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Home My WebLink About2980 MCCLINTOCK WAY - Building Permits� WORKERS' COMPENSATION DECLARATIC 1 hereby affirm under penalty of perjury one ot the following tleclarations: ❑ I have and wiR�maintain�a certificate of consent to self•Insure for vrorkers' compensation, as providetl for by section 3700 of the Labor Code, for the peAormance of the vrork for which this permil is issued. ❑ I have and will maintain vmrkers' compensation insurance, as requiretl by section 3700 of the Labor Code, for the peAormance o( the v.ork fw which this pertnit is issued. My workers' compensation Insurance cartier and policy number are: . � /� �,J �Camei:��'Si� 7P 7"L%/-� !/ (ihis sM,bn neetl rro� be wmdetetl i/the permil is valued at one nundre0 tlaMars (E1001 wless) "--..- : �i J S`��ti - i- 0 0 4' PolicyNumber. ❑ I certify that in the pertormance of ihe vrork 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 shoultl become subject to the workers' compensation provisions o! Section 3700 of th or oda, I sh forthwith comply with lhese pmvisions. % �� r� Aovliranl s Signature ale ��T;. �� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT 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 IABOR CODE, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing vnth Section 7000) of Division 3 ot the Business and Professions Code, and my license is in full force and eRect. uc. Z C�ass#_ �'_-3 %` � — �' �//,��o �. `Contracmr's ignaWre (�..r-Date CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrtn that there is a cons[ructbn lending agency fw [he peAortnance of tha �nork fv wfiich this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Atldress: SgreWre Dale OWNER-BUILDER DECLARATIONS: I hereby aKrtn that under penalty of perjury lha[ I am EXEMPT FROM THE CONTRACTORS LICENSE U1W for the following reason (Sec. 7031.5, Business and Pro(essions CoEe: Any city or county which requires a permit to consWct, alter, improve, demolish, or repair any sirucNre, pnor to its issuance, also requires ihe applicant (or such permit to fle a 5igned 5tatement [hat he or she is licensed pursuant [o ihe provisions o( the Conirac[ors License Law (Chapter 9(Gommencing with Section 7000) of Division 3 of the Business ana Professions Cotle) or that he or she is exempt iheretrom and the basis for the alleged exemption. Any violation of Section 7037.5 by any applicant for a pertnit subjects the applican[ to a civil penalry of not more Ihan (ve hundred dollars ($500).): ❑ I, as owner of lhe property, or my employees with wages as their sole compensation, WILL DO THE WORK, antl the structure is not intended or ofleretl 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, antl who tloes such work himself or herself or ihrough his or her own employees, provided that such improvements are not intended or oNered for sale. If, however, the building or improvement is sold within one yeai of completioq the owner-builder will have lhe burden o( proving that he or she did not build or improve for purpose of sale.). ❑, I, as owner of the property, am EXCLUSIVELY CONTRAC7ING WI7H LICENSED CONTRACTORS to wnstmct the project (Sec. 7044, Business and Professions Code: The contractors License Law tices not apply to an owner of property who builds or improves thereon, and who contracts for such project vnth a contracta�s) license pureuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signalure Dale 305]-46�3/01) � Owner ID verifed by c a lice. ,] Yes ❑ No Driver's License No. Expires: � Verif�cation of Ownership by (rype of document, i.e. - properry tax bill or deed�:. DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: �. �-' ❑ I hereby certify tha[ no excavation frve (5) or more feet in depth into vfiich a person is required to descend, will be made in connecl'an with work autFar¢etl by this pertnit, and that no building s[ructure, scaffdding, falsevrork, a demolition or dismanlling thereof, will be more than [hirty-siz (36) fee[ high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle 8, Califomia Administ2tive Code). ❑ As owner-builtler, I will nol employ anyone to do work which vrould require a permit from the Division of Industrial Sa(ery, as notetl above, unless such person has a permit to do such work fmm the division. Applitanfs SignaWre Division o( Industrial Safe[y Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the appliwnt or present or future 6uilding occupant neeC 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 Safery 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 hazard0us materials equal to or grea[er Ihan a weigh� of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas at standard temperature and pressure). 2. Does or will the applicant or present or fuWre 6uilding occupant need to file a registration fortn for acu[ely hazartlous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Cotle, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity o( acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume o( 55 gallons, or 200 cubic feet of compressed gas at standartl temperature and pressure). 3. Does or will Ihe applicant or present or (uNre building cecupant need [o prepare an RMPP (Risk Management antl Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Sec[ion 25534 of the California Health and Safety Code provides that ihe Costa Mesa Fire Department may require the preparation, certification antl fling with the Fire Department ot an RMPP by businesses which are required to regis[er acutely hazardous materials wiM 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. Dces or will the applirant or present or future building occupant require for the work which is the subject of lhis application a permit for such construction or modification from the South Coast Air Quality Managemenl Disirict or from any other air polWtion conUol district or agency? ❑ Yes ❑ No (Sectbn 658502 of the Califomia Govemment Code requires that Ihe requested information be fumished on applications for non-residential building pertnits). 6. Will any pan of the facility to be constructed under this permit be vrithin 1000 feet from the outer boundaries of a school? ❑ Ves ❑ No Qf'Yes", the (acility must meet the requirement of Sections 25534 and 42303 of the Calitomia Health antl Safety Code�. 7. If a pertnit from the Soulh Coast Air �ualiry Management Distnct or other air pollution control disinct or agency is required for the work which is [he subject of ihis application, have all of the disclosures prescnbetl by Califomia Health and Safety Code Section 42303 been madel ❑ Yes ❑ No 8. (If'yes", attach certificate of Gompliance (rom Ihe appropriate air pollution control officer). � � � ' . . - � �CERTIFICATE OF COMPLIANCE: I certify tha[ under,penalry of perjury the information given above is correct. I agree to comply with all slate laws and ciry ordinances regarding Hazardous Matenals and Emissions.. �, ,; Date . CERTIFICATE OF COMPLIANCE AND AUTHORIlATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is cortecL I aqree to comply vnlh all'state lavrs and ciry ordinances relating to huilding construction, and authorize representatives of the Ciry� of Costa- Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authonzed by this permit until final inspection. S'gnaWre o� Legai Owneqs) �ale . ,T%�1/�P �i.�,vlev Fna/orAulnorizetlAOPlicant Dal� ' �-��a1.�.._ . . , � ,.. , - CITY OF COSTA MESA � � �� - ' BIIILDING DIVISION ' - � 77 FAIR DRNE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • vnvw.ci.wsta-mesa.ca.us - - FOR INSPECTIONS CALL: (714) 754-5626 � � PERMIT NUMBER(/808-00233 PERMIT TYPE B_ROOF2 APN: 14120232 JOB ADDRESS: 2980 MC � Vicinity: ROOF Squares: ' 140 ;�':� fi�r�' SCOPE OF WORK: TEAR OFFp(E) F .SQUARES. ROOF TO COMPLY,..N/ITH T� OWNER: RISCHARD PHONE: APPLICANT: PHONE: Address: 260 E ALT( City/State/Zip: SANTA ARCHITECT: ENGINEER: FEE SUMMARY Reroof Plan Check: Reroof Permit Fee: Reinspedion Fee: TOTALFEES STATUS: DATE ISSUED: ;'r��: ISSUED BY: 21ALS AND REROOF WITH 4-PLY BUR�ON A��COP )OF STANDARDS FOR COMMERCIAL BUILDING trA ;y :� Address: ; 18901 E DOD,GE-A� n, w�'� City/§tate/Zip: SANTA ANA� CA;�< F�, `s'��^i. ,-� ,a- v �`_-v�� .�- �-� Address: N6646636ay�ci �,y Cdy/State/Lp � i'r, r` i 1 . :'°. n.m.,..e.,. , ...-,._..�. _,,,...—... * ,Lioe � t'':' {� � ;�PFIONE' t.. ;$�' � ;,7,14� ,�...�..—�- .._�.._- r..:::-_ ��' 'CEC i h {� s .Lice'n e No aw .u' r J` �-��x# , _.j i _ � License No. _�,,:_�'�:,. ;'3=.=_ .,.. ISSUED 08H3/2008 RMD wa3 m '� x ' t I E♦ +'�F � t y a� � ,,_ ��'� �� A Y�,j� i' . t 'J � R 1 tr_ � 4r� Q� fy �'4 -� f i L i 3 v f 11 "i �''i :�[ '+ ��-. �VO OO � T h+ "SY EF. 'aF . �' y ! � � c i y .E �F.i- F � `�. � f a �M Y' �.� *4�_ '^$502 85 � �,,.�, ,� �-�. -s s ''';� �, '� $0 OOd � � _=� .;_ -, �. { � ;� , � �'-,y . ^� t ',, >„-• �r �� u r � ,; -+ •- -s..:, $502 85 `-�.�%w�i i� ,R a�s.1s � 7,..4�:: �3 Y'' . ..i _'F_ �p, �,,., APPROX 140 Unit: Unit: : NOTICE: The work authorized 6y 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAS7INSPECTION. � ' , ' INSPECTIONS: In order for the work authorized under this permit to be wnsidered legal, such work must comply with all applicable wdes, 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. COOE . INSVECTONTYPE DRTE IN➢71RL5 COOEp INSPEClIONTYPE DATE �IN7RIRL5 7616 Fiaed System Final Fire Prevention 206 Final Mechanical 1266 • Pool Spa Final . �% __- 208 Final Plumbing - � 200 FinalRe-Rool P/d n,�.3/li.Q ��M`�'+�Z�O FinalElecincal /� 'r'�. '1 201 Final BIocWRetaining Wall V 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 FInalSign 222 Final Site 204 Final Dem0lition ' 250 Final Building/Occupancy .. Pfl0.1ELT ROOflESS: OWNEfl'SNAME: 2980 MC CLINTOCK WY noosess:R8901 ED�ODGEQA�EE E TR SANTA ANA,CA 92705 FflLNIENGINEEN: aooness: HEG.NO.: UNIT: uNiT: PEPMITTEE: aooeess: 18�9��0y1�DnO7�)DnGfi AVSCHARD ( 714 ) 544-3755 UCENSED CONTBACTOp OECI'AflAT10N'� 1'HE�eGy aliirm I�a� I am Iicen5e0 und2T"plaviSfORS �l ChaQier 9(commencing wil� SecliOn 7000) 01 �iviLon 3 0l ine Busineu aM Profe55ion5 CoOe. anU rtry license 4 in lull force and eiletl. CITY UL.: STqTE IIC.: CLASS: Oate: Signalure: WOPNEPS' COMPENSpTION DECLAflATION: I hereey aHirm Ihal I lave a cenififate ol cons¢nt lo selbinsure ot a cenilicate ol workers' Compenution Insura�e. a� a cenifie0 coDY ��ereo� (Smiqn 3800, LaO. C�. POLILY NO.: EXP. UATE: COMPFNY: ❑ Cetli�i¢G topy is �Cre�y �umi5hetl. ❑ Certiliedlropy is �ileG wii� IAe ciry BuilEing Oivision. ,ate: AODlicanh • E%EMPTIONFpOMWOflREBS'LOMPENSATIONOELUBATION: Rry�stttionneeOnotDecompkteAifOieperm�i5lorane�unOreG(5100�orlett). I cetlily IM1aI in IM1e pedormance ol Ihe work lor whic� ��i5 Vermit is i55uetl. I shall n � em0loy any person in any manner so as lo become su�let� lo I�e W^orkers' GComOensation laws ot Calilamia.- • Oa1e: �' -1 � - I �i Signa�ure: NOTICE: II. after malting Ihis Oeclaraliw, }rou s�oul0�h� Giec t workers ComDematlon provisions at tAe Laeor Cotl¢. you mu5t �otlAwith camplY vnlh SUCO O��sians or �N em dll Oe CeemeG revokeE. CORSiHUCT10N LENUING ACENCY: I Aereby a�lirm Ilut �pert is stmction IenOing agency for i�e perlormance ol t�e work lor w�ic� I�is permi� i5 issu¢tl (Section 31197. Civ. C�. t LFNOEfl: ADONESS: OWNEP BUILOEN OECIABATION: I �ere�y aliirm I�ai I am erempi Iwm t�e ContrattOR' Staie License Law lar tne tollowing reason (Section 7031.5 Business anC Pmiessional CoOe: Any ci�y ot county w�icn repuires a permii to consimci, al�er, impmve. aemotisR or ieoair any slmclure, prior lo its issuance. also repuires Ine appliCanl lor sucn permit to lile a sipned stalemenl �hat he/she is Iicense0 pur5uan1l0i�e provisions Olihe Conlratiars' $�a�e l�cense �aw�C�apler9�fAmmenCinq wifh SetliOn 7000�OIDiviSion 3 ol Ihe BU5ine55 ana Pmlessions CoOe) oi lhai he/She is erem0� ��er¢�tOm ina I�e Uasis tOr ��e all¢geA e�emplion. Any violali0n o� $etli0n 7031.5 6y anV appbtanl lor a permi� Sublec�s �he aOUliCanl �o a tivil penaliy OI n01 more Ihan live �UnErea E011ars (5500�. � I, as ownei ol ��e propeny or my employees vn�h wages as t�eir sole campensalion, will Uo I�e work, anU t�e simcture is nat imen0etl or onerea lor sate (Sectwn 70aa, Business an0 Pmf¢ssional CoOe: i�e Comractors' Slate License Law aoes nol aDoly lo an owner ol a pwpeny wlb OuAqs ar improves inereon, ane wlb Ooes sucn vrork nimsell/nerself ar ihroupn �is or �er ovm em0�a/¢es. OrwiUeC ttul sucA imp�pp¢menis are nol intenGeG or aflere0 lor sale. II, Mwever lhe builtling or imprOv¢mGnl it SOIG wil�in ane year o� ComWelion, �pe OwnGt will have Ne GurGen ol provin0 hNshe GiE nol builtl ar imprOve tor ine ouroose ol sale�. I, as awnei ai Ine Ompeny. am exclusivelY comracli�p wi�� IicenSeG mnlraciors �o consimct Ihe pmjed (Section 70aa. Business ❑ ana Protessions Caae: Tne Contractors State lkense Lrx Oces rot appy ta an owne� ol property wno omms o� �o�ares mereu� ane w�o comracts lor suc� pwlects wit� a wntracmqs) license pursuam m i�e Contraclors' State License Law�. 1 am aware inal piool ot their Wotlter's fAmpensdtun insurante slroula oe D��7eG �o me. � I am exempi untler Sepion: 0. 8 P. C. - br Inis reasonp: /� Date: �� 1 �-1 � Oamer. � I do nereby cenity inai I am aware ol anE unaersiand t�e repuiremems ol Calilor 1 I�� an a ry CoEe Sections 25505, 255J3, ana 2553A antl Ihat I or any �uture buil0ing acupanl wilVmll no� (�i¢le ane) need lo cam0 ��h id Slale tades anE I�e requir¢menls lor a permit Im conslmction or modibcation imm Ine An Ouabty Managemen� OislricL ResiOenti. consimclion aODlicalions are exemp� imm I�Cse D�Ovision5. Oale: ADDlieanl: � I pereEy cetlily I�al I �ave rea01Ai5 applita�ion anE 51aie ItW� �he orOmances an0 slate laws relating to OuiAmg con5iructqn anq �eret o�opeily loi inspecuon purposes. i C Date: �'_` 3 SignaWr¢:� Orivei'S License or Social Securi�y n: � t6n1-46 �Wlnlo—Buileing; Green—Cotle Enbrcemom: Ca a I agree to campry wit� all city an0 counry ihi5 Giy to ¢nter upM ih¢ a00ve�menfiMCd Pmk—Revenue: Goltlanroa—Assessar CITY OF COSTA MESA — SIGN PERMIT PEkMIT NO; SB 062960 PLAN CHECA NO: 0248"1-93 S CONSTRUCTION TYPE: PERMIT TYPE: STR SIG PERM NO: SB 062960 GOVT: N SUPP: N PURPOSE: OTH JOB DESCRIPTION ; NON—ILLUMINATED WOOD SIGN SQ FT; CLAIM VALUE; 250.00 CALC—VALUE; 250,00 GROOP OCC; H-2 / COMMENTS; TWO HUSINESSES..THE "MONOGRAMS ETC." F"CLEAN RACING USA" �r�r�rx�r�r�r�+r****xx*�***�tx�*x*x��r+r*�r�r�r�t� �e�xx�rx�x*��r*�r�r��t�r�r�**�rx��rxx�r�r*x�r*�*x��**��ru�r�r S I G N I N F O R M A T I 0 N DISTRICT; 3 TYPE; GROUND ILLUMINATION: NON CATEGORY; NEW DIMENSIONS; 3FT OOIN X 2FT OOIN AREA; 6,OOSOFT LETTER HT; 14 STkEET FRONTAGE 1; 285.00 STREET 1; t�lC CLINTOCR WY STREET FRONTAGE 2; 0,00 S1'REET 2; jPARCEL; 14120230 ZONE: C1 LOCATION > FRONT: X REAR: BUSINESS NAME: MONOGRAMS ETC/CLEAN RAC > LEFT; RIGHT: O T H E R T O T A L S G R O U N D S I G N THIS ACTIVITY . 6,OOSQFT OVE;RALL HEIGHT; 4FT� OIN THIS SITE , 6,OOSQFT GROUND CLEARANCE; 1FT ' OIN ITEMS OF INFO ; 7. ALANTER AREA; 12:OOS�rT ITEMS FOR ACTIVITY: 2 BLDG SET BACK: 20FT . COPY VERBIAGE . "MONOGRAMS ETC" "CLEAN RACING" . ADDRESS NUMBERS PLANNING NOTES: k i! k k ik ik ik if if �k it iF ik 1E i! k if if k k i! k if k iF if i! ik iF ik ik if ft ik if if if iF iF i! iF if ik iFi! iE iE k iE 1E iE itlkiE k ih it iE 1E iE i6 iF i! fE �k iF �k iE if ik �F �k iE iE # if 3E # 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 5 ZONING APPROVED BY �-1 �� DATE: ��9�9� BUILDING APPROVED Bi; : DATE; APPLICATION I5SUED BY• ' DATE: �,�F�� itit�k%1tit4ifikfkiEifiEiklfk�lfiFitikikif . . .iFiljliEiEi(-#�1Fifif� i61f LEGALI2ATION;N F E E S U M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/RES GRADING PERMIT 15.00 6,00 PLAN g,�5 SMIP/NON�—RES ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 21.50 0,00 9.75 31,25 31.25 .00 REVENUBLDGVPMT�PLUMHING ELECTRIC�MECHANDC SIGN1�SMIP�/TOT/SGRADING PLAN—CHECK 15,00 6.00 .50 9,75 if ih it if iE 1f ik if if k if if it iE k iF !E iE 3k !F fF if i! 1k ik iE iE if%iE if lf ?E iE 3E iE !f ibif k�k �1! iE �f If if ik ff ff-!E �x� k iE df �lE fE iE if !F iE ff it k iE iElf !E i41E �ElE ff it IF iE i4 �*� I N D I V I D U A L F E: E B A 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 THTS PERMIT 01 00142535—Q014253E T�] T 31.'?5 DAiE: D7/09/S3 TIhE: 10:03 CONSTRUCTION AND PLANNING APPROVALS Permit # t, Temporary Elec[rical Service or POIe 2. Soil Pipe�Undrgrnd. 3. ElecVicai Conduit Utiiity-Undrgrr.d. 4. Elecvical Conduit�Undrgrnd. 5. Steel Reintorcement 6. Electrical UFER Grnd. 7. Footings � 8. Foundation 9. Water Pipe-Undrgrnd. 70. Structural Floor System 11, Property Sower Line & House Connection 12. Sewer Cap 13. Roof Droins 14. Rough Plumbing 15. Rough Electrical-Conduit 76. RoughElectricWiring 17. fiough Wiring Sign 18. Rough Electrical-T Bar Ceiling 19. Rou9h Heating & Air Conditioning 20. Rough Fattory Fireplace 21. Ducts, in Suucture 22. Ducts, Vent�lating 23. Gzs Pipe�Rough & Test 24. Foof Framin9 25. Roof Sheathing 26. T�Bar Ceilin9 (Structural) & Monocoat 27, Frame and Flashing 28, lathing & 5�ding 29. Insulation 30. Drywall Nai�ing 37. Plaster Brown Coat 32. Electrical Ppwer Meter�Final 33. Finai Electr�c 34. Final Heating & Air Conditioning 35. Finai Gas Pipe�Test 36. Hood or Canopy � 37. Final Facto�v Firepiace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Finai 41. Solar pomestic-Final 42. Backflow Pteventer 43. Backflow Irrigation 44. landscape Irriqacion System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STFUCTURE & BUILDING � 48 FINALPLANNING 49. Electric Release to Edison 50. Gas Release to Southem Califomia Gas Co 51. CEfiTIFICATE OF OCCUPANCY No. Date Date POOI. ,rA Inspector pppROVAIS Permit � Date Inspector 52. Pool & Epuipment Location �I 53. Stee1 Reinforcement 54. Forms 55. E�ectrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER�GUNITE 6ev{� 58. Electrical Conduit�Undrgrnd. -v 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P�Trap, O U�drgrnd. . � 61. APPROVAL TO DECK 62. Backwash & ReceptorFinal 63. Heater & Vent-Fina4 64. Plumbing System - Final 65. Eiectrical-Final 66. Solar SYstem•Final 67. Fencing & Access Approval 68. APPFYQVED FOR PLASTEftING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit � 70. Underground Hydro 71. Product Pipia9 � Gac ❑ O+1 72. Undergraund Flush 73. Undergmd. Storage Tank � Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXEp SYSTEM FINA� �8. FIRE PREV. FINAL � ' � HEAITH OEPT. REQUIREMENT � 79. F,INAL INSPECTION ; 8b. FpOD CERTIFICATE ISSUED , 0 � ' 'IIMITED STATEMEN . JF RESPONSIBILITY TO WHOM IT MAY CONCERN: :19 $G .D � /`�c��Rr/acK �%�I / Street Address Bldg. Permit H • �� O 2Q�0� i This Permit R /`�/—zozJ3d AP Number I, %J�LbDAP.0 G� ��ScFi/I1Lt7 , as Owner in Title of the above referenced property, do hereby authorize: S�EV�-� L, fj/�-F30.