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2030 NATIONAL AVE
)STA MESA,CA 92627692-6716
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uN*: I CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: B 077673 PLAN CHECK NO: N
UNT:
uar:
LICENSED COMNRCTOHS DECLRFATION: 1 hareby afl�m uiMar penely d pnjury thei I am Icenmd uMx pwisiona d Cheqer 9
�mmmenan8 �h Section )OW) ��� 3 d I�e Bus�wss eM Pro/eseiau Code. eM mY licenae ia in lull �oice vM e/lect.
cm uc. No.: uc. cuss: uc. No.: EXP ;
Oaie: GonVada:
OWNEF BUILOEH OECIAFATION: I MreEy effirm unEer panelly d parjury ihet I em ecemq Irom �M Conlrepon Licenae lew lor IM
Idbvm9 raemn (Serabn ]0315 &niima erd Foleasiona Cada: anv cry « coun�y xhitli nauirea e Garmn m mmm�ct. Mx. imvwe.
demWsh, or repei ary atNcture, pv �a na ewerKe, aLvo requiree tM epd�� la wch peimit lo fib a sgmE ata�emem �het M a ahe
ie licensed W�wa�� �o IM provivonx d iha Conveaon Licema L.ew �CMqm 9(oommamiip Milh Setlqn )OW) ol Divaion 3 d �!n
Businasa eM Prdeaeione Code� or thet M or she ia exemp thmehom end the beais fa �ha elleped ezemqion. My v'delion d Sedion
]0�1.5 by erc� eppliranl for e permil subpds iha epd��� �o e dvil panelry d na more then frva hundred dollaa �5500��.
x[] I, ea owner al �he properlY ar my empbyeee wnh weges es iM1eir eole mmpenwion, will do tha woM, end the eVudure re rwt intenEeE
or Merad br mle (Seciion )oaa, Business eM Prolessions Coda: The Contrmors Licenae Lewaaee rw1 eppty Io en ownarol properry
who EUJEs a imD�es �hereon, aW vfia daes such wo�ic himeeM «heneY or ihrough he w Mr own amployeae, pavided ihet wch
' provemania are mi inieMaE «oHered lor eab. M. Mwever, iha buiNinp or vnqovemeM is aoN wilhin aie yeer d oompinbn, tM
ow�rer-0uikbr will heve iM Wrden W provinB � a� nM did M WiN a improve fa IM WN�e d aele).
� I. as owrer d �M poVaM, em erdu&veM conlredM wilh Ikerued con�reciws �o consUu.1 IM C�aled (5etlion ]Da1. Bwinms enE
Pmfasioru Coda: TM Contredwe licanse Lew Eoes iwl epply to en awnar M popeM wtw buiNs a impovm �Iwieon eM who
mnvec1s for wch prqads wi�h e mn�mdar(e) licenaed punuen� to iha Gonlreaas Lkenea lew).
� I em exemq under Section: B. d PA., br Ihie m
oe,,: �--�y- y6 �„�,,. _i`�� � 2��
i ao nereM �n�y inm i� e.�a a�a u�,e<rs�a m< rea���,<ou a ce�aomie r�m �e sderv code sea�a�s zsws. xss3a, ena
25551, aM thel I a eiry lulura buikiiq arvpent will / wil na (vrcb «re) need to compy wih aek etate mdes aM �he reyuiremenn la
e0eemnfaeanirupionormodRrmianham�heA'r" u�y areoameniDidrid.ReskeniielmnmeuaioneVG�'vnenssemWfromtheee
a���s.
oeie: noaice�c
WOHKEN'S COMPENS�TION DECL�PATION: I hereby etfirm uMx psnelty d pe�jury me d ihe IOIIovAnp Eedermum:
❑ I nave eM xitl mamen a cenJiceie d mnxnt lo aeX-insure Iw xvMan' campeneation, m povitleE Iw by Seaion 3]00 d the leEor
Cade. lar tM pa�lormenca of the xak lor wNch �M1is permn b iaeued.
❑ i na� �a �;e �m� �.on�rs �w�,=m� ��s���. e. �a���.a nr see� a�ao a m<�n« cm.. i« ma ron«�� a ma
wwk f« xfiitli ihis partnn is issued. MY wakan' campemffiion inwrence farrbr e'd pdiry number ere:
c�a:
vakvN�me�:
(rnis senio� n�d na c< c�ciarae a ma ca�e �s ro. ooa n��d,ad done� (Sioo) a b.�.)
