dollars ($500). I, as owner of the property or my amployees with wages as their sole .npensatlon, will do the work, and the structure is not intended or offered Tor sale (Section 7044, Business' and Professional Code: The Contractor's LICensO 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of Com- pletion, the owner will have the burden of proving he/She did not build or im- rove for the purpose of sale). ' I, as owner of theproperty, am exclusively contracting with licensed con- 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 , buiids-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 proof of, their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I herebyvicertlfy that -,,have read this application and state that the above information Is Corr I agree to comp with all city and county ordinances and state I ting to buildi g co st uctlon, and and authorize repre- sentatives f thi city to ent r,up the above-mentioned property for inspection urp } , � �( Signature Date �_� Drivers' License or SS lE_',1 F7 �- TYPEOFCONSTRUCTION LJ NEW LJ ADD LJALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. q16• DESCRIPTION OF WORK/USE OF BLDG. S Main Building E TYPE OF PERMIT' GRADING FOUNDATION STRUCTURAL T From ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ -OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K' CON ST RUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping, Ref. Remarks: , - Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks , Gas Service C Interceptors Kitchen Sink Lavatories T P --Trap Roof Drains Reinspection Fee Boiler PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Lets Water Closet Water Heater Water Service Auto -Wash Laundry Trays $15 Issue Fee Duct - Under Ground Duct - Structural Duct • Ventilating _ Exhaust:System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO 9� Heating System & Ducting E10-1 00,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 _1 - CMF 0865-46, rev, 10184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type 1 ❑ Canopy Type II' ❑ Refrigeration System E10-1 00,o00BTU blo0,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES L 5902 1/f 6/85 4.50 TL Zone Accessory Building: Z O N I N G R Parking Req./Provided E � Q M T S. ELECTRICAL Automatic WasherTransformer ❑ 15.50 KW Construction Pole Sub. ❑ 50:+ KW Cooking Unit i Dishwasher Dryers ❑Gas' ❑Electric «! Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW 05.15 KW Meter ❑up to 100 amps Meter Dover 100 amps Sub Panel Motors 101 HP ❑ 1 i4 8 Inc. Solar 09-15 HP 1:3 16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES $3 Reinspection Fee $15 1 1 Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building. Approved By Application Issued Gy REQUIREMENTS: Date Date I Date + r SUMMARY OF FEES I BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL PLAN CHECK 50% .$_ MECHANICAL $ 1 PLAN CHECK 25% '$ SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTA'L FEE $ $ $ $ $ $ S� $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # pate Inspector POOL & APPROVALS Permit # Date Inspector 1. TCmporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57, APPROVAL TO COVER-GUNITE 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. 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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25, Roof Sheathing 74. Overhead Hydro 26, T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION 32, Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy 37: Final Factory Fireplace 38, Final Plumbing 39. Water Servlce-Final 40. Gas Service -Final 41. Solor Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System .45. Sound Attenuation' 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 1 51, CEFfTIFICATE OF OCCUPANCY No Date I, —1 CC1 Applicant to fill In all spaces except those within heavy border linesrand sign all appropriate declarations, CITY OF COSTA MESA-'EUNSTRUCTION PERMIT Project Address • 7.11 W. 17th ST Bldg. (G) Unit 10 Applicant's Mailing Address 13110 Saticoy S t . N . Ho llywoo Owner's Name Troy Investment Fund Phone 549 -2988 Address 4321 Birch St. -Newport Beach,ca. Arch/Eng. License No. Address —128$2 Knott Ave. Stuie 216 Contractor's Name nurn Air ConditioningPhone 982 —1216 Address imailing) - 131 10 Bata coy St N . Hollywood, Ca. City License No. 33925 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of harter 9 (commenting with section 7000) of Division 3 of the Business a d rofessions Code, and my IiGense Is in full for�� and eff 346251 License Class CGU Date- 4/18184 Signature WORKERS' COMPENSATION DE LARATION I hereby affirm that I have a certif' ate of consent to self -insure or a certificate If Workers' Compensation Insurance, or a certified copy thereof (Section 800, Lab. C"k9$24 Lumbermans Policy No. Company BCertified Copy is hereby furnished. ' DateCerts copy is filed with the city Building�!�p1�ivisian. . Applicant 1-" 1C D Mc EXEMPTION FROM WORKERS' COMPENSATION DECLAR TION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, f Shall not employ any person in any manner so as to become subject to the Workers' Compensation Law$ of California, Date Signature 'NOTICE: If, after making this declaration, you Should become subject to tha Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit • Shall be deemed revoked. CON$TRuCT10N LENDING AGENCY I hereby affirm that there is a construction tending agency for the performance of the work for which this permit Is ,issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any Structure, prior to Its issuance, also requires the applicant for such permit to file a signed Statement that he/she is licensed pursuant to the provisions of 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 , tierefrom and the basis for the alleged exemption. Any violation of Section 'K3k.5 by any applicant for a permit subjects the applicant to a civil Salty of not more than five hundred dollars ($500). `J 1, as owner of the property or my employees with wage$ as their sole compensation, will do the work, and the structure is not Intended or offered for safe (Section 7044, Business and Professional- Cade: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have:the burden of proving he/she did not build or Im- Me for the purpose of sale). , as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property wno builds or improves thereon, and who. contracts for such project$ with a con- tractor( license pursuarit'to'the Contractor's License Law), I am aware that pro4f of their Worker's Compensation insurance should be provided tome. 0 1 am exempt under Section B. & P. C. for this reason Date Owner t hereby certify that I have rea, information is correct, I agree and State la relating to bu it sentgtives his city to ter lnsptctio pur oSeS, Signature �.0 Drivers' Lice se or'SS this appllcation and State that the above amply with all city and county ordinances construction, and hereby authorize repre- upon the above-mentioned property for PERMIT NO 4TRACT �~( (o NO. LOT NO. UNIT NO. o 2290 �J703�� , 15.50 TYPE OF CONSTRUCTION NEW ADD ALTERATION F1 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER --_- 1` ___ DESCRIPTION OF WORK/USE OF BLDG. REPAIR A.P. # zone S Main Building: Accessory Building: TYPE OF PERMIT El GRADING LJ FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL 1:151 PLUMBING MECHANICAL ❑ •OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU. YOS. - ACRES E T Front Z O A Rear N C Right N S Left G R Ping. Ref. qIEParking Req./Provided E Remarks: Planning Notes: Q M T PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Waslier Construction Pole Sub. Transformer ❑ 15-50 f<W El 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter Dup to 100amps Clarifiers Solar Collectors Dishwasher Meter ❑oyer 100 amps. Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan . Motors 1:10-1 HP 1:11'/, - 8 • Floor Drains Floor Sinks '_ Swimming Pool w/SpaF.A.U, Urinal Fixtures lnc.Solar'09-15 HP ❑16-15+ Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors -Water Heater Outlets Range Kitchen Sink Water Service Switches . Sign Lavatories, Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator ❑0.5 KW 1115.15 KW Trash Compactor Roof Drains i Reinspection Fee $15 Issue Fee $ .3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Duct - Under Ground Hood or Type I El Canopy Type I I 1:1 SERVICES REQUIREMENTS: Zoning Approved By Building Building Approved By Application Issued By . Date Date Data _ Z— Duct - Structural Refrigeration System 00.100,00013iU 01100,000 BTUSUMMARY Duct - Ventilating BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ 1_ TOTAL FEE $ 15.50 Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit, ICBO y0 Fire Dampers 1 Heating System & Ducting 6 0-100.000 BTU ❑ 100,000 13TL Registers 4 LO Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 30/84 White - Bulldfng; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING ° APPROVALS . Permit # Date Inspector POO .PA 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 f ,5, Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. - r 57. APPROVAL TO COVER-GUNITE 7. Footings s 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, ❑ Undrgrnd.; Test , 8: Foundation a� 9. Water Pipe-Undrgrnd. - j 60. Backwash Lines, P -Trap, ❑ Undrgrnd. .10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connfction 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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ 0il 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas O Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural] & Monocoat 75. Dry Chemical r27. Frame and Flashing 76. Dry Standpipe 28, lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30.. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32: Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes, 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer• 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No, Date Applicant to fill in all spaces except those within heavy border lines and sign all'appropriale declarations. CIT.Y.O� COSTA MESA CONSTRUCTION PERMIT ~Project Address Applicant's Mailing Address Owner's Name T�Q� INy�S`�m End Phone Address: PERMIT NO. 2 TRACT NO. LOT NO. UNFIT NO. 0, -- to _ 5903 1/16/85 - r' IS TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. # Zone Transformer -❑' 15-50 KW ❑ 50 + KW Main Building: Accessory Building: — _ Arch/Eng. License No. Address _ TVPE'OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ElMECHANICAL ❑ OTHER PROJECT DESCRIPTION Std. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU. YDS. ACRES E T Front _ B Rear ��-r 1 ti..E ! C _ Phone Contractor's Namhr5 -6' 766F e=€ • r kE� � Address Imailing) 571 LQ ,IJ6TDfvi G?� I City License No. �J - LICENSED CONTRACTOR DECLARATION A C R ight K S, L�. eftTION Ping. Ref.:* Parking Req./Provided Remarks: Planning Notes: - - I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of th usmeSS 8 d Pr $!ions Code, and my license is in full fort and effee . G License Class C- Lic se Ninrs 3 j7 Date i -1L}' �� Signature WORKERS' COMPENSATION DECLARATIO I hereby affirm that I have a certificate of consent.to self -Insure or a certificate ,f Workers' Compensation €nsurance,'or a certified'copy thereof (Section J800,' Lab: -C.) Policy No. JSa.1" .� % D y 8 Certified copy is hereby furnished Certified co y is filetl with the cit u- in vision Date y t Applicant EXEMPTION FROM WORKERS' COMPENSATION ECLARATION (This section need not be completed if the permit is for one hundred ($100)or less). I certify that in the performance of the work for which this permit is issued I sha,I,not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. , . Date Signature ` NOTICE: If, after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall" be deemed revoked. CONSTRUCTION'LIENDING AGENCY - - ' i I hereby afflrnt that there is -a construction lending agency for the performanCe of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name, Lender's Address. ' - OWNER BUILDER bECUARATION - , - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Sertlon 7031.5 Business and Professional Code: Any city or ' county which requires a permittoconstruct, alter, improve, demolish or repalr any structure, prior to its issuance, also requires the'appti"nt for such permit 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 Division 3 -of the Business and Professions Code) or. that he/she is exempt erefrom and the basis for the alleged exemption. Any violation"of Section 31.5 by any applicant for a. permit subjects the .applicant to a civil =nalty of not more than five hundred dollars '❑ 1,-as•owner of, the property or-my,employees with wages'as their. sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7U44, Business and Professional Code: The Contractor's License Law does not apply to an owner of d property -who builds or improves thereon, and -who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for - sale. If, however, tht building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed Con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law aoeS not apply to an owner of property who builds of improves, thereon, and who contracts -for such projects with a con- j tractor(S) license pursuant'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me, ❑ 1 am exempt undkr Section B. & P. C. for this reason Date -- Owner I hereby certify- that I'have rea this plication, and state that the -above - information is C . I, agree to omPh/with all city and county ordinances and state latin to buildi g co s uction, and hereby authorize repre- sentative of , i c to ente yup the above-mentioned property for Inspectio Signature date Bar Sink Backflow Preventer Backflow irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof -Drains Reinspection Fee Boiler $15 Duct- Under Ground ' Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 00-100,000 BTU 13100,0063T t ' I Drivers' License or 5S I Reinspection Fee CMF 0865-46, rev, 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 605© TL Z O N I N G R E. Q M T S IMBING FEES ELECTRICAL FEES Showers Service Sink4 - Automatic Washer Construction Pole Sub -- Transformer -❑' 15-50 KW ❑ 50 + KW Sewer Cap � Sewer Connection u r,+ . Cooking Unit Meter ❑up to 100 amps Solar Collectors Dishwasher Meter Dover 100 amps Solar Piping ' Dryers ❑Gas ❑Electric Sub Panel, Solar Tank Fan ' Motors P40-1 HP ❑ 1'A - 8 Swimming Pool w/Spa Urinal F,A.U. Fixtures Inc, Solar 139-15 HP 1:116-15+ Microwave - Water•ClOset Water Heater Device Boxes Outlets ,Pole Light Range Water Service Switches 'Sign Auto -Wash Garbage Disposal ;Standing Sections Laundry Trays Generator 00.5 KW 05.15 KW Trash Compactor , t Issue Fee $ 3 Reinspection Fee $15 Issue+Fee r $ 3 iANICAL Hood or Type I Canopy Type 11 . El ' - FEESI - DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date / Date, Refrigeration System 00-100,000 BTU 0100,000BTU SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ 1 PLAN CHECK 50% 1$ - S(i MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% ,$ System Repair/Alteration Fire Dampers Registers 4 " Issue Fee $34, E CONSTRUCTION AND PLANNING Date - _• APPROVALS Permit # Inspector POO SPA 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 USER 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, 0 Undrgrnd. .10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65, Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67, Fencing & Access Approval 17, Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 Dotes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. 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 Nn. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONI PCT1`O�I -PER PERMIT N 1. TRACT NO. LOT NO.UNIT NO, Meter ❑up to 100 amps C Project Address ~-K Meter Clover 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors ❑41 HP 01 % - 9 F,A,U, + Inc. Solar 119-15 HP, 016.15+' Fixtures Device Boxes Microwave " Pole Light % `•/ 0 13 - TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR Switches Applicant's Mai�lirt9yA�ddress ❑CONVERSION 11 DEMOLISH El OTHER A.P. # Owner's Namc =/V k_4 // � �� Phone .� 2 G �/SIC% DESCRIPTION OF WORK/USE OF BLDG. $ S Main Building: Address �+ Arch/Eng `t License No. TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front iJ�G, Z17 Address/ � LJ TENANT' ❑ ELECTRICAL El PLUMBING � MECHANICAL B Rear ENERGY P.C. ,$ i El -OTHER -OTHER , $ GRADING Contractor's Nam hone �-Z %Gd PROJECT DESCRIPTION , Sq. FT. OCCUPANCY C K Right $ ' Address (matting) CONSTRUCTION TYPE VALUATION S S Left City License No, Z _ ZONE GRADINGCU.YDS. ACRES PEng, Ref.'94E LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: I Planning Notes: • with section 7000) of Division 3 of the Business and. Professions Code, and " r my licenseis in f force an effect, a (/r License CI s ' 41 ' e No. 7 b Date � Signature WORK RS' C(OMPIIINSATION DEQ RATION ' hereby affirm that I have a certifi a Of consent to self -Insure or a certificate Workers'gmpensation Insurance, or a. certified copy thereof (Section. ,Policy No, —�� Company BCertified copy Is hereby furnished, Certified copy is filed with the city Buil"ng Division, Arto- Date Applicant EXEMPTION FROM WORKERS' COMPENSATION OECLA ATION (This section need not be completed If the permit is for one hundred (5100) Or less). I certify that in the performance of the work for which this permit Is issued I shall not employ any person in any manner so as to become subject to tke Workers' Compensation Laws of California. Date ' Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of -the -Labor Code, you must forthwith . comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY' I hereby affirm that there Is a construction lending agency for the performance of the work' for which this permit is Issued (Section 3097 CIV. C.) Lender's Name i Lender's Address OWNER BUILDER DECLARATION ` 1 hereby affirm that I am exempt from the Contractor's License Law for the fo;towing reason (Section 7031.5 Business and Professional Code: Any city or County which requires a permit tolconstruct, alter, Improve; demolish or repair 1 any structure, prior to its issuance, also requires theapplicant for such permit - 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 - Division 3 of the Business and Professlons, Code) or that he/she Is exempt & :, ofrom and the basis for the alleged exemption. Any v{otatlon,of Section 1:5 by any, applicant for a permit -subjects the applicant to a civil "gatty Of not more than five hundred dollars (5500). i ,❑ I,'as owner of the property or my employees -with wages as their. sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business, and Professional Code: The Contractor's 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 employyes, provided that such improvements are not intended or offered for sale. I1, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- Eovei for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- 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 I builds or Improves thereon, and'who"contracts for SuCh'projects with a COn= tractor(s) 11Cense pursuant'to_ the Contractor's License Law), I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P; C. for this reason t Bar Sink I Backflow'Preventer Backflow Irrigation Bathtubs Clarifiers ; Dishvvesher Drinking Fountains Floor Drains ' Floor Sinks Gas Service' Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler'- Duct'- Under Ground Duct - Structural Duct - Ventiliting Exhaust, System ❑ Multiple ❑ Firepi/Fact. Blt. (CBO # Date Owner Heating System & Ducting ,I hereby certify that I.have read this application and State that the -above- O0-100.00013TU C 1100,00OBT information Incorrect. Ilagree to c ply with all,clty'and county ordinances and state ws relating to buildin c nstruction, and hereby authors repro- .sentativ O this city en e u n the above-mentioned pro rty o Inspect] ur seS. C Signature at v Drivers' Li se or SS l Reinspection Fee CMF 0865-46, rev. 10/84 White - Building; Canary • Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap, Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa -Urinal - Water Closet Water Heater Water Service Auto -Wash Laundry Trays { issue Fee Hood or Type I ❑ Canopy Type II ❑ Refrigeration System ❑O-100,000 B+U ❑ 100,000'BTU System Repair/Afteration Fire Dampers Registers FEES. I $15 Issue Fee $ 3 ` 3661 12/07/14 53pE'S TLI Zone Accessory Building; Z O N I N G R_ Parking Req./Provided E Q - M - T is I Reinipection Fee I $15 I 1 Issua Fee ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter Clover 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors ❑41 HP 01 % - 9 F,A,U, + Inc. Solar 119-15 HP, 016.15+' Fixtures Device Boxes Microwave " Pole Light Outlets Range Switches Sign Garbage Disposal ; Standing Sections Generator'00.5 KW. 05-15 KW , Trash Compactor $ PLAN CHECK $ PERMIT I Reinipection Fee I $15 I 1 Issua Fee I $ 3 , DEVELOPMENT SERVICES REOUIREME(VTS:. Zoning Approved By Date Building' Approved By Date Application Issued By - - Data SUMMARY DF FEES BUILDING PERMIT �$ SMIP $ PLAN CHECK $ PERMIT l PLUMBING $ ISSUANCE $ PLAN CHECK 25% .$ ENERGY P.C. ,$ i ELECTRICAL $ GRADING $ PLAN CHECK 5096 $ MICROFILM $ ' MECHANICAL $ �7 �� TOTAL FEE PLAN CHECK 25% $ I • 1 CONSTRUCTION AND PLANNING Date APPROVALS Permit # Inspector POO: ;PA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location r - 2. Sail Pipe-Undrgrnd.' 53• Steel Reinforcement 3. Electrical ConduitlUtility-Undrgrrid. 54. Forms 4. Electrical ConduitiUridrgrnd. 55. Electrical Bonding ,,• 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 6• Electrical LIFER Grnd. r%` 57. APPROVAL TO COVER-GUNITE {_-• �f •7. Footirigs� E 9 58. Electrical Conduit-Undrgrnd. ; 8. Foundation { 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. 'Property Sewer Line. & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap i 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 APPROVALS Permit'# 20. Rough Factory Fireplace 21. -Ducts, in Structure 70. Underground Hydro 22., Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T•Bar Ceiling. (Structural) & Monocoat z 75. Dry Chemical 27: Frame and Flashing 76. Dry Standpipe 28: Lathing & Siding 77, FIXED SYSTEM FINAL 29._ Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: _ 34. Final Heating -& Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final - 42. Backflow Preventer _ 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46, Handicap Regulations 47. FINALS RUCTURE& BUILDING 48, Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51'. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OFCOSTA MESA ' CONST R CTION PERMIT Projef,+Address _ r Apprlicant's Mallin Address 1r Owner's Name r %1 f Pho Address Arch/Eng. _ License No. Address AAA JtH^ Contractor's Nam Phone Address (mailing) City License No. : _ LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in fu force and effect. Licen Class License No - pate • Signature WORKERS' COM SATION DEATION I her@by affirm that I have a certific a of consent to self -Insure or a certificate Pt Workers' Compensation Insurance, or a certified copy thereof (Section_ 3800, Lab. C.) Policy No. Company Certified Copy is hereby furnished. Certified copy Is filed with the city Building Division. Date �, Applicant ' _ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit Is for one hundred (5100) or less), I certify that m the performance of the work for which this permit is issued 1 shall'not employ any person In any manners as to become subject to the Worker ' Co a ation Laws of Calif Date " Signature„ •NOTICE: I ter making this deClarf on, 0u ShouI?become Subject to the Workers' Compensation provisions the Labor Code, you must forthwith comply with Such provisions or this permit shall be deemed (evoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name - Longer's�Address _ OWNER BUILDER DECLARATION - 1 hereby affirm that I am exempt tiom the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or couhty which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed Statement that he/she Is licensed pursuant to the provisions of 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 331:5 by any applicant for a permit subjects the applicant to a civil an,alty of not more than five hundred dollars ($500). El I as owner of the property or, my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property•wholbuilds or improves thereon, and who does such work himself/herself-or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however. the building or Improvement Is sold within one year of Com- pletion, the owner will have the burden of proving he/she did not build or im- roye for the purpose of Sala). I, as owner of the property, am exclusively contracting with licensed Con- 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 builds or improves thereon, and who contracts for such projects with a Con- tractor(s)Il Cense pursuarit to the Contractor's license Law). I am aware that proof of their Worker's Compensation insurance should be provided to me, c ❑ 1 am exempt under Section B. d. P. C. for this reason Date t Owner I ht'reby certify that I have read this application and State that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for Inspection pure ses. Date Signature Drivers' L e �e r SS TYPE OF CONSTRUCTION NEW LJ ADD L2 ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P., DESCRIPTION OF WORK/USE OF BLDG. S Main Building: • TYPE OF PERMIT E GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ ,OTHER A PROJECT DESCRIPTION SQ. FT, OCCUPANCY C Right CONSTRUCTION TYPE VALUATION 5 g Left ZONE GRADING CU. YDS. ACRES Ping. Ref. aW Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains, Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap' Roof Drains ' .Reinspection.Fee s15 Boil6r Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit, ICSO Heating System & Ducting ❑ 0-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 S15 JIBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal ' Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee IANICAL Hood or + Type I ❑ Canopy Type I I ❑ ; Refrigeration System r OD-1100,00OBTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers CMF 0865-46, rev. 10/84 White - Building; Canary - Appl Cant; Pink - Accounting; Goldenrod - Assessor - - Issue Fee FEES /D5B96 7/02/55 - — IZonee Accessory Building: ' Parking Req./Provided - ELECTRICAL Automatic Washer Transformer ❑ 15i50'KW - Construction Pole Sub. 1-150'+ KW Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan• F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW ❑5-15 KW Meter I Jup to 100 amps Meter ❑over 100 amps Sub Panel Motors 00-1 HP ❑1%-8 Inc. Solari09.15 HP ❑ 16-1 s+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 10050 YL Z O S 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved 9y Building Approved By Application Issued BY REQUIREMENTS:' a1=11 Date Date Dat 11/ D BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ Yn $ $ $ $ �^ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE I S 3 - JCONSTRUCTION AND PLANNING APPROVALS Permit # At z . Date Inspector /, } POO, 3PA APPROVALS Permit # Date Inspectnr 1Temporary Electrical Service or Port J (� 52. Pool & Equipment Location 1, �J 2. Soil'Pipe-Undrgrnd. I' -,� 53. Steel Reinforcement t 31! Electrical Condut� Utirjry-Undrgrnd:/ s v 54. Forms 4^Ele`tr.ConduiC,Undrgrnd. 55. Electrical Bonding �r S 1)$teel`ReinforceAnt 56. Rough Plumbing & Pressure Test 6• �Eiectricel OF ER:Grnd. .rte .. 11. Ir . - f . 57. APPROVAL TO COVER-GUNITE ��Footings f��.i �� . �' 58. Electrical Conduit-Undrgrnd. r� t, _ S. F6�untlation �fi �' 59. Gas Pipe, ElUndrgrnd., Test 9- Wa""te4ipe-Undr rrnd. �' �� t- g.._•1 � Lt - r 60. Backwash Lines, P -Trap, ❑Undrgrnd- d f 10. Structural Floor'Sys>'em 61. APPROVAL TO DECK f� 11. PropertbSewer Line & House Connektion _n 62. Backwash &Receptor -Final 12. Sewer 7 i 63. Heater & Vent -Final .� 13. Roof Drains v, 64. Plumbing System - Final 14. RoughfPlumbin'g_"� 65. Electrical -Final 15. Rough Electrical -Conduit f 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas © Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 9_�r 36. Hood or Canopy F! 37. Final Factory Fireplace 38. Final Plumbing 139. Water Service -Final 40. Gas Service -Final r"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 Np, Date _ Applicant to fill in all.spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PE T N T ACT NO. LOT NO. UN T NO. �'�" 'old l'D Project Address11 TYPE 4.F CONSTRUCTION NEW ADD ALTERATION REPAI R Applicant's Mailing Address 11' 8 Phone P� Jf45�� ONVERSION ❑ DEMOLISH ❑ OTHER A.P. # Owner's Name DESCRIPTION OF WORK/USE OF BLDG. Address �� %r,r �«1, �_ S Main Building: Arch/Eng. License N Address —� Contractor's Name Phone: Address (mailing) City License No. ' LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9: (cornmencing with section'7000) of Division 3 of the BuSiness and Profession$ Code, and my license is in full force and effect. License Class License No: Date Signature WORKERS' COMPENSATION DECLARATION' r hereby affirm that I have a certificateofconsent to self -insure or a certificate 1 F Workers' Comp nsation .insurance, or -a certified copy thereof (Section 3800, Lab, C.) icy No. Company Certifietl o y Is hereby furnished. Certifi i filed with the city BuiIdIn 'vis' Date Applicantaaeo4t, EXEMPT O FROM WORKERS' COMPS ATION DECLARATION (This sec ion need not be completed if the permit is for one hundred ($100) or I certify that in the performance of the work for, which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor -Code, you must forthwith - comply with such provisions pr this permit, shall be deemed revoked. CONSTRUCTION LENDING AGENCY , . I hereby affirm that there is a construction lending agency for the performance of the work F hi .ttais rs ssu d tlon 97 Civ. C.) Lender's Name V -%��lr� i '' l i -ISA -M-- - ' t-- Lender's Address ; &3 Crh 1:511- h- - - -- dN . n( '— U OWNER BUILDER DECLARATION - - I hereby affirm that I am exempt from the Contractor's License Law •for the following reason (Section 7031.5 Business and Professional Code, -Any city or county which requires a permit to construct, aiter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for,such permit to file a signed statement that ha/she is licensed pursuant to�the provisions of `the Contractor's License Law (Chapter 9 (commencing with Section 7000) of :'#." ,,vision 3 of the Business and Professions Code) or that he/she is exempt :refrom and the basis for the alleged exemption- Any violation of Section 31.5 by any applicant for o permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500), + ' h I, as owner of the property or my employees with wages as their sole , 'compensation, will do the work, and the structure isnot intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License.Law does not apply,to art owner of:a property who builds or improves thereon, and who does such work himself/herself or through his or, her own employees, provided that such irnprovements are note intended or offered for sale. If, however, the buirding'or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- ve for the purpose of sale). I,.as owner of the property, am exclusively contracting with licensed con- tract construct the project (Section 7044, Business and Professions Code: The Contractor.'s License Law -does not apply to an!owner of. property who builds or improves thereon, and .Who contracts far such projects with a can- tractor(s) license pursuant to the Contractor's License Law). I am aware that Proof of their Worker's Compensation insurance should be provided to me. L�-I amlexempt under Section B. & P. C. for this reason Date Ownet -I here - ertifj that I have read this application and state that the above infor ati n is correct. I ag ee to comply with all city andlcounty Ordinance$ and+state law lot' 't uilding construction, and hereby authorize repre- Bar Sink Backflow Preve-inter Backflow Irrigation Bathtubs Clarifiers _ Dishwasher Drinking Fountains ) Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains ' Reinspection 'Fee Boiler ' Duct - Under Ground Duct - Structural Duct --Ventilating Exhaust System ❑ Multipl Firepl/Fact.-Blt. lCBO # Heating System & Ducting ❑0.100,000 BTU O'100,00 i sentatives this i e -mentioned pro arty or � , inspection p f Sigr atur Reinspection Fee Drivers' L'+cense or SS : 1711. CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping, Solar Tank Swimming Pool vv Urinal Water Closet ' Water Heater Water Service Auto -Wash Laundry Trays —® ®_I ®_I ®®I ®I ®®I NOM': 0 $15 Issue Fee $ 3 - MECHANICAL FEES Hood or Type I E]; Canopy Type II El1 , Refrigeration System 1:10-100,000 BTU •QI00,000 BTU -- e El System Repair/Alteration - Fire Dampers i Registers I BT , i I � S151 1 - Issue Fee II I _ $ 3.1 _ 4509 5/9,_-Vt3 - I Zone Accessory Building: Z O N G . _ R Parking Req,/Provided E Q M _- T S. ELECTRICAL I FEES Automatic Washer ' Construction Pole Sub. I Transformer ❑ 15-50 KW ❑ 50 + KW TYPE OF PERMIT GRADIN FOUNDATION STRUCTURAL LJ -1:1ELECTRICAL�PLUMBING ❑ MECHANICAL Meter ❑up to 100 amps T Front TENANT ❑ .OTHER. Sub'Panel I B A Rear ' F,A.U. ! Inc,Solar ❑9-15 HP 1--l16-15+ 1 C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY Pole Light K Range CONSTRUCTION,TYPE -VALUATION$ Sign S Left ZONE GRADINGCU,YDS. ACRES� Trash Compactor Ping. Ref.# Remarks Planning Notes: '25%, TOTAL , Bar Sink Backflow Preve-inter Backflow Irrigation Bathtubs Clarifiers _ Dishwasher Drinking Fountains ) Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains ' Reinspection 'Fee Boiler ' Duct - Under Ground Duct - Structural Duct --Ventilating Exhaust System ❑ Multipl Firepl/Fact.-Blt. lCBO # Heating System & Ducting ❑0.100,000 BTU O'100,00 i sentatives this i e -mentioned pro arty or � , inspection p f Sigr atur Reinspection Fee Drivers' L'+cense or SS : 1711. CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping, Solar Tank Swimming Pool vv Urinal Water Closet ' Water Heater Water Service Auto -Wash Laundry Trays —® ®_I ®_I ®®I ®I ®®I NOM': 0 $15 Issue Fee $ 3 - MECHANICAL FEES Hood or Type I E]; Canopy Type II El1 , Refrigeration System 1:10-100,000 BTU •QI00,000 BTU -- e El System Repair/Alteration - Fire Dampers i Registers I BT , i I � S151 1 - Issue Fee II I _ $ 3.1 _ 4509 5/9,_-Vt3 - I Zone Accessory Building: Z O N G . _ R Parking Req,/Provided E Q M _- T S. ELECTRICAL I FEES Automatic Washer ' Construction Pole Sub. I Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit , Meter ❑up to 100 amps Dishwasher Meter Dover 10Q amps Dryers ElGas ElElectric Sub'Panel I Fan Motors 00-1 HP ❑ l % - B F,A.U. ! Inc,Solar ❑9-15 HP 1--l16-15+ 1 Fixtures Microwave Device Boxes ' Pole Light Outlets Range Switches' Sign Garbage Disposal Standing Sections Generator 130-5 KW 115-15 KW Trash Compactor i Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date 1 i Building Approved By Date Application Issued By � Dat .SUMMARY OF FEES BUILDINGiPERMIT $ SMrP $ PLAN CHECK $ PERMIT i 1 PLUMBING $ 9.00 _ ISSUANCE $ PLAN CHECK .25%I $ ! l' ENERGY•P.C. $ ELECTRICAL $ ' GRADING i $ I PLAN CHECK 50% $ MICROFILM ) S MECHANICAL I $ FEE $ '25%, TOTAL , PLAN CHECK $ .T CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POC SPA APPROVALS Permit # DateInspector 1. Temporary Electrical Service or Pole �y 52. Pool &Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Condi uit-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, El Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap - 63. Heater & Vent -Final 13. Roof Drains, Ir 64. Plumbing System - Final 14. Rough Plumbing 65, Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 4 16. Rough Electric Wiring 67. Fencing & Access Approval 17' Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electriral•T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. ,Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro 22: Ducts, Ventilating 71. Product Piping ❑Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79• FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: - 34• Final Heating & Air, Conditioning 35. Final Gas Pipe -Test 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 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 t ? 51. CERTIFICATE OF OCCUPANCY, No. Date _ Owner: MESA BUSINESS CENTER Permit: $394.75 F OWNERS ASSOCIATION CITY OF COSTA MESA f $6.30 Other: 1275 E CENTER CT DR BUILDING DIVISION 944 855 – l goo DEVELOPMENT SERVICES DEPARTMENT Zip: 4 �• PERMIT PERMIT NUMBER F Contractor: PACIFIC COAST WEATHER Address: 00981 W 18TH ST B99-00141 (714) 754-5273 Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 Phone: 949-548-9969 BUILDING PERMIT C.M. CA Job Address: 711 W 17TH ST Zip: Status: ISSUED Suite: H Applied: 01/28/1999 Vicinity: MESA BUSINESS CENTER Issued: 01128/1999 Parcel Nunmber: 93983082 Zoning: ' Applicant: HANSEN, DOUGLAS Address: 00981 W 18TH ST Phone: 949-548-9969 C.M. CA Zip: 92626 Owner: MESA BUSINESS CENTER Permit: $394.75 Address OWNERS ASSOCIATION SMIP Com: $6.30 Other: 1275 E CENTER CT DR Phone: 944 855 – l goo %L13F MANAGEMENT CO Zip: 91724 SlEfk E;0ZC— Contractor: PACIFIC COAST WEATHER Address: 00981 W 18TH ST Phone: 949-548-9969 C.M. CA Zip: 92626 License:' 699611 Arch : Eng: Address: Address: Phone: Zip: License: Phone: License: SCOPE OF PERMIT TIO EXIST,; RE -ROOF "SBS" HOT MOP; 11 -YR ROOF. RE -ROOF IS FOR "H" BUILDING. oWNER IS LISTED AS G-010. SHEATHING WILL BE REPAIRED ONLY AS NEEDED. Plan Check: $0.00 Permit: $394.75 SMIP Res: $0.00 SMIP Com: $6.30 Other: $0.00 Inspection: $0.00 Total: $401.05 SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 ACCESSORY Front 0-0 Rear 0-0 PARKING Existing: 0 Required: 0 NOTES: FEE SUMMARY ` PLANNING & ZONING Left 0-0 Left 0-0 Proposed: 0 Calc Valuation. $30,000.00 Claim Valuation: $30,000.00 Right 0-0 Right 0-0 EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to sell-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the labor Code, for the pertonnanoe of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number. (Th1s section need not be completed it the permit is valued at one hundred dollars ($100) or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws o1 Califomle, and agree that i1 I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these p5lqvinions. �7 [] Applicant Signature: Date: L� 4 WARNING: FAILURE TO SECURE WO RS' COMPFJ NATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($1100.000), IN DITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provislons o1 Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professlons Code, and my license is in full force and effect. LIc. p Class p Contractor's.Signature: Date: — CONSTRUCTION LENDING AGENCY: ❑ 1 hereby off inn that there is a construction lending agency for the performance of the work for which this permit Is issued, (Sec. 3D97, Civil Code), Lender's Name: _ Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to Constrict, after,'improve, demolish, or repair arty structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 8 (commencing with Section 7DDO) of Division 3 o1 the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031,5 by any applicant for a permit subjects the applicant to a civI penalty of not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors Licanse taw does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business end Professions Code for this reason: Signature: _ _ Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.a, - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMrT CERTIFICATION: ❑ I hereby certity that no excavation five (5) or more feel in depth into which a person Is required to descend, will be made in connection with work authorized try this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by ovary business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gat at standard temperature and pressure). .......................................................................................................................a.r.e......................................'y.h................................................................................................. 2 Does or vvl[I the applicant or present or future building ocarpent need to file a reg€stiction form for ecutefy hazardous materials? ❑Yes � No (Section 25533 431 the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time hes on hand a quantity of acutely hazardous materials equal to Or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certificetion end filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ..................................................... ... ......................................... ....... .... ............................................................................... I.,...................................................................-..... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully compiled with? 0 Yes ❑ No ................................................................................. IId'i-................................. r.t'h........................................-..............................................f'o.r................t'r,u.............................-n. 5 Does or wll] the eppl€cant or present or, future building occupant require for the work which is the s' 'u-6 of this a pllCalbn a ermit for such constructkon or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes I No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residentlal building permits). ................................. ....................................... ..... .... ..................................................................................... ..... I..........I........ ..................................................-------... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries o1 a school? ❑ Yes ❑ No (if "yes", the facility must meet the requiroment of Sections 25534 and 42303 of the Callfomia Health and Safety Code). - - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 7 If a parmlt from the South Coast qtr Quality Management District or other air pollution control district or agencyis required for the work which is the SubJect of this application, have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes [3 No ... ................................................................................................................................................................................................................................................................. 8 (I1 yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above Is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certily under penalty of perjury that I have read this application and state that the Information given is correct. I agree to Comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes, I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. natu a df Legal Owner(s)Date �r Z�' AndiOr Authorized Applicant Date CgD" INSPECTION TYPE QSTE SBL CODE INSPECTION TYPE GATE INTMA1,"t 1616 Fixed System Final Fire Prevention 200 Final Mechanical 1268 Pool Spa Final �208 Final Plumbing 2DO Final Re-Root �� 210 Final Electrical 201 Final BlockfReta€ning Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final BulldinglOccupency 2446.46 CITY OF COSTA MESA _ / 3 O O 7 CONSTRUCTION PERMIT Appl Ica nl to fill In all -spaces except those within I PERMIT NO. TRACT N 13' Project Address _'7_7 1 W. 7 7th--St-rept Applicant's Mailing Address'. Blvd - owner's Name Trn)y34_pct.ment Fund Phone 549-298 Address 432_1 Bir -ch qt__,._Nt-wpnrt Reach Arch/Eng. WT1I _ T, -APE r A_i r a ASS,, C CA Anse No. Address 24. B Mar_Ari--hur 137-vd__y n_r m -a ci P 1 M Contractor's Name hone Address (mailing) City License No, LICENSED CONTRACTOR DE ARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Coda, and my license Is in full force and effect. License Class License No. Date. - Signature ORKERS' COMPENSATION DECLARATION iereby affirm that I have a certificate of consent to WI -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3600, Lab. C.) Policy No. _ 5242000I6$3company Argonaut H Cgrtifled copy is hereby furnished. Cdrtifled copy Is flied with the city Building Division, Dale Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit 1S for one hundred ($100) or less). I certify that In the performance of the work for which this permit is Issued I shall not employ any person In any manner so aSA become subject to tyre Worker pe a I n Laws of Ca ornia, Date Signature NOTICE/ If,ia er aking this deciar n, you should become subject to the Workers' Compensation provisions f he tabor Code, you must fortnwith comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION'LENDING AGENCY 1 hargby affirm that there Is a construction tending agency for the performance of the work for which this permit is:Issued (Section 3097 Clv. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I heraby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter Improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 Of the Business and Profession$ Code) or that h@ she Is exempt therefrom and the basis for the alleged exemption, Any violation of Section 7031,5 by any applicant for ,a permit Subjects the applicant to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole CombenSatlon will do the work• and the structure is not Intended or offered for sate (Secilon 7044, Business and Professional Code: The Contractor's 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 employees, proviged that such Improvements are not intended or offered for Sale. If, however, the building or Improvement Is sold within one year of tom- plotlon, the owner will have the burtlan of proving he/she did not bulid or Im- , rove for the purpOse Of sale). I, as owner of the property, am exclusively contracting with licensed con- ctors to construct the project Section 7044, Business and Professions Code: The Contractor's Llcanse Law �oes not apply to an owner of property who bullrjs or Fmproves thereon, and who contracts for such projects w)th a con- trac_(or(s) license pursuant to the Contractor's License Law). ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby- Certify that I have read 4 application and state that the above Information Is correct. I agree to comply with all city and county ordinances and state laws relating to bufltling constructlon, and hereby authorize repre- sentatives of this city t enter. upon the above-mentioned properly for Inspectlon purposes, f _ Signature 11!d24(=a, . r _ _ Data Drivers' Lfc#nse or SS jP vy border lines and sign all appropriate declarations. 1 & 2 1 - H TYPE OF CONSTRUCTION U NEW U ADD L29 ALTERATION LJ REPAIR MCD CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 916 DESC RI PTION OF WORK FXtprinr Al -tPraf-inns 5 Main Building: TYPE OF PERMIT In GRADING D FOUNDATION 12 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear r ❑ -OTHERA C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY R-2 CONSTRUCTION TYPE VALUATIONS 42 963 ..2 nS Left ZONE GRADING CU.YDS. ACRES Ping. Ref. 'th 7 E 1 Remarks: P_ C.k20-84S Parking Req./Provided Use of Building: PLUMBING FEES Planning Notes: Sar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee S25 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating . Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICSO # Heating System & Ducting 0 0.100,000 BTU 0100,000 BT Reinspection Fee 1 $25 CMF 0865.46 6 rev, 32/@3 White - u ry - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping ' Solar Tank Swimming Pool,w/spa Urinal water C)oset Water Heater Water Service Issue Fee S 3 IANICAL FEES Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑ 0-100,000 BTU 0 100,000 BT U System Repair/Alteration Issue Fee 0111 5/10/84 254.51 Q Zone 14G Accessory Building: Z O N N G R E Park.Fees $ O U R E SPECIALMR RE UiMiENTS M E N T S ELECTRICAL FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures . Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW 05-15 KW Reinspection Fee - $ PUBLIC SERVICES REQUIREMENTS: Zoning'Approved By Building Approved By ' Application'Issued By Transformer ❑ 15.50 KW ❑ 50+KW Meter I Jup to 100 amps Meter Dover 100 amps Sub Panel Motors 1:10.1 HP ❑1'h - B Inc. Solar 09-15 HP 01&15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor Issue Foe 161'0 IKKG 91F r I _ SUMMARY O FEES BUILDING PERMIT•. S _954 --se- SMIP PLAN CHECK , , , $ PERMIT - =PLUMBING . - $ ISSUANCE PLAN CHECK 25% $ ENERGY P.C. ELECTRICAL , $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL - $ TOTAL FEE S 3 'PLAN CHECK 25% $ r :CONSTRUCTION AND PLANNING - Date APPROVALS . Permit # Inspector POOL a SPA APPROVALS , Permit # , Date = R Irispector_ 1: Temporary Electrical Service or Pale 52: Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53, Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54.' Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding. 5: Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. • 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test �.9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd., 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62- Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final j -,'l 5. Rough Electrical -Conduit 66. Solar System -Final - - 16. Rough Electric Wiring 67.1Fencing & 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- APPROVALS Permit'# , 20. Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydror ' 22. Ducts, Ventilating 71. Product Piping ❑ Gas, ❑ Oil 23. as Pipe -Rough &,Test 72. Underground Flush �.• - 24, oof Framing 73. Undergrnd. Sto+age Tank'❑ 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 7B. FIRE PREY. FINAL 30.E Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED . L 33. Final Electric Notes; 34, Final Heating & Air Conditioning 35: Final,Gas Pipe -Test 36. HoodDr Canopy 37. Final'Factory-Fireplace 38. Final.Plumbiiig' - 39. Water Service -Final 40. Gas Service -Final 41. Solar, Domestic -Final I V 42. Backflow Preventer 43. Backflow Irrigation. ; 44. Landscape irrigation System 45. Sound Attenuation 46. Handicap'Regulations _ 47, FINAL STRUCTURE&BUILDING y/�6 48. Special Requirements Completed 7q/ I ; 49. Electric Release to Edison , 50. Gas Release to Southern California Gas Co f•t ' 51. CERTIFICATE OF OCCUPANCY No. Date `I. Ch Applicant to fill in all spaces except those within heavy border lines andsign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PER R LT.NO. _ TRACT NO. LOT NO. U NO. Project Address?1 'I - J 7_r'4-5 f Applicant's Mailing Address Owner's Name fF L Eld � 7' Pho Address Arch/Eng.A`cNicense N if Address E �7� Contractor's Name G Phone ' Address (maiiingl City License No. LICENSED CONTRACTOR DECLARATION 1 -hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in Iiu1I force and affect. License Class. L -4,0 License No• Date ZZ Signature WORKERS' COMPENSATION OEC RATION 1 hereby •affirm that I have a certificate of consent to salt -insure or a certificate )f Workers' Compensation Insurance, or a certified' copy_ thereof (Section 3800, Lab. CJ ) Policy No. S�,0937,� Company QM27---- -- - --- Certified copy is hereby furnished. Gera ed/cop � fited with the cit ]vista Date../�r0 -'•� ' - Applicant EXEMPTION FROM WORKERS' COMP ATION DECLARATION (This section need not be completed if thiVipermit is for one hundred ($100) Or less). I certify that In the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be doomed revoked. CONSTRUCTION LENDING AGENCY. I hereby affirm that there is a construction londing agency for the performance , of the work for which this permit Is Issued (Section 3097 Civ. C.) Lender's Name Lender's -Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a -signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of 'Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section .7031.5 by any applicant for a permit subjects the applicant to a Civil , penalty of not more than five hundred dollars ($500). I; as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale. (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property.who builds or improves thereon, antl who -does such work himself/herself or through his or her own employees, provided that such Improvements aro not intended or offered for sale. If,however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). I ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the projectlSection 7044, Business and professions Code: The Contractor's License Law does not apply to an owner of property who builds of -improves thereon, and who contracts for such projects with a con- tractors) license pursuarit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be Provided to me. ❑ I am exempt under Section B. & P. C. for this reason TYPE OF CONSTRUCTION L NEW U ADD LJ ALTERATION- L) REPAIR ' ❑ ❑ DEMOLISH ❑ OTHER Backflow Preventer - - Service Sink CONVERSION Sewer Cap A.P.46 DESCRIPTION OF WORK/USE OF BLDG.' Clarifiers Solar Collectors Dishwasher • Drinking Fountains S Main Build) Swimming Pool w/Spa Floor Sinks. E Gas Service Outlets TYPE OF PERMI.T�( GRADING LJ FOUNDATION STRUCTURAL T Front ❑ TENANT mil ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Auto -Wash ❑ OTHER .. A Rear PROJECT DESCRIPTION SQ. FT.• OCCUPANCY K Right CON STRUCT)ON TYPE VALUATION $ Lett ZONE GRADING CU. YDS. ACRES Ping. Ref. °/f Remarks: 7-'11 Planning Notes: Roof Drains Reinspection Fee , 1 $15 IVI EC�_ Boiler Hood or Duct - Under Ground Canopy Duct - Structural Duct.- Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO + Date Owner Heating System & Ducting I hereby certify that I have read this application and state that the above 0- 100,000 BTU ❑100.000871 information Is correct. I agree to comply with all city and county ordinances and state laws relating to building con ruction, and hereby authorize cadre- sentatives of 'this ci y to e r up the above-mentioned property for inspection p!w Signature Data Drivers' Licens r 55 Reinspection Fee $15 IF 0865-46, rev. 14/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee Type ❑ Type I I ❑ _, EN, MEN �1 �1 Refrigeration System 4 00-100,000 BTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher y Dryers ❑Gas ❑Electric 3739 12/1.0/9h 12a30 Tl Zone Accessory Building: Z O _ N ' I N G R Parking Req)Provided E Q M . _ T S ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter Cover 100 amps Fan F.A.U. Z Fixtures - Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 05.15 KW Sub Pane( Motors 00-1 HP ❑ 1'h - 8 ' Inc. Solar 09-15 HP 016.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor PLUMBING Bar Sink Showers Backflow Preventer - - Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks. Urinal L . Gas Service Outlets Water Closet = Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Trap - Laundry Trays Roof Drains Reinspection Fee , 1 $15 IVI EC�_ Boiler Hood or Duct - Under Ground Canopy Duct - Structural Duct.- Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO + Date Owner Heating System & Ducting I hereby certify that I have read this application and state that the above 0- 100,000 BTU ❑100.000871 information Is correct. I agree to comply with all city and county ordinances and state laws relating to building con ruction, and hereby authorize cadre- sentatives of 'this ci y to e r up the above-mentioned property for inspection p!w Signature Data Drivers' Licens r 55 Reinspection Fee $15 IF 0865-46, rev. 14/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee Type ❑ Type I I ❑ _, EN, MEN �1 �1 Refrigeration System 4 00-100,000 BTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher y Dryers ❑Gas ❑Electric 3739 12/1.0/9h 12a30 Tl Zone Accessory Building: Z O _ N ' I N G R Parking Req)Provided E Q M . _ T S ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter Cover 100 amps Fan F.A.U. Z Fixtures - Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 05.15 KW Sub Pane( Motors 00-1 HP ❑ 1'h - 8 ' Inc. Solar 09-15 HP 016.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor $ 3L ' Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: ' Zoning Approved By Date Building Approved By Date Application Issued By te (2410 SUMMAR OF FEES BUILDING PERMIT $ SMIP I $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ ' PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $� MICROFILM $ MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ $ 3 -S CONSTRUCTION AND PLANNING � }APPROVALS Permit # Date Inspector POOL &SPA APPROVALS Permit # Date Inspector y1 . Temporary Electrical Service or Pole 52. Pool &Equipment Location 2.Soil Pipe -Un drgrnd. 53. Steel Reinforcement 3' Electrical Conduit Utility-Undrgrnd. 54. Forms -4.-Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5.'Steel-Reinf6rcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE T. Footings' _ 58. Electrical.Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test ' 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10`Structural Floor System I 61. APPROVAL TO DECK 11.-Property;Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 1.3. 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 APPROVALS Permit # 20., Rough Factory Fireplace 21, Duets, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final /v 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning Y �' 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 3B. 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. Hand icap,Regulations 47. FINAL STRUCTURE & BUILDING 4B. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date - CITY OF COSTA MESA - CONSTRUCTION PERMIT /� D .Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. Project#�dr,"ss 711 W. '1 "/ t j1 Street App�l(�t'sMailingAddress:2418 MacArthur Blvd C.D. Owner's Name TSV in Vestment Fund Phone 549-2988 Address N t Beach _ ArchlEng.'WM_L. Pere ircl asSCUkenseNo. Address Contractor's Nam hone Address Imailingf City License No, LICENSED CONTRACTOR ECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect, License Class License No. Date Signature 'YORKERS' COMPENSATION DECLARATION Hereby affirm that i have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C. - Policy No, 54200016.83- company Argonaut Certifled copy Is hereby furnished.,"--' Certified copy Is filed with the city Building Division, Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit Is for one hundred ($100) or IBSS). � ' 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 t ecome subject to tie Work v s tion Laws of Calif of . Date Slgnalure NOTI : lf,aafter making this decla tl n, you should become subject to -the ' Workers' Compensation provisions the Labor Code, you must forthwith comply with such provisions -or this. permit . shall be deemed revoked." CONSTRUCTION ' LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance, of the work for which this- permit is Issued (Section 3097 Civ: C.) Lender's Name Lender's Address OWNER B01'CbER DECLARATION I hereby affirm that I am exempt from the Contractor's Llcense Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant,for such permit to file a:slgned statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of ` �Ivlslon 3 of the ,Business and Professions Code) or that he/she,is exempt ':haerefrom and the basis for the alleged exemption. Any vlolattion•of Section 1.5 by any applicant for. a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the property or my ernployees.vn ith wages as their sole compensation will, do the work, and the structure is not Intended or offered for sale (Secflon 7044, Business and Professional Code: The Contractor's Llcense 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 employres, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner:wlll have the burden of proving he/she did_ not build_ or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with -licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). ❑ I am exempt under Section & P. C. for this reason i Date -b Owner I hereby ce�Y that I` have grad j If application and state that the above Information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre= sentatives o this city t enter upon the above-mentioned property for inspection p poses. Signature Date Drivers' Llc se or SS CMF 0865-46 rev. 12/83 White P MIT NO. TRACT NO. LOT NO. BLD 11096 1 & z TYPE OF CONSTRUCTION Ll NEW Ll ADD 1 24 Al TERATEON IJ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK — H REPAIR _ 0119 .5/10/84: A.P. #Zone S I - Main Building: Accessory Building: Z TYPE OF PERMIT LJ GRADING D FOUNDATION 12 STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL- ❑ 'OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION S 800 _ 00 ZONE GRADING CU.YOS. ACRES T Front N A Rear S N C Right G S Left . 3 R E Ping. Ref. # ZF 6 2- Park. Fees $ a Remarks: P. C. #20-84S Parking Req./Provided 1 Use of Building: R E M E N T S PLUMBING FEES Planning Notes: Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap ELECTRICAL FEES Bathtubs . Sewer Connection Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Clarifiers Solar Collectors Dishwasher Solar Piping Cooking Unit Meter ❑up to 100amps" Drinking Fountains Solar Tank Dishwasher Meter El over 100 amps" Floor Drains Swimming Pool vv/Spa Dryers ❑Gas ❑Electric Sub Panel Floor Sinks Urinal Fan Motors ❑0.1 HP ❑1%-8 Ga's Service Outlets Water Closet F.A.U. Inc, Solar ❑9-15 HP El 16-15+ Interceptors Water Heater Fixtures Microwave Kitchen Sink Water Service Device Boxes Pole Light Lavatories Outlets Range P—Trap Switches Sign Roof Drains Garbage Disposal Standing Sections Generator 00-5 KW 05.15 KW Trash Compactor Reinspection Fee $25 Issue Fee $ 3 Reinspection Fee $25 Issue Fee $ 3 MECHANICAL , FEES' a PUBLIC SERVICES REQUIREMENTS: Zoning Approved By V S ✓►+ C' ate 3 :ff Building Approved By Date ;Application laved By / at Boiler Hood or Type I ❑ Canopy + Type I I Cl ti Duct - Under Ground —= Duct - Structural - Refrigeration System ❑0-100,000 BTU E1100,000,BTU System Repair/Alteration _ r Duct -Ventilating Exhaust System 13 Multiple ❑ � .i BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ CHECK 25% $ ' ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ SUMMARY OF FEES 1SO SMIP $ cSZ) _ i PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ Firep1lFact. Bit. ICBO # Heating,System & DuctingPLAN ❑0.100,000BTU ❑100,000BTL Reinspection Fee $25 - Issue Fee $ 3 cant; Pink - Accounting; Goldenrod - Assessor TL D (:CONbI KUCTION AND. PLANNING i ` Date s APP VALS Permit # Inspector - -;.POOL;,_ _�A R• APPROVALS_ Permit*- ` �= r ; , ` ?Date < . t - _ Inspector Te . orary Electrical Service or Pole 52., Pool & Equiprrtent'Location s2. Soil Pipe-Undrgrnd.. _ 53' Steel Reinforcement 3: Electrical Conduit Utility-Undrgrnd. 54.E Forms tt _ 4: Electrical Conduit-Undrgrnd. 55.E Electrical Bonding 5. Steel Reinforcement (�[� 56. Rough Plumbing,& Pressure Test , 6. Electrical UFER Grnd. 57.'APPROVALTO COVER-GUNITE 7, Footings 58: Electrical Conduit=Undrgrnd.- 8. Foundation 59. Gas Pipe,` ❑ Undrgrnd., Test'". 9. Water Pipe-Undrgrnd. 60. Backwash Lsines, P trap, C] Undrgrnd.: 10. Structural Floor System 61, APPROVAL TO -DECK V " 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 FiriaC '- I 16. Rough Electric Wiring- 67. Fencing& Access Approval ,17. Rough Wiring Sign 68. APPROVED FOR PLASTERING I = 18.. Rough Electrical -T Bar Ceiling - 69. POOL/SPA SYSTEMS' -FINAL 19.'Rou6h Heating & Air Conditioning , FIRE DEPT. REQUIREMENT a APPROVALS Permit ` • 20. Rough Factory Fireplace 21, Ducts, in Structure s • I I r r 70. Underground Hydro li , - 22. Ducts, Ventilating _ 71. Product Piping Gas "Ll Oil 23. Gas Pipe -Rough & Test72. Underground Flush , 4. f r 24. Roof Framing 73.' Undergrnd. Storage Tank. ❑ Gas ❑ Oil . I 25. Roof Sheathing 74, Overhead Hydro l 26. T -Bar Ceiling (Structural) & Monocoat 75. Drly Chemical - I • ' , 27. Frame and Flashing 76. Dry Standpipe ' 28. Lathing•&Siding 77.. FIXED SYSTEM FINAL .29. Insulation I 78.E FIRE PREV. FINAL -30. Drywall Nailing HEALTH DEPT. REQUIREMENT t 31. Plaster Brawn Coat 79. FINAL INSPECTION r 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE' ISSUED i I '• .33. Final Electric Nates: 34. Final Heating & Air Conditioning F 1 !I 35. Final Gas Pipe -Test 36. Hood'br Canopy l - 37. Final -Factory Fireplace 38. Final Plumbing F I 39. Water. Service -Final i 40. Gas Service -Final 41. Solar-. bmestic-F,inal - , 42. Backflow Preventer - 43. Backflow Irrigation I 1- 44. ,Landscape Irrigation System ; - 45. Sound Attenuation 46. Handicap Regulations , I 47. FINAL STRUCTURE & BUILDING I + 48, Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ; I 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY O,F COSTA MESA CONSTRUCTION PERMIT - - PERMIT NO. TRACT NO. . , LOT NO. UNIT NO. Project Address 71.0 I COSTft- me - Applicant's e -Applicant's Mailing Address' Owner's Name �K'ir�{ 11`jy�CSZYYI�lLI"r Phone _ Address Arch/Eng. __ _License No. Address , Contractor's NameG p G 1�� PhoneF��(�� Address (mailing) 14 ,1?IAAJT" ST ,E�_I-oot yl1 6—rfxJ � City License No. - LICENSED CONTRACTOR DECLARATION I hereby affirm that Imam licensed under provisions of?Cart (commencing with section 7000) of Division 3' of tie Iness anrof is ons Code, antl mylicense is in ful),forc andeffect License Class � /b Licenso. S Date__1— U ' Signature WORKERS' COMPENSATION DECLARATION whereby affirm that I have a certificate of consent o self -insure or a certificate �f Workers' Compensation insurance, or a certified copy thereof (Section 800, Lab. C.) policy No. C' �� C' BCertified cgpy is hereby furnished. Cert'fied cqp is -,Wed with the cit n visio Date ID" Applicant EXEMPTION FROM WORKERS' COMPENSATIOW DECLARATION (This section need not be -completed if the permlt'is for one hundred ($100)'or less). I certify that in the performance of the work for which this permit is Issued, I shall'not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date' - Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit 'shall be deemed revoked. CONSTRUCTION LENDING +AGENCY. I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is ,issued (Section 3097 Civ. C-) Lender's Name ' - Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that I am.exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or' county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 _ tty of not more than five hundred dollars ($500). cha I, as owner of, the,proPerty or my employees with wages as their sole compensation will -do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's ' License Law does not apply to an owher of a property who builds or Improves thereon,. and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for 1 sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Inn- ' rove for the purpose of sale). , I, as owngr of the property. am exclusively contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractor(S) 11cOnse pursuant tp the Contractoi's License Law). I am aware that proof o, their Worker's Compensation insurance shoultl be providetl to me. ❑ I'am exempt untler Section B. & P. C. for this reason r Date ' Owner I hereby certify that I have, read this application and state that the -above informatioWtorr is 1 agree t Com with all city antl county ordinances and state tobuild- g c0 tructlon, and hereby authorize repre- sentativesy toent r up theaboe-mentioned property for Inspection- Signature Date I-10- a JDrivers' L 5908 1/16/85 bp50 TL Zone . Accessary Building: Z O N G R Parking Req./Provided r E O M T S PLUMBING FEES TYRE OF CONSTRUCTION NEW ADD LJ ALTERATION LJ REPAI R ELECTRICAL ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Bar Sink Showers A, P. - OESCRIPTION OF WORK/USE OF BLDG, Automatic Washer t Construction Pole Sub. Transformer ❑ 15.50'KW ❑ 50+ KW " 5 Main Building: Sewer Connection r E Cooking Unit TYPE OF PERMIT L1 GRADING' FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑, MECHANICAL B Meter ❑over 100 amps ❑ O•rHER Dishwasher A Rear Dryers ❑Gas ❑Electric C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K' CONSTRUCTIONTYPE VALUATIONS / Motors 1 HP ❑1 h - 8 S Left ZONE GRADING CU.YOS. ACRES Ping. Ref. Remarks: Inc.Solar ❑9.15 HP 016-15+ Planning Notes: 5908 1/16/85 bp50 TL Zone . Accessary Building: Z O N G R Parking Req./Provided r E O M T S CMF 0865-46, rev, 10184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink - Automatic Washer t Construction Pole Sub. Transformer ❑ 15.50'KW ❑ 50+ KW _ Backflow Irrigation Sewer Cap Bathtubs Sewer Connection r Cooking Unit Meter ❑6P to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Sotar Tank Fan / Motors 1 HP ❑1 h - 8 Floor Drains Swimming Pool w/Spa F,A,U, Inc.Solar ❑9.15 HP 016-15+ _ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets interceptors Kitchen Sink Water Closet Water Heater Water Service Device Boxes Dutlets Switches Pole Light Range 'Sign Lavatories y Auto -Wash Garbage Disposal ; Standing Sections P -Trap' 'Laundry Trays Generator ❑0.5 KW ❑5-15 KW Trash Compactor Roof Drains , Reinspection F,ea $15 Issue Fee $ 3 1 Reinspection Fee $15 issue Fee $ 3 i _ MECHANICAL FEES` DEVELOPMENT SERVICES REOUIREMENTS: Zoning Approved By pate Building Approved By Date-- ate 'Duct Application Issued By pat S Boiler- Hood or Type 1 ' ❑ CanopyType I I El Duct -'Under Ground Duct- Structural Refrigeration System '❑0.100,000BTU ❑100,000'BTU Duct - Ventilating BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% ,$ ELECTRICAL $ PLAN CHECK 50% $ ' MECHANICAL ;$ PLAN CHECK 25% $ SUMMARY OF FEES SMIP' $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ U MICROFILM $ i TOTAL FEE 1$ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers - Heating System & Ducting ❑0-100,000BTU❑100,000BT Registers _ Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev, 10184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date ' Inspector POOL a SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location -2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms •4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6- Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE ,7. Footings 58, Electrical Conduit-Undrgrnd, 8. Foundation 59. Gas Pipe, D Undrgrnd., Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection } 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64, Plumbing System - Final 14, Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17; Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 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 ❑ Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling {Structural} & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78, FIRE PREY. FINAL :30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric �V ZS C� Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. .Landscape Irrigation System 45. Sound Attenuation 46, Hand icap.Regulations 47, FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. EiTY OF COSTA MESA C NSTR IO P RMIT PERMIT NO. TRACT NO. LOT NO, UNIT NO. Project -Address Applicant's Mailing Address Owner's Name Phon Address ArchlEng, License No, Address Contractor's Na Phone L-tL%J Address (mailing} City License No. LICENSED CONTRACTOR DECLARATION I hereby,affirm that i am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in tkiii4orce d effect. License Class C License No. Date Signature WORKERS' COM SATION DLAR TION I hereby affirm that I have a certif ale of consent to self-insura or a certificate of Workers' Compensation Insurance, or a certified copy thereof_ (Section _ 800, tab. C.) Aicy No, Company - --- Certified copy is hereby furnished. Certified copy is filed with the city Building Division, Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section neeti-not be completed if the permit Is for one hundred ($100) or less). I certify that In the performance of the work for which this permit is issued I shall not employ any person in anKhoayLabor r as to become subject to the Work _' Co ens 'o Laws of Cal Date "' Signatur NOTICE: f, a er making this deetou should become subject to the Workers' Compensation provisions Code, you must forthwith Comply with Stich provisions or this permit shall be doomed revoked. CONSTRUCTION LENDING AGENCY ' I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.), Lender'sName _ Lend'er's Addrest _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file asigned statement that he/she is licensed pursuant to the provisions of 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 '.031.5 by any applicant for a permit subjects the applicant 'to a civil ,salty Of not more than five hundred dollars ($500). j 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (SeCtiOn 7044, Business and, Professional Code: The Contractor's 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 employees, Provided that such improvements are not Intended or offered for sale. It, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and _r'who contracts for such projects with a con- tractor(s) license pursuant'to the Contractos License Law). I am aware that proof of their Worker's Compensation insurance should be provided to -me. ❑ t am exempt under Section B. L P. C. for this reason Date Owner I hereby certify that I kava read this applicatlon and state that the above Information is Correct. I agree to comply with all city and county ordinances and stale laws relating to building construction, and hereby authorize repre- sentatives of is -c ty to enter upon the above-mentioned property for Inspection p r se Si nature % Dat �s TYPE OF CONSTRUCTION LJ NEW LJ ADD U ALTERATION U REPAIR ❑ CONVERSION ❑ DEMOL'ISH ❑ OTHER A.P. 90k DESCRIPTION OF WORKiUSE OF BLDG. S Mein Building: E TYPE OF PERMIT D GRADING ED FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER _ - — A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ S Left ZDNE - GRADING CU.YDS. ACRES Ping, Ref. # Remarks: Planning Notes: 6903 7/02185 Accessory Building: Perking Req./Provided 10,,50 TL- Zone Z O N 1 N G R E Q M T S Boiler Duct - Under'Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 00.100,000 BTU ❑l 00,000 BT 9 Reinspection Fee Drivers' Lic Se or SS CMF 0865.46, rev. 10184 white - Building; Canary Applicant; Pink •Accounting; Goldenrod -Assessor $15 i 1 Reinspection Fee I $15 FEES Hood or . Type t ❑ Canopy Type 11 ❑ Refrigeration System 130-100,000BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS:' Zoning Approved By Building Approved By Application Issued By $ 3 PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Z Automatic Washer Construction Pole Sub. ; ,Transformer ❑ 15-50 KW ❑ 50 t KW Backflow Irrigation Sewer Cap Bathtubs Clarifiers Sewer Connection Solar Collectors $ i ENERGY P.C. Cboking Unit Dishwasher Meter ❑up to 100 amps Meter ❑over 100 amps Dishwasher Solar Piping PLAN CHECK 50% Dryers ©Gas ❑Electric Sub Panel Drinking Fountains Solar Tank $ Fan = Motors 00-1 HP El )S - 8 Floor Drains Swimming Pool wiSpa ' F,A,U, inc. Solar'09-15 HP 016-15+ Floor Sinks Gas Service ` Outlets Urinal Water Closet, Z 16 Fixtures Device Boxes Microwave Pole Light Interceptors Kitchen Sink. Water Heater Water ServiceSwitches Outlets Range Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays - Generator 00.5 KW 05.15 KW Trash Compactor Roof Drains r 4 Reinspection Fee S15 Issue Fee $ 3 Boiler Duct - Under'Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 00.100,000 BTU ❑l 00,000 BT 9 Reinspection Fee Drivers' Lic Se or SS CMF 0865.46, rev. 10184 white - Building; Canary Applicant; Pink •Accounting; Goldenrod -Assessor $15 i 1 Reinspection Fee I $15 FEES Hood or . Type t ❑ Canopy Type 11 ❑ Refrigeration System 130-100,000BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS:' Zoning Approved By Building Approved By Application Issued By $ 3 SUMMARY OF FEES BUILDING PFRMIT $ SMIP. $ PLAN CHECK $ PERMIT PLUMBING $ Q- d O _ ISSUANCE $ PLAN CHECK 25% $ i ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL A APPROVALS Permit # Date Inspector 1 L. Tempordary Electrical Service or Pole �? 52. Pool & Equipment Location t 2. Soi�Pipe-Undrgrnd. if �� 53. Steel Reinforcement 1t 3!Elecirical Cond`u t7tility-Undrgr,nd`} 54. Forms116 4? Electrical/ Conduit Undrgrnd."� A" 55. Electrical Banding �E 55 I'Rginfortemerit' 1 56. Rough Plumbing & Pressure Test f 1� • 1Ele%ic�al UFER�&r cl. ��! 57. APPROVAL TO COVER-GUNITE !t. �Fooings �� 1 ;� 58. Electrical Conduit-Undrgrnd. 18 FO'uA-aati0n �� r { � r 59. Gas Pipe, ❑ Undrgrnd., Test • � �� 9. Water.P1pe-Undrgrndt, i i 60. Backwash Lines, P -Trap, ❑ Undrgrnd. ' lOStr{�ct�u�ral Floor Sy -stem` 61. APPROVAL TO DECK '11. Property Sewer Line& House Connection �.� e 1 1 62. Backwash & Receptor -Final 12. Sewer a' `� Y' '� 63. Heater & Vent -Final 13. Roo'fDra+ns 64. Plumbing System - Final 14. Rq�ugh�Plumbing a 65. Electrical -Final 15. Rough Electricaitonduit 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT, REQUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION 32, Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy X37. Final Factory Fireplace 138. Final Plumbing 2 kS.at CAW 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.000UPANCY No. Date N O N r<,) Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NQ, TRACT NO. LOT NO. Uf�IjTINd. Project Address __711wr 15"th St. Bldg(H) Unit 5 Applicant's Mailing Address 1311.0 -Saticoy_ St. N.Ho.11.ywood Owner's Name Tzoyz—iuvestmeat Fund Phone 549 298 Address /•'171 Ri rCb St ; Newport fiQ_c'ich. Ca. Arch/Eng, M&r4 License No. Address 12881 Knott AvP - Suite 216 Contractor's Name--Dur-n- Air Cand! H nni nngPhone _-982_1216 Address imailing) _] 1110 Sat-iG City License No. _ 3 99 5 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions o Charter 9 (commencing with section 7000) of Division 3 of the Business Professions Code, and my license is in full force and effe uconse Class 20 e e No. 346251 Date(/1R/84 Signature WORKERS' COMPENSATION DE LARATION 1 hereby affirm that 1 have a Certijifcate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section ilio, Lab, c•) ilicy No, -WC9-824 Company Lumbermans L� Certified copy is hereby furnished. ❑ CertiM opy is filed with the city B i is 1 Ing ion, Date I Applicant EXEMPTION -FROM WORKERS' COMPENSATION DECLA ATION (This section need not be completed if trio permit is for one hundred ($100) or less). Icertify that in the performance of the work for which this permit is issued, I 5 ha1 1 not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ, C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION i hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or ropalr 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 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 031.5 by any applicant for a permit subjects the applicant to a civil nalty of not more than five hundred dollars (5500). 1 I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sato. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project {Section 7044, Business and Professions Code: The Contracto('s License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractoris) license pursuarit'to the Contractoi's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner 1 hereby certify that I have re information is correct, I agree and state la toting to buil it sentatives f tri s city. to e e inspection purp es, Signature Drivers' Liceri/b or SS %1 TYPE OF CONSTRUCTION LJ NEW LJ ADD LI ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. -0 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TYPE OF PERMIT GRADING FOUNDATION—STRUCTURAL T Front ❑ TENANT El ELECTRICAL 1:1PLUMBING I MECHANICAL B Rear ❑ -OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Right K' CONSTRUCTION TYPE VALUATION 5 S Left ZONE GRADING CU. YDS• ACRES Ping. Ref. # Remarks: Planning Notes: 2295 5/03/85 Zone Accessory Building: ^^� Parking Req./Provided 15.50 TL Z O N I N G R E O M T S this application and state that the above 1 omply with all city and county Or' Inancar construction, and hereby authorize repre- upon the above-mentioned property for bf►�r:r' '�� Date 2D -- Reinspection Fee I S15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting X10-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 AF 0665-46, rev, 10/64 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink $15 1 Issue Fee Automatic Washer i Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors 4 Dishwasher Meter Dover 100 amps Dishwasher Solar Piping SUMMARY OF FEES $ $ $ $ $ $ $ 13.00-, .-, $ :2. 50 Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fire Dampers Fan Motors ❑0-1 HP ❑1 f, - 8 Floor Drains Swimming Pool w/Spa 00 F.A.U. Inc. Solar 09.15 HP ❑16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Kitchen Sink Water Heater Water Service Outlets Switches Range Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator 00.5 KW 05-15 KW Trash Compactor Roof Drains this application and state that the above 1 omply with all city and county Or' Inancar construction, and hereby authorize repre- upon the above-mentioned property for bf►�r:r' '�� Date 2D -- Reinspection Fee I S15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting X10-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 AF 0665-46, rev, 10/64 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 Reinspection Fee $15 1 Issue Fee $ 3 iANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Date Dat S �L Hood or Type I ❑ Canopy Type II ❑ Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ $ $ 13.00-, .-, $ :2. 50 SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ I 15.50 System Repair/Alteration Fire Dampers Registers 4 00 Issue Fee $ 3 CONSTRUCTION AND PLANNING Date APPROVALS Permit # Inspector POOL 'A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location y 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement _. f 3. Electrical Conduit Utility-Undrgrnd. 54. Forms Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test i Electrics! UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduif-Undrgrnd, r 8' Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. r. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. s 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13, Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15, Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS. Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72, Underground Flush •24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 1-M-4f(r L1G* 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irriqation 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 r Nn. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. f=1TY pir, C05TA MESA coN$1 riv%l ioN PERMIT PERMIT NO. _y' TRACT NO. LOT NO. uN{T NO. ~Project Address W . 'TK "7 - App) icaht's App)icaht's Mailing Address , Owner's Name . '112AY 0 EM: /Y1 -ElT_Phone Address Arch/trig, License No. Address Contractor's Name t GS I=L GTR 'C— Phone 77— Address lmailing) l 45 Q9_5�&)T �ST_ RLODI 1106 -Two City License No. 1] LICENSED CONTRACTOR DECLARATION - t hereby affirm that I. am licensed; under provisions of Chart r„9 (commencing with section 7000) of Dlvislon 3 of the Business an Prof Ions Code, and MY license is in full force and elle License Class 0 Lice No.c S i' Date Signature WORKERS' COMPENSATION DECLARATION ' $-hereby affirm that I have a certificate of consent to self -insure or a certificate I Workers' Compensation tnsurance,.or a certified copy thereof (Section .800, Lab. C.) i Policy No. )6K -S, _DI `]-70 C an SEL_E eCertified copy is hereby furnished Cer ified cop iyflled with the cit Buij n !vision Date Applicant EXEMPTION FROM WORKERS' COMPENSATION 10ECLARATION (This section need not be completed if tha-permit is for one hundred (3100) or Ices). t certify that In the performance of the work for which this'permlt is Issued, I , shall hot employ any person in any manner so as to become subject to the Work@rs' Compensation ,Laws of California. Date Signature - - 'NOTICE: 11, after making this declaration, you should,become subject to the ' Work@rs' Compensation provisions_of the Laborl Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction Pending agency for the performance Of the work for which this permit is •issued (Section 3097 Civ. C.) Londgr's Name Lender's Address ' OWNER BUILDER DECLARATION " • 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any Structure; prior to its Issuance, also requires the applicant for such permit to fiie a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's -License taw (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) on that he/she is exempt `.herefrom and the basis for the alleged exemption, Any violation of -Section ?_031.5 by any applicant for a permit subjects the applicant to a civil . enalty of not more than five hundred dollars ($500). I,' as owner of the property or, my employees with wages as their sole compensation, will do the work, and the'structuie is not intended or offered for sale.(Section 7044. Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Lm - Provo for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with-Ilcensed con- tractors to construct the project[Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who builgs 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 Proof of their Worker's Compensation insurance should be provided to me. ' ❑ t am exempt under Section B. & P. C. for this reason Date Owner ' I hereby certify that f_'have read this appflcation-and state that -the above Information is' rr t, ragree to comply with all clty.and county ordinances and State I lati to build! g cAnstruction. and hereby authorize repre- sentatives�-,�p to ent r nthe above-mentioned property tpr inspectionSignature Date J Drivers' License or SS TYPE OF CONSTRUCTION IJ NEW U AOD LJ ALTERATION U REPAIR '❑ CONVERSION ❑ DEMOLISH El OTHER A.P. 46DESCRIPTION OF WORK/USE OF BLDG. • S Main Building: E TYPE OF PERMIT LJ GRADING 0 FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER I A PROJECT DESCRIPTION SQ. FT, OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ S Left ZONE ` GRADING CU. YOS. ACRES Ping. Ref. 1# Remarks: I Planning Notes: I Bar Sink Backflow Prevente'r Backflow Irrigation Bathtubs j Clarifiers f Dishwasher Drinking Fountains Floor Drains' Floor Sinks- I Gas Service Outlets interceptors Kitchen Sink Lavatories P—Trap Roof Drains _Reinspection Fee Boiler $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple IJ Firepl/Fact. Bit. ICBO 4b Heating System & Ducting ❑ 0-100,000 BTU -j] 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 Whlte - Building; Canary . Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING . Showers ' Service Sink i Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal - water Closet Water Heater Water Service ' Auto.Wash Laundry Trays Issue Fee IANICAL Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑0.100,000 BTU ❑ 100,000 STU System Repair/Alteration Fire Dampers Registers Issue Fee 5909 1/16/85 r 12e58 TL i , Zone Accessory Building: Z O N N G R Parking Req./Provided E + M T S FEES -Automatic Washer - Construction Pole Sub, ELECTRICAL FEES - Transformer ❑ '15-50 KW ❑ 50 + KW ' Cooking Unit Meter ❑up to 100 amps Dishwasher Dryers ❑Gas ❑Electric Fan , Meter ❑over 100 amps.- Sub Panel Motors 1 HP ❑ 1 fS - 8 { Q F.A.U, Inc. Solar 09.15 HP 016.15+ 'Fixtures Micro"m;e - -- " Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal Generator 00-5 KW 05-15 ;Standing Sections KW Trash Compactor ' r r , $ 3 Reinspection Fee $15 mingkiiiiiiiinow Issue Fee $ 3. FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By WOW ' Date Date Date j — I c, BUILDING PERMIT $ PLAN CHECK $ PLUMBING - $ PLAN CHECK 25% $ ELECTRICAL $_� PLAN CHECK 50% S MECHANICAL 5 PLAN CHECK 2S% $ SUMMARY OF FEES SMIP• $ PERMIT E ISSUANCE $ ENERGY P.C. $ i GRADING $ MICROFILM $ TOTAL FEE $ $ 3 a CONSTRUCTION AND PLANNING 9 APPROVALS Permit # Date Inspector POOL ci SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-tJndrgrnd, 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. ' 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steei Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER•GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & Nouse Connection fit. Backwash & Receptor -Final 12. Sewer Cap 63. Neater & 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd, Storage Tank ❑ 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 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 /0 hoqKL' Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43. Backflow Irrigation 44. -Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING. 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF -OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. — • PERMIT TRACT NO. LOT NO. UNIT NO. CITPOF COSTA MESA CONSTRI TIO PERMIT n N , � �'l A -) Project Address ".3 Applicant's MailingA dress Owner's Name Phone AddressZr L� Ad%- Arch/Eng. _ - License No. - Address Contractor's Na ��e ZW / 4 Address {mailingl City License No.� r LICENSED CONTRACTOR DECLARATION ' I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7004) of Division 3 of the Business and Professions Code, and my license is in fu once d ffect. Licen' 14 License No. Oat Signature WORKERS' COMPENSATION D RATION 1 hereby affirm that I have a certlfic to of consent to self -insure or a certificate �f Workers' Compensation Insurance, or a certified copy thereof (Section �i00, -Lab. C.) .3licy No. Company L� Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building_ Division. Date _ Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (5100) or less). I certify that in the performance of the work for which this permit is issued I shali not employ any person in any rrr�yagQqner sous to become subject to the Worke s' Corp; n ati a Laws of Calif rfrMa. Date. "' y Signature ��Ij /J-� NOTICE: 1t, after ma Zing this declar ' n, y u should become subject to the Workers' Componsatlon provisions of he Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance' of the work fpr which this permit is Issued (Section 3097 Civ. C.) Fender's Name ._ Lenditcs'Address. OWNER BUILOER DECLARATION - I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed Statement that he/she is licensed pursuant to the provisions of 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 '031,5 by any applicant for a permit subjects the applicant to a civil !nalty of not more than five hundred dollars (5500). _J I, as ownor of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. if, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im. Eve for the purpose of sale). , 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuaht to the Contraetor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ `I am exempt Under Section B. & P. C. for this reason Date Owner I hereby certify that.I have read this application and state thatthe above information is cgrrect. I agree to comply with all city and county ordinances and state laws rglating to building construction, and hereby authorize repre- sentatives Of is cl to enter upon the above-mentioned property for Inspection p ses Dale C r Signature Drivers' Li Se or SS -P TYPE OF CONSTRUCTION LJ NEW LJ ADO LJ ALTERATION LJ REPAIR $ 3 ❑ CONVERSION ❑ OEMOLISH ❑ OTHER Reinspection Fee§15 A.P. yi6 DESCRIPTION OF WORK/USE OF BLDG. DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued ByDataZ-Pl• , SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ Q ISSUANCE $ PLAN CHECK 25% $ % ' SZ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% S 5 Main Building: E TYPE OF PERMIT GRADING El FOUNDATION C3 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B ❑ A Rear ,OTHER C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATION $ S Left, ZONE GRADING CU.YDS. 'ACRES Ping. Ref. # Remarks: Planning Nates: I PLUMBING I FEES 1 Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service i Interceptors Kitchen'Sink Lavatories P -Trap Roof Drains Reinspection Fee Boiler Outlets $15 Duct • Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO �# Heating System & Ducting ❑0.100,000 BTU ❑ 100,000 BT1 Reinspection Fee I $15 IF 0865-46, rev. 10/84 White - Building; Canary - Applicant; ink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/spa I Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays issue Fee MECHANICAL Hood or Type ❑ Canopy Type I1 ❑ Refrigeration System 00-100,000BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 2 5902 7/02/85 Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer, Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas DElectric Fan F.A.U. Fixtures - Device Boxes Outlets Switches Garbage Disposal Generator 1:10-5 KW ❑5-15 KW 10o50 TL ne L Transformer -fl 15-50'KW ❑ 50 + KIN v a Meter El up to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0.1 HP ❑ i h - 8 Inc. Solar 09-15 HP 016.15+ Microwave Pale Light Range Sign Standing Sections Trash Compactor J FEES Z O N 1 N G R E Q M T S $ 3 Reinspection Fee§15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued ByDataZ-Pl• , SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ Q ISSUANCE $ PLAN CHECK 25% $ % ' SZ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% S $ 3 CONSTRUCTION AND PLANNING ,� Date 0 APPROVALS Permit # "I Inspector POOL 'A APPROVALS Permit # Date Ins ectnr p" „1.. Temporary Electrical Service or Pole 52. Pool & Equipment Location r 2. Soil �i�b6-Undrgrnd. lf;. •) 53. Steel Reinforcement r� a _ 3"Electrical Conduitri'4tility-Undrgrnd. 54. Forms o" 4�'Electricaal'Conduit-Und?grnd. 55. Electrical Bonding r s 5.,Steelj efnforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER•Gmd. + Vis' rr .-. p, , "r- ;• 57. APPROVAL TO COVER-GUNITE l� ., n . 1 F o.I �� 58. Electrical Conduit-Undrgrnd. ond ;'6'r�ou�dation �jf : ' 1 f f 59. Gas Pipe, ❑ Undrgrnd., Test 9. Wate%' Pipe-Undrdirnd', t 60. Backwash Lines, P -Trap, ❑ Undrgrnd. cS I0 St u� Mural Floor System ti 61. APPROVAL TO DECK 11. Property Sewer Line& House Cdcinection n - 4 62. Backwash & Receptor -Final 12. Seer 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. POOLISPA SYSTEMS FINAL 19. -Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydra -26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76, Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 7 e, 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 140. Gas Service -Final 41. Solar Domestic�Final 42. Backflow Preventer &&7 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Spercial Requirements Completed 49. Electric Release to Edison 50. Gasl 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. GIT1aOF COSTA MESA CONSTRUCTION PERMIT 1 Project Address —711 Gi_ 17th Sr_ Bl dp_fH) Unit 4 1 Applicant's Mailing Address 11110 Sa r imy S r - N -Hai Lwand s Owner's Name't'+��,.oy 1n_ye_5t1II8L> ti —PI Ll LPhone,949-29 8 i Address --14-3')l Bj rCh-St^Newport• Reach, ra Arch/Eng. License No. Address 128&L K1J0ZZ_kV_ ltdIt--- 21 — - - Contractor'sNameDUCO Air, Condit ianing-Phone- 9$21216 Address (mailing) —1_31 10 Sa t jr_0 City License No. 30.92,5 LICENSED CONTRACTOR DECLARATION I her9by affirm that i am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the BusinASProfessions Code, and my license is in full force and eff License Class C 0 No. 346251 Date._ 4/18/,84— — Signature WORKERS' COMPENSATION DE LARATIO I her@by affirm that I have a cern ate of consent to self -insure or a certificate Of Workers' Compensation Insurance, or a certified copy thereof (Section 100, Lab. C.) ilicy No. Wr- -4$24 Company Lumbermans L� Certified Copy is hereby furnished. ❑ CertifiedIf,copy Is filed with the city Buildil�� 173 ision.� Date _.i! - - APPlicant —O y EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: if, after making this declaration, you should become Subject to the Workers' Compensatlon provisions of the Labor Code, you must forthwith comply with such provisions or this permit ' Shall be deemed revoked. CONSTRUCTION LENDING AGENCY I her@by affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to Construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed Statement that he/she is licensed pursuant to the provisions of 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 03.1,5 by any applicant for a. permit subjects the applicant to a civil natty of not more than five hundred dollars ($500). I. as owner of the property or my amplayees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sectiun 7044, Business and Professional Code: The Contractor's 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 employees, provided that such of are not intended or offered for sale, if, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- rova for thepurpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 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 progi of their Worker's Compensation insurance Should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date I h@reby certif information is and state to sentati"as t inspectiopurp Signature Drivers' Lic Si Owner that I have read this application and state that the above rect. I agree to mply with all city and county ordinances toting to buil ng Construction, and hereby authorize repre- city to er Pon the above-mentioned property for or'SS Date .1 - - Rom TYPE OF CONSTRUCTION LJ NEW LJ ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. ALTERATION LJ REPAIR TYPE OF PERMIT ED GRADING FOUNDATIO STRUCTURAL ❑} TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL lJ -OTHER _ PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION S ZONE GRADING CU.YDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 10.100,000 BTU 1:1100.000 BTI Reinspiartion Fee $15 GMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor LUMBING FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee I S 3 ��` I FEES Hood or Type I ❑ Canopy Type ll, ❑ Refrigeration System ❑0.100,000 8T U ❑ i 00,000 BT U System Repair/Alteration Fire Dampers Registers Issue Fee 1 S 3 2294 5/03/05 I M0 A.P. 9W Zone S Main Building: Accessory Building: Date Building Approved By T Front Date Application Issued By O AN Rear SUMMARY OF FEES C Right SMIP $ N SFLeft PERMIT PLUMBING G R Ping. Ref, + Parking Req.IProvided PLAN CHECK 25% E PlanningNotes: ELECTRICAL $ Q M S PLAN CHECK 50% $ _ T S MECHANICAL $ 13. 00 TOTAL FEE $ 15.5n PLAN CHECK 25% $ __2__5D_ ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter Clover 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors 00.1 HP Ell 'A - B F.A.U. Inc. Solar 09-15 HP 016-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal ; Standing Sections Generator ❑0-5 KW ❑5.15 KW Trash Compactor Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By _ Data SUMMARY OF FEES __- _Z_, BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. S ELECTRICAL $ GRADING S PLAN CHECK 50% $ MICROFiLM S MECHANICAL $ 13. 00 TOTAL FEE $ 15.5n PLAN CHECK 25% $ __2__5D_ 'CONSTRUCTION AND PLANNING Date APPROVALS Permit # Inspector POOL A APPROVALS Permit # Date Inspector p 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Ripe-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. r�� 57. APPROVAL TO COVER-GUNITE 7. Footings i 58. Electrical Conduif•Undrgrnd. 8' Foundation �. ti 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. ! 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Congectign 62. Backwash & Receptor-Finai 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 APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro -22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes, 34. Final Heating & Air Conditioning (190 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTUSE & BUILDING 48. Special Requirements Completed 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date „_„_� Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CON TR UCON PERMIT PERMIT TRACT NO. LOT NO. UNiT Np- .�� Project ,A�ftresg` Applicant's Mallin dress Owner's Name 2have Of Address f Arch/Eng. — License No. Address Contractor's Nahon Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that F am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is infqf,yivn effect. Llcen Class - License No. Date Signature WORKERS' COMPENSATION D RATION I hereby affirm that I have a certifl ate of consent to Selfdnsure or a certificate f Workers' Compensation Insurance, or a certified copy thereof (Section 300, t -ab. C.) Policy No. _._ Company - eCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Date - _— Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (5100) or less). I certify that in the performance of the work for which this permit Is issued 1 shall- not employ any person In any manner so as to become subject to like WOFIK s' o pan tIo ws of Calif Datd� - -- Signature 'NOTICE: If, atter making this dccI an, you should become subject to the Workers' COmpensation provision the Labor Code, you must forthwith Comply with Such provisions'o this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097 Civ, C.) Lender's Name Lender's -Address _ OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's. License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit Jo 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 Division 3 of the Business and Professions Code) or that he/sheis exempt Therefrom and the basis for the alleged exemption. Any violation of Section 031.5 byany .applicant for a permit subjects the applicant to a civil enaity of not more than five hundred dollars ($500). . 0 I, -as owner of the property or my employees with wages' as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. if, however, the building or improvement is Soid within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exClusivaly contracting with licensed con- 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 builds or Improves thereon, and who contracts for such projects with a con- tractors) license pursuarit'to'the-Contractor's License Law). I am aware that proof of thelr Worker's Compensation insurance should be provided to me. r ❑ 1 am exempt under Section B. & P. C• for this reason Date - - Owner 1 hereby certify ,that I have road this application and state that the above Information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repro- sentatives o - is y to enter upon the above-mentionedroperty for Inspection r ose . i Oat* 5904 7i02ie5 Reinipection Fee 1 $15*1 1 Issue Fee Boiler Duct - Under Ground Duct - Structural l Duct: Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑ 0.101],000 BTU ❑ 100,000 BTL Signature Reinspection Fee Drivers' nse or 55 CMF 0865-46, rev, 10184 Pink -Accounting; Goldenrod - Assessor $15 Hood or Type i ❑ ' Canopy Type 11 ❑ Refrigeration System 00-100,000 BTU 0 100,0015BTU System Repair/Alteration Fire Dampers Registers Issue Fee I s $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date`;` Application Issued By - _ ffW Data—CELL SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ Q c7ClISSUANCE $ PLAN CHECK 25% $ A 1%7_� ENERGY P.C. $ ELECTRICAL • $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ % �$3U TYPE OF CONSTRUCTION LJ NEW LJ AQD ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # Zone DESCRIPTION OF WORK/USE OF BLOG' S Main Building: Accessory Building: TYPE OF PERMIT GRADING C1 FOUNDATION ElSTRUCTURAL T Front Cl ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B N A Rear I C Right ' ` N PROJECT DESCRIPTION. SQ. FT. OCCUPANCY G CONSTRUCTION TYPE VALUATION $ S Left R ZONE GRADING CU.YDS. ACRES - Ping, Ref.# Parking Req.IPravided E Q Remarks: Planning Notes: M T S PLUMBING FEES Bar Sink Showers , ELECTRICAL FEES Backflow Preventer - -Service Sink - Q Auto'matic'Washer). Transformer ❑ 15.50 KW Backflow Irrigation Sewer Cap Construction Pole"Sub. ❑ 50 + KW Bathtubs , Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher ' Meter Dover 100 amps Dishwasher Solar Piping Dryers ❑Gas DElectric Sub Pane) Drinking Fountains Solar Tank Fan - Motors ❑ 0-1 HP Ell fi - B Floor Drains- Swimming Pool w/Spa F.A.U. Inc. Saler ❑9-15 HP 016-15+ Floor Sinks Urinal. Fixtures Microwave - Gas Service Outlets Water Closet Z Device Boxes Pole Light Interceptors Water Heater. Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P -Trap Laundry Trays, Generator 00-5 KW 05-15 KW Trash Compactor Roof Drains r - Reinipection Fee 1 $15*1 1 Issue Fee Boiler Duct - Under Ground Duct - Structural l Duct: Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑ 0.101],000 BTU ❑ 100,000 BTL Signature Reinspection Fee Drivers' nse or 55 CMF 0865-46, rev, 10184 Pink -Accounting; Goldenrod - Assessor $15 Hood or Type i ❑ ' Canopy Type 11 ❑ Refrigeration System 00-100,000 BTU 0 100,0015BTU System Repair/Alteration Fire Dampers Registers Issue Fee I s $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date`;` Application Issued By - _ ffW Data—CELL SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ Q c7ClISSUANCE $ PLAN CHECK 25% $ A 1%7_� ENERGY P.C. $ ELECTRICAL • $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ �$3U PONSTRUCTION AND PLANNING APPROVALS Permit # .� Date Inspector POOL jPA APPROVALS Permit # Date Inspector 1(Tempo ary Electrical Service or Po I 52. Pool & Equipment Location Soil Pipe-Undrgrnd• �f'� 53. Steel Reinforcement J.,oElect'rical-Conduit-Utility-Undrgrnd. 54. Forms - i�Eleetrical Conduit'Una'rgrnd. 55. Electrical Bonding 5. Steel Reinforcement► 56. Rough Plumbing & Pressure Test `j11 6. 'E UFER Grntl. f/y �,.... , - f f� 57. APPROVAL TO COVER-GUNITE 'rl h 7,,Footings `�. �� 58. Electrical Conduit-Undrgrnd. ,B. Foundr� n ]�',� � ` l .t 59. Gas Pipe, EJUndrgrnd., Test y 9. W to iroiPi pe-Und gra . _3 }' 60. Backwash Lines, P -Trap, 0 Undrgrnd, Structural, Floor System g +` 61, APPROVAL TO DECK . 11.' Property^Sewer LiAA House Connection 62. Backwash & Receptor -Final '12. Sewer Cap � e _�' r 63. Heater & Vent -Final 13. Roof'Drains Y e) J o 64. Plumbing System - Final r -� 14• Rough Plumbing= "+ 65. Electrical -Final s 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22• Ducts, Ventilating 71. Product Piping El Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd, Storage Tank ❑ 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- REOUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32, Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace Final Plumbing LAA 39. Water Service -Final 40- Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer T_yb L�0 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 5dison 50. Gas Release to Southern California Gas Co 51, CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTq MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. Project Address 711 .. _17_th_St. Bldg(H) Unit 6 Applicant's Mailing Address 131 1 Q Satirny ST. N.Holly3jood, Owner's Name Troy Investment Fund Phone 549 2988 Address 4321 Birch st. Newport Beach, Ca. Arch/Eng. layi,)I_�Ck License No. Address 12$-81Knott Ave, Suite 216 ��_ � Contractor'sN f3i,tiQniil&-Phone-912 12 6 Address (mailib110 pari �y St.�l_.1lntlywood'Ca. City License No. 33995 LICENSED CONTRACTOR DECLARATION I heresy affirm that tam licensed under Provisions of arter 9 (commencing with section 7000) of Division 3 of the Business a otessions Code, and my license is in full force and effect 346251 Ucense Class____.Li se o. Date -4./-143,L84. Signature Aese WORKERS' COMPENSATION DEC RATION I hereby affirm that I have a certiflC of consent to self -insure or a certificate -f Workers' Compensation tnsura ce, or a certified copy thereof (Section ,00, Lab. C.) olicy No. we 9824 Company Lumbermans BCertified copy is hereby furnished. Cert ifi py Is filed with the city Bu in vision pd Date,_,,, cT f Applicant EXEMPTION FROM WORKERS' COMPENSATION OECL RATION (This section need not be completed it the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to tke Workers' Compensation Laws of California., Date „ Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with suCh provisions or this permit shail be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any City or County which requires a permit to construct, alter, Improve, demolish or repair any structure, pr or 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 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 031.5 by any applicant for a permit Subjects the applicant to d civil :nalty of not More than five hundred dollars ($500). J I, as owner of the property or my employees with wages as their sole Compensation. Will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. 1f, however, the building or improvement Is sold within one year of com. pietlon, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). 1, asowner of the property, am exclusively contracting with licensed con- i 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 builds or improves thereon, j and _who contracts for such projects with a con- traCtor(s license pursuanthe Contractm t -to Contractor's License Law). I aaware that proof oftheir Worker's Compensation insurance should be provided to me. 0 1 am exempt finder Section B. & P. C. for this reason CI' Date Owner I hereby certify that I have rea information is correct. I agree to and State laws relating to bulloo sentatives o is city to e e Inspectlan r Ses. Signature ^Drivers' Lice Or SS IF 0865-46, rev. 10/84 this application and state that the above amply with all city and county ordinances construction, and hereby authorize repre- upon the above-mentioned property for Date ;5120— TYPE OF CONSTRUCTION L -J NEW L] ADD LI ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. Zone DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: E TYPE OF PERMIT 17 GRADING 0 FOUNDATION D STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL a Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K Left CONSTRUCTIpN TYPO VALUATION $ S ZONE GRADING CU. YDS. ACRES Ping. Ref. # Parking Req./Provided Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit, ICBO Heating System & Ducting EtD-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod . Assessor PLUMBING FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays IIssue Fee S 3 1 MECHANICAL FEES Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System . 00-100,000 BTU ❑100,000 BT System Repair/Alteration Fire Dampers Registers Issue Fee ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F. A. U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW ❑5.15 KW Transformer ❑ 15-50 KW El 50 + KW Meter I-Jup to 100 amps Meter Dover 100 amps Sub Panel Motors 110.1 HP 01A-8 Inc. Solar 09-15 HP ❑ 1&154- Microwave &-15+Microwave Pole Light Range Sign Standing Sections Trash Compactor FEES Z O N 1 N G R E a M T S Reinspection Fee 1 $15 1 1 Issue Fee I S 3 1 1 DEVELOPMENT SERVICES REOUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By, Dat FEES SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM 3 S $ $ TOTALFEE $ 15.50 SUMMARY OF BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ 13.00 PLAN CHECK 25% $ 9. 5f1 6 00 S 3 FEES SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM 3 S $ $ TOTALFEE $ 15.50 CONSTRUCTION AND PLANNING APPROVALS . Permit # Date Inspector POO E_ PA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3.' Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding i 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. l _/ 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduif-Undrgrnd. i 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60, Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System �' 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15, Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 goat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating& Air Conditioning 2.13'04. L44 35. Final Gas Pipe -rest 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43, Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46, Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONST TION PERMIT PERMIT NC] TRACT No. LDT No. r. 4- rur, Project Address 2/r_r,' 6F 7 ~ Applicarit's Mailing Address Owner's Name %vTPhone �g Address 'W3 /_1 L �FT' CC,, Arch/Eng, �-}-- �- Y License No, ?T �' Address %Z H a r r r" 14 6 Contractor's Name C, O Phone �f V 'Address {mai ling) � r � C , City License No. ? 4 -L- LICENSED LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and rry license is in II fQtce�d effect. ' �,.L �^ / License Ci !!.• icense Date 4U'Signature WORK RS' C MPENSAT10N DEC RATION I I hereby affirm that I have a certific a of consent to serf -insure or a certificate �* Workers' Compensation insurance, or a certified �copy �thereof (Section 70, Lab. PJt�ii 0 licy No.�'SI Company-r-•-^—�-+ Certified copy is hereby furnisned, ❑ Certifi d c y is filed with the city BuitcIb�Q Dlv rI i •Date APplicantPu� �`••'- EXEMPTIOd FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for'one hundred ($100) or. less). I certify that in the performance of the work for whicti this permlt is Issued I shall not employ any person. in any manner so as to ibecome subject to the Workers' Compensation Laws of California. - Date Signature ' NOTICE: If, after making this declaration, you should become subject to the ,Workers' Compensation provisions of the Labor Code, you must forthwith •comply with such, provisions or this permit shall be deemed revoked. 'CONSTRUCTION LENDING AGENCY " '• I hereby affirm that there is a construction lending -agency for the performance of the work for . which -this permit is Issued (Section 3097 Civ- C.). Lender's Name Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the CoAtractor 's�License Law for the following reason (Section 7031.5 Business and Professional Code, Any city or • county which requires a permit to construct,' alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of, the Business and Professions Code) orithat he/she -is exempt therefrom and the basis for the alleged exemption.�Any violation -of Section '31.5 by any applicant for a permit subjects the applicant to a Civil salty of not;more than five hundred dollars ($540). 1, s ,owner of the property or my employees- with ,wages as their sole a compensation; will *do the work, and, the structure is not intended or offered 0 In s and'Professional Code•'The Contractor's TYPE OF CONSTRUCTION , LI NEW LJ ADD LJ ALTERATION L..J REPAIR ❑ CONVERSION ❑ DEMOLISH [:]'OTHER A.P. DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E. TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front _ ❑ TENANT El ELECTRICAL ❑ PLUMBING 9 MECHANICAL B Rear [:1 ',OTHER - A PROJECT DESCRIPTION SQ. FT, OCCUPANCY C Right K Left CONSTRUCTION TYPE VALUATION S $ ZONE ' GRADING CU.YDS. ACRES Ping. Ref, Remarks: I Planning Notes: Bar Sink Backfiow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks --. -- - Gas Service Outlets Intercepiors Kitchen Sink Lavatories% P -Trap 4 Roof Drains Reinspection Fee 'y S15 for sale t$ CtrOn 7 44, Bus es 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement Is sold within one'year of Com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for, the purpose ofrsale). ' ❑ I, as owner of the property, am exclusively contracting with •licensed con- 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 builds or, improves thereon,,and _who contracts for such projects with a Con- tractors) license Pursuant to; the Contractor's License Law). l am aware that proof of their Worker's Compensatlon' Insurance should be provided to me. Automatic Washer Construction Pole Sub. - Boiler Cooking Unit Duct - Under Ground Dish a&V Duct - Structural e Gas ❑Electric Duct - Ventilating Fan Exhaust System C1 Multiple El' F.A.U. ' FirepllFact. Bit. ICBG � 1 , ❑ I am exempt under Section' B. & P. C. for this reason Date Owner ' ;I hereby certify that I have 'read this application and state that the above .information is correct. I agree to c ply with all-city'and county ordinances :and state, relating to buildin c nstruction, and hereby authorize repre- sentative of his city o e to ru on the above-mentioned pr er y for inspectic Pur oses. Garbage Disposal Heating System & Ducting W0-100,00013TU-❑100,000 BT Generator ❑0-5 KW ❑5-15 KW i # Reinspection Fee $15 Signature De Drivers' Lic se or SS CMF 0865-46, rev. 10/84 White - Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal - Water Closet Water Heater Water Service Auto -Wash i Laundry Trays FEES -_ M_ mm, SE�M [hili= YM -= • _ r. Issue Fee IECHANICAL Hood or Type I ; ❑ Canopy Type I I ' ❑ Refrigeration System 00.100,000 BTU ❑100,000 BTU System Repair/Alteration : fire Dampers V%I* Registers S 3 FEES 3662 12/07/814 Zone Accessory Building: I Parking Req,/Provided �7a. B 'fl Z , O N I N G R E Q M - T S ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps' Dish a&V Meter ❑over 100 amps e Gas ❑Electric Sub Panel Fan Motors❑0.1 HP❑1%-$ F.A.U. ' Inc. Solar ❑9-15 HP. ❑16-15+ Fixtures - Device Boxes Outlets Switches Microwave Pole Light - Range Sign Garbage Disposal ; Standing Sections Generator ❑0-5 KW ❑5-15 KW Trash Compactor SUMMARY OF'FEES BUILDING PERMIT $ SMIP - $ Issue Fee I S 3 F : ' • PLAN CHECK 25% $ I. - 6P, • /_7 t,Q� Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: I . Zoning Approved By Date Building Approved By Application Issued ByDat -- -- Date r z - - SUMMARY OF'FEES BUILDING PERMIT $ SMIP - $ PLAN CHECK $ PERMIT ' PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK $ 25% ,$ ;$ 50% S ISSUANCE :$ ENERGY P.C. $ GRADING $ MICROFILM S _ MECHANICAL $ TOTAL FEE $ — Issue Fee I S 3 F : ' • PLAN CHECK 25% $ I. - 6P, • /_7 t,Q� CONSTRUCTION AND.PLANNING APPROVALS Permit # Date Inspector POOL A APPROVALS Permit # Date Inspector j. 