HomeMy WebLinkAbout2681 PALA MESA CT - Building PermitsPA�, Co., Inc.
PERSONAL ADMINISTRATL-Y.E SER�'ICES, Co.
Condominium Management �irh the "Peaana! Toueh"
CITY OF COSTA MESA
P.o, sox i2oo
�OSTA MESA, Ca,. 92628-1200
ATTENTION; MS, GINA DIAZ
RE: MESA DRIVE HOMEOWNEP.S ASSOCIATION
2681 — 2690 PA�a, MEsa, CouPT
DEAR MS. DIAZ,
PO Box-2968 -
Costa Mesa, G1 9'62$
Tel.: (714� 641-0591
Fax: (114� (v31-I169
SEPTEMBER 16, 2OOS
PER PALA MESA COURT H.O.A. BoaRD OF DIRECTORS PLEASE BE ADVISED
THAT DIVERSIFIED CONSTRUCTION AND ROOFING COMPANY WAS GIVEN A
CONTRACT TO DO R& R AT REFERENCED ABOVE COMPLEX.
IF WE CAN BE OF FURTHER ASSISTANCE PLEASE ADVISE.
���. /-�o�<—
DORIS HOPE
,4SSOCIATION MANAGE,R
�� s3 0���.�� � � �z��
(714) 754-5273 • Fax (714) 754-4856 • www.c�.costa-mesa.BWlLDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
,lob nddress: 2681 PALA MESA CT
Suite:
Viciniry:
Primary Occ: R3
Parce� Number: TPN050002
Applicant: ZUNDEL,CHAP
Address: 2136 CARTWHEEL CI
Owner:
Atldress
Contractor.
Address
Zip;
Type of Construction: V-N
Zoning: '
Phone: 951-893-7805 ISSUED BY:
CORONO Zip: 92880
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PALA MESA COURT;�HOA s = �
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PAS CO INC � ,,� �� � __ ' �
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COSTA MESA; CA ���-� Pfione 714-641=0593
PO BOX 2968.OR 2953 RANDOLPHf«., ;;__Zip 92628 -- �, �'�„�..i „_
f.��� .. � - ...- : .�.:� w. `�'' �- i; �''�` ' ,
DIVERSIFIED CONSTRUCTIONrAND`DEVELOPMENT � ` ` `���_ � �•
2136CARTWHEELCI , -�',r�"�"' ' �� ^..� '` s� �,
`�'� Phone. 951-8937805 �• ��� �a"-�F'
CORONO „��-
gpgg0 � License: 558203 ,�� �
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Arch:�..:�..
AddresS:-�:.'"
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Zip:,y, ' k�.� �
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Flan Check '���i g
_��� Permit ��� ��$1
SMIP;Res �3
SMIP,Com �.9
;� Other: 9
I'n"spection� ��,__9
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nTotal: , $1
ACCESSORY
PARKING
Phone:
Eng:
Address:
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` � ,License: �� � z �`��a.'
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�- - SCOPE OF PERMIT �
AND REUSE REPLACE WITH SAME TILE ICBO# 2656
�; � FEE SUMMARY � � �`^
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Status: ISSUED
Applied: 09/22/2005
Issued: 09/22/2005
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� FELT� 2681'AND 2683
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r.-�' 'r $7.320
r �i'i i $7.320
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" �� PCANNING'& ZONING ' `� � ��
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JRE Front 0 0" ,� �,, Rear 0�0 Left 0 0 Rigfit � 0�0 � ,
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�.� 3, � " � � Right 0 0 -�, ��� � �
; Front 0- 0 Reaa�r 0 0 �� Lefl � 0�
'Tp � � 5 , � �: h' .b�r`b��. 4( I .� � � � -.� � � � � � i ...
�Existin '` 0 ` Required � 0 ��� '�P-r000setl � 0,� `�' ,, '
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NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomla statutes and related
regulations. (Ortl. No. 92-28, § 1, 12-21-92) �
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapeetlona end final approval must be obtainad. Failure to obtain inspections and final approval will result in the expiretion of this permit.
FOR INSPECTIONS CALL: (714) 7545828
2446d8IfJ00)
WORKERS'COMPENSAnON DECLARAnON: ' - �
I hereby affirm under penelty oi perjury one oi the tollowing declarations: �
❑ I heve end will maintain a certificete oi consent to salf-Insure for workars' compensetion, as provided tor Ey section 3700 of Ihe Lebor Code, for the pertortnence of the
�ork for which Ihi9 pertnit Is issued.
entl will maintain workers' campensatlon insurence, as required by section 3700 of the Labor Code, for the perfortnence ot t�e vrork for which this permit Is issuetl.
e My w ers'Coompe� n ran rder end policy numDer ere: o� ' '� �/7
�y � ' l�
(}h/o-5�on nee'd nof be completed i! fhe perm/f is velued at one huntlretl dollars ($100) or /e55J �� �
❑ I certity that in the peAortnence of the wark r which this permit is issued, I shall not employ any person in eny menner sa as to 6ecoma sublect to t�e workers'
comp ws ot Calitomia end e at tl I shoultl bewme subf ect to the workere' compensaiior' visions oi Saction 370y oi the Lebor Cotla, I shell fotlhwith
y th the provisio , . // /� /�
Ap ca • ignature: � Dete: �ll '(.2 � J
WARM : FAIL O SECURE WORK OMPENSATION C1�VERAQE IS UNLAWFLL AND SHALL SUBJECi EMPLOYER T MINAL T1E5 AND GVIL FlNES UP TOONE HUNDRED
� RE (5100,000). IN ADDfTION TO THE WST OF COMPENSATION, DAMAGES AS PROVIOED FOH IN OF THE IABOR CODE, IMEREST, AND ATTORNE`fS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aNirm that I em Ilcensetl under provl�ions of Chapter 9(commencing wiih Section 7000) of Division 3 of the eusineu end Pfofesslons Code, entl my license is in full
force end effecL lJc. # % Glass k fi- �
Cantractors Slgneture: S� _ Dete: G,7"L G�Y
CONSTRUCTION LENDING AGENCV:
❑ I hereby aNirtn Ihat there is a consWction lending egency for the pedormance ol iha work tor which Ihis permit is issued. (Sec. 3097, Civil Code).
Lentlafs Name: Lenders Address:
SignaWre: Date:
OWNER-BUILDER OECLARATIONS:
I hereby ettirtn Ihet untler penalry of perjury ihat I am EXEMP7 FROM THE CON7RACTOfiS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professions
Code: My ciry or wunry which requiraz a permit to consiruct, alter, improve, demolish, or repair any structure, pnor to its issuance, elso reduires the epplicant for such permit
ro file e signed statement that he or she is Ilcensed pureuent to the provisions of the Contrectors License Lew (Chepter 9(commencing wit� Sedlon 7000) ai Divlsion 3 af the
Business and Professions Code) or that ha or she is e:empt therefrom and the basis for the alleged axemption. Any violation oi Section 7031.5 by eny epplicant for e pertnH
sub�ects the epplicant to e dvil penalry of not more than five �untlre0 tlollars ($500).): �
❑ I, as owner ot the property, or my employees with wages es their sole compensation, WILL DO THE WORK, antl the siructure is not intended or oXeretl for sale (Sec.
