HomeMy WebLinkAbout285 PALMER ST - Building Permits' AVVlicant to fill in all spaees except those within heavy boraer Iines anE sign all avProo�iate Geclarations. '
9614 3/I9/ � Z��� �,pp TL
1 PERMIT NU. � TFACT NO. LOT NO. UNIT �- .- .
�,YOFCOSTAMESA� CO STRUCTIONPERMIT _/��� � - �_ , -
- Project Addrpss �
Applicant'S fNailin ress � TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR � '
Owner'SName � 5 � Pho� � � �ONVERSION ❑ �EMOLISH ❑ OTHER - p�p # � • . ' Zone -
, `�M � DESCRIPTION OF WORK/USE OF BLDG. - -
Address ' 7 � S Main Building:' - ' Accessory Building:
I Arch/Eng. License No. . , � , j . . • � . . . O
TVPE OF PERMIT GRADING FOUNDATION STRUCTIIRAL E Ffont
� Address. ; ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL' A Rear ' ' • N
Contrector"s Nam `bhone Q � �OTHER �
'1������ ��Q PROJECT DESCRIPTION� 5q. FT. � occuPaNCv C Right _ - G
�'o Addresslm�r 1�S.3.j-IA paGc�� •�•/ ���� CONSTRUCTIONTYPE - � VALUATION$ S Left ' ' � " �� � R
� City License No. �`3A . ZONE GRADING CU. v�5. ' , ACRES Ping. Ref. # ' Parking Req./Provided ' _ E
\ LICENSED CONTRACTOR DECLARATION - Q
I,hereby aftirm that I am licensetl untler provisions of Cha�tei 9(commencin9 � Remarks: Pldnni�y NOt¢5: M
1' wlth section ]000) of Division 3 ot the Business antl P�ofessions Cotle, antl , _ � T
� my license is in f W !or a effect. . `�7� � S
� License CIa55 � � Licen � � - . . ,
Date Signature . PLUMBING FEES _.
� WORKERS' COMPENSATION DECLARATION , � Baf Sink � Showef5 � � ELECTRICAL PEES
1 hereby aftirm that I have a certi(icate ot con5ent to Selt-insure or a Certi/icate
of Workers' Compensition .Insurante,. o� a certifietl copy thereot (Section ' ' � � -
3800, Lab, c. G � � Backflow Preventer - Service Sink' ��Automatic Washer - �� Transformer ❑ 15-50 KW
PolicyNo, ��O �� ' Compan��f%VP� �/�s' � Backflowlrrigation SewerCa ' ' ❑50+KW ' '
P ConstructiorPoleSub, i
�ertifietl copy ii he�eby furnished. � � . _
CerY ietl soyy is il�!.witn the city g Divis'�pG J��/ //��/� ��� �� Bathtu6s Sewer Connection Cooking Unit Meter �up to 100 amps
Date �� % `i—�1 APplicantX �MC ��'���1i�'
EXEMPTION FROM WORKERS' COMVENSATION DECLARATION r�' Clarifiers Solar Collectors � Dishwasher Meter ❑over 100amps ' �
(TniS section neetl mt b¢ mmpletetl iTthe permit i5 for one huntl�etl (5300) o� � � ,
less). • Dishwdsher ' Solar Piping •
, Dr'yers ❑Gas ❑Electric Sub Panel
I c¢rtify that in the p¢rformdnce of the work (ar which tM1is perm�t is IsSuetl, I
snall not employ any person in any manner so as to become subject to the Drinkin9 Fountains Solar Tank Fan � Motors �0-1 HP �t'f. � B
Workers' Compensation Laws of Calitomia. � ,
Date Signature Roor Drains � $wimming Pool w/Spa F.A.U. InaSolar �9-75 HP �16-15+ �
NOTIGE: I(, aiter making this tleclaration, you s�oultl become subjett to the '
Workers' Compensation provisions-of �the I.nbor Cotle, you mu5[ forlhwith p0� SinkS -. U�inal - Fixtu�¢5 � �
comply �wi[h, such p�ovisions or this pe�mit shall be.tleemetl revoketl. ' Mic�Ow3v¢ --� �
CONSTRUCTION LENDING AGENCV. GaSServiie Outlets WaLerCloset DeviCeBoXes 1
I nereby atfi�m that thete is a mnstruction lentling agency for the per/ormance ' POI¢ Light
of the work }or whicM1 this permit is issuetl (Section. 309] Civ. 0.) ' ' �
Lentlers Name Interceptors, - Water Heater y Outlets ' � Ran9e
Lentler's AGdress � � Kitchen Sink. Water Service ' , '
OWNER BUILDER OECLARATION � SWitCh¢5 Sign .