❑ I cerlity IMi in �he pa�lormence d iM work fa whch ihis pe�mn ia iesued, I ehell nU empby any pnxn in eny mennar eo es to
become subl� lo Ihe �w�kers' compenaeiian lewv d Celilpnia, antl apree ihet H I eMuld becane wbjea �o �ha xwMan'
campanaetian provisons d Seaian �]00 d �M1e Lebor CaEe. I ahell lathwilh mmpy xnh iM1oee pawionv.
oa�e: nod�c
Weminy: FaiNn ro�xuro worteri compmwtlon roverage /� ✓nbwNl, enC ahvll �ub/�cl en miplayw ro ctlMrol p�naltlu enJ
clvll flins up ro one hunOrM MouulM Ooll�n (f10q000), In Mf/fbn lo M� cwf ol compxwHon, Canups �� prov/eeJ br In
Sxflon 9]O6 0l fhs Lebor Cole, Inferes( entl efromey i/sea.
CONSTNUCTION LENDIN� pGENCY: I heraby eHirtn under peneXy d perjury tlat �here is e conatiuqbn IeMinB epency /or tM1a
�no��� a ma won� i« .n� ma wm,� �s as�aa ls<ao� xs�, cH. c).
LENDEP'S NAME:
LENpER'S RDUPE55:
I cerliN �hal I here med �hia epd��� � s�me thel �he ebove iniame�ion ia mrteG. I apree lo cwnpry xi1M1 ell ay eM wunry wdinarices
arM ateta lewa relmvq lo builEinB ���b^ ���eby anhorae repreeemeiivea d this my io anter upon the ebova�men�ioneE propeny
�OIIfIS�IBC1N11 pYfp0909.
ANA VILLA
PdntN e'
�t.� _ �� ����c_ o�,:� —L� _ 96
sw�mure a o«�,inaenv�nN�,ucoaree«
�St5t�48.WP) While-Buildiip d Sefety; GrearFle: Cenery-ApPF��: Pink-Rewnue; Goldenrod-Raeeasw
PERM NO: H 077673
GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : REPLACE WINDOWS 6 DOOR SQ FT: 1,000
CLAIM VALUE: 1,000.00 CALC—VALUE: 1,000.00 GROUP OCC: R-3 /
COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
et�x�*it*�x �tx+�*ieie***�rit*x�x��r*et�tx�*�r�tat*itit*ie�r+���riFieieirit�ititit�tit**at�x�at*iEitx����*x x ieiEetx�itieitititiE�*
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARKING REQ• PROV; PARCEL; 42249210 ZNE: REF NO:
PLANNING Nt5TE5>
�
1E if 1E 1E 1f� iE 1E!(� 1E iE �f iF iF If if * 1E 1E 1f iF 1E IE 1E 1E 1! 1E 1E iE 1E 1E iE 1E 1E 1E iE!(� iE 3E 1E fE 1E'!f IE 1E iE if 141E iF 1E IEiE Ik1E iE iE 1E 1Eif iE 1E if 1E 1E if'If' fE'lE 1F 1P if iE IE �E iE 1E if dE iE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED HY DATE:
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY: S� DATE: �( ��LC
iE+�+r*+r�+�+r+r��t�tatitat�t*at�t*itiEiFiF�FiF�F�FiF'iF�F�F3F�F7E3F7FiF3FfF3F�f7F7F7FTF iF 7F�FiF7FTFTf3Fif*itieat*�t**iE ��t
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
ERMIT 34.75 .50
SMIP/NON—RES
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 35.25 0.00 0.00 35.25 35.25 .00
NUE DIVISION TOTALS--> COLLECTED: 35.25 OVER/SHORT; ,00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
34.75 ,50
iE iE iE 1E iE iE iE 1E 1E 1E if IE 1E IE 1! iE iE IE IE 141E if� IE 1E IE �E iE if 1f 1F'!E 1E 1E 1E 181E iE iElE iE if iF 1E if 1E if iE iF 1E if�!(� IE 1E ii 1E 1E 1E'1E iflf 1f iE iE iE iF iFlflE iF iF if iE'IE iE jF 3F if iE iE
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 1000 ALTER BY VALUE RESIDENTIAL NOZONE 1,00 1,000.00
END OF FEES
EXP� I�D� L�
iiaa'E
•i• - - _ - -' .