7044, Business antl Professions Cotle: The Contraciors License Law does not apply to en owner of property who builds or Improves ihereon, and who tloes such work
himselt or herself or through his or �er own employees, provided ihat such impmvements are not intended or oflered tor sale. It, however, the building or improvement Is
sold within one year of completion, the owner-builder will heve ihe burden of proving ihat ha or she did not build or improva for purpose oi sale.). �
❑ I, es owner of the property, em EXCLUSIVELV CONTRAC77NG WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business end Protessions
Coda: The wmractors License Law tloes not apply to an owner ot property w�o builtls or improves thereon, and who comrects br such projact with e comractor(s)
license pursuent to ihe Contractore License LawS.).
� I am e:empt untlar sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID venllad by drivafs licen50. ❑ Yes ❑ No Onver's Licensa No.
Vedfication of Ownership by (rype ot tlocumem, i.e. - properry tex bill or daed):
DIVISION OF INUUS7RIAL SAFETV PERMR CERTIFICATON:
Expire5:
❑ I hereby certify that no excavation five (5) or more teet in tlepih into which a person is requirad to tlescend, will De mede in connection with work euthorized by Ihis
pertnit, antl that no building siructure, scaHolding, falsawork, or demolition or dismantling thereof, will be more then thirry-slx (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Titla 8, Califomle Atlministretiva Code�.
❑ As owner-builder, I will not employ enyone to do work which would require a permit from ihe Division of Industnel Sefery, es notetl ebove, unless such person �es e
permit to do such work from the division.
Signature: Date:
DivLsion of Industnal Sefery Pertnit Number.
CERTIFlCATE OF COMPLIANCE AND AUTHORVA710N 0 NTHY: I cartity under penalty of perjury that I have read this application and state Ihet tha infortnation given is
conect. I agree to comply with e0 tate laws end ciry ord' a es relating to building construction, and euthonze representatives of the Ciy of Coste Mesa to enter upon the
above-described property far insp tion pu . I g�r n to occupy or allow occupancy of any building euthorized by this permit until final inspection.
COOE �. INSPECTONTYVE
1616 Fixed System Final Fire Prevention
126fi Pool Spe Final
200 Final Re-Roof
201 FInaI BIocWRelaining Wall
202 Final Feciory Fire Place
203 Final Sign
204 Final Demolition
PdIE IHimALS
' " - �'J
CO�E 1 INSPECTION TYVE
206 Final Mechanical
208 Final Plumbing
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Flnal Building/Occupency
Pdg 1N��L5
"�'9..__.,:_ PASCO
09/22(2005 15:55 714641 ___..__.. . __--.--.,._
.
FRac'I : C[ Tt' OF COSTA MESA FMX t-�ii. : 714 7.=-A 45��
DECLARATiON OF AUTHQRlTY
FOR AIiENTB OF PRQPERTY OWNER
TO APPLY FOR PBRMITS
177 [=5.�4 02� UL ff.0. �r}
PAGE 02
Sep. 22 2L�75 r2:14F��1 al
a�ds. Pemdc a
T'trs Pormit ft
Stleet qtldress� �(p �� --� ���„�(�LL9 n7 E'Siq �- pP Num6er
;''�,� /�}'SSOG/A T�o✓ J77.sN�LLx
1, I(wel. .iS. �4.�.5 ��� deGare tnat I am the Awwec�iiNe ot the above
�__,......__.. __ __..---'
rNet�ncstl reAl prop�ny, and t�al I(we� here6y aulhorize:
Name: � � af_Q,S��� D.._.,=„r�,�� "Eic�_ 7ebphone Number� R f� �E ll �/�G r
Street Addrsas: tJ� � 44 iD t W/y�.L f' t r? .____,------ti _�—.
c�ry: �'�f��A s��e: _:__� _.---__-.._.. _ . rP: .. `�`��
C�uR r
�n Ob4in psrmits In my behalt as ownerlbuiltler, for �Ce �/-2�45�//.i A�iSa _,.�-���..,�_�±
at n�e above Meronced propeRy.
2. 3lwuld any portioe 6ecome an �mplqw anpapetl in t�e imDrovement ot the aopartY, �(We) shall immediatey provitle Worker's
Compensatlon Ineuranca covYrapa and cause a cerfi(icele o1?hat �averaQe to be fibd wilh ihe Bv7ldinp Ditiabn oi the City af Coeta
Mesa, es reQufretl by 31ate o1 Calllornia lawa.
3. A� ewneNballAer in lect, I understend antl eccepf tha� my reeponaibilltiee do nol hansfer M any oHier person, comO�Y or
oDlporBtbn. �
�. I eqrea ta IndemnNy end holO Me Cily of Coeta Mee2 and its BmAloyees or oNlcers harmlesa from any cleim resultinp in damape o�
pwaoMl io)ury to myssN or �ny Wher partiee as a reauh oi work sutho.ized by Me permits hom the Ciry ol Coam �desa.
6. i declere under Me penany or perjuy fhat the roreGWng �e m,e ene conect. •
ExacuteA thle _'��Zday o( ��nl �� ' 20 ��, , at _�'�j�.� jd>.L. , CaBPorNa.
�; rhr5� GYvvc-� f+°.G./�
, (jo�yico o� %9jie/rc�u2s
Pdnt neme: _��1 '. �_[� — D02 � 5 /a o,o c-'
�_�y 5lgneture: ''��or/y..,. �_,.
DaIB: ..�_��. A��� .
! �
No4: Thb mModradon does rot 9rent authoi2aYron � Perfam tlia wak es oN+'�er,
a sobly w�de� ar riMRen a�er at etromev m seamv thls vBmd� tn arry n++rian.
W l0.AB �nv.nq0)
09/22/2005 15:55 714641i169 PASCO PAGE 01 __
FROM :CITY OF COSTR MESA
FPX N0. :'14 7.��4 4E`6
'S�l. St 73
3r_p. 22 2��5 �2:14PD1 Pc
� � �.�00� � �� ��
OWNER-BUILDER �..�%
VERIFICATION
Addrma: � S/ Z(p/r O Permit q:
� cib� or counry, whiah ia rcyuired W bive notice pursuani [n Suciinn I yy30, .ehall attnch to such noticz, and, xv
�� condition precedenl io issumg x hu�lding pernut, roquire Ihe campleiion and require the �enim of', an owner•
builder vrrificntion.
�ttentinn Properiy Owner. . , �
An 'ow'ner-builder' bvildin� pennit has been app!icd fur ir. your namc u��d bvaring ynur signnture.
Plense car�plete and reWm Hiis informarion in ihe envelnpe prrnided at your earliest opportm�ity to �void
unnecessary dciay In prncecz+np mid issuing ynur bnildin� permit. Np buitdiny pernut will Ue issued until_lhis
��e:iLcaliun i� srcei.cd. -
l. f �xrsonally pian to provide die mnjor laba• and materiuls fnr constniction of'ihe proposed
nropeityimprovoment. ❑ Ycr � No
�. 1(heve/I•ave rn�il.._,.%{j,t.ti+ _�/� si�xd nn npplicetinn fnr u hu;ld;ng ptnnit for
the propoved wurlc.
3. I have cnntrac.teA witlx the folluwing p�r.m, (fimtl tn provide tlu yropnstd cunvtruoti��n:
I�amc.._��4 QL �,cn /�'�i5'3�✓ry�7•..l :
Addrcss ..__�C�-7"cJ�� ..L..�. .. _ (';ity --��v�vd �
phnne (9��) e�$��dT _...... . Conlrat'tiir`. Lia Nn. _��FS"?O �
a. I �la� to provide porpons of ihr. uork, hui I 1,uve hired tl�e f'ollowiug persun to conrdina�c,
su}xrvise nnd provide tlie major work:
Vame
_..__
Addreus . .,._. _....._ _ City __ _ ..