� -7 p�(`� i. y /. /3� � � �7ry� `j6� - 2 3G�Co ' Telephone No. to obtain permits in my behalf, as owner/builder, for /�1o�UiHCjjy S.��l %/JS>�.lu.it9ia�.J at the above referenced property. Should �y erson become an emolovee engaged in the improvement of the property, I shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per- son, company or corporation. I agree to indemniry and hold the City of Costa Mesa and its employees or o%icers harmless from any claim resulting in damage or personal injury to myself or any other parties. �NZ'BpoQc t�, /G%Scy�p_� Printed Name � e'� � Signature L \\`i� ORANGECWhT/ f1S J � �.. My GOrtvnistlon Ezplre� � ` • ApN 14.1996 Jb�ovv �]]9-68. ,e.. �0, L'FN "_ — b�ate (�� TARI�ATION REQUIRED . � I w� �<�w_�,�..;,< M Ya OwU�'.-� e�)C Q�` w � � ' V � �.o �oe.o;,n '°',`:ii , Q (nlY �{�'.�lil7:�:� Jt� � !I LLl� 9'��Ji _ it.r r, - �7 M 1 W � �IJ J� p�:� :]:: ]:� �JQqwu � W F-Lt �� - .��.�r^"�� Y r an� " - ' <:-i'�a� � -_ � O� � Jw...-;�u. � ' _ . . _ ' _ p � Ci z [� '. Ga '_- 3 � ^-,�--_, __ � `� cSi�.�` -. i Z c= ' . - � uU=cr,"'� O Q' UL `J .L= ; T � c=�""v..-�� :. a- F_ w sz� `� C �A< m` w '�Cp _=5 _ �LL��. m � ;�-;� O � �� N � m � N l0 A Q m C�� QlN � � �n U �m � � C� : :� �_ ; �.; Ci .- � iV`� � �� '� ��- < s'� .,� i Z o� -> a U c._ pOU � � � IL 4J+- N (L = '- � w a 7 d � ? Z � Z J I �. N a I a� _ �� H i N I X V � � m 1O m W � � � <o�l �1 � � oz� � � � � �� I � � tl� � , I .. '_.-.. i� � m � y� = W a � � N � lZ oa �, W v � W U, ¢ z z � LyJ � z N w Z o� �; J W � W Vl O Z � O � F ¢ � W ¢ m. � N � .: •.._ �:.: . N '. . . . . . . . . . . . . . . . . . . . l �L��•'. � rn c .y O 0 d W V C O u U W N N rn 0 C cO < m .. . O Cp L C m m � � � � m � a��nnooeess: zgt1U MC CLINTOCK WY owNee�sxnrne: THE,DORE E. RISCHARD aooness� 18901 E. DODGE SANTA ANA, CA 92705 �NCNIENGINEEN: ROONESS: flE0.N0.: uxiT: B UNIT: PENMITTEE: GARY BERGUM ( 714 ) 957--6190 nooxess: zgg0 MC CLINTOCK WY B COSTA MESA CA 92626 LICENSEO CONTMC70B OECIAMTION: I �ere0y attirm t�at 1 am IicenseE unAer o�odsions ol C�apter 9(commencinq vntA Section 7000) ot Division 3 al tAe Business anU Professions COEe, an0 my license is in NII force ana ettea. CITY LIC.: ' STRTF LIC.: CUSS: Da�e: Sipnature: WOBNEBS' COMPENSRTION OECUMTION: I hereUy affirm Itut I have a certifiwte of consent to seli-insure or a certificate of Workers' Compensation Insurance, or a certilietl wpy thereof (Sectian 3800, LaO. C). POLILY NO.: E7lP. O�TE: COMPRNY: ' ' � Certifie0 coDY �s �ere0y fumisAed. ❑ Cert�etl copy is �letl wit� tAe city BuilEinp Oivision. �ate: Applicant: E%EMVf10N FPOM WOflNEflS' COMPENSAlION OEGAMTON: (11is se 'on netd rrot De campkteA il the pemul is for one hu�dre0 �1700) ar less). I certity thai in the pertarmance ai t�e work tar wNc� tha permR i ue0, 1 shatl n� ploy any person in any manner so az ro Decome suhlect to e Workers' Ca �atian Laws af Calitamu. ' oate: G_ S�qnature: NO E:Ii, atter maltin0 �his EeUaratlan, you s�oNU Eecome su0}" ro t rkers' Compensation D�avisions oi [he La�or CoOe, you must forlMrit� comDly with such provisions or Iks�f% n s I Ueemed revaketl. ' CONS7BUCTION LENOINO �GENCY: I hereEy aifirm tAat there BR wn ion lendinp apency for the DeRarmance of the work lor whic� Ihis permit is iuue0 (Sectlon 3097, Civ. C�. . lFNOEfl: RUOflESS: OWNEP BUILUEB OECUMTION: I Aereby attirm t�at I am exempt Irom t�a Controctori State License law for Ihe I011owin0 �eason (Section 7031.5 Business anC Professlanal CoCe: My ciry al counry wMch reQuires a Dermit to consWd, atter, im0�%'e, OemolisA, or re0air any structure, D�or to its iuuance, also requires [Ire appliunt lor suc� permit to file a sipneE statement I�at �e/s�a is licensed pursuant to tM pranslans oi t�e Contnctors' State License Law (Chapter 9(wmmencirp wiN Section 7000) ot Oinsion 3 0l the Busines antl Profeuions CoGe) or that ArlsAe a exempt iheretmm anE the Easis for the alleAed exemD�� Y ��ation al Section 7031.5 Dy any aDaicant for a permit wbl�s ihe applicant to a cNil penalN a� nat more than 1he hunOreO tlollars (5500�. 1, as owner of the Droperty ar my employees wit� wapes as their wle�compensation, will Oo t�e work, ana iha � simcWre is not IntenAed or otlered for ula (SecUon 7044. Business anC Prafessional CoGa: T�e Comactors' State License Law Ooes not apply ro an owner ol a O�oPeM w�o builOs or improves t�ereon, and w�o Ooas suc� work Aimull/herseli ar ihmuAh � � his ar �er own employees, pmviEeA that sucA impmvements are nm intenUeO or attereU lor sate. It, however Ne bWlOinp or impmvemenl is sa10 wit�in one year of campletian, ihe owner will have ihe UUNen at provinp �e/s�e Oi0 not EuilA or im0�a�e lor the Durpose ol sale�. I, az owner ol ihe properry. am exUusively mnVaCtlnp wllh IkCnSeU fAnVati0f5lo CanStru[t the pr01¢CI ($¢tlion 70EE, Bu5ine55 ❑ an0 Pmfusions CaOe: The Coniractors' State Licerrse Law Eoes noi apDly to an ovmer ol O�oceRy who EmIEs or impmves l�ereon antl w�o contracts for such pmle��s vAtA a cantractoqs) license Dursuam m t�e Contractors' State License Law). I am aware ihat Drool ol t�eir Worker's Comoensation insu2nce s�aNC Ue O�oviEed ta me. � I am exem � unOer Secll '. B. 8 P. C. lor ihi son: ` •�7� r Oate: 0«nec I do hereCy ceniy ttut a wa of an0 unEerStand tAe requirtmenis of Califor Healt� alery Code Sections 25505, 25533, an0 2553d an0 ��at I ar 1 re ilding occupani wiN_II not (cirUe one) need �o cam0ly ' saiA s�aie wtles an0 i�e reQuirements for a permit for consimctwn tliliution imm the Nr Qualiry ManaOement Oistnct. Flesid ial constmction aODlications are exemD� ��om these D�ovisions. Oate: _ I hereby orEinanu D�oDertY Date: _ Dnver's AyDliwnt �ha� I have 2atlihi5 applicaiion anE Siati to ;t. 1 aqree Io wmpty vmh all ciry an0 counry olth6 cirytoenterupanlAe a6ove-mentianeA L� /�— SignaNre: � � � • icense ar Social Securiry x: Wpile—BuilEing; Green—COEe Enlorcement; Ceneiy—Npplicanp Pink—Ravenue; GOIEanrotl—Assessor CITY OF COSTA MESA — BUILD'ING PERMIT PERM NO: F 044634 PERMIT NO: P 044634 PLAN CHECK NO: �1 GOVT: N SUPP: N CONSTRUCTION TYPE: PERMZT TYP�: PLU PURPOSF: NEW JOB DESCRIPTION : GAS SEAVICE , • SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: / COMMENTS: �e��r*x��+r****�*��***�c**��**�**��t+r�*+tx*x�r**itit��r�r��*�rt****�r*�**x�****�**�****�rrt��r � Z O N I N G R E Q U Z R E M E N T S S E T B A C K S ------------ MAIN HUILDING ---------- ------- — ACCESSORY BUILDING ---------- FRNT: PT IN REAR: FT IN FRNT: FT IN REAR: 'FT IN I.EFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN . PARICTNG REQUIRED: PARKING PROVIDED; ' PARCEL: 00000000 ZONE: PLANNING NOTES> ' . . . . . . ) . . .. . . " ' ' _ ' iE �E 3E it iE i! �k �E i( iE if jE )f it iE iE iE it iE iE if i! 1E if �E if dF iE if ik K if iE iE iE iE iE iE if 3E iE iE �)E �E �k it ik i!� 1E if �%it it af iF if iE dE iE �EiE iE iE 1E 1F if iE iE iF iE j! iE 1E iF K 3E iF if if D E V S L O P M E N T 5 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 ➢Y : � DATE: APPLICATION, ISSUED BY: �i .' DATE: ��f�� **x�*3t�titat3tie�t*****�k*3t�t*�tiF'�iF3FiFiF7F3F'iF3Fif'� 'iF �F�FTF3F3F3FTF�F7FTF�t3FiFiF'3F�'iF7�'�7Fit3t*it�it��-�t-�t-* ir�rt�x- it if iF i(- k iE ik iE it df 1E 1F �E it iE it ik it it ik iF it iF iF iE it iE iE ik iF iE iE it iE iE 1E iElF iE iE iE iE 1E �)t if it iF 1E ik if iE f(� iE iE iE iE if iE iF if iE iE it IE 1E 1f iF iE it iE iE k if if IE iE # if ik LEGALIZATION;N F.E E S U M M A R Y ' STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC 'MECHANIC FIRL SMIP/RES GRADING PERMIT 2.00 ' 258 PLAN ISSUE FEE 3'.00 BUILDING—DIV—> PERMIT ISSUE TOTALS----> 2.00 3.00 PLAN—CHECK TOTAL ... �.�� 5.�� SMIP/NON—RES PAID DUE 5.00 .00 REVENU� DIVISTON TOTALS--> COLL�CTED; 5,'00 OVER/SHORT: .00 BLDG PM'P PLUMBING ELECTRIC ME�HANIC FIRE SMIP/TOT GRADING PLAN—CHECK J,�� /. it it ik it it ik k�)f it it iE * iE iE ik iF ik iE iE i! i! IF ik iF ik 1t 16 iE i( IE If k IE 9E 1E if fE i(-1t it fE 1E iklt if iE iE fE it !h iE iE ik il� jt it ik iE i(� ik i! if iE iE iE iE iE �E rt k iE iE k�t it iE iE if iE I N D I V Z D U A L� F E E H 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 ] GA5 SERVICE • 2.00 2.00 END OF FEES ' '_,..�' . ' � .-. �CONSTRUCTION AND PLANNING • . . POOL .PA ' APPROVALS Permit# Date 'I�spector 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-Undr9rnd. �. - 54. Forms ;�� / �-- 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding •,�.�' � 5. Steel Reinforcement' S6. Rough Plumbing & Pressure Test :� . 6. Electrical UFER Grnd. � 57. APPROVAL TO COVER�GUNITE ,• �� 7. .Footings 58. Electrical Conduit�Undrgrnd. �. � - 8. Founda[ion � � 59. Gas Pipe, O Undrgrnd., Tes[ �' � , i- 9. Water Pipe-Undrgrnd. ' � ! �:' � 60. Backwash Lines, P�Trap, O Undrgmd. �� 10. Structurel Floor System �- ;�� 61. APPROVAL TO DECK i �•�� . 11. Properry Sewer Line & House Connection _ F'= 62. Backwash & ReceptorFinal .• j� !��'�� _ � ,i� 12. Sewer Cap `,; 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 79._Rough Heating & Air Conditioning _ _,FIRE_DEPT. REQUIREMENT. 20. Rough Factory Fireplace . . = � . x �APPROVALS �=Permit # - 21. Ducts, in Structure, ' .- �. ,. _70. Under9round Hydro � 22.,_Ducts, Ventilating.. •� �77. Product Piping OGas ❑Oil 23. Gas:Pipe-Rough & Test . � . � � ' 72. Underground Flush - 24. Roof Praming � �. -� 73. Undergmd.StorageTank OGas ❑Oil 25. Roof She'athing � . � . 7q. Overhead Hydro . 26. T�Bar Ceiling (Structural) &-Monocoat - ' 75:: Dry Chemical - ' 27. Frame and Flashing� __ - �, � � 76. Dry Standpipe � _ .�28. Lathing�& Siding • � ' " . 77: FIXED SYSTEM FINAL•' - ' _29. Insulation , . � 7g��FIRE PREV. FIlVAL � ' �� 30. Drywall Nailing � - -• �� -� � HEALTH DEPT. RE�UIREMENT �31. Plaster B'rown Coat' '� ' ' -79' FINAL INSPECTION �32�Electrical Power Meter-Final �, 80^FOOD CERTIFICATE ISSUED �33.`Firial Electric � " � , �� ; � Noter. � (��q tYo T�'dKlA-�� Pin�' �� : 34.:Final Heating & Air, Conditioning' ". - � , � ' ' ' 35. Final Gas Pipe�Tesc " , , � � - � =36.-Hood or Canopy , ' . � � . . ,-_ � - -'37. Final Factory Fireplace ' ��- � ' ' . ` � -38. Final Plumbing -, r ` � � 39. Water Service-Final �' . � � ' .;40. Gas Service-Final , - _ r ,�' - � . �41. Solar pomesticFinal �� - • - 42. Backflow Preventer � _ � _ ' - , 43. Backflow Irrigation � + ` " S � -`44. Landscape Inigation SYstem _ � � ' -� ,_ _ , � �45. Sound'Attenuation �� - � .. � .. � =46. HandicapRegulations . „ � - � ; = 47`FINAL STRUCTURE & BUILDING = - "?`_ � - � ; 48. FINAL PLANNING � - � �, '� ', ' � i49. Electric Release to Edison . "'� - • . ��50r Gas Release to Southem California Gas Co �-> ' � � "51. CERTIFICATEOFOCCUPANCY '� No. Date LIMITED STATEMENT OF RESPONSIBILITY TO WHOM IT MAY CONCERN: �ECEIVED 0 CT 2 319�9 ,�� 9�a �� C'�„��K u�,� Streat Address Bldg. Permit # This Permit # U.�� 3 AP Number I, //�aDOYGE �, KiScIY/1/2� , as Owner in Title of the above referenced property, do hereby authorize: �'Ray .8�2.��,�r �o�c�� iS�� Name Telephone No. Slreel Address to obtain permits in my behalf, as owner/builder, for l>/)S ,S�2I/!G� atthe above referenced property. Should any ercen become an em In ovee engaged in the improvement of the property, I shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per- son, company or corporation. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties. � E � Printed Name �:�7 `,'r-o� CK C. � /� Signature O])9-46,rea BIB] F -/0 -� q Date Aop�icant to fill in all spaces exeeot those within heavy bartler lines ane sign all aporoo��ata aeclarations. cirY oF COSTA 'MESn CONSTRUCTIO�,rN PERMIT ProjectAddress �� o McCNN1CC.'� 1,17R'� U�iiT � App_cant's Mailing Address ��YO l L. .,j%ODL��r'_ �tt(a �fA�A� Owner'sName fhCODoi1.L E� �iYii�tCLt) Phone 5 '.7J�5 Address � S`16� F. Doo�% !�.'�: S:�rr.nz 41� a f L4 4Z7 .tn'i Arch/Eng. License No. Address Contrector's Name 7 Phone Address (mailing) City License No. LICE SEO Cfy__ ONTRACTOR DECLARATION I hereby af ir�'�If•vl-1-a ' sed untler provisions er 9(commencing witn section ]000) of Division antl Professions Cotle, anC my license is in tull force a� Lice O s License No. DdtT Siangtime WORKERS' COMPENSATION DECLARATION I nereby ai(irm Ihat 1 have a certiticate of consent ro selt-insure or a certificate of Workers' Compensalion Insurance, or a certifietl copy thereot (Sectlon 3800, �ab. C.) cy No. Company Cer[ifieG copy is hereby furnished. � Certifietl copy is (iletl with the city Bulltling Division. Date APplicant EXEMPTION FROM WORKERS' COMPENSATION DEGLARATION (This section neetl not be completetl if the permit is for one huntlretl ($300) or less). I certify that in the performance of the wo�k (o� which this p¢rm�t is issuea I shall not employ any person in any ma er so as to co e subjsct to t{�e' Worker5'� or[�pGpsat�pg�Laws ot CaliTy4 ��.,� �% Date ��iL4S�f3YS Siqnature ��'^� -��i./`i�_ NOTICE: If, atter makinq t�is tleclaration, you snoultl become subject to the Workers' Compensa[ion provisions of the Labor Cotle, you must torthwith mmply with such provision5 or thiz, pe�mit shall be tleemetl revok¢tl. CONSTRUCTION LENDIN6 AGENCV I hereby affirm that there is a construction lentling agency for the performan<e oP the work for whicN Ithis� p� it is Issuetl (Section 309] Civ. C.) Lenaer's Name N U /V LenOer's AOtlress OWNER BUILDER DECLARATION I hereby atfirm lhat I am exempt from the Contractor's license Law Por [he following reason (Section 7031.5 Busines5 antl Professional Cotle: Any city or county wM1ich requires a permit ta construct, alter, improve, tlemolish or repair any sVucture, prlor to its issuance, also requires Ihe applicant (or such permit to tile a si9n¢tl statement that he/sh¢ is IlcenS¢tl pursuant to Ihe provi5ion5 ot the Contractor's Li<ense Law (Chapter 9(commenong with Section ]000J of Division 3 of the Business antl Protessions Cotle) or that he/she is exempt therefrom antl the basis for the alle9etl exemption. Any violation of Section ]031.5 by any applicant for a permit subjects the applicant to a civll �alty ot not more than five huntlreG tlollars (E500). I, as Owne� ot the property o� my employe¢s wlth wage5 as thei� Sole n0ensa[ion, will tlo the work, antl Ihe struc[ure is not intentletl o� off¢reC �ior sale (Section 7044, Business antl Professional Cotle: The Contractor'S License Law tloes not apo�Y to an owner ot a property who builas or improves Ihereon, antl who tloes such wo�k himself/herself o� th�ough his o� h¢r Own � em0loyee5, prOvitletl tltat suth improvements a�e not intehtletl o� offeretl for sale. It, howeveq the builtling or improvement is soltl within one year of com- pletion, the owner will have the burtlen of provin9 he/she tlitl not builtl or Im- prova for tne ourpose of sale). ❑ I, as owner of the pro0erty, am exclusively contracting with Ilcensetl con- i traCto/s to construct the project ($ection 7044, Business and Profes5ion5 Cotle: The Contractor's License Law tloes not apply to an owner ot property who builtls or improves [he�eon. antl who contracts fo� such oroiects with a con- tractor(s1 I¢ense pursuant ro cne Contractor�s License Law). I am aware that proof of their Worker's Compensation insu�ance Shoultl be provitletl to me. ❑ I am exempt untler Section B. & P. C. for lhis reason / -9 A o I hereby ttrtify that I have reatl thiz application antl state that the abova in(ormalion is correct. 1 agree to comDty with all city antl county ortlinances antl state laws relatin9 to builtling construction, antl hereby authorize reore- sentatives ot t is city to enter upon the above-mentioned property for inspe<tion P�//, C� ./i iJ q j'L�v� Si9na[ure ��2 G- /%AfJ��t�CC.�aC Date �. Drivers' License or 55 qf . �� . ........ . __- __.__. .,..,,.. A.P.# 3 (0 11 S Main Buildi TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR E ❑ CONVERSION ❑ DEMOLISH ❑ OTHER( T FrOnt DESCRIPTION OF WORK/USE OF BLDG.� L-`-�� s��«� B Rear n TVPEOFPERMIT GRADIrvG FOUrvDATION S7RUCTVRa� C Right ❑ TENANT ❑ ELEGTRICAI ❑ PLUMBING ❑ MECHANICAL �I g� Left ❑ �O7HER Ping. Ref. # PROJECT DESCRIPTION SO. FT. OCCUPANCV �' planning Notes: CONSTRUCTION TVPE VALUATION $ 20NE GRADINGCU.YDS. ACRES .__ Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtuhs Clarifiers Dishwdsher Orinking Fountains Floor Orains Floar $inks Gas Service Outlets Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duc[ - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple FirepUFact.Blt.IC80# � Heating System & Ducting ❑ a� oo,000 aru o i oa,000 Reinspection Fee � $75 0865-46, rev. 5/88 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - 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 Isue Fee Hood or Typel ❑ Canopy Type II ❑ iefr tion Sys[em 0-100,000 BTU ❑ 100,000 BTU System Repair/Alteretion Fire Dampers Registers laue Fee FEES Auromatic Washer Construction PoleSub. Cooking Unit Dishwasher . Dryers ❑Gas= �Electric Fan " F.A:U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator �0.5 2ona B Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 1 amps Sub Panel Mo[o 0-1 HPO1N,-8 I .Solar �9-15 HP �i6-15+ Microwave Pole Light Sign Standing Sections KW �5-15 KW Trash Compactor FEES N i N G R E Q M T 5. Reinspeetion Fee $15 luue Fee $ 3 $ 3 DEVELOPMENTSERVICESREQUIREMENTS: 2oning Approved By Date FEES Building Approved By Date��,�, Appliwtion laued By Date.�..]'—'�Q=�.�II SUMMARV OF FEES BUILDINGPERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ �_ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ � MECHANICAL $ TOTALFEE $ �' PLAN CHECK 25% $ $ 3 O! QOOZQ5�3-�0020508 'F�a'r g�n� DATE: 11/2El8$ 7FI�E: 1+:24 CON�STRUCTION AND PLANNING POOL & ' ' APP�iOVALS Permit# .�ate Inspector p�ppROVALS 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• ElectricalUFERGmd. .� ` _ 57.�APPROVALTOCOVER-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 75. Rough Electrical-Conduit 66. Solar System-Final '16'�Rough Electric Wiring , 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro - 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23.' Gas Pipe-Rough & Te'st 72. Underground Flush - 24. Roof Framing i i� . . . 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 29. Insulation .� , . . 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plas'ter Brown Coat � 79. FINAL INSPECTION 32. Electrical Power'Meter-Final 80: FOOD CERTIFICATE ISSUED 33. Final Eleciric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test /2!, yY L�� 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing (Z�� =�� 39. Water Service-Final �40. Gas Service-Final 41. Solar pomestic-Final , 42. Backflow Preventer . . 