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 f 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• 'Electrical OF EKGrnd. 57. APPROVAL TO COVE R-GUNITE '�• 7. Footings; 5B. Electrical Conduit-Undrgrnd. �� •' 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. -• 10. Structural Floor System 61. APPROVAL•TO DECK 11: Property Sewer Line & House Connection 62. Backwash & Receptor -Final ' 12. 5ewer'Cap ,+ 63. Heater & Vent -Final 13. Roof Drains i 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.lRough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. lRough Heating & Air Conditioning 'FIRE DEPT. REQUIREMENT APPROVALS Permit # 20ARough Factory Fireplace 21. Ductsjn Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas 00il 23. Gas Pipe -Rough & Test 72. Underground Flush r 24. Roof Framing 73, Undergrnd. Storage Tank O Gas O 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 7� HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79: FINAL INSPECTION 32. Electrical Power Meter -Final �80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: _ F cc 34. Finai Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy ' 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer 43, Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51, CERTIFICATE OF OCCUPANCY No Date Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. �ITY.O COSTA MESA CONSTRUCTION PERMIT PEBWT NO. TRACT NO. LOT NO. UNIT NO. Backflow Irri' ation 9 , Project Address I j W { r' µ S CQ fl- e7 is Construction Pole Sub. ' eCertified copy Is hereby furnished , Applicant's Mailing Address TYRE OF CONSTRUCTION- NEw ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Certifietl copy js-fsled with [he cit B " ing lvisi - Bathtubs l �t Owner's Name �� l ti% :S.I, m Phone. I DESCRIPTION OF WORK/USE OF -BLDG. A P q{6 Address � S Main Building • Dishwasher E Dishwasher Arch/Eng. License No. TYPE.DF PERMIT GRADING ICI FOUNDATION El STRUCTURAL T. Front Duct - Under,Ground 1 ❑ TENANT .❑ ELECTRICAL ❑ PLUMBING ❑MECHANICAL B Address Contractor's Name-MDPIe►-C, GLeCM112 LC- -71-6f� ❑'OTHER A Rear . Fan ' -_Phone Refrigeration SystemAppllption r C Right ! Address {mailing) F��YAnTrS[. aCaorrlrn]6TDry 4i PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Swimming Pool vv/Spa CONSTRUCTION TYPE VALUATION $ S Left City License No_ ZONE GRADINGCU.YpS. ACRES Ping. Ref, LICENSED CONTRACTOR DECLARATION - Urinal * - I •hereby.affirm that I am licensed' under provisions of Charter'9 (commencing Remarks: - Planning Notes: with section 7000) of Division 3 of usiness and, Profes 'ons Code, and Firepl/Fact. Bit. ICBG # my license is in full force and eff / I- ��{ ' Gas Service License Class Licens -fVo. Device Boxes i Date -. Signature PLUMBING FEES WORKERS' COMPENSATION DECLARATION N I Bar Sink ! Showers of the work for which this permit is issued (Section 3097_ Civ. C.) I hereby affirm that I have a ierlificate of consent:to self -insure or a certificate f W k ' C ensation Insurance or a certified cap thereof (Section 1 0 or ers omp _ y - Soo, Lab. C;) - n - Backflow Preventer Service Sink t '- ' MECHANICAL Automatic Washer olicy No. D Backflow Irri' ation 9 , Sewer Cap Construction Pole Sub. ' eCertified copy Is hereby furnished , r thereon, and who does such work himself/herself or through his or her own Certifietl copy js-fsled with [he cit B " ing lvisi - Bathtubs l Sewer Connection Hood or Type I ❑ Cooking Unit Date }�fl — }C> Applicant EXEMPTION FROM WORKERS' COM EN ATIO DECL RATION Clarifiers Solar Collectors i Dishwasher (This section need not be completed if the permit Is for one hundred ($100) or less). Dishwasher Solar Piping ' - Dryers ❑Gas ❑Electric I certify that in the performance of the work for which this permit is Issued, 1 Duct - Under,Ground 1 ' _ shall -not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan ' Workers' Compensation `Laws of California.' , ' Refrigeration SystemAppllption r 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 I ' ❑0.100,000 BTU 0100,000BTU - Date Signature Floor Diains Swimming Pool vv/Spa F.A.U. NOTICE: If, after making this declaration, you should become subject to the Exhaust;System ❑ Multiple ❑ Workers' Compensation; provisions of the Labor! Code, you must forthwith Floor Sinks - - Urinal * - BUILDING PERMIT $ SMIP .$ I - 'Fixtures ' comply with such provisions or this permit shall- be deemed revoked. Firepl/Fact. Bit. ICBG # Fire Dampers, CONSTRUCTION LENDING AGENCY.. i Gas Service Water.ClosetY Device Boxes i I hereby affirm that there is a construction lending agency for the'performance •Outlets PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ of the work for which this permit is issued (Section 3097_ Civ. C.) interceptors - Water Heater' Du[lets Lender's Name ' _ — - - -• I hereby certify that I'have, read this application and state that the above- Lender's AddressKitchen _ Sink i Water Service information is cor agree to domply with all city"and county ordinances and state la a[ing o builtiv con uction, and hereby authorize repre- for Switches OWNER BUILDER DECLARATION i - i _ 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 I$ 1 k MECHANICAL $ TOTAL FEE $ - f Reinspection Fee $15 county which requires a permit to construct, ait&, improve, demolish or, repair _ k 'r thea licant for such permit P—Trap LaundryTrays ' y Sign ature Date Drivers' License or 55 Generator E10-5 KW ❑5-75 K any structure• pr o ! s ssuance, a so requ! es i' - 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 - - „031.5 by any applicant for a permit subjects the applicant to a- civil n malty of ot more than five hundred dollars ($500). - I as owner of the property or my.emplayees with wages,as their sole I Reinspection Fee $15 Issue Fee $ 3 5910 I/f6/65 4,50 , T Zone ! Accessory Building: Z O N N R - Parking Req./Provided E O M k S { ELECTRICAL FEES Transformer E315-50 KW ' ❑ 50.+ KW Meter ❑up to 100 amps l - Meter Clover 100 amps Sub Panel Motors 0.1 HP 011 ''A - B Inc.Solar 09-115 HP 016-15+ Microwave Pole Light i Range 1 Sign Standing Sections ; W Trash Compactor i I compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The' Contractor's � MECHANICAL FEES, Reinspection Fee $15 issue Fee k $ 3 License Law does not apply to an owner of a property:who builds or improves - - , thereon, and who does such work himself/herself or through his or her own 1 Bailer., Hood or Type I ❑ DEVELOPMENT SERVICES REOUIREMENTS: employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year•of com- ! - !Canopy Type I I' ❑ a Zoning Approved By I Date pletion, the owner will nave the burden of proving he/she did not build or Im. Duct - Under,Ground 1 ' _ Building Approved,8y Date prove for the purpose of sale}. i ' ❑ I, as owner of the property, am exclusively contracting with.licensed con- 1 Issued By ••-��--------- - Duct -Structural r Refrigeration SystemAppllption r 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 I ' ❑0.100,000 BTU 0100,000BTU - Duct - Ventilating - .... __,,,,,__ SUMMARY OF FEES bul$ds or improves thereon; and contracts for such projects with a con-- ^ Exhaust;System ❑ Multiple ❑ System Repair/Alteration _who tractor(s) license pursuant to the Contractor's License Law). I am aware that BUILDING PERMIT $ SMIP .$ I proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ r PERMIT Firepl/Fact. Bit. ICBG # Fire Dampers, ❑ I am exempt under Section Bk. & P. C. for this reason PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ Date Owner Heating System & Ducting Registers - - -• I hereby certify that I'have, read this application and state that the above- ❑Q100,000BTU 010 0,()OC) BTLJ- GRADING ELECTRICAL :$ is information is cor agree to domply with all city"and county ordinances and state la a[ing o builtiv con uction, and hereby authorize repre- for , C MICROFILM $ PLAN CHECK 5096 i sentatives t s city •to enter upp he above-mentioned property inspection p I$ 1 k MECHANICAL $ TOTAL FEE $ f Reinspection Fee $15 Issue Fee $ 3 Sign ature Date Drivers' License or 55 I PLAN CHECK 25% $ CMF 0865-46, rev, 10184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING ' APPROVALS Permit # "Date Inspector POOL. A APPROVALS ' Permit :# Date -' Inspector i V. 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 Reinforcgment, 56. Rough Plumbing & Pressure Test '6- Electrical UFER Grnd:. 57. APPROVAL TO COVE R-GUNI TE -7. Footings 5B. Electrical Conduit-Undrgrnd. B. Foundation 59, Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64• Plumbing System - Final 14. hough 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 Goat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric /p Notes: 34. Final Heating & Air -Conditioning 35. Final Gas Pipe -Test 36. Hood or.CanopY 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. ,La-ndscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations . 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed ` 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51 CERTIFICATE OF OCCUPANCY No. Date ' Applicant to fill in all Spaces except those within heavy border lines and sign all appropriate declarations, �f C}Tlr< OF COSTA MESA CO STRUC P RMIT P RMIT O. _ TRACT NO. LOT NO. UN NO -- / Pr*jEct AiS�ess � I os y /// Applicant's Mallin Address /� TYPE OF CONSTRUCTION NEW ADD ALTERATION RE AIR J ❑ CONVERSION El DEMOLISH 11 OTHER A.P. #, Owner's Name ne DESCRIPTION OF WORK/USE OF BLDG.' Address'0. S Main Building: If E Arch/Eng. __ License No. TYPE OF PERMIT GRADING T FOUNDATION STRUCTURAL T Front Address LJ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ -OTHERA Contractor's Name hone PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right Address (mailing) �` " CONSTRUCTION TYPE VALUATION $. S Left City License No: ZONE GRADING GU.YOS. ACRES LICENSED CONTRACTOR DECLARATION Ping. Ref. # I hereby, affirm that 1 am,licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: with section 7000) of Division 3of the Business and Professions Code, and _ my license is In force of ect, Licen Class License No Ld Reinspection Fee Date :r Signature - WORKERS' COMPENSATION D ARATION I hereby 'affirm that I have a cerlif ate of consent to self -Insure or a certificate Bar Sink if Workers' Compensation Insurance, or a certified copy thereof (Section IBackflow ;800, Lab. C.) Preventer Backflow Irrigation Policy No. Company Certified copy is hereby furnished. Bathtubs , Certified copy 15 filed with the city Building Dlvislon. , Date ' Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Glorifiers C ' (This section need not be completed if the permit is for one'hundred'($100) or less), I certify ,that in the performance of the work for hich this permit is issued I Shall -not, employ any person in any mann r so s to become subject to tale Worker '.Co qn Laws of Calif Date — 5ignaturc , Dishwasher Drinking Fountains Floor Drains NO71 E: If, a er ma Ing this decla you should become subject to the Workers'. Compensation provigions of he Labor Code, you .must forthwith Floor Sinks - comply with such provision; or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY I hereby affirm that there IS'a construction lending agency for the performance of the work for which this permit is Issued - (Section 3097 Civ. C.) Lender's Name ' - Gas Service Outlets Interceptors Lender's Address _ Kitchen Sink, OWNER BUILDER DECLARATION I hereby, affirm that I am exempt from the Contractor's License taw for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant -for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 Hatt of not more than five hundred dollars ($500). - Lavatories ' P—Trap _ Roof Drains ' •� e y I,` as'own'er of the property or my employees with wages as their sole compensation, will' do the work, and the structure is not intended or offered for sale (Section 7044, Business and, Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered forBoiler sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale), , I, as owner of the property, am exclusively contracting' with licensed con- 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 builds or improves thereon,•and who contracts for such projects with a con- tractors) license pursuarit'to the*Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. Reinspection Fee $15 - Reinspection Fee $15 Issue Fee . $ 3 FEES DEVELOPMENT SERVICES REOUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date "71 IZAL Duct - Under Ground ' Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this•application antl state that the above information is correct. I agree to comply with all city and county ordinances and 'state laws relating to building construction, and hereby authorize repre- Sentatives of this cit to enter upon the above-mentlonetl roperty for Heating System & Ducting E) 0-100,000 BTU ❑100,000 BT l Inspection pur es, Signature Dat Drivers' Lice a or55 - � [ Reinspection Fee CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Showers —Service Sink - Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool wlSpa Urinal Water Closet Water Heater f Water Service Auto=Wash Laundry Trays issue Fee IANICAL Hood or Type I ❑ Canopy Type 11 ❑ , FEES ■M .® .m Refrigeration System ❑0.100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee Automatic Washer, Construction PoletSub. Cooking Unit Dishwasher Dryers ❑Gas' Electric Fan F.A! U. Fixtures Device Boxes 0utfets Switches Garbage Disposal Generator 00-5 KW ❑ 5-15 K Zone I Accessory Building; Parking Req./Provided ELECTRICAL FEES i .Transformer ETI -5-50 KW ; El 50 + KW i Meter ❑up to; 100'amps Meter Dover 100 amps. _ Sub Panel Motors El0.1 HP ❑ 1 % 8 Inc.Solar 09-15 HP 1:116-15+Microwave Pole -Light Range Sign Standing Sections W Trash Compactor Z O N I N G R E O M T S II $ 3 Reinspection Fee $15 Issue Fee . $ 3 FEES DEVELOPMENT SERVICES REOUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date "71 IZAL SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ `0U ISSUANCE $ PLAN CHECK 25% $ / SZ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ i $ 3 CONSTRUCTION AND PLANNING 4 ;aPPRdVALS Permit Date Inspector POOL & SPA APPROVALS Permit # Date • ' Inspecror , Temporary Electrical Service or Po len ` i 52. Pool &Equipment Location , 2. Soup -Undrgrnd. �° 53. Steel'Reinforcementsl zu. -31 Elec�cal-- GonduitfUtiPity, Undrgr,rid!' 54. Forms' c � [.- 4,0,'EIecCii7a1,,Cand6'rJdhgrnd.� 55. Electrical Bonding r - 5. ,Steel- e_ inforceQnt t4 56. Rough Plumbing & Pressure Test l � /�� LLi+I �/J �• Electrical UFER.I Grpd. t 57. APPROVAL TO COVER-GUNITE �1 7/Footir�95',� e;, rr ,r 58. Electrical Conduit-Undrgrnd. Vii! $ FourSdation y!'j -n. !/f/ r I 59. Gas Pipe, ❑ Undrgrnd., Test �t �9! .Wate`�P' a-Und end. > .� g5 sr 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10VS uctural Floor Sys=em 61. APPROVAL TO DECK 11. Prope try Sewer Line &!-louse (:Wn;ctiont 62. Backwash &Receptor -Final 12. Sevver AP ✓ `� 63. Heater & Vent -Final 13. Roo, PAins O 64. Plumbing System - Final 14. ,R ough�l?lymbing� 65. Electrical -Final } V 15. Rough Electrical-Eonduit 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 s~ FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑Gas ❑Oil 23. Gas Pipe -Rough & Test .72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT i 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 1138, Final Plumbing ; Z-1$-tlt L94D 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final z 42. Backflow Preventer' 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound, Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 46. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date _ N CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 711 W. 17th St. Bldg. (H) Unit 7 Applicant's Mailing Address 13110 Saticoy St.N. o ywoo Owner's Name TRoy Investment Fund Phone 549-2988 Address x+321 Birch St.Newport -Beach Ca. Arch/Eng. Marin J. ROCK License No.� Address 12881 Knott Ave, Stuie 216 __ Contractor's NamNhtro Air Conditiotling Phone 982-1216 Addressfmailingl N.io_i1ywood,Ca. City License No. 3.3925 LICENSED CONTRACTOR DECLARATION , I herebyaffirm that l am licensed under provisions of Charter 9 (commencing with Section 7000) of Division 3 of the Business a Professions Code, and my license is in full fotyp and eff 346251 Ucense Class LV 'c ns o, Oa[d-11 R.A14 --- Signature WORKERS' COMPENSATION DE RATION I hereby affirm that I have a certifi ate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section tsoo, 4ab.9M4 _ _ ,)olicy ildl� company w Lumberroans H Certified copy is hereby furnished. Certifie y is filed with the city Buildi i is -on. j r Date Applicant _ __ f) k t v EXEMPTION ROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is -for one hundred ($100) or --. less). I certify that in the performance of the work for.which this permit is Issued I shall not employ any person in any manner so -as to become subject to tke Workers' Compensation Laws of California. Date Signature — — 'NOTICE: If, after making this declaratlon, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issyed (Section 3097 Civ. C,) Lander's Name -- - - -- - - - Lender's Address - OWNER BUILDER DECLARATION l hereby affirm that I am exempt from the Contractor'$, License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 subjectsthe applicant to a civil enalty of not more than five hundred dollars (3500). ❑ I, as owner of the property or my emplpyees with wages as their solo compensation, will do the work, and the structure 15 not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within One year of com- pletlon, the owner will have the burden of proving he/she did not build or Im- prove for the purpose Of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project(Section 7044. Business and Professions Code: The Contractor's License Law does not apply to an owner Of properly who builds or improves thereon, and _who contracts for such projects with a con- tractor(s) license pursuariCto the Contractor's License Law). I am aware that proof of their Worker's Compensation insurahce should be provided to me. ❑ 1 am exempt under Section B, & P. C. for this reason Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. I TRACT NO. I LOT NO. I UNIT NO. Date Owner I hereby certify that_1 have read this application, and state that the above information Is correct. I agree to comply with all city and county ordinances and state la relating to b - ding constructioh, and hereby authorize repre- sentatives t is city to ter upon the above-mentioned property for inspe, pur SOS. Signature ate C3� Drivers' Lice or SS CMF 0865-46, rev. 10184 TYPE OF CONSTRUCTION ❑ NEW ❑ ADD ❑ ALTERATION U REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. SW DESCRIPTION OF WORKIUG SE OF BLD. S Main Building: E TYPE OF PERMIT LJ GRADING 0 FOUNDATION M STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑]C MECHANICAL B Rear ❑ .OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CON STRUCTION TYPE VALUATION $ $IlLeft ZONE GRADING CU. YDS. ACRES Ping, Ref. Remarks: I Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories - P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting U 0-100,000 BTU ❑ 100,000 ST ' I Reinspection Fee I $15 White - Building; Canary'- Applicant; Pink - Accounting: Goldenrod - Assessor 2297 5/43/05 Zone Accessory Building: Parking Req./Provided 15050 TL Z O N N G R E O M T S PLUMBING - FEES ELECTRICAL FEES Showers Service Sink - Automatic Washer Construction Pale Sub. Transformer ❑ 15-50 KW - ❑ 50+ KW Sewer Cap Sewer Connection Cooking Unit ' Meter ❑up to 100 amps Solar Collectors b Dishwasher Meter ❑over 100 amps Solar Piping Dryers DGas ❑Electric Sub Panel Solar Tank Fan' Motors ❑0-1 HP ❑ 1'r5 B Swimming Pool vv/Spa F,A;U, Inc.Solar ❑9-15 HP 1316.15+ Urinal - Fixtures- - Microwave -Water Closet Water Heater Water Service Device Boxes Outlets Switches Pole Light Range Sign Auto -Wash Garbage Disposal 9 p ,Standing Sections Laundry Trays Generator 130.5 KW 05-15 KW Trash Compactor Issue Fee $ 3 Reinspection Fee im $15 Issue Fee $ 3 MECHANICAL Hood or Type I ❑ Canopy Type I I ❑ FEES DEVELOPMENT SERVICES , Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date Dat Z Refrigeration System 00-100,000 BTU E1100,000BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY $ $ $ $ $ $ $ 13-QO $^— OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ ' GRADING $ MICROFILM $ TOTALFEE $ 15'50 System Repair/ Alteration Fire Dampers Registers 6 00 4 00 Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POOL, _PA APPROVALS Permit # Date inspector 7. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' 1 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding f-!5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. F 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduif-Undrgrnd. 8; Foundation 59. Gas Pipe, ❑ Undrgrnd., Test ; 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System '� 61. APPROVAL TO DECK 11. Property Sewer Line & house Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67, Fencing & Access Approval - 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69, POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 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. Stdrage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32:' Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning •r3- 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 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 1 +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 tines and sign all appropriate declarations. CITY OF COSTA MESA ' CQN5I 1!-LA,TI PERMIT PFJgMIT NO. TRACT NO. LOT NO. L1ivET K16 Project Address 40 Applicant's Mail' n Addr Owner's Name one Address ArchlEng. License No. Address Contractor's Nam Phonei Address (mailing) l City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in f rc!47 effect. Licens Class License No OADate Signature WORKERS'COM ENSATION LARA710N I hereby affirm that I have a certif rate of consent to self -insure or a certificate of workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) ' Policy No. Company Certified copy is hereby furnished. t Certified copy Is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall- not employ any person in any man er $ as to become subject to the Worker Co p sa o ws of Calif pate S Signature NOT,I : if, after making this declar i y u should become subject to the Workers' Compensation provisions of he Labor Code, you must forthwith comply with Such provisions or this permit ,shall be deemed revoked. CONSTRUCTION LENDING AGENCY , I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's' Name'- ' Lendir's Address .. OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for Such permit to file a signed statement that he/she is Licensed pursuant to the provisions of the Contractor's License law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a, permit subjects the. applicant to a civil enalty of not more than five hundred dollars ($500). I,' as owner of, the property or -my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale, if, however, the building or improvement is sold within one year. of com- pletion, the owner will have the burden of proving he/she did not build or lm - rove forr the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for Such projects with a con. tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me, ❑ I am exempt under Section B. & P. C. for this reason , Date Owner 1 hereby certify that- I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentativesof this 'c y to enter upon the above-mentioned property for inspection ase . _ Signature2SF Dat Bar Sink Backflow-Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks _ Gas Service Outlets Interceptors Kitchen Sink Lavatories P --Trap Roof Drains Reinspection Fee . '1 $15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO 4 Heating System & Ducting ❑0-100,000 BTU (D 100,000 BT DriversL nse or SS =*d Reinspection Fee S15 CMF 0865-46, rev. 10/84 White - Building; Canary -Applicant: Pink - Accounting; Goldenrod - Assessor PLUMBING Showers ` Service Sink - - - Sewer Cap Sewer Connection Sojar Collectors ' Solar Piping Solar Tank l Swimming Pool w/Spa Urinal Water:Closet Water Heater Wates Service Auto -Wash Laundry Trays Issue Fee Hood or Type I ❑ ' Canopy Type 11 ❑ i Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers r Issue Fee 5899 7/02/85 Zone Accessory Building: Parking Req./Provided 1 TYPE OF CONSTRUCTION NEW LJ ADD ALTERATION LJ REPAIR FEES ❑ ❑ ❑ $15 Issue Fee: $ 3 CONVERSION DEMOLISH OTHER A p.=0 DESCRIPTION OF WORK/USE OF BLDG. DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By IDate / Application Issued By ' fy� Data 1/lf4 Cooking Unit S Main Building: TYPE OF PERMIT GRADING ❑ FOUNOATION ❑ STRUCTURALT 'Meter El over 100 amps_ Front 1:1 TENANT El ELECTRICAL ❑ PLUMBING 1:1 MECHANICAL B El 'ER A Rear PROJECT DESCRIPTION SQ. FT. OCCUPANCY C K Right CONSTRUCTION TYPE _ VALUATION $ g Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: j Planning Notes: _ Bar Sink Backflow-Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks _ Gas Service Outlets Interceptors Kitchen Sink Lavatories P --Trap Roof Drains Reinspection Fee . '1 $15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO 4 Heating System & Ducting ❑0-100,000 BTU (D 100,000 BT DriversL nse or SS =*d Reinspection Fee S15 CMF 0865-46, rev. 10/84 White - Building; Canary -Applicant: Pink - Accounting; Goldenrod - Assessor PLUMBING Showers ` Service Sink - - - Sewer Cap Sewer Connection Sojar Collectors ' Solar Piping Solar Tank l Swimming Pool w/Spa Urinal Water:Closet Water Heater Wates Service Auto -Wash Laundry Trays Issue Fee Hood or Type I ❑ ' Canopy Type 11 ❑ i Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers r Issue Fee 5899 7/02/85 Zone Accessory Building: Parking Req./Provided 1 I o e 50 TL Z O N I N G R E 0 M T S $ •3 FEES ELECTRICAL $15 Issue Fee: $ 3 Z UQ Automatic Washer, Construction Pole$ub. Transformer EI-15-50KW ❑ 50 + KW DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By IDate / Application Issued By ' fy� Data 1/lf4 Cooking Unit Meter ❑up to 100amps Dishwasher : t' 'Meter El over 100 amps_ Dryers ❑Gas O.Electric Sub Panel Fan' Motors ❑0-1 HP 01%-8 F,A.U. Inc. Solar 09.15 HP 1116-15+ Fixtures 'Microwave' ' 2—.44) Device Boxes Pole Light Outlets Range ' z 00 Switches Sign Garbage Disposal ; Standing Sections ; Generator 110-5 KW 1__)5-15 KW Trash Compactor I o e 50 TL Z O N I N G R E 0 M T S $ •3 , Reinspection Fee $15 Issue Fee: $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By IDate / Application Issued By ' fy� Data 1/lf4 _ SUMMARY OF FEES BUILDING PERMIT $ SMIP S PLAN CHECK $ PERMIT PLUMBING $ 1_J0 ISSUANCE S PLAN CHECK 25% $ / S•T) ENERGY P.C. S ' ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ ' L( PLAN CHECK 25% $ $ 3 CONSTRUCTION AND PLANNING APPROVALS , Permit # !: Date Inspector X POOL & SPA APPROVALS Permit # Date Insp,crnr _. 1., Tempary Electrical Service or Pole" 52. Pool & Equipment Location .2. Sod.P,ipt�-Undrgrnd. .� �� r1� 53. Steel Reinforcement 3�Elec cal Cond'uit;�lti� �y Undrgrnd,i 54. Forms r <Elacao') Cond iu tAr; n ' _ rnd. 55. Electrical Bonding y 5 Steel'Reinforcem"ent ' St • .� �� 56. Rough Plumbing & Pressure Test 6;.Ale ftfical UFER-G od. �: �� 57. APPROVAL TO COVER-GUNITE Vf . i �o fgs '401 lfr 58. Electrical Conduit-Undrgrnd. 1 �y 8 .yrs tion l'� r ,. i 59. Gas Pipe, ❑ Undrgrnd., Test �} 4 9-jWaier!Pipe-Undrg! d. �_ J 60. Backwash Lines, P -Trap, ❑ Undrgrnd. r 10.'Structural. Floor System y 61. APPROVAL TO DECK 11. P2perty"Sewer Line & House CNnection '1 I '0r j l 62. Backwash & Receptor -Final 12. Sewer Cap e �J� `� 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/SPASYSTEMS FINAL 19. Rough Heating & Air Conditioning . FIRE DEPT. REQUIREMENT APPROVALS Permit # 20, Rough Factory Fireplace 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 ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76, Dry Standpipe 2B. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL "30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31.'Plaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37.. Final Factory Fireplace -'38. Final Plumbing"1�• 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 �r 51. CERTIFICATE OF OCCUPANCY._► No. Date - J _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. I TRACT NO. I LOT NO. I UNIT NO. CITY OF COSTA MESA CONSTRUCTION P ERMIT Project Address 111 bl_ I I r n 5r,,HirtgI_H.; ttn-tr_ _s Applicant's Mailing Address 131140SaC1COY St. N.Hollywood Owner's Name Zroy Investment- Fiind Phone 549-2988 Address4391 Ri>rch_St. Ni-Wpnrr RP-arh_ La, Arch/Eng, J.Hock License No. Address ..-.^17881 Knott Ave. Siti rP '216 Contractor's Name- 11111r+0 Air, rnnr1i rJ nn1 Z hone 982-1216 Address (mailing)_1S11QSaticoy St. N.Hollywood.Ca. City License No. 334-2=5. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisionsof drter 9 (Commencing with section 7000] of Division 3 of the Business an ofessions Code, and my license is in full force and effec 346251 License Class 2 L s o. Date__4J_J&/_84_ Signature WORKERS' COMPENSATION DEC RATION I hereby affirm that I have a certifI a of consent to sell4nsure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section ta00, Lab. C.) Policy No. WC9$24 - Company Lumbermans BCertified copy is hereby furnished. CertifIFgpy is filed with the city BuildiV,0jv,tn- 7'e Date El 11 Applicant ll,,��((,�� ( - - EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (E300) or less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the , Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY ' I hereby affirm that there is a construction lending agency for the performance. of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, atter, improve, demolish or repair 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 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 �eenatty of not more than five hundred dollars (5500). .LJ 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure IS not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License taw 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 ' employees, provided that such improvements are not intended or oftered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build ar im- rove for the purpose of sale). I, as owner of the property, am exclusively Contracting with licensed Con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractors) License pursuarit to theContractor's License Law). I am aware that Proof of their Worker's Compensation inSuranCe should be provided to me. ❑ i am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have rea information is correct. I agree to and state laws relating to bull ' sen[afives is city to a er inspection urp ses. Signature Drivers' Li or SS Jh rdwai TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION " REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 90: DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION S S Left ZONE GRADING CU. YDS. ACRES Ping. Ref,=0 Remarks: Planning Notes: this application and state that the above 1 Imply with all city and county ordinances construction, antl hereby authorize repre- ipon the above-mentioned Property for Date Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service butiets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee Boiler PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal Water Closet Water Heater Water Service A uto-Wash Laundry Trays $15 Issue Fee Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 0}100,000 BTU 0100,000 BT Reinspection Fee I $15 rr —SMF 0$65-46, re 10/84 White - Building;'Canary - Applicant; Pink - Accountinb; Goldenrod -'Assessor MECHANICAL Hood or Type I ❑ Canopy Type I I ❑ FEES S 3 FEES Refrigeration System . ❑0.100,000 BTU E1100,000BTU System Repair/Alteration Fire Dempers. Registers 6 Issue Fee S 3 ddvj O/lis/C;1 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic washer Construction Pole Sub. {� Cooking Unit Dishwasher Dryers OGas DElectric Fan F,A,U. Fixtures Device Boxes ' Outlets Switches Garbage Disposal Generator ❑0.5 KW ❑5-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter Uup to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0.1 HP ❑ 1 % - B Inc. Solar 119-15 HP C1 16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor IDoCU TI_ FEES Z O N I N G R E Q M T S I I Reinspection Fee I S15 I I Issue Fee I S 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Buitding Approved By Dste Application Issued By Dat SUMMARY OF FEES BUILDING PERMIT $ SMIP $ ' PLAN CHECK S PERMIT PLUMBING S ISSUANCE S PLAN CHECK 25% S ENERGY P.C. S ELECTRICAL S GRADING S PLAN CHECK 50% S MICROFILM $ MECHANICAL $ _ 13 _M TOTAL FEE S 15.50 PLAN CHECK 25% S 1) 1; L1 CONSTRUCTION AND PLANNING APPROVALS . Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspecror 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 r 6. Electrical UFER Grnd. f" 57. APPROVAL TO COVER -GUN ITE 7, Footings t 58. Electrical Conduit-Undrgrnd. 8' Foundation5�Gas e, 0 Undrgrnd., Test r. 9, Water Pipe Undrgrnd. - 60. Backwash Lines, P -Trap, ❑ Undrgrnd, i 10. Structural Floor System ' 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection r 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`cwirn 67. Fencing & Access Approval 17. hough 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 APPROVALS. Permit # 20. hough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas 0 Oil 23. -Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27.. Frame and Flashing 76. Dry Standpipe 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 Z•1$'NL ton 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39, Water Service -Final 40. Gas Service -Final O 41. Solar Domestic -Final 42, Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITYOF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. Project Address -11d W`-_ TT 11• ifCI r7) / �! Applicant's Mailing Address Owner's Name �� D1 � STm E �r� Phone _ Address - Arch/Eng. License No.. Address 1� �� p� Contractor's Name ,(i I P- l -S �_i C- Phone r9L Address {mailing) Ill? Mri 9A3 - City License No, In LICErySED CONTRACTOR DECt-ARATION ' I hereby affirm that I am licensed under provisions of Charter 9 commencing with section 7000) of Division 3 of t siness and Pr fess s Gode, and my license -is in full 'for a and alta , License Class f l� - License o. Date Signature WORKERS' COMPENSATION DECLA AT ION I hereby affirm that f have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section '3800, lab-uC�.) sr Policy No. wt -Sl O q -,K-7C) C ' BCertified copy Is hereby furnished , Ciertified coplL pMed with the cit B in ivisi ' 4ate �--tiY t5"A Applicant EXEMPTION FROM WORKERS' COMPENSATIO t DECLARATION (This section need not be completed it the permit Is or one hundred ($100) or less)., I certify that In the performance of the work for which this permit is Issued I shall not employ any person in any manner so as to become subject to t1ke Workers' Compensation Laws of California. + i Date Signature -NOTICE: 11, after making this declaration, you should become subject to the Workers'- Compensation provisions of the Labor Code, you must forthwith comely with such provisions or this' permit shall be deemed revoked. ' CONSTRUCTION LENDING AGENCY•+ I hereby affirm that there is a construction lending agency for the performance of the work for, which this_ permit Is Issued (Section 3097 Civ. C,) Lender's Name ' i Lenger's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt frOm the Contractor's'LlCense Law for the foli4wing reaSOrt (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its.IssuanCe, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the.provisions of 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 anility of not more than five hundred dollars ($,500). 1 I, as owner of the property or -my employees- with, wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale .(Section 7044, Business' and Professional Code: The Contractor's L1c4nSe taw 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 employees, provided that such Improvements are not Intended or offered for safe- If, however, the building or improvement 1s sold within one year'of com- pletion, the owner will have the burden of proving he/she did not build or Im- ove for the purpose of sale). LJ I, as owner of the property, am exclusively contracting with licensed con- 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 builds Or improves thereon, and _who contractS for such projeCts with a con- tractor(s license pursuarit to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. t.7 1 am exempt under Section B. & P. C. for this reason Data Owner --_ — I hereby. certify that I have read this application and state that the above Information is correct. I agree to comply w all city and county Ordinances and state laws r to building onstr ti n, and hereby authorize repre- Senidtives + icy o enter Vg [ © above-mentioned property for Inspection urp 58 Sighature Date TYPE aFCDNSTRUCT)ON NEW ADO, ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Ap 46 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT LJ GRADING El FOUNDATION STRUCTURAL T Front ,- ❑ TENANT ❑ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B' Rear ❑ -OTHER A PROJECT DESCRIPTION SQ- FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION$ S Left ZONE GRADING CU. YDS. � ACRES—'Ping- Ref, Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigatioh Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof'Drains Reinspiction Fee $15 Boiler Duct - Under'Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firept/Fact. Bit. ICBO �# Heating System & Ducting ❑ 4100,000 BTU D1 00,000 BTI I Reinspection Fee Drivers' LicenSe or SS I, CMF 01165-46, rev, 10/84 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor $15 PLUMBING Showers Service Sink - Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet ' Water Heater - Water Service Auto -Wash ' Laundry Trays FEES 5907- I/ 6/85 4950 Zone Accessory Building: Z O N i + N G R Parking RegdProvided E- O' M T + S ELECTRICAL Automatic Washer - Transformer ❑ 15-50 KW Construction Pole Sub- 0 50'+ KW Cooking Unit Dishwasher Dryers ❑Gas ©Electric Fan F -A -U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 045 KW 05.15 KW Meter Lup to 100 amps Meter ❑over 100a mps Sub Panel Motors01 HP 01%-8 Inc, Solar ❑9-15 HP ❑16-15+ Microwave -- Pole Light Range Sign Standing Sections Trash Compactor FEES Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 iANICAL FEES Hood or . Type I El Canopy Type I I ❑ DEVELOPMENT SERVICES Zoning Approved By Building'Approved By Application issued By REQUIREMENTS: + Date Date Dat + Refrigeration System 134100,000 BTU ❑100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 2546 + ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES ,$ $ -$ _- $ $ $ ___,]�U $ $ SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTALFEE $ $ $ $ $ $� i System Repair/Alteration Fire Dampers Registers r Issue Fee $ 3 sPOOL CONSTRUCTION AND PLANNING . APPROVALS Permit# Date Inspector & SPA APPROVALS Permit 4# Date ' Inspector 1; temporary Electrical Service or Pole 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4• Electrical Conduit-Undrgrnd. 55. Electrical, Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test '9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final •15. Rough ElectricakConduit 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank © 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 PREY. FINAL '30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas,Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40, Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No • Date - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. • _11 CITY OF COSTA MESA CONSTRUCTION PERMIT PERMI NOT. TRACT NO. LOT NO. UN17 NO. Project Address �J1 w• njN -S• CQS`7f�� IM9 / Applicant's Mailing Address Owner's Name a ? 11V UC,S LM ✓✓ �11T Phone Address y Arch/Eng.- License No. Address - - - Contractor's Name_ Mahone Y77.6ly Address (maifingl_ fI?i gm&H c ST• �LOam�►�6Ta+J �1a3lb City License No. _ a a _ LICENSED CONTRACTOR DECLARATION' 1 "herel7y,affirm that I am licensed under provisions of Charter 9 (commencing ' with section 7000) of Division 3 of the Business and Professions Code, and my license Is in full forcer rip effect. �� { License Class $ Lice No. Date Signature 10 WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self-4nsure of a certificate -)f Workers' Compensation_ Insurance, or a certified copy thereof (Section !800, Lab. C. Policy No. G.S1 o 9 .:-7 _0 aftWil E C eCertifieci copy is hereby furnished Certifletl cop i sled with the citc ivisio Date I�19Y ^ Applicant EXEMPTION FROM WORKERS' COMPENSATIO ECLARATION _ (This section need not be completed If the permit Is for one hundred ($100) CF less). I certify that in lhq performance of the work for wnich this permit is Issued, I $hail not employ any person in any manner so as to'become subject to the ' Workers' Compensation Laws of California. .Date • - Signatuie 'NOTICE: if. after making this declaration, you should 'become subject to the ' Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provision$ or ,this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I nareby affirm that there is a construction lending agency for the performance of the work for wnich this. permit is 'Issued (Section .3097 Civ. C.) Lender's Name Lender's Address" - - - OWNER BUILDER DECLARATION I hereby affirm thy( I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which reg4ires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires tne•applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor'$ License taw (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 anally of not more than flue hundred dollars (5500). I, as owner of the property or my employees with- wages as their sole compensation, will do the work, and, the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. 1f, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 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 proof of their Walker's Compensation insurance should be provided to me, ❑ I am exempt under Section B. & P. C• for this reason Date Owner 1 hereby certify that I have reap Information is correct. I agree tpr and state laws I.yt' to builde sentatives ofd h ty o enter Inspection p r o Signature Drivers' License or SS hf AF 0865-46, rev. 10/84 White - E application and state that -the above ly with all city and county ordinances struction, and hereby authorize repre- i the above-mentioned property for ng; 5906_ 1/16/95_' 4.4 5C T _ TYPE OF CONSTRUCTION NEW ADD ALTERATIONREPAIR ❑ CONVERSION ❑ DEMOLISH ❑ DTH I -R ' DESCRIPTION OF WORK/USE OF BLDG. A.P. Zone S Main Building: Accessory Building: TYPE OF PERMIT GRADINGt- FOUNDATION 'STRUCTURAL ' ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL - ❑ OTHER E T Front , Z O B.A Rear `,. - M PROJECT DESCRIPTION SQ. FT. OCCUPANCY' CONSTRUCT{ON TYPE VALUATIDN S ZONE GRADING CU. YDS. ACRES - C Right N g Left G R Ping. Ref. # Parking Req./Provided E Remarks: Planning Notes: ' O M T S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ' l El 50 +KW ' Backflow Irrigation Sewer Cap Bathtubs Sewer Connection 'Cooking unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher _ Meter ❑over 100 amps _ Dishwasher Solar Piping r Dryers E]Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors Q1 HP 01%-B Floor Drains. Swimming Pool w]Spa F.A.U. Inc. Solar 09.15 HP ❑ 16-15+ • Floor Sinks - Urinal ' Fixtures' Microwave ' Gas Service Outlets Water Closet i Device Boxes Pole Light Interceptors Kitchen Sink Lavatories Water' Heater-. Water Service Auto -Wash Outlets Switches Garhage Disposal • Range Sign ;,Standing Sections P—Trap Laundry Trays- Generator ❑0.5 KW 05-15 KW Trash Compactor Roof Drains I - S Reinspection Fee $15 - Issue Fee $ 3 Reinspection Fee $15 Issuer Fee $ 3 r Boiler. Duct - Under Ground MECHANICAL Hood or Type L ❑ ' Canopy Type I I ❑ _ FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved'By Application Issued By REQUIREMENTS:, Date 1 Oate Date Duct - Structural Refrigeration System DO-_1"00,000_BTU ❑ 100,000:BT,U Duct - Ventilating + _ BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 2596 ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ r PERMIT $ I ISSUANCE $ $ ENERGY P.C. $ $ '-OG GRADING $ $ MICROFILM '$ $ TOTAL FEE $ $ ` d Exhaust'System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers Heating System & Ducting ❑ 0-100,000 BTU ❑ 100,000 BT Registers ! Reinspection Fee $15 Issue Fee $ 3 - Applicant; Pink - Accounting; Goldenrod - Assessor f CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspectnr 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test .6- Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7, Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. •10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line &. House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough E4ectrical-T Bar Ceiling 69. POOLISPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas G Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. _Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. F I NA L I NSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy, 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43, 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 ' LLJ H a J a } 'J LU (L O cc CL Z LL1 H LLJ rD- D O } U) t!! 1— COSTA MESA BUILDING—WETY DEPARTMENT P.O. BOX 1200 Costa Mesa, Callloinla ' 1 1 ` I II 1 111111 ELECTRICIAN 7 /�t%�� 1�7 rJ'� je/ TRACT NO.Ib9i� I ,/ PE MT NQ. R G'D 9Y LOT NO. DATE ISSUED BUILDING USE //) c9% BUILDING � �'^ �✓�� ADDRESS 7// r % ADDRESS /2,/ LZIA{_AIU7— —CITY �._ �� TEL. NO.%DQW- STATE LICENSE NO Q CLASS. —/Q j CITY LICENSE NO. a / No. ITIM EACH poll COSTA MESA, CALIFORNIA - .1 Dwelling, Sq, Ft. 3 NEAREST . Garage, Sq. Ft. OWNER a2oa '— — jL (g First 20 Outlets, each_44MAIL O ADDRESS Outlets, Additional CITY TEL. NO. First 20 Fixtures, each ! HERFBY� ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CATION AtJp STATE THAT THE ABOVE IS CORRECT AND AGREE TO{COMPLYVWITH ALL CITY ORDINANCES AND STATE LAWS REG. ULATING ELECTRICAL WIRING. y Y 1 CERTIFY THAT i POSSESS THE ABOVE VALID STATE OF CALIFORNIA CLASSIFICATION OR 1 AM THE LEGAL OWNER OF THE SINGLE FAMILY RESIDENTIAL PROPERTY DESCRIBED ABOVE. Signature of PERMITTEE Fixtures, Additional Dryer Fan A Hearer ti Oven, Domestic ✓ MO. ITEM EACH FEL$ Pole, Constructiont"' , � Sign 6 I Trans. 2.00 Range, Roimezticy Transformers KW Mise. Y� Generators KW Motors {See Schaduloi ` HIP HP HP Tocol Foes APPROVALS Meters, ea. SNS/ECTOE DATE :7 Permit Fee 3 00 NDUIT Svb•Totol Fess FI- POTotal Fees UTIEDF1 - CMF 0313-46, rev. 7/75 For items not listed refer to Fe hedule BLDG. PERMIT N4. s rj F7474 73i, :3� OS MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only OUILDING W BUILDING ADDRESS 5/Iy A DRESS V. ` 1 T� TRACT R U OWNER _ � .t Ate/ e ADD MAIL D TEL ADDRESS USE OF NEW BUILDING ' CITY NO. OWNER 141 SE TE CITY J �� c NO CONSTRUCTION OF LOT NOW ON LOT RONT F LENDER taSE OF BRANCH ADDRESS ARCHITECT TEL, 1T '39QC aan JUL 25-77PcA—ID002640* ****53.30 ,1 4P41CITION FOR STRUCTURAL PERMIT RE f A.P. NO. Y DATE RECEIVED T !SS E • ERMIT NO. BUILDING ADDRESS ADDRESS ZONE YPE V. ` 1 T� TRACT R L BLOCK NEW ADD ADDRESS TEL ZONE NO.OF PLANS USE OF NEW BUILDING ' CITY NO. OWNER 141 SE "moi VALUE A►fl,.. $SV�V I hereby acknowledge that I have read this application and state that the above information Is correct and agree to comply with all laws regulating building construction, and I shall not employ any person In violation of the workmen's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Dlvlsion 3, Chapter 9, and that such licensee are in full force and effect, or I am exempt from the provislons of the Stat California Buainass and Professions Co Division 3, Chapter Signatureof�t permittee T�G�l C -00t Authorized Agent THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMIT FEE S 15111.0 CM PLAN CHECK $ $ V TAX E TOTAL PAID E FIRE 4 Z- ADDRESS ZONE YPE GRDUP — �� F0' DATE -J_l ONTRACTOR BYPROVE ADDRESS TEL ZONE NO.OF PLANS USE OF NEW BUILDING ' CITY NO. STATE CITY YARDS APPROVED YARDS APPROVED OC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF CLOGS. (FROM C/L STREET) OF LOT NOW ON LOT RONT F taSE OF 9XISTING BLDG. R. SIDE F FT Separate permits are required for L, SIDE FT. electric, plumbing and heating work. REAR F F7. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET, MYT. MAIN & MAIN BLDGS. ACCESS, CLOGS. / f� j�, / T�r, I/[! "�+�J / ' / %I / U�. C URP # APPROVED �] APPROVED r j I ! ` I hereby acknowledge that I have read this application and state that the above information Is correct and agree to comply with all laws regulating building construction, and I shall not employ any person In violation of the workmen's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Dlvlsion 3, Chapter 9, and that such licensee are in full force and effect, or I am exempt from the provislons of the Stat California Buainass and Professions Co Division 3, Chapter Signatureof�t permittee T�G�l C -00t Authorized Agent THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMIT FEE S 15111.0 CM PLAN CHECK $ $ V TAX E TOTAL PAID E rl sI ADORtSS OF BULM G: 711 W 17TH ST OMITS IIAYEIFIt"w- BRADY WILLS ADDRESS: 711 W 17TH ST #11-6 COSTA MESA,CA 92626 APPL.1f UNG ADDRESS: ARCHITECT OR ENGINEER: ARCH. OR ENd'S ADDRESS: UNT: H-16 UC. ND.: UNT.. CON1RACTOR'S NA1IE: CORMACTOR'S MABDfr ADDRESS LIC. Nd UNT. LICENSED CONTRACTORS DECLARATION: I hereby affirm under penalty of PMwy the (am fcarmed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prdesaimm Code, and my kcense is in full force and efled. CfrY UC. NO.: LIC. CLASS: LIC, NO.: E X P Date: Conuactor. OWNtR BUILDER DECLARATION: 1 Thereby affirm under pww&y of pwjwy that I am exempt from the Contractors License law for the lotowi g reason ($adios 7031.5 Business and Professions Code: Any ciy or county which requires a perms to oorstMCI, aher, improve, demolish, or repair ary emtcture, prior to in issuance. also rgxAma the applicant for ouch permit to fila a signed danarnera dw he or she licensed pursuant to the provisions of the Contractors Licenae Law [Chaper 9 (commencing with $adion 7000) of Division 3 of the svhass and Prda= m Code) or that he or she is exernpi therefrom and the beam for the alleged examptuh. Ary videtor of Sed'oh .37.5 by any applicant for a permit ethjeds the applicant to a civil penalty OF nit more than Dm hundred doges {SSWD, ❑ 1. as owner of the mops" or my employees with wages as their sole compensation, nil do the world and the aurae q noi internded or offered for sale (Section 7044, Business and Profeasiors Code: The Contractors L3orse Law does rpm apply to an owner of properly who to" or improves thereon, and who does such work himself or herself or through he or her own employees, provided that such improvements are nit intended or offered for sale. fl, however, the building orimprov ofd is sekl within one yew of almpk0icn, the owner -builder will have the (Maden OF proving he or she did nit fold or improve for the propose of sale). ❑ I, as owner of the property, am exdushrdy contmaing with licensed contractors to conabW the project (Section 7044, Business and Professions Cads: The Contradors Licama Law does not appy to an owner of property who builds or improves thereon and who contracts for such projects with a contrador(s1 licensed pursuant to the Commmore License Law). ® f am a undle, rion: B P 7 0 4 4 B. a P.c., lor OW ER DER rDea lTarrer: 1 do car* thin I am aware d and tamdmstand the requ0am d l;elicnhm and Safety Code Sectfona 255D5, 25&13. and E. that I or any future building occupant will 1 win nd (dFc% ons) need to an with said stets sodas d the regoimme is for e.consructionormodiScalonfromtheAiiyaWarepemeraDislncl.Residentialcostmdionapprnostiomareaoemptfromthese Date: Appliearr: WORKER'S COMPENSATION DECLARATION: I hereby afrrm under penalty of perjury one or the following dedarwiona: ❑ I have and will maintain a codifcate of oonsenl to eat -insure for workere' compensation, as provided for by Section 3700 of the Labor Code. for the performance or the work for which this permit is issued. 1 have and wil maintain workers' compensation insurarnoe, as required by Section 3700 Of the Labor Code, for the performance of the work for whidh this permit is eaued. My workers' Companseticn ita ranhoe carrier and policy member are: Carrier: Parry Number: a aecl need ra be compkrod r the perrni o Ax ane hurdrod dobnr iStoof orb=j . [, I osnAy that to the pafwAV4e of the work for which this permit is mated, I " nit employ any person in any mania so as to becorvns ambjerd to the w~' co, gow tion lows of CeWonia. and agree date If I dtotld become subject to the workers' compensation provisions of Sedion 3700 of the Labor Code, I shall forthwith comply with those pnoviddu. Date: Appfrat! Warming: Failure to secure wortarro' compwsadon oovarapa Is unlawful, and Mail aWfect an employer to crfnYnal parsaltlq and civil firma rp to one hramdrsd thousand dollars (tf O OWA in eddldon to fha coat of co mparmatlory dansapsa am provldad for In Saollon 9706 of Ilia Labor CodA lrnterw t� mild of rnWa fees, CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury the thea is a conensdon iadsg agency fit the performance of the wok for which this permit is issued {Sedigh 3097. Civ. C). LENDER'S NAME LENDER'S ADDRESS: I neat=ly that I have read this application and dee that [he above inlomteion is caned. I agree to comply with all my and county ordinances and stale laws relating lo building condntcbon trod hereby authorize mpresrdatives or the dry to enter upon the shme•rnwdened propel for ihepecion Purposes. un BRADY WILLS %, (5151-44.WP) E Safety; Omen -File: Canary-Appkam; Pink -Revenue; GoIdemod-Meassor ' CITY OF COSTA MESA - BUILDING PERMIT PERM NO: E 0849b_ PERMIT NO: E 084461 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: ALT JOB DESCRIPTION : REPLACE SUBPANEL "EXTERIOR" SQ FT: CLAIM VALUE: CALL -VALUE: GROUP OCC: Fir / COMMENTS: BRING SERVICE iFyEi4��ii•iEii•irir�;t�*iEriiEiEif**ifiEif iEiE�i4�if*�iF�iFk-ktiFirriEititiEiE�-iEifififiEiE�x�x�;fiFic�i4*iE}E�(-yfiFy(-yE��*�;Yi6sc.� Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------- MAIN BUILDING ---------- --------- ACCESSORY BUILDING---------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RIGHT: FT IN PARKING REQ: PROV: PARCEL: 93983048 ZNE: REF NO: PLANNING NOTES> i - iF D E V E L O P M E N T S'E R V I C E S R E Q U I R E M E N T S= ZONING APPROVED BY DATE: - BUILDING APPROVED BY : DATE: - APPLICATION ISSUED BY: . DATE: -• iE��*-II-iE�;fiE-)EiE��if*if�ififiE;t•ii- x >r� ,� � LEGALIZATION:N F-E'E S [� M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRICr MECHANIC FIRE SMIP/RES GRADING PERMIT 27.25 0%` SMIP/NON-RES PLAN r„ ISSUE FEE 22.00 - BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 27.25 22.00 . 0.00 49.25 49,25 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 49.25 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 49.25 3f ?E iP 3f- yi- i+f- iE it iF � 14 iiE lE iE * iE � iE �f lh -Irt i+t i+t ->f iE iE �E �E iE � aE if �F �E >•F if iE iiE * � � � iE >'f i4 �f ill- � -lE �f if iE -lF � � aE � iP irk iF iF -1F irk iE iF -lE �E 14 ill• ill• if iti x � if * if -1F iE I N D I V I D U A L -F..E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST 'TOTAL COST ELE 1 SERVICES BELOW 600 V & BELOW 101 AMP 27.25 27,25 END OF FEES 1 T ' r 08-28-1997/62:17 PA349.25 n' RCPT4:;a1-'6311511 i PEkM I T : 084461 F ' CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector, POO f_ PA APPROVALS Permit # Date Inspector ,I,. Temporary Electrical Service or Pole 52, Pool & Equipment Location 2. Soil Pipe-Undrgrnd, 53. Steel Reinforcement 3, Electrical Conduit Utiiity•Undrgrnd, 54. Forms 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test B. Electrical UFER Grnd, 57. APPROVAL TO COVER-GUNITE 7, Footings 58. Electrical Conduit-Undrgrnd, 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60, Backwash Lines, P -Trap, ❑ 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 11 Roof Drains 64. Plumbing System - Final 14, Rough Plumbing 65. Electrical -Final 15, Rough Electrical -Conduit 1 66. Solar System Final , 1,6, Rough Electric Wiring 67, Fencing & Access Approval i 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING' ` 18, Rough Etectricai•T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL ` 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 1Gas 0 Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24F, Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25. Roof Sheathing M 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 B0. FOOD CERTIFICATE ISSUED Notes: 32. Electrical Power Meter -Final 33, Final Electric 34. Final Heating & Air Conditioning j6 r/ `v �j'^I Z -� n a,c(- �aggP .`Pf - -� 35. Final Gas Pipe Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. 