. . ... . _..—
Phnnc ( ) _.. Comrnctor's I.;c. No.
5. 1 will p�ovide snme nf the work bui I buce coutracted (ltired) the f'ollo�cing pt�sons a�
provide thc work indicaicJ: � -
Namc Addresa Phonr TVpc of Work
1�4'J-r1fi (R�V 1:IM)
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.
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CITY OF COSTA MESA
CALIFOANIA 92628-1200 P.O. BOX 1200
DEVELOPMENT SERVICES DEPARTMEN7
5eptember 17, 1990
xo:
puilding Safety Division
Code £nfarce-�ent
Communications
Copley-Colony of Costa Mesa
Gounty Administration Office
County Clerk/Bd. of Supervisors
County Registrar of Voters
County Tax Assessor
Engineering Division (2j
Fire Administration
Fire Prevention
Manager, MIS
Mesa Consolidated Water Dist.
Ney�port-Mesa Un. School Dst. (2)
Pdcif.ic H�11
Police Dept. - Ping. & Research
Santa Ana Heights Water Company
Sanitary District Engineer
Southern California Edison Co.
Southern California Gas Co.
State Board of Equalization
Street Division
U.S. Post Office - AIS
U.S. Post Office, Adams Avenue
File (2)
The City of Costa Mesa wishes to advise you that the followinq
addresses have been changed or added:
�161
161
161
�161
161
OLD ADDRESS
"A" Mesa Drive
"B" Mesa Drive
"C" Mesa Drive
"D" Me=_a Drive
` " Mesa Drive
NEW ADDRESS
2689 Pala Mesa Court
2687 Pala Mesa Court
2685 Pala Mesa Court
2683 Pala Mesa Court
20^01 Pala Mesa Ccurt
�' 165 Mesa Drive 2682 Pala
�� bS�Iesa Drive 2684 Pala
165 Mesa Driv-e --�-2686 Pala
��, 165 Mesa Drive '2688 Pala
3 165 Mesa Drive _2690 Pala
� �� �i�
Mesa Court
Mesa Court
Mesa Court
Mesa Court
Mesa Court T
A.P. N0.
439-221-64
439-221-23
For your convenience we are listing the agencies above that we have
notified of the change. In addition to those listed, you are
advised to notify your correspondents of the change in order to
avoid any possible interruption of mail service.
77 FAIR DRIVE
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PALA MESA CO
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MESA DRIVE
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1 2683
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2688 � i
2686
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2ss2
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_..ieng. ��G �cense No. � L )'S'15
P.ddress 37-4+C� �[�� iJ _ � G� �7�/3
COntraCtor'S Name '✓ Q Phnne _�
Address lmailing)
City License No.
LICENSED CONTRACTOR DECLAfiAT10N
I nereDy aAirm t�at i am licensetl unaer arovisions of C�arter 9(commentlng
wi[h section 7000) ot Divislon 3 of t�e 8usiness antl Professions Cotle, antl
rrmy license is in (ull lorce antl effect.
License Class License No.
Date Si9nature
WORKERS'COMPENSATION DECLARATION
I here�Y affirm tba[ 1 have a ttrliticdte oi consent to selt-insure or a CMt}�{�te
05 Workers' Compenution Insurance, or a certifietl coOY thereot (Section
� 400, La�. CJ
� olicy No. � Company
BC¢rtilieG copy is hereGy �urnisbetl.
Certifie0 copy is filetl with tha tit� Builtling Division.
Date ApPlicLnt
EICEMPTION FROM WORKERS' CaMPENSATION DECLARATION
(This section neetl not Ge completetl i� tbe permit is for one �unOreC (5300) or
Iess).
' 1 certily ihat in tbe Perlormante oi ihe wOrk br wh'icb this pe�mk is isSueE, I
51W11 not e ploy any person in any manner so as to become su� ject te.ihe
II Wor n aiI"qrLaws of Californi;. - •^ �-�
D � Si9nature �
N 71C : i, after makMg tnis aecla Ion, vou snoultl oecome sueject to tha
Wotkers' COmpCoSalion O�OviSi0a5 0� t�e tdbor COtl¢, you must brtllwitq.
cpmO�Y w�t� suc� proviSiOnS or t�is Oermit s�all be tleemeC rcvoked.
CONSTpUCT10N LENOING AGENCV
1 hereby afBrm t�at t�ere IS a mnsVuction lentling agency for the per70rmance
01 th¢ wark for wbich tMs permit is issuetl (Sec[ian 3097 Civ. C.)
LsnCer's Name
Len6e�'s l�adre:s
OWNE(t BUILDER DECIARATION
1 hereby a111rm lhat 1 am exem0t from the Cm[ractorY License Uw tOr the
following reason (Section 7031.5 Busineis antl Professional Cotle: Any c(tY or
county w�ich requires a permit to construct, alter, im�rove, tlemolish or rCpdi�
any s[ructure, pAo� to its isSUance, D�sO roQuires [h¢ dPplicant f0� Sucb pe�mft
to file a stgnetl s[atement that �e/s�e fs fiwnsetl pursuant to tne D�a��Hons ot
th¢ Contractor': LJce�se Law (C�apter 9{commencing with Section �aOQ) oi
Division 3 ot the Busineis anG Pro/essions Cotle) or that ne/sne iz exempt
therGtrom ana tna basis Io� ��e aliegetl exemption. Any viOldtio0 of SeCtion
31.5 by any apP���ant lor a permit subjects tne applicant ta a civll
�alty ot not mor¢ than /ive �untlretl tlollars (E500).
I, as owner of the proOmb o� my em0loy¢es wiM wages as Moir so18
Compenze�lon, wlll tlo the work, antl tbe sbucture is not intenOed o� oftered
lor Sale (SaCtiOn 704d, Business dntl ProfeSsional CoOe: The ContractOr'S
License 12w tloa5 not app�Y to an owner oi a property w�o builas o� imD�oces
the�eon, antl wh0 QoeS suc� wofk RimieltJh¢rs¢It p� thrtlugh hi5 0� �!r Own
emfl�oyees, prorideA t�at such ImD�ovements are not inrenaed or oHered �m
Sd1Q �f, M1owev!/, tl1G CII�Itlinq Of ITp/oVem¢nt i5 Soltl within onG Y�� O� COT-
v�etion, tne owner wlll �ave t�e burden of p.oving he/she tlid not buila or im-
provefort�e pur0oze olsale7.
� I, as owner of Ibe proPerty, am exUusively �ontracting wit� �iGens¢O co^'
Ir0ct0�sto WniVuci the project ISection 7044, Business antl Prohessions COCe:
The ConRactor's licen5e LLw dOes not dpply to dn own¢� of 0*oPeilY w�0
builtls o� �mproves thereOn. ind who co�tracts �or su<h oroiects with a Con-
trecto�(SI ��censs Pu�tuam to ene Coatractars liceoy¢ Law). � am aware tha[
proot of tpeir WOrker'S COmpenSation insuran[e shoultl b¢ OrOviG<E �O TG.