43. Backflow Irrigation :' i 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 , _ �— —' Applicant to fill in all spaces except lhose wlthin heavy EorCer Ilnes an0 si9n a�l apD�oO/�ale tleclarationi. � PERMIT NO. TRACT NO. LOT NO. UNIT N Ci7Y�oFCOSTA�,jM ESpn CO�ISTRUCTI'O1N PE�R1MIT P3 SQ� � A.P.qW zo�a ProjectAddress ^�UO M(LLI�UYOC(( 1//�/ U1Ji"T F" � A �7 o E Main Building: Flccessory Building: Z Appliwnt's Mailing Address (7 IR`IO( L i Do011'. /-�UL Sry /1%Q. � TVPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR Front OWner'S Name ��ix1�6dL �� 1�ISCH/FQ� phoneS�W•�J%SJ � CONVERSION ❑ DEMOLISH ❑ OT%� R � T ' O f DESCRIPTION OF WORKIUSE OF BLDG. `� - ��-U��-� B Rear N Address -.�,5��4�%� �• nGDGr AuE .S,murn A,:a c'_l� 9�7c, � C Ri9ht N Arch/Eng. License No. TVPE OF PERMIT GRADING FOUrvDATION STRUC7VRAL � K G Address ❑ TENANT ❑ ELEGTRICAL ❑ PLUMBING ❑ MECHANICAL g- L¢ft R � Phone ❑�oTHER Ping. Ref. 51E Perking Req./Provided E Address (mailingl PROJECT DESCRIPTION 54. FT. oCCUaArvCv " Planning Notes: M CONSTRUCTION TVPE VAIUATION 5 T City LiCenSe No. ZONE GRADING CU.YDS. ACRES LICEN�SED CONTRACTOR DECLARATION S' I hereby affi�Pllr 'thaYYam-1 etl untlar provislons of Ch commencing Remarks: witn section ]000) 01 Division tho-Bu rofessions Cotle, antl my license is in fu11 force antl eite ELECTRICAL FEES License Class —Licenze No. Date Signature PLUMBING FEES Automatic Washer Tronsformer ❑ 75-50 KW RKE0.5' GOMPENSATION DECIARATION Baf Sink Showefs COnstfuCtion PoleSUb. � 50+ KW I ne�eby aHirm Ihat I nave a certificate of consent lo selLinsure or a C¢rtiTicat¢ o( workers' Compensation Insurante, or a certitietl copy thereof (Section Backflow Preventer Service Sink Cookin9 Unit Meter �up to 700 amps '000. lab. C.) �.y No. Company Backflow Irrigation Sewer Cap Dishwasher ,.., Meter ❑over 700 amps Jertifietl copY is bereby �umishetl. LJ Certine�d py is,filed with the city e1y ��J^q Dydision.(� �) � iJ J Bathtubs Sewer Connection Dryers OGas ;�Electric Sub Panel Date �� Applicant �L^ �Fan Mot rs�bl HP�iM-8 EXEMPTION FROM WORKERS' COMPENSATION OECLARATION Clafifiers Solar CoIlCctofs � iess�s section neetl not be completetl ii the permii is for one huntlrea (g100) or Dishwasher Solar Piping F�p'�U� c. Solar 09-15 HP 076-15+ I ce�rtity ihat in the pe�fo�mance of [he wo�k for whiGh thiz p¢rm�t is issuetl, I Fixtu�¢5 �� snall not employ any person in any man e zo as to become subje t to the Drinking Fountains Solar Tank _ _. Microwave workers' orrWe w Laws ot Califor ��n ✓� _� '�Device BoxeS �� Pole Li ht Date �� "�� Si9nature FloorDrains SwimmingPoolw/Spa 9 NOTIGE: Ii, after making tnis tleclaration, you zhOUld Oecome su0ject to the Ran e Workers' Compensation provisions of the Labor Gotle, you must for[hwith Floor Sinks U�inal 2 ^ Outlets y comply with such p�Ovi5iOn5 Or [his pe�mit shall be tleemetl �evoketl. SwitCh¢5 CONSTRUCTION LENDING AGENCV I GasSefviCe Outlet5 WaterClos¢t Sign 1 hereby a�firm [hat lhere is a Construction lentling agency fo� the pe�fo�mance Garba 2 DIS 0521 ot the work for wh�h,�thi�palmlt is issuetl (Section 309] Civ. C.) Interceptors Water Heate� 9 P Standing S2C[lons LentleYs Name � (1 TI" Lentler'S AOtl�esz Kitchen Sink Warer Service Generator �0-5 KW 05�15 KW Trash Compacmr OWNER BUILDER OECLARATION I hereby aftirm lhat 1 am exempt from the ConVactor's License Law tor Ihe Lavato�ies Auto-Wash tollowing reason (Sectlon 7031.5 Business antl Professional Cotle: Any city or county wnich requires a vermit to constru<t, alter, improve, aemolish or repair P—Trap Laundry Trays ' any struciure, prlo� to It5 i55uance, also r¢qWres Ih¢ dpplicant for Such pe�mit to file a signetl stacement that he/she is Iicensetl pursuant to [he provisions of Roof Drains the ConVactor's License Law (Chapter 9(commencing wi[n Section 7000) ot Division 3 of Ihe Busin¢55 anU Prot¢sslons COtlt) Or tllat Ile/sh¢,is exempt ReinSpectiOn FBB $15 ISSUB FBe $ 3 therelrom antl the basis for the alle9etl exemptlon. Any violaflon of Sectlon 7031.5 by any applicant for d Pe�mit sublects the applicant to a clvil wRy ot not more than tive hunared tlonars (E500). DEVELOPMENT SERVICES REQUIREMENTS: � as ownet of tlle ploperty ol my emplOy¢¢S with wages as lhelf sole RBinSpBC[iOn Fee $15 IEuO FBB $ 3 Zoning AppfOved By Date ,ip¢nSallon, will Co the w0/k, antl the struc[ure I5 not Intentl¢tl Ot�ofterCtl io. saie (Section 7044, eusiness ana Professional Cotla: The Contractor's MECHANICAL FEES Buildin8 APP�ovad 8y Data l.icense Law tloes not apply to an owner of a property who builtls or Improves lO � thereon, antl wito tloes sucb work �ImSelt/berself or through hls or her own Applltdtl00 ISSUBd By- Det employees, provitletl tnat such Improvements are not Intentletl or oHereC for Boiler Hood or Type I ❑ sale. If, nowever, tne builtling or improvement is soltl within one year of com- Canopy Type 11 ❑ � pletion, the owner will have the burtlen ot proving he/sh¢ tlia not bulltl or Im- Duct � Under Ground SUMMARV OF FEES nrove tor the purpose of sale). BUILDING PERMIT $ SMIP $ ❑ I, as owner ol the property, am exUusively contractin9 wlth Iicensetl con- Duct -Structurel FefrigeraGon System P�AN CHECK § PERMIT tractors to construct the oroject (Section 7044, Business and Protessions Coae: � The Contractor's License Law does not apply to an owner of property who Duct- Ventilating �0.700,OOOBTU ❑100,OOOBTU PLUMBING $ ISSUANCE $ Cuiltls or improves thereon. antl who contracts �or such oroiects wlth a con- tractor�sl hcense pursuan[ ro me Goncractors License Law). I am aware Ihat Exhaust $ystem ❑ MWtiple ❑ stem Repair/Alteration PL.P.N CHECK 25% $ ENERGY P.C. $ orooi of their Worker's Compensation insurance shoultl be provitlotl to me, ELECTRICAL $ GRADING $ ❑ I am exempt untler Section B. h P. /or this reason Firepl/FacL BIL �CBO dk Fire Damper5 MICROF�LM $ � � •� d + PLAN CHECK 50% $ � t -/ .lu.l. Heating System & Ducting Registers P�+ i hereby certiry that i have read this appiication antl state Inat the above ❑0.100,000 BTU 0100,0008 MECHANICAL $ TOTAL FEE $ �'�" In/ormation is correcL 1 agree to comply with all city antl county orainances PLAN CHECK 25% $ antl sta[e laws relating to builtling construction, and hereby authorize re0re- sentatives of this� $ity to en[er po/�9/� ihe above-mentionetl Oroperty�/for Inspectionpur�yoRS; 1�D �/C/ti�� Datelo;3/� D Signature L/L��l/ o�ivers� uce�se or ss �. — � Reinspection Fee S75 I�sue Fee $ 3 G1 �'��1£22E—QGOi8216 T�1T S.QO OB65-46. rev. 5/88 Wnite - 6ulltlin9: Canary - Hppliwnt; Wnk - AccOunung; ttoiaen�0a - As5e55o� vm c.• ivr,��i o� i iu�� ia•x CONSTRUCTION:AND PLANNING POOL & \ APPROVALS Fetmit # -ate Inspector AppROVALS Permi� � Date Inspector t. Tempo�ary Elect�iCal Service or Pole � ' 52. Pool & Equipment Location , 2. Soil Pipe�Undrgrnd, ' � � 53. Steel Reinforcement � ' i 3. Elect�ical Conduit Utility-Undrgrnd. ,� � ;, i 54. Forms ' 4. Electrical Conduit-Undrgrn�l. 55. Electrical Bonding . i 5. Steel Reinforcement • 56. Rough Plumbing & Pressure Test �� 57. APPROVAL TO COVER-GUNITE , � .'6. Electrical UFER Grnd. . ' • 7. Footings � a. � �� 58. Electrical Conduit-Undrgmd. ' � B. Foundation �� 59. Gas Pipe, � Undrgrnd., Test � 9. Water Pipe�Undrgrnd. 60. Backwash Lines, P-Trap, O 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 .16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SFA SYSTEMS FINAI 19. Rough Heating & qir Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 77. Product Piping � Gas ❑ Oil 23.rGas Pipe-Rough & iest 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. Plas�ter 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 ��-f�YY L iD 36. Hood or Canopy 37. Final Factory Fireplace 3S. Final Plumbing (��-}l?f LED 39. Water Service�Final ' 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation I 44. ,Landscape Irrigation System " 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTUF7E & 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 � _ ,t,�� 1 Project Address __C,�_"1. r� v- wx ^ i�rol r- � tP ,e� ,'ipp�iwnt's Mailina tldress /7 Owner's Nam��d � �µ �� o� � Addreu Arch/Eng. License No. Addreu Contractor's Nam Phone Addreu (mailing) Ciry License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am Ilcensetl unticr provitions oi Charter 9(commencing with sectlon 7000) of DlviSion 3 of the Businass antl Professioni Cotle, antl my Iicense I5 in full tor�e anO effect. U<ense Class License No. Dat¢ $I9naWro WORKERS' COMPENSATION DECLARATION ' hereby aftirm that I have a certlficate ot consent lo self-inzure or a certifiwte Workers' CompenYytion Insurance, or a cerNNetl copy thereot (Sectton l00, Lab. C.) Policy No. Company 8 Cettifletl copy is h0reby furnl5he�. Certiflea copy is (iletl witn the city Bullaing Division. Date Appli<ant EXEMPTION FROM WORKERS' COMPENSATION OECLARATION (ThiS section neetl not be complat¢tl it [he permit IS fOr One buntlretl (5300) or less). I certity that In the pgrlormance ol Ihe work lor which thiz rQ��t is issuetl, I shall nOt employ any person In any ry� er 5y aS try f/ec e sL ecl Io thG Worker$ C�pon`atjp�yyu5 of CalCf6�5� /�� S Date l'� 1 T Y Slgnature -l�'��'� L NOTICE: It, after making this tleclarallon, you snoultl become sub�ect to tne WO/kers' COmpenSatip� prOvi5ion5 OI IhC labor Cotle, you must Iorthwith comply w7th such provisions or tn7s parmit shan be tleemed ravokatl. CONST0.UCTION L@NDING AGENCV I nareby atfl�m that lhere Is a conSV uctlon lentling agonty lor Ihe Oe�formanta o( the work 10r wnlch th15 Pnrmit Is Issuetl (SocHon 309] Civ. CJ Lentler's Name Lender's Atltlress OWNER BUILDER �ECLHRATION I he�eby aHl�m that I am ¢xomp[ from tbe Contr�ctor's LitenSe Law br the tollowin9 reason (Sactlon 7031.5 Business antl Protessional Cotle: Any c�ty or county whlch rGqW�eS a pe�ml[ to ConSt�uCt, alte�, Improvo, tlemoli5h or re0air dOY SINCIUIE. P(IOI �O ILS ISSIIdOCB� dI50 reqW�es t�e appllcant tor SUCII pCITII to flle a signetl slatement that he/she is Ilcensetl punuant to the provisions of the Contractor'S UcGnse Law (Chapt¢r 9(commenCing with SecHon ]000) Ot Olvlsion 3 of the BVsiness antl Protesslons Cotle) or lhat he/she is exempt lerefrom antl the besis for the allegetl axemptlon. Any violaHon o( Sectlon 031.5 by any appliGant tor a permit subj¢ct5 the applican[ to a civil �e.f�Ity of not more than flve huntlretl t1011arS ($500). D(1 I, as owner ot the proPerty or my employees with wages as their sole rolnpensation, will tl0 the work, antl the s[ructura i5 not intentletl or otfered �for sale �Section 7044, Buslness antl Professional Cotle: The Contractor's LicenSe Law tloes not applv to an owner of a ProOerty who builtls or improves thereon, antl wno tlOez such work �Imself/horself or through his or h¢r own employ¢ei, provbetl tha[ Such improvamenls are not Intentlea or ottcretl tor sale. If, hOwev¢r, Ihe bulltlin9 Or improvement IS SOItl withln one year o1 COm- pletion, ttte owner wlll have the burtlen ol provin9 �e/sne tlitl not builtl or Im- �rove tor the purvose a( salo). I, as owne� ot thq p�operty, dm excluslvary conbaCUn9 wlth IlCtnsetl Con- tractors to conivuct the pro�ect (Sectlon 7044, Business antl Professions Cotle: Thc Contrattor's License Law does not apply to an owner ot property wno builtls or improves theroon, anG who conlracts lor such prolecti witn a con- tra<lor(s Ilcense Our;uanl�to tha Conttaclor'S LICenSn L.aw). 1 am aware that prool o� their WOrker'S COmpensalion InSurance s�oultl �a provitletl [o me. ❑ I am exempl untlet SetUon B. 6 P C. ior thfs reason na�n � nwnn. �_ , a i/ e I �er¢by certity that 1 have reatl this application an0 stale Iha[ tne above inlormation is correct. I agree to comply with all city antl countY orainances anU state laws rMati�g to builtling construction, antl hereby authorize rapre- sentatives ot tnis city to enter up tho above-mentionetl property for inspettion Pu�p,lr,ry��e � � � 2i �� Signature �/�pk � Date Driverz' License or 'Cj Type of Sign L�� City of Costa Mesa / ❑E�ectric LE}m�nelecvic SIGN PERMIT � ■ ■ / � ■ � � � Desttiption Canopy Attraction Boartl Advertising Statuary , Other Tract Sign (Security & Riqht of Entry Agreement Special Event (Request torm submitted) Change of Copy (amortization) Ground Well Roof Prqecting Construction Convenience Super Graphic ELECTRICAL FEES F ixtures Device Boxes Outlets $witches Sign Standing Sections laue Fae $3 Valuation $ "��- Planning Fee $ � v � � Building Permit $� r• D �% Plan Check $ � ' 1 '� Electrital $ Plan Check 50% $ SMIP 5 !� • �� TOTALFEE $ �G�•Z� Prtgrams ❑ Shopping Center/Integrated dev. ❑ By Owner/or ❑by City Dete le2[er sent: e� � � � �.,�A., :; JAN 2s �saa ,j ,j � CITY 0 ASiCAf IAESA O(/ice Use O Veriance Pro rry Plannad Signing L� /�' � C.U.P. No A. P. No. 1 �" Zonin Illuminetion Sign Dist. Dete Received —a� Non-Illuminated Received hy Interior Illuminetion Street front e: Exterior I Ilumination � !�� jfr C/ Front:_!J�� FL Streat: �%1� Right: FL Streer. Lefn Ft. S[reet: Rear Ft. Streer. INSPECTION APPROVALS Sign I Dete Underground Conduit Building set back from ultimate rightof�vay ft. Sign Lowtion Front q¢ar_�^Right _�_ Left J Sign Description Sig� (,( / Dimensions / Area Letter Height Faundations (1) � z � _ � sq. ft. Rough Wiring F�aming Final Elec[ric Final Planning Sign DEVELOPMENTSERVICESREQU ENTS: Planni� APProved BY: � � Date _ Building Approvad By: Date � AppN�tian lauad By: Date rav. 8/86 W�ite-Builtling; GreemCotle Enforcement: Canary-qpplicant; Pink-ftevenue; Goltlenrotl-Assessor 121 x �.1t. 131 z sq.ft. Itemsof Information: (11 (2) (3) Tot I tor Activity Copy Ver6age JJ �/r� � � I' � me � Ground Sign: Overell Height Plenter Area Ground Cleeronce ro�ei sy F, of All t ea This ectivity Total S'� e � N }es: , �� / � � � I "U r� �, \ � ' ' � � , ApPlicant [o }i,,, _�Ithin heavy borEer lir.es antl sign ail aPPr00riate Geclarations. - , eirt�coSYA yM:�ESA �COaNAS7� �1CTION PERMIT ..PrnjertAddres} %�� IVIC(:Iin�o�K WCxv •A'pplitanl'sf:Aailin.'r,ddiess 'qS /,. Owne„� Naine� d� ' Phtlq n-�`� Address ��(�%� D�� /��j—� N Arch/Eng, license No. � Add �ess � ' • . . . Codtrgctor'sNam �Lfl Phone2' �� ,L ./ �y' '� �,�, ��7 y Address (mailing) �7�.45 �,r �d.3l�w�+�Z � + 1 L S�/- ! City �icense No. (O 3 � , � : LICENSED CONTRACTOR OECLARATION'� , � 1 hereby attirm that 1 am Iicensetl untler prqv151on5 ot Charter 9(mmmencing wlth Section 7000) of Division 3 o tne BuSin¢ss antl ProfeSilonS Cotle, antl my IiGense is In full t rte ntl ei/ecL C O�Z '' ' LiconEe class � o. � / Oate_ - � Si9na[ure - WORKERS' COMP NSATION D RA 10 - 1 hereby atfirm that I nave a rertifi�a[e o( onsent o selfdnsure or a certlficate , •f WOrkers' CompCnsation Inm�ance, o a ceriitietl copy thereof (SeGtion 800, �b. C / /� - A_5 PolicY No. �Z � g � �I Bo �PanYLV��«"L /QS 8 Certifietl copy is hereby furnishetl. ' Cert' ie copy is iletl wi[h the cit i Ing u �Date Applicant EXEMPTIO�RKERS' CO SAT O ECLARATION ' _ (This Section neetl not be completetl it ttte permi is f ohe �untlretl (E300) or less). -� � _ I c¢r[�ry tM1at in tlte pertOrmance of the work fo�'wltich this perm�[ is ISsuetl, I shall not employ any person in any manner so as to become•subject to'the workn,rs' Compensation Laws ot Califomla. ' • � � , � Dale Si9natwe • ' NOTlCE: If, alter making this tlaUaration, you shoWa become subject 10 the WorkNrs' Compensation orovisions of the Lnbor Cotle, you must forthwith comply with such provisions Ot lhi5 pCrmit 5M1a11 b¢ tleemetl revoketl. CONSTRUCTION�LENDING AGENCV I he�eby affirm LM1at there is a ConSt�uction lentling agenty for the pertormanCe of Ihe work fOr which Ihis permi[ is isSUetl (Section 309� tiv. C.) L.entl@r's Name Lentler's Atltlresz OWNER BUILDER DECLARATION I he�eby affi�m Ihdt I am exempt trom Ine Contractor'S License Law tor the followin9 reason (Sec[ion 7031.5 Business antl ProfesSional Cotle: Any ci[y or coun(y �yhich'requires a permit IO conStruC[. alter, improve, tlemolish or repair e, also requires Ne appliwnt tor such permit /she is licensetl OurSuant to the O�ovisions ot apter 9(commencing with Section 7000) of Nofessions Cotle) or Iha[ he/she is exempt allegetl exemption. Any vfolation of Section petmil SUDjects Iho applicant to a civil tlretl tlollars ($500�. o� my amploye¢z with wdge5 as thei� sOle antl ihe SVuciure Is no[ intentletl or offetetl : antl Professional Cotle: The Cont�actor'S owner oi a property who builtls or improves 'k himsel//herseli or tnrough his or her own iprovements are not Intentletl or offeretl for m antl tbe ba5is for Ihe by any applicanl fOr a ot not more tnan tive nun � owne� of the property satinn. will do the work. ' I(, howeveq the buildin9 or improvement is soltl witbin one year Of com- ��bn, the owne� will nave the burtlen ot Oroying he/she tlitl not builtl or im- �e for (M1e purpose oi sale). I, as owner o( the property, am ezclusively wnlracling with Ilcensetl cOn- :�orsto consVutt the Pro�ect (Seciion ]044, Business antl Pwfessions Cotle: = Coniractor's License Law tloes not apply to an owner ot 0roperty who �as or imo�oves tnereon. antl who con[racts tor such projects wilh a<on- ;tor(s) bcense pwsuant to the ConVactoPs License Law). I am aware that �of of their Worker's Compensation insurance shoultl be provioetl to me. I am exempt untler Seclion B. & P. C. for thls reason Date that Siqneture Drivers' Lice or CMF OB�5-46, r¢v. 10/84 _ Owner have reaa this application antl state that the above a9ree to comply with all city antl countY ortlinances o builtli g cons[ruclion, antl hereby authorize re0re- to nt upon the above-m¢ntionetl. �pro�'�pe"r�ty� fo�r Dalee.ti�� , -� ' � TYPE OF CONSTRUCTION � NEW IJ ADD LJ ALTERATION IJ pEPA1fZ ��CONVERSION ❑ DEMOLISH ❑ OTH R DESCRIPTIONOFWORK/USEOFBLDG.�4J ��"'��"L�Q ' Y�I.I[y • �TVPE OF PEI�MI'� ❑ TENAN7 '❑ OTHER PROJECT DESCR �CONSTRUC ZONE� Remarki: GRAOING U FOUNDATION b STRUCTURAL ;TRICAL ❑ PWMBIfYG ❑ M@GHANICAL ION Sq. Preventer Irrigation rinking Fountains loor Drains loor Sinks as Service Outlets Kitchen $ink Lavatories P-Trap Roof Drains Reinspection Fee 8oiler Duct - Under Ground Duct - Svuctural Duct - Ventilating Ezhaust System ❑ Mu Firepl/Fact. BIL ICBQ//i ! N 1 VAlUA710N $ GRADINGCU.VDS. AC Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimmi ool w/Spa ater Closet Water'Heater Water Service Auto-Wash LaundrY Trays $15 luue Fee MECHANICAL Hood or pe I ❑ Canopy Type I I ❑ ❑0.100,OOjLL�TU 0100,000 Fea � $15 ite - Builtling: Canary - Applicant; Pink - Actountin9: Goltlenrotl - AsseSsor j�frigeration System ❑0-700,OOOBTU ❑100,000 System Repair/Alteretion Fire Dampers Registers luue Fee a.a. �k r'G S Main Buildin9: TFront 20� 8 Rear 2,�(p A � Right S Left 3 0 ' Ping. (ief. qW �2- � Plannin9 Notes: NP1t � Automatic Washer Construction PoleSub. Cooking Unit DishwaSher Dryers ❑Gas ❑Elea Fan F A.U. Fixtures Device Boxes OuUets Switches Garbage Dispo �'.