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�COAlSTRUCTION AND PLANNING � � �OL & SPA
. qP�ROVALS Permit # Date Inspector qppROVALS Pe�mit # Date Inspec2or
t. 7emporary EleCtrical Service or Pole 52. Pool & Equipment Location
2. Soif Pipe-Undrgrnd. 53. Steel Reinforcement
' 3; �e�ectrical Conduit Utility•Undrgmd. 54. Forms
�= _4i Electrical Conduit-Undrg��d. 55. Electncal Bonding -
� 5. S�`reel Reinforcement 56. Rough P�um6ing & Pressure Test
•r.c '
--� Electr;ca4UFEflGmd. 57. APPROVALTOCOVER�GUNITE
-'�. FaOtings 58. Electrical Conduit�Undrgrnd.
�.
-^a. Foundation 59. Gas Pipe, O Undrgmd., Test
' 9. Waier Pipe-Undrgmd. 60. Backwasb lines, P-TTap, d Undrgmd.
10. Suuctural Floor Svstem 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection - , 62. Backwash & Receptor-Final
12, Sewer Cap 63. Heater & Vent-Final
73. Roof Drains 64. Plumbing Sys[em � Final
14. Rough Plumbing � 65. Electrical�Final
15. fiough E4ectrica4�Conduit '.. 66. Solar SVstem-Finaf .
i6. Rouqh Electric Wiring 67. Fencing & Access Approval
77, qaugh Wiring 5�9� 66. APPROVED FOR PLASTERING
18. Rou9h £Vectrical�T Sar CeiVing 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Ai�Conditiorying� „,- n v .; . .� FIRE��FEPTrREQUIR�MEN.T
.. _ � T �
20. .idou� Factory Fi[ep:ace >:r - s c-r , qppF70VACS �� Permit # '•� - -
"1 -IL Y. L- ' <. f• t .
21. Duc�s; in Str�cture � . .. .. � _ � '' l ' ^ ` .
,� t _ s * G � ' + • 70. �.Undergroupo li-yr)ro -
22. SucCS, Vehti�aiing :_ �' �Y �_^• C, , y • 71. Produc'�PiP.ing 3'ias C'� Oil .
23. Gas �pe;Eiou� & Tesi =;� T"' �. �'r,. ` 72. Undergroyod Flush.: �. �� _
24. fioof Fracning u+ � � �� 73., Undergrnd. S[oFa9e�anK O Gas ❑ Oii
25. �oo�She'athing �,:Y �, � �� � .. � .�w, 7d: `Overhead Nydra�� � `� �'
26. �-Bar Ceiling {Str4�ceruali & IDIqIIocoat r -. > ^��� 75i Ary Chemical �� * '• . j
r.
_ 27. Frameari3 Flashir�� �y��., , „ � ' �: 76. Dry StandpTpe � t- r.- ' - �
_28. Lathing&Sid�in9:-. � O.^F - r L x 77, FIXED�'s'YSTEM�FINAC - ' '
.-� "
_ 29. Insulatioih _' 4; S -' .. .. � 78. FIRE PREV. F{'NAL v' V, � '� �
� y
30. DlY�vall ryailing �i . r'- � , � ;HEALTH DEPT. REQUIREMENT � ,
� 31. Plaster 8�nwn,Coai,.s � � � `�. # • � �' 79. FINAI YbISPECT�N - _.
-r - •� c.; r: � - . . T•. .
, 32. �Electrica�'poWer Mecer Final r� �t � 8.: FOOD CERTIFJCATE ISStlED-
33. Fina�E�ectric -. c � ,,..�' ,y� ,� � j� Notes: - -. ' '}=-
- 34. 'E.ina�Heating& Ai� �qnditioning' � r � • r � _ _. _
" :. .
� 35. finai Gas Pipe Tes€�* C�� " X` � �^" �`r y� �'1"
_, r. �. �a; � .-+ ..� u �. .