8ackflow Preventer 43. Backflow Irrigation 44, Landscape Irriqation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50, Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ADDAMOFBut.ODR 711 W 17TH ST Olin` H2 CITY OF COSTA MESA -- BUILDING PERMIT awNElrSN7YE1F*Ow" TODD TRAVIS PERM NO: B 08 3$ ' ' "°01iES'` 711 W 17TH ST ♦ PERMIT NO: B 085038 PLAN CHECK NO: 02542-97 L GOVT: N SUPP: N it IDa', CA 92627 714-650-7446 CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT ARCHRECTORENGINEER Ur W.: JOB DESCRIPTION : SPRAY BOOTH W/ DRY CHEM FIRE SUPRESSION SQ FT: 6,000 WN, OR FJ10.'S A00REM: GMT: CLAIM VALUE: 6,000.00 CALL—VALUE: 6,000.00 GROUP OCC: B / COMRACTOR'9 NAIL COWRAC1XWSMAILING COMMENTS: "FREEHAND SIGN CO." SPRAY BOOTH - ADORM: Ur NO.: se iE >tiF s4 }F i4 i>t i>t * * it 7a` �F alt• ;k if * if iF sf * it i>t i4 i4 i4 it it it i4 i•E * ;f * iF * i4 i>t sf sf * >tiF sE }F �F >tiF s4 it sf iE iE iF iE iF * * iF sf * i>t sF if ;f ;tE 7a` �F >tiF if if ;f } f;tE ;?r OMT: Z O N I N G R E Q U I R E M E N T S LICENSED CONTRACTORS DECLARATION: I hereby alfrm under penally of Perpey theta I am Icermad under pmvsiors of Chapter R S E T B A C K S (oomman=hg with Section 7000) of Division 3 of die Br®toss end Professions Code. and my DWM is in M force and Nlsa. CITY LIC. NO.: LIC. CLASS: LIC, NO.: EXP:------------- MAIN BUILDING ----------- ----- ACCESSORY BUILDING — + Date: Card] or.. FRNT: FT IN REAR: FT IN FRNT : FT IN REAR; FTIN LEFT: FT IN RIGHT: FT IN LEFT: FT IN RIGHT: FT IN OWNER BUILDER DECLARATION: I hereby a17'imh under peaty Of perjury that I am exempt from the Caareelore License Law tar fie IOliDwhng reason (Section 70313 Business aril Prtiassoee Code: Arty ray or county wNdh usque a Permit to aw:aM d, allr, urWr , dwnoLah' e liDrhsea pursuant 4w repw to t gvginors d tthhe �reda's°i�+e Law [pplicarra Chapter 9(cornmeencinysuch permit twahasee�° i000l� a+he PLANNINGARKING RN TES> FREE SOTANDING SPRAY BOOTH TO BE INSTALLED INSIDE AN - Business and Prat&sa and Code] or that he or she is aeempt therefrom and the basis for the aneoae eeamprm, Any viofario r d Seton > EXISTING INDUSTRIAL SUITE FOR A SIGN MANUFACTURER. k' 7031.5 by any applicant for a permit o d*Kts rho applicant to a civil penalty of nor more than We hundred dollars [S500D. }I it ;{ sf it sir iF if sF ii iE }F iE iF Sf iF iF sl iF sf it it i'F * iF if iE i•E ; E ; E ;f iE iF i'F iE ;f ;f }[ 9E j} iE ;f ;f iE iE sF i4 i4 err iF iF sl sF iF it iF iF sf ;>r if at iE Sf ; f_; EBF j{ sE i4 iE ii i•E ❑ ],as owner d the �Operty or my empbyees wige h was n their sole oomper*rgion. w'9 do the work aril the structure 's not bdanded or offered for nab ( 7041, Busi sea srW Pnolsasotn Code: The C.ordradars Lichee Law does nil apply loan owner of property D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N--,T. -S who builds or Improves thereon, and wt* does such work hff"W or herself or through he or her oras ampbyees. provided that such imp wements are nil +gerded oroared for sale. 0, lhawever, tit baWft ori provameti a sold withoh one yearafmn;Imfion. Che . owner-buBds Will have the t uda d povil he or she dd not WW or improve for the pvwd pe sale), ZONING APPROVED BY V% R DATE: 1, w owner d the property. am mclusiwely oordredihp wi:h 6oareed aontrad= to aowtnMa the project (Section 7041. Busineea atd - . j �( Professions Code: The contractor, Lomas Lew does not apply a an owner d 7- tor thereon ane who BUILDING A P P R O V £D B Y _ ��I'rn DATE : !1 tnntrecta tar such pojeas wash a cunrxtoe(s) licensed prauerd to the Coit IantexemptunderSection: BPaP.C..mh APPLICATION ISSUED BY: DATE: Y` Kate: �' Owrhar. iE iE if ii x iE ; E sf ; f iE ii sF iE st st st st ii iP x ore x x x x x x ; E ;f x x iF st sr sr sr i4 ore t y con I am Aware d erd urdxswd to regtmwnrsa d California Health ane safety code SWkwo 25505.25M. and LEGALIZATION : N F E E S U M M A R Y STRUCTURAL S£ G M E N T: Y 25534 erne t I orarty hrnr. hualdplp 000ryerd. will !will not (utricle One) need to comPM rlh said atara ado Intl the nagndramanm for ids an exempt ham these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE S M I P /RES GRADING e pannhl lar mustrtrction or lnaehfiwtian trorn the Ae us anagrmrd Drstrid. Rsadersial Doruetnrdion eppiw p°°"ions. PERMIT 112.25 Date: Applicant: S M I P /NON — R E S WORKER'S COMPENSATION DECLARATION: I hereby affirm under peneey, of prjuy one of ds fallowing declarations: PLAN 72.96 1.26 ❑I have and will msideih a coMiem s d Dorusn to eall4rmnfor worker' canpensation, at Provided for by Section 3700 d the Labor ISSUE F E E Code, for the pen«manceofthe work l«which this Pon isinued. BUILDING--DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ I have ane Wirt maintain workers' compamaron imrarroe. as required by Sedan 3700 of de Labor Cade, for the Pedamarme of the TOTALS — — — — > 113.51 0.00 72.96 186.47 186.47 .00 work for a' idh the perhhe is ies,red. My worlass' compensation iruaanes wrier and poky number are: Carp;er, REVENUE DIVISION TOTALS--> COLLECTED: 113.51 OVER/SHORT: .00 PokyN+rhbW, BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK (Rhea section need not be cunV* ted 7 the prmr is for one hundhsd dadam ISTaoj or less) 112.25 1.26 I oenh that in iM paAomwuca d the work for which the permit a Astec,-t'thheG nil arnploy .f7triom manner p m to , became subject to tfhe wonkere' oompernatien laws d CaG1 and agree that it uroonhe ed to 1M wslms' if1frfrf yF it 7f1f1f it if iF1f i' iF iF ii iF st il1f sir•1f if iE1f iF if if ifrf iE iE 7f1fif +k iF sr if if it s� if1fifif �e it i' it ie �F �F ie iEif i' i' if if 'sir iF 7f• i' sir it iF st it COmpenaetian pnOviaiohf d Sadiron 3700 d IM La6Er�dtfTIIi7al " t ata 7 Appl�aad: A L F E E B R E A K D O W N log: FiNtae fo a.cun —nit ' conprsetlon cwsrapa le taYarhtl, end cora eu�jeet an wrtplorsr ro ufmfrar psrreftlp and TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST clvll arse W to oma hund►ed thousaWd dollar. (SIO%000,. ih addltlon to as Cwt of earprsallaq chunq as as pnvfded for In se`uan3n*ofma»orcada'fer"aer.and aamrrerOtam SFC 6000 ALTER BY VALUE COMMERCIAL NOZONE 1.00 6,000,00 CONSTRUCTION LENDING AGENCY: I hereby affn. order Penally Of parjsy that tete is a coratmrahon lending agency for the END OF FEES performance d the work for which this permit a issued (`bion 3097. Irv. C). LENDEq'S NAYS LENDER'S ADDRESS: I certify that I hers read the application end ,tele that the above It dot. etch a coned. I agree m eadply with at airy end oourdy aditmrpm and store lass reiating to buiyng eansWdion and hereby aulhorue represadatives of this airy to enter upEm the above-mentioned ed popery for "SpeL'°n parte. 10-86-1997110:83 NW113.51 ]3.5] 2]DD 3334 "" AVIS pERMIT:T0B e� 8 Data: —�`� Signature at OensdAgerWAvdh htrador (5151 4tl.WP) WhGe-Bu&[N a Sdety, Green-Fide: Canary-Appicam: Pink-Revenue: Gdderimd-Aaeenw ' C19NSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL _ SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd. 53. Steel Reinforcement -3.,Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 6: Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe•Undrgrnd. 60. Backwash Lines, P•Trap, ❑ Undrgrnd, 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Ronf Drains 64. Plumbing System - Final 14, Rough Plumbing 65. Electrical -Final 16. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring j •67, Fencing & Access Approval 17, Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling -69. POOL/SPA SYSTEMS FINAL i9. Rough Heating-&-Air"Conditioning FIRE DEPT. REQUIREMENT APPROVALS - Perini[ # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Duets, Ventilating - 71. Product Piping 0 Gas 0 Oil 23, Gas Pipe -Rough & Test 72. Underground FILdSh 24. Roof- Framing' _ 73: Undergnid. Storage Tank. ❑ Gas ❑ Oil 25. Roof Sheathing 74; Overhead Hydro 26. T-Bar"Ceiling {Structural) & Monocoat " r : , 75 Dry Chemical 27. Frame and Flashing 76. Dry Standpipe } 28. Lathing & Siding k ; 77. FIXED SYSTEM FINAi 29, Insulation 78. FIRE PREY. FINAL , 30. Drywall Nailing - ,' HEALTH DEPT. REQUIREMENT _ 31, Plaster Brown Coat - 79. FINAL INSPECTION ' r 32. Electrical Power Meter•F;na1 I' 80.', FOOD CERTfFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning " F � i 35. Finai Gas Pipe -Test , 36. Hood or Canopy 37. Final Factory Fireplace 38, Fnal Plumbing - 39. Water Service -Final .40. Gas Service-Finat 41. Solar Domestic -Final 42. Backflow PreventeT 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation r' r 46. Handicap Regulations :Y 47., FINAL STRUCTURE&BUILDING 48. FINAL, PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ; W 51. CERTIFICATE OF OCCUPANCY No. Date ADDRESS OF UOLDMl —111 W 17TH ST UNT: H2 O R`sNAR'IFItN0917a: TODD TRAVIS ` ADDRESS: —111 W 17TH ST CA 92627 714-650-7446 ARCHITECT OR EI MEER: LIC. NO.: ARCH. OR EM'S ADDRESS: UNT: CONTRACTORS NA1F£ CONMACTOR'S RA1LM ADORES9: Lr— N0» UNT: LICENSED CONTRACTORS Dt-CLARATIOW I hereby affirm under penalty of perryry that I tun loenahsd under prwisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in Fug face and allied, CITY LIC. NO.: LIC. CLASS: UC. NO.: EXP: Date: Contractor. OWNERBUILDER DECLARATION; I hereby affirm under penalty of perjury that I am etempt from the Corarectors License Law for the fWowfrhg reason {$'action 7031.$ Business and PrdesBiom Code: Any cky or county which requires a permit to construct. after. Improve. demolish, or repair arty structure, prior to its issuance, Also requires the applicant for such permit to foe a signed statement that he or she is licensed purntera to the psrNisions d the Comrctore License Lew (Chapter B (mmmsnmy wqh Section 7000) of Division 3 of the Busireas and Professors Code] or that he or she is exempt 100401, end the basis for the ePeped sannptnn. Any vuolaticn ON Section 7031.5 by any applicant for a permit subjects the appliar to a civil penalty of not more than five hundred dollars )S500D. ❑ I, as owner d the property or my empWyeas wish wages as their sole compensation. will do the wok, and the strumae is not irdef or offered for sale (Section 7044, Business and Professions Code: The Contractors License Law does rot apply to an vomer d property who budds or improves thgreon, and who does such work himself or herself or through he or her own employees, provided thea Bich improvemams are not intehded or dlerad fa sale. t, however, the building or improvemer is add within one yea d completion, the owner -builder will have the burden d proving he at she did not build or improve for the purpose d sale). I, as owner of the property, am exckoively cortrcting with lioersed contractors to wrtsbW De project (Section 7041, Business and professions Code: The C6ntredan License Law dose not apply to an oaFprtsp�ra builds or improves thereon and who contraus for snrUn protects wrCh a octdrector(a) licensed pars Canrtrtrumoa ❑ exempt under Section: B. :..., Owner:ootdy that 1 am aware understand the requirements d Caidarm liaekh end Safrry Code Ssc ms 25505.25513. andend that I o Amy hture buildieouupa d will I wit not (drefe ere) need to comply vdh said state codes end the requirements low a permit focosmuctionor modifirationtrom the Airy ._%sgement Diol. Residmsid mstrumon appledionams eramq from these provisions. Date: • Applicata: WORKER'S COMPENSATION DECLARATION: f hereby affirm under penaty of perjury one of is following declaration: I have and wnl meintan a aerL&Ave of oo miss to setansu s fm rerkss' oomPens'ation, ea provided for by Semon 3700of the Labor Code. for the pedama%cb of the work fo which this perm% is issued, t here and ha maintain worker' mnpersation irmurance, as regemad by Session 3700 of tie Labor Code, fm the pwkwm roe d the work for which this permit is issued. My workers compensation inwn vme carrier and policy number air: Cartier, Policy Number: This section need not be completed T the permit is Aon one hundred daffars [$too] or less.) 93 I ceriy that in the Performance of the work 1w which this permit is issUad. I shall t.+mpkyam Peron In Any manner so as to become Subject to rhe workers' compensation laws d Caldo mw an t if I Aho e o the workers' 6-4 er"ion pnov cions of SectLdpflem the Lobo Code, I e coat-siona- alfnaa to secure rs'atlrers'tan coverage la lwrfawhd, acrd ehdt sublact an ertWorev to eti rai panafdes and LP to one httndr4 thousand (fTOQ0o0A err addition to the ecsl of eorrupMteatbr; Qan�a v pr"i ind fbr In Section 9706 of the labor Lode, Antareat, and &Homey's fou. CONSTRUCTION LENDING AGENCY: 1 hereby affirm under penalty of perjury that there is a oomrud'nn lendrg agency for the performance of the work fm whkh this perms is issued (Section 3097, Cir. C), LENDER'S NAME LENDER'S ADDRESS: I Certify thea 1 have read this amicalion and mate thea the above indarmalion is correct. I agree to comply with erg Holy erd courdy ordinencee and stale laws relatiry to building c n struma% and hereby aulhorce leplesentwi ea d this city to enter upon the above-meregrhed popery for inspection purpoass. 0151-4410p) Date: Whits$uildiy 5 Safety; Green -File: Canary-App5cant; Pink -PA verve: Goldenrod-Aesessa CITY OF COSTA MESA — BUILDING PERMIT, PERM NO: E 085039 PERMIT NO; E 085039 PLAN CHECK NO; N GOVT; N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE; ELE PURPOSE: ALT JOB DESCRIPTION ; SPRAY" BOOTH W/ DRY CHEM FIRE SUPRESSION SQ FT: CLAIM VALUE: CALL—VALUE: GROUP OCC; B t COMMENTS: "FREEHAND SIGN CO." SPRAY BOOTH REF:B-85038 rE iFsE # ie ie ii• � ii• i4 i4 � yfrE ie ie iFrE ifrE if * iF iP iF ilil- ilit i4rE is i4 if if ii• iF il- iF i'FrE iP if � is ie i4 i4 u�c i4rE is ii- iF ifrE iE iF iF � iE il- � � ii• iE iE * * iE ii• iP iF ii• if ie ie if Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------- MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN LEFT, FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN PARKING REQ: PROV; PARCEL; 42409111 ZNE: REF NO; PLANNING NOTES> if if it itF if � ii� �F � � iF iE ;f ;f ;f ;f iE iF � i' � i' it ii• � dF � � iE ii• � iE ;f �F iE � � ;f it if yf if i# if �!- if yfrf 7iF fi if yf � yf � � i# � iE i# iE iE iF it � iE ir!- i' ii• it• it if it it � it if ,k D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY n DATE: BUILDING APPROVED BY DATE: q APPLICATION ISSUED BY: lam— DATE: !� iF ie iF iF its• ie � ii• ii• ii• � � � � * *rE iF � i4 iF if ��it yr >t do ' ie ye st st• ti�� sE�7F if � is iE i4 is � x yE x sr x e x it it is 3e LEGALIZATION:N F E E y S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 11.00 50# SMIP/NON—RES PLAN ISSUE FEE 22.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 11.00 22.00 0,00 33.00 33.00 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 33.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN --CHECK 33.00 iF if its• ii• x iE dF iF � �F it ililit i4 � iE its• * * iF iE dF jE * * # ie its• * il- it il- il- il- � ;f iF ;r ;t * iF iE * iF � � +f +f if ii- it- � ;t ;t ;t jc �E;iF it iF � if � � i� i# ii• it � � � it it i# it iE it i# I N D I V I D U A L F E E B R E A H D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 1 MOTOR/POWR APPARATUS 1,1 — 10,0 HP 11.00 11.00 END OF FEES 18'-85-1997/18:84 AR/633.88 RWTVAI-8813335 PERMIT:BS5B34 CQNSTfikiCTION AND PLANNING APPROVALS Permit # Date Inspector • . POO L ;PA APPROVALS Permit # Date Inspector 1. temporary Electrical Service or Pole 52. Pool & Equipment Location 2. SPiJ Pipe-Undrgrnd. 53. Steel Reinforcement 3: Electrical Conduit U0ity-Undrgrnd. 54. Forms -4, Electrical Conduit•Undrgrnd. 55. Electrical Bonding 5, Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER•GUNITE 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 & 4ouse Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63, Heater & Vent-Finat 13. Roof Drains 64• Plumbing System -`Final 14. Rough Plumbing 65, Electrical -Final 15, Rough Electrical -Conduit 6 Solar System Final Fericing & Access Approval • 16. Rough Electric Wiring lQ! r 17. Rough Wiring Sign r 68..APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling '69, POOLISPA SYSTEMS FINAL 19. Rough Heating & ATrConditloning - FIRE DEPT. REQUIRENrENT APPROVALS - , Permit # 20. Rough Favory.Fireplace 1 _ r 21. Ducts, in Structure !• - } ' 70. Underground Hydro 22, Ducts, Ventilating'` .• , � � t- _ r 71. Product, Piping 0 Gas C3 Oil 23. Gas Pipe -Rough & Test t 72. Underground Flush ' 24. Roof Framing" �. ! ,• 73: Undergrnd. Storagc-Tank; D Gas D Oil 25, Roof Sheathing r + 'r 74-,- Overhead Hydro t 26. T -Bar Ceiling (Struotural) & Monocoat 15: Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing 8 Siding = 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PR EV. FINAL 30. Drywall Nailing ' ' HEALTH DEPT, REQUIREMENT 31. Plaster Brawn Coat t79. FINAL INSPECTION " 32.E Electrical Povver tvieter-Final . FOOD CERTIFICATE ISSUED 33. Final-Flecsric -. test = 34. FinaMeating & Aic Conditioning- ' 35.. Final Gas Pipe!Test 36. Hood or Canopy ' 37, Final.Factory Fireplace 38. Final Plumbing 391 Water Service -Final i- -01 Gas Service -Final 41. Solar Dompstic-Final' '42: Backflow Preventer 41. Backflow Irrigation 441. Landscape Irrigation System 4 Sound Attenudtion + 7 4.6, Handicap Regulations ' 47'. FINAL. STRUCTURE & BUILDING ;= -J_ 48. FINAL PLANNING 49'. Electric Release to Edison r iril� 50'. Gas Release to Southern California Gas Co W w 51'. CERTIFICATE OF OCCUPANCY No Date _ ADDRESS OF BU LDIRG: 711 W 17TH S1 ISM: H2 WINERB NAME IF mow TODD TRAVIS ADDRESS; 711 W 17TH ST :dSTA MESA, CA 92627 714-650-7446 APPL. MAILINO ADDRESS; ARCHITECT OR OMEFR: ARCH. OR ENG.'S ADDRESS: LIC. 1410s CONTBACTor MAuE_- CONTRACTORS NAILING ADOREM LIC. 110; UNT: hiss: LICENSED CONTRACTORS DECLARATION: I hereby dfsm under penally d parpay tet I am Tanned uhdr prov®rs d Chmp[r 9 (commenting with Section 7000) of Oirisim 3 of the Business and Prdssitms Cods. sad my Boerne it in Iul face and effect. CITY UC. NO.: LIC. CLASS: LIC. NO.: EXP. Date: Contractor OWNER BUILDER DECLARATION: I hereby atf rm wider Porsity d Perjtvy thea 1 am exempt from the Contractors License Law lot the fdbwig reason (Section 7031.5 Business and Prdesworo Code: Airy city or county whidt requires a permit to eornlrud, eber, improve. demolish. or repair any seucmae. prior to its esrannm, also requirm the aPp6nart For such peh>ra to file a signed statement that he or she is licensed pursuant to the provisions d the Contractors License Law (Chapler 9 (oanmencirq vAK Section 7000) of Division 3 of the Business and professions Code) or that he ads is exempt therefrom and the basis for the etlegsd exemption. Arry violation d Section 7031.5 by any applicant for a penis subjects the applicant to a 6A penally d not more then five hundred dollen ISSDOD. �] 1. as owner d the property or my empoyeea with wapee as their sets compensation, wig do ds wok and the strumae is not intended or offered for sale (Section 7044, Business and Prof =facia Cods: The Centractore Licrse Law does root applyto an ownerd popery what builds or imprm" thereon• and who does such work hinds or herself or thraph his or her own enploysee, provided thea such imprwornenis are not intended or offered for sale. g, howre+w. ft Gelding a impneve menl is sold within one yasr of completion, the v oww_bvildar wiO have the Gorden d pnaving he or she did not bAd or i mprum for the purpose d sale). L¢J, I. as owner d the property. am exc4sivdy co tnectitg with 5wasid contractors to construct the protect (Sedion 7044. Busihasa arid ges"so w Cods: The Contractors Loerae Law does not appy to anownerd bslds or 'vnprww threm and +ho s for sues projects with a contractors) I csnaed p rsurt to the Licrupt uadr Sanxion: B. d P.C.. far Owner.ertify that I am aware d and wrderstmd the requirement d California Health anted Salary Code Sectors 25505. 25533, and es I a arty haute Glikfmg ocarpert will / will not (t9cls one) need tD comply with said ads codes and the regtitements far onstructiaeor n+odificalion from the Air'dWgrgwoamara District. RaaidemW construction app:rstions am exempt from two Date: Appfcem: WORKER'S COMPEN$AT10N DECLARATION: I lmeby affkm under porky d pwP" one d the f,m, I p decarations: Q I have and wit mantas a cstdicre d c nem to eellarmae fa wa kars' congm anon. as provided for by Section 3700 d cls Labor Code, for the pffonaanee d the work for which that permit is Issued. Q I hew and wit maintain workers' oompematton intusnce. as regrmed by Section 3700 d the tabor Code. Sot the geAamrros of the work lot iv idt tfn permit ie issutd. lily workers' mon insut- e — ins and Poky rumber we: Carrier- Poky artierPoGuy Number. This ' reed not be comvesd 1 the permit is ke one Manned doge /31001 w lass) I con' Ilhhq N the performance of the work for which Itdt pnwmb b maned• I ah W e anner oro m to becorn rrbjed to the work", comperaaticn laws of California. end 904 ' ions the wmitag CCM sation pnvraon of Section 3700 d the Labor Code. 1 Date: Wain r FaAum fo seeun wol*wa' con*wwadon ccvwapre !s unfair" and shelf "Act an erpfoyr So CmWn f pefisn" ane res w hon ors humdfad thousand doors (SIGA000A In aedlfAsn to ft coat of wrftPusatlor4 dammigas as PM10 sol for !n action 77'06 of the LsDow Code. IrrtareaL scud afmr"sY's 1'"A STRUCTION LENDING AGENCY: I hanby affirm under Psrsby of perWy that dwe is a amnreructiph endng agency for to pe anoe of the work for which this perp t is 'b=led {Section 3097• Cir. C), _ LENDER'S NAME LENDER'S ADDRESS: I certify That I have read ibis application rd state that the abae'vdrsmation is correct. I agree to oompy with s0 dry and oaasy ordinances and rate fawn relating to Gelding construction rid hereby sudnorce rapre0ertatives d this try 10 err upon the above -ma ii ned Praprry for inspection Purposes. TODD -TR -71 -pi S Done: (515/ro.WP) Green -File; Caeca-Applicrn; Pink -Ravens: C3aldenrad Assmeor CITY OF COSTA MESA - BUILDING PERMIT LP ERM NO: M 0$524 PERMIT NO: M 085244 PLAN CHECK NO: N GQVT: N SUPP: N CONSTRUCTION TYPE: V -N PERMIT TYPE: MEC: PURPOSE: ALT JOB DESCRIPTION SPRAY BOOTH W/ DRY CHEM FIRE SUPRESSION SQ FT: CLAIM VALUE: CALL -VALUE: GROUP GCC: B i COMMENTS: "FREEHAND SIGN CO." SPRAY BOOTH REF:B-85038 iF iF iF i4 iF iF iF iF iF iF ftF ftF iF iE iF iF ftF iF iF iF iF iF iF iE iF if iF iF iE iF iF iF iF iF iF iF if iF iF iF iF iF iF iF iF k iF * #F * iE #F #F iF iE #F !F •lf * !F * d{• * #F #F i4 iF if #F �E 1r IIF i4 iF Mfr iF #F k iF Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ• PROV: PARCEL: 42409111 ZNE: REF NO: PLANNING N 'TES> > #F •:H di di di i+ #F yr iF iF * #F #F iF iF iF * #F #F iE iF iF #F iF iF iF #F #F #F # iF iF iF #F #F inE iF iF ii #F #F •1F # •iF it #F iE #F iF irr * ftl• i# •iF ori• •iF ori• ori• ori• ori• * * � >k iF iF •1H •1H ;4 lir * •1H # •iF it• # ii •iF dr D E V E L O P M E N T S E R V I C'E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY DATE: 7 APPLICATION ISSUED BY: DATE : •:H it it it if •:H iE it it iF •:H •:H •1H •1F iF iF •1H •1H •1H iF # # >r � �E * i+lF>k if i';w ii• i# � sf 3e LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEG 'NT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 9.50 254 SMIP /NON -RES PLAN ISSUE FEE 22.00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 9.50 22.00 0.00 31.50 31.50 .00 REVENUE DIVISION TOTALS--> COLLECTED: 31.50 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 31.50 iE iF iF •1H if if ib ib fit ill• ill• •1H •1H •1H * iF iF •1H i} •1H if dF iF i� •:H �(• it ,tis ,tis iF •:H •:H �4 iF it it •1H •1H •:H •1H iF iF ,tis •1H •1H •1H ib iF ill• iF ,� � iF iF ii iF iF * iF iF;# i4;+ •iH •iF •iF •:H •:H i+ i? �(• •:H iF;k iF •k ii iR ii I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST MEC 1 INST HOOD W/DUCTS FED BY MEC EXHAUST 9.50 9.50 END OF FEES rill.[ F OCT 15 1907 ClN OF COSTA MESA C�A)STHUCTION AND PLANNING APTOVALS Permit # Date Inspector POOL ,QA APPROVALS Permit # Date Inspector 1. TVnporary'hlectricaE Service or Polt 52. Pool & Equipment Location 2. Sgiil Pipe-Undrgrnd. 53. Steel Reinforcement j31 Electrical Conduit Utility-Undrgrnd. , . 54. Forms - ' =4., Electrical Conduit Undrgrnd. 55. Electrical Bonding 5.' Steel Reinforcement, .56. Rough Plumbing & Pressure Test '•y6' Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7d Footings 58. Electrical Conduit-Undrgrnd. $, Foundation 59. Gas Pipe, © 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 &!-louse Connection 62, Backwash & Receptor -Final 12, Se+Yer Cap 63. Heater & Vent -Final 13. R f Drains 64. Plumbing System - Final 14. Rough Plumbing ,;y 65, Eiectrical-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 A. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APP'�O1%f '1�� F P�i<mrt # + - "t 20. ou-.h F to;r F llace ,� �� r is ;_ 21..'Sucta, in_Strt tutei K i ...• i�5 r ,S 7 t 70.:-Undelg&Vugd 1,, dro r , 22. �Ducq, V, entila. ink3 c i a+ 71. Prodtilt J Y w as kOil 23. Gas Pipe_Ro & rest i m s + Tj .7,•- .. ,.r . - 72. UndergrOxid 1`fulh +• 24.1Roo:Frarming' 4x it r '"'" } * �' ;� T r •x r� R 7T Undergrrid.$tor Tanf ❑Gas Mil 25. Roo.Shothing � '; i�. x ti r0 7 74t Overhead HydrD 26. CeiEing iStrthtt�rall & 1scrosoi oaE is �1 7�~ Dry Chiral ; `� 1-4 27.lrar;e and Flashim * .ar-1 4D t w+ ye D IYI j A. Dry Standpipe�tz + Y 28. ~Lattsing'& Siding k � '~~ k ..I •Ik 7 FIXEDT� T ��FIN& � :z: 29. Insulation r. S t FIRE PREY. Fll�tAL t =' 30. Drywall bailing 7 -FfEALI DEPS, fiEDUIREMENT 31. Plaster E#Lown.'Coat .S F ;r < ; i 7E. FINAL' ,riPEC_I�QN ; y 32.':Electric0:Por*r Meter7inal I !)i 801 FOOD GEATIr-CAT E 10S ED 33. in Ete�tric� iz tr f�otes: '; 7�Tt -; •� 1�ol 34,.-Finai„HeA. ing-$r Air +Condition' ir3g5 35.15inrGajPipF-Test { 1 36.5Wocia or;Ganopy rr' I - 7i kr E 1•� J J '° '37, finillFa ttory Fir!06 x. _ ir'Y < 38. Final Plumbing •n fi^3 e V S }•si -+ + yS J M. Water SeVvice-Final r L i40. Gas ServLce-Final L ;� T4 IT, 41. Solar Doyilestic-Fina'! 7S 42. iackflovv'Preventer; .43. Backflow Irrl§ation F •5:S 71 t - ` -' ', j.+' R4. Landscape IrF+Gatiog. Systema 1 ,,;z x '� f v .Z5. Zound Attenuation" -''� `' n' r, tik t X ~ t V c ,= Y j f j, r X36. jlandicap.Regvlativ s ., �. r .. 47.:EINAIL 5TRItCTUFfE & 13UIEDING 48. tlhlAL PLANNING` ,. ,fz � ►� _ r ;49. Electric Release to dison - 1 + a 1. � ' St). Gas Release to Soutoern Cali4ogia4Gas Co + +L CERTTIFICATE OF OCCUPANCY No. Date ADDRESS OF BUMO 16' 711 W 17TH ST U"T' H2 OMfF1ER81WIE IF KNow- TODD TRAVIS A°DRESS: 711 W 17TH ST ,��St�p►, CA 92627 714-650--7446 ARCNfTECT OR ENMEER: UC. NOs ^ 'l ARCH OR M'S ADDRESS: UNIT: . CONTRACTORS NATE CONMACTOR9 MAJUNG ADDRESS: Uc No.: utrT: LICENSED CONTRACTORS DECLARATION: I haebr affirm ruder penalty d perµay Orn I sm tioamasd under provisos d Chapter B (oommerrsq with Sect +on 70070) d Dirison 3 d Ors Businessad Piak*c oars Code, and my Bosse is in frm face and dfed. CITY UC. NO.: LIC. CLASS: LIC. NO.: EXP: Dae: Casredor. OWNER BUILDER DECLARATION: I lweby atfrmm under penalty of parjry IMI I am exempt from the Conlrecors Limroe Law for the fdlow'irV reason (Section 7431.5 Business and Pratess0on0 Code: Any ray or outwty which requires a permit 10 owntrud,tter a, improve, demdish, or rapei any satrcRae, Prior b its axraros. etre the apptimrr tar mrh peed to file a signed atdmroa the he or ahs is !caved pUrerrenll to IM prO�ians d the Coraredwe hems Law (t.h "err 9 (ommimin b with Section 7000) of Diris r 3 of the Buseress and Prdassors Code) or that he w she is e+ampl thsafrom and the tam Me to alleged amnion. Any voad'ot d Sedan 7031.5 by any appliwa for a permit s &*u the appfrara to a civil po aty d not more than rive hrudrad dollen (1500]). 1,® owrw d per the proty w mm my arropyses with wages as their sale peration, Will do Or do the vAXk ane enda intended ure not inteed orMored Iry 0810(Section 7044, Business and Prdessiav Code: The Corureaore Liosne Law does not apply loan inmw d popery who Milds or improves thereon and who does such work himself or herseff or through his or her awn erroyfeea, prvridad this sucfr improm lords are M intanded w offered for sale. J, however. the buildirq w inprovernent is sold within one yea of eanpletam, the owner -builder witl have the burden of proving he (9 she did nal build w improve for the purpose d sale). I. as owner of the property. an exclusively ax adi g with Boomed contractors so mmtrud the W*Kl (Section 7044, Busmen end Pmdesswm Cods: Tte Cararedaa License Law dor not m an ohnmer d �whMll�bu�Wzprares threw and rkmo cmiracds for such prgjsr¢ with a haaredor(s) licensed to theexempt under Sexton: B. A P.0 (SIM L. — Ownsr. comity that I am aware d and underriend Oho requirernarn d CaJoris Fletlh end Safety Cade Sediors 25.SOS, 2'553.7, and Ohs I or sty future buddm con will y war rot (circle one) need b comply with amid Sas cods and the requirements for aanatrudfam a maddranom hen the Ar e y anhegerhwr District. Reaidssel aannrmdion applications aro oxempl horn the e Dae: AtKraen: WORKER'S COMPENSATION DECLARATION: I hereby of m ands penalty of porjay ane at the followiq ded"brw: ❑ I have and whl,neint4in o certificate d consent to ma4to ore roc warltra' eaepernanion, as provided for by Sector 3700 of the Luba Code, for the perlomance d the work for which this permit is Inured. ❑ I here and will mainl4in wwkm * comlon insunwa. as required by Selo, 3703 of the Labor Cade, tar the performance d the work for which this prnrit m ®red. My workan' oOmpsnsal on Insurance mtrier and Policy number eta: Catrin: Policy Number rnhis section need not be cmrplsred if rho pamrf is Mr ons hundred dodws 151001 or Ism.) I candy that in the pedomrsnw at the work for whish this per. is issued. I elya4K any manner0o as to wbjea to the Workers' mmpensatiafh taws d Cefdorr" ynd e�roe bacOtne to the workers' lion pravlsiom d Section 3700 d tha labor Code�,shd wish ossa warm . FaJrrn+ m setae anrtrsrs' ammpetsssft- eorarepr - c n l- -Ad and ata!! m dlsN ore OM oyvr to eritwrred ! ponoves w mea Trp m otms hvtdrmrl Mousard dollars (J7040001h atrdltlon m tlms scut of raornperta+riton danmapea as prerFdad for In Secdo n 3706 of the Lagar Coda. Interest wW atrornwa fees. CONSTRUCTION LENDING AGENCY: I hereby at6nnv under penalty d pwjsy that there is a ormtnrdion londn agerhcy for the performance d 11 wank fpr which this Permit a enud (Seton 3097, cin. C). LENDER'S NAME LENDER'4 ADDRESS: I comity that I have read this appfsorr and dde that the above irdamrd'on is comw. I agree to ownpsy wish as my and couoty orderenoss and sae Iowa rotting 10 burding com=mon and hereby sahon zo repreventacves of Na ay to neer upon the abowmanioted property tor irnpodi purposes, ode:ib—G 1L 7 (5lstre.wP) Vft d Slott; Green-F,le: canary_ pp6=d: PinkrFlararw,e: aamanrmd-Ascom r CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: F 085037 PLAN CHECK NO: 02543-97 L PERM NO: F 085031 GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: FIR PURPOSE: ALT JOB DESCRIPTION : SPRAY BOOTH W/ DRY CHEM FIRE SUPRESSION SQ FT: CLAIM VALUE: 1,500.00 CALC—VALUE: GROUP OCC: B / COMMENTS: "FREEHAND SIGN CO." SPRAY BOOTH / REF PLAN CK# ilk dE ilk ik ilk ilk ilk ilk ilk dE ik ik ilk ilk alk ilk ilk ilk ilk ilk ilk ilk ilk ilk ilk )E � � � 3k ilk ilk ilk iE ilk �k ilk ilk �k �k iE 3k 3k alk � iE ilk iE ilk ilk ilk ilk ilk ilk ilk ilk ilk ilk ilk 3k alk alk if )E ilk ilk ilk � ilk ilk ilk ilk ilk iE � +w � ri iF Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------- MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42409111 ZNE: REF NO: PLANNING NOTES> > �t4 ilk ilk )k +h � ilk ilk �k aE �k ilk ilk ilk ilk ilk ilk ilk ilk ilk ilk ilk if ilk ilk if alk aE 3k ilk �k ilk ilk ilk iE 3k ilk if ilk aE ark �k �k ilk ilk ilk ilk ilk ori- ilk ilk ilk ilk ilk 9k ilk 3k iE ilk iw ilk ilk ilk # iE iE ilk ilk ilk #ilk ilk ilk ilk � � ilk ilk ilii• D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : I DATE: APPLICATION ISSUED BY: DATE: J ilk ilk � ilk aE aE ilk ilk 1k ilk ilk ilk ilk ilk 1k ilk ilk ilk iE �k �k iF yt tit ilk >� ilk ilk ilk ilk ilk ilk ilk ilk trt x it iE LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEG ENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 49.00 651 SMIP/NON—RES PLAN 31.85 ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 49.00 0.00 31.85 80.85 80.85 .00 REVENUE DIVISION TOTALS--> COLLECTED: 49.00 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK — 49.00 ilk ilk ilk'yk ilk 'Ik 'Ik 'If 1t ilk ilk ilk ilk iE '1E iE ilk iF ilk 1k ilk iF ilk ilk ilk ilk 7i' ilk 1k ilk ilk ilk 'YE ilk ilk iE'ik � � 'ilk iE � 1E ilk ilk ilk ilk iE 'ie ilk ilk ik -}k iE iE iE'1k � iE ilk ilk ilk ;f ilk ilk if ilk ilk ilk �E ilk ilk ilk ilk ilk � ilk I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST FIR 49 FIRE EQUIP FEE (FROM BLDG VAL TABLE) 1.00 49.00 END OF FEES 18—%-1997/10:06 AIVi49.00 RDTI:61-0013336 PERMIT:885037 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector 4 POOL ,PA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55, Electrical Bonding 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 6. Electrical LIFER Grind. 57. APPROVAL TO COVER•GUNITE 7., Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd„ Test 9. Water Pipe•Undrgrnd, 60. Backwash Lines, P•Trap, ❑ Undrgrnd. 10, Structural Floor System 61. APPROVAL TO DECK _ 11. Property Sewer line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66, Solar System Final 16. Rough Electric Wiring 67. Fencing.$& Access Approval 17. Rough Wiring Sign 68. APeROVED FOR PLASTERING' 18. Rough Electrical-T Bar Ceiling ! 69. POOL/SPA SYSTEMS FINAL 19i Rough Heating & Air Conditioning r " - 'FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21', Ducts; in Structure . = 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas C1 Oil 23. Gas Pipe-gougt & Test + 72. Underground Flush 24. Hoof Framing' = + .73.. Undergrnd. Storage Tank, ❑ Gas ❑ Oil 25. Roof Sheathing 74, Overhead Hydr6' 26. T•Bar'Ceilir�g (Structural] & Monpcoat 4 75. Dry Chemical iQ'r_5f9.7- 27. Frame and, Flashing 76. Dry Standpipe 78. Lathing & Siding •" I 77, FIXED SYSTE{'l FINAL 29. Insulation f 78. FIRE PREV, FINAL fG - / HEALTH DEPT. REQUIREMEN F 30, Drywall Nailing ! `, ri 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical power Meter•Fi�al t 80 FOOD CERTIFICATE ISSUED 33. Final.Electric l _ Notes, • 34. Final Heating & Air_ Conditioning 35. Final Gas PipeJest 36. Hood-or Canopy 37. Final.Eactory Fireplace -j 38. Final'Plumbing + Y 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. FINAL PLANNING ' 49. Electric Release to Edison 'J 50. Gas Release to Southern California Gas Co u 51. CERTIFICATE OF OCCUPANCY No. Date - - �' Ile -,---� jtAr of Costa 2Y) esa Development Services, Division of Building and Safety j CERTIFICATE OF OCCUPANCY This certificate is issued pursuant to the requi ements & -the Uniform Building Code, Section 308 r.. i r . \ adopted by the City of Costa Mesa certifies -that -at the time 6his`issuance the building structure herein .. - �c �, below described was inspected aand�a 6rov or'occupancy.as f'llows: 711 W. 17tih`St:!/#e 8-85038 e G. ,A N� Bldg. Permit No. Building Address g Use SQray Booth.w/ Dry/them Group B Typ J of'Coi Owner of Building T0,4o Tragi Address 711 W. 17th,,St-- ] BUILDING OFFICIAL -MPMVIXX Acting Building Official trucn6ny-H Fire,Z 7—" 2 Tenar Costa Mesa CA 92�26� REQUIRED TO BE r Use Zone MG, ,,,•__ •f Freehand Sign Co. +2. �rr. POSTED IN A CONSPICOUS PLACE .• Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO- LOT NO. UN T NO Project Address 711 W. 17th St. Bldg(H) Unit 2 Applicant's Mailing Address `1 11 10 Saticoy St. N.HoIlNo0 Owner's Name T-ro==-- lrtyestment Fund Phone 549--2988 Address 4191 Birch t, NewpQtL.-Beach, Ca. Arch/Eng.M—grin i - ROnle ^License No. Address Contractor's Narrb_ D11C0 COriditI nin�Phone 982-1216 Address (mailing)1? 1 1 Al R Saticoy= St N _ Hn1 1 y,iaad_, C'A _ City License No. —?n._, -_ LICENSED CONTRACTOR 4ECLARATION I hereby affirm that I am licensed under provisions of, Charter 9 (commencing with section 7000) of Divlslpn 3 of the Business an ofessions Code, and my license is in full force and elf e 346251 License Class C Li se , Date4 / 1_�/? Signature WORKERS' COMPENSATION OEC RATION 1 hereby affirm that I have a certiflc a of consent to self -insure or a certificate Workers' Compensation Ihsura ce, or a certified copy thereof (Section .00, Lab. C.) - WC9824 Lumbermans Nolicy No. Company HCertified copy is hereby furnished. Certifi ocpy is filed with the city Builc!D i��33sjon. n �� Date.,t Applicant i1 �t EXEMPTION FROM WORKERS' COMPENSATION OECLARATION (This section need not be completed if the permit is for one hundred ($100) or less)- 1 certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to t6 Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply 'with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDINI3 AGENCY I hereby affirm that there is a constructior�iending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name _— Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the ContraCtor's License Lew for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a perrhit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement thlt he/she is licensed pursuant to the provisions of theContractor's License Law (Chapter 9 (commencing with Section 7000) of Division, 3 of the Business And Professions Code) or that he/she is exempt `•erefrom and the basis for the alleged exemption. Any violation of Section 31,5 by any applicant for a permit subjects the applicant to a civil .salty of not more than five hundred dollars ($500).' LJ Ii as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Bu„iness and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im. prove for the purpose Of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con. 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 builds or improves thereon, and _who contracts for such projects with a con. tractor(s) license pursuarit t4 the Contractor's License Law). i am aware that proof of their Worker's Cornpensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have' read this application and state that the above information Is Correct. I agree comply with all city and county ordinances and statela relating to bti' ' g construction, and hereby authorize repre- sentatives is city to r upon the above-mentioned property for inspectio Aur ses. Signature Date/ Drivers' Llce se ori55 TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR s ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. qI6 DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi E TYPE OF PERMIT El GRADING C1 FOUNOATiDN LJ STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING Q MECHANICAL B Rear ❑ -OTHER A PROJECT DESCRIPTION SQ. FT, OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ $ I Left ZONE - GRADING CU.YDS. ACRES Ping. Ref. Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors 1 Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee , $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit, iCBO 1 Heating System & Ducting Gla 100,000 BTU 0100,00013T Reinspection Fee 1 $15 AF 0865-46 ev- 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 2292 51E?3/85 Accessory Building: Parking Req./Provided 15eSO TL Zone Z O N I N G R E Q M T S PLUMBING FEES ELECTRICAL FEES Showers Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Sewer Cap Sewer Connection Solar Collectors Cooking Unit Dishwasher t Meter El up to 100 amps Meter Cover 100 amps , Solar Piping Dryers ❑Gas ❑Electric Sub Panel Solar Tank Fen Motors 00-1 HP 011% - B Swimming Pool vv/Spa F•A•U• Inc. Solar El 9-15 HP 016-15+ Urinal Fixtures Microwave Water Closet Water Heater Water Service Device Boxes Outlets Switches Pole Light Range Sign Auto -Wash Garbage Disposal Standing Sections Laundry Trays Generator ❑0.5 KW 05-15 KW Trash Compactor Issue Fee $ 3 Reinspection Fee $15 Issue Fee' $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: _ Approved By Date , Building Approved By Date Application Issued By DateL- Hood or Type I ElZoning Canopy Type I I ❑ Refrigeration System 00-100,000 BTU 0100,000BTU SUMMARY BUILDING PERMIT $ PLAN CHECK $ PLUMBING S PLAN CHECK 25% S ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ OF FEES SMIP $ PERMIT 'ISSUANCE $ ENERGY P.G. $ GRADING $ MICROFILM S 11-00 TOTAL FEE 15 $50 2.50 System Repair/Alteration Fire Dampers 6 Registers 6 OO DO Issue Fee S 3 CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POC 3PA APPROVALS Permit # Date Inspectnr 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. •Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electri•,al Conduit Utility-Undrgrnd, 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding h' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test r' 6. Electrical UFER Grnd. t % 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduif-Undrgrnd. 8: Foundalion 59, Gas Pipe, ❑ Undrgrnd., Test 9. i 'Water Pipe-Undrgrnd, �, = ! 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10.'Structural Floor System =. _ 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12- Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15.! Rough Electrical -Conduit 66. Solar System -Final 16.1 Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign i 68. APPROVED FOR PLASTERING 18.. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19: Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS. Permit # 20., Rough Factory Fireplace 21.E Ducts, in Structure 70. Underground Hydro 221 Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23: Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergmd.Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28, Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36- Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing Z./ &-IfG CAVO 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 -;w Applicant to fill in all spaces except those within heavy border tines and. sign all appropriate declarations. CIT OF COSTA MESA CONST UC I N PERMIT LP IT O TRACT NO. ' LOT NO., U i NG. Project Address O I hereby a irm a ave a cer i ica e o consen -)f Workers' Compensation lnsurance,�or a certified copy thereof (Section 800, Lan, C:} I h TYPE OF CONSTRUCTION NEW ADD, ALTERATION REPAIR Z d Automatic Washer _ � Applicant's Maili ddress CONVERSION E:1 DEMOLISH El OTHER t Construction Construction Pofe'Sub. r Cooking Unit ' ,Ditty No. Company copy is hereby furnished. H Certified copy is filed with the city Building Division. _❑ Clarifiers rA.P.Owner's . Duct - Ventilating - - -- - Nam on DESCRIPTION OFWORK/USEOF'BLDG. 'Dryers ❑Gas ❑Electric Drinking Fountains Solar Tank L 1 am exempt under Section — B. & P. C. for this reason Address F.A.U. - Floor Sinks . _ _ _ Urinal !. - - - Fixtures - Main Building: Device Boxes Interceptors - Water Heater, Outlets E Water ServiceL Arch/Eng, License No. TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ! ''.❑ TENANT .❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL' B Generator ❑0 5 KW ❑5-15 K Address ❑ .OTHER _ A Rear - Contractor's Nam Phone f PROJECT DESCRIPTION' SQ. FT_ OCCUPANCY— C K . R ight Address (mailing) CONSTRUCTION TYPE VALUATION $ S Left City License No. ZONE GRADING CU. YDS. ACRES Pin g_ Ref. # ' LfC64SED CONTRACTOR DECLARATION I hereby,affirm that I am licensed under provisions of Charter 9 (commencing Remarks: r - Planninq'Notes: with section 7000) of Division 3 of the Business and Professions Code, and my license is in full 1grce d effect, Lice Ie Class - License No.'s 1) Z : �!` r - Dat r t:CSignature PLUMBING FEES WORKERS' CO NSATION DLARATION ff th t I h t' ' t f t to self -insure or a certificate Bar SinkShowers ' I hereby a irm a ave a cer i ica e o consen -)f Workers' Compensation lnsurance,�or a certified copy thereof (Section 800, Lan, C:} I h Backflpw Preventer Service Sink Z d Automatic Washer _ � ackflow Irrigation Bathtubs i Sewer cap' Sewer Connection $ Construction Construction Pofe'Sub. r Cooking Unit ' ,Ditty No. Company copy is hereby furnished. H Certified copy is filed with the city Building Division. Date Applicante EXEMPTION,FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit i5 for one hundred ($100) Or - r -less). less) I certify that in the performance of the work for which this permit is issued, l shall=not, employ any person in any ner s as to become subject to the Work s'( en i Laws of Cali r ia. Date `r Signature 'NOT CE: If, after making this decta on, you should become subject to the Workers', Compensation provisions the Labor Code, you must forthwith comply- with such provisions or this permit 'shall be deemed revoked. CONSTRUCTION LENDING AGENCY- , • + I hereby affirm that there is a'construction lending agency for the-piarformance' of the work for' which this permit is issued (Section 3097 Civ. C.) Lender'sl Name' Clarifiers Solar Collectors . Duct - Ventilating - - -- - Dishwasher Dishwasher - Solar Piping 'Dryers ❑Gas ❑Electric Drinking Fountains Solar Tank L 1 am exempt under Section — B. & P. C. for this reason Floor Drains Swimming Pool w/Spa F.A.U. - Floor Sinks . _ _ _ Urinal !. - - - Fixtures - Gas Service � � Outlets Water Closet � - �t 0 - v Device Boxes Interceptors - Water Heater, Outlets Kitchen Sink Water ServiceL U 'Switches Lender's Address BUILDER DECLARATION OWNER BE I hereby affirm -that I am.exempt from the.Co_nfractor's License Law for the following reason' (Section 7031.5 Business and professional Code:'Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure; prior to its issuance, also requires the applicant for such permit to file a,signed statement that he/she is licensed pursuant to the provisions of 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 th b 15 for the aIle ed exemption Any•violalion-of Section _ Lavatories Auto -Wash Garbage Disposal P—Trap �' -Laundry Trays,- Generator ❑0 5 KW ❑5-15 K Roof Drains r - - - ere rom an a as 9 c "731.5 by any applicant for a- permit subjects the applicant to a civil nalt_y of not more than five hundred dollars ($500). ' J 1, as owner of the property or my employees with wages as their Sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's' 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 employees, provided that such, improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year, of corn- ' pletioi7, the owner will have the burden of proving he/she did not build or im- - ' Reinspection;Fee l •$15, - M , $ r Boiler. $ , Duct - Under,Ground I prove ,for the purpose of sale). El 1, as owner of the property, am exclusively contracting with,licensed con- 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 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 proof of their Worker's Compensation insurance Should be provided to me. I PERMIT ' Duct - Structural ' ' . Duct - Ventilating - - -- - ISSUANCE Exhaust System ❑ Multiple ❑ PLAN CHECK Firepi/Fact. Bit, tCBO # L 1 am exempt under Section — B. & P. C. for this reason Date Owner 1 I.hereby certify that I,have read this application and state that the above information is correct- I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this cit to enter upon the above-mentioned property for inspection p ses. 7 . SignatureDate ! Drivers' L! Se Or SS y;c ELECTRICAL Heating -System & Ducting ❑0-100,000'BTU 0100,000BT - - PLAN CHECK ' Reinspeetion Fee $15 CMF 0865-45, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 FEES Hood or ' Type 1 ❑ Canopy Type I I, ❑ ' • 4 ' Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers' Registers r � Issue Fee $ 3 11 5898` .7YO21051 Zone 10 1U Accessory.B u i lding: , Z O . - N f' N R Parking'Req,/Provided _ ` E Q M T S ELECTRICAL FEES ,. Transformer ❑ 15-50 KW - 0 50,+ KW t ' t Meter ❑up to 100'amps Meter Dover 100 amps -Sub Panel Motors ❑0-1 HP 01'/x • B i ' I Inc. Solar .❑9•.15 HP ❑16-15+ Microwave Pole Light i Range Sign' F Standing Sections W Trash Compactor , Reinspection Fee I $15 I Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By $ 3. SUMMARY OF FEES BUILDING PERMIT , $ SMIPj $ PLAN CHECK $ I PERMIT ' PLUMBING, $ ISSUANCE is PLAN CHECK 25% $ _ S"U ENERGY P.C. $ ELECTRICAL $ GRADING I $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ ,CONSTRUCTION AND PLANNING APPROVALS Permit # /1 Date Inspector POOL ?A APPROVALS Permit # Date Inspectnr 1� Temporary Electrical Service or PoC 52. Pool & Equipment Location 2. Soil Pipe-Undr rnd. '-%� P� 9 ✓� 53. Steel Reinforcement 3' Elecir4ical ConAilbtil�y-Undrknd V 54. Forms til 4�lect ial' Condui't',Gnd�grnd. (b 55. Electrical Bonding, 5Stee'1tReinforcerrient 56. Rough Plumbing & Pressure Test %rte -6 Electrical UFEFt.Grnd. _W. .., �. . �.i' 57. APPROVAL TO COVER-GUNITE �► i} i.- t,'tootingsl c j !� • 58. Electrical Conduit-Undrgrnd. 8 F Jkdation 59. Gas Pipe, ❑ Undrgrnd., Test I �� .L Y Wat r Pipe-Undr6rad�. ;j 60. Backwash Lines, P -Trap, ❑ Undrgrnd. .10. Struct Viral Floor System t 61. APPROVAL TO DECK 11. Property,Sewer Line & House Connection ° 62. Backwash & Receptor -Final � 12. Sewer Capce,`� ♦j 63. Heater & Vent -Final 13. Roof Drains 4+, 64. Plumbing System - Final 14_.;Rough'P �umbingl '� 65. Electrical -Final u 15. Rough Electrical -Conduit ! 66, Solar System -Final '16. Rough Electric Wiring fir. r 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 APPROVALS Permit # 20. -Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25, Roof Sheathing 74, Overhead Hydro 26, T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76, Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating &-Air Conditioning 35. Final Gas Pipe -Test. 36. Hood or Canopy " 37. Final Factory Fireplace '38. Final Plumbing Z•(3- (�(t,D 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. Daie� _ Applicant to fill in all spaces except those Within heavy border lines and sign all appropriate declarations. Bar Sink 5905. 1/16/85 4060 rITY QF COSTA MESA CONSTRUCTION PERMIT Project Address �j 1 Yy - -1uT._ �Qs'i19— tma✓ 5$ PERMIT NO. I -71 TRACT NO. LOT NO. UNIT NO, it Workers' Compensation Insurance, or a certified copy thereof (Section - - - 800, Lab; C.) _ Policy No. WGS I 0 •� a Cb ny L BCertified copy is hereby furnished. Certified copy is led with the city �dl Divisi Applicant's Mailing Address,TYPE Owner's Name U Phone Address — TYPE OF CONSTRUCTION 0 NEW LJ ADD LJ ALTERATIONLJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. Sewer Ce p Bathtubs A,P.: Zone Cooking Unit S Main Building: Accessory Building: ` _ Arch/Eng. License No. Address ..... TYPE OF PERMIT LJ GRADING FOUNDATIDN LJ STRUCTURAL PUMBING ❑ MECHANICAL ❑ TENANT ❑ ELECTRICAL ❑L OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY r CONSTRUCTION TYPE VALUATIONLeft $ ZONE GRADING CU.YDS. ACRES E T Front (This section need not be completed if the permit Is for one hundred ($100) or less . I certify that In the performance of tht work for which this permit is Issued I shall not employ any person in any manner so as to become subject to t6 Z O A Rear I - N Contractor's Nam�OR121 LIE -C -ER i L Phone � Address _1 �L _ iJ�x.��T S"T• �j-oam,N (o7or>J r-��6 (mailing) City License No; U i I LICENSED CONTRACTOR DECLARATION I hereby affirm that I am -licensed undtr provisions of Charter 9 (commencing with section 7000) of Division Siness and Professions Code, and my license is In full force and of ct. _ License Class C` f L7 Llcen No. Date Signature Drinking Fountains Solar Tank . Right Motors jg0-1 HP El % - 8 N K K $ , Floor Drains G • R Ping. Ref. Parking Req./Provided E Remarks: - I _ Planning Notes: Q M CONSTRUCTION LENDING AGENCY I I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued (Section .3097 Civ. C.), Lender's Name .� _ -- - - _ ` - T S PLUMBING FEES Device Boxes Outlets Pole Light g 'Range WORKERS COMPENSATION la C RATION I hereby affirm that I have a certificate of consent to salf-Insure or a certificate any structure, pr or o o repo p I Bar Sink Showers ELECTRICAL ' -- Backflow Preventer i _ Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ i5-50 KW- ❑ 50 + KW it Workers' Compensation Insurance, or a certified copy thereof (Section - - - 800, Lab; C.) _ Policy No. WGS I 0 •� a Cb ny L BCertified copy is hereby furnished. Certified copy is led with the city �dl Divisi DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By -- - - _,_ nate Building Approved By Date Application Issued By Date / / S Backflow Irri alien 9 Sewer Ce p Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date. 1� I t1+ Applicant, EXEMPTION FROM WORKERS' COMPE14SATI N DECLARATION Duct - Ventilating_ Clarifiers Solar Collectors Dishwasher i Meter_❑over 100 amps, (This section need not be completed if the permit Is for one hundred ($100) or less . I certify that In the performance of tht work for which this permit is Issued I shall not employ any person in any manner so as to become subject to t6 System Repair/Alteration Dishwasher Solar Piping Dryers Gas ❑1 lectric Sub Panel Drinking Fountains Solar Tank . Fan Motors jg0-1 HP El % - 8 Workers' Compensation Laws of California. Date Signature _ 'NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith. compiy with such provisions or this permit 'Shall be deemed revoked. Heating System & Ducting ❑0-100,000 BTU 0100,000BT ! , Floor Drains Swimming Pool w/Spa ' F.A.U. Inc. Solar El 9-15 HP El 16-15 Floor Sinks - - - - Urinal - Fixtures Microwave - CONSTRUCTION LENDING AGENCY I I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued (Section .3097 Civ. C.), Lender's Name .� _ -- - - _ Gas Service Outlets interceptors - Water Closet Water Heater - - Device Boxes Outlets Pole Light g 'Range Lender's Address - OWNER BUILDER DECLARATION - I hereby, affirm that I am exempt• from the Contractor's License Law for the following reason (Section.7031.5 Business and, Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair L t Its Issuance al; Fres thea plicant for such permit _ Kitchen Sink - Lavatories Water Service I Auto -Wash + $witches Garbage Disposal Sign Standing Sections Laundry Trays P -Trap _ Y E10 -5W C35-15 Generator 0-5 K5-15 KW Trash Compactor ) to file a signed statement that he/she IS licensed pursuant to the provisions of Rao( Drains the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profession$ Code) or that he/she is exempt - `heretrom and thea basis for the alleged exernpti0n: Any_violatlon of Section rr t 131.5 by any applicant for a permit subjects the applicant to a civil , nalty of not more than five, hundred dollars ($500). } L1 I `as'owner of the property or my ampioyee$ with wages as their sola Reinspection Fee $15 Issue Fee $ 3' compensatlon, will do the work, and the structure i13 not Intended or otfered for sale .(Section 7044, Business an(I Professional Code: The Contractor's License Law does not apply to an owner of a property'who builds or improves thereon, and who does such work himseif/herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. It, however, the building or Improvement is sold within one year of com- pletion, the owner -will have the burden of proving he/she did not build or Im- prove for the purpose of sale)'. ❑ I, as owner of the pioperty, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: I The Contractor's License Law does hot apply to an owner of property who builds or -improves thereon, and _who contracts for such projects with a con- tractors) Ilcense pur'suarit to'the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason I L FEES Hood or Type I ❑ _ Canopy Type II ❑ Reinspection Fee $15 Issue Fee $ 3 _ ', Boiler MECHANICAL DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By -- - - _,_ nate Building Approved By Date Application Issued By Date / / S Duct - Under Ground Duct -Structural Refrigeration System r 00.100,000 BTU_ 0 100,000 BTU Duct - Ventilating_ SUMMARY OF FEES , BUILDING PERMIT $ SMIP . $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE S PLAN CHECK 2596 $ ENERGY P.C. $ ELECTRICAL � UG GRADING $ $ d MICROFILM $ CHECK 50% .$ .J MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO g!` Fire Dampers Date owner 1 hereby,certlfy that [have read this plication and state that the above gree to camp Ith all city and county ordinances and state Ibuildin con tru tion, and hereby authorize repre- informatioiw!011 Sentative$ enter upq th above-mentioned property folPLAN inspection S Signature ' Date>Ifi-� Drivers' License or SS Heating System & Ducting ❑0-100,000 BTU 0100,000BT ! Registers � i Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 'CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL PA APPROVALS Permit # Date lnspecrnr 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement _3. Electrical Conduit Utility-Undrgrnd. 54. Forms -4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57, APPROVAL TO COVE R-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test ., 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, O Undrgrnd. 10, Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection - 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15, Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign, 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping O Gas 0 Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank O Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro ,26. T -Bar Ceiling (Structural) & Monocoat 75, Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77, FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39, Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final - 42. Backflow Preventer 43. Backflow Irrigation 44. .Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations , 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 71.1 W 17TH STUNIT: H--2 OWNER'S NAME: JACK ROBINSON ADDRESS: SAME 714-650-9233 ARCH/ENGINEER: DAVID BUCHNAN REO•NO•: C01�218 3 ADDRESS: 501 31ST ST NIT: B N:B. CA 92627 PERMITTEE: JACK ROBINSON (714)650-9233 ADDRESS: .711 W 17TH ST H2 C. M. I CA 92663 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) at Division 3 of the Business and Professions Code, and my license is in full farce and effect. CITY UC.: t STATE LIC.: CLASS: Signature: RXERS' COMPENSATION DECLARATION: I herebyaffirm that I have a certificate of consent to self -insure or a certificate of Workers' ;s pen'ahon Insurance, or a Certified copy thereof Section 380D, Lab. C). POLICY NO:: EXP, DATE: COMPANY: Certified copy is hereby fumished. ❑ Certified copy is filed with the city Building Oivisfon. ' Applicant -- EXEMPTION FROM WOR(ERS' COMPENSATION DECLARATION: ,tion need net be completed if the permit is for,one hundred (5100) or fes). I certify that in the performance of the work for which this per is issued, I shall not employ any person in any manner so as to become subject to the Wo ers' Cc pensation Laws of California. Date: 2 0 Signature."fi NOTICE: If after r9aldrig this declaration, you should S jest to the workers' Compensation previsions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is'a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ, Q. LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt tram the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any Structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business -1,d Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031,5 by ,,applicant for a permit subjects the applicant to a cM penalty of not more than five hundred dollars (5500): �y I, as nwner of the property or my empPloyees with v6ges as their sole compensation, will do the work, and the till structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Lew does not appy to an owner of a property who builds or improves thereon, and who does such work himselftherself or through his or her own employees, provided that such improvements are not intended or offered for sale. 11, however the building or improvement is sold within one year of completion, the Owner will have the burden Of proving he/she did_ not build of improve for the purpose of sale). - I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' State License Law does not appy to an owner of properly who builds or improves thereon and who contracts for such projects with a contractors) liWse pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. 