�� i , � DZone C Accessory Bui�ding: Z O N I N G R � Z Parking Req./Providetl SO g'/J E ) M T ._ .. S ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW KW �5-15 KW Meter LJup ro 100 Meter ❑over 1 a Sub Panel Mo�O-1 HP O i%- 8 c.Solar �9-15 HP �16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compacror FEES $ 3 I � Reinspection Fee $15 Issue Fee g 3 FEES DEVELOPMEN7SERVICESREQUIRE NT i"�r/�'?.�r�tiK �r-�s-8� Zoning Approved By �r Date Buildin9 Approved 6y Date �p Appliwtion luued By �Date O' �.Q � 7 SU MARV OF FEES � p BUt(.DING PERMIT 3--�J�� SMIP $ Oe $ 3 ��`PLANCHECK $ 3��-r PERMIT ° ISSUANCE $ PLUMBING S PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ � . CONSTRUCTION AND PLANNING POOL & SPA / APPROVALS Permit # Date Inspector p�ppROVALS 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 � (� 7 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 �j ' 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 64. Plumbing System - Final . 14. Rough Plumbing 65. Electrical-Final � 75. Rough Electrical-Conduit 66. Solar System-Final - 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign ' 68. APPROVED FOR PLASTERING ' 1S. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT I •� . l 20. Rough Factory Fireplace APPROVALS Permit # � _ 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. Undergmd. Storage Tank 0 Gas ❑ Oil I 25. Roof Sheathing '� �� - 74, Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding , 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: a� FQR ��6� 1�1'iY,��-.... .i . 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test � Y7 �` .�� 36. Hood or Canopy Z I 8 D � 37. Final Factory Fireplace �� 8� :. 38. Final Plumbing , , 39. Water Service-Final / s/ f�ST�,��iY 40. Gas Service-Final , 41. Solar pomestic-Final ' 42. Backflow Preventer � 43. Backflow Irrigation � . 44. Landscape Irrigation System • � �' ,45. Sound Attenuation � � 46. Handicap Regulations � 47. FINALSTRUCTURE&BUILDING j/a��si ' � 48. Special Requirements Completed � �' ,. � " � . 49. Electric Release to Edison . � _ +� • 50. Gas Release to Southern California Gas Co � � • . .; : 51. CERTIFICATEOFOCCUPANCY • • • No. Date ' � •' F CITY OF C05TA M�SA CALIFORNIA 92628•1200 P. O. BOx 7200 DEVELOPMENT SERVICES DEPARTMENT CERTIFICATE OF COh1PLETION Street Addrass 2980 McGlintock Wav 'Phis certifies that the building shell constructed under the permits shown below`is found to be in conformance with the plans submitted and approved. 'this certification is only for the design and details shown on the approved plans, and shall not be construed to author- ize occupancy of any portion of the structure. A Certificate of Occupancy will be issued upon completion of each portion of the building covered by separate tenant improvement permits. Building Permit No. �lectrical Permit No. Plumbing Permit No. Mechanical Permit No. _ .��. /'�/88 Date / Building Division (714) 754-5626 - �'S'S%I�I7�I�I�S:�e : o � • � •�: �• • Assistant Development Services Director, Bnilding Safety �-f�-� !' BY Code Enforcement/Business License (�14) 754�5234 77 FAIR DRIVE Planning Divfsion (714) 754,5245 Director of Public Works Development Division City of Costa Mesa 77 Fair Drive Costa Mesa, California 92626 Attention Subject Reference Project: � ►YNES � CO. CIVIL ENGINEERING ANDSURVEVING WILLIAM R. HAYNES, L.S. (1928 - 1987) ROBERT E. STEAFFENS, P.E. Gary Conlon, Assistant City Engineer Civil Engineer's Certification of Compliance for Line and Grade Grading Permit Number: 008622 Job Address: 2980 McClintock Way, Costa Mesa Owner: Ted Rischard General Contractor: Martin Bui ders Work Began: 8-28-87 Work Comp ete : 10-15-87 In accordance with the Costa Mesa Gradin and Excavation Code and the requirements of the Building Code, I certify approva of this project as outlined above, to line and grade of drainage devices. Said work has been completed substantially in conformance with the approved grading plan for this project and in full compliance with said Codes. Certification includes horizontal and vertical control for drainage devices. This certification does not include approval of the placement and compaction of earthwork within the purview of others. By �� ; � J/i /h--' (,�. , �// � Date %/?� 27 Robert E. Steaffen , RCE f� 2 06 President, W. R. Haynes & Co. 3829 BIRCH STREET • NEWPORT BEACH, CA 92660 • TELEPHONE (714) 852-8626 .� < e � v �`; ��13950 MONTE VKTR 11VENUE CXINO. C�IIFORNIA 91710 � (77415410191/Iiti1945-7656 CONTRqCTORS LICENSE N0.17698i To: Martin Builders Inc 1495 East Warner Santa Ana, Ca 92705 RECEIVE� �'�`! 0 2 t�7 JOB NAME: Ri schard Bu i I d i ng 2480 McClintock Avenue Costa Mesa, Ga PACIFIC ROOF STRUCTURES ORDER NO. 8704 AITC Certificate No. 40730 A Gentlemen: October 29, 1987 Enclosed piease find copies of AITC Certificates of Conformance for the above wbject ,� •. -`• project. Please forward these ceKificates to the appropriate building department so that ;;:..:,. the final inspection can be issued on our scope of work. Should additional atiachments be required, please oontact us immediately. REMARKS: COPlES TO: Yours very truly, Dierk D Peters DUKE PACIFIC,'INC. ,... . -,... .... �. a :ooi-iz CITY OF COSTA IT AVGlicant to (ill in all sDaces exceo� those witnin neavy bortler lines and sign all aoo�oo/�ate tleclantions. PEFMIT NO. Ai ITI� . T N UNIT NO. C7,S Ff - �� '8 �— ' App:lcant'3 N�adin� �A/pdr Z� • . Owner's N� �`� �tld/ Q�d L Phnnn� •�j� Address v�T�r�, �'��_�fa��l1 �ry� 4t'7d Arch/Eng. —. License No. Address —T Contractor's Nam Phone 2 �� Address Imailing) � Ciry License No. �L LICENSED CONTRACTOR DECLARATIpN 1 hereby affi�m [hat I am Iicansetl untle� p�ovi510ns o1 ChartGt 9(coTmencing with Set[ion 7000� ot Dlvision 3 0l t�e gusiness antl Prot¢SSiOns Cotl¢, anE my Iicenze is in lull force antl eHact. Licen Class� ��_�/ �eN.235o3?� Datc �� 51g t.�y � r WORKERS' COMV NSATION OE R TIO i I hereby afFlrm tnat I have a certiiicate o tonsen to self-insure or a certiticate of Workers' Compensa[ion Inturanco, or a certltietl copy tnereot (Section 3800, Lab. CC'z 5 F7T /' d.� Policy rvo. ! 0 Com any! �%� - � //-ertifietl copy iz hereby furni5h¢tl. LY Certif etl o0Y �5 filetl with tha Nty B' iq[f6 � Oate APPlltant EXEMP 10 FR MWORKERS'COMP@ qT CLARATION (ThissecSion neetl not be COmplete0 it th@ permi s tor ne huntlretl (b100) or less). 1 certi�y lhat in the Oetformdnce o1 Ine Wo�k fOr whicn tnii Oe�m�t i5 is5uetl, I shall not employ any porson in any mannor so as to becOm¢ subject to tne Workers' CompenSaHOn l.aws of Cali/Orn�a. Oa[e Si9nature NOTICE: It, atter making Ihis tlaGlaratloq, you ShoWd become subjecl to IhB Workers' COmpenzatlon provl5ions ol tqe LabOr Codc, you must tor[hwith comply with such Orovislons or thi5 p¢rmil snall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV I nereby affl�m lhat thom I5 a mnStruCliory lentling a9ency for the Perto�manco of tho work tar wnich this permit Is issuetl (Se<tlon 3097 Civ. C.) Lentler's Namo Lentler's Atltlress OWNER BUILDEH �ECLARATION I hereby afflrm that I am nxampt irom (he Contractor's LI<ensc Law for the following reason (Sectlon �03L5 Business antl Prolossional Cotla: Any city or county whicn requires a p¢rml[ to conitruct, alter, Improve, tlemollsh or repalr any structure, pdor to Its Issuanca, also requlras tho appllcant tor such permlc to /ile a signetl slalemenl thal hc/she I5 11cen504 pursudnt to �he provlSlons ot [hc ConVaclor's LiGense Law (Chaptor 9(�ommenCin9 wlth SettlOn 7000) oi Division 3 of the Buiineis antl Profeislons Cotla) or tnat ne/shc Is exemp[ [hereM1om antl th¢ DasiS IOr tne allegetl exempliOn. Any violatlon o1 SecHon ]031.5 by any a00�iGant tor d petmi( zubfects lh¢ applicant [O a civil rendlty ot not more lhdn fiva huntlretl tl011ars (5500). ❑ I, ds own0/ 07 Ih0 P�OP¢/ly or my emO�oYoes with wage5 as their zole comoensation, wi�l Oo Me work, antl the structure Is not IntonOetl or otferetl for sale (SecUon 7044, Buslness antl Profess7onal Cotle: Tha Contractor'z License Law tloes nOt apply �o an owntr p( a O�oO<rty who builtls or Imp�ove5 Ihmeon, anU who tloos such wo/k himSel�/�erSalt or tivOu9h bls or her own emploY¢es, 0/ovitled that sucb ImP�OVOrt�anls aro not intentlatl or ott¢re0 b� sale. 11, however, the bulltling or imptovement Is soltl wilhin on0 Year O1 com- pletion, tha owncr will have ttta bu�tlan ol provin9 hC/ShC tlIG not bulltl or im- i�rova torine purposa olsale). I, as owner ot lhe proper[y, am oxclusivoty contracting wlth Iicensea con- I VactOls Io <Onstlutt tha prO�ect IS¢ctlon 7044, Busin¢55 dntl Prote55ions Cotla: The Contractor'z Utense Law doe5 not apply to an owner o1 pmperty who builtls or improves l�ereon, antl who cbM�acts for Suth prOjGcts wlth a con- tractor(5) license pursuant to the Conttdc[or'S LICen50 Ldw�. I am aware lhat proof o( their Wo�ker'S Compunsatlon Insurance Shoultl be prOvltlutl to m¢. � I am exempt untler Secilon B. 8 P. C. tor thiz reason Da[e Owner I hereby certily that I have r¢atl Niz apo��atlon antl state tnat Ne above intormation is correct. I a9reo to tomply V,.ith all Nty antl wunty ortlinances antl state laws relaUn9 to builtling cons(ructlon, antl hereby authorize repre- sentatives ot t iS-' er u on tne above-mentionetl property for inspectlon pu iCs. / ` / Signatur! Date1(��_� Drivers' Li 1 5 9f TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q.p,# DESCRIPTQNQF�'WQ,RK/USE OF B�D��-� T�R�- f� .c4 [�f/� s nn� TVPEOFPERMIT GRADING FOVNDATION STRUCTURAL � ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHHNICAL A RE ❑ OTHER C PRQIECT DESCRIPTION 5Q. FT. OCCUPANCv K CONSTiEUCTIONTVPE VALUATION$ � L ZONE GRADINGCU.YDS. ACRES �- Remarks: � ` � �� P�i Sink Preventer Irrigation Drinking Fountains Floor Droins Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P-Trap Root Drains Showers Service Sink Sewer Cap Sewer Connettion Solar Collectors Solar Pipin9 Solar T� Pool w/Spe Water Closet Wnrer Hearer Water Service Auto-Wash ES qeinspection Fee I $15 I � Issun Feo I � 3 Duct- UnderGround Duct - Structural Duct - Ventilating Ezhaust System ❑ Multiple Firepl/Pact. BIL IC60 # / Heating System & Ducting ❑ P7 00,000 BTU � 100,000 Reinspection Fee � $15 GMF 0865�46, rev. 30/84 While - Builtling; Canary - AppliGanl; Pink - A<counting; GOIGenrotl - Assessor Hood or Typel 0 Canopy Type I I ❑ 9efri [ion System 100,0008TU ❑100,000 System Repair/Alteration Fire Dempers Registers laue Fee � $ 3 Automatic Washer Construction Pole $ub. Cooking Unit Dishwasher Zone Acceuory Building: ELECTRICAL � Transformer ❑ 15-50 KW ❑ 50+KW Dryers LJGas LJElectric Fan . F.A.U. Fixtures Device Boxes Outlets Switches Garbage Dispoul Generamr �0�5 KW OS-15 KW Reinspection Fee $15 DEVELOPMENTSERVICES Zoning Approved By Building Approved By .�j� ApD��tion laued Bv—b�.d� BUILDING PERMIT $ PIAN CHECK § PLUMBING $ PIAN CHECK 25% S ELECTRICAL $ PIAN CHECK 50% $ MECHANICAL $ PIAN CHECK 25% $ Meter LJup to Meter ❑over Su6 Pan M�s�O-1 HP O7'H-8 nc.Solar 0g-15 HP �76�15* Microwave Pole Light Ran�e Standing Sections TrasF Compactor Iszue Fee RV O z O N I N G R E Q M T S FEES 5 3 SM�P g . S � PERMIT ISSUANCE 5 ENERGV P.C. S GRADING S MICROFILM $ TOTALFEE $ �y•,3 CONSTRUCTION AND PL•ANNING . POOL & SPA APPROVALS Permit# Date Inspector qppROVALS 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 Reinforcementf 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd : 57. ,P,PPROVAL TO COVER�GUNITE , 7. Footings •�- �,�.�.�. Q d, 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. Elec[rical-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 �� I• 20. Rough Factory Fireplace APPROVALS Permit # � 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil - 23. Gas Pipe-Rough & Test 72. ,Underground Flush �. 24. Roof Framing 7,3. Undergmd. Storage Tank O Gas ❑ Oil ;� - � 25. Roof Sheathing ' 74. Overhead Hydro 26. T-Bar Ceiling (Strticturall & Monocoat � 75. Dry Chemicaf ' � 27. Frame and Flashing 76. Dry Standpipe . � 28. Lathing & Siding 77. FIXED SYSTEM FINAL ' • ' � 29. �nsulation 78. FIRE PREV. FINAL �� 30. Drywall Nailing � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat � � 79. FINAL INSPECTION � ' :. l' . 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSI�IED � ' 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 � � ' . ; I' 40. Gas Service-Final � � � • ; ' � 41. Solar pomestic-Final i ,. • ( ' . . •' � 42. Backflow Preventer ' ' •` i Y� : ' 43. Backflow Irrigation � � � , . � ' ' i � 44.'Landscape Irrigation System ; � � 1 i. .', i ��45. Sound Attenuation � �� i.• . . �. � ' . i . � ; , , � 46. Handicap Regulations . � . � ,47.'FINAL STRUCTURE & BUILDING „2�� , ' , � ` , ' - 48,; Special Requirements Completed ' i ;�,� . -49. Electric Release to Edison -• • ' ; � ` .' � � 50. Gas Release to Southern California Gas Co • � '' 51. CERTIFICATE OF OCCUPANCY ' � No. Date � - , . , - . _ . , � . ADP�icant to /ill in all spaces execpt t�osc within �eavy bo�Eer Ilnes anG si9n all aDoropriate eeclarations. ,"'ITY�aiECOSTAMESA CONSTRUCTIO P MIT ��'T_"3°�q�.� ��NO� r�°�'�°S UNITNO. PiDlect Acl(1re45 � RO G .�- �/ ADPlicant's Maeling Address l Ownei�sNa'me � < < o Phone�"/ Addresc '� - • Z' � 5 , Arch/Eng. '� License No. Address �/ Contractor's Nam N ��LD Phone L Z� Address (mailing) � i 5 �' .`��.� �Ciry License No. � '3 LICENSED CONTRACTOR DECLARATION 1. 1 hereby aHirm lhat I am Ilcensetl untler provision5 0l Charter 9(<ommencing � v witn secUon ]000) ot Olvislon 3 of lhe Business antl Pro(e5sion5 Cotle, antl I my license is in iull forc ntl eifect. .j S� 3 Liten e Cla een ` Oate � T' Si9nature ' WO 5' COMPENSATION D A A I � ` I hereby ailirm that I have a certi/itate c sent o 581f-Insure or a certititate of Workers' Com`pensation Insurance, or a ce/rUtie�tl� �copy th reof (Section 3800, Lab. C.Z/3$�O! C�iI"�• �G. Policy No�. � Cc npany Certi(i¢tl Copy is hereby tumishetl. Ce tjfie copy is filetl with the cit 'VdimrO s� Date 7! APPlica EXEMPTION�RKERS'CO SA I - DECLHRHTION (This sectian neetl not be completetl i/ tho per t Is f one huntlretl (5300) or less). I certify tnat in the periormance of Ihe work for which this perm�t is issuetl, I Shall no[ amploy any perzOn in any manne� so as to become subject [o the Workers' Compensatlon Laws of Calitornla. Da[e Signature NOTICE: If, after making this tleclaratlon, you snoWtl become subject to the Workers' Compensation provizions ot the Labor Cotle, you mus[ rorcnwicn comply wilh such p�ovisions or th15 permil Shall be tl¢em¢d revoketl. CONSTRUCTION LENDING AGENCV 1 he�eby aftirm tnat there IS a Wnstruttlon lentling agency for the pertormance of Ihe wark tOr which Ihis perml[ is issuetl (Seclion 309� Civ. CJ Lentler's Name Lnntlor's Atltlresz OWNER BUILOEN UECLARATION I hereby a(firm that I am exompt trom the Convactor'z License Law for the /ollowing r¢ason ($eclion 7031.5 Buslna55 antl P�ote55ional Cotle: Any city or wunty which reQuirps a permit to con5trucl, alter, improvB, Oemalish or repair any si�ucturo, prior �o Its i55uanc0, also raqWr¢s lhe applicant (or SucM1 Pe�mit to file a Signotl zlatement tha� he/ih0 iz Ilcensetl pu�5uant lo th¢ Orovisions oi the Contractor's Ucense Law (Chapler 9,�tommen<in9 with Sectlon ]000) ot DIVI51on 3 ot the BUSInOss antl Profe5Lon5 CotlO) Or thdt hc/SFIe is e%empt there/rOm and Ihe basis lor th¢ alleg@tl OxGmptlOn. Any violation ot Section �031.5 by any applicant fOr a pCrmit subjects lhe applicanl to a civll !ndlty of not more lhan livo huntlretl tlollari (5500). � I, a5 owncr ol [ho property or my OmployCCs wilh wages d5 lhei� sole COTp¢nsalion, will tl0 thu wOrk, antl lhe it�ucture I5 not Intentletl o� ofter¢tl tor sale (SeGliOn 7044, BUSiness antl Pr01855iOnd1 Cotle: The Con[ractor's License Law tlocs not apply to an ownor ol a pronerty who bulltls or improves thereon, ana wno tloes such work hlmselt/narseli or Urough his or her own em0�oyee5, provltic0 that Su<h imprOvem¢nl5 aro nOt intentlOtl or ofteretl for sale. If, hOwover, thC Dulltling or ImprOvoment is Soltl wilhin one year of com- pl¢tloq t�e ownOr wlll Itav¢ lhe burtlnn oi proving hC/She tlitl not builtl o� im- �fOv! �o! lhp pulpo5o OI Sale�. U I, as owner ol the property, am exclusivery contracting with Iicensetl con- t�actor5to tOnSVUCI lhe projCGl (Section 7044, Bu5in�5s antl Protessions Cotle: The Contractor's License law tloes not apply to an owner ot property who builtls or imDroves theroon, antl who conVacts for such projects with a con- tracmr(sl Iicense Oursuant to tnc Contractor's License �aw). I am aware mat prooi o( lheir WOrkcr's ComPensation in5uranc0 shoultl be prOvlOetl to me. ❑ I am exemo� untler Section B. 8 P. C. br thi5 reason Oate Owner _ rve reatl tniz a above mnces repre- v.tor � lu e�✓ wt 57 -23 TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISM ❑ OTHER DE�IONOF WOR�C�SE,Q� 4L� �e' j�h' 6� y L TYPEOFP MIT GRA�ING FOUNDATION STRVCTURAL ❑ TENANT�ELECTRICFI ❑ PWMBING ❑ MECHANICAL ❑ OTHER ✓Lf-D(N PROJECT DESCRIPTION 50. F. oCCUPArvcV CO N STqUCTION TVPE VALUATION S��GC O ZONE GRA�INGCU.YDS. ACRES Remarks: Q �. Bar Sink Backflow Prevenrer Backflow Irrigation eathtubs Clarifiers - Dishwasher Drinking Fountains Floor Drains Floor Sinks GasService OuUets Sink Roof Reinspection Fee FEES Showers Service Sink Sewer Cap Sewer Connection Soiar Collecrors Solar Pipin9 Solar T� Swim �g Pool w/Spa nal Water Closet Warer Heater Water Service Auto-Wash Laundry Trays $15 Issue Fee 5 3 Duct - Under Ground Duct - Svuctural Duct - Ventilating Exhaust System � Mul[iple ❑ Firepl/Facc BIL ICBO �# Heating System & Ducting ❑4700,000 BTU ,0008T IDrivers' �icense r 5 ��Tr I I`pe�nspection Fee I $15 CMF 0865-46, rev. 30/04 Whiie - Builtling: Canary - Applicant; Pink - AccOunting; Goltl¢nrotl - A55essor A.P. •/k S Main Bu E Front T e Rear A C Right K Left S Ping. Ref. # 8604 10/29/87 � �z -�o zo�a Accessory Building: Pnrking Req.�Provided Automatic Washer Construction PoleSub. Cooking Unit D ishwasher Dryers OGas ❑Elec Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generaror D0�5 KW C ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over100amps Sub Panel . Morors �0-1 HP �7'f. - 8 Inc.Solar �9-15 HP �16-15+ Microwave % � Po1e Light Range Standing Section5 5 KW Trash Compacror Reinspection Fee 815 Issue Fea iqNICAL FEES Hoo�or Typel ❑ DEVELOPMENTSERVICESREDUIREMENTS: Canopy Type I I ❑ Zoning Appravad 8y Building APProved BY --- �- Refrigeration System ❑aioo,000 eru $ystem air/AI[erz ire Dampers Registers Issue Fee $ 3 91093 TL Z O N I N G R E Q M T S FEES 5 3 � 9 / SUMMARV OF FEES BUILDING PERMIT $�'Q-• vSC�Zi SMIP 5 D'cS� PLAN CHECK $ �_�F�.r_ PERMIT P�UMBING $ ISSUANCE S PLAN CHECK 25% $ ENERGV P.C. S E�ECTRICAL $ ��•�, t00 GRADING S PLAN CHECK 50% $ 'h G O MICROFI�M 5 MECHANICAL $ TOTALFEE S_�• 9 3 PIAN CHECK 25% $ CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permii# ��' Date Inspector qppROVALS 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 ConduirUndrgmd. �m.�y1,� 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. 