I heieby affirm that I am exempt from the Contracror's License Law for the Lavatories • ' Garbage Disposal ' ' Standing Sections
tollowing reason (Section 7031.5 Business antl Professional Cotle: Any clty or _
counly wM1�ch r¢quires a permit to const�uct, alte�, imD�ove, tlemolish or repair p— ' '� G¢n¢�2t0� �0-5 KW �$-15 KW T�dSh COT act0� �
any struct��e, prlor to its Issuance, also �equires the applicant for SUCh permit Trap . P
to tile a si9�etl statement that he/she is licensetl pursuant to the provlsions of Roof'Drains
. the ConVa�tor's License Law (Chapter 9(commencin9 with Section 7000) of '
��Division 3 of the Business antl ProfessiOns Cotle) or fhd[ he/She is ezempt - , �
[herefrom antl the basis for the alleqetl exemption. Any viola[ion o( Section � � " �
'7031.5 bY any applicant fo� a pe�mit subjeGts tM1e apP�icant to a civil
; enalty o� mt more than five huntlretl tlollars (g500). -
� I, as owner oi the properry or my employees with wages as their sole ReinSpec[ion Fee . $15 , Issue Fee . $' 3
compensation, will tlo the work, antl Ihe structu�e is not intentletl or ofteretl ' ReinSp¢ctiOn F¢0 • $15 ISSUe F¢e $ 3
for sale I�ction 7044, Business antl Protessional Cotle: The Contractor's MECHANICAL FEES
LicenSe �w tloes not apply to nn owner of a property wlto builtls or im0�ove5 - � � �
thereon, ana wno aoes sucn work nimseli/herself or throu9h his or ner own , - , DEVELOPMENTSERVICES RE�UIREMENTS: , �
employees, provitletl that such improvements are not intentletl or offeretl for Boile� Hood or Type I ❑. , ,
sale. 11, no�+ever, the builtlin9 or improvement is soltl within one year of wm- Canopy' Type I I ❑ Zoning Approved By Date
pletion, �he owner will have the burtlen Of proving he/she tli� not builtl or im- � DUct - Und¢� G�ound � -
�rove for the purpose of sale). Building Approved By /, Date
LJ I, as owner of the property, am exclusively contractin9 with licensetl con- Duct -Structural Refrigeration System Application Issuad By �y1 /' Data�
tractors ro construct the project (Section 7044, Business antl Profe55ions Cotle: - -
The Con�ractor's License Law tloes mt aoP�Y �o an owner ot oroperty who Duct - Ventilating . ❑0400,000 BTU ❑100,000 BTU , ' SUMMARV OF FEES
builtls of improves ihe�eon, antl who contracts fo� such"p�ojecf5 with a con- .
tractor�s) license pursuant'to the Contractoi's License Law). I am aware that Exhaust Sys[em ❑ MWtiple ❑ System Repair/Alteration �• BUILDING PERMIT �$ SMIP $ '
proof of their WOrker's Compensation insuran[¢ shOultl be provltletl to me.