0 I am exempt under Section: B. & P. C. tar thisrea On: , Date: 2Q Owner: I de hereby Ally that I am aware of and understand the Tequiremehis of C N Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant will/will not (circle One) need to campy with said slate codes and the requirements for a permit for construction or modification from theld�uallty Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for in ction p rposes. / Or (late: f 2 � Signature: Driver's license or Social Security M 184148 White—Building; Green -0009 tnrarcemem; Lanary—Applicant: fllnK—Hevenue; uowenroa—^Sasso+ CIT"FC TA MESA --.BUILDING PERMIT PERM NO: B, 045570 PERMIT NO: B ,045570 PLAN CHECK NO: 01.676-189 S GOVT; N SUPP: N CONSTRUCTION TYPE:.V-N PERMIT TYPE: STR, 1 PURPOSE`:'ALT , JOB,DESCRIPTION ; T. I.:-293' SF" OFFICE SPACE, 29.3SF,ADD '.SQ FT: 586 CLAIM VALUE:, f 10,000.00 CALC-VALUE: 14,532.80 GROUP. OCC,, B-•2 /. COMMENTS: •�**�•�•>E**��•,>f***�•�•iE,>f�•�••�;>f***�••�*;>f*�••>E•>E****•>E•>E**•>E•>E��**�•�•,>f•>E�•>E•>E•>E•>E•>E•>E•>E•�•�•��**•��*�••��**�•�•*•>E*•>E Z O N I N G R E Q U I R E M E N T S S E T B A C. K S ------------ ---- — — ---------- T MAIN -BUILDING ---- ACCESSORY BUILDING - FRNT: FT IN REAR: FT IN FRNT: FT) IN REAR FT IN LEFT: FT IN RGHT: FT IN -LEFT:. FT' IN RGHT:' FT IN', PARKING REQ: •294 PROV: 298 PARCEL: 00000000 ZNE: REF NO:' ; { PLANNING NOTES> INTERIOR ALTERATION INCLUDING THE CONSTRUCTION OF A 453 SQFT..f ,+ > MEZZANINE. 4- ;D -;D E V E L O P M E N T S E R_ V I C EE S i R E Q U I R' E M E N T S ZONING APPROVED BY°l2 V DATE: 0 BUILDING APPROVED BY DATE: t APPLICATION ISSUED'BY: -DATE" Z PJ !E !E 4[• i(• !E !E 4[• i(• !f i(• il•'lE i<'lE i(' i(','lE * �E 9E iF'lf• 3�� if •th )E i(• i(• !f !E �E �(' r '1(•,'1(• ; if if '1(•'1(• !4'1(• if if !E !E !E !f i(• i(• i(• i(• !E !E i(• i[• if if '1(•'1(•'1(• if if if '1(•'1(• !E i(• i(• i(• i(• !E !E !E i(• �t if !E !E i(• if ik i(• !E i! !E !f !E !f IE !f i(• ik i(• ik if if if if '1(•'1(• if if if '1(•'1(• if iE if '1(•'1(• if '1(• *'1(• LEGALIZATION : N F --E. E' - S U ML M A' R Y aTRUCTURAL .SEGMENT : Y' 'ELECTRIC MECHANIC FIRE SMIP/RES t'GRADING BLDG PMT PLUMBING PERMIT 162.00 SNIP/NON-RES PLAN ' 105.30: 2.18 ISSUE FEE - . BUILDING -DIV-> PERMIT ISSUE PLAN --CHECK TOTAL PAID DUE TOTALS----> 164.48 - 0.00 105.30. 269.48; 269.48- .00 REVENUE DIVISION TOTALS�_> COLLECTED-' 222.'6W OVER/SHORT: rl' .00 BLDG PMT PLUMBING;ELECTRIC MECHANIC FIRE .SMIP/TOT GRADING PLAN -CHECK 162.00 {' 2.18 58.50 4[• i(• i(• i(•'1(• * if if '1(•'1(•'1(•'1(• *'1(• if if i(• !E !f !f i(• ik ik i(• !E !E !f i(• i(• ik �F if if �(•'1(• if !E i(• if iE !E i(• i(• i(• ik !E !E !E !f!E •th !E !f !E !f !f i(• i(• ik if if if if �t il• il• !E if i(• i(• !E !E !E i(• i(• ik ik !E !E I N D I. V I D U A L F E E -B R E A' K ,D O W N TYPE QTY D E S C R I P T I O N UNIT COST .TOTAL COSI' SFC 293 OFF -SHELL TYPE V --N -AVER 39.68 .11,626.24' SFC_ 293 OFF -INT. ALTER TYPE V --N --AVER 9.92 2,906.56 ` END OF FEES s 01 00050845-00050847 T O T 222.68f ( DATE: 01/02/90 TItiE: 14:32 CONSTRUCTION AND PLANI._ ,; t.90L 'PA - APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole rr 52. Pool & Equipment Location 2.r,Soil Pipe-,Undrgrnd:, � `� _ 53. Steel Reinforcement 13. ical Electr'Co!f du ivMility•Undrgrnd. -!;r ;t 54, Forms �t.4. ElectricaTCronduil Undrgrnd. 55. Electrical Bonding t }s. Steel Retn€arceinent 56. Rough Plumbing & Pressure Test • Electlicat C1FER`LG. rnd. 57. APPROVAL TO COVER-GUNITE . Footings ; ,� 58. Electrical Conduit-Undrgrnd. -� 8. Foundation F' 59. Gas Pipe, ❑ Undrgrnd., Test 9• Water Pipe-Undrgrnd. .',` 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line:& House Connection 62. Backwash & Receptor-Final I., t 12. Sewer Cap a. 63. Heater & Vent-Final 13. Roof Drains,,, i 64. Plumbing System - Final l _ 14, RoughPltumbin, W :� 65. Electrical-Final •; '. 15. Rough EI'ectrical-Conduit � 7 66, Solar System-Final 16. Rough Electric.Wiring 67. Fencing & Access Approval X17, Rough Wiring Sign 68, APPROVED FOR PLASTERING % 18. Rough Electric;Jl T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19 Rough Heat ng &Air Conditioning DEPT. REQUIREMENT v L• w k * .--FIRE �APPR©VALS-_Peritiit # �w 20�oQh factory F•i�eplace Y * ' ry c,* 21.-Ducts, in�Str ctu�e' " " '` ` =' `'* * -70. Undergo 1h Hydro 22:cDu6ts, Vintitating y� r 7 71, Prod ❑6.as ❑Qii 5 `, _, uctt�ping 23. Gas-Pipe-Rough & Test J* * - 72. Undergro'eind Fly ,rt r+ r.. 7' Y� i• r 1. •R i -t +. _.! 1: .}r Jam• 247Roi3i Fr yn x h ;;73�Undergrni3.Storagg;T�nk'❑Gas ❑Oil �, ; 25. Roof Sheathing -74:)Q6 erfiead Hydro _ 26.`.'.T-Ear Ceiling (Strucural) &=M556cof ., *�; C,>• 75;-� Dry cheical � L; 27:-'-Frame and Flashing: -` zZz 4Mtr k r �~ 76. Dry Stanr�"pi�e -� x 4. `281Lathing & S2ing "' ` - - 77�- FIXED §Y, STEfVltFlNAL * �.,�� R Insulation* i w 78 FIRE PREV. FINAL X29. ��l* r X30. Drywall�I�lairng ;• ;k 3 :;` a; .: 'FIEALTHrDEPT. KE001Ri MINT rJ _ r „i31. Piaster &own Coat: ~79.YFINAL INSPECTMN x 1 ^�• X32' Electrical Polder 4er;Final' '807-FOOD CERTIFICATE ISSUED_, j 1. V'lJ x'33 Final Electric• t: a • 4.7 i # (�: •J S• =1- 1• Notes: C+ MA-: _1- _ W X3<Fi4l He tirlg & Ai�,.Conditioning- '�'-' * ` I l is * , m C) 9 j >G 01 M.'!E. ; a; xc _, 35.'=Final Gas Pipe Testt •:�. x.c ; -;�� R s;36. Hood o`� 'wl r' y OC r=Canopy I 1 iK •+: i f:�:y X _. ;;1 c �, r'I i •� C7 G r< X I t :r l i•` * C7 'C O •t t^ [''� -•37.•Final Factory Fireplace -� of3 jc l '� kx A. , �`^ ''38cFirtal Prumb�g x je �� Q^' t 3� �= 1 rx+c �•� * - .J V 39.�Water ServicerFnal� 1 � . . v• 1.1 .+ +. � �' - M40. Gas Service-Final • '-' e, M E41 ``Solar Domestic-Final `u x ! 11'. aK 42. ~Backflow Preventee ;•� =� ti I l + "" r� 43. Backflow Wigatiori ^' '- 4 > ; ivy J ; -44 Landscape IiriGatidn Syste = sJ �� z :r � t� :�A � tli 0: c•t � � x ^z q.•s `45:�Sound Attenuation 01 ,Z46.- Handicap Regulations tz n: �� w 47•~ FIIRA L STRTJCTUoE & BUILDING i� � r 3• l�. 48�FINAL PLANNING `• �` 44.� •aI f" r� 0 :.t A! t 01 y49`rElectriaelease toldison ' :C ` t, �;; -, ,,� t'• .,.: ...• %50�Gas:Release to Southern California Gas Co •�4•kr a; b V tea., �• x " s o ru :,:"v 51. CERTIFICATE OP`OCCUPANCY '; * .r M n"" -• No. - Date ADDRESS of BwLDW 711 W 17 T Ii ST UNIT: H— 6 OWNER'4NAME IFKNOW MESA BUSINEES CENTER P-1 ADDRESS: 711 W 17TH ST #G 10 sita COSTA MESA,CA 92626 MAILING ADDRESS: uv RRECT OR ENGINEER: LIG NO - ARCH. OR ENG.'S ADDRESS: UNIT: coNTRACTOR'sNAME NOOR ELECTRICAL SERVICE E (714)631-8777 CNlMACTOWS MAILING 711 W 9. 7 T H ST mus& COSTA MESA CA utplo_ 452774 92627J um: J004 LICENSED CONTRACTORS DECLARATION: I hereby affirm under penalty d periury IhM under provisions of Chapter D (commencing with Section 7000) Of Division 3 of the Business and Prdessions Code, is in full force and effect. r rr uc. No.: 0 3 0 8 7 7 LIC. CLASS: C 10 uc. NO.: 4 4 EXP: 03/98 � � Contractor: FINER BUILDER DDECCLLARRATION: t heroby� perjiay that I em exempt from the CoMroaore License Law for rhe following reason (Section 7031.5 Business and Prof na :Any cdY a county which requires a permit to construct• eller• improve, demolish, or repair any .trudrue. prior to its requuea the applicant for such permit to file a signed statement that he or she I$ licensed pursuant to the provisions d the Cana ors License Law [Chapter B (commencing with Sediln 7000) d Division 3 d the Business and Prdessiorn Code] or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation d Sediah 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mare than two hundred dollars (2500]). I. as owner d the pi opetyerr my employees with wages as their sole compensation, will do the work. and die structure is not iaerded or offered for cele (Section 7061. Business and Professions Coda: The Cantrectora License Lew dose rpt apply to an owner of property who builds or inprove3 thereon. end who does such work himself or herself or through hit or her own employees, provided that such imprwemants ere not intended a offered for sets. t, however, the building or improvement is add within one year of completion, the owner-buildar win have the burden of proving he cc she olid nat build or improve far the purpose of sale). Q I. as owner of the property. am exckmiraly contracting with icensed wmraewrs to construct the project (Section 7044. Business and Professions Code: The Contractors Lcer" Law dose that appy to an owner of property who bunds or rnprwes Ih&nwn and who contracts for such projects with a ccnarador(s) lensed pursuers to the Cantremore Lixnsa Law). Q I am exempt under Section: B. 6 P.C.. for tis reasm: Date: 0w .. I do hereby certify that I ern aware of end understand the nequira nets of California Health end Safety Code Sedions 2SMS, 25539, and 25594. end that i a any future huildi a omipena win i will rpt (circle ons) need to comply with said date codas and the requirements for a permit fa construction« modifirdionfrom the Ai�rry Venepemert District. Reaidu Isl mnstrwion eppfeations aro exempt from tl e provisions. Date: Applicant: WORKER'S COMPENSATION DECLARATION: I hereby affirm under penalty of perpay aro of the following declarations: Q L have and will maintain a oendicoe d consent to san-0haas for workers' oompervatnn, as provided for by Section 37110 of the Labor Code, far the psdornhatrce of the work for Mich this perrrth is issued. ] 1 have and wit rnsintan workers' owpsnsmion insurance, ® required by Section 3700 of the Labor Code, for the performance of the r 41 worts fa which thin paurth is issued, Icy workan' mnpenaation irm"nee carrier and po" rwmber alta: Carrier. Policy Number: (This Section need nor be compisrad I the permit is for one hundred daaars fS1Wj or Mss.! Q I candy tied in the perfomherte d the work for which this permit is oeernd. l shah m Y penin In any mariner so as to became subject to the workers' compensation laws d Caiifamia. and agree d became subjed to the workers' compervatim provisions d Section 3700 d IM Labor Code. 3 hwih provisions. Data: ApplXara: t. Warning: Fr6ure to secure.11ran' womparrsadon rot n 1, and f atbjscf err arnploysr ro crGNrrf phsnattfu end cfrff Rnu up to one hundred thousand dotLn ($1 tri n ro dna cusf of cumloartanUa4 damages as provided for In Ssctfon 3m6 of die labor Cods, Interest, and afro a f CONSTRUCTION LENDING AGENCY: I hereby under penalty d perjury that there in a construction lending agency for the performance of the work for which the permit is awed (Section 3097, Cir. C). LENDER'S NAME: LENDER'S ADDRESS: I candy that I have road this application end stats it�W the above information is owed. I agree to eon;*f with aft cry and county, ordirherroes and slate laws relating to building consfrudhort _�eby authorize represatative i d this city to better upon the above-mentioned property for inspection purposes. A97 �' K :�['] / r Ume: ,I -t— mattrro of CwrherlAperhtlAppicamtlCmtredor (5151.46p White-Bunding 8 Salary; GreenRle; Canary -Applicant; Pink -Revenue: Goldenrod-Ashesssor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 082285 PERMIT NO: E 082285 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: �.�. PERMIT TYPE: ELE PURPOSE: ALT JOB DESCRIPTION : ELECTRIC SERVICE REPAIR SQ FT: CLAIM VALUE: CALL—VALUE: GROUP OCC: B / COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RIGHT: FT IN LEFT: FT IN RIGHT: FT IN PARKING REQ: PROV: PARCEL: 93983048 ZNE: REF NO: PLANNING NOTES> D E V E L O P M E N T-- S• E- R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY BUILDING APPROVED BY DATE- ATE: DATE- DATE: APPLICATION APPLICATION ISSUED BY: DATE: * � 1E iE � * iE iE # ±E iF iF � SE iE # rt 1E Sri• irk # iE if * * if- * iI- iF iE * iE �E �E LEGALIZATION:N F E'; E' S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 27.25 50% SMIP/NON—RES PLAN ISSUE FEE 22.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----] 27.25 22.00 0.00 49.25 49.25 .00 REVENUE DIVISION TOTALS--> COLLECTED: 49.25 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 49.25 I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TAL COST ELE 1 SEIVICES BELOW 600 V & BELOW 209 AMP 27. � 27,25 END OF FEES k Pik F t,oSj�, DESA CONSTRUCTION AND PLANNIP APPROVALS Permit # Date Inspector )L & SPA APPROVALS Permit # Date Inspector 1, Temporary Electrical Service or Pole 52. Pool & Equipment Location 2, • Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4, Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7, Footings 58. Electrical Conduit-Undrgrnd. 8, Foundation 59, Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe•Undrgrnd. , 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10, Structural Floor System 61, APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash 8+ 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe-Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ Gas © Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Ory Chemical 27. Frame and Flashing 76, Dry Standpipe 28. Lathing & Siding LI 77. FIXED SYSTEM FINAL s 29. In elation 78. FIRE PREV. FINAL 30. Dry ill Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40, Gas Service-Final 41. Solar Domestic-Final 42, Backflow Pre venter 43. Backflow Irrigation 44. Landscape irrigation System .v 45. Sound Attenuation 46. Handicap Regulations^ 471. FINAL STRUCTURE & BUILDING �* 48. FINAL PLANNING` i t 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51, CERTIFICATE OF OCCUPANCY No D;Te UMI L JOB ADDRESS 71.1 W. 17th St. Bldg. Hl BUILDING PERMIT NO. 39b93 GENERAL CONTRACTOR Ordner Eldr. DESCRIPTION of WORK Faint Spray Booth AP No -116-2(>0-09 LOT TRACT FIRE ZONE VALUE $ 5 00. 00 INSPECTIONS Si nature I Date TYPE GROUP ZONE MG so GAL SUBCONTRACTOR PERMITS ISSRED Date Number Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER ROUGH WIRING Heating and Vent. TRENCHES 0 FORMS 0 STEEL REINF. FLOOR SYSTEM BOND BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING — IN Fj OUT PLASTER, BROWN COAT STRUCTURAL. FINAL HEATING. VENT., REFRIG. AND A.C., FINAL PL NG, FINAL AND GAS TEST ectric r ELL AIC, FINAL 174- r BUILDING. FINAL vi,14 7 SPECIAL REOUkREMENTS CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address % I I UU Applicant's Mailing Address Owner's Name fJv / Phone — Applicant to filt in all spaces except those within heavy border lines and sign all appropriate declarations. Address Arch/Eng, - License No. Address Contractor's Name MbR12I'S ]<LR„ -TP IC_ PhonemR77,_e-g Address (mailing) City License No. C2 LICENSED CONTRACTOR DECLARATION I hereby',affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the_RU51ness and Professions Code, and my license is in full for a and effe License Class Aja icen No. I Date Signature WORKERS' COMPENSATION DECLARATION ' ,hereby _affirm that I have a certificate of consent to self -insure or a certificate c, _, Workers' Compensation Insurance, or a certified copy thereof (Section i00, lati.�C�}rc Policy No. Y56�_�-V��.--.3_ any eCertified copy I$ hereby furnish d. I, c Certified copy is ed with the CI y in Nisi Date_ —t i Applicant EXEMPTION FROM WORKERS' COMPENSATI DECLARATION (This section need not be completed'if the permit is for -one hundred ($104) or less). ' I certify that in the performance of the work for which this permit is issued I Shall not' employ any person in any manner so as to become subject to tie Workers'; Compensation'Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed_ revoked. CONSTRUCTION LENDING AGENCY - i hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ, C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION, I hereby -affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031'.5 Business and Professional Code: 'Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure; prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 ?031.5 by any• applicant for a permit' subjects the applicant to a civil enalty of not more than five hundred dollars ($500). _ I, as -owner of the'property or my employees -with wages as their sole Compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business. and Professional Code:, The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletlon, the owner will have the burden of proving he/she did not build or Im- Erove for the purpose of Sale). I, as owner of the property, dm exclusively contracting with licensed con- 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 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 Proof off; their Worker's Compensation insurance should be provided to me, ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby. certify that I have read this appli tion and state -that the above inform ti ct. I. agree to amply wi all city and county ordinances and stat law ati g to buildi g constru "on, and hereby authorize rep or sentative of thi ci Oto ent upon t above-mentioned property for inspectio u b s, Signature Date r! Drivers' LicenseZrrSS CMF 0865-46, rev. 10/84 PERMI %�� , TRACT NO. LOT NO. UNIT N�• T171 � O 5904 i TYPE OF CONSTRUCTION NEW App ALTERATION REPAIR ❑ CONVERSION - ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORKIUSE OF BLDG. ., A_.P # Zone , S Main Building: Accessory Building: _ TYPE OF PERMIT GRADING FOUNDATION J STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL -❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ,ACRES T Front ' i • d B A Rear _ - N 1 C Right N S Left G R- Ping.' Ref. Parking Req./Provided E, Remarks: Planning Notes: Q M T S Bar Sink PLUMBING FEES Showers I 1 ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer _ Construction Pole Sub. Transformer ❑ 15 50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtuhs Sewer Connection Cooking Unit r Meter ©up to 100 amps; Clarifiers Solar Collectors > Dishwasher _ _ Meter Dover 100 a'mps_, Dishwasher Solar Piping Dryers ❑Gas ' ❑Electric Sub Panel' ; Drinking Fountains ! Solar Tank 1 Fan • Motors)Q0-1 HP ❑ 1''A - 8 Floor Drains Swimming Pool w/Spa 'F.A.U. Inc. Solar ❑9-15 HP ❑ 16-15+ 1 Floor Sinks - -0 Urinal * Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range kitchen Sink' Water Service r Switches Sign Lavatories 'Auto -Wash Garbage Disposal I Standing Sections P -Trap Laundry Trays " i Generator ❑0-5 KW 05.15 KW Trash Compactor Roof'Drains ' Reinspection Fee" 515 Issue Fee S 3 Reinspection Fee $15 8 IssuetFee $ 3 MECHANICAL FEES Boiler Duct -Under Ground Hood or ' Type I E)DEVELOPMENT Canopy Type I I ElZoning - SERVICES REQUIREMENTS;. Approved By Building Approved,By Application Issued By- - _ i Date Date r L(! _.._Date l l& -003 Duct - Structural Duct - Ventilating Refrigeration System ❑0-100,000 BTU 0100,000_13TU BUILDING PERMIT , $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL '' $ PLAN CHECK 25% $ SUMMARY OF FEES SMIP $ PERMIT 4 ISSUANCE $ ENERGY P.C. $ DD GRADING' $ SO MICROFILM I$ I TOTAL FEE I$ �r4 Exhaust System ❑ Multiple ❑ System Repair/Alteration I FirepllFact. Bit. ICBO # Fire Dampers Heating System & Ducting [30-100,000 BTU ❑100,000BT I Registers __ i I Reinspection Fee $15 Issue Fee $ 3 - Applicant: Pink - Accounting; Goldenrod - Assessor t CONSTRUCTION AND PLANNING !I APPROVALS Permit # Date Inspector POOL ,y SPA APPROVALS Permit # Date Inspvctnr 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms A. Electrical Conduit-Undrgrnd. 55. Electrical Bonding' 5. Steel Reinforcement' 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, i] Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12, Sewer Cap 63, Heater'& Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16, Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOLISPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. 'Ducts, in Structure 70. Underground Hydro 22. Ducts,' Ventilating 71. Product Piping 0 Gas O Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd, Storage Tank O 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 34. Final Heating & Air Conditioning Nntes: 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace -38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date IN - y DEVELOPMENT SERVICES REOUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat SUMMARY OF FEES BUILDING PERMIT S SMIP $ PLAN CHECK $ PERMIT PLUMBING $ oO ISSUANCE $ PLAN CHECK 25% $ �_ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE S _ PLAN CHECK 25% $ Applicant to fill In all spaces except those within heavy;border lines and sign all appropriate declarations. OE CQS7A MESA CONSTRUCTlO ERMIT P RMIT NO. JCITY TRACT NO: LOT NO. UNI f 6 ` Pl!bject'AMress Ri -� Applicant's Mailing A cess TYPE OFCO(VSTRtiCT(ON NEW ADD ALTERATION REPAIR ElCONVERSIOry ❑ DEMOLISH ED OTHER Owner's Name 7 d e DESCRIPTION OF WORK/USE OF BLDG' A P, Address S Main Building: E Arch/Eng- License No. TYPE OF PERMIT GRADING FOUNDATION 0 STRUCTURAL T Front ❑ TENANT ❑ELECTRICAL ❑ PLUMBING ❑ 'MECHANICAL, Address El OTHER A Rear Contractor's Nam Phone C Right PROJECT DESCRIPTION • S4. FT. OCCUPANCY K Address (mailing) GONSTRUCTIONXYPE VALUATION S Lett City License No. ZONE GRADING CU.YDS. ACRES Ptng. Ref, 0 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: with section 7000) of Division 3 of the Business and Professions Code, and my license is In f rce n ffect. Liceni Class License No., Dat Signature MP WO KERS' CONSATN ION LARATIO 1 hereby affirm that I have a cer cafe of consent to self -insure or a certificate af Workers' Compensation Insurance, or a certified copy thereof (Section 380o, Lab. C.) ' Policy No. Company eCertified copy is hereby furnished. Certifled copy Is filed with the city Building Division. Date Applicant EXPMPTION FROM WORKERS' COMPENSATION DECLARATION ("this section need not be completed if the permit is for one hundred (3100) or less). I certify that in the performance of the work for which this permit is issued I shall not employ any person In any mann r so a to become subject to tie Worker Cu sat' n Laws of Caiifo WOr f Signature NOTIC : If, after making this deciarat you --Mould ecome subject to e Workers' Compensation provisions ofWhe tabor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - i hereby affirm that there is a construction lending agency for the, performance Of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION - - I hereby affirm that i am exempt from the Contractor's Llcense Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 l therefrom and the basis for the allegedexemption. Any violation of Section 7081.5 by any applicant for a permit subjects the applicant to a civil �rialtY of not more than five hundred dollars ($540). LJ 1, as owner of the property or my employee$ with wages as their sole Compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's .Llcense Law does not apply to an owner of a property who builds or )mprove$ thereon, and who does such Work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- - pletion; the owner will have the burden of proving he/she did not build or im- 54ve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a can- tractor(s) license pursuant*to'the'Contraetor's i-Icense Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. L7 1 am exempt under Section S. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above Information Is correct. I agree to comply with all city and county ordinances anq state laws relating to building construction, and hereby authorize repre- sentatives of _!"I city to enter upon the above-mentioned prope. y r lnipectlon pas. r Slgnature Date Drivers' Li a or S )° Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher 7 Drinking Fountains Floor Drains Floor Sinks Gas Service j Outlets Interceptors Kitchen Sink ' Lavatories, P -Trap Roof Drains Reinspection Fee Boiler $15 Duct- Uhder Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO =AL Heating System & Ducting 00.100,000 BTU 0100,000 OT Reinspection Fee I $15 CMF 0865-46, rev. 10/84 white - Building; Cana - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Coltectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Issue Fee IANICAL . Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System 00.100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES 5 3 H-/ Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Oryers ❑Gas DElectric Fan F.A.U. Fixtures Device Boxes 5997 7/02/85 Zo ne Accessory Building: Parking Req.iProvided ELECTRICAL Outlets Switches Garbage Disposal Generator 1:10.5 KW ❑5.15 KW Transformer ❑ 15.50 KW ❑ 50 + KW Meter jJup to 100 amps Meter Dover 100 amps' - ' Sub Panel Motors ❑0-1 HP 01 % - S Inc. Solar 03.15 HP ❑16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor { FEES LReinspection Fee f $15 ` 1 Issue Fee 40.50 TL' FEES $ 3 Z O N I N G R E M T S DEVELOPMENT SERVICES REOUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat SUMMARY OF FEES BUILDING PERMIT S SMIP $ PLAN CHECK $ PERMIT PLUMBING $ oO ISSUANCE $ PLAN CHECK 25% $ �_ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE S _ PLAN CHECK 25% $ T3_ FONSTRUCTION AND PLANNING APPROVALS Permit # .' Date Inspector POOL & SPA APPROVALS Permit ;#' Date Inspector �.Tempo r y Electrical Service or Poled il 52. Pool & Equipment Location � J 2. Soil�Pipe}Undrgrnd. dA r-, 53. Steel Reinforcement 3. Elec_cai.Condttt�Util y-Undrg'rnd!0 - ' 54. Forms -4�1ect al Condui -Undrgrnd. i w . 55. Electrical Bonding Y 5.Steel Re forcemfn �` rvr 56. Rough Plumbing & Pressure Test V 6•ectr.'cal UFER Grnd. ; 57. APPROVAL TO COVER-GUNITE �- 7.-Faotir)gsy► �� _.,v' ,,i`� 58. Electrical Conduit-Undrgrnd, BIFoundation 'h�y r 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water'Pipe Uridrgr,nd� �j `�,. ,n , r L 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10'lSt uFt raf Floor System `b' i 61. APPROVAL TO DECK 11. Property Sewer Line-'& House Connection 62. Backwash & Receptor -Final 12, Sewer Eap f ; 63. Heater & Vent -Final ` 13. Roof Dns} o; 64. Plumbing System - Final `•' 14. 5gh ,)Lmbing '�' 65. Electrical -Final 15. Rough Electrical -Conduit r- fib. 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. POCIUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster 8rown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33• Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace _ 138. 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 _ 0 MN R Applicant to fill in all spaces except those within heavy border lines and declarations. -—'r NO TRACT NO LOT NO UN17 CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 711 ._-W 1 7th St- 'Al {jg Uni t_1 Applicant's Mailing Address 13110 Saticoy St. N.Hollywood, Owner's Name _Troy Investment Fund _Phone 459-2988 Address 4321—Birch—St . Newport—Beach, Ca. Arch/Eng. Maria J. Rock License No. Address 12881 Knott Ave._ Suite 216 Contractor's Namellttco Air Conditioning Phone 982-1216 Address (mailing) _D110 SaticoySt. N.Holl wood Ca. City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business Professions Code, and my license is in full fgrce and ;PN Ucens��e� // Class y� �p �� C 2QLi ns No. 346 251 Date 4118f 8-4 � Signature WORKERS' COMPENSATION DE ARATION I hereby affirm That 1 have a certifi to of Consent to self-InsurO or a certificate of Workers' Compensation Insur nce, or a certified copy thereof (Section ztaoa, Lab. ca WC9824 Lumbermans olicy No. Company 8 Certified copy is hereby furnished. Dateertifi Ujpy is filed with pp3 ca city BuildI6LD, yli� . EXEMPTION 1FROM WORKERS'COMPENSATIO``CCN DECLARATION (This section need not be completed if the permit is for one hundred (5100) or less). I certity that •)n the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date -- Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION 4ENOING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm -that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the E3usiness and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who Uoes such work himself/herself or through his or her own employees, provided that such improvements arc not intended or offered for sale. If, however, the building or Improvement is sold within ane year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpote of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s) I)cense pUrsuarit'to the Contractor's License Law). 1 am aware that proof off their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason E 1" 1,61 G S NO, TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION L1 REPAIR Reinspection Fee ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 46 DESCRIPTION OF WORKIUSE OF BLDG. $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By S Main Building: Data Date nal E TYPE OF PERMIT GRADING 0 FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑D MECHANICAL B [:),OTHER A Rear 6 00 Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATION 5 Left ZONE GRADING CU. YDS. ACRES Ping. Ref, + Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service .Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof'Drains Reinspection Fee 1 Sls Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact, Bit, ICBO Date Owner Heating System & Ducting . hereby certify that I have read this application and state that the above 1 1 Di -100,000 BTU ❑ 100,000 BT information is correct. l a to comply with all city and county ordinances antl state I s refacing �t b titling construction, and hereby authorize repre- sentative o this t:it o nter upon the above-mentioned property for inspect( n p rposes, it ]i7,i[ Signature Date '5 "_�"`� Reinspection Fee Drivers' '44 Ljfense or $S :p CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod -Assessor S15 PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water. Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System C10-100,00OBTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES 2291 """5%03/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas ElElectric Fan F.A,U, Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 05-15 KW Transformer Cl 15-50 KW ❑ 50+KW Meter LJup to 100 amps Meter Clover 100 amps Sub Panel Motors ❑O.1 HP [31 'A - B Inc.Solar 09.15 HP ❑16-15+ Microwave Pole Light Range Sign ;Standing Sections Trash Compactor 15.54 fit. FEES Z O N I N G R E Q M T S S 3 Reinspection Fee $15 I I Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: 4RIi :3 Data Date nal S L BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRfCAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ $ $ i 1 -00_ $ _ 2.50 SMIP $ PERMIT I ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ 15.50 6 00 4 00 S 3 CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pale 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms s 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement -. 56. Rough Plumbing & Pressure Test 6. Electrical UFES Grnd. ' -•.rx 57. APPROVAL TO COVER GUNITE 7. Footings .s 5B. Electrical Conduit-Undrgrnd. 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. r. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10, Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Con' ectign 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 APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 PREY, FINAL 30.: Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating &• Air Conditioning /-447 4.0 35. Final Gas Pipe -Test 36, Hood or Canopy - 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison -50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date _39693 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 FDR or Applicant to ll in Completely J IA - BUILDING II W• f flyLD�� (1 ' 11 1 �l ,, I -I T 'LI]C• �'4' o%-rN- ice`Ie1-A NOL(,4'1 -(& N BRANCH " ADDRESS ARCHITECT OR ENGINEEF ADDRESS TEL. NO. CONTRACTOR nn ADDRESS ?6)2T 0,'I'7,� CITY I�+tr1.� �pQ-� �t No. �2 �'t' (, X44 STATE CITY LIC. NO. LiC. NO. SIZE=NOW O.OF BLDG& OF LOT ON LOT USE OF EXISTING BLDG. SIZE OF NO. OF NEW BLDG. ROOMS STORIES EXTERIOR WALL ROOF COVERING COVERING USE OF BUILDING AND WORK TO BE PERFORMED ( 1" A- I,) T qPP A-/ I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I em properly licensed as a contractor under the State of California Business and Professions Code, Divisicn 3, Chapter 9, and that such licenses are In full force and effect, or I am exempt from the provisions of the State of California Business and Professions Codepi�vision 3, Chapter 9. Signature of Permittee Authorized Agent Palo APPLICATION FOR BUILDING PERMIT RECE V/,EEP BY DATE RECEIVE DATE IS UED/r DISTANCE BET. —2Ld0-� 1 PE A -P, NO. ACCESS. SLOGS. BUILDING }� ADDRESS ` [l r �� 16CLO 67�M $ Oa RACT`�K BLOCK W A P OWNER VALUE kill S $ FIRE ZONE TYPrc GROUP APPROVED BY 40— DATE 6 ZON NO. OF USE OF NEW PLANS ?-- BUILDING �b YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM C/L STREET) REAR X X — FT. FT. DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. SLOGS. VAR. � DATE C.U,P, * APPROVED APPROVE srAT TOTAL FEE —$ — TA& o F THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; Q VALUATION oa AA�� U✓ PERMIT FEE $ N 67�M $ Oa PLAN CHECK $ E `o TOTAL FEE —$ — Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MEySACONSTR UCTION'PERMIT ITO. IT N TRACT NO. LOT NO. UNIT NO, Project Address �! �tY • �I tO �7�,�- � _J 14.1 Applicant's Mailing Address TYPE -OF CONSTRUCTION NEW ADD ALTERATION REPqR ❑ CONVERSION ❑ DEMOLISH U OTHER A.P ilk Owner's Name �--ZG.B, Phone `DESCRIPTION OF ORK/USE OF BLDG. i4f��.1 %�_ zNGR- — Address M B 'Id Arch/Eng. License N0. r, on?nIa7 Address ' Contractor's Name Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class - License No. Date Signature WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -Insure or a certificate f Workers' Compensation Insurance, or a certified copy thereof (Section ,800, lab. C.) < Policy No. Company H Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed It the permit is for one hundred ($100) or less). i certify that in the performance of the work for which this permit is Issued I shall not employ any person in any manner so as to become subject to tyre Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration„you should become subject t0 the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit $hail be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires•a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit t0 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 Division 3 of the Business and Professions Code) orAhat 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 Sof not more than five hundred dollars ($500). ❑ 1, as owner of'the property or my employees with wages as their sole compensation,' will do the work, and the structure is not Intended or offered for sale (Section 7044,, Business and Professional Code: The Contractor's F&cense taw does not appiv to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or nor own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- ple the -owner will have the burden of proving he/she did not build or Im- pro or the purpose -of sale). t I, as owner of'the property, am exclusively contracting with licensed c4n- tractorst6 construct the project (Section 7044, Business and Professions Coda: :The Contractor's License Law oes_not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s1 license pursuant to the Contractor's License Law). I am aware that proof o their Worker's Compensation insuMe should be provided to me, ❑ I am exempt under Section--,�y5� -- -y,% P. C. for this reason rDate Owner I hereby certify that I have read s appli On and sta that the above information is correct. I agree to comply with all city and county ordinances and, state laws rel to buildi construction, and hereby authorize repre- sentatives of th' ty to upo the above-mentioned pro erty for ipspection pur � vj S"gnature ate��Gll7 rDr€vers' L€cense �tr2E i" (e�.Ci' 114111111 pE” S a ul mg. TYPE F PERMIADING LJ FOUNDATION STRUCTURAL T Front TENAN7 El ELECTRICAL- El PI El MECHANICAL A Rear OTI IER PROJECT DESCRIPTION SO. `FT._Z OCCUPANCY 15.2 C Right CONSTRUCTION TYPEy _l.�l VALUATION$ isCaC7.� S Left . I�� ZONE A. �� ,.. GRADING CU. YDS. r ACRES Ping. Ref. # Remarks: AC ��"� '�Y-'� <,e -Z �D .�i1 /fir Planning (Votes: ! -C_- -77= !�60 7- d6 s MECHANICAL PLUMBING Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap - Bathtubs Sewer Coction Clarifiers SolaItectors Dishwasher otar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool vv/Spa Floor Sinks Urinal Gas Service O ets Water Closet Interceptors . Water Heater Kitchen Sink Water Service . Lavatori P—T p Auto -Wash Laundry Trays Roof Drains $ PLAN CHECK 25% $ Reinspection Fee $15 Issue Fee MECHANICAL Boiler ❑up 100 amps Hood or Type li ❑ Canopy Ty t( ❑ Duct - Under Ground Duct - Structural S Panel Refriger on System 130• 0,000 BTU 0100,000 BTU Duct - Ventilating F.A.U. 7Z Exhaust System ❑ Multiple ❑ Fixtures I ystem Repair/Alteration Firepl/Fact. Blt.•ICBO Pole Light Fire Dampers Heating System & Ducting 00.100,000 8TU ❑ 100 0 BT Switches Registers Garbage Ditp&al General 130.5 KW ❑5.15 KW Standing Sections Trash Compactor Reinspection Fee I $151 I Issue Fee CMF 0865-46, rev. 10%84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor .--) FEES $ 3 FEES $' 3 39 9/26/86 1! Zone. Accessory Building: Parking Req./Provided Cp 75010 ' TL Z O N I N G R E a M T S ELECTRICAL ': FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 1_1,5 KW ' Cooking UnitMeter. ❑up 100 amps Dishwasher Meter over 100 amps Dryers ❑Gas DElectric S Panel Fan Motors 00.1 HP ❑ 1% - 8 F.A.U. 7Z Inc. Solar ❑9-15 HP ❑16-15+ Fixtures I Microwave Device Boxes Pole Light Outlets Range Switches Sign ` Garbage Ditp&al General 130.5 KW ❑5.15 KW Standing Sections Trash Compactor $ PLAN CHECK Reinspection Fee $15 I ' Issue Fee I $ 3 I DEVELOPMENT SERVICES REOUIREMENTS /h _ Zoning Approved By Date Building Approved ByGate 21 '' Application Issued By Dat SUMMARY OF FEES ' Or BUILDING PERMIT '$ 744, �M'� SMIP ' $ PLAN CHECK $ PERMIT PLUMBING - $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN.CHECK 50% MICROFILM $ -$ _ J MECHANICAL TOTAL FEE $. 76, t at a PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POOL & SPA APPROVALS Permit Date Inspector 1: Temporary Electrical Service or Pole 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNfTE 7. Footings 1; p 58. Electrical Conduit-Undrgrnd. 8• Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd'.. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final ' 12. Sewer Cap 63. Heater & Vent -Final 13.- Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15, Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL t� '• 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # _ .r 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush C 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 4 .s 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical .f 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL - t 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing 27HEALTH DEPT. REQUIREMENT i 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 .j s 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace` - 38. Final Plumbing 39. Water Service -Final , F d ' 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System '- e. + , 45. Sound Attenuation `! t ! r y 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison �" + 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and Sign all appropriate declarations. PERNjj,T fAD. - „ TRACT NO. LOT NO. UNIT NO. CITY OF COSTA 5 O TCTION Pr-niviIT Project Address'� Applicant's Mailing Address Owner's Name —P ho Address pC-_-5�—14y-- Arch/Eng. License No. Address -- Contractor's Nam hone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I ant licensed under provisions of Charter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation insurance, or a certified copy thereof (Section ,5800, Lab. C.) Policy No. Company eCertified copy is hereby furnished. Certified copy is filed with the city Building Oivision. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permw it is fo ne hundred (5100) or less). I certify that in the performance of the work h this p t Is is s I shall not employ any person in any man s to c e s je the Workerrl�Co�R�salipiYiaws of Calitorn Date �+✓� ..77 dd ��Signature NOTICE: If, after making this declaration, yo—ushouw1wrome, suqoct to the Workers' Compensation provisions of the Labor Ci5idg, you mus forthwith comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there IS a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ, C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permlt 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 Division 3 of the Business and Professions Code) or that he/she is exempt 2nrefrom and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a permit subjects the applicant to a civil alty of not more than five hundred dollars ($500). I, as owner of the property will do the work, and the Structure Is not Intended or offered for Salo (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who build$ or Improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Cade: The Contractor's License Law does not apply to an owner of property who 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 proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that a read this application and state that the above Information is torr a ee to ly with all city and county ordinances and state laws r ti buil onstructl n, and hereby authorize repre- sentatives Df is t o above-mentioned property for ins pectlon p p Signature �✓ ,its Drivers' Lic se TYPE OF CONSTRUCTION LJ NEW LJ ADD L! ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P yll, DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRACING 0 FOUNDATION El STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B El OTHER OTHER Roar G _ Right PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION S S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: a V Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap — Roof Drains Reinspection Fee Boiler $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑0-100,000 BTU E] 100,000 BT Reinspection Fee 1 $15 GMF 0865-46, rev. 10/B4 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal / Water Closet Water Heater Water Service - Auto -Wash Laundry Trays 5031 3/31/137 Zone Accessory Building; Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 05-15 KW , Transformer ❑ 15-50 KW ❑ 50 + KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors LIG-1 HP Cl 136 - 8 Inc. Solar ❑9-15 HP 016.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 26900 TL FEES Issue Fee $ 3 CHANICAL FEES in Respection Fee S15 Issue Fee $ 3 Hood or Type I ❑ DEVELOPMENT SERVICES REQUIREMENTS: Canopy Type I I ❑ Zoning Approved By Date Building Approved By, Date Refrigeration System Application Issued By- - - --n 11 -Date ❑0-100,000 BTU 13100,000 BTU SUMMARY OF FEES System Repair/Alteration BUILDING PERMIT $ SMIP $ LAN CHECK S PERMIT Fire Dampers LUMBING' $ ISSUANCE $ Registers PLAN CHECK 25% ENERGY P.C. S ELECTRICAL S GRADING $ PLAN CHECK 50% $ r MICROFILM $ MECHANICAL $ TOTAL FEE $ Issue Fee S 3 PLAN CHECK 25% $ r}' Z O N I N G R E Q M T S CONSTRUCTION AND PLANNING APPROVALS Permit # t_ Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 11. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54, Forms 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings, ` 58. Electrical Conduit-Undrgrnd. 8. Foundation/ 59. Gas Pipe, ❑ Undrgrnd„ Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12, Sewer Cap 63. Heater & Vent-Final ` 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring i 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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74, Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78, FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80, FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36, Hood or Canopy f e 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final .40, Gas Service-Final 41.• Solar Domestic-Final 42. Backflow Preventer 43, Backflow irrigation i 44. -Landscape Irriqation System i 45. Sound Attenuation 46. Handicap Regulations , 147. 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 x qk (714) 754-5273 - Fax (714) 754-4856 - www.ci.cosla-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 711 W 17TH ST Suite: i Vicinity: UNIT J Primary Occ: B Eat<501 Office/ Bar<50 Type of Construction: V Parcel Number: TPN02004 Zoning: Applicant: BATIOFF, JOHN Applied: 04/11/2005 Address: 17182 ARMSTRONG AVE. Other: $0.00 Inspection: $0.00 Phone: 949-260-1900 IRVINE, CA Zip: 92614 Owner: MESA BUSINESS CENTER ASSOCIATION Address 711 W 17TH ST Phone: 949-672-9035 COSTA MESA_CA Zip: 92627 Contractor: DRI COMMERCIAL Address: 17182 ARMSTRONG AVE Phone: 949-260-1900 I RV I N E,.CA Zip: 92614 License: 818623 Status: ISSUED Applied: 04/11/2005 Issued: 0411112005 ISSUED BY: —4 A21i Arch Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT , TEAR OFF EXISTING BUILT-UP ROOFING & INSTALL NEW BUILT-UP ROOF SYSTEM (UNIT J) - 110 SQ. FEE SUMMARY Plan Check: $0.00 Permit: $411.95 - t SMIP Res: $0.00 SMIP Com: $5.67 Other: $0.00 Inspection: $0.00 Total: $417.62 SETBACKS MAIN STRUCTURE, Front ,0-0 ACCESSORY 'Front 0-0 PARKING Existing: a NOTES: Calc Valuation: Claim Valuation: PLANNING & ZONING Rear 0-0 Left .0-0 Right 0-0 Rear 0-0 Left 0-0 Right 0-0 Required: 0 Proposed: 0 $27,000.00 $27,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12.21.92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 445"46 (6100) AV DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ f have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. KII have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of tho work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: We;V46 A ,1 C-A6,Am co, -0 F PyAlpI06 Policy Number: WL2T_J 4- J(2 2— f* 2_ {This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ I certify that in the performance of the work for which this permit Is Issued, f shall not employ any person in any manner so as to become subject to the workers' compensation laws of 9alifornla, and agr a that if 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shell forihwtth comply with these pr sions. (Applicant Signature: pate; Q5 WARNINd-FAILURE TO SE RE WORKERS' OCWENSATION COVERAGE IS UNLAWFUL AND SHALL SUaIECT AN EMPLOYER TO CRIMINAL PENALTIES AND ClvIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (3100,000). IN ADDITION TO THE COST OF OOMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that i am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic, a class'll. Contractors Signature: pate; CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a Construction lending agency for the perlormance of the work for which this permit is issued. (Sec. 3097, Civil Code), Lender's Name: Lender's Address: Signature: Date: OWNER-BUIL_DER.DECLARATIONS: I hereby arm that at under penalty of,perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any -city or couny which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions C,ode)'or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, Or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business end Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ t, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS it) construct the project (Sec. 7044, Business and Proiessions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: _ Date: Owner ID verified by drivers License. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL. SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, faisework, or demolition or dismantling thereof, will be more then thirty-six (36) feet high, (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division, Signature: Data: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes (D No (Section 25505 of the Celifomia Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feel of compressed gas at standard temperature and pressure). —...................—....................._..........:......—...................._..__.....................-----......................................... ....._...................... ................................. ........_........_....................... -........ __.— ......... .... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ElYes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .. ........... .....................................:.............................................................................................................................................................................................................................................................................1111........................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. W ... ....................._..............._......:................................................................................ --................................ .................................................. --l.......... .......... ...............-........................ ........................................ _... _.._.................. --..... 4 an RMPP is presently rdquired, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No — .. . _..........—....:...................................._--..................... _.........................._........................................ ---......................................................................................................... _..................... 5 Does or will the applicant or present or futu....re...building occupant require for the work which Is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any Other air pollution control district or agency? U Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ............_--..... ..................•--............................................................................................................................................"..................................___................................................................ .................................... Will any part of the facility to be constructed under this permit be within 1000 foot from the outer boundaries of a school? ❑ Yes ❑ No (If 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............ _............................................................................ .....................................................-- ---------............................._........ ..... ...-----,.....__.,_......................................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ NO ........... ----.-_........................................................................................................................................................................................................................................................................................................................................................................ 8 (If 'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: 1 certify that under penalty of perjury the information given above is correct. i agree to comply with all stale Yaws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ignalure Ot gal Owner(s) 7 Dam Andldr AuthetTzod Applicant 7 f�DaSta CODE I• INSPECTION TYPE DAN ItlTITIAL BODE 4 INSPECTION TYPEJ l�� INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final BlocklRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final BuildingiOccupancy Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CI�OF COSTA MESA CO a I U N PEF}MIT PERMIT NO. TRACT NO. LOT NO: UNIT NO. Projrct Address Applicant's Mailin dress Owner's Na e 1 ho! Address Arch/Eng. License No. Address Contractor's Nam Phon Address (mailing) City License N_o. LICENSED CONTRACTOR DECLARATION I hereby affirm that f am licensed under provisions of,Chartor 9 (commencing with section $7000) of Division 3 of the Business and Professions Code, and my license is in f �forc d affect• � Licen Ct ss � License No L Date — Signature WORKERS' COM6EN5ATlON p AATION I hereby affirm thdt I have a certific [e of consent to self -Insure or a certifl"te of Workers' Compensation Insurance, or a certified copy thereof (Section a800, Lab. C.) )Iicy No. Company dCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (5100) or less). I certify that in the performance of the work for which this permit is Issued, 1 shall' n t employ any person in any man r so to become subject to the Worke Co a Sat' ws of Califor Date " Signature 'NOTICE: If. after making this declara you should -become subject to the Workers' Compensation provisions Of Me Labor Code, you must forthwith comply with such provisions or this permit shalt be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm th$t there is a construction lending agency for the performance of the work for which this permit is Issued .(Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I amexempt from the Contractor's License law for the following reason (Section 7031.5 Business and Professional Code: Any city or County which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a'signed statement that he/she Is licensed pursuant to the provisions of 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 SOction 7031.5 by any applicant for a permit subjects the applicant to a civil ,salty of not more than five hundred dollars ($500). i, as owner of the property or my employees with wages as their sole ompensation, will do the work, and the structure is not intended or offered for sale (Section 7044,'Business and Prof6ssional Code: The Contractor's License Law does not apply to an owner of a property who build$ or Improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within One year of com- pletion, the owner will have the burden of proving he/she did not build or Im- rove for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor% License taw does not apply to an owner of property who builds or improves thereon,and _who contracts for such projects with a con- tractor on- tractors) license pursuarit to the Contractor's License Law). 1 am aware that proof o their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt 4ndor Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct• Iagree to comply with all city and county ordinances and State laws relating to building construction and hereby authorize repre- sentatives of �is citylto enter upon the above-mentioned property for Inspection ��ryoges. Signature _��''�T.• f 1 r.�as.. — - -- _ _ Date%y;=�,�e Drivers' Llc or SS / I JO Lf I I I I - TYPE OF CONSTRUCTION 0 NEW ADD 0 ALTERATION 0 REPAIR - - ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. ~�yr Zone DESCRIPTION OF WORKIUSE OF BLDG. S Main Building: Accessory Building: E TYPE OF PERMIT GRADINGEl FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUNIStNG ❑ MECHANICAL A Rear - of ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ - S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. Parking Req./Provided - + Remarks: Planning Notes; Z O N I N G R E O M T S CMF 0865.46, rev. 10/84 White - Building; Canary pp cant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink (} Automatic Washet Construction Pole Sub.. Transformer ❑ 15.-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher. Meter [Dover,100 amps, - _ _ - Dish'Washer Solar Piping Dryers ❑Gas -❑Electric Sub Panel Drinking Fountains Solar Tank Fan A i Motors 130-1 HP 01 14 - B Floor drains Swimming Pool w/Spa F.A.U. Inc. Solar 01945 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service: Outlets Water Closet Device Boxes Pale Light Interceptors Water Heater Outlets Range Kitchen Sink Lavatories Water Service Auto -Wash 7_ Switches Garbage Disposal Sign ; Standing Sections P—Trap Laundry Trays Generator 00-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee $15 kssu 5 Fee $ 3 Reinspection Fee 1.$15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date Boiler Hood or Type I ❑ Canopy Type I I 0 Duct - Under Ground Duct - Structural Refrigeration System E30-100,000BTU ❑ 100,000 BTU Duct - Ventilating SUMMARY BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25%• $ OF FEES SMIP $ PERMIT Utz ISSUANCE $ / S ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ %y Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers Heating System & Ducting Do- 100,000 BTU ❑100,000 13TL Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865.46, rev. 10/84 White - Building; Canary pp cant; Pink - Accounting; Goldenrod - Assessor f- CONSTRUCTION AND PLANNING Permit " r1 , r - Date Inspector POOL & APPROVALS Permit Date Inspector 1 . Tempos y Electrical Service or PoW `� 52. Pool & Equipment Location 2. Soil'Piip7jUndrgrnd. /�_fi ;'' 53. Steel Reinforcement 3- Slecqwrlcai Condult� ility-Undrgrnd j 54. Forms E 4!Electncal Conduit Undrgrnd. Vi 55. Electrical Bonding 'i ir{ 5. St e1rRej4'iforcem89k_ 56. Rough Plumbing & Pressure Test _61ectr.ic2 U F E rnd. 57. APPROVAL TO COVER-GUNITE � 7,;,W irigsa ^ � �' y 5B. Electrical Conduit-Undrgrnd. 8!