8. Foundation � � 59. Gas Pipe, � Undrgrnd., 7est 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 �- -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 W�ring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # � _ 21. Ducts, in Structure ' 70. Underground Hydro 22. Ducts, Ventilatin9 71. Product Piping O Gas ❑ Oil - t' 23. Gas Pipe-Rough & Test 72. Underground Flush � � I 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil . � . 25. Roof Sheathing 74. Overhead Hydro , � 26. T-Bar Ceiling (Sttucturaq & Monocoat 75. Dry Chemical . 27. Frame and Flashing 76. Dry Standpipe � 28. Lathing & Siding 77. FIXED SYSTEM FINAL ' • � 29. Insulation 78. FIRE PREV. FINA� ' � 30. 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 � 47. Solar pomesticFinal ' ' ' • � • 42. Backflow Preventer ' � � ' � . - � . i � . �. 4< : 43. Backflow Irrigation f � �' �;, " 1 � � 44. Landscape Irrigation System �� ' � . � . • ' � 45. Sound Atten�ation � . � , 46. Handicap Regulations '�, . ., .. , � �� 47. FINALSTRUCTURE&BUILDING + . •' ` . � , 48. Special Requirements Completed - � - 49. Electric Release to Edison � , - �" 50. Gas Release to Scwthern California Gas Co . �' '.� ,�� 51. CERTIFICATE OF OCCUPANCY ' , No. Date _ ' " � � :ITY OF COSTA Project AddreSs — ADolicant to till in all spaces except those within heavY bortler Ilnes anE sign all apo�ovriate Eeclarations. RMIT � PE�IT NO. �^ TRACT NO. LOT NO. UNIT N6. Owner's Name � �� `�^� cPho^ne, �,.. Address L�S�� 1�� ;l �'L� Arch/Ertg. — License No. Address q��,,�_ �, ��+��(�[>�� ` Convactor's NamP��/�-`�'o"�.r'/L �—."�/�7jJ_�6-tNhon¢-4�2��/� Address (mailingl�� L • � �u4' � A�ii.C¢G City License No. T� I LICENSED CONTRACTOR DECLARATION I hereby atfirm that I am licensetl untle�'provisions of Charter 9(commencing witn secHon 7000) of Division 3 of the Business antl Professlons Cotle, antl my license is in full forcejwtl^it¢c� / � � Licen�se/ Cla C•�� •S�b L' en• Dat�`� Si9nature WORKERS'COMPENSATION DECLAR ON I hereby affirm [nat I have a certificate of c ns t to self-insure or a certificate of Workers' Compensation Insurance, or a certifietl mpy tnereof (Section 3800, lab. C.) �.n�y� I O Pol' N ��7�4/V`��Company Certifietl coOY i5 �ereby furnishetl. C�r.ji�q�c�y%letl with the city on DatP ( G� ( Applicant EXEMPTION FROM WORKERS' CO E SA I N ECL R (This section neetl not be completetl if the permit is t r one h 00) or less). I tertify that in Ihe performance oi tne wo�k for which thi5 perm�t i5 issuetl, I shall not employ any pe�son in any manner so as [o become subject [o the Workers' Campensation Laws of Califomia. Date Signalure NOTICE: If, aftet making this tleclaration, you Shoultl become subject to the Workers' Compensation provisions�ot the Labor Cotle, you must forthwi[h comply wilh such O�ovisions or this pe�mit shall be tleemea revoketl. CONSTRUCTION LENDING HGENCY � I hereby aftirm that Ihere is a construction lentling agenty for the performance of the work for which this permit is issuetl (Section 3097�SCiv. CJ Lentler's Name Lender's Atltlress OWNER BUILOEH UECLARATION I hereby affirm that I am ezempt irom the Contractor's Llcense Law tor the followin9 reason (Section 7031.5 Business antl Professional Cotle� Any ciYy or county which requires a permit to construct, alter, improve, tlemolish or repair any strutture, prior lo its is5uance, also requires the applicant for sucn permit to file a siqnetl statement that he/she is licen5etl pu�suant to the piovisions of the Cont�actor'S License Law (Chapter 9(commencin9 with Section ]000) of Division 3 of the Business antl Professions Cotle) or that ne/she is exempt the�ef�om antl the basi5 for the alleqetl exemption. Any violation ot Section �031.5 by any applicant for a permit subjects the applicant [o a civil =_nalty of no[ more Ihan tive huntlretl tlallaro ($500). , I, as owne� ot the property or my employees with wages as thei� sole compensation, will tlo the work, antl the strvcture is not intentletl or otferetl for sale (Section 70G4, Business antl Professional Cotle: The Con[ractor's License Law tloes not rppty to an owner of a p�opertY who builtls or improve5 [hereon, antl who tloes such work himself/herself or through his o� hEr own employees, provitletl that such improvements are not intentletl or offeretl for sale. If, however, the builtlin9 or improvement is soltl within one year of com- pletion, the owne� will have tne burtlen of proving h2/she tlitl not builG or im- prove for the purpo5e of sale). ❑ I, as owne� of Ihe property, am ezclusively cont�acting with licensetl con- Iractorsto.construct the project (Section ]044, Business antl Professions Cotle+ The Contractor's License Law does not apply to an owner of property who builtls or improves thereon, antl who contracts for such project5 with a con- tractor(s iicense pmwant to the Conbactor's �icense Law). I am aware Ihat proof o� their WorkeYs Compensation insurance should be provitled to me. ❑ I am exempt untler Section _ B. & P. C. for Ihis reason Date Siqnature � Drivers' LicenSe Or � Owner n antl state that tne above city antl county ortlinances antl hereby autnoriie repre- ve-mentioned�r��t� i �E OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REGAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TYPE OF PERMIT IJ GRAOING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL �LUMBING ❑ MECHANICAL ❑ OTHER p.,�iOJECT DESCRIPTION 5(?. FT. oCCUaANCV— COfJSTRUCTION TYPE VALUATION $ ZONE GRADING CU. VDS. ACRES_ Remarks: Sink cflow Preventer cflow,lrrigation Dishwasher Drinking Fountains Floor Drains Floor Sinks GasService / Outlets Interceptors J Kitchen Sink Lavatories P—Trap Roof Drains $hOWers Service Sink Sewer Cap Sewer Connection Solar Collecrors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Cioset Water Heater Water Service Auto-Wash Reinspection Fea I $15 � I Issue Fee I $ 3 Boiler Duct-Under ' und Duct - Structural Duct - Ventilating Exhaust SYstem ❑ MWtipl Firepl/Fact Blt. ICB Heating Syste ucting ❑0-100, TU 0100,000 Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Builtlinq; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor r Hood or�pe I ❑ CdnOpy TVpC I I ❑ 3eTrigeration System �0-700,000 BTU ❑100,000 BTU System Repair/Alteration Registers Issue Fee $ 3 A.P. # S Main Building: E T Front B Rear A C Right K Left S Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dryers LJGa�. Fan F.A.U. Fixtures Device Boxes Outlets �"� Switches lectric 5076 9/11�87 ZO�e Accessory Building: Parking Req./Provided . ELEC7RICAL ' Transformer ❑ 15-50 KW p eo+Kw Meter ❑up to 100 mps Meter ❑over 1 amps Sub Panel Motors 0-1 HP 01 %- 8 In olar 09-15 HP 016-15+ icrowave Pole Light Range Sign Standing Sections 5 KW ash Compactor � I Reinspection Fee I$15 ' I Issue Fee DEVELOPMENT SERVICES REQUIflEMENTS: Zaning Approved By Building Approved By Application Issued By .q � 119a25 TL FEES $ 3 Z O N I N G R E Q M T S , SUMMARV OF FEES'� � BUILDING PERMIT $ SMIP ' $ PLAN CHECK $ PERMIT PLUMBING $ .00 �SSUANCE $ PIANCHECK 25% $ 3`� ENERGYP.C. $ ELECTRICAL $ GRADING . $ PLANCHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ r�9 as PLAN CHECK 25% $ , CONSTRUCTION AND PLANNING POOL & SPA _ APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector 1; Temporary Electrical, Service or Pole 52. Pool & EquipmeM Location 2. Soil Pipe-Undrgrnd." ' �(f��'Z (��Q 53. Steel Reinfarcement� 3. Electrical Conduit UtilitY-Undrgrnd. • 54. Forms , 4. Electrical Conduit-Undrgrnd. , 55. Electrical Bonding ' 5. Steel Reinforcement� 56. Rough Plumbi�g & Pressure Test • . 6. Electrical UFER Gmd.. �� 571APPROVALTO COVER-GUNITE i 7. Footings � � �\ i58. Electrical Conduit-Undrgrnd. '� 8. Foundation ;� `� �� 59. Gas Pipe, O Undrgi nd., Test i � 9. Water PiPe-Undrgrnd�. �'� � 60. Backwash Lines, P-7rap, O Undrgrnd. � 10. Structural Floor SYstem ,,;�` 61. APPROVAL TO DECK 71. Property Sewer Line;& House Connection ��`,�7-� �%� 62. Backwash & ReceptorFinal 12. Sewer Cap ; �.63. Heater & Vent-Final ' , 73. Roof Drains � 64. Plumbing System - Final 14. Rough Plumbing ' '�(/r?A-Sn LU� 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. POOUSPA SYSTEMS FINAL 19. �Rough Heating & Air COnditioning • fIRE DEPT. REQUIREMENT 20. R`ough Factory Fireplace APPROVALS Permit # _ 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 Fratning � 73. Undergrnd. Storage Tank O Gas ❑ Oil � 25. Roof Shea'�hing �' 74. Overhead HYdro 26. T-Bar Ceiling (Structura�l) & Monocoat 75. Dry Chemical ' i 27. Frame and Fla�hing' - 76. Dry Standpipe �� 7. 28. Lathi�g & Sidinc�� 77. FfXED SYSTEM FINAL� -� ' I 29. Insulation % � � 78. FIRE PREV. FINAL 30. Drywall Nail�ing �� ' HEALTH DEPT: REQUIREMENT � � 31. Plaster B'rown Coat 1 '�� 79. FINAL INSPECTION ','. �'� � � 32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED ' 33. Final Electric Notes: . � , � 34. Frnal Heating & Air Conditioning � � - 35. Final Gas Pipe-Test �Z.,q�� L�0 .- . ��; . 36. •,Hood or Canopy , . - •37.�.Final Factory Fireplace �-� � ' . � _ i .� �.38:�Final Plumbing �7/6".�� [� ,�:"'�'' �, '`�{� . � l� .; ;3�:;Water Service-Final - , � ,�� _ � ,/.� ' 1.�40. GasService-Final '/ I�'�� "- - �. 41 . Solar pomesticFinal � � �( '� r'. � ,,j �� ' � �.,. _ r .�`,42. Backflow Preventer �' ;Y " ' �' ,, � � , ., 43.�Backflow Irrigation '%%i� � �'/� � `, ''4Ai.��L'arldscape Irrigation System -`r � _ .+,r. , � ' ,`___ , 45:�$ouqd Attenuation � �3 �;'� '� � - .F i .... . ✓� Y � � ._ 46:^�Han$icap Regulations _ '' w` � I' 47iF1NALSTRUCTURE&BUILDING '� %� � 1�,, ��,.��: �� i`� 4 48.�SpecialRequirementsCompleted - .✓�� '!"� ��'�i' , I. .. 49.✓Electric Release to Ediso� ' � . � �� 50. Gas Release to Southern California Gas Co �i � ' � .� 51. CERTIFICATEOFOCCUPANCY - - • � , • I No. D2te � ' • � � � � . CI Applicant [o fill in all ipaces except Ihose within heavy bortler lines anG zign all apPropriate tleclarations, , CITY OF COSTA MESA CONSTRUCTION PERMIT PE T N . �� TRACT NO. LOT NO. UNIT NO. . 3I � � I/ � 3/8� BoC7O � L Project Atldress 29�n /Y1C G�L/i!/`iOC,C L.7�, �L, � ApplicanT'S Mailing Add�255 I��O "C" SO. RiK^HEfi �/. TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAI R ' ' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q.p, # Zone �Oivner's Name' �� RlSC'X�.PQ Phone DESCRIPTION OF WORK/USE OF BLOG. Address ��' �IxG Fi/L � 59NAV .�t/14. S Main Building: Accessory Building: Arch/En License No. TYPE OF PERMIT ❑ GRnDirvG� FOUNDarIOrv E Z 9 y ❑ $TRUCTURAL T F�Ont � Add�¢55 J ❑ TENANT ❑ ELECTRICAL '�—TPLUMBING ❑ MECHANICAL A Rear N Contractor's NamP �� C•-L Phone�r7Q� � OTHER . . Address Imailingl ��'o �C" `-'�• �xN6Y -�7, y, �_ 7JJ�,/R PROJECT DESCRIPTION 5a. FT. - ocCUaANCv C Right N CONSTRUCTIONTVPE VALUATION$ S LCft G City License No. �3��B ZONE GRADING CU. VDS. ACRES R UCENSED CONTRACTOR DECLARATION Ping. Ref. # Pd/king R¢q./PrOvid2d E Q I hereby afli�m that I am licensetl untler provisions of Charte� 9(commencing Remarks: Pi2nnin9 NOL¢5: M with section ]000) of Division 3 of the Business antl Professlons Cotle, an0 my Iicense is in full force antl effecL �� ^ �T� ��, �� OF �v�� S License Class fisey1� � � �Date �'�3'�5'onar rr) E�y .�l/fi�.-i PLUMBING FEES WORKERS' COMPENSATION DECLARIITION Bd� Sink ShOw¢f5 I hereby afiirm that I have a certfficate oi consent to self-insure or a certificate ELECTRICAL FEES of Worke�s' Compenza[ion Insurance, or a ce�tlfietl mpy thereof (Section BdCk(IOW P�¢v¢�t¢t ServiC¢ Sink � 3800, Lab. Ca. Automatic Washer Transformer ❑ 75-50 KW ( Poiic No. G�"� Company �� "`��' / Backflowlrri ation SewerCa ❑ 50+KW ` Y 9 P Construction PoleSub. � 7� �Certifietl copy is hereby fumishetl. ` V Certifie co is (iled with the city in i I Bathtuhs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date �-� Applicant� - EXEMPTIO�RKERS' COMFE SATION DECLARATION Clarifiers Solar Collecrors Dishwasher Mete� ❑ove� 100 amps (This sectian neetl no[ be wmpletetl if the permi[ is fo� one huntl�etl ($100) or less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel . I certify that in the perto�mance o� the work /or which this perm�t is issuetl, I shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors DO-1 HP �1 %� 8 Workers' Compensation laws of Calitornia. Date Signature Floor Drains Swimming Pool w/Spa F.A.U. ❑9-15 HP �16-15+ NOTICE: If, after makin9 this declaratlon, you should become subject to the _ Inc.Solar Workers' Compensa[ion provisions of the Labor Cotle, you mus[ forthwith FIOOr Sinks Urinal Fixture5 comply wi[h such provlsions or thiz De�mit sM1all be tleemetl revoketl. MiG�owave CONSTRUCTION LENDING AGENCY Gas Service Outl¢t5 Wat¢f CI052t D¢vic¢ BOzes POIf Li ht 1 he�eby affirm that there is a construction lentling agency to� tbe pectormanCe 9 of tne work for whi�SM1is permit is issuetl (Section 3097 Civ. CJ Interceptors . Water Heater Outlets Ran e �entler's Name a � 9 Lentle�'s Atlaress Kitchen Sink Water Service Switches Siqn OWNER BUILDEH �ECLAftATION I hereby affirm tbat I am exempt from the Contractor's Licens¢�Law tor the Lavatories Auto-Wash Garba e Dis osal followin9 reason (Sectlon 7031.5 Business antl Professional Cotle: Any city or 9 P Standing Sections county which requires a permit to construct, alter, improve, tlemolish or repair P—Trap Laundr Tra s any structure, prior to its issuance, also requires the applicant for,such permit � � Generetor �0-5 KW 05-15 KW Trash Compactor lo tile a siqnetl slatement that he/she is Iicensetl pursuant to the provisions of RoOS DldinS the Contracior's License Law (Chapter 9'(mmmencinq witn Seclion ]000) of Division 3 of the Business antl Grofessions Cotle) or that ne/she is exemp[ therefrom antl the basis for the allegetl ezemp[ion. Any violatiOn of Section 7W1.5 by any applicant tor a permit subjects the applitant to a civil ' �enalty of not more than five huntlretl tlollars ($500). $ 3 I, as owne� o( the property or my employees with wages as their sole ReinSp¢ction Fee $15 Istue Fee compensation, will Oo the work, antl the structure is not intentletl or o�feretl Reinspection Fee $15 Issue Fee $ 3 for sale (Section �044, Business antl Protessional Cotle: The Contractor's MECHANICAL FEES License Law tloes not apply [o an owne� of a property who builtls or improves thereon, and who tloes such work himseli/herselt or throu9h his or her own DEVELOPMENT SERVICES REQUIREMENTS: employees, providetl tnat sucF improvements are not intentletl or otferetl tor BOiler HOod or Type I ❑ sale. If, however, the bulltling or improvement is soltl witnin one year ot com- Canopy TyNe II ❑ 2oning Approved 8y Date pletion, the owner will have the burtlen of proving he/she tlitl not builtl or im- Duct - Under Ground Building Approved By Dat� prova for [he purpose of sale). ❑ I, as owner oi the property, xm exclusively contraoting with licensetl con- Duct -Structural Refrigeration System Appliration luued By Dat tractots to construct the project (Seclion ]044, Business antl Pwfessions Coae: The Contra<tor's License Law tloes not appry to an owner ot property who Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARV OF FEES - buiitls or improves thereon, antl who mnt�acts tor sutM1 projecls with a con- tractor�s) iicense purzuant to the ConVactor'S License law). I am aware that . BUILDING PERMIT $ ' SMIP $ Exhaust System ❑ Multiple ❑ System Repair/Alteration proof of tneir Worker's Compensation insurance shoultl be proviCetl to me. ' PLAN CHECK $ PERMIT ❑ I am exempt untler Section B. & P. 0.�or this reason Firepl/Fact. BIL ICBO # Fire Dampers PLUMBWG $ � ISSUANCE $ oate Owner Heating System & Ducting Registers PLAN CHECK 25% $� ENERGV P.C. $ I hereby certify tnal I have reaC lhis application antl state tnat the above ❑0.100,OOOBTU �t00,000BT ELECTRICAL $ GRADING S infovma[ion is co��ecL I agree to comply wi[h all city antl county ortlinan[e5 antl state Iaws elatin9 �o builtling construction, antl hereby autnorize repre- . PLAN CHECK 50% $ MICROFILM $ sentatives o is city� ente� upon the above-mentionetl P/ope�ty for inspection ses. signature .C.f /�l�R�...-t oatef�� MECHANICAL $ TOTAL FEE $ sso � Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25� $ Drivers' L' SS Yk �%� CMF 0865-46, rev. lU/tl4 White - 8ulltling; Canary � Applicanp WnH - AccounLng: Goltlenrotl - AssesSor CONSTRUf,TIONAND'PLANNING � POOL&SPA , APPROVALS Permit-#� Date Inspector AppROVALS Permit# Date Inspector I. 7-: 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. 55. Electrical Bonding 5. Steei Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings'� � • 58. Electrical Conduit-Undrgrnd. 8. Found�ation +, 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Back�vash Lines, P�Trap, O Undrgrnd. 10. Structural Floor SYstem 67. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & ReceptorFinai 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final � 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA�SYSTEMS FINAL 19. Rough Heating & Air Conditioning - � FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # _ 21. Duc[s, 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) & Monocoat 75. Dry Chemical � 27. Frame and Flashing 76. Dry Standpipe �', r 26. Lathing & Siding ' 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 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 Notes. � � t 34. Final Heating & Air Conditioning �.,% 35. Final Gas Pipe-Test � . 36. Hood or Canopy � � .i 37�. Final Factory Fireplace i,' , 38�. Final Plumbing �_�tf8� (�9 ' .� �, �� a. 39. WaterService-Final �' ' � ' " � � ' 40. Gas Service-Final % ,� " r . 41. Solar pomestic-Final � ' ' � . .. �, i 42. Backflow Preventer � � " , • �' v, . ,. . . . ' 43. Backflow Irrigation �y-gQ L� ��' ' ' �. � �" i�/ %I i ;44. Landscape Irrigation System � " ' ' � � �i - � - . �,4�. Sound Attenuation � " � • .' % � . " �� 46..Handicap Regulations •� � , '� � :t ,. 47,! FINAL STRUCTURE & BUILDING � - .; ; • '. � � ' , .,J. 48. Special Requirements Completed , .7'• , � �, . 49: Electric�ReleasetoEdison � • � .� • a 50. Gas Release to Southem California Gas Co • �, � �' , 51. CERTIFICATE OF OCCUPANCY , , .. No. Date ' • ' � n �� l i, . ':' �r AOD��ant to fill in all spaces exeept thosa wlthln heavy Dorder Iines antl sign a11 avoroo��ate tleclaratlons. CITY OF CASTA MESpA CONSTRUCT ION ERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. � . ProjectAddr¢ss o C �irJtOC l�ih MC-'SA- �`'� 31cn�8 . z35� 12/30/B7 �4:�'06�, 'Applicant'S Meiling Addr¢55 I q5 t LJ�+Rne2 S,/� Z� TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR �YYIfi2Ti ✓1 �L1 '�YS Phone a4' -' i 9 � � CONV ERSION ❑ DEMOLISH ❑ OTHER A,p, q�b Zone Owner's Nama ' 'j DESCRIPTION OF WORK/USE OF BLDG. Addr¢ss .