PLAN CHECK $ � PERMIT ��'
❑ 1 am exempt untler 5ection e. & P. C. for this reason firepl/Fact. Blt. ICBO # PLUMBING § ISSUANCE ,$ ,
Date Owner Heating System & Ducting PLAN CHECK 25% $' ENERGY P.C. $
I herebY. �ertiry that I have reatl this apPlication antl state that the above� '❑0.700,OOOBTU 0100,OOOBT GRADING $.
informa��on is correct. I agree to comply with all city antl county orCinances � . ELECTRICAL $
antl state laws relating to builtling wnstruction, antl hereby authorize repre- PLAN CHECK 50Yo $ MICROFILM �$�
Sentatives Of this city to enter upOn t above-m¢ntionetl•pwperty for � , �/�
inspection p .J��
Signatu�e Dafe �� MECHANICAL $ ' .TOTAL FEE � $
Drivers' License or 55 � � Reinspection Fee $15 . laua Fee , $ 3 PLAN CHECK 25% $
CMF0865-46,rev.4/84 White-Builtling;Canary-Applicanh,Pink-Accounting;Goltlenrotl-AssesSor -
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CONSTRUCTION AND PLANNING � ' POOL & SPA . - . ,
�APPROVALS Permit#� Date Inspector qppROVALS "Permit# - Date Inspector
,c .
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 Cond'uit-Undrgmd. '- _ � 55. Electrical Bonding
•5. Steel Reinforcement . 56. Rough Plumbing.& Pressure Test _
6. Electrical UFER Grnd. �- .� , ,' � 57. APPROVAL TO COVER-GUNITE ,
7. Footings � � . - ' �. �� . 58: Electrical Conduit-Undrgrnd. -'
8. Foundation ' - � � 59. Gas Pipe, O Undrgmd., Test �
9. Water Pipe-Undrgrnd. � ' 60. Backwasfi 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 � -
� 74. Rough Plumbing ' �� 65. Electrical-Final ��
15. Rough Electrica6Conduit - " • 66. Solar System-Final ,' -
16. Rough Electric Wiring , •67. Fencing & Access Approval -- �
17. Rough Wiring Sign - i 68. APPROVED FOR PLASTERING '
18. Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL �
19.'Rough Heating & Air Conditioning , . �/; FIRE DEPT. REQUIREMENT � �
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 Flathing 76. Dry Standpipe '
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation � . , 78. FIRE PREV. FINAL � ��
30. Drywall Nailing � , � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � 79. FINAL INSPECTION �� � �
32. Electrical Power Meter-Final � � , •80: FOOD CERTIFICATE ISSUED
33. Final Electric . � , Notes: � '
34. Final Heating & Air Conditioning ' . -
35. Final Gas Pipe-Test , 3� �' 'P .
G / n•
36. Hood or Canopy , '
37. Final Factory Fireplace ' � • . � '
38. Final Plumbing � � . � �� - , � � .
39. Water Service-Final � - � �
t
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 Cq . � , ,
51. CERTIFICAT�OF,OCCUPANCY - � '_ - , � -
No. Date " , � � �
PflOJECT ADOFlfSS: 2$ S PALMER ST
�OWNEH'SNpME: PR-ICE, CHRISTOPHER R
aooness: PRICE, LISA A
+ Z85 PALMER ST
COSTA MESA,CA 92627
f PflCHIENGINEEfl:
i AODNESS:
.
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flEG.NO.:
UNIT: 1 � 2
UNIT:
FEHMI77EE: LISA PRICE f 719 ) ti50-3952
aooeEss: 2 8 5 PALMER ST
C,M. CA 9Z627
ULENSE� CONTppCTOB DECIANATION: I hereby aflirm IAat I am licensetl untler provisions ol Chap[er 9(commencing wit� Seciian
7000) ol Division 3 ol the Business antl Protessons Catle, an� mY hcense is in full fo¢e antl eifeci.
CITY LIC.: STRTE IIL.: C1A55: EXP ;
Oa�e: Signature'.
WONNEflS' COMPENSFTION DECLAflATION: I hereby affirm Ihat I �ave a ceniiicale of consen� b sel4insure or a certificate af Wolkers'
Campensa�ion Insurance. or a ceneietl copy ��ereof (Sectian 3800. Lab. C�.
POLICY NO.: EXP. UpTE:
COMPNNY:
i � Cerotietl �py is hereby lumished. ❑ Cenitied topy is tAetl wi\h \�¢ tiq 8uilding Division.
Date: Applicant:
E%EMPTIONFqOMWOBKEPS'COMPENSATIONOECIAPATION: Qhi55��nneetlnotbecom0le�eUit�hepermi�i5forone�untlretl�E1W)aNess�.