=oundasion �vt �- 59. Gas Pipe, ❑ Undrgrnd., Test 0WaierjPipe Unci grind? y60. Backwash Lines, P -Trap, ❑ Undrgrnd., 10:,,�^c ural Floor System 61. APPROVAL TO DECK 11. PropertvSewer Line & House C6h Iction 62. Backwash & Receptor -Final r. � 12. Sewer`Cap W/7 L t 63. Heater & Vent -Final 13. Roo�r`ains �� A") 64. Plumbing System - Final -• 14. R5' gWP.rumbing� 6/ 65. Electrical -Final {� 15. Rough'Electricarl1Conduit 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 E 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑Gas DOil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank IDGas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75, Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36., Hood or Canopy 37� Final Factory Fireplace 38. Final Plumbing 039. Water Service -Final ~40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preventer �� P 43. Backflow Irrigation '-5-js7 %,&'-) 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 CO Applicant's Owner's Nor Address JJ RMIT Applicant to fill In all spaces except those within he yy border lines and sign all appropriate declarations. Arch/Eng. _ License No. Address w Contractor's Nam % >Q Phone Address (mailing) City License No. IF LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of 'Division 3 of the Business and Professions Code, and my license is in f for a d effect. Llcens Cl— License No.. O Date Signatur ' WORKERS' COM ENSP: TiaN LARA71pN '.hereby affirm that I have a cert tate of consent to self -Insure or a certificate ( Workers' Compensation -insurance, or a certified copy thereof (Section .800, Lab. C.) Policy No. Company BCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissecfion need not be completed If the permit Is for one hundred ($100) or less). I certify that In the performance of the work for which this permit is issued, I shall not employ any pergori in any ner so as to become subject to the Workerr,,� C lsat)p��Laws Of Call or a.' Date Ls " Xrr�--T Q _"Signature NOTICE: If, after making this tleclar on, you should become subject to the Workers' Compensation provisions the Labor Code; you must forthwith comply with such provisions or this permit - shall be deemed revoked. CONSTRUCTION- LENDING AGENCY I hereby affirm that there It a construction lending agency for the performance of the work for which this permit Is Issued .(Section 3097 Cly. 'C.) Londer's Name - - - Lender's Address - OWNER BUILDER DECLARATION I hereby affirm'•that I am exempt from Ina Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or County which requires a permit to Construct, alter, improve, demolish or repair any Structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 h031.5 by any applicant for a permit subjects -the applicant to a civil penalty of not more than live hundred dollars ($500). I, as owner of the property or my erihpioyees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who build$ Or Improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. if, however, the building or Improvement is Sold within one year of com - pldtlon, the owner will have the burden -of proving he/she did not build or im- rove forr the purpose of s4te), 1, as owner of the property, am exclusively contracting with licensed COM- . 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 builds or Improves i therepn, and _who contracts for such projects with a con- traCtor(s) 1lcense pursuant'to'tha Contractor's License Law). I am aware that proof o1 their Worker's Compensation insurance should be provided to me. I] i am exempt under Section B. s!, P. C. for this reason Date Owner I hereby certify that information Is correct. and state laws relating sentatives of t s cit inspection se$. Signature Drivers' LI nse or SS CMF 0865-46, rev. 10/84 I have read this application and state that the above Iagree to comply with all city and County ordinances to building construction, and hereby authorize repre- to enter upon the above-mentioned rope ly for •rCi'1?A��/�� Dat PERMIT O, �J ?a TRACT NO. LOT NO. UNIT NO. / 5906 7/02/65 10. 50 TI TYPE OF CONSTRUCTION NEW LJ ADD LJ ALTERATION M ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. REPAIR A.P. Zone S Main Building: Accessory Building: TYPE OF PERMIT D GRADING 0 FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRVCT(ON TYPE _ VALUATION $ ZONE GRADING CU. YDS. —'ACRES E T Front Z O B A Rear N I C Right N K S - Left G R Ping, Ref. + Parking Req./Provided E Remarks: Planning Notes: _ M, / T S PLUMBING FEES, ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink _ Q _ Automatic Washer Construction Pole'Sub- Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors _ Dishwasher- Meter ❑oyer 100 amps Dishwasher Solar Piping 137yers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0.1 HP 01'A - 8 Floor Drains Swimming Pool w/Spa F,A,U. Inc•Solar 09.15 HP 01&15+ Floor Sinks Gas Service Outlets Urinal Water Closet? 6 Fixtures Device Boxes Microwave Pole Light Interceptors Kitchen Sink Water Heater Water Service , Z Q Outlets •� Switches Range Sign Lavatories ,. Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays . Generator ❑0-5 KW ❑5.15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 I Issue Fee J6 $ 3 Boiler Duct - Under Ground MECHANICAL Hood or Type I ❑ Canopy ' Type I I ❑ FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By . Application Issued By Date Data Date Duct - Structural Refrigeration System ❑0.100,000 BTU ❑100,000 BTU Duct - Ventilating SUMMARY BUILDING PERMIT $ PLAN CHECK $ !/. PLUMBING $ Q PLAN CHECK 25% $ /• ELECTRICAL S PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ OF FEES SMIP $ PERMIT •O Q __ ISSUANCE $ SZi ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact, Bit. ICBO # Fire Dampers Heating System &Ducting ❑0100,DOOBTU ❑100,OOOBT Registers Reinspection Fee $15 Issue Fee $ 3 cant; Pink - Accounting; Goldenrod - Assessor EK7�,_� '*' , I O.NSTRUCTION AND PLANNING PROVALS Permit # r.. Date Inspector POOH SPA APPROVALS Permit # Date Insppr-toi TempoX.y Electrical Service or Pole asd 52. Pool & Equipment Location Soil'RipefUndrgrnd. �t f} w' 53. :Steel* Reinforcement . .' €lectr;cal'Conduit l'�tikity•Undrgrnd?)l1 .� r S+� 54. Forms {� f j Iectrica1 Conduit Uddrgrnd, f� 55. Electrical Bonding , 5fSt'eel Rein forcer enA 56. Rough Plumbing & Pressure Test �� r /i 6• Electrical UFEeG,nd.y. , 57. APPROVAL TO COVER-GUNITE +� 7.�Foofin,9s r� % i -F{ 58. Electrical Conduit-Undrgrnd. S, Foundation �+ i `ii 59. Gas Pipe, 0 Undrgrnd., Test r ;� 9.�Wter`Pipe-Ur'jdr9'r'hd0j Y� ;, 60. Backwash Lines, P -Trap, 0 Undrgrnd. iry 1l]!Structlural Floor System � ll 61. APPROVAL TO DECK 11. Proper`t� Sewer Line &House Co^nGction ; 62. Backwash & Receptor -Final 12. Sewer Cap a,�' y f 63. Heater & Vent -Final 13. Roof Drains "t P 1 64. Plumbing System - Final 14. Rou h` I'umbin � 9 .P 9_1 65. Electrical -Final ;v 15..Ro697E1ectricdI Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Hough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT y . APPROVALS Permit # 20. Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas D Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank D Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: - 34• Final Heating & Air Conditioning _ 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory'Fireplace 38, Final Plumbing P 7 CIE/) t:T.Water Service -Final 40. Gas Service -Final ,, 41. Solar Domestic -Final A 42. Backflow Preventer GZA 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 Nn. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT N TRACT NO LOT NO- GIT.Y OF COSTA MESA CONSTRUCTION PERMIT SUMMARY OF FEES BUILDING PERMIT uN1T �' SMIP .Project Address 4y. �� L•.. ��Tf� iJ�G 5 $ License Class �� I - Lice ns fYo. pate Signature _ a•� FEES ,.,sem Applicant's Mailing Address , —= TYPE OFCONSTRUCT(ON' NEW ADD DAI TERATION REPAIR" TYPE ❑ CONVERSION ❑DEMOLISH 1:1 OTHER , ' ELECTRICAL _ Owner's Name VR,,)Y .- 11�F,LT� Phone DESCRIPTION OF WORKIUSE OF BLDG. A P. Address Backflow Irrigation Sewer Cap r S Main Building: t Clarifiers Solar Collectors - Dishwasher Solar Piping ArchlEng. License No. TYPE OF PERMIT GRA DING�I FOUNDATION STRUCTURAL T Front Workers' Compensation Laws of California. " ❑ TENANT ❑ELECTRICAL ❑ PLUMBING ❑MECHANICAL B Address ry ��977-Lp7� Nam {�� S L�.t�L�Phone � L �5� ❑ OTHER A Rear - Contractor's e� l�i�, _ e. _ , �' PROJECT DESCRIPTION SQ. FT, OCCUPANCY C K Right Address (mailing) CONSTRUCTION TYPE VALUATION $ S; Left 33 �� City License No. — - ZONE GRADING CU. YDS. ACRES ' Ping. Ref. 5 LICEIJSED CONTRACTOR DECLARATION t-ender's Address OWNER, BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code. Any ttty or County which requires a permit to construct, alter, improve, demolishlor repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she i5 licensed pursuant to tne'provisions of 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 "erelrom and the basis for the alleged exemption: Any violation of Section 31,5 by any, applicant for a permit subjects the applicant to a civil nalty of not more than five hundred_ dollars ($500). LJ i, as owner of the property or my employees With wages as their sole compensation', will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The, Contractor's License Law does not apply to an owner of a property who buittls or improves k himself/herself or throe h his or her own I hereby affirm that I am licensed under pr islon5 pf Charter (commencing Remarks: Planning Notes: with section 7000) of Division 3 of the us ess and Pro fe ns Code, and r g SUMMARY OF FEES BUILDING PERMIT my license is In full f cg an�effect SMIP PLAN CHECK $ License Class �� I - Lice ns fYo. pate Signature _ PLUMBING FEES WORKERS' COMPENSATION DECLARATION I hereby affirm that i have a certificate of consent to self -Insure or a certificate Bar SinkShOwerS , ' ELECTRICAL +. workers' Compensation Insurance,+or a certified copy thereof (Section i00, Lab,,C.i r�100' No. WGA �O 3 Compan L--e� ❑ Certified copy is hereby furnished. p Cert[fiedc�opy - f" etl with ih city uildl g Tn. pate )—( yr Applicant FXEMPT.ION FROM WORKERS' COMPENSATION O CLARATION (This section need -not be completed if the permit Is for one hundred ($100) or less). 1 certify that In the performance of the work for which this permit is issued, I ' shalR not employ any person in any manner so as to become subject to the .. Backflow PMenter - - -- Service Sink - - - Backflow Irrigation Sewer Cap r MECHANICAL , Bathtubs ( Sewer Connection t Clarifiers Solar Collectors - Dishwasher Solar Piping Drinking Fountains Solar Tank Workers' Compensation Laws of California. " Floor Drains ! Swimming Pont val'Spa i Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers', Compensation provisions of the Labor Code, ynu must forthwith comply with', such provisions or this permit shall be deemed revoked, Floor Sinks Urinal - Gas Service- Outlets Water Closet CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ, C.) _ Interceptors - Water Heater ' L-ender's Name Kitchen Sink, Water Service t-ender's Address OWNER, BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code. Any ttty or County which requires a permit to construct, alter, improve, demolishlor repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she i5 licensed pursuant to tne'provisions of 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 "erelrom and the basis for the alleged exemption: Any violation of Section 31,5 by any, applicant for a permit subjects the applicant to a civil nalty of not more than five hundred_ dollars ($500). LJ i, as owner of the property or my employees With wages as their sole compensation', will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The, Contractor's License Law does not apply to an owner of a property who buittls or improves k himself/herself or throe h his or her own Lavatories Auto -Wash ' P—Trap Laundry Trays Roof Drains - Reinspection Fee $15 - Issue Fee ". $ 3 MECHANICAL FEES thereon, and who does Such wo employees, provided that such,€mprovements are not intended or offered for 4ale. It, however, the building or improvement is sold within one year of Com - i plat€on, the owner will have the burden of proving he/she did not build or im- rbve for the purpose of Sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the proiect(Section 7044, Business and professions Code: The Contractor's License Law docs not apply to an owner of property who guilds 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 proof of their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section . B. & P. C. for this reason pate Owner I hereby certify that l have read this information is correct. agree to c mpl and State la re building cons sentatives tis - y enter Pon inspection u gignature Drivers' License or SS =f rtion-.and state that the above aif city and county ordinances on, and hereby authorize repre- above-mentioned propertyfor %� Date 1—f O• Boiler - Duct - Under Ground Duct - Structurat Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO * Heating System & Ducting 00-1 00,000BTU-❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System 00.100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 Automatic Washer 5912 1/16/85 1.1-ne Accessory Building: Parking Req -/Provided : ELECTRICAL 4 i Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW Cooking Unit Dishwasher Dryers ❑Gas +❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW El 5-15 KW Reinspection Fee $15 be 50 TL Z O N I N G R E Q M T S Meter ❑up to•100 amps' Meter ❑Over 100 amps ' Sub Panel 1 Motors0.1 HP ❑ 1% - B Inc, Solar 09-15 HP Ell &15+ Microwave ` Pole Light -Range Sign, ! Standing Sections Trash Compactor Issue Fee . DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Det PLAN CHECK 25% $ $ 3 SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.0 ELECTRICAL 5 D GRADING PLAN CHECK 50% ;$ MICROFILM MECHANICAL S TOTAL FEE PLAN CHECK 25% $ $ 3 [ 4 1 CONSTRUCTION AND PLANNING ' APPROVALS Permit # Date Inspector POO, ,PA APPROVALS Permit # Date InspPctor 1, Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrr+d. 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 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & Nouse 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 -7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. 8ackffow 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 _ r CIN Applicant to fill in all spaces except those Within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT Mn U(�jT�O ProleccAddress 71 t w- l7rh St_, Bldg M Unit 2 �JT2- Applicant's Mailing Address 13110 Saticoy St. N.H011yWOOd, TYPE OF CONSTRUCTION NEW I I ADD ALTERATION REPAIR Owner's Name Trny Investment Fund Phone 549 2988 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A. P. 906 Address _4321 Birch 5t. Newport Beach, Ca. DESCRIPTION OF WORK/USE OF BLDG. ^T s Main Building: Arch/Er*arin ,1 . ROCK _ License No. TYPE OF PERMIT C1 GRADING C1 FOUNDATION STRUCTURAL T Front Address 12881 Knott Ave. Suite 216 ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 1:4MECHANICAL A Rear Contractor's Name Duco Air Conditioning hone 982 1216 ❑OTHER PROJECT DESCRIPTION SCI. FT. OCCUPANCY C Right Address (mailing) 1311() Saticoy 5t. N.Hollywood, Ca. K CONSTRUCTION TYPE VALUATIONS g I Left City License No: 39925 ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION Ping. Ref. I hereby affirm that I am licensed under provisions of Charler 9 (commencing Remarks: Planning Notes: with section 7000) of Division 3 of the Business and P I slons Code, and my license is in full force and effect, License Class E4 0 �4"�].2.r]l� DateSignature WORKERS' COMPENSATION DEC RATION I hereby affirm that I have a certific of consent to self -insure or a certificate f Workers' Compensation Insuran e, or a certified copy thereof (Section 800. Lab. C.) WC9824 Llmlbermans Policy No. Company ® Certified copy is hereby furnished. Dateertifie�!! Ipy is filed with the CityBuilBuilg1 9 Divis an EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less), I cert ify'that in the performance of the work for which this permit Is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's LICOnse Law for the following.reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisionsof the Contractor's Licanse Law (Chapter 9 (commencing with Section 7000) of DivIslon 3 of the Business and Professions Code) or that he/she Is exempt 'herefr0m and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). EJ I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the Structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work hlmself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. I1, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- rove for the purpose of sale). ' I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon_ , and who contracts for such projects with a con. tractof(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided tome, ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have rea- information is correct. I agree and statqii relating [o bu i sentativethis city t0 t inspectioposes. Signatur Drivers' e or SS -W I PLUMBING I FEES I I this application and state that the above 1 comply with all city and county ordinances g construction, and hereby authorize repre- upon the above-mentlonod property for ` Date -� Bar Sink Backfiow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Interceptors Kitchen Sink Lavatories P --Trap Roof Drains Reinspection Fee 0 $15 Boiler Duct • Under. Ground Duct - Structural Duct - Ventilating , Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO ck Heating System & Ducting 250.100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 IF 0865-46, ev. 10/84 White - Builciing; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type ❑ Canopy Typell ❑ Refrigeration System 00.100,000BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan 2299 5/03/25 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW _k_� ❑ 50+KW F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW ❑5.15 KW Meter Llup to 100 amps Meter Dover 100 amps Sub Panel Motors 00-1 HP 01 'A - B Inc. Solar 09-15 HP 016.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 15.50 TL FEES Z 0 N I N G R E O M T S 5 3 Reinspection Fee $15 1 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Date Dat Z BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES 5 5 $ $ $ S S 11.00 $ _ _'7 4r) SMTP $ PERMIT ISSUANCE S ENERGY P.C. $ GRADING 5 MICROFILM 5 TOTAL FEE $ 15 6 OC 41 ON 5 3 CQNSTRUCTION AND PLANNING ` APPROVALS . Permit # Date Inspector POO, SPA APPROVALS Permit # Date Insperrnr 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location r' 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 7 3• Electrical Conduit Utility-Undrgrnd. 54. Forms ; 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test t 6• Electrical UFER Grnd.-• 57. APPROVAL TO COVE R-GUNITE ; 7• Footings 58. Electrical Conduit-Undrgrnd. 8' Foundation , 59. Gas Pipe, ❑ Undrgrnd., Test 9• Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. i 10. Structural Floor System '; r 61. APPROVAL TO DECK 11. Property Sewer Line & House Conriectign 62. Backwash & Receptor -Final 12. Sewer Cap j 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing 65. Electrical -Fina! 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 APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72, Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 r �! c9 i ZI-2211 124,9W 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38, Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE.OF OCCUPANCY No. Date r Applicant to fill In all spaces except those within heavy, border lines and sign all appropriate declarations. CITY OF C STA MESA CONSTR.UMON PrERMIT Applicant's Maili2SAcldress Owner's a e P Address Arch/Eng., License No. Address Contractor's Na Phone Address (mailings 14 City License No. LICENSED CONTRACTORDECLARATION 1 hereby affirm that'd am licensed under provisions of Charter 9 (commencing with section,7000) cif Division 3 of the Business and Professions Code, and my license is in f rce d ffect. -17, Ucens Class — Llcense No Dale Signature WORKE5' O SATIONART10k . tiereby affirm that I have a certi aAle of consent to self -Insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section J00. Lab. C.) Policy No. t Company ' 8 Certified copy is hereby furnished. ' Certified copy is filed with the city Building Division. Date Applicant ' EXEMPTION FROM WORKERS"COMPENSATION DECLARATION (This sect Ion'need net be completed if the permit is for'one hundred ($100) or less): I certify.that'in the performance of the work for'whlch this permit is,issued, I shall not employ any person in any marl er s as to become subject to the Worker Co p sat n Laws of Califor 7 Date `� Signature NOTIC : lr,-altYr mrkhfg this declar you should become subject to the Workers' Compensation provisions of bOb Labor.Code, you must forthwith comply with. such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY' I hereby'afflrm that there is a'construction lending agency for the performance of the work for which this permit is issued, (Section .3097 Civ. C.) Lender's Name' Lender's Address OWNER BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prier 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 the Contractor's License Law (Chapter 9 (commencing with Section 7000);of- '"Hvision 3 of the; Business and Professions Code) or that he/she is exempt erefrom and the basis for the alleged exemption. Any violation of Section 131.5 by any applicant for a permit subjects the applicant to a civil enalty of -not more than five hundred dollars ($500). 0 I, asp owner of the, property'or my'employees with wages as their sole , compensation, will do the work, and the structure is not intended or offered for sale, (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, Ethe owner will have -the burden of proving he/she did not build or'im- ve for the purpose of sale). LU 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and who contracts for such projects with a con- tractor(s) license pursuarit'to the'Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason DateOwner I heretry certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city enter upon the above-mentionedroperty for inspection Signature V _I r�.�— Date Drivers' P MIT N TRACT NO. LOT NO. UNIT NO. ) 5907 ]/02/85 0oFJ0 TYPE OF CONSTRUCTION NEW ADD 0 ALTERATION El ❑ CONVERSIONS ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. REPAIR A. P. - Zone S Main Building: Accessory Building: T' TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 0 MECHANICAL ,❑ DTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ , ZONE GRADING CU.YDS. ACRES T Front O B AI Rear_ N C Right N' K S Left G R_ Ping, Ref. # Parking Req./Provided' E Remarks: Planning Notes: Q M T S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer - Service Sink Z Q Automatic Washer 'Construction Pale Sub.. - Transformer ❑ 15-50 KW � El 50+KW' Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit 'Meter ❑Up to 100 amps Clarifiers Solar Collectors } Dishwasher. _ ' Meter ❑oyer 100,amps Dishwasher Solar Solar Piping Dryers ❑Gas, ❑Electric Sub Panel Drinking Fountains Solar Tank Fari Motors 00-1 HP 011A -'B Floor Drains Swimming Pao! wlSpaF.A.U. Inc.Solar, ❑9-,15 HP 015.15+ Floor Sinks Urinal Fixtures Microwave Gas Service (,,Outlets Water Closet 0 (J Device Boxes Pole tight Interceptors- Water Heater Outlets Range Kitchen Sink Water Service Q() Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator ❑0-5 KW ❑ 5-15 KW Trash Compactor Roof Drains ` Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Approved By Date ' Building Approved By Date Application Issued By Boiler Hood or Type I El. Canopy ' Type I I E)Zoning Duct - Under Ground Duct - Structural Refrigeration System ❑4100,000 BTU 0100,000 BTU Duct - Ventilating SUMMARY BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50%- $ MECHANICAL SS PLAN CHECK 25% $ OF FEES SMIP $ PERMIT : :40 ISSUANCE $ J ENERGY P.C. $ GRADING $ MICROFILM $ $ �Q Exhaust System ❑ Multip!e ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers Heating System & Ducting ❑0-100,000BIT U El 100,000 BT Registers Reinspection Fee $15 Issue Fee $ 3 GMF 0865-46, rev. 10/84 ppliCant; Pink - Accounting; Goldenrod - Assessor 1 CONSTRUCTION AND PLANNING APPROVALS Permit # _ Date Inspector POG SPA APPROVALS Permit # Date Insparrnr J0 . ,Tempor'ary Electrical Service or Pole% fg 52. Pool & Equipment Location r 1 J 2, SoillPipf-Undrgrnd. .4 53. Steel Reinforcement 3yElectrical CondUi ,Utility-Undr`grnd�J t 54. Forms A" Qc'tjrnd. y 55. Electrical Bonding steel ,Reis forceni;e t psi 56. Rough Plumbing & Pressure Test 'L'l el .6• 'Electrical UFER'Grnd. r •i v i 57. APPROVAL TO COVER-GUNITE 7� 'ooiJngis t�7 •,.1 % 58. Electrical Conduit-Undrgrnd. ft elF66n%on I✓ f�'1 it 59. Gas Pipe, ❑ Undrgrnd., Test 9' Wate`r'' i�e-Undr rnd� P g� r rr 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 1.0. Structural Floor Sys em `) 61. APPROVAL TO DECK 1,1-!0P�pert)r'Sewer Line House Co� ection r; 62. Backwash & Receptor -Final J� 12. Sewer Cap ,.n -!r i 7 63. Heater & Vent -Final :A 13. RoofN �ns A ri } 64. Plumbing System Final 14.,!RQudh PI mbing�j 65. Electrical -Final yv 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure ` 70. Underground Hydro 22. Ducts, Ventilating 71 . Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 flailing 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 x.37. Final Factory Fireplace 38. Final Plumbing 39, Water Service -Final .S,--)- 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations _ I 47, FINAL STRUCTURE & BUILDING 48. Special. Requirements Completed , 49. Electric Release to Edison r 50. Gas Release to Southern California Gas Co l4 51. CERTIFICATE.OF OCCUPANCY No Date r 0 - t-• t Applicant CITY -OF COSTA MESA %I _, 1 Q T to III in all spaces except those within heavy border lines and sign all appropriate declarations. ' SUMMA�y RY , O FEES BUILDING PERMIT $ s/iSSMIP PLAN CHECK •' - $` PERMIT -PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.0 ELECTRICAL $ GRADING ` PLAN CHECK, 50% $ MICROFILM MECHANICAL ' $ TOTAL FEE o -PLAN CHECK, -e-25% $ PE MIT TRACT NO, LOT NO.. BLD. CONSTRUCTION PERMIT {I" - ] j. '?(;- s. 1 & 2 J ' Project Address Mailing Address , 2 d1 A C A3CA , TVPE OF CONSTRUCTION NEW ADD ALTERATIDN REPAIR CONVERSION ❑DEMOLISH ❑OTHER APq!Applicant's *2— Owner's Name � '�'>^ Qji TnyP_SttRP4t F.1,In hone 549-298 DESCRIPTION OF.WORK _) .Xtey—i r r A 1 t 1 a4tI nne S MainBuildin g: Address t Be Ch T B A C K $ TYPE OF PERMIT GRADING LJ FOUNDATION STRUCTURAL ❑ TENANT ❑'ELECTRICAL ❑PLUMBING ❑MECHANICAL ❑ ,OTHER PROJECT DESCRIPTION SQ. FT, OCCUPANCY R – 2 _ CONSTRUCTION TYPE VALUATION $ d'2 r 9 C�'1,_2a_ ZONE GRADING CU. YDS. ACRES Front Arch/Eng. WM- L- Pereira ASSOticenseNo. Address dg-1—mar Contractor's Nam hone Address (mailingl City License No. Rear Right Left Ping. Ref. Z� Remarks: P • C - #20-84S Parking Req./Provided LICENSED CONTRACTOR DEC ARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and Use of Building: my license is In full force and effect. License Class License No. PLUMBING FEES Planning Notes: Date Signature WORKERS' COMPENSATION DECLARATION ' I hereby affirm that I have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab, C.) olicy No. 524200016P Company Arg�j�iAttt Certified copy Is hereby furnished. Certified copy Is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit is for one hundred ($100) or less). I certify that In the performance of the workfor whlc this permlt is issued I shall not employ any person In any anner so as t become subject to tke Work: p satlon Laws of Calif nla, Date Signature NOTI : If,, fter making this declar ti n, you should become subject to the Workers' Compensation provisions the Labor Code, you must forthwith, comply with such provisions or his permit shall be deemed revoked CONSTRUCTION LENDING AGENCY I hereby affirm that there is a'constructlon lending agency for the performance of the work for, which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its Issuance,'also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 apnalty of not more than five hundred dollars ($500). as owner of the property or my employees with wages as their sole y`npensatlon will do the work, and the structure, Is not intended or offered r sale (Secilon 7044• Business and Professional Code:, The Contractor's 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 employees, provided that such Improve men t5 are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- , KXrove for the purpose of sale). 1 I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner Ihereby Certify that F have reatl Is application and state that the above Information Is correct. I agree to comply with all City and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to ant r, upon the above-mentioned Pr pert for Inspection pu oses. �/ Signature ftr Date Drivers' Llce .,.SS Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service outlets Interceptors Kitchen Sink Lavatories P–Trap Roof Drains Reinspection Fee $25 Boiler . ' . I ' Duct - Under Ground Duct - Structural Duct -Ventilating , Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG •# Heating,System & Ducting 00-100,000 BTU ID 100,000 BT Reinspection Fee $25 CMF 0865-46 rev. 12/83 White - Building; Canary - Applicant: Pink - Accounting, Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool'vi/Spa Urinal Water Closet Water Heater Water Service issue Fee IANICAL Hood or Type I ❑ Canopy Type I1 ❑ Refrigeration System (DO-100,00019TU ❑100,000 BTU System Repair/Alteration Issue Fee 0112 5/10/B4 -D3. l7 oS, DtoI Zone Accessory Building: Park. Fees $ ELECTRICAL Automatic Washer Construction Pole Sub, Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan f F.A.U. 'Fixtures Device Boxes ' Outlets Switches ' Garbage Disposal , Generator 00�5 KW El 5-15 KW Transformer 254.51Ti Z O N I N G R E Q U I R E - E N T S FEES ❑ 15-50 KW ❑ 50+KW Meter I..-jup to 100 amps Meter Dover 100 amps Sub Panel Motors 00.1 HP 01 'A - 8 Inc,Solar ❑9-15 HP ❑16-15+ Microwave Pole Light Range Standing Sections Trash Compactor FEES Reinspection fee/' $26 Issue'Fee ` $ 3 PUBLIC'SERVICES REQUIREMENTS: Zoning Approved BY FCC- Date 3- 22_77– Building'Approved $y Y Date $ ' SUMMA�y RY , O FEES BUILDING PERMIT $ s/iSSMIP PLAN CHECK •' - $` PERMIT -PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.0 ELECTRICAL $ GRADING ` PLAN CHECK, 50% $ MICROFILM MECHANICAL ' $ TOTAL FEE o -PLAN CHECK, -e-25% $ ' $ 3 $ -CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector r POOL & SP -, APPROVALS - Permit # Date Inspector. 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location . 2. Soil Pipe-Undrgrnd, 53.' Steel Reinforcement J _ %• _ 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, ❑-Uridrgrnd., Test ' -,9. Water Pipe-Undrgrnd. '60. Backwash Lines, P -Trap, O Undrgrnd, ` 10. Structural Floor System 61. APPROVAL TO DECK ;-11. Property Sewer Line & House Connection `' 62. Backwash & Receptor -Final ". 4 .12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains n 64. Plumbing System -Final - ; 14. Rough Plumbing r 65. Electrical -Final ` 15. 'Rough Electrical -Conduit 66., Solar System-Fin"al , 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= APPROVALS , Permit # ' 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro - ` r 22. Ducts, Ventilating 71.- Product Piping 1] Gas,.,o Oil 23., Gas Pipe -Rough & Test 72, Underground Flush 24.i Roof Framing 73. Undergrnd. Storage Tank O Gas7.l] Oil 2bWoof Sheathing _ 74. Overhead Hydro 1 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ' r 27. Frame and Flashing �J S5r 76. Dry Standpipe , 28. !_aching &Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL c 30. Drywall Nailing HEALTH DEPT. REQUIREMENT , 31. Plaster Brown Coat S1I� $% C?S, 0 79, FINAL INSPECT?ON 32. Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED ' 33. Final Electric Notes: a 34. Final'Heating &,Air Conditioning ± + 35. Final Gas Pipe -Test s 36. Hood,'or Canopy 37. Fina(Factory"Fireplace ' A •B 3B. Pinal:Plumbing" 3 r ' 39. Water. Service -Final. 40. Gas Service -Final 41. Solar "156mestic-Final 42. Backflow Preventer ' 43. Backflow.Irrigation-f 44, .Landscape irrigation -System , 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 2,1049. Electric Release to Edison t y T• ' ' l { 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date t _ - Applicant to fill in ail spaces except those within heavy border lines and sign all appropriate declarations. 23N 5/03/65 15.--.0 , CITY OF COSTA MASA CONSTRUCTION PERMIT PERMIT NO. r7 _79_) TRACT NO. LOT NO, UNIT NO, Project Address 711 W. 17th S; BL•d . {,T} Unit / } � Applicant's M$ilingAddress 13110 Saticoy St. N.Hollywoo Owner's Name Troy Investment Fund _Phone 549-298 Address 4391 Birch St. ,Newport Beach, Ca. Arch/Eng. gi ll .l . KQQ.K - License No. AddressSuite 216 Contractor's Name Duco Air CQnditioninhone 982-1216 Address (mailing) Ho OOd Ca. City License No, 33925 LICENSED CgNTRACTOR DECLARATION I hereby afflrrh that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business Professions Code, and my license` is in full faCrce aqA effec 346251 License Class GU en No. Date 411S/84 Signature WORKERS' COMPENSATION DETC.A.RATION hereby affirrrl that I have a certifif consent to Self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section - loo, Lab, k9824 Lumbermans Policy No. Company BCertified copy is hereby furnished. Certified 4py is filed with the city Buildigg,Division. Date.) Applicant l_.i<'Cl EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that In the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, alter making this declaration, you should become subject to the Workers'Compensation provisions of the Labor Code, you must forthwith comply +with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there IS a construction lending agency for the performance' ofthe work for which this permit Is issued (Section 3097 Civ. C.) Lon der 's Name - Lender's Address_ OWNER BUILDER DECLARATION + I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/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 erefrom anti the basis for the alleged exemption. Any violation of Section J31.5 by any applicant ' for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). r] . 1, as owner of the property or my employee$- with wages as their sale compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or,im- prove for the -purpose of sale). ' ❑ I, as Ownr:r of the property, am exclusively contracting with licensed Con- 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 builds or imbroves thereon, and who contracts -for such projects with a con- tractor(S) license pursuant'to the Contractor'i License Law). I am aware that proof of their Worker's Compensation insurance should be provldod to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above Information is correct, I agree Comply with all city and county ordinances and state la s relating lob ng construction, and hereby authorize repre- sentatives this city to"r- r' upon the above-mentioned property for inspection ur oses, l` /-43 17 Signature Date : + *- Dri TYPE OF CONSTRUCTION LJ NEW LJ ADD L—I'ALTERATION .LJ REPAIR s CONVERSION ❑ DEMOLISH ❑ OTHER A. P. # Zone DESCRIPTION OF WORK/USE OF BLDG. - Dishwasher Meter ❑over 100amps 5 Main Building: Accessory Building: - Fan Motors ❑0-1 HP ❑ 1 K - 8 F.A.U. Inc. Solar 09-15 HP 0116-15+ Fixtures. Microwave $ 3 Device Boxes Pole Light Outlets Range DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By Switches Sign Garbage Disposal ; Standing Sections 1 TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front 0 ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ®MECHANICAL B N ❑ OTHER A Rear I $ 3 C Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY G CONSTRUCTION TYPE VALUATION $ g Left R ZONE GRADING CU. YDS. —4ACRES Ping. Ref. Parking Raq./provided _ E Q Remarks: Planning Notes: M T S Bar Sink Backflow Preventer Backflow Irrigation Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P --Trap Roof Drains Reinspection .Fee Bailer PLUMBING Showers Service Sink Sewer Cap' Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal _ Water Closet Water Heater Water Service Auto -Wash Laundry Trays $15 Issue Fee Duct'; Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO =# Heating System & Ducting 1. X30-100,000 BTU ❑ 100,000 BT i ' Reinspection Fee $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type 1 ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU ❑100,000 BT System Repair/Alteration Fire Dampers Registers Issue Fee FEES ELECTRICAL FEES Automatic Washer .Transformer ❑ 15-50 KW - Construction Pale Sub, ❑ 50 + KW $ 3 Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100amps Dryers ❑Gas ❑Electric Sub Panel Reinspection Fee Fan Motors ❑0-1 HP ❑ 1 K - 8 F.A.U. Inc. Solar 09-15 HP 0116-15+ Fixtures. Microwave $ 3 Device Boxes Pole Light Outlets Range DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By Switches Sign Garbage Disposal ; Standing Sections 1 Generator ❑0-5 KW ❑5-15 KW Trash Compactor $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: 1 Date Date Dat S 2� BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ $ $ 13-00 $ 2.50 SMTP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTALFEE $ 15.50 $ 3 CONSTRUCTION AND PLANNING Date APPROVALS Permit # Inspector POC , SPA 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 r . 6. Electrical LIFER Grnd. ? - 57. APPROVAL TO COVER-GUNITE 7, Footings 58. Electrical Conduit-Undrgrnd. 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9, Water Pipe-Undrgrnd. { 60. Backwash Lines, P -Trap, ❑ Undrgrnd, + 10, Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Conr�e ction 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 APPROVALS Permit # 20, Rough Factory Fireplace 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 ❑ 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 T 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning Z1� s5 l 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42, Backflow Preveriter 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.O00UPANCY Nn. Date (Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. �I CITY OF COSTA MESA CONSTRUCTION PERMIT ' PERMIT N = TRACT NO. LO7 NO. UNI�V6, �" �7 � Project AddressA / �(J J { {s: _ 3663 12/07/BI4 In res Applicant's Mailing Address �'C' N-/ - TYPE OF CONST RUCTION ❑ CONVERSION ❑ DEMOLISH NEW ADD ALTERATION REPAIR ❑ OTHER A.P. E Zone i p Owner's Name Phone' 4 ; DESCRIPTION OF WORK/USE OF BLDG. -' ;- iS Main Building: Accessory Building: Address C Arch1Eng `) License,No.,, Z - TYPE OF PERMIT_ GRADING � FOUNDATIO�;�Nrr 'STRUCTURAL T. Front II n I, r0 Address 4d �� `' 0i? ❑TENANT ❑ ELECTRICAL ❑PLUMBING 9'-MECHANICAL, I B Rear "' - - .. iN Contractor's Nam hone0 ''z �< ❑ 'OTHER C'- Right N ` - �% oy /U• PROJECT DESCRIPTION ' Sq. FT. OCCUPANCY K . G 1 Address (mailingl _r _ Wig' Z S CON STRUCTION TYPE 1 VALUATION $ S Left j R City License No. _ ZONE GRADING CU.YDS. ACRES Ping, Ref. # Parking F1eq,IProvided _ ,E LICENSED CONTRACTOR DECLARATION = 1 I hereby affirm that I'am licensed under provisions of Charter-.9 (commencing Remarks: I { .Planning Notes: with section 7000) of Division 3 'of the Business and; Professions Code, and my license is in full orc nU effe (i� j �` j } ; I -: j S License CI s is aeo I� , Date/ signature " PLUMBING r ; i FEES i WORK RS' OMPENSATION O LA RATION, Bar Sink Showers ,, ELECTRICAL I FEES hereby affirm that I have a certif to of consent to self-insure or a certlflcate 1 ' Workers' Compen%ation Insurance,_or a certified copy thereof (Section, _ - -- Backflow Preventee w Service Sink Automatic Washer .. Transformer ❑ 15-50 KW' ` 340, lab. ❑ 50 + KW Policy No. Company�r,��✓//�a r —�.r— Backflow lrri ation 9 Sewer Cap ! Construction Pole Sub. BCertified CC')P§ is hereby urnished, ' Certified copy is filed with:the city Builds ivl tori. Bathtubs y r Sewer Connection' i ) , Cooking Unit Meter ❑up to 100 amps , Date �� Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers Solar Collectors ' Dishwasher _ _' _ _ _Meter Dover _1.00 amps (This section need not be'completed if the permit Is for one hundred ($100) or Dishwasher Solar Piping Dryers ❑Gas 'L ]Electric Sub Panel lless). ess)' 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 tl�e Drinking Fountains ' Solar Tank Fan -+ _ Motors El 0- 1 HP 01 h i3 Workers' Compensation _laws'of California. Date _Signature Floor drains I ) Swimming Pool w/Spa F,A,U. ' Inc. Solar E19-15 HP L11 6-15+ : •NOTICE:'If, after making this declaration, you should become subject to the 'Workers_'Compensation -provisions of.theLabor Code, you-must forthwith__. .• Floor Sinks - - --- Urinal - - -j-- - -Fixtures- - --" '--'- r Microwave comply with such' provisions or this permit shall be deemed revoked. LANDING AGENCY ' Gas - CONSTRUCTION I hereby affirrri that there is a construction lendJng1agency for the performance, Service Outlets {` • l Water Closet ' Device Boxes i Pole Light of the worki for � Which this ,permit is Issued (Section _3097 Civ.. C.) y interce tors' i - ._ Water.Heater. Outlets r Range Lender's Name"p Lender.'s Address'- --- _ Kitchen Sink ` ' Water Service r Switches f r Sign - ' OWNERBUILDERQECLARATION- ' 1 hereby affirm that l am exempt'ifrom the Contractor's�License Law for the. Lavatories - „^ Auto-Wash I -� Garbage Disposal ' Standing Sections following reason (WtIon 7031',5 Business'.and Professional Code: Any city or - r county which;reouir@S a permit to construct, alter, Improve, demolish or repair P-Tia p - I Laundr Tra 5 _ y y ) Generator ❑0 5 KW ❑5 15 lCw Trash Compactor any structure; prior to its'issuance, also requires the applicant for such permit is licensed to the of - ! to file a signed statement that he/she, pursuant provisions Roof'Drains '•� - , the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3.0f the Business and Professions Cade) or'that he/she-.'is exempt - - ' herefrom and the'basis for the alleged exemption.'Any violation ,of Section 1' _^ { ,. l 031.5 by..,any applicant for a .permit-subjects, the applicant -to a civil penalty of not' more than five hundred dollars ($500). , ; ' I LJ I, as owner of, the or`my employees^,with wages as their. sole • Reins ction Fee pe r $15 z l t Issue Fee , "• $, 3` r I y i' ; .property • compensation, will 'do the work•, and the structure is not intended or,offered for sale l(Section 7444; Business -and Professional Code: .The !Contractor's' - FEES; I Reinspection Fee $15 Issue Fee , $ 3' ' t _� , _ :_+ MECHANICAL: License law does not apply to an owner of a property who builds or improves thereon, and who does' work himself/herself or through his or her own Boiler '� - Hood,or Type I ❑ ` DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for El, , Zoning Approved By ' Date f sale, If, however, th@ building or improvement Is sold within one year of Com-'Canopy pletion, the owner will have the burden of proving he/she did not build or im- Duct - Under Ground; Type I I i Building Approved By Date r Eye for the purpos@ of sale). I, as owner of the property, am exclusively contracting with Ilcensed con- (Section 7044, Business and Professions Code: Duct - Structural Refrigeration System - '= Application Issued By__ + pat - ■' • tractors to construct the project The Contractor's Litense Law does not apply to an owner of property who = Duct Ventilating ❑0-100,000 BTU ❑100,0_00 B;1 U ) SUMMARY OF FEES I builds of improves thereon,'and•who contracts for such' projects with a'con-- tractor(s) license pursuant-to the License Law I am aware that = ) Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT '$ ? SMIP . I, !$ 1 I proof o their worker's Compensation' insurance should be provided to me. f PLAN CHECK $ PERMIT 1 i C1 I am exempt und6r Sectiori Bi & P. C. for this reason Firepl/Fact. Bit. ICBO Fire Dampers J ; ISSUANCE $ PLUMBING i$ I$ Date Owner •have. Heating System & Ducting Registers PLAN CHECK 2596 �$ ENERGY P.C. 1- hereby `cert7fy• that I read, th;s'appJlcation -and state that the above �} 19(?-100,000$TU ❑ 100, 000 BT � , ELECTRICAL $ GRADING'$ r Information is corregt, 1•agree to comply with al1'city'and county ordinances and state laws relating to buiId,ng struction, and hereby authorize repre- !I i I ( PLAN CHECK 5006 $ � ; i I MICROFILM $ sentatives his cit to enter p n the above-mentioned prop ty for inspection ur )ses; y ��1 l MECHANICAL { $ Signature ie, []ate�1 I I I Reinspettion Fee $15 Issue Fee � $ 3 ( PLAN CHECK 25% $ TOTAL FEE$ Drivers' L•Ice a or SS r - l � } CMF 0865-46, rev, 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND:PLANNfNG APPROVALS Permit # 7DateInspector POOL - SPA APPROVALS Permit # • " Date-.- .., Inspector 1 •'Temporaiy.Electrical Service or.Pole 1 52. Pool & Equipment Location 2. Soil Pipe-Urldr6rnd. 53. Steel Reinforcement 3::Elec1trical,C6nduit Utility.Undrgrnd. 54. Forms $ 4. Electrical;Conduit'Undrgrnd, ti 55. Electrical Bonding 5.,Steel Reinforcement . 56. Rough Plumbing & Pressure Test _ •' ' 6• Electrical Ul ER,Grnd, 57. APPROVALTOCOVER-GUNITE 7. Footings 58. Electrical.Conduit-Undrgrnd. - l 8- Founc4ation. r 59. Gas Pipe, ❑ Undrgrnd:,-Test 9.- Water,Pipe-Undrgrnd. .60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System _. 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Fina4 12. Sewer -Cap y 63: Heater &Vent Final 13, Roof Drains ; ? 64. Plumbing System - Final 14. Rough' Plumbing' 65. Electrical -Final 15. Rough Electrical-Conduif' _ 66. Solar System -Final ^ 16. Rough Electric Wiring; 67. Fencing & Access Approval 17. -Rough Wiring Sign' 68. APPROVED FOR PLASTERING 18. Rough Eler,-trical-T Bar Ceiling 69. POOL/SPA SYSTEMS.FINAL . 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 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 ❑ 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: 4' 34. Final Heating & Air Conditioning 35. Final Gas Pipe=Test 36. Hood or Canopy : 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Hand icap'Regulations , 47. FINAL STPUCTURE & BUILDING 48. Special Requirements Completed' 49. Electric Release to Edison I c 50. Gas Release to Southern California Gas Co 51. CERTIFICATE_OF'OCCUPANC_Y No. Date - _ 1 1 Cl*rOf COSTA MESA CONSTRUCTION PERMIT'S''' Project Address 7& w. l f14 S)-.. ins, � tj t%c zA Applicant's Mailing Address 5 Owner's Name S Phone Address 2Z ;2r- Arch/Eng, License No. (33 Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. Address Contractor's Name&1019 5 P hone�66 ` Address (mailing) C City License No. Z_5�1 Lin LICENSED CONTRACTOR DECLARATION i herebyaffirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Cotle, and my license is in f 41 force and effect. 3/ License Class - L1 case -foto Date Signature WORKERS' COMPENSATION DEC7AATION hereby affirm that I have a certlficaonsent to self�nsure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section" 600, Lab. -C.71 G Policy No, r ��/3 Company Certified copy is hereby f furnished. Certs tl c pyG1c� led with the cit ivisi Date, �• - Applicant EXEMPTION FROM WORKERS' COM NSATION DECLARATION (This section need not be completed i! a permit is for one hundred ($100) or less). I certify that in.the performance of the work for which this permit is Issued I shall -not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: if, after making this declaration, you should become subject to the Workers" Compensation provisions of the Labor Code, you must forthwith . comply _ with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ- C.) Lender's Name- _ Lender's Address OWNER BUILDER DECLARATION ' I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code; Any City or county which requires a permit to Construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions o! 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 Ner©from and the basis for the alleged exemption. Any violation of Section 1.5 by any applicant for a permit subjects the applicant to a civil oenalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole Compensation, will do the work, and the structure is not Intended or offered for Sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- 6 rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code-- The ode:The Contractor's License Law does not apply to an owner of property who ' build$ or improves thereon,and who contracts for such projects with a con- tractor(s) license pursuarit'to the 'Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner l / I hereby certify that I have readthisapplication and state that the above Information is correct. I agree to compiy with all city and county ordinances and state laws relating to building cons ctlon, and hereby authorize repre- sentatives of Ithis city to a upo a above-mentioned property for inspection / Signature Date IP -4-9q Drivers' License SS =)p CMF 0865-46, reWI0/$4 White - Building; Canary - Applicant; Pink - Accounting FERMI i NU. I KALI 1 Nu. LU I IVU. UNIT NO, Date Bar Sink TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR q7L n i �/ 1 f1 / R(t Backflow Prevenler ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. + Zone Transformer ❑ 15=50 KW ❑ 50 + KW DESCRIPTION OF WORK/USE OF BLDG. Bathtubs Sewer Connection BUILDING PERMIT Cooking Unit Meter ❑up to 100 amps Clarifiers S Main Building: Accessory Building: Meter _©aver 10_0 amps _ Dishwasher Solar Piping E Dryers ❑Gas ❑Electric Sub Panel ' Drinking Fountairis Z TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front Floor Drains i Swimming Pool w/Spa O ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Floor Sinks Urinal r r TOTAL FEE N ❑ OTHER A Rear Device Boxes Outlets Switches I Lavatories C Right Garbage Disposal ; Standing Sections N PROJECT DESCRIPTION Sq. FT. OCCUPANCY Generator 00-5 KW 05-15 KW ,Trash Compactor Roof Drains CONSTRUCTION TYPE VALUATION S S Left R ZONE GRADING CU.YDS. ACRES Ping. Ref. # Parking Req. /Provided f E Remarks: Planning Notes: M T S Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System 0 Multiple ❑ Firep)/Fact. Bit. ICBO # Heating System & Ducting 00-100,000 BTU 0100,00013T I I-ReinspectionFee 1 $15 ; Goldenrod -Assessor t Issue Foe S 3 FEES Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000 BTU ❑ 100 000 BT System Repair/Alteration Fire Dampers Registers Issue Fee I I $ 3 I I Reinspection Fee 1 $15 1 1 Issue Fee J S 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: PLUMBING FEES Date Bar Sink Showers ELECTRICAL FEES Backflow Prevenler Service Sink - Automatic Washer H Construction Pole Sub. Transformer ❑ 15=50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection BUILDING PERMIT Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors $ Dishwasher Meter _©aver 10_0 amps _ Dishwasher Solar Piping ISSUANCE Dryers ❑Gas ❑Electric Sub Panel ' Drinking Fountairis Solar Tank ELECTRICAL Fan Motors ❑0 1 HP ❑ IA • B Floor Drains i Swimming Pool w/Spa 50% 1 $ F.A.U. Inc. Solar ❑9-15 HP El 46-15+ Floor Sinks Urinal r r TOTAL FEE ' Fixtures - Microwave 3 qd Gas Service Outlets Interceptors Kitchen'Sink Water Closet Water Heater Water Service Device Boxes Outlets Switches -Pole Light Range , Sign Lavatories I Auto -Wash Garbage Disposal ; Standing Sections P -Trap Laundry Trays Generator 00-5 KW 05-15 KW ,Trash Compactor Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System 0 Multiple ❑ Firep)/Fact. Bit. ICBO # Heating System & Ducting 00-100,000 BTU 0100,00013T I I-ReinspectionFee 1 $15 ; Goldenrod -Assessor t Issue Foe S 3 FEES Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000 BTU ❑ 100 000 BT System Repair/Alteration Fire Dampers Registers Issue Fee I I $ 3 I I Reinspection Fee 1 $15 1 1 Issue Fee J S 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By— Dat SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $r�+ .n)t1 GRADING $ PLAN CHECK 50% 1 $ --- Z_ -_ -�_Q� MICROFILM $ MECHANICAL $ TOTAL FEE $ Q PLAN CHECK 25% , $ d' CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POG SPA APPROVALS Permit # Date Inspecrnr 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 UFE,R.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, ❑ Undrgrnd. 10. -Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final ;12. Sewer Cap 63. Heater & Vent -Final '13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical,Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 177. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18! Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAI_ 19., Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit# 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil -23. Gas Pipe -Rough & Test 72.. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 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 p` Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 3B. 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 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink- Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink ` Sewer Cap Sewer'Connection Solar Collectors_ Solar Piping Solar Tank Swimming Pool wlSpa Uri 1 ma Water Closet Water.Heater Water Service Auto -Wash Laundry Treys ' FEES I( 5911 1/16/85 Zone Accessory Building: Z 0 N G R Parking Req./Provided E O M T S Applicant to fill Infill spaces except those within heavy border tines and sign all appropriate declarations. + CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT. NO.., TRACT NO. LOT NO. UNIT NO. Backflow Preventer OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following 'reason (Section 7031.5'Business and Professional,Code: Any city or county which, requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Cont`ractor's-License Law (Chapter 9 (commencing with Section 7000) of Division 13 of the Business and Professions Code) or that he/she "is exempt "herefrom and the basis for the alleged exemption. Any violation,. of Section 131,5 by_any- applicant for a permit subjects the applicant to a civil nalty of not more than five hundred dollars ($500). - - ,J I, as owner of thelproperty or my employees with wages as their sole .comRensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professlonal Code: The Contractor's License taw 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 f employees, provided that such improvements are -not intended or offered for - sale, if, however, the building or improvement is sold within one year.of com- pletion, the ownerlwill have the butden of proving he/she did not build or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contraCtinglwith licensed con- tractors to construct the,prOjeCt (5ectinn 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves• thereon, and who contracts for such -projects with a can- tractors) license pursuarit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. .Project Xiddress -71 I 1y. O C O, F� me -S-A Bathtubs ti Date 9 Applicant EXEMPTION FROM WORKERS' COMP sATION ECLARATION Clarifiers goiter (This section need not be completed'if the permit IS for one'hundred ($100) or less): I I certify that in the performance of the work for which this permit is issued, I Shall -riot employ any person In any manner so as to become subject to the Dishwasher Drinking Fountains Exhaust System ❑ Multiple ❑ Workers' Compensation Laws of California.' Date 5ignatuie Applicant's Mailing Address - TYPE OF CONSTRUCTION NEW ADD ALTERATION .REPAI R P CONVERSION El DEMOLISH El OTHER Floor Sinks Heating System & Ducting ❑0100,000BTU ❑100,Oo0BT Owner's Name _T'tr I IV tJ�STm �A7T Phone ' 'DESCRIPTION OF WORK/USE OF BLDG, A.P. # I$ Address $ S Main Building: PERMIT PLUMBING g ISSUANCE $ Arch/Eng. License No. TYPE OF PERMIT LJ GRADING 0 FOUNDATION 'STRUCTURAL T Front ELECTRICAL $ L .00 GRADING ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL PLAN CHECK 50% $ Address a. T I _LEC le 1�- Phone 7T6��C� ❑ OTHER A Rear TOTAL FEE $ Contractor's NameJyi �� $ C Right r—LPROJECT I�'/Rn1T of • RtoamuU 6Ta/t� 9.xi DESCRIPTION SQ. FT. OCCUPANCY K Address [mailing)-� Gf CONSTRUCTION TYPE VALUATION S S Left City License No.1 ZONE GRADING CU. YDS. ACRE5 Ping. Ref. # ' LICENSED CONTRACTOR DECLARATION , Ffiereby•affirm that I-am•licensed under provisions of harter commencing Remarks: Planning Notes: CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink- Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink ` Sewer Cap Sewer'Connection Solar Collectors_ Solar Piping Solar Tank Swimming Pool wlSpa Uri 1 ma Water Closet Water.Heater Water Service Auto -Wash Laundry Treys ' FEES I( 5911 1/16/85 Zone Accessory Building: Z 0 N G R Parking Req./Provided E O M T S with section 7000) of Division 3 mess an Pro Si s Code, and my license is in full force nd'effe License Class ' f19 Lice e No. • Gas Service -Outlets - Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW I hereby affirm that there is a construction lending agency'for the performance- of the work for which this permit is issued . (Section 3097 Civ, C.) Lender's' Name-' - Date J-1tL— E 51 Signature ' Kitchen -Sink .. WORKERS' COMPENSATION DECLARATIO I hereby affirm that I have a certificate of consent to self -insure or a certificate Bar Sink Backflow Preventer OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following 'reason (Section 7031.5'Business and Professional,Code: Any city or county which, requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Cont`ractor's-License Law (Chapter 9 (commencing with Section 7000) of Division 13 of the Business and Professions Code) or that he/she "is exempt "herefrom and the basis for the alleged exemption. Any violation,. of Section 131,5 by_any- applicant for a permit subjects the applicant to a civil nalty of not more than five hundred dollars ($500). - - ,J I, as owner of thelproperty or my employees with wages as their sole .comRensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professlonal Code: The Contractor's License taw 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 f employees, provided that such improvements are -not intended or offered for - sale, if, however, the building or improvement is sold within one year.of com- pletion, the ownerlwill have the butden of proving he/she did not build or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contraCtinglwith licensed con- tractors to construct the,prOjeCt (5ectinn 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves• thereon, and who contracts for such -projects with a can- tractors) license pursuarit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. 