� �� 5 -� �+�'he2 S• A. S Main Building: Accessory Building: Arch/Eng. � LicenSf No. TVPE OF PERMIT GRADtNG FOVNDq710N STRUCruRAL T Front . p Address ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING �I MECHANICAL A Rear N Contractor'sNam � Ir n i�JU� phone 639-I�d{5 ❑ O7HER tI' PROJECT DESCRIPTION Sq. FT. ocCUVANCv C Right N Addreulmailing1.1^7�N� ST�ATC �Ga� �R�n�ei CONSTRVCTIONTYPE VALUATIONS g Left G Ciry LiCense No. (�S�i I ZONE GRADING CU. VOS. ACRES R LICEf�SED CONTRACTOR DECLARATION Ping. Fef. # Porking (ieq./ProvitleA E I bereby affirm that I am Iicensetl untler Orovislons of Char[er 9(commencing Remarks: - 24�G/ % Planning No[es: M wi[h se[tion 7000) oi Dlvlsion 3 01 tha Businoss antl Professionz Cotle, and . my license Is in t W for<e ntl eitect. � S License C) �- %� - },Icense o�.'�� P�UMBING FEES Date �Z/ Qi c'��ar .a —�— ��S�R��. W00.KER5' COMPENSATION DECLARATION �/ v � Bar Sink - Showers I hereby aftirm tnat I have a certillcate of consent to selt-insure or a certiiiwte � � ELECTRICAL FEE$ of Workers' Compensalton Insuranco, or a certlfietl copy t�ereot (Section BackflowPrevenler ServiceSink 3ao0, Lab. cJ Automatic Washer Trensformer � 15�50 KW Poiicyrvo. Company Backflow•Irrigation - � SewerCa � � ❑50+KW P Cons[ruction Pole Sub. �Certifietl copy is �ereby fumishetl. ' . Ce�?��jef�,m_3�' is filetl wim the city B 1 g rv'�° n�. �� Bathtubs Sewer Connection Cooking UniY Meter ❑up to 100amps DatP' � u � $% ApPlicant �� ^'"'� EXEMPTION FROM W00.KER5'COMPENSATION L ATION Clafifier5 $olarColleC[or5 D'IShwaiher Metef ❑over 1008mp5 (Thiss¢ctiOn nee0 not �o compl8[ed il Ine Oermit is tor one nuntlretl ($300) or less). � Dishwasher Solar Piping�. Dryers ❑Gas ❑Elecvic Su6 Panel I c¢rtity Ihat ln the perto�mance o( the wo�k for whiGh this p¢rm�t i5 Issuetl I shall noi employ any person in any manner so as to became subject ro tf�e Drinking Fountains Solar Tank Fan Morors �0.1 HP �1'h- 8 Workers' Compensation Lawi o/ Calilornia. Date Si9natura Floor Drains Swimming Pool w�Spa F.A.U. NOTICE: It, after making this tleclaration, you shoultl becoma subject to the � Inc.Solar 09-15 HP �16-15+ Wofkers' CompenSdtion provi5lOn5 OI t11e I.dbo! Cotle, y0u mu5t fOrthwi[h FI00f $iOkS U�indl FixtUf¢5 camply with Suth prOviSions ol thi5 parmlt Shdll b! tlBemBU /evokatl. MiUOWdvC CONSTRUCTION LEfYDING AGENCV G�SSerVice Oullets WatefCloSet DeviCC8oxC5 PoleLi ht I h¢reby aftirm that Ihero is a conSVUCtion IGntling agency tor tne pertormance � - 9 of the wark for wnich tNi permit is issuetl (Sectian 3097 Civ. CJ �' •�1 Interceptors Water Hearer putlets Range Lentler's Name � Lentler's Aaaress Kimhen Sink Water Service $witches Sign OWNER BUILDER DECLARATION � I her¢by afflrm lhat I am Oxempt trOm lllu ConlydCtor'S Llcense Law for [he LeVdtOli¢5 AutO-WdSh GOf60 2 Di5 0531 tollowin9 reason (SocHon 7031.5 Business antl Protcizlonal Gotle: Any dty or • 9 V Standing SCctions counry which rcqWres a permlt [o con5t�uct, altor, Improve, tlemolistt or repalr P�T�2p � Leund� T�a 5 any ztructure, prlor to its Issuanco, alm requlres [he applicant tor sucn permit Y Y Generator �0-5 KW �5�15 KW Tresh Compactor to liio a signetl ztatumunt Ihat hn/sno Is Iicansotl pursuant to the provisions of �Roof Drains • tne Contractor's U<en5o Law (Chaptcr 9(commenUng with Section 7000) ot _ DiviSion 3 0l the Businass antl Pro/ozsionz Cotle) or that ne/she it exempt therelrom antl Ihe ba51s tor the alle9etl exemption. Any vlolation of Sectlon 7031.5 by any applicant tor a Parmlt 5u0jocts tM1e applicant ro a dvil �enalty of nOt mo�e Man five huntl�etl t1011arS (E500�. I, as owna! of the'property Or my omployee5 wi[Il wages ds their sOle RainSpBGtiOn FOB $15 Iitue FBB S 3 ' <oTp¢nsation, will tl0 th8 wofk, dntl th0 iVUCWfO IS nOl IntentlCtl Of of(eletl ReiOSpBCIiOn F88 $1rJ ISSuB FBa � 3 tor sale (Section 7044, Businass antl Proioszional Cotlo: The Conlractor•z MECHANICAL FEES License Law Goes nol appry to an owner ot a proparry wno bulltls or improves ' � thereon, antl who tloes such work nimsolt/harsolf or tnrough his or her own DEVELOPMENT SERVICES REQUIREMENTS: employees, provitletl that such ImOrovemunts are not IntenOotl or offeretl for Boiler HOod o� Type I ❑ sdl¢. II, howoveq tho bulltling or Imp�ovomant Is sald withln Onu yea� ot com- C2nOpY Typ2 I I ❑ 2oning App�oved By Date pletioq [he owncr will nave lhu burtlan oi proving he/she tlitl not builtl or Im- Duct - Under Ground Buildin8 Approved By Date prove for fhe purpose oi Salo). �^- /� ❑ 1, as ownor of tne vroperry, am exclusivaly contrattln9 wilh Ilcensetl con- Duct -Sttuclural Retrigeration System APpliWtion IAued By x� Dat �`� o t�actor5 t0 cOnrt�ucl tha Orojec[ (Section 7044, Busin¢ss antl Prote55ion5 Cotle: The Contractor's License �aw does not apply lo an owner of property who Duct - Ventilating �6100,000 BTU ❑100,000 BTU builas or Improves tnareon, antl who tontracts tor suth projects with a wn- $UMMARV OF FEES tractor(sl iicensa pursuant to tne Contractor's Licanse Law). I am aware that Exhaust System � Multiple ❑ System Repair/Alterotion BUILDING PERMIT S SMIP 5 proot of their Worker's CompensaHon insurance shoWtl be provlCetl to me. PLAN CHECK 5 ' PERMIT ❑ I am exempt unaer Seccion B. & P. C. for this reason Firepl/Fac[. Blt. IC809V� Fire Dampers PLUMBING S ISSUANCE S aDate Owner 'Q Heating System & Ducting Registers ENERG�' P.C. $ PLAN CHECK 25% $ I hereby certity ihat I have r¢atl tnis appiication antl state that the above �0.100,OOOBTU O100,000BT � (� ELECTRICAL 5 GRADING S iMormation iz correcL I agree to comply wilh all tlty antl county ortlinances antl state laws relating to bulltling canztruction, antl hereby authorize repre- MICROFILM S Seniatives ot ihis tlry to ent upon tho abOva-mtnNaneA property fOr PLAN CHECK 5096 $ inspection pur es. � B MECHANICAL $ ��.3� SO �'7,� � Signature Q Daie TOTALFEE 5�.,dL Drivers' License or 55 � Reinspection Fee $15 Issve Fee P�AN CHECK 25% $ .�� CMF 0865-46, rev. 10/84 White - Building; Canary - qpp�icant; Pink - Accounting; Goltlenrod - Assessor CONSTRUCTION AND PLANNING POOL & SPA . APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Loca[ion 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, O Undrgrnd: 70. Structural Floor System ' 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 72. Sewer Cap 63. Heater & Veni�Final � 73. Roof Drains 64. Plumbing System - Final 74. Rough Plumbing . 65. Electrical-Final � 15. Rough Electrica�-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. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning ��..� (�� FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# _ 21. Ducts, in Structure 70. Underground Hydro . 22. Ducts, Ventilating ' 71. Product Piping � Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground,Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro ' 26. T-Bar Ceiling (Structural) & Monocoa[ 75. Dry Chemical 27. Frame and Flashing � 76. Dry Standpipe 28. Lathing & Siding 77. F�XED SYSTEM FINAL . 29. Insulation 7S. FIRE PREV. FINAL � 30. Drywall Nailing HEALTH DEPT. R6QUIREMENT _ 31. Plaster Brown'�Coat 79. FINAL INSPECTION � 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Finat Heating & Air Conditioning ,.,�?�� (�O - ' 35. Final Gas Pipe-l'est � � 36. Hood or Canopy 37. Final Faaory Fireplace ' 38. Final Plumbing 39. Water Service-Finai - 40. Gas Service-Final - . 41. Solar pomestic-Final � 42. Backflow Preventer 43. Backflow Irrigation ' • " 44. Landscape Irripation System 45. Sound Attenua[ion � • •� . 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING , 48. Special Requirements Completed ' • 49. Electric Release to Edison , ' •� 50. Gas Release to Southern California Gas Co - � 57. CERTIFICATE OF OCCUPANCY - � • No. Date . � _ . � � � � Applicant to fill in all spaces except those within heavy ooraer Iines ana sign all apvropriate tleclarations. CiTN,oF coSTA mESA CONSTRUCTION PERMIT Project Address � z9HO MGCZ1RtOC�S� Unit "--At' Q'pplicant's Mai�irg Address 1495 East Warner . Owner's Name Z�� S��d Phone 544-3755 Address� • 1H�OI- r.0�—C�Qe AV2. , Santa Ana, CA 9z�]�5 Arch/Eng. License No. Address Contractor's Nama �rt1ri 81111d2Z'S IriC phone 241-1141 Addresslmailing) 1495 East Wanler� Santa P.tld� CA 9270 Ciry License No. 6351 � LICENSED CONTRACTOR DECLFRATION I hereby a((itm that 1 am licensetl untler provisions of Cha�te� 9(commencing with section ]000) of Divislon 3 o the Business antl Professions Cotle, antl mv license is in tull torw and eftect. z35�33 License C ss ic se No. Date _ Signatu�v� WOR ' OM ENSATION DECL RA ON I hereby aHirm that I have a certificate of consen to selLinsure or a certificate of Workers' Comp4ensation Insurante, or a certlfietl cop ihereo fSeCfi n Pol��ic�Y Ndo.�/_ �/! S I O�`ComPa�y �f/� a� L• Y'�. � Ce�tifie� Co�py is5.�heetlbwithrthehcit�y B' 'm�g.[/�� Ivisio /��, G Datg^��f�� APPlicant�imr�_{hL�l��'%OGF� EXE TIO��RO WORKERS'CO PENSATIONDECLARATION (This section neetl not be com0�etetl if the permit is for one hundretl (5100) ar Iess). I certify that in the performance ot the wo�k for wM1ich this Oerm�t is issuetl, I Shall not employ any person in any manner so as to become subjeGt to the Wo�kers' Compensation Laws of CalifOrnia. pate $ignature NOTiCE: If, afier makinq this tleGaratlon, you snoultl become subject to the Workers' Compen5ation provisions of the Labor Cotle, you must forthwith wmply with such provisions or this permit Shall be tleemetl revoketl. CONSTRUCTION �ENDING AGENCV I hereby afflrm tha[ there iz a mnstructiOn lentlinq agency fOr the pe�fo�mance of the work Por which tnis permit is issuetl (Section 309] Civ. C.) Lentler's Name Lentler's ACaress OWNER BUILDEH bECLHRATION I hereDy affirm tnat 1 am exempt from the Con[�actor's License Law for the followin9 reason (Section 703L5 Business antl Professional Cotle:�Any city or county which requires a permit to conrtruct, alter, improve, tlemolish or repair any stru<ture, p�b� to its issuance, also requires the appliCant for sucb pe�mit to tiie a si9ned statement that he/she Is licensetl pursuant to the provisions of the ConbactoYs License Law (Ghapter 9(mmmencing with Section 7000) ot 'Division 3 ot the Business antl Professions Cotle) or tnat he/she is exempt therefrom antl the ba5i5 tor [he allegetl exemp[ion. Any violation of $ection 7031.5 by any applitant for a permit subjects Ihe applicant to a civil , �enalty of not more than five huntlretl tlollars (E500). LJ 1, as owner of the property ov my employees witb wages as their 5ole compensation, will tlo the work, antl the structure i5 not intentletl o� ofteretl for sale (Section �044, Business antl Professional Cotle: The Contractor's License law tloes not apply to an ownet of a property wno builtls or improves thereon, antl wno Eoes such work himself/hereelf or through his or her own employees, providetl iM1at such improvemen[s are not intentletl or offeretl fo� Sale. If, howevEr, Ihe building or improvement is Soltl within one year of com- pletion, the owner will nave the burtlen of proving he/she tlitl not bulltl or im- �rove for the purpose ot sale). I, as owner of the p�operty, am exclusively contracting witn lic¢nsetl con- tractorsto wnstruct the prqect (Section ]044, Business antl Professions Code: The Contractor's License Law tloes mt apply to an owner ot property who builtls or improves thereon, antl wM10 contracts tor such projects with a con- tracror(s) iicense pursuant ro the Contractor's License Law). I am aware that proo/ of tbeir WorkeYs Compensalion inwrance shoultl be provitletl to me. ❑ I am exempt untler Section � B. & P. C. for this reason Date Owner 1 hereby certity that I have reatl this application and state that the above information is orrect. I agree to comply with all city antl county ortlinances antl state laws latinq to builtling construction, antl hereby authorixe re0re- sentatives ot t's ter up the above-mentioneA pr rt / for inspectlon p r ses. ( �� Signature� Da Drivers' License SS CMF 0865-46, rev. 10/B4 White - Builtling; E 3 o v ff'Z- su�-l�'iv. "�3- %� TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER . A.P.# .],�]]. — DESCRIPTION OF WORK/USE OF BLDG. COITSi12TCld1 � ' S Main Building: TVPEOFPERMIT GRADING� FOUNDATION STRVGTURAL T Ffont' ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 6 Rear ❑ OTHER /Buildinq A �5-� C Right PROJECT DESCRIP710N SQ.FT. L-� oGcuv �rvrCVn —�— CONSTRUCT/IONTVPE � � VALUATION$ �-'I�OO.QO� 5 Left ZONE�1JC-2 GRADING CU. V�S. ACRES P�ng. Ref. # Remarki: / � � � Q ' � PldOninp NOtES: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Dishwasher Drinking Fountains Floor Oreins Floor Sinks Gas Service Outlets Kitchen Sink - Lavatories , P—Trap � Roof'Drains Reinspection Fee $15 Boiler Duct-UnderGround Duct - Siructural Duct - Ventilating Exhaust System ❑ Multiple ❑ FirepVFact Blt. IC80 # Heating System & Ducting ❑0.700,000 BTU �100,OOOBT Rainspection Fee � $75 AppliGanl; Pink - Accounting; Goltlenrotl - Assesso� FEES Showers Service Sink Sewer Cap Sewer Connection � Solar Collecrors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash . LaundrY Trays ' Issue Fee , � $ 3 Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,OOOBTU ❑100,000 System Repair/AI[eretion Fire Dampers Registers Issue Fee Aummatic Washer Construction Pole Si Cooking Unit Dishwasher Dryers ❑Gas ❑EI Fan F.A.U. Fixtures Device Boxes � Outl¢Ls ' Switches -� ' Garbage Disposal Generator �0-5 KW ' 47�� : �� - 3Q ' . Zone . Accessory Building: 2 O N 1 N G R Parking Req./Provided E � M T S. ELECTRICAL - Transformer ❑ 15-50 KW ❑ 50+KW � Meter ❑up to 100amps Meter ❑over 100 amps Sub Panei ,. Motors �0-1 HP 01 %- 8 Inc. Solar �9�15 HP 016-15+ Microwave Pole Light ' Range FEES Standing Sections � 5 KW Trash Compactor T r Paaer . ' " Pole 100 s Sinctle Phase - � Reinspection Fee -I $15 luue Fee $ 3 fEES DEVELOPMENTSERVICESREQUIREMENTS: � ' Zoning APPraved By - Date ' Building Approved By Data ��-T 7 Application luued By � Date SUMMARV OF FEES � BUILDING PERMIT $ SMIP . $ ' PLAN CHECK $ PERMIT- PLUMBING $ ISSUANCE § PIAN�CHECK '-25% $ - ENERGY P.C. $ ELECTRICAL $' •UD GRADING $ - PLAN CHECK 50°,6 $ MICROFILM $ MECHANICAL $ TOTALF.EE $ �� OJ $ 3 PLAN CHECK 25% $ CONSTRUCTION AND PLANNING POOL & SPA _ APPROVALS Permit# Date Inspector p�ppROVALS Permit# Date Inspector 1. Temporery Electrical Service or Pole �� a' S2. Pool & Equipment Location � , 2. Soil Pipe-Undr9rnd. � 53. Steel Reinforcement � � � 3. Electrical Conduit UtilitY-Undrgmd. 54. Forms � 4. Electrical Conduit-Undrgrnd. 55. Electrical Bondin9 � � 5. Steel Reinforcement ' '_ 56. Rough Plumbing & Pressure Test � , �. 6. Electrical UFER Grnd. , i � 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, O Undrgrnd. � 10. Structural Floor System 61. APPROVAL TO DECK . i t. 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 Electrica6Conduit 66. Solar System-Final � 16. Rough Electric Wiring 67. Fencing & Access Approval� ' � 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL � 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20, Rough Factory Fireplace APPROVALS Permit# _ 21. Ducts, in Structure 70. Underground HYdro � 22. Ducts, Veniilating � 71. Product Piping O Gas ❑ Oil - � , 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil � 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical . 27. Frame and Flashing 76. Dry Standpipe � .� • 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 7S. 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 Q�- 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 pomestic-Final � � � • -42. Backflow Preventer � ' . � � i ' 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 - � � � � i � . 50. Gas Release to Southem California Gas Co _ - . �. �._ 51. CERTIFICATE OF OCCUPANCY . ' ., ; No. ' Date ' � ' - � Aovlicant ta fill in all spaces except tnose within neavr ooraer lines antl sign ali approvria[e eeclarations. CYfY OF WSTA MESA CONSTRl7'CTION PERMIT PERMJS NO� . _, __ TRACT NO. LOT NO. UNIT NU. Proj.:r•AUdress.'-2 S BO � M e C L 1 N'�'� �. � ,ApplicaRt"s 14�aiVlug Addreu � S �` Q S�� Owner'S`Ja�m�e;{y � � � �R 0 Phone Atldress� �7 �� -Q� f%C�� ✓ �G Arch/Cng � Licenu NO. Address Contractor'sName..�h��'�''� �/�'C' Phone77��S�/=� Addresslmailing) ��Z'SG '�-K�QM�^'\ �` City License No. � 7 � o� LICENSED CONTRACTOR DECLHRATION I hereby afftrm that 1 am licensetl untler OroviSions of Charter 9(commencing with section ]000) of Olvision 3 of the Busines5 antl Profeszions Cotle, antl my license is in ff II force ana eflect. �J 7 o Licenz Class `� � ' nse NOPt� �( � 7� Date ��) � ^ � 5'9 t � WORKERS' COMPENSATION DE ARATION 1 hereby affirm that I have a certihcate ot conzent to selt-insure or a certificate oi Workers' Compensation Insuranoe, or a certitiea mpy [M1ereof (Section 3800, lab. C.) Policy No. Company 8 Certitietl copy is hereby fumishetl. Certitietl copY is filetl with the city Builtlin9 Divislon. Date APplicant E%EMPTION FROM WORKE0.5' COMPENSATION DECLARATION (This section need nat be comDletetl i1 [he permit is tar One hundretl ($300) or less). 1 certify tha[ in the pertormance ot th¢ rk for which this perm�t is issuetl, I shall not e ploy any person in any ier so as o become subjec[ to the Workers' qyP sali0� Laws of Calit a.a � Date Q � Si9nature NOTICE: It, after makin9 this aeclar on, you shoultl become subject to tne WOMe�s' Compen5ation provlslon5 f the Labor COtle, you must torthwi�h comply with such provlsions or this permlt shali be tleemetl revoketl. CONSTRUCTION LENDING AGENCV I herety afflrm lhat lhera 15 a<onSlruction Iending agency to� tne per�ormdnce of the work tor whiCh this permit is issuetl (Sectlon 309] Civ. C.) LenGer's Name Lenaer's Atltlress OWNER BUILOER UECLFFATION I hereby affirm that I am exempt trom the Contractor's License Law for the following reason (Seclion �031.5 Business antl Protessional Coae: Any city or county which requires a permit to construtt, al[¢r, ImD/ove, tlemolish or repalr any struclure, pno� to i[5 Issuance, alm reqWres the applicant lor such permi[ lo flle a signetl slatement tM1at he/She is Iicensetl purSudnt to the provi5ion5 Of the ContractoCs License Law (ChaOte� 9(commencing wlth Section 7000) of Division 3 of the Businesi antl Profe55ions Cotle) or [hat he/she i5 exempt lherefrom antl the basi5 tor Ihe allegetl ezemptlon. Any vlolatiOn of Sec[ion �031.5 by any aOP�kan[ tor a permit subjects lha appliwnt to a civil �enally of not more lhan tive huntlretl tlollars (E500). .