❑ 1 am exempt unaer SecUon B. L F. C. foi t�i5 reason
Oate
�a
�. Owner Wtinl "��t`' �{ .ti,C�l �-/�
1 11ive Iadtl th15 applicati0n antl state tbat tll6 9COVG
1 aqr�p to comO�Y wi[h all city an0 county o/tlinances
to CutlCi�p construction, antl �ereEy autho�he �eG�e-
� to antar upon t��g.me�netl DtoMrty �ar
Date i% ' .
: � —
, � �� I a�f� I�� =2
TYPE OFCONSTRUC7ION EW AOD ALTERATION REPAIR
❑ CpNVERSION Q OEMOl�SH ❑ OTHER qLy �—�—
DESCRIPTION OF W RKNSE OF BLDG, r-��V �_f��_
� � 1�-
TVP^E OF PERMIT U GRADING ❑ FOUNOFTION ❑ STRUCTURAL
LJ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL
❑ 9THERg � Z.L�QS
PR0.IECT DESCRIPTI 5 �� oCCUVANC
CONSTfiUCT10NTYPE VALUATION§ ��
ZONE GRADINGCU.�'�5. ACRE�
Remarks: : �4'.'� ,(j'��
4-
Bar Sink
Backflow Preventer
88tkfloW �rrigation
Bathtubs
Clarifie�s
Dishv�esher
Drinking Fountains
Fioor Droins
Flonr Sinkc
Gat ServiG.e Outlets
I�terceptors
Kitthen Sink
LevetOries
P-Trap
Roof Droins
ReinspORion FN S15
Boiler
Dutt � Untler Ground
JUtt - Ventiletinq
Exhauzt System ❑ Mu�tiple
FirepllFact. Blt. �CBO d`
Heating SYs[em & Ducting
❑a�oo,000 eTu �ioo,000
Reinspaction Fw � S75
Nta � 8ultain9: Canary - APVlicant: Pink - AttounUa9: GaltlenroQ - Ai¢eswr
�. ..
Service Sink �
Sew¢r Cap
SewerConnection '�
Solar Collectors
Solar Pipin9 �
Solar Tank
Swimming Po01 w(Spa
Urinal
WdCer ClOset'"
Water Heater
Warer Service
Auto-Wash
Laund�y Trays
Issue Fae
Hootl or Type I ❑
Canopy Type I I ❑
Refrigeration System
❑6100,OOOBTU ❑100,000
System qepair)Aiteration
Fire Dampers
Fegiaters
Ittue Fee
FEES
53
FEES
� 3
S Main Buildi
E
T Front
B Rear
A
� Righi G
K Left G
S
Ping. Ref. #
Planning Notes:
q n
I
N
G
R
��j`�.' ParkingReq./Provided 3 E
U
M
T
S.
Automatic Washer
Consttuction Pole Sub.
Cooking Unii
Dishwasher
Dryers ❑Ga:
Fan
F.A.U.
FIXSU(ES
Device Boxes
Outlets
lectric
Garbage Disposal
Generetor �P5 KW
ELECTRICAL
Transformer � 15-50 KW
❑ 50 + KW
KW
� Reinspection Fee ! $15
DEVELOPMENT SERVICES RE�
Zoninp Approved BY �
Building Approved By _
Appliqtion Issued Bv
Meter ❑up to 100 amps
Mete� ❑over 100 amps
Sub Panel
MotorsO61 HP QiX-8
Inc.Sniar �9-15 HP �16�15+
Microwave
Pole Ligh2
Range
Sign
Standing Sections
Trash Compacror
luue Fee
EMENTS:
FEES
S 3
SUMMARY OF FEES �� {i�
BUILDINGPERMIT $ �V �3U 2�{'SMIP $ � �!
PLAN CHECK $ PERMIT
PIUMBING $ ISSUANCE $
PIAN CHECK 25% $ ENERGY P.C. $
ELECTRICAI. $ GRADING $
P��INCHECK 50°!0 $ MICROFILM $
MECHANICAL $ T�TALFEE $ �d�.OS
PLAN CHECK 25% $
. ,f 1`�.� ', ..: '
. . . . .. . . _ ... .. /
C{TY OP COSTA MESA CONSTRUCTION PERM� ) E,
Project Address — ' �� �I C3'4 .�2/l�C� �
Applicant's'"�Iin�Address %�� SarH�-�'� ��� �iN
Owner's Name � � �'`1 ��sT .f/� Phone�l
Address �� � m �A ��% �f/�
ArchlEng, Liceose No,
Addr¢ss
Contractor's Nam L� � �=� � / • Phone �
Address Imailing) 7?�� y„�/-Q �f,�i7�i� L-d 1'4J� �is1'��a
Ciry L�cense No. �}_y,� � P7 _ 1� /'
LICENSED CONTRACTOR DECLARATION
1 heeeby aflirm tnat 1 am licensetl unae+ provislons Ot Charte� 9 �tommencinq
witM1 settion ]000) 01 Division 3 of th¢ Bu5ine55 antl PrOtezsiOns Cotle, antl
my ficense is in full orce and efTecL S f'3y7
license C1ass � License No.
Date �ID-Z:D S�9nature
WORKERS' COMPENSATION DEC4 RA ION
I hereby affirm [nat I have a certifiw[e of consent to sel/-insure or a certi(wte
- Wolk¢r5' COmOenSdtiOn InSUlance, of a Uftifietl cOOY thefGof �$¢Ctlon
10, Lao. C. (/� v�
rnolicy No.�jS��IO �� Companyl,R/� ��D
N_Certifietl copy is �erebY furnis�etl. /
� Certifietl p rs filetl with the city Bui {n sio .
�Date ��%��� APPliwnt � ��
E%EMPTION FROM WORKERS' COMP ATION DECLARATION
(This section neetl not be completetl it the perml['�s tar one �unOreO �E300) or
less).
I certify that in the p¢rfOrmance of th< wo/k fo� whiGh this pe�m�t (s is5uetl I
s�all not emplOy dny pe�son In aay man�er so ai to bemri�e iu0j¢ct t0 t�e
Workers' CompensatiOn laws Of CalifOrnia.
Date �Si9nature
NOTICE: If, aker making tnis tleclaration, you shoula Decome subject to tpe
�Workers' ComPensation provisions of the Labor Cotle, you mus[ fortbwith
comply with such provisions or this permit shall be tleeme0 revokeE.
CONSTRUCTION LENOING AGENCV
' I hereby affirm inat t�ere �s a construction lentling agency �or the peAormante
O� th¢ work (Or whiCh this pGrTlt is ISSuetl (Section 3097 Civ. C.)
�pntler's Name
' Lentler's AtltlresS
OWNER BUILDER DECLARATION
� I hereby aHirm Ihat I am exempt (rom [he ConVactor's License L9w for the
following reason (Sec[lon ]031.5 Businezs antl Protessianal Coae: Any city or
county whicn repuires a pe�mit to cO05trutt, alt¢�. imp�ove, G¢moli5h O! r¢pai�
any stluctwe, priol 10 it5 isspd�ce, a150 requireSlhe applican[ fOr SUCh p0�mit
to tife a si9n¢tl statement tnat hejshe i5liceasea pursuant (o the prOviuo�s of
(he Contracto�'s License law (Chapter 9(wmmencinq witn Section 7000) o(
DivlSion 3 0� tne Business antl Protessions Cotle) or tM1at ne/s�e is exempt
'+relrom antl the basis /or the allegetl exem0�ion. Any violation o� $ection
� ;1.5 by a�Y apP���ant tor a permit subjec[s ihe applicdnt io a civil
�dlty of not mo�¢ thdn (ive huntl�etl tlolld�s (5500�.