I ce�ify Iha� in ��e petlormance ol �he work tor which Ihis permil is issuey I shall no� employ any person in any manner so as to 6ecame
subiect to the oBers' om en tion Laws of Califomia ���- {/'
Da�e: � Signalur �/� -/-� ✓N-�� � "�A ��•
NOTICE �. af�er aking his Oeclaratian, you shoQfd OecomB subjec� �o �he Wo�kers' Compensa�ion provisions o� �he La6or
Cotle. yau mus� tarlhwith com0ly wii� such pmvisions or �his De�mi� shall be Ueemetl revoketl.
CONSTBUCTION LENUING AGENCY: I here�y aflirm thal there i5 a tonSlmCiiOn lending agenty lor �he pedormante ol �he work tOr
which Ihis permit is i=sue0 (Seciion 3097, Civ. C�.
LENDEfl:
AOONESS:
OWNEq BUILOEH DECLANFTION: I �ereby aflirm Ihat I am exemUi �mm ihe Coniractors' State License Law for itle tollowinA �eason
(Section 70315 BuSiness ana Pwfessional Coae: Nny cily ol couPry which requires a permit b cons�mct, alt¢r, impwve, tlemolish, or
re0air any s�ruc�ure. Orior �o its issuance, also requires t�e apPlicant �or such permi� tolile a 5igneU s�a�emenl tha� �e/s�e is licensetl
pursuam to 1he ��ovisions af ihe Contracrors;Staie License Law (C�apter 9(commencinp wilh Seclion 7000) of Division 3 oi ihe Business
antl Pwlessions Cotle� or Ihal he/she is exempl �herelmm antl �hf. basis lor Ihe allegetl eremD�ioa Nny viola�ian ot Section 7031.5 by
any applicant lor a permi� suDjecis ihe aDPlicant to a civil penalry of not more than five hunOretl tlollars �$500�.
I, as owner o� the Ompeny or my employees with wages as their sole comDensa�ion, will tlo the work, antl the
❑ simcwre is nol intended or aiferetl for sale (Section 7044, Business and Pmfessional Cade: The Coniractors' State License Law
tloes nat apOty m an owner ol a propetly who builtls or impmves �hereon, an0 who does such woB him5el�lhersel� or thmugh
his or her own employees, pmvitlea Iha� Suth impmvemdn�s are not in�endetl or o��eretl br Sale. I�, �Owever the buiiding or
impro�emem is soltl wilhin one year of comple�ion. Ihe awner will have �he bur0en ol proving he/she Oid not �uiltl or improve
�or Ihe purpose oi sale�.
I, as owner of Ihe pmpeny, am e�clusively conVacting wittl licensetl con�rac�ors to cons�mc� lhe pmject (Seclion 7044, Business
❑ and Pmfessions Cotle: i�e ConVactors' S�ate License Law Does no� apply lo an owner of propeny who bui105 or improves �h¢reon
antl who conlracls br such pmlects wilh a coniractor�s�license Dursuantlo Ihe ConiractaK Slate License Law),I am aware
thal ��ooi ol lheir Worker'S Compensa�ion insurance ShoVIA be O�ovi0e0 io me.
QI am exempt under Semion: $ P 7 O 4 4 B. 8 P. C.
mr m�is �reas/on: O/W�N(E�R—BUIDER �(,/ /n
Oa[e: (X //�l'�`7 �`7 � Owner���[!'�"—�� � Cl� •
I Oo hereby aetlity Ihal I am aware � an6 tl un0er5iantl �he requiremenls al Cali�amia Heal�h and Safery Cotle $ections 25505. 25533, antl
2553d an01ba1 I ar any fuWre Auiltling occupanl will/will nat (circle ane) neetl �o comDly wi�h saiG sta�e codes an0 �he requiremenis tor a
permit lo� consimdion or motlificaiion imm �he Fu Ouahly Management Oisiricl. Nesidenlial consiruction applicatians are exemp� irom
I�ese pmvisions.