" 36. Haofi or CanoPY ".r = - •.i s � � � n: . `- . -
- 37. Final FaMory Fire�t�"c�,%� . a � . �' " _ . _
n ,: 'r 4
-.38. Finai.7lumbing '. �,'� -: � , ,��. - a. .. - �' -
� 39. Water Service�Einei '.. F_ i 7�` � ' "' �
r ' ' f i--. ' !T:
40. Gas Service-Pirial ;.. �` '': � _ ' ' � � `� - " .- '
- F . t 1. �� ' �
^41, Solar pomestio-Pinat'' � - � � ° - • - -
K _ � - r ('�. � -
42. Backflow PreYenter ; ' , . '
f- r r- � ?.C" E' F
��
43. Backflowlrric�ation � rJ� * � .�;' � � - � ,.
_ .
r
�d4. iLandscape Irrfgation System ` _ r� � - � _ s s = - .. �
45. Seund Aitenuation < -' .. i " - �:. �.; ,` : T tr' a � '
ti - - ^«-
46. HBndjFap'Regulations '; k � � ` � � - - = i
, i t'7vC
47. FIN,tiL STRUCTURE & BUILDING *' , � � � ' ' `-'
R C �
48. FlNftl PLANNING; E=� ,' ` �- ��
� I ;� n
A9. filecf�+c Rslease to Edison � � i'� � =
r.
50. Gas �elea�5e to Soutfiern Californi`�(",asCu ` ,� �' - = -� � r '+ ' -
51. CERTIFICATE OF OCCUPANCY
No. Date
/� �,, ��
��
�D 3v %%,��' � �' ���
���i %�°� � _ - - -- -
__ ____
ITE PERMITS ARE REQUiRER
ELECTRICAL, PLUMa{NG,
ITIf�G, VFh.`71LATIi1G AND
REFRfGERATION WORK
� �:aa � �
;:
;tiU, �'R '�'Si ACC4��"rFtNY
L {fVSP�CT{0� REQUESTS�
F) . �,.�d,�i_S ..if_ � PEnSGtlS AftE TO
Uf =�ir'iO�tD, 1+� 5.,6�EST TNA7 THE
ST.�T Of G.t�i�..i:ln D!V!SlOfV UF
1��,.' T'•i,L S FEiY HE CDi�SULTEO FOR
ADQi, �;2.:l. RE4UIRfMEMS.
9'
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Buitding
1NESE PLANS• �—'�--'••,�cc�
��� NO �� 8� ON JOB AT I
OF DFpi, �A G� WITHOUT PRIOR i
TME �SSLANCE OR GRANiING OF A PERMIT OR)
OF PLqyS AND SPEGIFICATIptVS SNALL NOT BE C
70 BE A P,ERMii FOR, Ok kN APPRD9A� pF, ANY
OF ANY OF THE PRDVISlOitS Of I1fl3 CpOE. NO PEI
SUMING TO GIVE AUTHORITY TO VIOlA7E OR Cp,
PROYISIONS OF �HIS Cppg SHALL BE VAL10, EXCE
FAR AS i E WORR OR USE WHiCN IT AUTNOR¢ES IS
v-
� ISSUAflCE �f r.� -
� ONS SHAII � ��"�rt �� �PoN PL
NDT t:RF/E.T iHf BUIIDICC
��snin �� ..fTER REQUlR7fi6 i.E ��r�arrr�...�.
PRE•
TH€
MySq
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AND
IN Y��� RATIO� N L�f �,t�+"�a �� F.SC.i FREVEAli1NC
OF T�LRTION OF iHIS CODE ���k� ��r ��E�Fd37,EH }yyEp
E CITY. � DF �'n'Y IDPtltl�A �R�ID4P�ArIr�
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CITY OF COSTA MESA.
pLANNiNG DEPT. --
/✓�ECT TO BLD/G DEP7. REG. �'_
�g tvi-.J�',z�2� �
BY .�.�...._.... DATE.....__.__. f
DIRECTOR OF Vld.N41NG
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OWN E R R[X�K _ T,
JOB ADDRESS 20�
GENERAL CONTRACT
AP No. 7 7�S'1 l—1 fl
NSPECTIONS
SOIL
} GAS
YWATER
ROUGN PLUMBING
PROP. $WR. LINE Q MOU:
SPRINMIING SYSTEM
\v MISCE4L4NCOU5
`ROUGH MEniING nN0 MR 1
TEMPOA>R� SEAVICE OR I
UN�ERGRDUNp � PON
ROUGM WIRING
TREHCHES FORMS
FLOOR SYSTEM
BONO 9EAM � SiEEL
SMEATNING
FRRME AN� FLASM�NG
LAiMING — In n OU'�
PL�STEA.BAOWN CO�T
STRUCYUA4L. FINAL
HE4TING. VENT., PEFRIG.