4 Workers' Compensation Insurance, or a certified copy thereof (Section 100,"Lab'. C.) ' ^olicy No. IayG�,rr D3 D Com n E eCertified copy is hereby furnished. Certified copy I&Afled with the city Old' g D ision� l ' Backfiow Irrigation Bathtubs ti Date 9 Applicant EXEMPTION FROM WORKERS' COMP sATION ECLARATION Clarifiers goiter (This section need not be completed'if the permit IS for one'hundred ($100) or less): I I certify that in the performance of the work for which this permit is issued, I Shall -riot employ any person In any manner so as to become subject to the Dishwasher Drinking Fountains Exhaust System ❑ Multiple ❑ Workers' Compensation Laws of California.' Date 5ignatuie Floor Drains ❑ t -am exempt under Section B. & P, C. for this reason 'NOTICE: If, after making this declaration, you should become subject to the Workers_'. Compensation, provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoker]. Floor Sinks CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink- Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink ` Sewer Cap Sewer'Connection Solar Collectors_ Solar Piping Solar Tank Swimming Pool wlSpa Uri 1 ma Water Closet Water.Heater Water Service Auto -Wash Laundry Treys ' FEES I( 5911 1/16/85 Zone Accessory Building: Z 0 N G R Parking Req./Provided E O M T S CONSTRUCTION LENDING 'AGENCY ' I ' - ' ' • Gas Service -Outlets - Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW I hereby affirm that there is a construction lending agency'for the performance- of the work for which this permit is issued . (Section 3097 Civ, C.) Lender's' Name-' - Interceptors Kitchen -Sink .. ' Lender's Address ' _ DEVELOPMENT SERVICES REOUIREMENTS: OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following 'reason (Section 7031.5'Business and Professional,Code: Any city or county which, requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Cont`ractor's-License Law (Chapter 9 (commencing with Section 7000) of Division 13 of the Business and Professions Code) or that he/she "is exempt "herefrom and the basis for the alleged exemption. Any violation,. of Section 131,5 by_any- applicant for a permit subjects the applicant to a civil nalty of not more than five hundred dollars ($500). - - ,J I, as owner of thelproperty or my employees with wages as their sole .comRensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professlonal Code: The Contractor's License taw 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 f employees, provided that such improvements are -not intended or offered for - sale, if, however, the building or improvement is sold within one year.of com- pletion, the ownerlwill have the butden of proving he/she did not build or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contraCtinglwith licensed con- tractors to construct the,prOjeCt (5ectinn 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves• thereon, and who contracts for such -projects with a can- tractors) license pursuarit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. Lavatories P—Trap ' Roof Drains ' ti - Reinspection Fee $15 ' Fixtures Microwave' ' goiter Duct - Under Gioundl ' Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # f Application Issued By ❑ t -am exempt under Section B. & P, C. for this reason 1_4 Date 1 Owner I hereby' certify that. I'have rVothis plication and state that -the above information I agree om y wcth all city antl county ordinances and state ws r ting to M.Ico s uction, and hereby authorize repre-sentatives of t i cit 'to enup [he above-mentioned property jr inspectio ur e 1 cc Signature Date F''f Drivers' License or SSI Heating System & Ducting ❑0100,000BTU ❑100,Oo0BT Reinspection Fee s I ' $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink- Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink ` Sewer Cap Sewer'Connection Solar Collectors_ Solar Piping Solar Tank Swimming Pool wlSpa Uri 1 ma Water Closet Water.Heater Water Service Auto -Wash Laundry Treys ' FEES I( 5911 1/16/85 Zone Accessory Building: Z 0 N G R Parking Req./Provided E O M T S ! Issue Fee $ 3 AANICAL- , FEES Hood Or Type 1 ❑ Canopy Type 11 ❑ - . Refrigeration System 00-100,099BTU J 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee , I $ 3 FEES I ELECTRICAL I Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW Reinspection Fee !Cooking Unit Meter ❑up to 100 amps ' Dishwasher Meter. ❑over_100 amps DEVELOPMENT SERVICES REOUIREMENTS: Dryers ❑Gas ' ❑Electric Sub Panel Fan Motors KO -1 HP ❑ 1:4 - S Zoning Approved By F,A.U. Inc. Solar 09-15 HP 016-15+ Fixtures Microwave' ' Device Boxes Pale Light Outlets Range Date Switches Sign f Application Issued By Garbage Disposal ; Standing Sections 1_4 Generator [10-5 KW ❑5-15 KW Trash Compactor ��` d _L_(0 SUMMARY OF FEES ! Issue Fee $ 3 AANICAL- , FEES Hood Or Type 1 ❑ Canopy Type 11 ❑ - . Refrigeration System 00-100,099BTU J 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee , I $ 3 FEES I Reinspection Fee $15 Issue -Fee ' $ 3 DEVELOPMENT SERVICES REOUIREMENTS: Zoning Approved By Date Building Approved By Date f Application Issued By _Date ��` d _L_(0 SUMMARY OF FEES BUILDING PERMIT I$ SMTP. $ PLAN CHECK $ PERMIT PLUMBING g ISSUANCE $ PLAN CHECK 25% $ ENERGY P.G. $ ELECTRICAL $ L .00 GRADING $ PLAN CHECK 50% $ MICROFILM '$ MECHANICAL $ TOTAL FEE $ + L4 PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL PA APPROVALS Permit # Date lnspPcrnr -1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement -3. Electrical Conduit Utility-Undrgrnd. 54, Forms 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE -7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewef Line & House Connection 62. Backwash & Receptor -Final 12, Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbirig 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72, Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 7B. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric ( Notes: 34. Final' Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. •Landscape Irrigation System 45. Sound, Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITE( OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. Cl�i IG�7 - •' _ -r_ � - Project Address :1I VV . 13Tµ ST, Cbs'Tfl mersil- Applicant's Mailing Address Owner's Name ��`� 1 rJ 0 6&! 'f Phone Address Arch/Eng. License No. Address _ Contractor's Nam MDR PIS SII - Phone Address (mailingjA_99�14iU1T 1?LLC ,A)61 J S;�31�0 City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that 1 am licensed under provisions of Ch ter (commencing with section 7000) of Division 3 of t usiness and P ofe i ns Cetle, and my license'is in full force anQeffe 3► License Class Licens o. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate •f Workers' Compensation Insurance, or a certified copy thereof (Section _ 300, -Lab. C.) » r /olicy No.yjc! � C e r eCertified copy is hereby furnished. Cer ified cop i +ted with the cit n ivisi Oate_--)� Applicant Let— EXEMPTION FROM WORKERS' COMPENSATI DECLARATION (Thlssection need not be completed if the permit Is for one hundred ($100yor less). I certify that In the performance Of the work for which this permit is Issued, 1 shall not' employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date _ Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor' Code, you must forthwith ' comply with such provisions or this permit shall. be deemed revoked. CONSTRUCTION LENDING .AGENCY I hereby affirm that there is a construction lending agency -for the performance of the work for Which this permit Is issued (Section 3097 Civ. C.) Lender's. Name. Lenders _'s Addres_ - -- -- OWNER BUILDER IDECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the +oIlowing reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter improve, demolish or repair any structure, prior to its issuance, also requlres tate applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing'wlth-Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt 0herefrom and the basks for the alleged exemption. Any violation of Section 131.5 by any applicant for a permit subjects the applicant to a civil ,nasty of not more than five hundred dollars ($504). + , J I, as owner of the property or my employees. with wages as their sole compensation, will qo the work, and the structure is not Intended or offered for sale '(Section 7044, Business and Professional, Code: The Contractor's License Law does nqt 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvoment is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with. licensed con- 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 builds or Improves thereon, and _who contracts for such projects with a con- . tractor(s) license pursuant -to the Contractor's License Law). 1 am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date -- Owner I hereby, certify that I have -read this application and State that the above inform lion i or I agree to comply ith all city and county ordinances and state I s tin to building cons ction, and hereby authorize repre- sentatives of t is ¢i[ to enter .upon he above-mentioned properly for Inspectillpure s 1 i Date TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR Cooking Unit ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Dishwasher _ A.P. q)s DESCRIPTION OF WORKIUSE OF BLDG. ' Sub Panel. ,Fan t 'Motors -1 HP ❑ 1 A - 8 - _ Inc. Solar 09-15 HP El 16-15+ S 'Main Builth Device Boxes Outlets Pole Light Range E Sign ; Standing Sections TYPE OF PERMIT GRADING ED FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BUILDING PERMIT ' ❑ OTHER $ A Rear PERMIT C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY KLeft 25% $ ' CONSTRUCTION TYPE VALUATION $ $ $ ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks: MICROFILM Planning Notes: Bar Sink Backflow Preventer - — - Backflow Irrigation Bathtubs , Clarifiers + Dishwasher Drinking Fountains Floor Drains I Floor Sinks _ Gas Service Outlets Interceptors Kitchen Sink Lavatories_ - P—Trap , y Roof Drains Reinspection Fee $15 Boiler Duct -'Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating Systdm & Ducting 00-1 ()(),000 BTU ❑iw000BT Signature I Drivers' license or 55 Reinspection Fee $15 CMF 0865.46, rev. 10/64 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor P Showers Service Sink — Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool vv/Spa Urinal ' Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type I ❑ Canopy Type 11 ❑ FEES ®is Refrigeration System • r -o 00-100,000 8TU) ❑ 100,000 BTU System Repair , /Alteration Fire Dampers Registers 1 I I Issue Fee I ` $ 3 A 5913- 1/16/55 J Accessory. B tii ld i ng: Parking Req./Provided ELECTRICAL LL 30 TL Zone Automatic Washer Construction Pale Sub. '.Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps, Dishwasher _ Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel. ,Fan t 'Motors -1 HP ❑ 1 A - 8 F.A.U. Inc. Solar 09-15 HP El 16-15+ Fixtures Microwave Device Boxes Outlets Pole Light Range Switches Garbage Disposal Sign ; Standing Sections Generator 00-5 KW 1:15.15 KW Trash Compactor SUMMARY OF FEES Z O N I N G R E M = T S FEES Reinspection Fee $15 Issue Fee S 3 DEVELOPMENTS ' EAVICES REQUIREMENTS: Zoning Approved B Date Building', Approved By Date Application Issued By Dat SUMMARY OF FEES i BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.G. S + ELECTRICAL $ GRADING $ PLAN CHECK 50% $ d MICROFILM $ MECHANICAL $ TOTAL FEE $ ' PLAN CHECK 25% $ _ CONSTRUCTION AND PLANNING APPROVALS Permit # Date r. . Inspector POOL PA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54, Forms 4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7, Footings 58. Electrical Conduit- Undrgrnd. .8. Foundation 59. Gas Pipe, ❑ Undrgrnd„ Test 9, Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof [)rains 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 APPROVALS Permit # 20. Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ 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 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 (� �%l Notes: 34, Final -Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No, Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations, CITY OF COSTAMESA CONSTRUCTION PERMIT "Project Address 7% — 0 M r= S Applicant's Maiting Address Owner's Name _ TRp`l 1 Qy STm > Phone Address Arch/Eng, License No. Address Contractor 'sName S 2L-L-CTRIC-•-Phone 1'6 Address inns iIin9) b 1 4A) 67W %L City License No. LICENSED CONTRACTOR D£CIrARATION I hereby affirm that I. am licensed under provisions of C after 9 (commencing with section 7000) of Division 3 of ie siness and of ss, ns Code, and my license is in full force and effect. License Class �� I t� Li sen No. Date Signature WORKERS' COMPENSATION DECLARATION(' hereby affirm that I have a Certificate of consent,lo Self -insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab, C.) Policy No• )� CO EL-� BCertified coyCertified p�y4SS filed bwith rthe hcty Buit ivisio Date IIID— 1CS Applicant EXEMPTION FROM WORKERS' COMPENSATIO DECLARATION (Thissection need not be completed if the permit is or one hundred ($100)'or less), I certify that In the performance of the work for which this permit is issued, I sha11L not employ any person in any manner so as to, become subject to the Workers' Compensation Laws of California. Date Signature ` 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such previsions or- this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY' I hereby affirm that there Is a constructiori lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name _ Lender's Address OWNER BUILDER DECLARATIDN ' I hereby affirm that 1 am exempLfrom the Contractor's License Law for the following reason'(Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure; prior to Its issuance, also requires the applicant for such permit to file asigned statement that he/she is licensed pursuant to the provisions of 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.ofi Section 7031.5 by any. applicant for 'a permit subjects the applicant ,to a_ civil penalty of not more than five hundred dollars ($500). Ll 1, -as owner of the property or my employees with. wages as their sole compensation', will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale, If, however, the building or improvement is sold within one year of corn ' pletlon, the owner'wiil have the burden of proving he/she did not build or Im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensod Con- tractors to construct the project (Section 7044, Business and Professions Code: i The Contractor's Liconse Law does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a con- • tractors) license piirsuarit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P: C. far this reason Date Owner I hereby certify that i have read this a lica"0n and state that the above information Is c t. I,agree to compl ith all City and county ordinances and State s elati g to buy ding con Ction, and hereby authorize repre- sentatives of Is c y to a ter opo the above-mentioned property fo inspectio pur SC SignatureLG4, Date DriversLicense or S5 7 CMF 0865.46, rev. 10184 5914 1/16/85 4#50 iL PERMIT O. TRACT NO. LOT NO. UNIT NO. - r - TYPE OF CONSTRUCTION NEW' ADD ALTERATION REPAIR ❑ CONVERSION -❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A -P•,# Zone S Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ -OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES E T Front Z O B A Rear N I C Right N S Left G R' Ping. Ref .# Parking Req./Provided E Remarks: _ Planning Notes: = M T S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic'Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 50+ KW F Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit a Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher _ Meter ❑over 100 amps r- r 1 Dishwasher Solar Piping Dryers ©Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 1 HP ❑ 115 - 8 Floor Drains t Swimming Pool w/Spa F.A.U. Inc.Solar 09.15 HP 016.15+ Fioor Sinks } Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen -Sink Water Service Switches Sign , Lavatories _ Auto -Wash Garbage Disposal ; Standing Sections P—Trap' Laundry Trays Generator 1:10-5 KW 05-15 KW Trash Compactor Roof Drains - - Reinspection Fee :$15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 Boiler` j Duct - Under Ground' MECHANICAL' FEES._ I Hood or i Type I ' ❑ Canopy Type I i ElZoning . DEVELOPMENT SERVICES REOUIREMENTS: Approved By Building Approved By Application Issued By Date F Date Date it I {o Duct - Structural Refrigeration System E10- 100,000 BTU El100,000 BTU Duct - Ventilating SUMMARY BUILDING PERMIT S PLAN CHECK $ PLUMBING g PLAN CHECK 25% $ ELECTRICAL IS PLAN CHECK 50% S MECHANICAL $ ' PLAN CHECK 25% $ OF FEES SMIP $ PERMIT ' ISSUANCE $ ENERGY P.C. S GRADIN GRADING $ MICROFILM g TOTAL FEE $`? Exhaust System CJ Multiple 1-1 SystemRepair/Alteration Firepl/Fact. Bit, ICBG# Fire Dampers Heating System & Ducting i ❑ 0.1 oo,000 BTU ❑ 100,000 BT I Registers Reinspection Fee $15 ' Issue Fee S 3 rY - Applicant: Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector .-1. Temporary Electrical Service or Pole 52. Pool '& Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4, Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVE R-GUNITE .7. Footings 58. Electrical Conduit-Undrgrnd, B. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. -10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13, Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. 'Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electricat-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydra 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28, Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test' 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. 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. pate Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. - Backflow Preventer - -- - - Service Sink' CITYOF COSTA MEA CONSTRUCTION PERMIT pE�ITI (� - - TRACT NO. LOT NO. UNIT N . Bathtubs Sewer Connection Cooking Unit i � fl- S-A l I Dishwasher _ (This section need not be completed If the permit W for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Dishwasher Solar Piping . Dryers ❑Gas ❑Electric -Project Address _Cat o2 Fan . - Floor Drains Swimming Pool w/Spa F.A.U. TYPE OF CONSTRUCTION- ; NEW ADD ALTkRATION REPAIR Fixtures ' Gas Service. -Outlets ' Water Closet Applicant's Mailing Address '❑ ❑ DEMOLISH ❑ OTHER- InterceptorsWater He Outlets Owner's Name Phone CONVERSION DESCRIPTION OF WORK/USE-OF BLDG. A.P. # Lender's Address - Kitchen Sink Water Service - Switches _ OWNER BUILDER t]ECLARATION I hereby'affirin that I am exempt from the Contractor's License Law for the following reason (Section 7031'.5'Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair , Lavatories, Auto -Wash I - S Main Building: Generator ❑0 K 5 KW ©5.15 Address _ E information is gree to c plywith all city and county ordinances and state law rel 'ng t builtlin const ction, and hereby authorize repre- Arch/Eng, License No. TYPE OF PERMIT LJ GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ELECTRICAL ❑ PLUMBING 1:1 MECHANICAL B Address M'R eIS �GEG- L 917-6f[ ❑ OTHER _ Rear MECHANICAL $ TOTAL FEE $ Contractor's Name l Phone C h Right g Signature I kh� iAA-yr MIm ) Mrl) ` PROJECT DESCRIPTION SQ. FT. - OCCUPANCY K issue Fee $ 3 Address (mailing) IST'r .RLQ ZR CONST RUCTION TYPE VALUATIONS S Left City License No. ..,r. ZONE ^' GRADING CU.VDS. ACRES Ping. Ref. Oz LICENSED ICESED CONTRACTOR DECLARATION _ I'hereby affirm that 1 am Ilcensed under provisions of harler'9 (commencing Remarks: Planning Notes: with section 7000) of Division 3 siness an Prof e ons Code, and my license is in full force and effe t. License Class iC) Lice Date Signature PLUMBING, FEES WORKERS' COMPENSATION DECLARATION[Bar Sink Showers I hereby affirm that I have a certificate of consent to self -insure ora certificate ' 5915 1/16/85 Zone ; Accessory Building: Parking Req./Provided ELECTRICAL f Workers' Compensation Insurance, or a certilled copy thereof (Section 300, lab. C.) Policy No, \111(SI O ��'�� -y - Backflow Preventer - -- - - Service Sink' Automatic Washer Backflow ation Irri 9 Sewer Cap Construction Pole Sub. B Certified copy is hereby furn[she s it in Ivlsi . Certified copy id with the cit B Bathtubs Sewer Connection Cooking Unit Date I � —Applicant EXEMPTION FROM WORKERS' COMPEN&ATIO14 DECLARATION Clarifiers Solar Collectors Dishwasher _ (This section need not be completed If the permit W for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Dishwasher Solar Piping . Dryers ❑Gas ❑Electric Drinking Fountairis Solar Tank Fan Workers' Compensation Laws of California. Date: Signature -NOTICE: if. after making this declaration, you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall• be deemed revoked. - Floor Drains Swimming Pool w/Spa F.A.U. , Floor Sinks' -' - - Urinal - Fixtures ' Gas Service. -Outlets ' Water Closet Device Boxes ' _ CONSTRUCTION ;LENDING AGENCY - - I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ, C,) InterceptorsWater He Outlets Lender's' Name ` - - - Date owner ' Lender's Address - Kitchen Sink Water Service - Switches _ OWNER BUILDER t]ECLARATION I hereby'affirin that I am exempt from the Contractor's License Law for the following reason (Section 7031'.5'Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair , Lavatories, Auto -Wash I - Garbage Disposal P -Trap - -- Laundry Trays Generator ❑0 K 5 KW ©5.15 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 (commanCingiwith Section 7000) of Division 3 of the Business and Professions Code) or' that. he/she is exempt `herefrom and they basis for the alleged exemption. Any .violation of Section 731.5 by any' applicant for a permit subjects the, applicant to a, civil T, I d ed dollars $500) Transformer ❑ 15-50 KW El 50 + Kw Meter ❑up to,100amps. Meter over 100 amps ' Sub Panel Motors 0-1 HP ❑ 1 % - 13 Inc. Solar 1:19-15 HP Ell 6-15+ Microwave Pole Light Range Sign Standing Sections , W Trash Compactor = 1 salty of not more than ve un r ( a 3 . L] I,'as,owner of the ,property or my employees with wages as their sola ReinspBttion Fee' $15 Issue Fee $ Compensation, will do the work, and the structure Is not intended or offeredReinspection Fee $15 Issue Fee for sale (Section 7044, Business and Professional Cotler' The Contractor's - MECHANICAL_ FEES License Law does not apply to an and of a property.who builds or improves' thereon, and ,who'does such work himself/herself or through his or her own Boiler Y' Hood or Type I ❑ I DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not Intended or offered for -- sale. If, however, the building or Improvement is sold within one year -Of Com- 'Canopy Type I1 ❑ Zoning Approved By pletion, the owner will have the burden of proving he/She did not build or im- Duct-'Under,'Ground I : prove for the purpose of sale). Building Approved.By ❑ I, asowner of the property, am exclusively contracting'with licensed con- Duct - Structural Refrigeration System Application Issued By tractors to construct the'project (Section 7044, Business and Professions Code: i 4050 TI_ Z O N I N G R E Q M T S The Contractor's License taw does not apply to an owner of property who - Duct - Ventilating - L.10 -100,000131U ❑100,000 BTU - - ' SUMMARY OF FEES builds or improves thereon. -and _who contracts for such projects with a con- tractor(s) license p'ursuant'to the Contractor's License Law). I am aware that to me. BUILDING PERMIT $ SMIP $ Exhaust System ❑ Multiple El System Repair/Alteration proof of their Worker's Compensation insurance should be provided ❑ 1 am exempt under Section B, & P, C. for this reason PLAN CHECK S PERMIT ISSUANCE Fireplffact. Sit. ICBO Fire Dampers i PLUMBING $ $ PLAN CHECK 25% $ ENERGY P,C, $ Date owner ' Heating System &Ducting Registers a I hereby certify that I have read -this application and -state that the above ❑0-100,000 BTU ❑100,OOOBT i ELECTRICAL $ -CO GRADING $ t information is gree to c plywith all city and county ordinances and state law rel 'ng t builtlin const ction, and hereby authorize repre- �`-i - PLAN CHECK 50% $ SD MICROFILM $ sentatives of this ty o enter upon the above-mentioned property i� _ inspection pu pose- G+ Date 1-f L g•� MECHANICAL $ TOTAL FEE $ Signature I Reinspection Fee $15 issue Fee $ 3 PLAN CHECK 25% $ Drivers' License or SS CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 'CONSTRUCTION AND PLANNING Date APPROVALS Permit # Inspector POOL PA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe Undrgrnd. 53. Steel Reinforcement ,3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd, 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8, Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring - 67. Fencing & Access Approval 17, Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25, Roof Sheathing 74. Overhead Hydra 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. F I NA L I NSPECT ION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Eiectric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer -43. 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 ' 61. CERTIFICATE OF OCCUPANCY, No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA ' CONSTRUCTION PERMIT PERMIT NO., <7_ TRACT NO. LOT NO. UNIT _ 'Project Address fi` Applicant's Mailing Address . Owner's Name r t�G Y� - "mo�i"Lti�s,$f^%S OJ r. Phone Address Arch/Eng. License No.. Address - Contractor's Nome 416:2 R A fj 1 E_ C'iA, K Phoney.? Ag� ddress (mailing)♦✓ _ A -i I City License No. -1 - LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed undgr provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full orce and effect. I �j License�Classi se o. �+ 171 _W2 Date J �. Signature WORKERS' COMPENSATION DECLARATION , hereby affirm that I have a certificate of consent to self -insure or a certificate ,Workers' Compensation Insurance, or a certified copy thereof (Section 800,. Lab./C'.) _ -- C `,r r- Policy No.IJ e__ .� %t� 9 270 Company BCertified copy Is hereby furnished. Certified copy Is filed with the city jngDiy?s ft.A T Date "'ti�j _ Applicant - . �((�� EXEMPTION FROM WORKERS' CO ENSATIO DECLAR (This section need not be completed if the permit is for one hundred ($100) or less). 1 certify that in the performance of thq work for which this permit is Issued I shali not employ any person in any rhanner so as to become subject to the Workers' Compensation Laws of California. Date Signature — 'NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with, such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance ofthe work for which this permit is issued (Section 3097 Civ. C.) Lender's Name --- Lender's. Address OWNER BUILDER L DECARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: •Any city or county which requires a permit to construct, alter, improve, demolish or repair . any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 'ierefrom and the basis for the alleged exemption. Any violation of Section )31.5 by any applicant for a permit subjects the applicant -to a civil enalty of not more than five hundred dollars ($500). ❑ I, -as' owner of the property or my employees with wages as their sole compensation, will do the work, and the structure .is not intended or offered for sale (Section 7044, Business anq Professional Code: The Contractor's'• License Law does not apply to amowner of a property who builds or improves thereon, and •Who does such work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have .the burd@n of proving he/she did not build or Im- ?r•,ove for the purpose of sate). LJ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon,•and _who contracts for such projects with a con- tractor(s) license pursuarit'to the Contractor's License Law). I am aware that , proof of their Worker's Compensation insurance should be provided to me. ❑ I.am exempt under Section _ B. & P. C. for this reason Date Owner 1 hereby, certify that 1 have read this application and state that the above information is correct. I agree to*compty with all city and county'ordinances and state laws relating to building construction,, and hereby authorize repre- sentatives Of is city • t e ter u Qn the above-mentioned property for inspection p es, w 4 e,�r Signature ate Drivers' License or SS :)P- AF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor' 5916 1./16/.65 Lo EG TL Reinspection Fee _ Boiler $15,1 1 Issue Fee Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact- Bit. ICBO # Heating System & Ducting O 0.100,000 BTU ❑ 100,000 BT Reinspection Fee Hood or Type I ❑ ,• Canopy Type II ❑ Refrigeration System 00-1100,000BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee S 3 Reinspection Fee $15 Issue Fee $ 3 FEES TYPE OF CONSTRUCTIONA I NEW LJ ADD LJ ALTERATION LJ REPAIR pate Date Date ❑ CONVERSION ❑ DEMOLISH [:]OTHER A.P. 46 Zone DESCRIPTION OF WORK/USE OF BLDG. ' S Main Building: Accessory Building: - E Z TYPE -OF PERMIT LJ GRADING FOUNDATION STRUCTURAL T Front _ 0 ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ A Rear N .OTHER C Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY K G CON STRUCTION TYPE VALUATION $ S Left -- . R ZONE GRADING CU. YDS. ACRES Ping. Ref. # Parking Req./Provided E Remarks: Planning Notes: M i S PLUMBING I FEES s Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW Backflow Irrigation Sewer Cap Conitruction Pole Sub. -1 50 + KW Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors ' Dishwasher Meter Dover 100 amps ' Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motor 1 H P1:1136 - 8 f� Floor Drains Swimming Pool w/Spa F,A.U, Inc. Solar ❑9-15 HP 016-15+ Floor Sinks Urinal Fixtures _ Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories - Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor , Roof Drains s - Reinspection Fee _ Boiler $15,1 1 Issue Fee Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact- Bit. ICBO # Heating System & Ducting O 0.100,000 BTU ❑ 100,000 BT Reinspection Fee Hood or Type I ❑ ,• Canopy Type II ❑ Refrigeration System 00-1100,000BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee S 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: _ - __- pate Date Date SUMMARY OF OF BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK -25% $ ELECTRICAL $ 4'-�O PLAN CHECK 50% $ MECHANICAL $ f PLAN CHECK 25% $ FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. , $ GRADING $ MICROFILM $ ' TOTAL FEE $ $ 3 CONSTRUCTION AND PLANNING APPROVALS . Permit # Date Inspector POG SPA APPROVALS Permit # Date Inspector `1. Tempg�ary Electrical Service or Pole ,,� n 52. Pool & Equipment Location -soil Pj rn 'e-Undr d. p g ,� �r v 53. Steel Reinforcement .3: Electri19aI Conduit-Utility-Undrgrnd. .t 54. Forms 4! Electri'dal Conduit-Undrgrnd. 55. Electrical Bonding 5.'Ste'eI- Reinforcement ,_ 7 56. Rough Plumbing & Pressure Test 6: Electrical LIFER-Grnd'. 57. APPROVAL TO COVER-GUNITE �7. Footings 58. Electrical Conduit-Undrgrnd. 8' Foundation ! t •. d., Water Pi a-Undr rnd. ` '' p g i � ..-.. �', �- � 59. Gas Pipe, ❑ Undrgrnd., Test 60. Backwash Lines, P -Trap, ❑Undrgrnd. ►ti 10' Structural Floor System 61. APPROVAL TO DECK Property Sewer Line & House Connection 1 1 62. Backwash & Receptor -Final IL}Sewer Cap v t. t ; 63. Heater & Vent -Final 1'3' Roof Drains 64. Plumbing System - Final 14. Rough Plumbing ; r 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. POO USPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating- 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ 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 3�. Plaster Brown Coat 79. FINAL INSPECTION 3i -Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric !p Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventers . 43. Backflow Irrigation 44. Landscape Irrigation System _2( 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF.COSTA MESA ' CONSTRUCTION PERMIT 15roject Address l Applicant's Mailing Address Owner's Name % N .� Phone Address - Arch/Eng. License No. _ Address Contractor's Name < < Phone( Address (mailing//�E rc�R �/�nJ1 -C W- City Lican-sn No. LICENSED CONTRACTOR DECLARATION Chereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is In full force and effect, License Class Date t—If Q - k.0.- Signature SJ WORKERS' COMPENSATION DECLARATION I hereby affirm that i have a certificate of consent to self -Insure or a certificate f Workers' Compensation Ihsurance, or a certified copy thereof (Section d800, Lab, C.) „ — - Policy No `S w -77t7 Company , S 4 4-11CC Certified copy is hereby furnished. Certified copy is fifetl with the city B fli`1 0 Date_!+/�- r Applicant EXEMPTION FROM WORKERS' COMPENSATION 6iZLAR (This section need not be Combleted if the permit Is for one hundred ($100 less) I certify that in the performance of the work for which thls permit is issued, I shalt not employ any person in any manner so as to become subject to the Workers'. Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with' Such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY ` I hereby affirm that there is a construction lending agency for the performance ofthe work for which this permit is issued (Section 3097 Cly. C.) Lender's Name , Lender's Address - - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Sectlon 7031.5 Business and Professional Cade: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its 1SSuance,also requires the applicant for Such permit 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 Division 3 of the Business and Professions Code) or that he/she is exempt 'herefrom and the basis for•the alleged exemption. Any•vtolation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their Sole .compensation, will do the work, and the structure Is not Intended or offered for Salo (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that suCh improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletlon, rthe owner will have the burden of proving he/she did not build or im- ove.lorr the purpose of sale). I, is owner of the -property, am exclusively contracting with licensed Con- 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 builds or improves thereon, a_ nd who contracts for such projects with a con- tractors) license pursuarit'to• the,Contractor's License taw). I am aware that proof of their Worker's Cornpensation insurance should be provided to me. ❑ I am exempt under Sectioh B. & P. C. for this reason Date Owner I hereby certify that 1 have read this application and state that the above information -Is correct. I agree to comply with -all city and county ordinances and state laws relating to byilding construction, and hereby authorize repre- sentatives of is ;Cit r:n er upon the above-mentioned property for inspection rp s.` Signature RataL ��s� Drivers' License or SS 5917 1/IA/si PEJR NiT O. TRACT NO. LOT NO. UN`111T NO• 1 ' ' TYPE OF CONSTRUCTION NEW ADO ALTERATION L1 REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A. P. q)k 7ne S Main Building: Accessory Building: TYPE OF PERMIT DGRADING FOUNDATION El STRUCTURAL' ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL _ ❑ -OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CON STRUC-T-ION TYPE VALUATION $ ZONE GRADING CU. YDS. ACRES E T Front Z 0 B A Rear- _ N I C Right N K S I Left G R Ping. Ref, 91kParking Req./Provided E Remarks: Planning Notes: Q M ' T S PLUMBING FEES ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Floor Drains Solar Tank Swimming Pool w1spa Fan, F.A.U. Motors 1 HP ❑ I% - 8 Inc. Solar ❑9-15 HP 016.15+ f Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories Urinal , Water Closet Water Heater Water Service t Auto -Wash Fixtures Device Boxes Outlets Switches Garbage Disposal Microwave - Pole Light Range Sign ! Standing Sections P --Trap Latindry Trays Generator 00-5 KW 05.15 KW Trash Compactor Roof Drains Reinspection Fee $15 1 Issue Fee $ 3 Reinspection Foe $15 Issue Fee S 3 , Boiler Duct - Under Ground MECHANICAL FEES Hood or Type ❑ Canopy Type li ❑ DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued BY REQUIREMENTS: Date Date Data �n Duct - Structural Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU Duct - Ventilating SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% S ENERGY P.C. $ ELECTRICAL$ [�_� GRADING $ PLAN CHECK 50% $ MICROFILM S MECHANICAL $ ' TOTAL FEE $ PLAN CHECK 2596 '$ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepi/Fact, Bit, ICBO # Fire Dampers Heating System & Ducting ❑0.100,000 BTU 0100,90013T Registers - Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10184 White _ Pink - Accounting; Goldenrod - Assessor ' CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POt.- di SPA APPROVALS Permit # Date Y Inspector ' 1. Temporary Electrical Service or Pole f 52. Pool & Equipment Location 2.-SoiVipe-Undrgrnd. "i 53. Steel Reinforcement C;�r '3. Ele`Gtrical Conduit-Utility-Undr'g'rnd. 54. Forms 4'. 1=lectricat Conduit-Undrgrnd, S 1 r •� 55. Electrical Bonding C� +5' Steel Reinforcement v 56. Rough Plumbing & Pressure Test "1 6) E=lectrical UFER Grnd. �• _ 57. APPROVALTO COVER-GUNITE t7.� Footings ^� f n 58. Electrical Conduif-Undrgrnd. 1, $: Foundation 0 -1 - , .. 1 59. Gas Pipe, ❑ Undrgrnd., Test l �� 9� Water Pipe-Undrgrnd. « ^i 60. Backwash Lines, P -Trap, ❑ Undrgrnd. �+ 10: Structural Floor System r 61. APPROVAL TO DECK 11,. Property Sewer Line & House Connection • , 62. Backwash &Receptor -Final 12: Sewer Cap =� , 63. Heater & Vent -Final n 13.'Roof Drains 64. Plumbing System -Final 14. Rough Plumbing` i; '� 65. Electrical -Final j 15. Rough Electricai'-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 APPROVALS Permit # 20. Rough Factory Fireplace 21..Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24.; Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25.' Roof Sheathing 74. Overhead Hydro 2& T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe . 28. Lathing & Siding 77, FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30,. Drywall Nailing HEALTH DEPT-. REQUIREMENT 31 Plaster Brown Coat 79. FINAL INSPECTION 32 -Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39, Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 'y 43. Backflow Irrigation 44. Landscape Irrigation System x 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 nI Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 1 2302 5/03/65 15oF0 TL - PERMIT NO. TRACT NO. LOT NO. UNIT NO CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address Applicant's Mailing Address 13110 Saticoy St. N_.Ho,Lylaood Owner's Name Tray Investment—Fuad—Phone 549 2988 Address —4321 Birch St. Newport Benc , (.'P— Arch/Eng. Marin J. flock License No. Address -12$$1 Kn0.t Aye sUtt.G__2,1_6 Contractor's Nam e,1uc0 Ai r con diZinn __ i n -Phone _82 _1216 -Address(mailing)I3-1_ 0 Sarinny r. N-14allpaondjr-a. City License No. 19925 LIC£NSEO CONTRACTOR DECLARATION I hereby. affirm that I am licensed under Provisions of C erter 9 (commencing with section 7000) of Divislon 3 o e Business an feSsion$ Code, and my license is in full force and effec . License Class 20 LI n o, 346251 Dat!✓F�1_9/8_ Signature WORKERS' COMPENSATION DECror N I h@reby affirm that 1 have a certificnt to self -insure or a certificate If Workers' Compensation Insuranrtified copy thereof (Section 3840, Lab. C.) Policy No._?X9824 company 346251 HCertified copy is hereby furnished. Certified lopy is tiled with the city Buildin Date �--D Applicant �^ ExEMPTIO04 FROM WORKERS' COMPENSATION DECLARA tON (This section need not be completed if the permit is for one hundred (S100) or less). 1 Certify that in the performance of the work for which this permit is issued 1 shall not employ any person in any manner so as to become subject to t6 Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I htreby affirm that there is a construction lending agency for the performance Of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lehder'sAddress - -- - -- OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for Such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 )033.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($504). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and professional Code: The Contractor's License Law dyes 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of Com- pletion, the owner will have the burden of proving he/she did not build or Im- rove for the Purpose of Salo), 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7444, Business and Professions Codo: The Contractor's License Law does not apply to an owner of property who bt,ilds or Improves thereon, and _who contracts for such projects with a con- tractor(sl license pursuarit'to the Contractor'd License Law). 1 am aware that Proof o their Worker's Compensation insurance should be provided to me, ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have rea, information Is correct. 1 agree to and state law ing to buitd' Santa tives o t s elatcity to en r Inspection rp e Signature Drivers' Llcenjlror SS =P to Reinspection Fee TYPE OF CONSTRUCTION W ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. -- A.P. Zone S Main Building: Accessory Building: TYPE OF PERMIT LJ GRADING M FOUNDATION 11 STRUCTURAL -❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑D MECHANICAL ED PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION S ZONE GRADING CU.YDS. ACRES. E T Front BiJ)LD1NG PERMIT PLAN CHECK PLUMBING- PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% Z 0 A Rear N -OTHER C Right N g Left G R Ping. Ref. # Perking Req./Provided E Remarks: Planning Notes: a M T S PLUMBING FEES ELECTRICAL Automatic Washer Transformer ❑ 15.50 KW - Construction Pole Sub. ❑ 50 + KW FEES Bar Sink Showers Backftow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection = Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps Dishwasher Solar Piping Drinking Fountains Solar Tank �% Dryers ❑Gas DElectric Fan Sub Panel Motors ❑0-1 HP ❑ 1 X - 8 Floor Drains Swimming Pool w/Spa Floor Sinks Urinal F.A.U. Fixtures Inc. Solar 119.15 HP ❑ 16-15+ Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash P -Trap Laundry Trays Garbage Disposal Generator ❑0-5 KW 05.15 KW Standing Sections Trash Compactor Roof Drains s application and Stale that the above 1 ply with all city and county ordinances 'istruction, and hereby authorize repre- n the above-mentioned property for `-49 Ab �r�at. �9 I� Reinspection Fee 1 .$15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting Do,1 oo,0o0 BTU ❑ 100,000 BT Reinspection Fee I $15 CMF 0865.46, rev. 10194 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 ::_Wl iANICAL FEES Hood or Type I ❑ - Canopy ; Type tl ❑ DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: _ - Data date Dat Refrigeration System 00-100.000 BTU ❑100,000 BTU- BiJ)LD1NG PERMIT PLAN CHECK PLUMBING- PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% - SUMMARY OF FEES S S $ $ $ $ $ _13-0 $ 2.50 SMiP S PERMIT ISSUANCE $ ENERGY P.C. $ GRADING S MICROFILM S TOTALFEE $15.50 System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS - Permit# Date Inspector POOt__.-. SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2, -Soil Pipe-Undrgrnd, 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms ' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8' Foundation . 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 1 60. Backwash Lines, P -Trap, ❑ Undrgrnd. ` 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. 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 i9. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS. Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank ❑Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Mortocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28, Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35, Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43, 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 NDate CP Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. _ TRACT NO. LOT Nd . UNiT Nn Project Address 711 W Applicant's Mailing Address 131-10 SatiCoy t. N. hollywood, Owner's Name Tr(ni- ILVPRtmant_Fund Phone 544 24AR Address 4321 Birch .:t. Newport Beach, Ca. Arch/En�arin J Rock License No. Address 12881 Knott Ave. Suite 216 Contractor's Name Tinrn Air f'.nnrli ti nni nrsPhone 922 1216 Address {mailing) City License No. 3 995 LICENSED CONTRACTOR DECLARATION I hereby affirm that I' am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and P fessions Code, and my license is In full force and effect License Class C 0 Lice s N 34625E Date4J-18/84_ Signature WORKERS' COMPENSATION DEC RATION I hereby affirm that I have a certil1 a of consent to self -insure or a certificate %f workers' Compensation Insurance, or a certified copy thereof (Section 800, Lab, C.) Policy No. - 14C 9-82/ Company Lumbermans e Certified copy is hereby furnlshed. Certifi py is filed with the city Bui(d�n� ivision. ` I C', t , Date Applicant (�Jf A -IC/ -_ _-- EXEMPTIO14 FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less), I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject t0 the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the labor Code, you must forthwith comply with such provisions Or this permit shalt be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ, C.) Lender's Name Lander's Address OWNER BUILDER DECLARATION - I hereby affirm that t am e exempt from the Contractor's License Law for th following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions Of 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 violatlon-of Section ?31.5 by any mpindotllars subjects applicant to a civil alty of not morethan five hundred L� 1, as owner of the prupafty or my employees with wages as their sole compensation, will do lho work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. it, however, the building or Improvement is sold within One year of com- pletlon, the owner will have the burden of proving he/she did not build or im- prove.tor tno purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project(Section 7044, Business and Professions Code: The Contractor's License taw does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a con- tractor(s) license Pursuarit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I nave read information is correct, 1agree to ( and state laws re ting to buildinc sentatives of t ity to enter inspection pur Se Si t re application and state that the above y with all City and county ordinances truction, and hereby authorize repre- the above-mentioned property for TYPE OF CONSTRUCTION LI NEW LJ ADD LJ ALTERATION LI REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P + DESCRIPTION OF WORK/USE OF BLDG, 5 Main Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 0 MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CDNSTRUCTION TYPE VALUATION $ S I Left ZONE GRADING CU.YDS. ACRES Ping, Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 S15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 1 00-100,000 BTu ❑ io0,009 BT gna u Reinspection Fee Drivers' License SS # 1F 0865-46, rev. 0/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor S15 I11 Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type I ❑ Canopy Type l l ❑ Refrigeration System 130-100,000 BTU 01100,000BT System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automatic Washer Construction Pole Sub. Cooking Unit D ishwasher Dryers ❑Gas. DElectric 2301 5/03/85 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50 + KW Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 130-5 KW 05.15 KW Meter Uup to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0-1 HP 01%-8 Inc.Sotar 09.15 HP ❑16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 15.50 TL FEES z O N I N G R E Q M T S S 3 Reinspection Fee $15 Issue Fee S 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By— REQUIREMENTS: Data Date Data Z BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF S $ $ $ $ S $ 13_-00 $ — S11 FEES SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTALFEE S S $ S $ $ 4 00 S 3 CONSTRUCTION AND PLANNING APPROVALS . Permit # Date Inspector POO. ;PA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53, Steel Reinforcement / 3. Electrical Conduit Utility-Undrgrnd. 54. Forms - 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding , 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test - 6. Electrical UFER Grnd, f :ter 57. APPROVAL TO COVER-GUNITE i f 7. Footings j 58. Electrical Conduit-Undrgrnd. 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House ConuectiQn 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains f 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 APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping- ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 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 t1 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. U " Q. Project Address ---711-W. 17th St. Bldg(J) Unit 1 Applicant's Mailing Address 13110 Saticoy St. N.Hollywood Owner's Name Tzay TnvEstment Fund, Phone 549 2988 Address 44321 Rirrh St, NPw1)nrf• RPar_h�ia Arch/Eng" M�,.,;,,,,.r.,,in T License No. Address 19881 Knnt,t Ave GIli to 216 Contractor's Name Durr Air r nncu t; nnino Phone 989 191 Address (mailing] —13 Sa t j Coy St N Hal lwnn� C:a City License No. 33925 LICENSEO CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business an rofesSion% Code, and my license Is In full force and effect. 346251 License Class C Li se o, Dat4.-1$ / Q� Signature WORKERS' COMPENSATION DE RATION i hereby affirm that I have a certill. to of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. )J XN ' WC9824 Company Lumbermans HCertified copy Is hereby furnished. Certifie copy is filed with the city Buildin �vjs � �J� f Date Applicant r A C EXEMPTION FROM WORKERS' COMPENSATION DECLARA ION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that In the performance of the work for which this permit Is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: if, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097 Civ. C.)_ Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5,Business and Professional Code: Any city or county which requires a permit.to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 ?031,5 by any applicant for a permit subjects the applicant to a civil ].natty of not more than five hundred dollars (5500). ❑ 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuarit'to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and slate that the above information Is correct. I agree to comply with all city and county ordinances and state s relating to b Ing construction, and hereby authorize repre- sent o this city [o er upon the above-mentioned property for inspectid u oses.olp �� C• Signature Date [! Drivers' LiC Se or SS 7z- "' TYPE OF CONST. I - - 0 NEW 0 ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A Pl DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT LJ GRADING 0 FOUNDATION0 STRUCTURAL T Front 1:1TENANT ElELECTRICAL ElPLUMBING 0 MECHANICAL 15 A Rear ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION S S Left ZONE GRADING CU.YDS. ACRES Ping. Ref, # Remarks: Planning Notes: I PLUMBING I FEES l 2248 5/03/85 Zone Accessory Building: Parking Req./Provided 15p50 Z O N N G R E Q M T S Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00.1 HP ❑ 114 78 Floor Drains Swimming Pool w/Spa F.A,U, Inc. Solar 09.15 HP ❑ 16.15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ' Standing Sections P—Trap Laundry Trays Generator ❑0-5 KW 05-15 KW Trash Compactor Roof Drains Reinspevion Fee Boiler $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. iCBO # Heating System & Ducting E30.100,000 BTU ❑ 100,000 HI Reinspection Fee 1 $15 CMF 0865-46, rev. 10184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Foe $ 3 Reinspection Fee $15 1 1 Issue Fee $ 3 MECHANICAL Hood or Type I ❑ Canopy Type II ❑ FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date Dat Refrigeration System 130-100,000BTU ❑ 100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY DF FEES $ S $ $ S s $ _- 13.00 s 2.50 SMIP s PERMIT 1ISSUANCE S ENERGY P.C. $ GRADING S MICROFILM S TOTAL FEE s 15.50 System Repair/Alteration Fire Dampers Registers 4 PO Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POOL _,;PA APPROVALS Permit # Date Insperrnr 1, Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd, 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8: Foundation ! 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. .- Y 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12, Sewer Cap . 63. Heater & Vent -Final 13. Roof Drains �, 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas 0 Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd, Storage Tank ❑ Gas ClOil 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-Frinal 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 'LI�0-s- of 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46, Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison . 50. Gas Release to Southern California Gas Co ,51. CERTIFICATE OF OCCUPANCY No. Date ,.f rq Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations, CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address _ Zl1 W. 17th St. Bldg(J) Unit 3 PERMIT NO. M 8 TRACT NO. LOT NO. U z : J TYPE OF CONSTRUCTION NEW LJ ADD LJ ALTERATION LJ REPAIR 1:1 CONVERSION El DEMOLISH EDOTHER DESCRIPTION OF WORKIUSE OF BLDG. Applicant's Mailing Address —13110 Sati rraY St N.HO11YWOOd Owntr's Name Trnir T 549 2988 Phone _ Address �l+—�21 Birch StTlaTonnrt Reach -Ca. Sub Panel Fan TYPE OF PERMIT El GRADING ED FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ® MECHANICAL [::],OTHER -- -- ArchlEng. Mar-in-1,� ,Book _License No. __ _ _ Address 1 �5��F1A1 C �VI�, Sui t to % i fi Contractor's Name- D...,,, Air f nnri; ri nn; na X89 1216 Address (mailing) „�, �t x,$011 wnnrl —1311..0 Sata�co S -e• 3 PROJECT DESCRIPTION SQ. FT. CONSTRUCTION TYPE OCCUPANCY VALUATION $ City License No. 39Q25 _. _ �cr� ZONE GRADINGCU.YDS. ACRES LICESED CONTRACTOR DECLARATION N Switches Sign Remarks: ; Standing Sections I hereby affirm tnat I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business an rofesslons Code, and Trash Compactor PLAN CHECK my license is in full force and effe 34b251 License Class C Ll 0 0. Date�,�,�(f Signature PERMIT PLUMBING FEES WORKERS' COMPENSATION ISE ARATION I herby affirm that f have a certiff a of consent to self -insure or a certificate Bar Sink Showers Backflow Preventer Service Sink .f Workers' Compensation Insur nce, or a certified copy thereof (Section 800, Lab. C.) Wc9824 Lumbermans Policy No. Company BCertified copy Is hereby furnished. Certo copy Is filed with the city Buildir��y��y1�si n. Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Date Applicant L1�^� --- EXEMPT( N FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (3100) or less). I certify that in the performance of the work for which this permit is Issued, i shall not employ any person In any manner so as to become subject to tho Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Workers' Compensation Laws of California.. Floor Drains Swimming Pool w/Spa Date Signature NOTICE: if, atter making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit snail be deemed revoked. CONSTRUCTION LENDING AGENCY 1 her@by affirm that there Is a construction lending agency for the performance Of the work for which this permit Is issued (Section 3097 Civ, C.) Lender's Name Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lender's Address OWNER BUILDER DECLARATION I hereby affirm that t am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, atter, improve, demolish or repair 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 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 031.5 by any applicant for a permit subjects the applicant to a civil 'natty of not more than five hundred dollars (3500). ' t� I. as, owner of the property or my employees with wages as their solo compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale, If, however, the building or Improvement is sold within one year of Com- pletion, the owner will have the burden of proving he/she did not build or Inn- Prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the protect (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains Reinspection Fee S15 Issue Fee $ 3 MECHANICAL FEES Boiler Hood Or Type I ❑ Canopy • Type I I ❑ Duct - Under Ground Duct - Structural Refrigeration System 1:10.100,000 BTU ❑100,000 BTU Duct - Ventilating Exhaust System ElMultiple © System Repair/Alteration tractor(sj iicense pursuant to the.Contracto-r's License Law). I am aware that Proof off their Worker's Compensation insurance should be provided to me. Firepl/Fact. Bit, ICBO-* Fire Dampers ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I N@rebycertify that I have read this application and state that the above information Is correct. I agree to ply with all city and County ordinances and'state law elating to builds onstructfon, and hereby authorize repre- sentatives o t s city to ent r on the above-mentioned property for inspection 1 Heating System & Ducting 100-100,000 BTU 0100,000BT Registers , Reinspection Fee $15 Issue Fee $ 3 Signature Date - - Drivers' Licens or SS � CMF 0865-46, re%10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 2300 5/03/85 A.P. 0 1 Zone S Main Building: Accessory Building: E T Front B Rear A C R ight S Left Ping, Ref. # Parking Req./Provided Planning Notes: ELECTRICAL Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW' ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas [--)Electric Sub Panel Fan Motors ❑0-1 HP 01)4 8 F.A.U. Inc. Solar ❑9-15 HP ❑18.15+ Fixtures Micrbwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal ; Standing Sections Generator 1:10-5 KW 05-15 KW Trash Compactor 15.54 TL Z O N 1 N G R E a M T S FEES Reinspection Fee S15 Issue Fee S 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat �� SUMMARY OF FEES BUILDING PERMIT $ SMIP S PLAN CHECK S PERMIT PLUMBING S ISSUANCE S PLAN CHECK 25% S ENERGY P.C. S ELECTRICAL S GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ —13- 00 TOTAL FEE $ 15 •_50 PLAN CHECK 25% $ --) Sn_ CONSTRUCTION AND PLANNING APPROVALS - Permit,# Date Inspector POOL __ SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. -Soil Pipe-Undrgrnd, 53. Steel Reinforcement - r 3. Electrical Conduit Utility-Undrgrnd.' 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 1 6. Electrical UFER Grnd. + 57. APPROVAL TO COVER-GUNITE ` ,J 7. Footings 58. Electrical Conduit-Undrgrnd. 8: Foundation 59. Gas Pipe, ❑ Undrgrnd., Test !% 9. Water Pipe-Undrgrnd. - : 60. Backwash Lines, P -Trap, ❑ Undrgrnd. , 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Conriectign 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 APPROVALS. Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27, Frame and Flashing 76, Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29, Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning j z/ 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PFRMIT NO. I TRACT NO. I LOT NO. I UNIT Nf) CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address _ 711 W_ 17th Sr, 1i]�ja (.T� 1 TTni r Applicant's Mailing Address 13.110 Saticoy St. N.HO11ywo0 Owner's NameTZoy Investment Fu11d. Phone 549 29 8 Address 4-321rch 5t. Newport Bei3ch, Ca_ Arch/Eng. License No. Address Suite 216 Contractor's Name hone 982-1 � ) Address (mailing1311Q Sati my Sr- N_ H a1 13 ii Jona^ City, License No, 3399 9 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of 'ter 9 (commencing with section 7000) of Division 3 of the Business an Pr fessions Code, and my license is in full force and effec . License Class Li n o346951 DateSignature WORKERS' COMPENSATION DEC ARATION I hereby affirm that I have a certifi to of consent to self -insure or a certificate ,f Workers' Compensation insur ce, or a certified copy thereof (Section 500, lib. C.) Policy No. WC9824 Company Lumbermans H Certified copy is hereby furnished. Certif' opy is filed with the city Bui Ig i ision. Date Applicant—�!L`.-� EXEMPTIO FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensatiqn Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such brovlslonS or this permit shall be deemed revoked. CONSTRUCTION LP-NDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for. Which this permit is issued (Section 3097 Civ, C.) Lender's Name Lender's Address -- OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requir@s a permit to construct, alter, improve, demolish or repair any Structure, prior to its Issuance, also requires the applicant for such permit to file a Signed staternent that he/she is licensed pursuant to the provisions of 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 031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). - 0 i, as owner of the. property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered forSale (Section 7444, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who dhes such work himself/herself or through his or her own ' employees, provided that such improvements are not intended or offered for sate. If, however, the hulloing or improvement is sold within one year of com- ptetion, the owner will have the burden of proving he/she did not build or im- rove for the purpos(a of sale). I'as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's Litense Law does not apply to an owner of property who builds or improves thereon, and who contracts for Such projects with a con- tractor(s) license pursuarit to the'Cdntractor's License Law). I am aware that proof o their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby "InI have r d tnis application antl state that the above informatioI agree comply with all city and county ordinances and state to b ng construction, and nereby authorize repre- sentatives y to n r upon the above-mentioned property fob nspectio SignatureDate Drivers' Li CMF 0865-46, rev. 10/84 - Wnite - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 2303 5/03/95 15,50 TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR s ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. # Zone S Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATI�O-NI LLJJ STRUCTURAL ❑ TENANT 1:1 ELECTRICAL 1:1 PLUMBING U MECHANICAL ❑ PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION S ZONE GRADING CU.YDS. ACRES ~� J E T Frpnt Z O 13 A Rear N OTHER C Right N g Left G R Ping. Ref. # Parking Req./Provided E Remarks: Planning Notes: O M T 5 PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink _ Automatic Washer l Construction Pole Sub, Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Floor Drains Solar Tank Swimming Pool vv/Spa Fan F.A.U. Motors ❑0.1 HP ❑ 1'h - 8 Inc. Solar 09-15 HP 1:116-15+ Floor Sinks Urinal Fixtures Microvvave Gas Service Outlets Interceptors Kitchen Sink Lavatories Water Closet Water Heater Water Service , Auto -Wash Y Device Boxes Outlets Switches Garbage Disposal Pale Light Range Sign ; Standing Sections P—Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee S 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By ^.Date Approved By Date Application Issued By Date:: _ Boiler Hood or Type I • D Canopy,Type 11 [] Duct - Under GroundBuilding Duct - Structural Refrigeration System ❑0.100,000 BTU 01100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY $ S $ $ $ $ S —13.00 $ OF FEES SMIP S PERMIT ISSUANCE $ ENERGY P.C. $ GRADING S ' MICROFILM $ TOTAL FEE $ 15.50 2.50 Exhaust System ❑ Multiple ❑ System Repair/Alteration Fiirepl/Fact. Bit. ICBO # Fire Dampers 1 Heating System & Ducting ®0-100,000BTU ❑100,000BT Registers b 10 Reinspection Fee $15 Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS - Permit:* Date Inspector POO, SPA APPROVALS Permit :#-' Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location �. 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement t' 3. Electrical Conduit Utility-Undrgrnd. 54. Forms t 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. ( +y./' 57. APPROVAL TO COVER -G UNITE 7. Footings ~; 58. Electrical Conduit-Undrgrnd. ,t 8- Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15, Rough Electricat-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, POO USPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS- Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank []Gas © Oil 25. Roof Sheathing 74, Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75, Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. drywall Nailing HEALTH DEPT, REQUIREMENT 31. plaster Brown Coat 79, FINAL INSPECTION 32, Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning !! 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 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 e� 51. CERTIFICATE OF OCCUPANCY No-___ Date „ Cf Applicant to fill in all spaces except those within heavy. border and sign all appropriate declarations. CITY OF COSTA MESA C NSTR�TION PERMIT, PERMIT NO TRACT NO. LOT NO. Project Address Applicant's Ma"i 9 Address Owner's Name hon Address Arch/Eng. License No. Address t Contractor's Nam Ph e Address {mailing] City License No. LICENSED CONTRACTOR DECLARATION I.hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in f rce and effect. License lass License No Date — i9nature WORKERSC MP ATiON UA RATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate of workers' Compensation Insurance, or a certified' copy thereof (Section 300, -Lab. C.) alley No. Company eCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued I shall not employ any person in any n1apper s s to become subject to the Work e Cp ati ws of Calif n Date Signature 'NOTICE: If, after ma Ing this declaritJ6n, you should become subject to the Workers' Compensation provisions c the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 her by affirm that there Is a construction lending agency for the performance ' of ]e work for' which this permit Is Issued (Section 3097 Civ. C.) Len Name Leny�r's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 -131"5 by any applicant for a permit subjects the applicant to a civil salty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such' improvements are not intended or offered for sale. If, however, the bulldinq or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I. as owner of the property, am exclusively contracting with licensed con. 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 builds or improves thereon,-antl _who contracts for such projects with a con- tractor(s) license pursuarit't0 the Contractor's Llcensi Law). I am aware that Proof off their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. tL P. C. for this reason' Date Owner I hereby certify that I have read this application and state that the above information is correct. I agreeto comply with all city and county ordinances and state laws relating to'.i,ding construction, and hereby authorize repre- sentatives of this Ci to enter upon the above-mentioned Property r inspection ses. y Signature Date 14 Drivers' Li se orr55 TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TYPE'OF PERMIT GRADING FOUNDATION 11 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL - A Rear ❑ ,OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU, YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Interceptors , Kitchen Sink Lavatories P—Trap Roof Drains - Reinspection Fee -Outlets $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact• Sit. ICSO 965 Heating System & Ducting ❑0-100,000,13TU ❑100,000BT Reinspection Fee I $15 ?IF 0865-46, rev, 10/84 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor PLUMBING Showers - Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays issue Fee MECHANICAL Hood or Type I , ❑ Canopy Type II ❑ Refrigeration System 1--10.100,000 BTU ❑ 100,000 BT System Repair/Alteration Fire Dampers Registers Issue Fee Zone Accessory Building: Z O N I N G R Parking Req./Provided E 0 M T S FEES ELECTRICAL FEES Q(� Automatic Washer Construction Pole Sub. Transformer ❑ 15-'50 KW ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors 00-1 HP ❑ 135 - 8 F.R.U. Inc. Solar 1:19.15 HP 1:116-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range O Switches Sign Garbage Disposal ; Standing Sections Generator ❑0-5 KW ❑5-15 KW Trash Compactor $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued Date --?117g,3-. BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY $ $ $ $ _ $ $ $ $ OF FEES SMIP $ PERMIT 9-00 ISSUANCE $ �. �' ENERGY P.C. $ GRADING $ MICROFILM $ p AL FEE $ ^�.r ,SD $ 3 CONSTRUCTION AND PLANNING rAPPROVALS Permit# Date Inspector I, POOL 'A APPROVALS Permit # Date Inspecrnr 1h Tempeyary Electrical Service or PolB 1) {� 52. Pool & Equipment Location �) 2, Soil P`p -Undrgrnd, 53. Steel Reinforcement '.�,EleCrical Cond'ulity Undrgrnd 54. Forms 4r Elect'rii al Conduit -U d(grnd. 55. Electrical Bonding j 5Steel Reinforcement r� jj 56. Rough Plumbing & Pressure Test 6• �Electrica] UFER G nd. . _ ✓} �' 57. APPROVAL TO COVER-GUNITE 7; .Fo t %J gs 58. Electrical Conduit-Undrgrnd. . ift Por ';,_ tion L'l� i .� 59. Gas Pipe, O Undrgrnd., Test 91te-rP�r d �1 13e-Undrg. 60. Backwash Lines, P -Trap, Undrgrnd. 10�'Strlc'tur 1 Floor System l +� [� 61. APPROVAL TO DECK 11. Pro'pertzy-Pewer Line&'House Coln6ction 62. Backwash& Receptor -Final 12, Sewer Capp iA 63. Heater &Vent -Final 13. hoof D`/ �`.► 3 64. Plumbing System - Final 14. Rough`•Rumbin 4d 65. Electrical -Final t 15. Rough Electrical-donduit 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Duets, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. UnSerground Flush 24. Roof Framing 73. Undergrnd. Storage Tank []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 PREY. FINAL 30, Drywall Nailing HEALTH DEPT, REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning , 35. Final Gas Pipe -Test �Z'! 36. Hood or Canopy 37. Final Factory Fireplace i 38. Final Plumbing j �t 39. Water Service -Final I 40, Gas Service -Final + 4,1< Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant t0 fill In all spaces except those within heavy border lines and sign all appropriate declarations. CI7"Y OF COSTA MESA CO STRUCT ON PE MIT Pro)1.-act PF.F1MlT NO. TRACT NO. LOT NO. UNIT NO, p ect Address Applicant's Malifinq Address AV r Owner's Name V Phone— Address -- Arch/Eng. License No. Address Contractor's Nam Phone Address (mailing, City License No. LICENSED CONTRACTOR DECLARATION 1 -hereby affirm that I am licensed under provisions of Charter 9 (commencing with section ,7000) of Division 3 of the Business and Professions Code, and my license is in f y1lorce d if t. Licen •Class A License NQ3G2ane12 Date Signature WORKERS' COMPENSATION D RATION I hereby affirm that I have a certificate of consent to selfansure or a certificate ,f Workers' Compensation Insurance; or a certified copy thereof (Section 800, Lab. C.) Policy No. Company BCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit Is for one hundred ($100) or less). I certify that in the performance of the work forwhich this permit is issued I Shall not employ any person in any ma er so s to become subject to t(te Workeys' Cotp�ti@yws of Calif Date CC �' Signature -- , 'NOTICE: If, after making this declare- n, you Should become subJR,ec�o e Workers' Compensation provisions o the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address _ OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of 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 431.5 by any applicant for a permit subjects the applicant to a civil analty of not more than five hundred dollars ($500). ❑ I, as owner of the properly or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such, improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will.have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively Contracting with licensed con- 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 builds or improves thereon, and _who contracts for such projects with a con- tractor(S) Ilcense pursuant�to the Contractor's License Law), I am aware that proof of their Worker 'S Compensation insurance should be provided to me. ❑ !'am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county Ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this 'ty to enter upon the above-mentioned property f r inspection se Signature Date Drivers' L;t_�-,S ,3- TYPE OF CONSTRUCTION LJ NEW LJ ADD L_J ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. -0 5910 7/op/85 Zone IOn50 $ Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION M STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION S ZONE GRADING CU.YOS. ACRES E T Front Z 0 13 A Rear_ - N C Right N. K Left R Ping. Ref. Parking Req./Provided E Remarks: Planning Notes: - - M T S PLUMBING FEES " ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink Automatic Washer Construction P_OleSub• Transformer ❑ 15-50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit, Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwrasher Meter _❑Over. 100 amps Dishwasher War Piping Dryers ❑Gas DElectric Sub Panel Drinking Fountains Solar Tank Fan % Motors ❑0-1 HP ❑ IA -8 Floor Drains Swimming Pool vv/Spa F,A,U. Inc. Solar ❑9.15 HP C1 16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service , - Outlets, Water Closet 71100Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories P—Trap Auto -Wash Laundry Trays Garbage Disposal ; Standing Sections Generator ❑0.5 KW 05.15 KW Trash Compactor Roof Drains Reinspection. Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee S 3 MECHANICAL FEES SERVICES REQUIREMENTS: Zoning Zoning Approved By Date Building Approved By Date Application Issued By Dat Boiler Hood or Type l El Canopy Type 11 ❑ Duct - Under Ground Duct - Structural Duct - Ventilating Refrigeration System 00-100,000 BTU ❑ 100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 2596 ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ Qf •Oji ISSUANCE $ $ T ENERGY P.C. $ $ GRADING $ $ MICROFILM $ $ TOTAL FEE $ /-d- $ s t/ Exhaust System ❑ Multiple ❑, System Repair/Alteration Firepl/Fact. Bit. ICBG # Fire Dampers Heating System & Ducting Registers [10-100,000 BTU El 100,000 BT Reinspection Fee $15 Issue Fee $ 3 AF 0865-46, rev, 10184 White - Building: Canary - ppiicant: Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING r 'APPROVALS - Permit # Date " fnspe r POOL PA APPROVALS Permit # Date fnspecmr r1. Tempay Electrical Service or Poli - 52. Pool & Equipment Location 2. Soi�ipte-Undrgrnd. �•� 0? 53, Steel Reinforcement 3`ElectriA' Conduii�l tilitY Undrgrnd] rO 54. Forms v 4'�-Elec Cica)Conduit7Wi tfr rnd. J All tG 55. Electrical Bonding A rr -5 Steel;Rpforcemew?it�� x 56. Rough Plumbing & Pressure Test itt 6f le tr,!ical UFER &-A ixti�`vn f� , 57. APPROVAL TO COVER-GUNITE l r 7.40Fting§ t'R oo 1�,' 5$ . Electrical Conduit-Undrgrnd. 8 Fou�r�nation 59. Gas Pipe, 0 Undrgrnd., Test IPA _9. %W e��ye-Undrg�nd. �� 60. Backwash Lines, P -Trap, ❑ Undrgrnd. p� lO�Stru tubal FloorrSyystem 4 r A r u l -y •, F, n 61 • APPROVAL TO DECK 11. Ppert/r�''fSewer Line& House Connection 62. Backwash & Receptor -Final 12. Sewerpr� -Final 63. Heater & Vent -Final 13. Roof Drains �� 40' o a ^ 64. Plumbing System Final 14. Ro �gh',Plumbing� 65. Electrical -Final 1711 15. Rough Electric ll `Cysonduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17, Rough Wiring Sign 68. APPROVED FOR PLASTERING 18, (lough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19•. Rough Heating & Air Conditioning _ FIRE DEPT- REQUIREMENT APPROVALS Permit # j 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas• ❑ Oil 23. Gas Pipe -dough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74: Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76, Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37- Final Factory Fireplace 36. Final Plumbing 39. Water Service -Final -pr Awe 40, Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer f 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date _ i ,,dwk� , _ CITY OF COSTA MESA CO STRI2NIPERMIT Project Address Applicant's Mailing Address Owner's Na a ho Address zux Arch/Eng. License No. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. M L Address Contractor's Nam %�� Phone. Address (mailing) City License No. !�x r' LICENSED CONTRACTOR DECLARATION i•hereby affirm that,l am licensed under provisionsof Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license'is in f orc�d feet. tacens Class License N Date Signature' WORKERS' CO PL=NSATION DE RATION I hereby affirm the! I have a certifica a of consent to self -insure or a certificate of Workers' Compensation. Insurance, or a certified copy thereof (Section 800, Lab. C.) o_licy No. Company BCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS%COMPENSATION DECLARATION , (This section need not be completed if the permit Is for one hundred ($100) or less). 1 certify. that in the performance of the work for which this permit is Issued, I shall not employ any person in any mnne s s to become subject to the ' Work Co ens I Laws of Califo _ Date r Signature NOTICE: If, a ter making this declare i , you should become subject to the Workers' Compensation provn isios o he tabor Code, you must forthwith comply with' such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY ' I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 '031.5 by any applicant for a permit subjects the applicant to a civil nalty of not more than five hundred dollars ($500). ❑ I, as owner of the property'or my employees with wages as their sole , compensation, will do the work, and the structure Is not intended or offered for sale, (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ' - ❑ I. as owner of the property, am exclusively contracting with licensed Con- tractors to construct the prosect (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon,,and who contracts for such projects with a con- tractor(s) license pursuant•to'the 'Co iitractor's License Law). I am aware that proof of their Worker's CompenSall on insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application acid state that the above Information is correct. I agree to comply with al) city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentallves of is ci to enter upon the above-mentioned roperty for in p S. Signature Dat 'r Drivers' Li se or'SS =)F P RMIT NO.TRACT 17?// NO., 1.j'5911 LOT NO. UNIT NO. 7/02/55 10,,503 TYPE OF CONSTRUCTION NEW ADD LJ ALTERATION ❑ CONVERSION' ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLOG. REPAIR A.P. Zone' S Main Building: Accessory Building: TYPE OF PERMIT GRADING1:1 FOUNDATION LJ STRUCTURAL ❑ TENANT -❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER. ' PROJECT DESCRIPTION SQ. FT, OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU. YDS. ACRES E T Front 2 0 a A Rear N, I ' C Right N K S Left , G R. Ping, Ref, Parking Req./Provided E Remarks:. Planning Notes: M . T S, PLUMBING FEES ELECTRICAL FEES f Bar Sink Showers Backflow Preventer Service Sink OJ Automatic Washet " Construction Pole Sub,I Transformer ❑ 15-50 KW ❑ 50 + KW i Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter. ❑overA00amps. Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan MotorsOO-1 HP Eli,/. -8 Floor Drains Swimming Pool vv/Spa F. A. U. Inc. Solar ❑9-15 HP ❑ 16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet' Device Boxes Pole Light Interceptors, _Water Heater Outlets Range Kitchen Sink Water Service a Switches Sign Lavatories 'Auto -Wash Garbage Disposal stand irng.sections P—Trap Laundry Trays Generator ❑0.5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $'3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Duct - Under Ground Hood or Type 1 ❑ Canopy' Type 11 ❑ DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date Data _ `S Duct - Structural Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLAN CHECK 2596 ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMITPLUMBING $ 00 'ISSUANCE $ ' $ � ENERGY P.C. $ $ GRADING $ $ MICROFILM $ $ TOTAL FEE $ $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG # Fire Dampers Heating System & Ducting ❑0-100,000 BTU ❑100,00067 Registers Reinspection FeeT $15 11 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING Date APPROVALS � Permit # Inspector � POOL, A APPROVALS Permit # Date Inspector . 1.. Temp%y Electrical Service or Palr7 52. Pool & Equipment Location h ..2. Soil Pib'!Undrgrnd. f' 53. Steel Reinforcement n- 3., Eleclf,cal•Condui�t E7 iliSy Undrgrnrry \I . l.' e ' 1 �~ 54. Forms v 4 --Elect 4 I1Canduit�lndrgrnd. .55. Electrical Bonding 3. Steel jReinforcem6nt� v�. i ✓ 56. Rough Plumbing &Pressure Test i'01 ? '6:�'Ele66201 LIFER brpd. �� r .rii1 57. APPROVAL TO COVER-GUNITE Ali 7! �ootdn�g cJ n, IJ 58; Electrical Conduit-Undrgrnd. 8? FoudationVA m L 59. Gas Pipe, E)Undrgrnd., Test I. Wtip-ate�ipe-Undrg �d! !a ~ r� 60. Backwash Lines, P -Trap, ❑ Undrgrnd. f 10. Str�c��t gyral Floor System r I1 61. APPROVAL TO DECK 11. Properixiewer Lin` & House Connection i 62. Backwash & Receptor -Final 12. Seer Ca`) 63. Heater & Vent -Final 13, Roof Ddains to 1 64, Plumbing System -Final rr 14. Ro4h.Plumbing 65. Electrical -Final N 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access'Approval " 17. Rough Wiring Sign 69. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT - APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating '' 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing t 73. Undergrnd. Storage Tank ❑ 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 i 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 1x 36. Hood or Canopy 37. Final Factory Fireplace 38'. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer \ 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL,STRUCTURE & BUILDING 48. Specia.I-Requirements Completed 49, Electric Release to Edison - - 50. Gas Release to Southern California Gas Co \57. CERTIFICATE OF OCCUPANCY �. Date ad C1 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA STRUCN PERN�IT PEAMI7 NO. _ TRACT NO. LOT NO. UNIT NO. Project Address 1711��%'`j�'►'- Applicant's MailinS,,AOdress Owner's rJacne one Address ! Arch/Eng. License No. Address Contractor's Na Phon Address (mailing] L r City License -No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is In f for and effect. Liven Cl s License Nq Date lana t, WORKERS' COMPENSATION AgZARVION 1 hereby affirm that I have a certif ate of consent to self -insure or a certificate ' -)f Workers' Compensation Insurance, or a certified copy thereof (Section - 1800, Lab. C.) Policy No, Company, 8 Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or I certify that in the performance of the work for which this permit is Issued, I shah not employ any person In any m er so as to become subject to the Wor s'. C an io ws of Calif 1 Dat Signature "NO CE: 11, fter akl g this declar I ybu should become subject to e Workers' Compensation provisions o he Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION- LENDING AGENCY ' I hereby affirm that there is a construction lending agency for the performance of the work for which this_ permit is issued (Section 3097 Civ, C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for.t6a following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demallsh or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensedPursuant to the provisions of the Contractor's License taw (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars (5500). I, as owner of the Property or my employees with wages as their sole -compensation, will do the work, and the structure is not intended or Offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- ptetlon, the owner will have the burden of Proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: Tho Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for Such projects with a con- tractor(s) license pursuant'to the Contractor's License (aw). I am aware that proof of their worker's Compensation insurance should be provided to me, ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application• and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city enter upon the above-mentioned 'property for inspection p S. 1 Signature Date Drivers' Lic n or S� 1& V 5 TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION L_1 REPAIR ❑ CONVERSION ❑•DEMOLISH ❑ OTHER A.P. DESCRIPTION OF WORK/USE OF BLDG. S Main Build! E TYPE OF PERMIT El GRADING LJ FOUNDATION 0 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION $ S 1_eft ZONE GRADING CU. YDS. ACRES Ping. Ref, # Remarks: Planning Notes: FEES 5908 7/02/65' Accessory Building: , Parking Req,/Provided I ELECTRICAL 100.:0 TL Zone Z O N 1 N, G R E Q M T S FEES (% PLUMBING Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Drinking Fountains Solar Piping ` Solar Tank Floor Drains Swimming Pool w/Spa FloorSinksUrinal Gas Service Outlets Water Closet Interceptors Kitchen Sink Water Heater Water Service Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains Heating System & Ducting ❑x100,000 BTU ❑100,000 BTU FEES 5908 7/02/65' Accessory Building: , Parking Req,/Provided I ELECTRICAL 100.:0 TL Zone Z O N 1 N, G R E Q M T S FEES (% Automatic Washer, Transformer ❑ 15.50 KW Construction P_ oie Sub. ❑ 50 + KW Reinspection Fee $15 Issue Fee $ 3 Cooking Unit Meter ❑up to 100 amps MECHANICAL FEES Dishwasher _ Meter ❑over 100 amps Boiler Dryers ❑Gas ❑Electric Sub Panel Fan Motors 00.1 HP ❑ 1)4 - 8 Hood or Type I ❑ Canopy Type it ❑ F,A-U. Inc. Solar 139-15 HP C116- 15+ Duct - Under Ground Fixtures Microwave .JJ 6U Device Boxes Pole Light Z Outlets Range Switches Sign Garbage disposal ; Standing Sections Exhaust System ❑ Multiple ❑ Generator ❑0-5 KW ❑5-15 KW Trash Compactor AF 0865-46, rev. 10/84 W - - ; Pink - Accounting; Goldenrod - Assessor Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved B A y Date Application Issued By Data _ Boiler Hood or Type I ❑ Canopy Type it ❑ Duct - Under Ground Duct - Structural Refrigeration System ❑x100,000 BTU ❑ 100,000 BTU Duct - Ventilating SUMMARY OF FEES BUI LDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ �� d0 ISSUANCE $ PLAN CHECK 25% $ / ' ENERGY P.C. $ GRADING $ ELECTRICAL $ , PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ - /0 --its PLAN CHECK 25% $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firep1lFact- Bit. ICBG Fire Hampers Heating System & Ducting ❑x100,000 BTU ❑100,000 BTU Registers Reinspection Fee $15 Issue Fee $ 3 AF 0865-46, rev. 10/84 W - - ; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING Date 'APPROVALS Permit # _ Inspectgr ill POOL -.,.,PA APPROVALS Permit # Date Ins Pfftii p . Temprr Electrical Service or Poi ,) 52. Pool & Equipment Location 2. Soil Pr e�'Undrgrnd. 1 53. Steel Reinforcement 3.. Elerical Conditih-Undrgr(Ad. .r R 1 A► 54. Formsr ei Cl 4. Electvica Conduit U'drgrnd. r 55. Electrical Bonding 5. Stee`R✓rnforcemefit �r '� 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVE R-GUNITE ? c� 6�-,AElectrical LIFER Grnd. s�'•'' 7, Footifig' h 58. Electrical Conduit-Undrgrnd. Ir B.iFour�dation R 59. Gas Pipe, ❑ Undrgrnd., Test 4 ,n 9I Water/Pipe-Undrgrnd! * 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structuyal Floor Syst1m 1 + 61. APPROVAL TO DECK 11�-Propertytewer Line & Housedori`niction Y -f 62. Backwash &Receptor-Final 12. Sewer+Cap I lo 63. Heater & Vent-Final 13. Roof Orlins •� 11 10,4-nt� el 64. Plumbing System - Final 14. RoughBiumbin9 d 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 APPROVALS Permit # 20, Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23• Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29, Insulation 78. FIRE PREV. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe-Test x /ff 36. Hood or Canopy 37. Final Factory Fireplace '3$ Final Plumbing ow 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 1�•f ;P� 43. Backflow Irrigation r 44, 'Landscape Irrigation System 45. Sound Attenuation c 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. CER IFICATE OF OCCUPANCY Nn. Date CITY OF COM=A MESA CONSTRUCTION PERMIT Job #851;, Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. LOT NO. BLD / ' Project Address 711 W. 17th St. Ste.J4 -COSta Ilp-sa_._ Applicant's Mailing Address - G53.1�,�.[W cn neo Owner's Name nl'Ci oh composit-P,_; Phone—i1 Address oSt Ste - 14, Costa Mesa 9962 7 Arch/Eng.' License No. Address Contractor's Nam Phone 546 -Z653 - Address (mailingl 2952 Cenrury Place, Costa Mesa 92626, City License No. 005963 ' LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect. License Class — �* License N��8604 — Date,� y_ Slgnatu r j - J WORKERS' COMPENSATION O - RATION ' hereby affirm that I have a certificate of consent to self -Insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. '/"S _ifq5y CompanyKIA2'GI 66� - ❑ Certified copy is hereby furnished. ertlfi tl co is flied with the ci Bui D1vislon. Date"`� APPlican EXEMPTION FROM WORKERS' COMPENSATION DECLARATION -- (This section need not be completed if the permit is for one hundred ($300) or less). I certify that in the performance of the work forlwhich this permit is Issued I shall. not employ any person in any manner so as to become subject to lite Workers' Compensation Laws of California. ' DateSignature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be' deemed revoked. CONSTRUCTION LENDING •AGENCY• 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit, is Issued (Section. 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION } I here4y affirm that I am exempt from the Contractor's License Law for the fel]owing reason (Section 7031.5'Business and Professional Code: Any city of county which requires a permit to construct, alter, Improve, demolish or. repair any structure, prior to Its issuance, also requires the applicant for such permit ,to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of '1vlsion 3 of the Business and Professions Code) Or that he/She is exempt herefrom and the basis for the alleged exemption. Any'vlolatlon of Section 1031.5 by any applicant for a Permit subjects the applicant to a civil Penalty of not more than five hungred dollars (5500). LJ 1, as owner of the property or my employees with wages as their sole compensation will do the work, and the structure Is not Intended or offered for sale (Sec{ion 7044, Business and Professional Code:, The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Ir n. rove efor the purpose of sale). I I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or Improves thereon, and who contracts for such projects with a con. tractor(s) license pursuant to,the Contractor's License taw): ❑ ' I am exempt under Section B. & P. C. for this reason Date Owner I herebycertify that I have read this application and state that the above information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, nd'hereby authorize repre- sentatives—tftis�city to enter—u on the ab e -mentioned property ,for inspec n pure as. Smnat `� Date f TYPE OF CONSTRUCTION NEW ADD LJ ALTERATION R PAIR Backflow Preventer ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Backflow Irrigation A P. -E 1 DESCRIPTION OF WORK ' Sewer Connection Clarifiers Solar Collectors 1j _ Solar Piping S Main Building: Floor Drains Swimming Pool wlSpe Floor Sinks Urinal i TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL 1:1 PLUMBING l�VMECHANICAL Lavatories F.A.U. ❑ LOTHER A Rear C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Range CONSTRUCTION TYPE VALUATION S S Left, ZONE GRADING CU.YDS. ACRES Ping. Ref. + Remarks: Parking Req./Provided Generator ❑0.5 KINT1.5-15 KW Trash Compactor Use of Building: PLUMBING FEES. Planning Notes: Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors 1j Dishwasher , Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool wlSpe Floor Sinks Urinal i Gas Service Outlets Water Closet Interceptors ' Water Heater Kitchen Sink Water Service Lavatories F.A.U. P --Trap Roof Drains Microwave Reinspection Fee $25 Boiler Duct _ Under Ground Duct - Structural Duct - Ventilating Exhaust System Multiple ❑ Firepl/Fact. BIL ICBD �k Heating System & Ducting 00.100,000 BTU 0100,0005T Driers' License or SS =r Reinspection Fee CMF 0865-46 fey. 7/83 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System 1:10-1100,00OBTU 0100,000 BTU System Repair/Alteration Issue Fee 2666 1/18/84 - 1 Zone Accessory Building: Park. Fees $ I � � J 1.50 TL Z O N I N G R E Cl L! . 1 R E M E N T I ELECTRICAL FEES Automatic Washer Construction Pole Sul). Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit `w - 'Meter El up to 100 amps - Dishwasher Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan' Motors 00-1 HP ❑ 114 - B F.A.U. Inc.Solar 09-15 HP ❑16-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal Standing Sections ' Generator ❑0.5 KINT1.5-15 KW Trash Compactor S 3 Reinspection Feer $25 Issue Fee $ 3 FEES PUBLIC SERVICES REQUIREMENTS: Zoning Approved By Application Approved By Application Issued Data Date D,t j ^ SUMMARY OF FEES BUILDING PERMIT $ • ' SMIP $ ! ' PLAN CHECK $ PERMITS PLUMBING $ ISSUANCE $ f �T' PLAN CHECK $ ENERGY P.C. $ ELECTRICAL - '$ i GRADING $ PLAN CHECK $ MICROFILM $ MECHANICAL TOTAL FEE $ PLAN CHECK 7 3 $ 3 , I CONSTRUCTION AND PLANNING } APPROVALS Permit # Date Inspector POOL- -SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2." Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55, Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 6. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60, Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. 'Property Sewer Line & House Connection62. 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.i 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 APPROVALS Permit # 201 Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Tett 72. Underground Flush 2Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25Roof 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 y,G,rL Amklelwi r 35. Final Gas Pipe -Test _ S 36. Hood or Canopy 512,f{f9V•4,0rn ov- 8,{ V- ww LE9 37. Final Factory Fireplace 38. Final Plumbing mi 39. -Water Service Final 7- '40. Gas Service -Final '40. 41. Solar Domestic -Final : r' 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 APPIleani to fill In all spaees e't .._.•arid sign all appropriate declaratlona. 1� CITY OF COSTA MESA %2 1,3 PE MIT NO. TRACT NO. LPT NO. BL . CONSTRUCTION PERMIT /`-� 11096 •1 & 2 J Project Address 7 1 1 W- 1 7 t n Street Applicant's Mailing Address .2 41-8 MacArthur i31vd . C , Q . Owner's Name Tx,7_ hone 5 4 9-29 8 8 Address 4 32 R rr1-, St X— : nrtRPAr_h_ Arch/Eng. anse No. Address 2416 MacArthur Blvd . , Corona del M Contractor's Name Phone Address imailing) City License No. LICENSED CONTRACTOR DECLARATION f hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of DI vision 3 of the Business and Professions Code, and MY license Isdn full force antl effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to sell -insure or a ceftlfitate of Workers' Compensation Insurance, or a' cortifled copy thereof (Section 3800, Lab. C.) Policy No. 5 2 4 2 0 0 016 8 3 Company Argonaut BCertified copy Is hereby furnished. Certified copy Is filed with the city Building Division, "Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit Is for one hundred ($100) or less). I certify that In the performance of trio work for which this permit is Issued I shall not employ any person In any manner so as t become subject to the Worker 11 yn Lni Laws of Ca1)f a. Date Signature 16 NOTICE. If,ia ter making this declare n, you should become subject to the workers' Compensation provisions o the Labor Code, you must forthwith• comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the ;work for which this permit Is Issued (Section '3097. Clv. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the'Contractor's License Law for trio following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3of the Business and Professions Code) or that he/she Is exempt therefrom'and the balls for the alleged exemption: Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a 6,41 -pQnalty of not more than five hundred dollars ($500). , I, as owner of the, property or my employeas with wages as their sole compensation will do the work, and the structure Is not intended or offered for sale (Secflon 7044, Business and Professional Code: Tho Contractor's 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 employees, provided that such Improvements are' not intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- p1�rove for the purpose of sale). '•fit 1, as owner of the property, am oxclusively contracting with licensed can- traCtors tb construct the project (Section 7044,.Business and Professions Code. The Contractor's License Lave does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a can. traC.tor(s) license pursuant to the Contractor's License Law). , ❑ i am exempt under Section B. & P. C. for this reason Date Owner I hereby- certify that I have read is appllcatlon and state that the above Information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this cityy,� to enter upon the above-mentioned property for Inspection rposes. �J Signature Date ael AL Drivers' L anse or SS # TYRE OF CONSTRUCTION .NEW ADD .� ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK Exterior Alti?rations---- Automatic Washer Construction Pole Sub. A.P. # Z e S E T B A C S Main Building: TYPE OF PERMIT 0 GRADING LJ FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL r ❑ OTHER Front Rear PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE — VALUATiON $ 800-00 ZONE GRADING CU. YDS. ACRES Right Left Ping. Ref. # �E Remarks: 1P _ C . # 20-84S Parking Req./Provided Microwave Pole Light Use of Building: PLUMBING FEES 'Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor DTa'ins Floor Sinks Gas Service outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee $25 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 00-100,090 BTU 0100,000BT Reinspection Fee • 1 $25 CMF 0865-46 rev. 12/83 White -Building; Canary -Applicant: Pink -Accounting; Goldenrod -Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool v4spa Urinal Water Closet Water Heater Water_Service r Issue Fee ,; Hood or Type I ❑ Canopy Typeil ❑ Refrigeration System 00-100,000 BTU ❑,100,000 BTU System Repair/Alteration ? Issue Fee I71?Q 5/1{}/84 Zone Accessory Building: L;5 , f u Park. Fees $ ELECTRICAL - Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 513 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter Dover 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors ❑t}1 HP 01'%-8 F.A.U. Inc.Solar'❑9.15 HP 016-15+ Fixtures Device Boxes Microwave Pole Light Outlets Range Switches Sign ,Garbage Disposal Standing Sections Generator ❑0.5 KW 05.15 KW Trash Compactor FEES Z O N I N G R E O U I R E E N T $3: Reinspection Fee 1 $25 Issue Fee $ 3 FEES PUBLIC SERVICES REQUIRE Zoning Approved By Building Approved By Application issued By ENTS V5 �' ata Date Dat ,I T BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% $ $ $ $ $ $ $i $ SUMMAR_Y F FEES i � SMTP, $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ O D / /S`-- $ 3 TI. :CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector ;POOL & SPA APPROVALS Permit'# Date irispector,: 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd, 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms -, 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement (% 56. Rough Plumbing *& Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE Footings r,8. 58. Electrical Conduit-Undrgrnd. Foundation 59. Gas Pipe, 2 Undrgrnd., Test - 9, Water Pipe-Undrgrnd, 60. Backwash Lines,.P-Trap, ❑ Undrgrnd. - 10. Structural Floor System 61. APPROVAL TO -DECK .. 11..,,Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System- -Final x•14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wirinrl 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 APPROVALS Permit# 20..Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ Gas []Oil 25, Roof Sheathing 74. Overhead Hydro .26.--T--Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water. Service -Final 40. Gas Service -Final 41. -Solar-Domestic-Final 42. Backflow Preventer f 43. Backflow Irrigation 44. ,Landscape Irrigation System _ 45. Sound Attenuation :46. Handicap Regulations 47. FINAL STRIJCTURk & BUILDING / 7 48. Special Requirernenu Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co , 51. CERTIFICATE OF OCCUPANCY No. Date - A0PLICATION FOR A BUILDING PEP -14T Tract Block 7 Lot BUILDING PERMIT NO. Vim/ Electrical Permit No. 4 BuildingI Jt , Address 'I/ J� - (tet- {L I j Permitit um _ W. Cross Mech nlcal Area Street Per t No. / Owner bo') � ��Oc� Type of Project: ❑ New EI/Alter ❑ Addition Address / 0712C9 -11A), < 4r -3 ElRepair ❑ Convert 11 El ElOccupancy Pmt. 14 t� �1 city S(� � [.�� zip ! ! hone6 i, _ F�� A.P. Sup. Dist./ Insp. Area ;:architect/ Designer License No. Zone Spl. Pmt. No. Setbacks P/L Front C/L St. Street Width Adtlreii ' City Zip Phone Yards Left Rear ave Proj. a ig Engineer License No. ark ng Spaces ReQu ed Provide Covere2l Address City ZIP Phone Struck Height No, of Stories No. of Family _ LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 Park Fees Yes Required No C.T. Fee Receipt Zoning Approved By: Date (commencing with Section 7000 of Division 3 of the Business and Professions Code andm II ns is in full force and @f(gc Misc. License Cias is nse Num er D Date ` Cor�trtor : �� r 5 Address LJ Proposed the of Structure City and Zip 1. 1I LI1<C� `�OL6Z on f Z CONSTRUCTION LENDING AGENCY I hereby affirm tftat there is a construction lending agency for the performance of the work for which this permit is issued (Sac. 3097, Civ. C.), Occ. Class Type Ode Const. Year USEIOCCUPANCY SIZE SO. FT. Lender's Name N Candor's Address —� 1. OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law 2. for the following reason: ❑ I, as owner of the property, or my employees with wages as their solo compensation, will do the work, and the structure is not Intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with 3 4• licensed contractors to construct the project. ❑ 1 am exempt under Sec. , B&PC for this reason Date _Owner WORKERS' COMPENSATION DECLARATION Total Valuation Encroachment Permit Req red ❑ Yes ❑ No I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof �'441 L 4 1 ey-� �, /i` �] ��, �U�� Policy No mCompany,57A /- dalLP. Certified copy is hereby furnished. Certifi c y is filed with C/]�/ OF �.Af • Grading Pmt. ��^''ll Required El Yes CJ No Grading Pmt. No. Rough Grading Approved by: Data Date V �! Applicant CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed -if permit is for $100 or less). I certify that in the performance of the work for which this permit is issued, I shall not omploy any person in any manner so as to become subject to the Workers' Compensation Laws of California. PERMIT FE S Data Applicant NOTICE TO APPLICANT: If, after making this Certificate of Structural $ Pla Check $ Exemption, you should become subject to the Workers' Compensation Electrical $ Sp Cial $ In est. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO Plumbing 3 COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS Mechanical $ RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTH. ORIZE R RESENTATIVES OF THIS COUNTY TO ENTER UPON THE EMTION PRO ERTY FOR INSPECTION PUR- PO F_ pre -Grade InspectionPre-L Si ature of Applicant or Agent Date �� (� �{ I 1 Rec. o. $ Rec. No. Permit $ Issue Print Applicant's/Agent's Name - All spaces within this box must be completed to process Plan Cheek By: Issuance Approved: CMF 0335-46 (BU -281 rev. 6180 12 Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY'OF COSTA MESA - PERMIT NO. TRACT NO. LOT NO: BLDG. NO. CONSTRUCTION PERMIT ,. 6u9 i ' 5/ X5152 7.00 Project Address // / 714 .Str 3 TYPE OF CONSTRUCTION Owner 0,u LPhone-V.2-mac ElNEW El ADD ElALTERATION * �/1 Address 2.-3 LVLAA✓.ar A409.-6.9•2-6(-0 ❑ REPAIR ❑CONVERSION ❑DEMOLISH .4P. Arch/Eng. Q License No. :❑ OTHER ZONING REGULATIONS -WORK 'SK`"r � A.P. r Address DESCRIPTION OF '$J �� 4/te,eAa 0.,yflf PLNG. �Contractor f3 4 Phpne- TYPE OF PERMIT' ggREF. LINE D GRADING ❑ FOUNDATION ❑ STRUCTURAL ST.Address PROPEW LICENSED- CONTRACTOR DECLARATION I licensed Charter 9,(com- ❑ TENANT ❑ ELECTRICAL )4RLUMBING ❑MECH• 41CA SIDE Y ARI I hereby affirm thM am under provisions of -7000) of,Olylslon 3 of the -Business and 4 M - El OTHER' RIGHT mencing with section Professions Code, 'and my license is in full force and effect.. REAR -YARD (TO P/L) _ 7 _PROJECT DESCRIPTION Ll cense Class License No. _ PKC: SPACE REQ. PROVIDED,. Date Signature = - SQ. FT. _ .i �STREETWIDTH PARK,FEE $' WORKERS' COMPENSATION DECLARATION.- _ that f have a certificate of consent to self -insure or a OCCUPANCY�CONSTRUCTION T_ YPE 3 i4� fO - 'ZONING -APPROVED BY -, ' - GATE - ,I hereby affirm certificate of Workers' Compensation Insurance, or a certified copy _F7. VALUATION -- - ZONE + thereof (Section 3800, Lab. C.). GRADING CU. YDS. ACRES SPECIAL CONDITIONS: Percy No. Company - - - jrtified copy is hereby furnished. _ KS:aop.y�� _ 3��U �,�iVFp .,":rtified copy is filed with the city Building Division. �/EWMPTION %B� r7.//VL%6-7p(This FROM WORKERS' COMPENSATION DECLARATIONC Liy section need not be completetl It the permit Is for one hundred,$100) or less). cert{fy that In the performance of the work for which this permit Is Issued, I shall not employ any parson in any manner so as to becomeING .-PL:AN CHECK'ELECTRICAL - PLAN'CHECKsubject to the workers' Compensation taws of California._Date rK,T. Signature UBS SHOWERS "Uvyt NOTICE: If after making this declaration, you should become subjectTS,.. 1, URINALS "- - - - - GENERATOR - 0-1 KW 1-10 KWto the Workers' Compensation provisions of the tabor Code, you must TRANSFORMER {.forthwith comply with such provisions or this permit shall be deemedORIES DOUBLE LAYS- - -APPLIANCE 10-50KW_50+-KWrevoked. �. - - -NKS LENDING AGENCYI �-'- DISHWASHERS - - ' MOTORSCONSTRUCTION hereb affirm that there Is a construction lendin a enc for the per- y g g y --- ---�(INC.SOLAR E SINKS SUMPS' '"' . ) - 10-SO�HP 50 + NP - formance of the work for which this permit Is issued (Section 3097 Lender's Name Lentle -FLOOR SINKS FLOOR -DRAINS' ''FIXTURES ' - 'OUTLETS SWITCHES -- _ _ _ _ _ Lender's Address ` DRINKING FOUNTAINS '- SGAS TUBE SIGNS - - - - - INTERCEPTORS CLARIFIERS POLE -LIGHTS - OWNER SUP LD£R-DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for SWIMMING POOL' --' - P TRAP' POLES METERED - - .SUB— the'following'reason (Section 7031,5 Business and Professions Code: Any city or county which requires a permit to construct, alter, WATER SERVICE - 'ALTERATION' 1 PANELS- - ` MAIN SUB r - Tr Improve, demolish or repair any -structure, prior to Its issuance, also re- quires the ap�llcant for such permit to file a signed statement that he GAS SERVICE OUTLETS -) SERVICE - - ---AMP Is -licensed pursuant to the provisions of the Contractor's- License Law [Chapter 9 (commencing with Section 7000) of Division 3 of the- - WATER HEATERS' " BTU OUTPUT BBusiness-and Professions Code) or that he Is exempt -therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by SEWER CONNECTIONS' an- zplicant for a permit subjects the applicant to -a -civil penalty pf more than five hundred dollars ($500). SO LAR'TANK ---.0 -"COL•LIECTORS _ OLLIECTORS t (� s owner of the property, or my employees with wages as their sole compensation, will -do the work, and the structure is not Intended SOLAR PIPING SYS. '" ISSUE FEE-' •- - - - - or offered for sale. (Section 7044, Business and Professions Code: The Contractor's -License Low does not. apply, to an owner of a property ISSUE FEE '-� -� �' -[APPLICATION APPROVED BY -- DATE I who builds or improves thereon, and who does such work himself or through his -own, employees, -provided that such Improvementsare not _ MECHANICAL PLAN CHECK Ir � � _ SUMMARY OF FEES � r Intended or offered for sale. If, however, the building or improvement Is sold,within one_year.of completion, the owner will have the burden of proving he did not build or improve for the purpose of sale). - - - - HEATING SYSTEM 0-100,000 BTU •iBUILDING -�- [PERMIT $ �". -• -r-- - r ' 1 ❑' -I, -as -owner of -the property, - am- exclusively contracting with AND DUCTING �-- _ ,- •-_ - y _ ,SMTP. .J$ �$ cC licensed contractors to construct the project (Section 7044, Business 100,000 + BTU IP LAN CHECK 'a 0 PERMIT � and Professions Coder The Contractor's License Law does not apply to _ _ .. 'PLUMBING ISSUANCE. $ . an owner of property who builds or Improves thereon, and who con- REFRIGERATION 0-100,000 BTU $ tracts -from sueh•projects with a contractor($) Iicasned pursuant to SYSTEM --- I • GRADING" $ the Contractor's License taw), 100,000 + BTU PLAN CHECK $ ; ❑ I am -exempt under Section '8. & P. C. for this . BOILERS BTU ELECTRICAL $ -'$ 1 - reason--- - r• =i ,. 'PLAN CHECK $ MICROFILM $. Date Own SYSTEM REPAIR, ALTERATION TOTAL FEE'$ r � 1 hereby certify that 1 have read this application and state that the above EXHAVST SYSTEM MULTIPLE ! MECHANICAL $- - - _ 'I `LESS AD- Information is correct. I agree to comply with all city and county , PLAN -CH LAN CHECK $ VANCE PC - $ _- ordinances and state laws relating to construction, and hereby authorize representatives of this city -to enter upon the above mentioned property for ins ction_ 1,10isem /'A 1� � •C r FINAL FEE $ Signature _. - Drivers' License or SS ISSUE FEE -• _ - _ -Assessor GMF 0865-46 White -Building; Canary -Applicant: Pink -Accounting: Goldenrod CONSTRUCTION AND PLANNING APPROVALS Permit # F-3 736 Date Inspector POOL & SPA ,'i t APPROVALS Permit # - Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location . SoilPipe-Undrgrn, _ 44• Steel Reinforcement 3. Electrical Conduit Utility: Undrgrn. 45. Forms 4. Electrical Conduit-Undrgrn - 46. , Electrical Bonding 5. Steel ein orce 47. Rough Plumbing & Pressure Test 6. ..Electrical LIFER Grn 48. APPROVAL TO COVER-GUNITE 7. Footings 49, Electrical Conduit-Undr rn 8. Foundation 50. Gas Pipe, ElUndr rn, Test 9. Water Pipe-Undrgrn~ . 51. Backwash Lines P -Tray.❑ Undrarb - - 10._ Structural Floor System 52. APPROVAL TO DECK 11. . Property Sewer Line-& House -Connection 53. 'Backwash & Receptor -Final ' 1.2.. Street Sewer -.Connection " ' - 54.-- Heater & Vent -Final 13. Rough.Plumbing _ _ _ ;PlumbingFinal 14. Rough Electric -Conduit ;.- - v -56.- Electricai-Final 15. Rough Electric -Wiring - 57.: Solar System -Final - 16. Rough Heating & Air Conditioning 513. Fencing & Access Approval 17.- Ducts, in Structure 59. APPROVED FOR PLASTERING -18. Ducts, Ventilating 60. POOL/SPA SYSTEMS FINAL !' 19. Gas Pipe -Rough & Test 20. Roof Framing - 21. Roof SheatFiin - - = NOTES: ' 22. Frame and Flashing - ' 23.- -Insulation ) 24. Lathing & Siding - 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter -Final - 28. Final Electric 29. Final Heating & Air Conditioning _ 30. Final Gas Pipe -Test 31. Final Plumbing 32, Water Service -Final - - 33. - Gas Service -Final 34. Solar Domestic -Final r` 35. 'Landscape Sprinkling System ' 36. Sound Attenuation J ' 37. Handicap Regulations ' 38. FINAL STRUCTURE & BUILDING - 39._ Special Requirements Completed 40. Electric Release to Edison • A I- 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY - No' Date City of Costa Mesa Development Services Department CERTIFICATE OF OCCUPANCY No. G V b J Building safety Division P. O- Box 1200 Costa Mesa, California The Building located at 711 W_ 11 -7th ct•rrwr .7-9 has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group 2 Occupancy. Use of Building fOffiCAl & Warehouse Legal Description 424-091-03,04.05.06 (see reverse side for Metes and Bounds) Building Permit No 813088 Electrical Permit No.E17191 Plumbing Permit No. P19707 Mechanical Permit No..t'tl$27,• Number of apartments and/or guest rooms ISSUED TO: Building Official '16 i i'rOV Z[1V2StIIeIlt Fund 4321 Birch Street by Nlewpart Beach, CA Date L"', This Certificate of Occupancy SHALL BE posted in a conspicuous place on thepremises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec, 307 (e) U.B.C. / CMF 1015.46 rev. 1/83 White - Owner; Canary - Numerical Fife; Pink - Bldg. Permit File 4 COSTA MESA BUILDING -SAFETY DEPARTMENT APP P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 REC V For Applicant to Fill in Completely — Use Ink Only BUILDING qg ADDRESS ++/��{ L r��// 7 Y — /.l TENANT' VfiL � I� MAILING }/]r ADDRESS (J�/ 1 ( A---- J/__ . TEL_ j.- d 1922 5/04/81 36.50 TL ,TION FOR STRUCTURAL PERMIT Y 7/ 7 A.P. NO. 'r -C I- / / `r7' BUI LDI SNG S ADDRESS_ UNIT OR SPACE NO. TR,NO. LOT BLK. :>gj or- M 1=-5A I ob !I h n -r cnr Adi t:ITY t 49=0%/7- f��..;P/r— NEW ADD LTER REPAIR MbV1NG CONSTRUCTION LENDER BRANCH dDEMOLIOSH OWNER ADDRESS s VALUES ARCHITZCT TEL. USE OR ENGINE§R NQ. u ' ADDRESS ZONE TYPE GROUP f i � �Sit!;� APPROVED BY DATE Lt?l R CONTACTOn� ADDRESS I D&Ij$ AZ TEL, �7 9 CITY Gf! NO. .L/f�Iv STATE CITY APPROVED SETBACKS �•� ,p��y-r� L�(wl t LIC. NO. 1 LIC. NO. SIZE NO. DF BLDGS (FROM G/L STREET) OF LOT NOW ON LOT FRONT FT. USE OF EXLSnNG BLDG Separate permits are required for L. SIDE FT, electric, plumbing and heating work. REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION (0/64iA 1jVSrALe_ 5 ,�iL76r#-(�0+(�-t Rbveo F -B-3-7 lJ y., ,A1� i¢{Gsl- (btte.Y- aPPROveD J2�`�-�% L4 I hereby acknowledge that I have read this application and state that the above Information Is correct and agree to comply with all laws regulating building construction, and I shall not employ any person In violation of the workman's compensation laws of the State of California. I hereby certify that I em properly licensed as a contractor under SO. FT. the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are In full force and effect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE NLY: em exempt from the pr visions of the State of California Business VALUATION PERMIT FEE ; and Professions Code 3 ision Chap r 9. /// OQ Signature of /Y Permittee PLAN CHECK g 2 2 TAX o S �a ; or r Authorized Agent Date TOTAL PAID $ , SQ D Z . W W a U �Z Z_Q O u~i am J ::) J In Q W tt7 J J In Q E-) cn Z W Er 0. t1j W Z Jp In Z J tr W W Z I— w0 [h 1= Z)O 1— Z Q U J a LL Q O F- 0 0 Z 0 1— U F— f/} z 303,7 *R-1-74Faso00 a15* **1N.79 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFOR141A 92626 �PJL ATION FOR BUILDING PERMIT For Applicant to Fill in Completely RE I � Y D 7E ECEIV p SUED DING ''//,, tLRESS /I ADD13U vV' P T OWNER /Q A.P. NO.BUILDING MAIL u ADDRESS Zi �'-1 �� ' .+yam+ 1y'� ADDRESS LDC �J K 71 U _ CITY _f4QIJ rTvo�'�33 q1�Z TRACT z'S LOT BLOCK CONSTRUCTION AO PA LENOER fZ frt frD BRANCH J�f r1 OWNER ADDRESS 'A`p/ VALUE S ARCHITECT TEL.. OR ENGINEER Zf N FIRE fE �'3 3 B �� +��C i ADDRESS Y ZONE Th E GROUP •f r �� L BYPROVEO CONTRACTOR fv^/ 2 • DATE ZjS{x' �r ADDRESS ZONE,/ / NO. OF USE OF NEW�,µsfu 4 `a PLANS BUILDING o TL. rr�� CITY�R/l%E NOE.Cj5j"likir STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO, LIC• NO, MAIN BUILDING ACCESSORY BUILDING SIZE �/ r 0.t. NO. OF BLDGS. iFROM C/L TREE T) OF LOT %: S NOW ON LOT FRO FT. FT. USE OF R. £ D FT. SIZE OF .y NO , OF 6440- ��!% N W BLDG. ov ROOMS TORIES �/ L, SIDE FT EXTERIOR WALL�QG ROOF /t r,M �' a /� COVERING j COVERING w REAR _ FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. f� ' VAR. * DATE C.V.P. * APPROVED APPROVED P QATF �7 1 hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with J all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of t the State of California, I hereby certify that I em properly licensed as a contractor under 50. FT, c THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Divisicn 3, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. am exempt from tl a pro v' ions of the State of California Business VALUATION and Professions Cocie, D' i on 3, Chapter 9, PERMIT FEE $ Signature of Permittee PLAN CHECK $ Authorized Agent / TOTAL FEE $ . APR 17-714�AIOOO 698 J -**2311.50 037 COSTA MESA BUILDING -SAFETY DEPARTMENT • P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626. I TION FOR BUILDING PERMIT For Applicant to Fill RE I E Y DATE RECEIVED D E SUE �in�.jCompletely BUILDESS ~ ADDRINI ILI ESA J T 1 K RE -ROT N OWNER �� lie V• h= -V ND A.P. NO. MAIL BUILDING ADDRESS -7I+ w f7TM'Sr 8L PC, Z ADDRESS LU CWJ CL TEL, CITY NO. TRACT LOT BLOCK �— Z Z Q CONSTRUCTIONQ ALTER RE MOVING W Q LENDER f- a CO J Z) BRANCH J 0 OWNER V J/L.ID ODJ ADDRESS VALUE M J Q ARCHITECT TEL. USE FCi $ Uto Q OR ENGINEER N FIRE c F— 'U a ADDRESS ZONE TYPE GROUP oL Ly APPROVED W Z CONTRACTOR BY DATE `� r Jp Z _m J Ir ADDRESS ul LU TEL. ZONE ND.OF USE OF NEW ZCITY NO. PLANS BUILDING 0 STATE CITY YARDS APPROVED YARDS APPROVED (n CC LIC, NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING 0 0 512E NO. OF BLDGS (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. FT 1-- SIZE OF NO. OF Z NEW BLDG. ROOMS STORIES L. SIDE FT. FT. tai EXTERIOR WALL ROOF COVERING COVERING REAR FT. FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & 11 a MAIN SLOGS, ACCESS. SLOGS. Q VAR. 46 DATE 0 G.U.P. # APPROVED APPROVED (n Z VI hereby acknowledge that I have read this application and state O that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workmen's Compensation laws of N the State of California. ZI hereby certify that I am property licensed as a contractor under SO. FT, o the State of California Business and Professions Code, Divlsicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. c am exempt from the provisions of the State of California Business and Professions Cc -tie, cie, Division 3, Chapter 9, co PERMIT FEE $ n Signature ofm Permittee $ PLAN CHECK $ � E o Authorized Agent LL TOTAL FEE $