Oale'. Appiicani:
I �ereby ce��ity �hal I have rea0 this applica�ion antl slate Iha� �he a�ove inlormation is correci. I agree �o comply vnlh all ciiy and counry
OrdinanC¢santls�atelawsrelatinglo�uiltlmgcans�mciionanaherebyau onzereDreSenlalivesof��iSCiryloenteruDonlhea6ave�mentione0
properiy fo� �ns ecGan p rposes � �J
. �ate: ��J � Siqnaiure: l/� �� � �%�` �,
'. oriver's ��ense or Socia� Secunty a:
164L06 White-8uilaing�. Green—CoOe Enlarcement; Canary—Applicang Pmk—Revenue; GdCenroC—Assessor
CITY OF COSTA MESA — BUILDING PERi1IT
PERMIT NO: E 067631 PLAN CHECK NO: N
CONSTRUCTION TYPE: PERMZT TYPE: ELE
FERM 1J0; E 057631
GOVT; N SUPP; N
[i1:II����lU-�IJ
JOB DESCRIPTION ; UPGRADE ELECTRICAL SERVICE SQ FT:
CLAIP4 VALUE: CALC—VALUE; GROUP OCC: /
COMMENTS: ONLY ELECTRICAL YdORK
�tec� u��r*�**-�t*+�+F*��t�x�a��t*��t-!�-�jt-»ri�c���+t**ar*-�t-�t�-*-�tjtx��-*�!c��x-,�t��*�--�-�etx�at-x�x-�-�x--�rec-�t�r**�t*�t�c-�i��s*�-�ac�cu-+r����
Z O N I N G R E Q U I R E M E N T S
S E 2 b A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR; FT ZN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IP:
PARKING REQ • PROL�; PARCEL; 42516114 ZNE: REF NO:
PLANNING NdTES>
i
*�**�#�**+r*�a��*�*****�**�x�,�***����**���r�r*��**�+���*�*+��**�***�����k*�*���+��**�+�
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING AFPROVED BY DATE;
HUILDING APPROVED BY : DATE:
APPLICATION ISSUEP BY; � DATE: � IS�,cIi.�
�ir�r*x��t*rr**i�**x�*+��t**?��'iF*��ri�+t*�z�r�*���Tf����#a x4�iF+.��rrt**�F+��+��u,�****x�*�7�.: �+r**�rk�r*
vc iE iE iE i! 1E jE iE iE iE if 1P iE iE # if iElE iE iE iE iF?f 1E iE fE aE iE if iE iE IE aE ik iE jF?F jE if iF if if iF jE if if iF #: �E iE if if iE if iE iE fE A= iF iF if if iF 3F if 1k jE ?F if iE #E iE �)t iE iF iE iF i4 a�
LEGALI2ATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;N
BLDG PMT PLUhtBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT
40.50
� SOx
PLAN
ISSUE FEE 15.00
HUILDING—DIV—> PERMIT ISSUE PLAN—CAECK
TOTALS----> 40,50 15.00 0,00
REVENUE LIIVISI(�N TOTALS--> COVI,ECTED:
BLPG PMT PLUMHING ELECTRIC �1ECHANIC
55.50
TOTAL
55.50
SMIP/NON—RES
PAID nUE
55.50 .00
55.50 OVER:SHORT; ,00
FIP.E SMIP/TOT GRADING PLAN—CHECK
iE iE if iE iF iE if it jf if-it iF iE iF iE if iE 3f iE if if if iE iE iE jE iE iE iE �f iF if if a(-if if iE iE if iE #E iF iE iE iF iE iE # jt �N-�lf if iF �if j(-�7e K-iF �F iE i( iF N� # iE �If �lE iE iE iE jE # iF �tf jf if * iE 1E
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 C�ST
ELE 1 SERVICES HELOW 600 V& BELOW 201 AMP 18.50 18,50
ELE 1 SUB—PANEL 11,00 11,00
ELE 1 MISC CONDUIT NOT LISTED REQ PERMIT 11.00 11.00
END OF FEES
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41 Q0162332—�0162382 T C�T
DA7E� Ob/id/9d TIflE: 35:08
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CON5TRUCTION AND PLANNING . POOL & SPA
APPROVALS Permit # Date lnspector AppROVALS Permit # �ate Inspector
1. Temporary Elecvical Service or Pole 52. Pool & Equipment Location �• �
Z. Soil Pipe�Undrgrnd. 53. Steel Reinforcement - �
3. Electricai Conduit Utility-Undrgrnd. 54. Forms � '"
4. Etectrical Conduit•Undsgmd. 55. Etectricai floRding `�. �
5. Steel Reinforcement 56. Rough Piumhing & Pressure Tzst
6. Electncai UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Foot�ngs � 58. Electrical Conduit-Undrgmd.
8. Foundation 59. Gas Pipe. O Undrgrnd., Tes[ �
9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P�Trap, O Undryrnd.