PLUMB�NG, FINLL �NO W.
ELECTPIC, FIN4L
DATE
SUBCONTRACTOR
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' COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to FHI in Completely — Use Ink Only
BUILDING .�. ., .� � ...� _ ''"' _ " _ "
OWNER � OIS
MAIL
ADDRESS ZO3U I
cirv C'E+STA-vYlE
CANSTRUCTION
LENDER �v
BI7ANCH N//�
ADDRESS /V��
ARCMITECT
OR ENGINEER
ADDflESS
CONTRACTOR C
ADDRE55 (/
CITV
STATE
LIC. NO.
S12E
OF LOT
USE OF
EXISTING 9LDG. � ESI
TE L.
NO.
TEL.
�+�+��Il17 2/26/79 5.50CAT6
G:} y�li' 17 000041�75 63 I A -
APPLICATION�F�OR STRUCTURAL PERMIT � ✓
G
RECEIVED 8V DATE RECEIVEO� �TF ISSt1Fn
�'
A.P. NO. S�� ��D PEPMIT NO.
ADIDRE S ZO30N�T�ON�"L A��L �TA
! TRACT I%IZ LOT ZJ� BLOCK
TEL.
NO.
CITY
LIC. NO.
(NO.OF BL�DG$
NOW ON LOT /
Separate permits are required for
electric, plumbing and heating work.
OF BUILDING AND WORK TO BE PEFFOR�
I horeby oeknowletlpe thet I hava reatl this application antl stete
thac tha nbove intormntion Is correct and aB�ee to comply with
oll laws regulating builtlinp conatruction, antl 1 shall not amploy
eny porson In vloletion of Na workman's compansetlon laws of
tha State of California.
I heroby canify thet 1 am properly IlcensaC es a contractor undor
the Stete of Calitornio Businass antl Professions Cotle, D(vision 3,
Chapter 9, end [hat suth Iltensef are In full foree and affxt, or 1
am oxompt from tha provl5lons Of She Stete of Callfornle Busfnass
ontl Pro(assiona C/o�tla, Division 3, Che tar 9.
SipnoturoOf //�,
Permlttae /��/1 � ' /'�
Authorizatl Apant /
U
NO. OF
—� PLAN$
VARDSAPPROVED
MAIN BUILDING
DISTANCE BET
MAIN BLDGS.
VAR. Ne
rGROUP "
DATE �/ v�Q— /'
USE OF NEW
BUILDINC.�� (�n((
VAROS APPROVED
ACCESSORV BUILDING
FT.
FT.
;L'iO.e. F
e��° FT.
BEf. MAIN &
ACCESS. BLDGS.
DATE
APPFOVED
THE AMOVNTSHOWN UNDEfl VA�VATI
THE PURPOSE OF ESTABLISHING A PERMIT
VALUATION PERMIT FEE $ ,
�� PLAN CHECK S
�'
5 r� TAX b
TOTALPAID S
FOR
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OWNER Rnr.x r.nr� H_o DATE �_15-
APNollS-511-10 LOT 2�3 TRACT 1712 FIRE
SUBCONTRACTOR
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SPi
MI!
AOl
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UN(
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P. SWR. LINE �J NOUSE CON.
INKI.ING SYSTEM
HEnTING PNp AIR CONOIiIONING
FLO�A SYSTEM
BONP BEaM � STEEL REINFORCE
SHEATNING
FqqME nN0 FLnSHING
L/THING — IN (� OUT n
PLPSTER,BROWN COAT
STRU�TUR4L, FINAL
HEA7ING, VENT., qEFRiG. �NO �.C., F
PLUMBiNG. FINnL nN� WS TEST '�
ELECTA��. FIN/•L
o���� nuir. r�.ini
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING �.,�ti.�yf..,}_ r // /�._�
OWNER
MAIL
ADDRESS G
CITV �
CANSTRUCTION
�ENDER
BRANCH
ADDRE55
ARCHITECT
ADDRESS
CONTRACTOR �'
ADDFESS
TEI.