� I, as Owne� of [he property or my employees witn wage5 a5 their sole compensation, will tlo the work, antl the s[ructure is not intentletl or offeretl for sale (Section 7064, BuSineSS antl Profe55ional Cotle: The Cm[ractor's License �aw tloes nol apply to an owne� ot a property who builas or impwve5 thereon, antl who tloes SucM1 work M1imself/hers¢II or Ihrough �Is or her own employees, Urovitlatl tM1at suCh impwvements are not Intentletl Or oftereU to� sale. I/, however, the builtlin9 0� Improvement is zoltl within One yea� of com- platlon, tM1e owne� will have tbe burtlen of prOving he/She tlitl no[ builtl or im- prove fOr the purpOSe o1-sale). ❑ I, as owner o/ [he pro0erty, am excluSlvely cOnt�acting with Ilcensetl con- tractors to canstruct the prOject (Sec[ion ]044, Businezz antl Protessionz COtle: The Contractor's license Law does nOt ap01y to an owner of pro0erty wno builtls or improves lhereon, antl who contracts to� SUth projects with a con- tractor(s1 imense pursuant to LM1e Contractor's �icense Law). I am aware tbat proof o( their Work¢r's Compensatlon insurance shoultl be prOvitletl to me. ❑ i am exempt untler 5ection B. & P. C. for this reason Date Owner I hereby certify tnat 1 have reatl this application antl state that the above IMormation is correct. I agree to comply wich ail Uty antl county ortlinances antl stat¢ laws rel ting to builtlin9 cons[ruction, antl hereby authorize repre- sentatives of f�� city t�o/� nte� upon tne above-mentionetl property tob� insoection pu[¢y e� AO _ Date "" � �a Signature Sf< <�� Orivers' Li 55 � �� TYPE OF CONSTRUCTION LJ NEW LJ ADD U ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p# DESCRIPTION OF WORK/USE OF BLOG. S Main Buildi TYPEOFPERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL 8 Rea! ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OGCUPANCY C Right K Left CONSTRUC710NTVPE VALUATION$ $ ZONE GRADING CU. VDS. ACRES p�ng. Ref. # Remarks: (fy 1 Q O� Q� F 2P"� 1� Planning Nores: Bar Sink Backflow Preventer Backflow Irrigation rinking Fountains loor Drains loor Sinks as Service Outlets Kitchen Sink Lavarories P-Trap Roof Drains Reinspection Fae � $15 Boiler Duct- Under GrOund Ouct - SVuctural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. BIt ICBO # Heating System & Ducting � o-i oo,000 sTu � i ao,000 er Reinspection Fee � $15 1F 0865-46, rev. 10/B4 White - Builtlin9: Canary - Applicant; Pink - Accounting; Goltlenrotl - Azsessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Wa[er Heater Water Service Auto-Wash Issue Fee Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑aioo,oaosTu ❑ioo,000eTu System Repair/Alteration Fire Dampers Registers Isue Fee $ 3 $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher �ryCfS ❑(�id5 ❑EIQC Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generamr �0-5 KW C 3158 I/14/BB Buildin9: Parking Req./Provided r 114050 Zon ELECTRICAL Transformer ❑ 75-50 KW ❑ 50+KW Meter ❑up to 100 amps Me[er ❑overt00amps Sub Panel � Motors �0-1 HP 01 %- 8 Inc.Solar �9-15 HP �16-15+ Microwave Pole Light Range I I Standing Sections 5 KW I I Trash Compactor � Reinspaction Fee �$15 � I Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By 8uilding Approvad By Application luued By FEES Z O N I N G R E Q M T S SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING g ISSUANCE 3 PtAN CHECK 25% $ ��-��j�� ENERGY P.C. $ ELECTRICAL $ 11��,ZV ADING $ PLANCHECK 50°6 $ �y OW�CROFILM $ MECHANICAL $ —� TO7ALFEE $ � PLAN CHECK 25% $ 'CONSTRUf,TION AND PLANNING - ' POO L & SPA � � � � " ;i Date Inspector Date �Inspector APPROVALS Permif#-� � ApE OVALS Permit# ,, . Y. 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. �`� 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. 8. Fou�dation �. �� 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 1 i. 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 Sysiem-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 Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # _ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑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 (S[ructural) & Monocoat 75. Dry Chemiral 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. FinalElectric ��¢ Notes: j �4 B8 � �e � � � °.+ 34. Final Heating & Air Conditioning i'{� P f' � -� 0. / ;' �- 35. Final Gas Pipe-Test 'tp �Li(� OJ� I'10�' /1 36. Hood or Canopy Q�Y I(�0.l fMi� 37. Final Factory Fireplace � 38. Final Plumbing 39. Water Service-Final . ' 40. Gas Service-Final ' � � � ' 41. �Solar pomestioFinal ' � � 42. Backflow Preventer � • , � . 43. Backflow Irrigation ' 44. Landscape Irrigation SYstem � 45. Sound Attenuation � . 46. Handicap Regulations � ' 47. FINALSTRUCTURE&BUILDING . � • r ` 48. Special Requirements Completed � � . . � � 49. Electric Release to Edison �' 50. Gas Release to Southern California Gas Co r,• �^� , j 1 51. CERTIFICATE OF OCCUPANCY No. Date _ : ''' • � � �� cr MESA CO IT Aoo�icant to flll in all sDaces except tnose within heaby bortler Ilnes antl sign a11 aoo�oD��ate tleclarationz. PERMIT NO. � TRACT N0. LOT NO. UNIT NU. ' ' ' �J7,$' S:G.Q.E'sarK.B viL Applicant's'Nf.^{ing Address 1� - Owner'y�Nam�jA / / S� /�� --�% �/� Phnna� Address �l] 40 � C �[ /�t�V � /"'~'�.M. ' ' ' � �'.T2 DS Arch/Eng. � License No. Address � '� ' ? 8 -PP? Contractor'sNam '�' UH' EG / hone � � Address (moiling) �� csy �- �+ �'��` / � City License No. �� O� LICENSED CONTRFCTOR DECLARATION I hereby alfirm that I am licensetl untler provisions of Charter 9(commencing witn Section ]000) of Division 3 0l Ihe Business antl Profe55ionz Cotl¢, antl my license is in (}�❑/orce antl eftect. / Licenze lass `� � � � i�<e ryo�(� Dale <'o�a� � a WORKERS'COMPENSATION P CLARATION I hereby af(irm that I have a certificate of consent to zelf-insure or a certiflcate of Wotke�s' Compen5a[ion Inzurance, o� a certl(ietl copy thereot (SeGtion 3800, Lab. C.) Policy No. Company eCertifietl coOY is M1ereby furnishetl. Certifietl copy is file0 witlt the city Builtling Division. Da�e Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This Secfion neetl not be completetl it the permit is fo� one huntl�etl ($100) or Iess). 1 cer[ify that in ihe perto�mance of [he work tOr which lh' perm�t is issuatl, I shall not employ any pe�son in any ma r so as to ome subject to (he Workers' om s't�'9a Laws ot Califo I Dale � �� r / $I9natur¢ ¢ NOTICE: I(, aicer makin9 this tleclara n, you shoWtl oecome subject to tna Wo�kers' Comp¢n5ation provisions the Labor Cotle, you must lorthwith compty with such provisions or Ihiz permit snall be tleemetl revoketl. CONSTRUGTION LENDING AGENCV 1 hereby aftirm that there is a construction lentling agency for the performance of th¢ work for which tni5 permit is issuetl (Sec[ion 3097 Civ. CJ Lenaer's Name Lentler's AtlOress OWNER BUILDEH DECLARATION I hereby aftirm thai I am exempt from the ConVactor'S License Law for [ne following reason (Sectlon 7031.5 Business antl Protessional Cotle: Any city or county which requires a permit to construcl, alter, improve, tlemolish or repalr any ztructure, p�ior [o its issuance, a150 requires the applicant tor suGh pe�mil to file a signetl stat¢ment thal he/She is licenz¢tl pursuant to the prOvisions of Ihe Contrdctor's License Law (Chapter 9(commencing with SecHon 7000) ot 'Oivision 3 of Ihe Busine55 antl P�ofessions Cotle) o� lhat h¢/she I5 exempl IM1ereirom antl ihe ba5i5 fOr the allegetl exemption. Any violation of Se<tion ]031.5 by any applicant tor a pe�mii subjec[s [M1e ap0licanl to a civll ^nalty of not more than five huntlretl tlollars (E500). I, as owner of tM1e properly or my employe¢S wi[h wa9e5 as their sole .mpensation, will tlo.the work, antl the structure is not Intentled or oiferetl mr sale (Seclion ]044, Business antl Protessional Cotle: The Con[ractor's License Law tloes not apD�Y to an owner ol a pro0erty who builtl5 0� improves thereOn, antl wM10 tloe5 zuch work himselt/herself or throu9h h15 or her own employees, provitletl that such improvemenis are not intentletl o� oHeretl to� Shce. I(, however, the builtlin9 or improvement is soltl within one year o( com- pletlOn, the owner will have the burtlen ot O�oving he/she tlltl no[ builtl or im- , prove for tM1e purpose ot sale). �❑ I, as owner a/ the pwperty, am exclusively con[ractinq with IicenSetl Con- ' tractors to construct the projec( (Section 7044. Business antl Professions Cotle: The Contractor's License Law does not apply to an owner of property who Duiltls ot imDroves thereon, antl wtto Cont�acls for such projecls with a con- trac[or(5 hcense pu�suanl to lhe Coni�actOr'S Litense L.aw). I am aware that proo( o� lheir WorkeYs Compensalion inw�ance sM1oultl be OroviOetl lo me. ❑ I am exempt untler Section B. & P. G. tor tnis reason Date Owner I hereby certify thal I have rea� information is corre I agree to antl state laws rela i to builtlir zentatives ot i£ y to e er inspection pur s . Q $ignatu�e tnis application antl state lnat lhe above >mO�Y �+�[h all city antl county ortlinances cp nst�uction, antl hereby au[ho�ize repre- fpon lh¢ above-mentionetl property fo� 1 Ddle � /U �) F3o/5 TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR �O CONVERSION ❑ DEMOLISH ❑ OTHER q p. # DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi TVPEOFPERMIT�p. GRADING FOUNDATION STRUCTURAL T FfOnt ❑ TENANT I� ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A�Rear � OTHER � Right PROJECT DESCRIPTION 5c�. F7. oCCUPANCv K CONSTRUCTIONTVPE VALUATION$ g Left �ZONE GRADINGCV.YDS. ACRES PIng.Re(.# Remarks: RE �. .R Z 9 493 �Y�� yG/ PlanningNotes: Sink Prevenrer Irrigation Drinking Fountains Floor Orains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink / Roaf Reinspection Fee Showers Service Sink Sewer Cap Sewer Connection Solar Collecrors Solar Piping Solar Ta Swi in9 Pool w/Spa rinal Water Closet Water Heater Water Service Auto-Wash Laundry Trays $15 Isue Fee Dutt - Under Ground Duct - SVucwral Duct - Ventilating Exhaust System � Multiple ❑ Firepl/FacL Blt. IC80 # Heating System & Duc � ❑0.100,OOOBT 100,OOOBT I I Reinspection Fea Drivers' Lic e or SS � 1F 0865-46, rev. 10/84 White - Builtling; Canary - APpllcanL Pink - Accountin9� Goltlenrotl - Assessor $15 Hoodor Typel ❑ Canopy Type I I ❑ Refrigeration Sys ❑0.100, TU ❑100,OOOBT em Fiepair/Alteration Fire Dampers RegiSters Issue Fee Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec� Fan F.A.U. Fixtures Device Baxes 4960 9/10/87 Accessory Buildin9: 0 ELECTRICAL Transformer ❑ 15-5qKW ❑ 50+K11V� g' Meter ❑up to 100 amps Z Meter ❑over100amps Sub Panel Motors � 0-1 H P � 1%- 8 Inc.Solar 09�15 HP �,16-75+ Microwave � f Pole Li9ht � Range ' Switches ${9� � � Garbage Dispoul Standing Sections, �. � Generator 00.5 KW �5�15 KW Trash Compactor . $ 3 I �— Reinspection Fee $15 luue Fee FEES �DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By r7/ Aauliwtion laued 8y $ 3 Z O N I N G R E Q M T S FEES $ 3 SUMMARV OF FEES " " BUILDING PERMIT $ SMIP .� $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% S ENERGV P.C. $ ELECTRICAL $ ICi� GRADING 5 PLANCHECK 50% $ S 2• 3O MICROFILM 5 MECHANICAL S TOTAL FEE $�S ' D PLAN CHECK 25% $ _ r� CONSTRUCTION AND-PLANNING POOL & SPA , APPROVALS Permit;# Date Inspector ' qppROVA'LS Permit# Date Ins�ector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location � 2- Soil Pipe-Undrgrnd. 53. Sieel Reinforcement � � � 3. Electrical Conduit Utility-Undrgmd. �� 54. Forms � 4. Electrical Conduit- dr d. �� . 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. 1 8. Foun ation . - 59. Gas Pipe, O Undrgrnd., Test I , 9. Water Pipe-Undrgrnd. d'�� 60. Backwash�Lines, P-Trap, � Undrgrnd. ��1 10. Structural Floor System 61. APPROVAL TO DECK i ' i t. 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 ��L�r . Fencing & Access Approval � ' 17. Rough Wiring Sign � � 68. APPROVED FOR PL'ASTERING ' 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducis, 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.StorageTank �Gas ❑Oil 25. Roof Sheathing ' 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frameand Flashing 76. Dry Standpipe � 28. Lathing & Siding - 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL � 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 37. Plaster Brown Coat 79. FINAL INSPECTION � �r, . 32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED • � 33. Final Electric �� Notes: O�� f 34. Final Heating & Air Conditioning .! � k 35. Final Gas Pipe-Test � � 36. Hood or Canopy 37. Pinal Factory Fireplace ' . - � 38. Final Plumbing , , , - 39. Water Service-Final � ' - � 40. Gas Service-Final � 41. Solar pomestic-Final � �. � � 42. Backflow Preventer . � 43. Backflow Irrigation . 44. Landscape Irrigation SYstem ' ' • 45. Sound Attenuation � ' • . . • /. 46. Handicap Regulations , � � ' � � �. 47. 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 _ - � - _ � f' _�> ADo��ant to /ill In all spaees except those witnin neavy eortler Iines antl zign all aDVroDriate Ceclaratlons. CITY OF COSTA/Jry� SA C-O7�N�STRUCT1ION PER,M�I1T PERMIT NO. _ __ 7R9CTJ�0. n LOT NO. UNIT NU. Project Address •^�8O //� a C�in / OC/� �//1 ci ApplicaN'SMailinaAdArrss � Sf9'0 G�EH.a— L��n Owner'sName ��1-i/ ��*< <' x�5��Phone�SC./� Address %2.• , r�Ll� � C- 7�% � Arch/Eng. � C� License No. Address W� r`NC�- i✓� Contractor's Nam Phone �✓ �� Address Imailing) � ! Ciry License No. LICENSED CONTRACTOR DECLARATION I nereby afflrm tha[ I am Iicansetl untler provisions ot Charter 9(commonAng witn sactlon 7000) p1 Dlvision 3 ot tne Business antl Professions Cotle, antl my Iicense is in full tOrce antl e(tect. License Class LlCense No. Date Signature 'vORKERS'COMPENSATION DECLARATION ereby aHirm that 1 �ave a certiticate o/ consent to zelt-7nsure or a cerillicate Worke�s' Compeq5ation Inzurante, or a cartltiGtl copy there0f (Seclion 3800, Lab. C.) Policy NO. COTpany BCertiti2tl topy is qp�eby fumisltetl. CertNietl wpy is /petl with fhe city Builtling DlviSion. Date Applicant E%EMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection neeU not be Completetl i( the permit 151or one huntlred (5100) or less). _ 1 certity that in lhe p¢�formanca of the wor�for whicn thi5 p<rm�t is Issuetl, I shall not employ any porson in any manrye so as t9 becqme subjett to the Date 3�l�L�y Si9nature y¢�t /►' "� NOTICE: If, a/ter mdkin9 lhis tleclaration, you shaultl become subject to the Wor!(er5' Comp¢n5dqpn provls7on5 Ot [he LdbOr Cotle, you mu5! foftllwith compty witn such provislons or tnis permlt shall be tleemetl revoke0. CONSTRVCTION lENDING AGENCV • I hereby affirm that thnro is a Const�uctlon Ientling agenty for [he per�ormance OI ihe work far whiGh [his permit is Issuetl (Section 3097. Civ. CJ Lantle�'S Name Lantler•s ACtlresz OWNER BUILDEN DECLARATION � I hereby atfirm t�at 1 am oxnm0� frOm Ibe COn[raclor'S LlcenSe Ldw br the /ollowing r¢ason (SaGtlon 7031.5 BuSineiS antl Profe55ional COtla:�AnY ��Y o� county wnlc� requires a permlt lo con5truct, aller, Improva, CemO115h or rCpair any s[ructure, prior {o Its Issuance, alzo reqWres the applicant for such pormit lo flio a signetl statqm¢nt thal �e/She Is Ikrnsatl pursuant to [hc psOviSiOns ot ��he Contra<tor's Licenso Law (ChaO�er 9(commoncing with Sectlon 7000) ot 'IVISion 3 0( lhe 6u5iness antl ProtesSiOns CotlC) or thal he/sne I5 nzempt ,erefwm antl the basis for tha allegetl axomption. Any violallon oi Sectlon .031.5 by any app��ant for a p¢rmit SUDjectS the applicanl t0 a civll �enally of not more than livo nuntlretl tlollars (5500�. LJ 1, as owner ot the property or my employees with wagns az thoir sole <ompensatiOn, will tl0 the work, antl the slrucWre IS not intentl¢0 or ot�emtl IOr sale (Section 7004, Bu5ine55 antl Pr0lessional Cotle: Tho COnt�aclor'Y Licenze Law tloes nbt appry to an owner ot a property wbo bulltls or improvei thereon, anU wno docs such work him5elf/ha�soll or Ihrougn his or ho� own employeus, proNtletl t�d[ suclt imp�ovemen[5 arn nol Inlentla0 or oltaretl 10r 5810. II, noweve�, tha bulltling o� ImP�ovamint IS So10 wlthln one Year Of com• plellon, thc owner W�II have lne burtlen ol proving ha/she tlitl nol builtl or Im• prove for the purpoSe ol zale). ❑ I, as owne� oi the Droperty, am excluslv¢ly coriVacling with IicenSotl COn, traclors to conitruc( �he project ($et[ion ]044, Business antl Profe55ions Cotle: Tha Contractor's License L.�w tloes not apply to an owner ot prooerty who builtls or improves thlreon, antl who contracls lor Such prOjeGts with a con- Vactor(s) utense p4nuant to the Con[ractor's LICOnse l.aw). I am aware Iha( pro0f o( tM1eir Worker'S Compen5ation in5urance shoultl be prOvitletl to me. � I am exempt untler Sectlon B. 3 P. C. lor this reazon �J �e' o �� i I hereby certify that I nave reatl thiz applicatlon antl state tnat the above Informallon is co��e�t, 1 ag�ee to Comply with all clty antl coun[Y ortlinances antl state laws re ing to bulltling consVuctlon, antl hereby authorize reprn Senlatives Of t s i o e t¢r upon tne abOve-mentionetl P�oper�y fo� inspection s. � � Siqnature Date� Drivers' License or $5 $ � PE OF CONSTRUCTION LI NEW U AOD L�1 ALTERATION U REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTH DESCRIPTION OF WORK7USE OF BLDG. � _ TYPEOFPERMIT�GRADING LJ�FOVNDATION LYSTRUCTURAL ❑ TENANT ELECTRICAL LyPLVMBING ❑ MECHANICAL ❑ OTHER PRQIECT DESCRIPTION 5�. FT. V OCCVPANCv_ CONSTRUCTION7VPE.�^ VALVATION§� ZONE GRADINGCU.YDS. ACRES— Remarks: ��' �� `J� Backflow Prevenrer Backflow Irrigation Drinking Fountains Floor Drains Fioor Sinks � uas Service Outlets I nterceprors Kitchen Sink Lavarories , -� D -T..... � . ioor,urmns , Rainspection Fee $15 Duct-UndorGround Ouct - Stroccural Duct - Ventilatin9 Exhaust System ❑ Multiple ❑ Firepl/Fact. BI[. IC80 # Heating System & Ducting ❑o-i oo,000 sru O i oo,000 gy Reinspeetion Fee � $15 CMF 0865-46, rev. ]0/84 Whii¢ - Builtling; Canary - qpplicanp Pink - ACCOunting; Goltlenrotl - Assessor P Showtts Service Sink Sewer Cap Sewer COnnection Solar Collectors $olar Pipin9 Solar Tank Swimming Pool w/Spa Ur'rnal Water Closet Wacer Heater Water Service Auto�Wesh Isue Fee Hood or Typel ❑ Canopy Type I I 0 Refrigeration System Oaio ,oaoeru ❑iao,000 S em Hepair/Alteration� Fire Dampers j Registers � Issua Fee FEES g 3 $ 3 A.P.SW .- LO Z� $ Main Building: E T Front B flear A C Right K Lef $ Ping. Hef. �k Planning Notes: �(�PA/� /1 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures Device Boxes Outlets' Garbage Disposal Generaror QO-5 KW � Rainspection Fee � DEVELOPMENTSER Zoning Approvetl By _ Bui�ding Approvad By Appliwtion Issued By_ 45Q7 zin�:i � Zone Accessory Building: Z O N I N G R Parking Req./Provided E � M - . T S ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Merer ❑up to 100 amps Meter ❑over 100 amps Sub Panel Momrs�O7 HP �tYa-8 Inc.Solar �9-15 HP �16�15+ Microwave Pole Light -_, FEES Standing Sections • 5 KW Trosh Compactor . $15 15zue FBe $� {EQ��EMENTS: ^ �',— :/' SUMMARV OF F BUILDING PERMIT $ �Z.fJIJ PLAN CHECK $ ' O PLUMBING S PLAN CHECK 25% $ 1- •ry� ELECTRICAL $ _�_CpL N1 PLANCHECK 50% $ 3 •� MECHANICA� § � PLAN CHECK 25% $ MIP 5 , �� PERMIT ISSUANCE 3 ENERGY P.C. $ GRADING $ MICFOFILM $ �/J� TOTAL FEE $ •'�✓ CONSTRUf.TION AND P}.A'PINING - POOL & SPA ,APPROVALS . Permit #�U I' Date , Inspector AppROVALS Permit # D�e Insper.t�r, 1.