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Home My WebLink About408 HAMILTON ST - Building PermitsCITY OF COSTA MESA �o ""' Q BUILDING DIVISION i�� 77 FAIR DRIVE. COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us � FOR INSPECTIONS CALL: (714) 754•5626 �o.,wrne `�' _ PERMIT NUMBER: E10-00171 PERMIT TYPE ELEC APN: 41917108 JOB ADDRESS: 408 HAMILTON ST CM vicinity: . . � � � . '� �. .� SCOPE OF WORK: SERVICE UPGRADE TO 100 AMP. NO RELOCATE. OWNER: PETERSON, JAMES E TR � PHONE: APPLICANT: JOHN ROWE ELECTRIC PHONE: 774•9683608 � CONTRACTOR: JOHN ROWE ELECTRIC Address: 9422 MOKIHANA DRUnit: City/State: HUNTINGTON BEACH�, CA CELL: ELECTRICAL PERMIT FEES Electrical Plan Check Fee: Electrical Permit Fee: Reinspection Fee TOTAL FEES $o.00 $54.00 . $0.00 . $54.00 . STATUS: DATE ISSUED: .ISSUED BY: Sui4e/Uriit: _.. ISSUED 07I13I2010 KJB Address: 400 VISTA GR4NDE -Unit. City/State/Zip: NEWPORT BEACH, CA Address: 9422 MOKIHANA DR Unit: . City/State/zZip: HUNTINGTON BEACH, CA License No. 768892 PHONE: 714-966-3608 ZipCode: 92646 NOTICE: The work authorized by this permit shall wmply with all applicable handicap access requirements under California statutes and relatetl regulations. (Ord. No. 92-28, § i, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit. CO�Et. INSPELTIONTYPE OATE IN7ITIALS CODEO INSPEC710NTVPE DATE IN➢TAlS 1876 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ,..�� 200 Final Re-Roo( 210 Final Elecintal ��Y�� 201 Final BloCk/Retaining'Nall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Appmval 203 FinalSign 222 Finat Site 204 Final Demolition 250 Final Building/Occupancy WORKERS' COMPENSATION DECLARA710N: I hereby a(firm untler penalty o( perjury one of Ihe followinq deUarations: ❑ I have and will main[ain a certificate of consent to self-Insure (or workers' compensation, as pmvided for by sec[ion 3700 of Ihe Labor Code, for the peAormance of the vrork tor which Ihis pertnit is issued. ❑ 1 have and will main[ain workers' compensation insurance. as requiretl hy section 3700 of lhe Labor Code, fw [he perfortnance of [he work fw which this pertnit is issued. My workers' wmpensation Insurance carrier and policy number ar �Ef ��tted f�yt'S �rS CO � �� defM Alhe permR u vaNM at rne hurMretlWPais (S10pJ w less.) -.dicyNum er[�wKN I3$o55-1 ❑ I certify that in the pedormance of the work (or which Ihis permit is issued, I shall not employ any person in any manner so as to become subject to lhe �.rs' compensation laws of Cali(ornia, and agree that if I shoultl beco su�ject lo the workers' compensation provisions of Section 3700 of th abor de. I shall fort 'th comply vrith these pro�vis'7ions. \ /—��v �.A�'ciSi9wture—�� a1e/ c.• — WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby affrm Ihat I am licensed under provisions of Chapter 9(commencing wilh Section 7000) of Division 3 of lhe Business and Professions Code, antl my license is in full force and eRect. t�c # � �85 ciass.ir Gf � —7-13` �J .{'j is.Si re� Dai� e s t�� CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrtn lhat Ihere is a constmctbn lentling agency for the peAortnance o( the v.ork fa which this pertnit is issued. (Sec. 3W7, Civil Code). Lender s Name: Lender's Address: Signalure Da�e OWNER-BUILDER DECLARATIONS: I hereCy af(rm �hal under penalty of perjury Ihat I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business and Protessions Code: Any city or counry which requires a permit to constmcl, alter, improve, tlemolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to f le a signed statement thal he or she is licensed pursuant to the provisions of the Contractors License Law (Chapler 9(commencing with Seclion 7000) of Division 3 of ihe Business and Professions Code) or thal he or she is exempt therefrom and Ihe basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penal[y of not more than fve hundred dollars ($500).): ❑ I, as owner of the property, or my employees vnth wages as their sole compensation, WILL DO THE WORK, and the siructure is no[ in[ended or oflered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an ovmer of property who builds or improves Ihereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold vrithin one year of completion, the owner-builder will have the burden of proving that he or she did not builtl or improve for purpose of sale.�. ❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the projeCl (Sec. 7044, Busine55 and Pmfessbns Code: The cont2ctas License Law dces not apply to an owner of property who builds or improves thereon, and who contracts for such project vnm a cmtracta�s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: SiqnaWre Date 305]�a6 �YO)) Ovmer ID venfied by driver's license. ❑ Yes ❑ No Dnver's License No. Expires: Verification of Ownership by (type of tlocument, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certAy that no excavation frve (5) or more feet in tlepth into wfiich a person is requiretl to descend, will be made in connectbn with work authorizetl by this pertnit, and that no builtling sWcture, scaffdding, falsevmrk, a tlemolition or dismantling thereo(, will be more than thirty-six (36) feet high (Chap. 32, Grp 2, M 2, Sec. 341, Ttle 8, Cali(omia Atlminislratrve Cotle). ❑ As owner-builder, I vrill not employ anyone to do work which woultl require a pertnil (rom the Division o( Industrial Sa(ety, as notetl above, unless such person has a permit to do such work from the tlivision. Apdiwn[s SignaWre Date Division o( Industrial Sa(ety Permi[ Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or fuWre building occupant need to fle antl certify a Business Plan for emergency response to release or Ihreatened release of a hazardous matenal? ❑ Yes � No (Section 25505 of the Califomia Health and Safety Code requires, with some exceptions, that a.Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time tluring a reportetl year a quantity of hazardous materials equal to or greater than a weight of 500 pountls, or a volume of 55 gallons, or 200 cuhic feet of compressed gas at standard femperaWre and pressure�. 2. Does or will the applicam or present or fWure building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of Ihe California Health and Sa(ety Code. with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantiry of acutely hazardous matenals equal to or greater lhan a weighl of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas al stantlard tempereture and pressure). 3. Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Managemenl and Prevention Pmgram for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Healih antl Safety Code provides that the Costa Mesa Fire Departmen[ may require ihe preparation, certifcation and filing with ihe Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the Calilomia Health and Satety Code been fully complied with? ❑ Yes ❑ No 5. Does or will Ihe applicant or presenl or future builtling occupant require for �he work vfiich is the subject o( this application a permit (or such construction or modification from the South Coast Air �uality Management DisMct or from any other air pollution control tlistncl or agency? ❑ Ves ❑ No (Section 658502 of the Calitomia Govemment Code requires that the requested infortnation be fumished on applications fa non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No Q( "yes", the facili[y must meel lhe requirement of Sec[ions 25534 and 42303 of the Cali(omia Health and Safery Code). 