CITV NO.
p 3538 2/15/79 60.50 TL
1+ 3536 2/15/79 6Q.5�C�KP9
a� 3538 00004474 61 Ip p� %
AP LI A IONrFOR STRUCPURAL PERMIT �i�`�
RE 1 D DATE RECEIVED DATE ISSUE
� -
A.P. NO. S— e+II—' �� PER' T NO.
6UILDING
ADDRESS �-03o NAT/oNqL .VE
TRACT I�II Z l0T �� R BLOCK .
FIRE RT� /V{+�
20NE T
APPROVED
BV
� �
ZONE , NO.OF
PL4N5
DATE L �I 5 �.
USE OF NEw
BUILDING
F STATE CITV / AflOSAPPROVEO V FDSAPPflOVED
� LIC. NO. LIC. NO. MAIN BUILDING ESSORV BUIIDII
{z� 512E NO.OF BLDGS. (FROM C/L STREET)
LL OF LOT NOW ON LOT FRONT �. FT. �
� E%ISTING BLDG. SI � 7 T �7 , ,' FT
�
FSeparate permits are required for L SIDE I FT. S^ , FT.
� e]ectric, plumbing and hea[ing work. REAR a1 /D � Fr.
� USE OF BUILDING AND WORK TO BE PERFORMED
F DISTANCE BET. BEf. MAIN &
qMAIN BIOCS. ACCEffi. 8LDG5.
a / ��,/ VAR.# DATE
a IL�I(� C.U.P.� /1PPROVED
� � �.Q APPROVEDCw�'�
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� I heraby acknowletlpe that I heve reatl this epplication and stete
y� that the above Intormation la correct antl aprea to comply wlth
4 all lawz regulatin9 bu(ItlInB �onrtruction, antl i shall not employ bi%
Z any person In violetlon of t�e workman's compensat(on laws of . A�
� tha Stata of Celifornla. ����
x - G 2
3 I hereby certify that I am p�opeNy Ileensed as a contractor untler � D• Q. FT.
Me Stete Of CalitOrnla Businau enG Profaulons Cotle, Division 3, THE AMOUNT SHOWN UNOER VALUATION I
Chnpror 9, end that such Iitenses nre In full force entl effect, or I THE PURPp$E OF ESTABLISHING A PERMIT FE O�
am exempt trom tha provisions ot theStete of California Business VAIVATION PERMIT FEE
entl Professlons Cotla, D'v sion 3, Chapter 9. �q $ Q'
� � C/. /' �l PLAN CHECK §
SlBnature f �..f�—� %��
Pelm Ittea l// �/
$ �f� TAX S
Authofl2 d AB t TOTAL PAID b
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Aoolicant ta fii� in all sDaces within heavy Eortler Iines antl sign all appropriate tleelarationi
CITY OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. � BLDG. NO.
CONSTRt1CTION PERMIT ,8 E r73S 1712 233 __ _, 8269 I I/ I 6/81 21.00
' •_ ..-� �. �.� - -- ..,. .._ _,. .. .. ..
ProjAEtAddress 2 ational E1VB. TYPE OF CONSTRUCTION ���� � �^
OWnef �n]]. ht TaFo H - Phone — Zp NEw $J noo ❑ ALTERATION _ ,
Address S'dj�e ' ❑ REPAIR ❑ CONVERSION ❑DEMOLISH ZONING REGULATIONS
. Arch/Eng. License NO. � ❑ OTHER
. . . DESCRIPTION OF�WORK P'•P' �
Address
Cootrecto� ThO1ri3S GY'OU Phone IAPMO 52222 20NE PLNG. REF. �
97 - 3 YPE OF PERMIT; �� ��i�;?�NG
SETBACK T. O V LINE
nddress12900 GG BlVd. G ❑GRADING ❑ FOUNDATION �STRUCTURAL ID VAFD
LICENSED CONTRACTOR OECLARATION ❑ TENANT � ELECTRICAL �PLUMBING ❑MECHANICA 5Ep �
I hereby a(firm that I am IlcenseU untler provl4�on5 of_Charter 9(tom- � , RIGHT
menting wlth seCtion ]000) ot Divlsion 3 of tne 9usinezs antl ❑ OTHER '
Rotessions CSC�antl my Ilcense is In fW� torce q}/R<L - REAR VnRD (TO P/l)
y,G � PROJECT DESCRIPTION
LICenSe CIa55 ` µ Litbnse No. � � PKG. SPACE REp. PROV I�ED
Date - Sl9nature _ _ _ _ _ - SQ. FT. ' � '-
WORKERS' COMPENSATION DECLARATION
OCCUPANCV_CONSTRUCTION TVPE STREET WIOTH PARK FEE$ '
1 hereby atfirm that I have a Certiticate o/ Co�Sent to 5e1�-in5ure or a VA�VATION ZONE ZONING APPROVED BV - OATE '