U I, as owner of the prooerty or my employees with wa9es as their sole
comp¢n5ation, will tlo th¢ work, antl [he st�ucture is not intentletl Or Offe�etl
for syle (Section 7044, Business antl Professional Cotle: The Co��/actor'S
License law tloes not appiy to an owner of a D�oW'rty who Ouibs or imo�oMs
lnereon, aotl who tloes wch Wo�k himselt(herSeH or tnwugb hi5 0� h¢� Own
em0loyees, provltletl tha[ such improvements are not intentletl or offered tor
saie. I1, �owever, tne builtling or improvement is soltl wit�in one year of com-
plelion, the owner will ndve the bu�tlen Of Provin9 he/s�e tlitl nat bJi1E o� Im-
prOve for the purpose oi Sale).
❑ I, as owner ot the property, am exclusively conLacting with Iicensetl con-
traCtor5lo construc[ the project (Section 7034, Business antl Professions Cotle:
The COnlrattoYs License Law Coes not apply to an owner ot prOpe�ty Wt�o
builtls or imoroves IhereOn. antl who contlatts Ipr suc� oroiects wit� a con-
tractor(s) hcense pursuant io [ne ConVactor•5 LicenSe Law�. 1 am a�+are l�ai
proo( of their worker's Compensation insurance shou�a be orovitletl to me.
❑ 1 am exempt un0er Sec[ion 8. & R C. (v [nis reason
Date Owner
I hereDy certlfy [hat I have reatl this application antl state [hat t�e above
information is wrrect. I a9ree to comGlY wrth all city antl county ortlinanres
antl state laws relatinyo buil0in9 conitruction, antl hereby authorize repre-
untatives of tnis fY�to enter uPon t�e above-menlionetl DropertY tor
InSPection purpose .
Si9natu�e Oate �O^ �
Drivers' LicenSe or 55 �
� paces except lhose within �eavy pOrCer lines antl's�gn'a���ev.�-...__,�,_
Pt�l7 NO. � TRACT N0. LOT NU. U IT NO... A P#
3� I S Main Buildinq:
TYPE OF CONSTRUCTION NEW H�D ALTERATlON REPPI R E
�❑ CONVERSION ❑ �EMOLISH ❑ OTHER � j Front
DESCRIPTIONOFWORKIUSEOFBIOG. A Rear
C Ri9ht
TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL K
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL S Left
❑ �OTHER Ping. Ref. #
PR0.IECT DESCRIPTION 5(2. FT. OCCUPAN v Planning Notes:
tONSTRVCTION TVPE VALUATION $ �
�ZONE GRADINGCU.VDS. ACRES
Remarki: `/ C . ��L `,
_�
Bar S��k
Backflow Preventer
Backflow Irrigation
82thiUbS
Clarifiers
Dishv.asher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P-Trap
Roof Dreins
Reinspection Fee $15
Boiler
Duct - Under GroUnd
Duct - $tructural
Duct � Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. iCBO �
Heating System & Ducti�
❑ G7 00,000 BTU � 10D,OOO BT
Reinspec[ion Fee � 515
0965-4fi, rev. 5)88 White - Builtlin9; Ca�ary - qppi)�ant; Pink - Actountin9; GolCenroO - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
So4ar Tank
Swimming Ppol w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
laue Fae
Hood or Typel ❑
Canopy Type I I ❑
Refrigeratfon System
�aioo,000eTu ❑�oo,000
System Repair/Alteration
Fire Dampers
Registers
FEES Automatic Washer
Construction Pale S�
Cooking Unit
Dishwasher
Dryers ❑Ga5 ❑EI
Fan
F.A.U.
Fixtures
Device Bozes
Outfets
Switche5
Garbage Dispou�
Generator �65 KW
$ 3
FEES
Fee
Accessory Bw
ELECTRICAL
Transformer � 15-50 KW
❑ SO+KW
Meter ❑up to 100 amps
Meter �over100amps
5 KW
$15
Sub Panel
MotorsOal HP O7X-6
IncSoiar �9-75 HP �16-15+
Microwave
Pole Light
Range
Sign
Standing Sections
Trasfi Compactor
luue Fee
DEVELOPMENT SERVICES i2EQUIREMENTS:
Zoning Approved By
Building App�oved By
SUM �FEES
BUILDING PERMIT $ -- SMVP
PLAN CHECK 5 PERMIT
PLUMBING S ISSUANCE
PLAN CHECK 25% 5 ENERG� P.C.
ELECTRICAL S GRAOING
PLANCHECK 50°b $ MICROFILM
MECHANICAL $ TOTAL FEE
PLAN CHECK 25% $ �
�Z
O
N
I
N
G
R
E
�
M
T
S.
FEES
$ 3
Isue Fee I § 3 I I - - /
- ? i .��
'
r
aTYOFCOS7AM/ESn 'CONS7RUCTIONPERMIT J��,.,;7-
Project Adtlress _ �k'% � ����''T `�''� `�_2__
Appli�ant'�'-�qilingAddress ��l i� E �'7 �'�-"t2T��L'�
Owner's Name Phone
Aadress _
Arch(Eng. License No.
Address _ �.
Coniractor'sNameLYr�.C�f'.� T.LLC-�iE�Gphon +' �
' Addresslmailin9l�/n % �- Sy �'��Y�-V`�"��i41'�%�
City License No. — �is� .Z
LICENSED CONTRACTOR DECLARATION
I nereby aHirm that I am licensetl un0er provi5ions of Charter 9(commencing
with section 7000) of Divislon 3 0( the Business antl Protessio�s Cotle, antl
my license is i� iull / rce a eitect.
IJLQl1� (,'Id55. � �� LIC�5E O /����� �a�
Dale �� '�i 5 9 t a'T�.�s� � /c=_
WORKERS' LOMPENSATION OE RATION
� nereby a1(irm roat I have a certificate oi consent to seH-insure or a certifiwte
Workers' Compensation Insurance, or a certifietl copy t�ereo/ (Section
,00, Lab. CJ
Policy No. Company
eCertiiietl caPY �s hereby turnishetl.
Certitietl copY is tiletl with Ihe city Builtling Division.
�ate Applicant
EXEMPTION FROM WORKERS' COMPENSATION OECLARATION
(Tnis section heetl not Da completetl it tne permit is for one huntlreU (5100) or
IessJ.
I certify that �n the per/ormance ot the work for � fF� thjs oer k iz Issuea�l
s�a11 not emp�oY aay per5on in any maoaer s t �R« t�e
Worke Cc�q� ��SE�I�P" LdwS of Cdlif `/
Date ��fZ�—�('• Signature ��" ��
NOTICE: If, a�ter making this tlecl [ion, you s oultl+ecome Subject to t�e
Workers' CorqPensation provisions of the Labor Cotle, you must forMwith
comply with such provisions or tnis Dermit snall Ee tleemetl revoketl.
CONSTRVCT�ON LENDING AGENCV
1 hereDy afflrn� tnat there is a construction IenEing agency for Me performance
of the work for w�ich this perm�t i5 issuetl (Section 3097 Civ. C.)