•Temporary Electrical�ServiGe or Pole ' 52. Pool & Equipment Location � y 2. Soil Pipe-Undrgrnd. �� r Q-Vi'�� L�D .� 53. Steel Reinforcement ` � ° � 3. Electrical Conduit Utility-Undrgrnd. 54. Forms �� 4. Elecirical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcementf 56. Rough Plumbing & Press.Ure Test 6. Electrical UFER Grnii: 57. APPROVAL TO COVER=GUNITE � 7. Footings � � f-� 58. Electrical ConduibUndrgrnd. . � 8. Foundation, ��,. - 59. Gas Pipe, O Undrgmd., Test � 9. Water Pipe-Undrgrndc'� � • 60. Backwash Lines, P-Trap, O Uhdrgrnd. n 10. Structural Floor System •�. 61. APPROVAL TO DECK� � 11. Property Sewer Line'& House Connection 62. Backwash & Receptor�Final : � ,. 12. Sewer Cap 63. Heater & Vent-Fina� -� 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 3.3_�� GE� 65. Electrical-Final . _ 75. 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. POOUSPA SYSTEMS FINAL ' � 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �' . 'i 20. Rough Factory Fireplace APPROVALS Permit # � -�'� 21. Ducts, in Structure 70. Underground Hydro ,. 22. Ducts, Ventilating 71. Product Piping 0 Gas ❑ Oil ' 23. Gas Pipe•Rough & Test 72. Underground Flush �� 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro . i 26. T-Bar Ceilinq (StructuraU & Monocoat � 75. Dry Chemical � ' 27. Frame and Flashing �y 76. Dry Standpipe � ti' ' � i • 28. LatHing & Siding 77. FIXED SYSTEM FINAL ,� 29. Insulation 78. FIRE PREV. FINAL ;,. � � 30. Drywall Nailing �5/ HEALTH DEPT. R,EQUIREMENT , �� 31. Plaster Brown Coat 79. FINAL INSPECTION �- ;-� 32. Electrical Power Meter-Fi�al 80. FOOD CERTIFICATE ISSUED ��' � 33. Final Electric � - Notes:� L�G < ��;�'�h{� ' 34. Final Heating & Air Conditioning -_ ° bon '6. .. -� �e 35. Final Gas Pipe-Test r, �`! 36. Hood or Canopy � 37. Final Factory Fireplace � � 38. Final Plumbing l�/'7/� L� . 39. Water Service�Final 40. Gas Service-Final � . 4 ' , 41. Solar pomestic-Final , . . � 42. Backflow Preventer � 43. Backflow Irriga[ion - - . . � . . . � . � ' ' 44. Landscape Irripation System ' - � . , 45. Sound Attenuation , � ' 46. Handicap Regulations � , ' , 47. FINALSTRUCTURE&BUILDING y � � I.� � 48. Special Requirements Completed � . • 49. Electnc Release to Edison � l � 50. Gas Release to Southern California Gas Co � " 51. CERTIFICATE OF OCCUPANCY ` No. Date � _ f. � CIT\' OF COSTA MESA CO Project Address 7 Q� / Applicant's Mailing Address � .. i T _ i_ _ . _ � UCTION PERMIT Applicant to till in all spaces except t�ose within neavy DorEer Iines anG sign all appropriala Oaclarations. Address '�% r a�� a.. v.: � t ArchlEng. Licenu No. Address Cm�M1.eeter=a�lam Phone Address (mailing) City License No. LIC ED CONTRACTOR DECLARATION I hereby a a[ I am licensed untlor provisions of Ch mencing witn seclion ]000) IOn 3 0( Ihe rotesSions Cotle, antl my Iicense is in full forte antl Licnncn r a _�� Date Si9nalure WORKERS' COMPENSATION DECLARATION I hereby affirm tnat 1 have a certificdte of consent to self-insure or a certiticate �i Workers' Compensation Insuranca, or a certifietl copy thereof (Sectlon 800, Lab. C.) Policy No. Company BCer[ifi¢tl Copy is hereby �Umishetl. Cerlifietl copy is filed with the ci[y Builtling DlviSion. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Tnis section neetl not be completetl if [he permit is for one huntlretl (y300) or iess�. I certi/y that in tne performance oi the work for whiGh Ihis perm�t is issuetl I shall not emo�oy any pe�son in dny Tann r 50 as l0 b co�*7� subjeLt to t�e Workers�voryp=rtsation Laws of Calitor�i /�a C� YIA� /�� Da[e � �Il� Si9na[ure �� K. . /t� �C�- NOTICE: I(, atter makin9 this tleclaration, you shoultl become subject to tne Workers' Compensalion provisions of the LaGor Cotle, you must forthwitn comply with such provivons or this permlt snall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV 1 hereby affirm that there is a construc[lon lentling agency for the Oerformance of the work for wryipry_��permlt is Issuetl (Sectian 3097 Civ. CJ LPntler's Name N�� Lentler's Atltlress OWNER BUILDER DECLARATION I hereby attirm lhat I am exempt from the Contractor's License �aw for the following reason (Section 7031.5 Buslness antl Professional Code: Any city or county which �equire5 a Oe�mlt to const�uct, alter, imp�ovo, tlemoli5h o� �epai� any 5[ructure, prior to its issuanGe, also requireSlhe applicant tor Such pe�mit to file a signetl Stdtement that h¢/She I5 IicenS¢tl pu�suanl to the p�ovi5ions Of Ihe Gontractor'S License Law (Chapter 9(COmmandng wlth 5ectlon 7000) ot Division 3 ot the Business antl Professions Cotle) or that he/sne is exempt thereirom antl the basis for the allegetl exemptlon. Any violation of SecHon '031.5 by any applicanf for a parmit subjects [ho applicant to a civll Znalty ot no['more than tive huntlretl tlollars (E500). LJ 1, as owner of the proper[y or my employeos with wages as their sole compensation, will tlo the work, antl the structure Is not Intentletl or.offeretl for sale (Section ]044, Business anE Professional Cotle: The Con[ractor's License law tloes not apply to an owner ot a property wno builtls or improves [hereon, antl who tloe5 such work himself/herself o� through hls o� h¢r Own emD�oyees, provitletl that such improvemen[s are not intentled or of(eretl tor sale. It, however, the builtling or Imorovement is soltl within one year ot com- o�etion, the owner will have the Durtlen of proving he/she tlla not bulla or Im- p�ova fOr the purpose of Sale). ❑ I, as owner ot the oroperty, am exclusively contractlng witn licensetl con- l�aGtOn to const�uct the project (Sectlon 7064, Bu5ine55 antl Ptofe55ions Cotle: The Conbactor's License Law does mt apply to an owner of pro0erty who builtls o� Improves therean, antl who contracts to� sucM1 oroiects with a ron- tractor(s) hcense pursuan[ to me Coneractor's Licanse l.aw). I am aware that proof o( their Warket's CompensatiOn Insurance shoultl be prOvitletl to me. ❑ I am exempt untler Section B. & P. C. tor this reason A n /h-31-%f O - •Gu-. I hereby certity that I have reatl this aoP��cation antl state tnat the above ! information is correc(. 1 agree lo comply witn all tlty antl county ortlinances � antl state laws relating lo builtling constructfon, antl hereby authorize re0re- sentativ¢s oi tniz city [o enter pon the above-mentionetl property tor inzpectlon purp es. l .[ / Signature � �Yi�'��nt ��v-ei Date ��•�3/'SD Drivers' Licenu or 55 � �' � TYPEOFCONSTRUCTION I�YNEW UADD LJALTERATION IJREPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTI`N�W RK/USEOF�LD � � I C TVPEOFPE�GRA�ING !J FOUNDATION ❑ STRUCTVRAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PRQIECT DESCRIPTION 54. FT. oCCUParvCv — CONSTRUGTIONTYPE � VALUATION$ ZONE GRADINGCV.YDS. AC0.E5 Remarks: Bar Sink Beckflow P�eventer Backflow Irrigation Bathtubs Clarifiers Dishv.rasher Drinking Fountains Floor Drains Floor Sinks Gas Servic.e �Ut12L5 Kitchen Sink Lavatories '-Trap Roof Drains Reinspection Fee $75 Duct- Untler Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. iC80 dk Heating System & Ducting � ❑6100,000 BTU 0100,0008T Reinspection Fee � $15 0865-46, rev. 5/BB White - Builtlin9;,Canary - Applitant: Pink - Accounting; Goltlenrotl - 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-Wesh Issue Fee Hood or Typel ❑ Canopy Type I I ❑ Reirigeration System ❑aioo,000sTu ❑ioo,000eTu S�tem Repair/Alteration �Fire Dampers Registers Issue Fee FEES $ 3 FEES aa A.P. �W S Main Buildin9: E T Front B Rear A C Right g . Left Ping. Ref. # Planning Notes: Automatic Washer Cons[ruction Pole Sub. Cooking Unit Zona Accessory Building: Par ELECTRICAL Transtormer ❑ 15-50 KW ❑ SO+KW Dryers ❑Gas e,�Electtic Fan F.A.U. Fixtures Device Boxes ' � Outlets Switche5 Garbage Disposal Generator �0-5 KW �5-15 KW Meter IJup to 100 amps Meter ❑over100amps Sub Panel Motor ❑0.1 HP 01 F- 8 a Solar �9-15 HP 016-75+ Microwave Pole Light Range Standing Sections Tresh Compactor � Reinspection Fea �$15 I I luue Fee DEVELOPMENTSERVICESREQUIREMENTS: ZoninB APP�oved By Building Approved By APplitBtiOn ISSUBd BV _ _ FEES $ 3 O N 1 N G R E � M T S. SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PV1N CHECK $ PEfiM1T PLUMBING $ �,�� md ��UANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE $ � O a PLAN CHECK 25% $ 01000t�215—O�1013215 Tr_oT -.0� DAT.: 10/3183 TICIE: i::�S.^. „ CONSTRUCTION AND PLANNING POOL ,;PA � �' APPRQVALS Permit �k ' Date Inspector AppROVALS Permit # Date Inspector i 1. Te �fporary Elect�ical Service or Pole 52. Pool & Equipment Location � . 2. Soil Pipe-Undrgrnd. ' � 53. Steel Reinforcement , ' 3.�Electrical Conduit Utility-Undrgrnd. ' S4. Forms �� , • 4.'Electrical Conduit-Undrgrnd.; 55. �Electrical Bonding 5. Steel Reinforcem2nt • 56. Rough Plumbing & Pressure Test � 6 , 6. Electrical UFER�Grnd. . 57. APPROVAL TO COVER-GUNITE � ' i 7. Footin9s -� 58. Electrical Conduit�Undrgrnd. ,' 8. Foundation �� 59. Gas Pipe, O Undrgrnd., Test ' I 9. Water Pipe-Undrgrnd. , �, 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System � 61. APPROVAL TO DECK _ • 11. Property Sewer Line & House Connection ,' i 62. Backwash & Receptor-Final ' 0 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 I-leating & Air Conditioning FIRE DEPT. REQUIREMENT � 20. Rough � ctory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro :v 22. Ducts, Ventilating �+� 71. Product Piping O Gas ❑ Oil 23y'Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil % 25. Roof S�eathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat �� 75. Dry Chemical 27. FrameandFlashing ' 76. DryStandpipe 28. Lathing�& Siding 77. FIXED SYSTEM FINAL 29. InsulaE�ion 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 � 1 ' Notes: .. 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test �.�„�� (.gD 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing �1�p_i(d' (��O . 39. Water Service-Final • 40. Gas Service-Final ' � 41. Solar pomestic-Final i 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 . �CIYY OF COSTA MESA CONSIA�UCTION PERMIT ProjectAddre�ss ��84 J��o'- - � ApplycanYs Mailing Addres� �pX �%�� %/F/7�� dwner's Name �F'iCTlb.2£-1-��_',i,��ne �� " u�4 Address �'T/� «� a Arch/En9. License No. Address Convactor's Nam Phone Address (mailing) Ciry License No. LICENSE� CONTRACTOR DECLARATION I hereby aftirm that I am licensetl untl¢� provi5ion5 of Charte� 9(commencinq with seclion 7000) of Division 3 of the Business antl Protesslons Cotle, antl my license is in full fo�ce antl etfect. License Ciass License No. Date Si9nature WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self-insure or a certificate of Wotkers' Compensation Insurance, o� a certifietl copy thereof (Sectlon 3800, Lab. C.) Policy No. Company 8 Certifietl copy is he�eby fumishetl. Certifietl mpy iz filetl with tne city Builtling DlviSian. ��ate APPlicant E%EMPTION FROM WORKERS' COMPENSATION DECLA0.ATION (Thiszection neetl not be completetl if Ihe pe�mit B to� one huntlretl ($100) or less) I certity thal in the pe�fo�mance of the wo�k fo� whlcM1 this permk is issuetl I shall not employ any pe�son in any manne�/�o7 as to bec ' ct to [h¢ Wo�ket C mper�s �iion I.aws of Califorrti�_/ Date � "��— a • Signature �� — � NOTICE: I(, aiter makin9 this aeclaration, }Tou shoWtl become subject to the Wo�kers' COmpenzation provisions of ihe Labo� Cotle, you must forthwl(h comply with such provi5ions ar this Oe�mit 5M1a11 be tleemetl revoketl. CONSTRUCTION LENDING AGENCV 1 herety affirm tha[ there is a const�uction iending a9ency !or Ihe perto�mance af the work for wM1icM1 this permit is issuetl (Section 3097 Civ. CJ , Lentler's Name Lentler's Atltlress o-�— E OWNER BUILOEft bECLAftATION I hereby aifirm that I am exempt from the ContractoYs License Law for the following reason (Settion ]031.5 Business antl Professional Cotle: Any city or county which �equires a pe�mit to construct, alter, Improve, tlemolish or repair any structure, prio� to its is5uance, also requi�es the applicant for Such permit to file a signetl statemen[ thal he/sM1e Is li[ensetl pursuant to Ihe provisions of the Contracior's License Law (Chapter 9(rommencing with SecHon ]000) of �ivision 3 of the Business antl Professions Cotle) or tna[ he/sne is exempt tM1erefrom antl the basis forthe allegetl exemption. Any violation ot Section ]031.5 Dy any applicant for a permit subjects [he apPlicant to a civll �e9� Ity of not more Ihan five huntlretl tlollars ($500). d.''-� 1, as owner of the property or my employees with wages as their sole compensation, will tlo the work, antl the sVucture is not intentletl or offeretl fo� sale (Sectlon ]044, Business anE Professional Cotle: The Contractor's �icense Law tloes not apply to an owner of a property who builtls or improves the�eon, antl who tloes such work himself/nerself ar throu9h his or her own employees, provitletl lhat suth improvements are not intentletl o� otferetl tor sale. If; howeve�, the builtling or improvement is soltl within one year of com- pletion, the owner will have the burtlen ot proving he/she tlitl not build or im- prove for the purpose of sale). ❑ 1, as owner ot the property, am exclusively contracting with licensetl con- [ractor5to tonstruct[he project (Section 7044, Business antl Protessions Cotle: The ConVactor's License Law tloes no[ appty to an owner oi property who builds or Improves [M1ereon, antl who contracts tor such projecls with a con- tractor(z) li<ense pursuant to tne Contractor's License Law). I am aware that proof of Sheir Worker's Compensation insurance shoultl be provitletl to me. ❑ I am exempt untler Seciion a�=. t r this reason �� Date�' � � ' Ownei � ---.�r �� I hereby certify that I have reatl this application antl state that above intormation is correcL I agree to comply with all city antl county ortlinances ntl state laws relating to builtling construction, antl he�eby authorize repre- sentatives of th�ItVJto enter n the above-mentionetl property for inspection p�y,pose .� &. � nt to fill in all ipaces except lhase within �eavy bortler lines anO si9n all appropria[e Oeclarations. � 522Co -� �-C TYPE OFCONSTRUCTION , NEW AD� ALTERATION REPAIR � � ❑CONVERSION ❑DEMOLISH OT%ER_ p�p.# DESCRIPTION OF WORK/USE QF Rlj]C. t S Main euildi 1"�'IP�CRiI. — E TVPEOFPERMITry{ ❑GRA�ING FOUNDATION ❑STRUCTURAL T FlOnt ❑ TENANT !�l ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B R¢3f ❑ OTHER 1 - A PROJECT DESCRIPTION 5(�. FT. oCCUPANCV C Right K Left CONSTRUCTIONTYPE VALUATION$ $ 20NE GftADING CU. YDS. ACRES Ping. R¢f. �k Remarks: A��/ �L.Y .. � PldnOin9 NOt¢5: Sink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks ' Gas Service Outlets Interceptors� Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee � $75 Bailer Duct-UnderGround ' Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Neating System & Ducting ❑ ai oo,000 eTu O i oo,000 en Signature cu.• Dateo`�—Z/— Drivers' License or 55 � — Reinspec[ion Pee $15 CMF 0865-46, rev. 10/B4 White - Builtling; Canary - qpplicanq Pink - Accounting; Goltlenrotl - Assesso� Sf10WEf5 Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Laundrv Travs Issue Fee Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0-100000BTU ❑100,000 System Repair/Alteretion Fire Dampers � Registers luue Fee FEES Automatic Washer Construc[ion Poie Sub. Cooking Unit D ishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Dispoul � Generator DO-5 KW �5� GJ:O.) ��. / Zone Accessory Building: Z O N I �.. N G 1 R Parking Req./Provided E Q M T S ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100amps Sub Panel Motors �0-i HP O1 %- 8. � Inc.Solar �9-75 HP 016-15+ Microwave Pole Light Sign Standing Sections 15 KW Trash Compacmr FEES $� v Rei�spection Fee $15 luue Fee $.3 FEES DEVELOPMENTSERVICESREQUIREMEN7S: Zoning Approved By Date Building Approved By Date Application Issued By Data �� SUMMARV OP FEES � � BUILDING PERMIT $ SMIP $ � PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ � ENERGV P.C. $ ELECTRICAL $ ».l a GRADING 5 PLANCHECK 50% $ MICROFILM $ MECHANICAI $ . TOTALFEE $ 33,5� $ 3 PLAN CHECK 25% $ CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspector qppROVALS 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. Elec[rical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Elec[rical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structurel Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Hea[er & 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. flEQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 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.StorageTank OGas ❑Oil 25. Roof Sheathing . 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 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 Elecvic aG Noies: � 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 i . 41. Solar pomestic-Final i ' r 42. Backflow Preventer ' � � � 43. BackflBw Irrigation � � , 44. Landscape Irrigation System i 45. Sound Attenuation 46. Handicap Regulations V . . 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 , , LIMITED STATEMENT OF RESPONSIBILITY TO WHOM IT MAY CONCERN: �9fo ,y� Cz„�,o�,�CU„y S(reet Address Bldg. Permit # � � � This Permit N� 3 Z Z�� i�i-zvz-3a AP Number I, iit`aDECc ��s�i//hz1� , as Owner in Title ot the above referenced property, do hereby authorize: -� � �,-� �aTo �..�sTQ.AG � �i y-3S�G- �/ S�S me � Telephone No. � 9�0 -1,— Street Address �5� to obtain permits in my behalf, as owner/builder, for at the above referenced property. Should �,y erson become an amolov engaged in the improvement of the property, I shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. As owner/builder in fact, I understand and accept that my responsibiiities do not transter to any oiher per- son, company or corporation. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties. �f��190t2L C. IC/f<y/�,¢i� Printed Neme b��C..t-tzCCR-2. �/Gux.`a^tT Signature 0�19�48, rev. NB] ,2-/9- £ssl Date City of Costa Meu Development Services Department Building Safety Division P. O. Box 7200 Costa Meu, California CERTIFICATE OF OCCUPANCY No. QO^�r�7`.�5 The Building located at 2980 McCli.ptOck Wav� Sllit2 E •'�� has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto: for a Grpup R-2 Occupancy. Use of Buildi Legal Description J�41-202-30 (See reveru side for Metes and Bounds) E 322'v8 P 35948 Building Permit No�32070 Elecirical Permit No�E32070 Plumbing Permit NoBPE 32070 Mechanical Permit No. ISSUED T0: Number of apartments and/or guest rooms Building Official P7illiam 4. Howard m�-..�An,-n R. Ri �rh�rcl . , � . �16A1 E. Qodge Avenu2 by ti'�' � i.�/ .•� �— �'anta Tjn�. l`d Q77n�i Date [�OVCS'�?YiI18� 1s88 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 3015�46 rev. 1/83 White -Owner; C - Numerical File; Pink - Bidg. Permit File