10. Struttural Floor Svstem � 61. APPROVAL TO DECK ,
7 7. Property Sewer Line & House Connection 62. Backwash & ReceptorFinal �
12. Sewer Cap '� 63. Heater & Vent�Final �
13. Roof Drains '�" 64. PWmbing System - Final '
74. Rouqh Plumbing 65. Electrical-Final �
15. Rough ElectricabConduit 6fi. Sotar SYstem-Final . �
76. Rough Electric Wiring 67. Fencing & Access Approval _
ll. Rough Wiring Sign 68. APPROVED FOR PLASTERING .'
18. Rouah Electrical�T Bar Ceiling 69. POOL/SPA SYSTEPfiS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rouc�h Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating , 77, Product Piping �Gas ❑Oi1
23. Gas PiPe-Rough & Test 72. Under9round Flush
24. Roof Framing 73. Undergrnd.StorayeTank OGas �Oi1
25. Roof Sheathing 74. Overhead Hydro
26. T-8as Gel4ing {Structusaq & Monocoat . - 75. Drv Chemicat
27. Frame and flashing - 76. Dry Standpipe
28. Lathing & Siding � 77. FIXED SYSTEM FINAL
29. Insulation � � 78. FIRE PREV. FINAL
30. Drywali Nailing HEALTH DEPT. REQUIREMENT
31. Piaster Brown Coac 79. FINAL INSPECTION
32. Efectrical Powzr MeterFinai �/��/ 80. FOOD CERTIFICATE ISSUED
33. Final Electric ���_t��u(�_� Notes: � Q -Q ��(" r�,,. ��). '�
( r,t.'� -.f- _l, _Sr _UM1� 7 �.
34. Final Heating & Air Gonditioning �
35. Final Gas Pipe�Test ���
36. Hood or Canopy
37. Finai Factory Fireplace -+:
38. Final Plumbing �
39. Water Service�Final
40. Gas 5ervice-Final .
41. Solar pomesticFinal � .
42, Backflow Preventer
43. Backflow Irrigation '
44. Landscape irrigation SYstem
45. Sound Attenuation
46. Hand�cap Ragutations �
47. FINAL STRUCTURE & BUILDING -
� 48. FINAL PLANNING ��,
49. Electric Release to Edison --�
�
50. Gas Release to Southem California Gas Co -
5L CER7IFICATE OF OCCUPANCY
No. Date
CITY OF COSTA MESA
BUILDING DIVISION
OWNER-BUILDER VERIFICATION
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such
notice, and, as a condition precedent to issuing a building permit, require the comp�etion and require the
return of, an owner-builder verification.
Attention Property Owner:
An 'owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity
to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued
until this verification is received.
t. I personally plan to provide the major labor and materials for construction of the pro-
posed property improvement. � Yes ❑ No
2. I(have/have not) �tGYt signed an application for a building permit for the
praposed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
Name �
Address Ciry
Phone ( ) Contractor's Lic. No..
4. I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise S��rovide the major work:
Name
Address City
Phone ( ) Contractor's Lic. No.
5. I will provide some of [he work but I have contracted (hired) the following persons to pro-
vide the work indicated:
Address
Type of Work
�
I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State
of California Health and Safety Code and have completed the above information to the best of my per-
sonal knowledg compliance with is State law.
Signed��lQ � • �-� � Date: ��'l'i �f
Name: LlSG� � • �r� �Q.
. (Printed or Typed)
C.D.L. # or S.S. # '�
754-5273
1042ifi
ORANGE COUNTY BUILDING DEPARTMENT APPLICATION POR PERMIT ,
� 636 North Broadwar �1 ` -
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