Lentler's Name
Lenaer's Atltlress
OWNER BUILDER DECLARATION
I herebY affirm that I am exempt from the Con[ractor's License Ldw ior the
fouowing rea5on (Settion 7031.5 Business antl Protessional Cooe: Any tlty or
[ounty whicb /¢quire5 a Oe�Tit to const�uc[, alt¢/, improve, tlert�ollsh o� reDai�
any svucture, P��or to it5 issuance, al5o reqWres t�e apP�icant fOr zuch permit
to file d Signetl statement that he/Sh¢ i5 licensetl pursuan[ to IhC p/ovisions of
tne Co��ractor's License Law (Chapter 9(wmmencin9 with Sectlon 7000) of
Division 3 ot the Business antl Profesvons Cotle) or that ne/she is exemOt
� herehom anQ the basis for the allegetl exemption. Any vlolation of SecHon
031.5 by dPY appliGant (or d pe�mit suDjects the applitant to d<Ivil
penalty of noC more than five huntlretl tlollars (E500).
❑ I, as owner o1 [he property or my employees wit� wa9es as t�eir sole
compe^Sdtion. �+'��I tlo the work, antl t�e s[ructure i5 not inten0etl or otferetl
for sale (Section 7044, Business anE �ro(e55ional Cotle: The Contractor's
LiCense Law Ooes nol app1Y to an owne� of a p�op¢�ty who build5 O� imp�ove5
tnereon, ana who tloes such work hlmself/M1erself or t�rough his or �er own
emp�oyees, provitletl that such improvements are not intentletl or ofteretl for
sale. II, however, the builtling or improvement is 5010 within ona Year of com-
pletion, the o�+'�er will have the burtlen of prOvin9 M1e/s�e tlitl nOt builtl o� im-
prove io� the purpose of Sale).
❑ I, as owner o( the property, am ezUusively contracting witM1 Iitensed con-
Vacto/5 to cohsttuc[ the p�qett (SCctiOn ]044, BuSinezi antl PrO�eSSiOns COEe:
The Contractor's License Law does not apply to an owner oi property who
Duiltls or imoroves tnereon. antl who �oniracts for such oroiects wIM a con-
lractor(s) hcense pursuam ro tne ConVactor•s License Law). i am aware thac
prooi of [hei� Worker's Compensatio� insurance shoultl be provitletl to me.
❑ I am exemp� untler $ection 8. 3 P. C. for ihis reason
Date Owner
{ hereby certi�Y that 1 have reatl this appli<ation ana state that the aCove
inlormation is correct. I agree to com w' all city antl <ountY orCinantes
anE state laws �elating t uiltli tion, antl hereDy au�norize repre-
untatives of this ' e up he above-mentionedp Prop.etrty c.fo�r
__'.'_ �� e . �/��-- Date/��J'02�
_' -.�/
PERMIT NO. I l HACT NO. LOT NO. UNIT NO.
E 3 5 �-1�3.
TYPE OFCONSTRUCTION NEW ADD ALTERATION L� REPAIR
❑ CONVERSION ❑ DEI IOLISH ❑ OTF�ER
DESCf3yPT10N OF WORK/USE OF BLDG. �£G'��^��-+�Z-
TYPE OF PERMIT LJ GRA�ING U FOVNDATION LJ STRUCTURAL
❑ TENANT�LECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
1PROJECT DESCRIPTION 5�. FT. OCCVPANCV_
µ4CON5TRUCTION TVPE VALVATION $
ZONE GRADINGCU.YDS. ACRES_
Remarks:
Sink
Preventer
Irrigation
Drinking Fountains
FtOor Orains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P-Trap
Root Dreins
Reinspection Fee � $15
BOiler
Dut� - Under Ground
Duct � Structural
DuCt - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact Bit. iCBO #
Hea��ng System & Ducting
❑6100,OW BTU �t00,0008Ti
painspection Fee � 515
-__..,....ec<nr,_, _
PLUMBING V
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Tra'ys
Isue Fee
Hood or Typel ❑
CanoPV TVPe II ❑
Refrigeration System
❑0-100,OOOBTU ❑100,OOOBTU
System Repair/Alteration
Pire Dampers
Registers
laue Fee
$ 3
FEES
$ 3
�
A.P. �
S Main Buildi
E
T F�ont
B Rear
A
C Right
K
g Left
Ping. Ref. #
Planning Notes:
Automatic Washer
ConStruction Pole Sub.
Cookina Unit
Dishwasher
Dryers ❑Gas E
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator O0.5 KN
Fee
lectric
�
2one
Accessory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter Llup to 700 amps
Meter ❑over100amps
Sub Panel
Motors D0�1 HP 01 h- 8
Inc.Soiar �9-75 HP 016-75+
Microwave
Pole Light f/�qQ�Lj�S
Sign
Standing Sections
5-15 KW Trash Compactor
$15 laue Fae
DEVELOPMENTSEHVICESREQUIREMENTS:
Zoning APProved By
Building Approved By r'
FEES
$ 3
N
I
N
G
R
E
�
M
T
S.
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE 5
PLAN CHECK 25% S ENERGY P.C. $
ELECTFICAL $ � GRADING 5
PLAN GHECK 50% S MICROFILM $�^�
MECHANICAL $ TOTALFEE $ IC�L—'
PLAN CHECK 25% $
Z°I LS X D,031 : . : ... . . i- ��. . - • -
/
CI7Y OF COS7A MESA CONSTRUCTION PERMIT�
Project Address � 'e q� C� ��
Applitant's Mailing Address ��:.�� i-17�CO�Y� G• Q +^
Owner's Name W�� � Fn`��-� rr^t Phone
Address �'...a����fY+.aC�To.<` 1 ZYV,��P—_?��--
Arch/Eng. � - er �� ��'C- Licenu NoG`l3a.s
Address �'�3 3"d''� ��.,ae:'j�.c1. `�
Contracmr'sName CCc� �es�nc�"i�i�rCc.Viphone�3��0��
T � ��9�ih
Addresslmailing) ��^� L�Y1GD�h4VP dCa`�loQ
City License No. 3���� J -
LICENSED CONTFACTOR DECLARATION
I Oereby affirm that I am licensetl untler provisions of C�arter 9(corwhiencing
�� witn section 7000) oi Division 3 of [he Business and Professions �(Stle, antl
� my license is in tw1 force antl ettect. ��n��
' LicenSe Gass L�mse No, o
Date ��.`Z.� Si9natute
WORKERS'COMFENSATION DECLARATION
'"?reDy altirm that I have a certificate ot consent to selt-insure or a Cartificate
� Worken' ComOensation Inwrance, or a certifietl copY Ihereof5(Section
VOIc�Y No.���+.1b3��.K ComPanY\_i�n��h�4��TS
rtifietl copy is hereby fumishe
Certi ietl copy is filetl wit� t�e c iltli '��i�f.�.-
Date �aS�.i qpplicanl ��'e�-�-
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(T�issection neetl not be completeE if the permit is for ane hunCrea (5100) ar
less).
I cxrti7y that in th¢ p¢rTormance of the wo�k to� which tM1iS peim�t i3 isSUGtl, I
zhall not emO�oY any person in any manner so as to become suEject to the
Workers' Compensalion Laws o( California.
�ate Signature �
NOTICE: If, after making tnis tleclaration, you shoultl become su0ject to the
Workers' Compensation provisions of the Labor Cotle, you muzt torthwith
comO�Y with such provi5ion5 or thi5 permit 5hall be tleeme0 ;revoketl.
CONSTRUCTION LENDING AGENCV
I her¢by a�firm t�at t�ere is a wnstruction lentling a9enty tor tne perfbrmance
of the wolk for which thi5 Dermit i5 i55u¢tl (SCCtiOn 3097 rCiv. G.)