c¢rtiticata OS Worker5' CompenSdtion InSurdn<e, oi a certitietl copy '
theraot (Section 3800 Lab C.). GRADING CU. VOS. ACRES SPECIAL CONDITIONS: ' � ' '
Pollcy No?,AJ�$��Company PRl l i m" A e��� _ -- .L. t� , ,
❑ Certifieo copy Is It¢�¢�y fU�nish¢tl. " ' REMARKS: StI'UC l.Ua,l — Y'aCAS — O
� Certifietl copy is filetl with Ihe dty, Builtling Divislan. , `'� ' ' -
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' '
(This sectlon neetl not�be completeG ifthe�pe�mihls�for one huntlrea — � . - - - � -
SE100) or Iess). - " �- �
C¢/tlfy thdt in thE pCrformance ot th¢ work (or which thi5 pe�mi[ is
issuetl, I shall not employ any person in any rPanner so as to become PLUMBING PLAN CHECK ELECTRILAL PLAN CHECK
subjact to the Workers' Compensatlon'Ldws ot Cdlifornia. - -
Date Signature � - BATHTU85 SHOWERS . '
NOTICE: If a(ter making this tleclzration, you shoultl become subject TOILETS � VRINALS GENERATOR p.l KW_1-10 KW '
to [he Wo�kers' Compensatwn provislons ot [h6 Labor Cotle, you must TRANSFORMER - - .
Torthwlth complY w��h such provisions or this Permif shall be tleemetl LAVATORIES DOUBLE LAVS APPLIANGE 10-50 KW_50+KW�•
levOk2tll ' ' -- ' ' -
CONSTRUCTION LENDING AGENCV KIT. SINKS DISHWASHERS MOTORS 0-1 HP 1-30 HP � 1 [O
1 hereby affirm that there is a construction lentlin9 aqenty for the per- SERVICE SINKS � SUMPS UNC. SOLAR) 30-50'HP 50 1 HV J
/ormance of the work for which this permit is issuetl (Section 309�
Civ. C.). FLOOR SINKS FLOOR DRAINS FIXTURES OUTlETS SWITCHES
L¢ntler'S Name
Lentler'sAtltlress a.S O. DftINKINGFOUNTAINS � �GASTUBESIGNS .
OWNERBUILDERDECLARATION INTERCEPTORS CLARIFIERS � POLELIGHTS
I heraby affirm that I am exempt from.the Cont(actor'S License I..aw for '
the following reason (Section 7031.5 Business antl Professions Cotle: SWIMMING POOL P TRAP
Any city or county-which requires a perm�� to construcq alteq PO�ES METERED SUB
Improve, tlemolish or repair any structure, prio/ to tts issuance,also re- yyATER SERVICE ALTERATION PANELS MAW SUB
qukes ine appllcaM for such permit to 7Ne a si9�etl statemen( fnat he
Is licensetl pur5uant to the provislons of the Contrac[or's License L.aw GAS SERV ICE OUTLETS SERV ICE AMP -
(Chapter 9(commencing..with.5ection ]000) of Division 3 of the
Bu5ine55 antl Profess�ons Cotle) or that he is exdmpt therefrom antl the yyqTER HEATERS BTU OUTPUT '
Dasis for the allegetl exemptlon. Any viola[ion of Section.]031.5 by
any applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS ��
of not more-Ihan five huntlretl tlollars ($500). - � -
❑ I, as owner ot the property, or my employees with wages as their SOLAR TANK oo OLLECTORS � Q 6 QQ '
501¢ C0�9peh5dtlon, will tl0 th¢ work, antl the SirUcturE Is not Intentletl -' '
or offeretl for zale. (Sectlon 7044, Busine55 and A'o�essions Cotle: The SOLAR PIPING SVS. Q QQ �SSUE FEE i�
Contra<tOr's LIC¢n52 Ldw tloes not apply to dn ownel o( a property �
who builtls or Improves tM1ereon, antl who tloes such work himself or ISSUE FEE QQ APPLICATION APPROVED BV DATE
Nrough his own employees, provltlCtl [hat sucn �mprOvements a�e not
IntentleC or oiferetl for sale. If, howeveq tne builtling or Improvement MECHANICAL PLAN CHECK