Lentler's Name
Lenaer's Atltlress
OWNER BUILDER DECLARATION
1 hereby affirm lhat I am ezempt irom the Con(ractor's Licente Ldw for the
following rea5on (Section 7031.5 Bu5ine55 antl Pro�¢SSional Cotle: Hny city o�
county wnicn requires a permit [o construct, alter, improve, tlemolisn or repair
any slructure, p�ior t0 its i55udnce, also requires the appliCant to� Suth pe�mit
to file a signetl sidtEmen[ thdt he/She is licensetl pu�suant to [he O�oviSions ot
tne Contractor's License Law (ChaD�er 9(commencing with Section ]000) o�
,�ivision 3 of tne Busines5 antl Professions Cotle) or that he/she is exempt
�relrom an0 the basis Tor the allegea exemplion. Any violation of Se<tion
�31.5 by any applicant tor a permit subjects the applicant to a civil
�enalty oi not more than five huntlretl tlollars (g500).
I, az owne� of the property o� my employee5 with wage5 as their sole
Wmpensa[iOn, will tlo Ihe w0/k, antl tM1e 5tructUt¢ i5 not intentl¢tl or ofteretl
for sale (Section �044, Business antl Professional Cotle: The Contractor's
License Law doe5 not apply [o an owner of a properry who builtls or improves
thereOn, antl who tloe5 suth wo�k him521f/herseH or thrOuqh his or het own
employees, provitletl lhat su<h imDrovements are not int¢nCetl O� of/eretl tor
saie. If, noweveq Ine builtling or improvement is soltl within one year of com-
pletion, the owner will have the burtlen Ot Proving he/she tlia not builtl o� im-
prove iortne ourpose of sale).
❑ I, as owner o/ Ihe property, am ezclusivety wntrat[ing witM1 IiCenSetl COn-
tractorsto wnstruct Ihe oro7ect (Se<tion ]oaa, eusiness antl Protessions Cotle:
The Contraclor's LicenSe l2w tloes nOt aOPly to an owner of proPerty who
Duiltls o. improves tnereon. anC who mnVacts for such oroiects wiN a con-
Vactor(s) hcense pursuan[ to me Contractor's �icense �aw). I am aware tnat
proof of their Worker's Compensation insurance shoultl be provitlee to me.
❑ I am exempt untle� $ection B. L G. C. f0� t�i5 reason
Date Owner �
I hereby certity that 1 have reatl this avPlication ana state t` he aEove
information is correcL I a9ree to comply with all city antl Wun tlinances
antl state laws relati to builtling consVuction antl here�y auf e repre-
senta[ives his ity o ter upon the above-mentionea Oroperty for
inspection u s 4.
Signature Date
Drivers' License or 55 �# �
PERMff NO. TRACT N0-"" —�......
r��- � _"
S � Main a���...
TYPE OF CONSTRUCTION NEW ADD I_.J ALTERATION LI REPAIR E
❑ CONVERSION ❑ DEMO�ISH ❑ OTHER T FrOnt
DESCRIPTION OF WORK/USE OF BLDG. 4(�-� A Fiear
TYPEOFPERMIT GRADwG FOVNDArIO^N/ STRUcrURAL �C Right
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING f(6MECHANICAL S l¢ft
❑ �OTHER . Ping. REL #
PRQIECT DESCRIPTION 5�. F7. OCCUPANCV pianning Notes:
CONSTRUCTION TVPE VALUATION $
ZONE GftADINGCU.VDS. ACRES
Remarks:
$ink
Preventer
Irrigetion
Drinking Fountains
Floor Orains. .
Floor Sinks '
CidS$2fVICE DULICtS
Interceptors
Kitchen Sink
Lavatories
P-Trap
Roof DrainS
Reinspection Fee � $15
Boiler
Duct-Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
H,,�e�ating System & Oucting '.
a LrtJ-100,0008TU�100,0008ii
Reinspection Fee � E15
OBfi5-46, rev. 5/88 Wnite - Builtling; Canary - qpplicanL Pink - Accounting; Goltlenrotl - Assessor
Shower5
Service Sink
Sewer Cap
Sewer Connection
$oiar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Tra'ys
laue Fee
Hood or Type I ❑
Canooy Type I I ❑
Retrigeration System
❑0-100,000 BTU 0100,000
System Repair/Alteration
Fir¢ Dampers
' Recisters
laue Fee
FEES Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
' Dryers ❑Gas ❑Electric
fan
F.A,U.
Fixtures
Device Boxes
0 utlets
Switches
Garbage Disposal
Generator �a5 KW �5-15
$ 3
FEES
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Me[er �up to 100 amps
Meter �over 100 amps
Suh Panel
Motors �61 HP � 1'/, - 8
�.So�ar 09�15 HP �16-15+
Microwave
Pole Light
Range
Standing Sections
Trash Compactor
Fee �$75 � � luue Fee
DEVELOPMENT SERVICES RE�UIREMENTS:
2oning Approved By � ^
Building Approvad By 1 CJJ�
SUMNMfiY OF FEES ��
BUILDING PERMIT S SMIP
PLAN CHECK 5 PERMIT
PLUMBING 5 ISSUANCE
PLAN CHECK 25% 5 ENERGV P.C.
ELECTPICAL S GRADING
PLAN CHECK 50°k $ MICROFILM
MECHANICAL 5 33 •�d TOTAL FEE
PLAN CHECK 25% $
N
G
R
E
Q
M
T
S.
FEES
$ 3
AVP���ant to fill in all ipaees except those within heavY bo sign'airap��
: CI7Y oF COS7A M/ESA '1,A�NrSTRUCTION P Mlf�fj T
Project AddreSs = I � l !� �� �1/ � /,�,
.i _ "-"� �_—
Applicant's Mailing Address
Owner's Name � �-s�`�9`-
. Address -�1 �wn�7"�- -i � , 9.f b h
Arch/Eng. .�� • License No.
Address
t Contractor's Name S— �� one 4�
� Address (mailing) S"'- '
' City License No. �S3/S—
� LICENSED CONTRACT00. DECLARATION
1 M1ereby affirm that I am licensetl untler provi5ions ot Charte� 9(commencing
' with dection ]000) of Division 3 0! the Business antl Professions Cotle, antl
my IicenSe is in full fo� na enect. �3 �.�. Z
� License`'a2 _ ' en e N�
. Date � Signature
• WORKERS' COMPENSATION DEC ATION
- 'nereby aifirm that I have a certifi of consent to self-insur or ertlticate
' �/ Workers' Compensation Insu�a /cye, o� a certifietl copy tnereoi (Section
3800. Ndo. �//��il.�/� 'b 8 Cp �
i Y
Certifietl cop is nereby furnishetl.
� Certi}� �f ' etl with the cit B" A"
Ir� Date I / Applicant .
� EXEMP 10--�RKERS' CO A ION DECLAR
�. � (Tbis section neetl na[ be completetl i h permit is for one h tlr ($300) or
Iess).
�( 1 certity tha[ in th¢ performance o[ work tor whicn thi erm�t is i55uetl, I
sball not employ any person in manner so as [o be me subject to the
Workers' Compensation Laws o( ifornia.
Date Signature
� NOTI[E: If, after making [his tleclaration, you sboultl become subje<t to the
, Workers' Compensation provisions of the Labor Cotle, you must forthwith
comO�Y H'�th such p�ovisions o� tnis p¢�mlt shall bE tlG¢metl revOk¢tl.
I' CONSTRUCTION LENOING AGENCV
1 hereby affirm that there is a construction lentlin9 a9ency tor the pertormance
. ot [he work for which thi5 permit,is i55uetl (SectiOn 309� Civ. CJ
Lentler's Name
. Lentler's Atltlress
� OWNER BUILDER DECLARATION
1 hereby affirm Lhat 1 am exempt from the Con[ractor's License Law for the
- following reason (Section 7031.5 Business antl Professional Cotle:'Any city or
wuntv which �equires a Oe�mit to Const�uct, alte�, improve, tlemolisn o� �¢pair
a sianetl 5tatemenYthat
„ i:tP�y eretrom antl the basis for the alle9eG exemption. Any violatlon ol Section
-;:031.5 by any applicant (or a pe�mit 5ubject5 the� applicant to_a civil
`� enalty of not more than five hunGretl tlollars ($500).
I, as owne� of the property o� my employees with wage5 as thei� sole
wmpensation, will tlo the work, antl the s(ructure is not intentletl or-ofteretl
- for sale (Section�]044, Business antl Professional Cotle: The Contractor's
Licenu Law tloes not apply to an owner ot a property who builtls or improves
• Iheieon, antl who tloes such work him5elf/hers¢If or tbrough hi5 0/ he� own
� employees, piovitletl that such improvemen[s are not intentletl or otfered for
sale. Ii, however, the builtling or improvement is soltl within one year ot com-
ple[ioq the owne� will have the bu�Cen Of proving he/she tliC not builtl o� im-
p�ove for the purpose of Sale).
❑ I, as ownet of tM1e property, am exclusively mnt�acting with IicEnsetl con-
. Vactorsto construct the project (Section 7044, Business ana arotessions Cotle:
Tne ContractorY License Ldw tloes not apply to an owner of property who
builtls or improves thereon. antl who'cont�acts fo� such orolect5 with a ron-
Vactor(sl bcense pursuani to ine Contrattor's License Law). I am aware that
. proof of tneir Worker's Compensatlon Insurance 5hou1C be provitletl to me.
❑ 1 am exempt untler Section B. & P. C. �or this reason
Date � " / ��L'%Y� Owner (. �� > >
t hereby certity-that I have reatl this applicat
information is corrnsE. I aaree to comolv with :
state
above
nances
�7/ �...,,.....,. __. .._. v�.�fi—i-.v
1 � VP � � ` ,G
TVPE OFCONSTRUCTION � NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ OEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG. �
TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 5c1. FT. oCCUPANCv
CONSTRUCTION TVPE VALUATION $
ZONE GRADINGCV.VDS. ACRES
Remarks: R 2� �1 1 I. Q
Bar Sink
Backflow Preventer �
Backflow Irrigation;
Bathtubs �
Clarifiers / '
Dishwasher �,; �
Drinking Fountains 't
Floor Drains �1•
Floor Sinks �
Gas Service Outlets
Sink
Roof Drains
Reinspection Fee
$15
Boiler
Duct - Under GrOund �
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. �CBO #js�'
Heating System & Ducting
- ❑aioo,000sTuoioo,000eT�
Signature Date/ �/ � I I
Drivers' L" ei or � Reinspection Fee
0865-46, r. 5/88 WM1ite - 8 iltling; Canary � Applicant; Pink - Accounting; Goltlenrotl - Assessor
$15
Service Sink
Sewef 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 Typell ❑
Refrigeration System
❑0-t00,0008TU ❑100,000
System Repair/Alteration
Fire Dampers
Registers � �
Issue Fee
A.P. #
S Main Build
E
T Front
B Rear
A
C Fllght
K . Left
S
Ping. Ref. #
ES Auromatic Washer'
Construc[ion Pole Sub.
Cooking Unit
D ishwasher`
Oryers ❑Gas ❑Elect
Fan f
F.A.U.
Fixtures . 4'/
Device Boxes .
Outlets : ' -
Switch¢5 • '
Garbage Dispoul
Generator �0-5 KW C
Fea
Accessory Building:
Req./Provided
ELECTRICAL
Trensformer ❑ 15-50 KW
❑ 50+ KW
Meter ❑up to 100 amps
Meter ❑over100amps
Sub Panel
Motors�0-1 HP�Ih-8
Inc.Solar 09-15 HP �76-15+
Miciowave
Pole Light
Range
Standing Sections
5 KW � Trash Compactor
$15 luue Fea
$ 3 DEVELOPMENTSERVICESREQUIREMENTS: .
2oning Approved By
FEES Building Approved By
� Application Issued By r2
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK . . $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ . MICROFI�M $
MECHANICAL $ � TOTALFEE '$
PLAN CHECK �25% $ •
O
N
I
N
G
R
E
�
M
T
S.
FEES
$ 3
�a
F�
oi nn�a�asa-aeozaass, rc���r i;,,ci
QRTEs i?1/±bI89 TIl1E: 1i:4:�
� CONSTRUCTION ANDPLANNING '
APPROVALS Permit #
t. Temporary Electrical Service or Pole
. 2. �Soil Pipe-Undrgrnd. �
r
. 31 Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrgrnd. `
� . Steel Reinforcement �
.6. Electrical UFER Grnd.! .
�7.•Footings �
�., . :
8.- Foundation .
_i
9:..Water Pipe-Undrgrnd. ,
�10: Structural Floor System ��
'11. Property Sewer'Line & House Connection
. �,
72. Sewei Cap � . � _
13. Roof Drains , �
14. RougFi Plumbing-�
15. Rough Electrical-Conduit
•16. Rough Electric Wiring
,17. Rough Wiring Sign
78: Rough Elearical-T Bar Ceiling
19. Rough Heating & Air Conditioning �
r
�20" Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating ��-
23. Gas Pipe-Rough & Test -�,
24. Roof Framing ,
25. Roof Sheathing --•
26. T-Bar Ceiling (Structural) & fvlonocoat
27. Frame and Flashing
28. Lathing & Siding
29.. Insulation
30. Drywall Nailing
31�� Plaster Brown Coat
,
32. Electrical Power Meter-Final
33. Final Electric
34. Final Heating & Air Conditioning
I35. Final Gas Pipe-Test
I36. Hood or Canopy
�37. Final Factory Fireplace
�38. Final Plumbing
i9. Water Service-Final
i
�0. Gas Service-Final
�
�1. Solar pomestic-Final
�
2. Backflow Preventer
�
(. Backf�ow Irrigation
�
� Landscape Irrigation System
i
� Sound Attenuation
IHandicap Regulations
IFINALSTRUCTURE & BUILDING
�Special Requirements Completed
i
Electric Release to Edison
i
3as Release to Southern California Gas Co
Date
\ `: ,:;_ ,.;Y
i°.
�Date Inspector
_,�.
�-',
- ,s
i :
� /i
a
. . ••-1r. . .r"^. 'x � -- : ' �
PG �SPA
APPROVALS Permit # -
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, 0 Undrgrnd., Test -
60. Backwash Lines, P-Trap, � Undrgrnd.
61. APPROVALTODECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIREDEPT.REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
77. Product Piping OGas ❑Oil
72. Underground Flush �
73. Undergrnd. Storege Tank 0 Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes:
Date Inspector
r. .
�.r.
: i
i � .
J
�
�
�
G
e
n
0