Is soltl within one year ot completion,'the owner will have t�e burtlen S MM�i,V OF FEES
of provin9 he tlitl not builtl or improve for the purpose of sale). BUILDING
❑ I, as owner of the property, am exclu5ively contracting with HEATING SVSTEM 0-100,000 BTU PERMIT y�� ��t � SMIP s
AND DUCTING
Iicensetl contractors ta construct [he project (�ction 7044, Bu51ne55 300,000 + BTU PLAN CHECK $ PERMIT -
antl Professions Cotle: The Contractor'S License law tloes not appry to ISSVANCE $ �
an owner o( property who builtls or improves thereon, antl who.con- REFRIGERATION 0-300,000 BTU PLUMBING S�
tracts trom zuch projects witn a contracror(s) licesnetl pur5uant to SVSTEM GRADING E
the �Contractor's License Law).. 100,000 + BTU PLAN CHECK 5 �
❑ I am exempt untler Section B. 6 P. C. for this BOILERS BTV . ELECTRICAL § -'S - $
reason MIGROFILM $
Date Owner - SVSTEM REPAI R, A�TERATION . PLAN CHECK � S TOTAL FEE'y
1 hereby<ertitythat I have reatl this applicatlon dntl state that the above EXHAUST SVSTEM MVLTIPLE _ MECHANICAL $ . �
Information is cor t. I gree [o com I wit it antl count PLAN CHECK g LESS AD-
(?` e PY Y Y VANCEPC $
OfdlfldOCES hcltl Sid C � WS ry la g to cons uctl antl hefeby aut�lorize ' � '`
representatives of [ s r. t enter� n the above mentionetl /1 /, (�t�
property for s� lon D s. nL_
$Ignature Date . , _ FINFLFEE E'"-
Drlvers• License or 55 � — —
ISSUE FEE - '
CMF 0865�46 White-Builtling; Gnary-AppliUnt; Pink-Accounting: Goldenrotl-Assessor .
._,; ; CONSTRUCTION,AND PCANNDIN/G��'���� POOL & SPA �
i.
APPROVALS Permit#f�L��L11�2. Date Inspector qppROVALS Permit# Date `'�Inspect�r
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location
. Soil ipe-Undrgrn 44. Steel Reinforcement �
3. Electrical Conduit Utility-Undrgrn � 45. Forms �
4. Electrical Conduit-Undrgrn 46. Electrical Bonding
. tee ein orce 47. Rough Plumbin & Pressure Test �
6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE`
7. Footings 49. Electrical Conduit-Undr rn �
8. Foundation 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra ❑ ndr rn
10. Structural Floor System 52. APPROVALTO DECK �
11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connection 54. Heater & Vent-Final
13. Rough Plumbing • - � -
14. Rough Electric-Conduit " • - � "' �56. Electrical-Final
15. Rou h ElectrioWiring - 57. Solar System,-Final
16. Rough Heating & Air Conditioning • encing & Access Approval
17. Ducts in Structure APPROVED FOR PLASTERING
16. Ducts, Ventilating
19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing
21. Roof Sheathin
22. Frame and Flashing NOTES:
23. Insulation
24. Lathing & Siding
25. Drywall Nailing
26. Plaster Brown Coat
27. Electrical Power Meter-Final
28. Final Electric � �
29. Final Heating & Air Conditioning
30. Final Gas Pipe-Test
31. Final Plumbing
32. Water Service-Final �
33. Gas Service-Final
34. Solar pomestic-Final � �
35. Landsca e S rinklin S stem �
36. Sound Attenuation '
37. Handicap Regulations - � `
38. FINALSTRUCTURE&BUILDING ' ' � �
39. Special Requirements Completed � � � •
40. Electric Release to Edison ' � --
� 41. Gas Release to Southern California Gas Co. '� -� � �
42. CERTIFICATE OF OCCUPANCY � �- � �
No Date