7. If a permit fmm the South Coasi Air Quality Management DisVict or other air pollution control district or agency is required for the vrork which is Ihe subject of this application, have all ot Ihe disclosures prescribed by Califomia HeaNh and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf yes", attach certifica[e of compliance from the appropnale air pollution control offcer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signawre Da�e CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state thal Ihe information given is correcL I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the Ciry of Costa Mesa to enter upon the above-descrihetl property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. t e o1 Legai O� e}—' pate %—/3—� c� mndlo, uthonzeE Appl�tanl b�, Ddle ti � , • f"� .. ._ . _ _. .. _ _ _.. . _t. . ' Applicant to.fill in all spaces�exceo� those witnin heavy boraer lines �1 � CI Y OF COSTA MESA ONS �RUC I N PERIV�IT PE ,�� ,� ` 'TRACT�NO.' LOT�P � h�n8'� .�.m��:�h .s-�- � � . Pr ject Address - Applicant's Mailing A dre /} - � t� ' TVPE OF CONSTRUCTION ; �vEW ' ADO !P Owne�'sName�..� v 'Phone l , � � � CONVERSION ❑ DEMOLISH ❑ OTHER _ � . �� . , , ,.�,DESCRIPTIONOFWORK/USEOFBLDG. Atldress, - ' - antl 5i9n.al6apPropriale tleelarelions.- .-.. .. -- "- ' ' � - ' ' - 5I'2L { -4� ��i{��iq � -" - F, T','.. '��. i o �? UNIT N6r. . - �. �. � . ; � � . . . '- . ' . ' `. ' . , .. ' _ ' . ' � - , r ' . LTERATION .REPAIR � � - '` . . . A.P. # ' . �' � • � - . - Zone � , Areh/Eng:,' License No. TVPE OF PERMIT � � GRADWG� O' FOUNDATIOIV LI STRUCTURAL Address� : ' � - - ' ❑ TENANT � � ELECTRICAL � PLUMBING ❑ MECHANICAL � . i' o COnt�aCtol'S Nam � ho e r� �OTHER ' � Address (mailing) . � � • PROJECT DESCRIPTION SQ. FT� : � OCCUPANCV_ , CONSTRUCTION-TYPE .VALUATION$ City LicenSe No. � ZONE � GRADING CU. YDS. _ LICENSED CONTRACTOR DECLARATION r � 1 hereby a(firm that' I am licensetl untler provisions of Charter 9(commencing Rema�ks: 1 � • � � " with 5ection 7000) of Division 3 of the Business antl Professlons Cotle, antl - � my license is i f rce antl eitect. . � �• ,, ' � ' � License ass ' Lice be do Date_-I��.-J� Si9nature � /' ' ' PLUMBING � ORKERS' COMPENSATION DECL RATION � � Bar Sink Showefs iereby atfirm that I M1dve a certifitate Of con5ent to self-insuie or a tertifiGat¢ of Workers' Compensation �Insurance,'or a certifietl-copy'th reof (Section' - ' i. � Backflow Preventer �� Service Sink 3800, Lab.� . � Polity No. Company Backflow Irrigation Sewer Ca � � �ertifietl copy is he�eby fumishetl. � , � P � ' CertJ'f� qf y is filetl wifh the city �i (Itl��i4isipn�A �}� J,, Bathtubs Sewe� ConnecUon Oate�L_I_� Applicant �.�r � «�� /"--� / �� %� ` ' . , EXEMPTION�FROM WORKERS' COMPENSATION DECLARATION �_ Clafifief5 . . . . Solar ColleCtors- (This section neetl not be campletetl if the permit is tor one huntlretl (5100 or � � iess). � i � Dishwasher , � Solar Pipin9 I cerlify,that in the performance of the work tor�which this perm�t is issuea, I� , shall not employ any person in any manner so as to become subject to�the . Drinking Fountains � Solar Tank � Workers' Compensation Laws ot California. • . Date ' Signature � • Floor Dreins � ' Swimming Pool w/S 'NOTICE: If, after makin9 this tleclaration, you shoultl become subject to She Workers"Compensation provisions of Ne Labor'Cotle, you must forthwith' FloorSinks � Urinal , ' mmply,with such ,prOviSions or IhiS�pe�mli shall be tleemetl revoketl. GONSTRUCTION LENDING� AGENCV � � GdSServiC¢ ��OutIeLS " 'Wd[elCIOS¢t ' I hereby af(irm that ther¢ i5 a mnstructiOn lentling a9ency to� the perfo�mance ot the work tor wnicn this permit� is issuetl:(Section' 309� Civ..C.) , Interceptors _ WaterHeater . LenOer's Name Lentler's Atltlress � � ' - Kitchen Sink : - ,Water Service � � OWNERBUILDER �ECLARATION - ' , . I hereby atfirm�that I am exempf �rom the Cont�acto�'s License Law focth¢ • 'L3vdtO�ies� ' �+ � - AutO-W25h foilowing reason (Se<tion ]031.5 Business antl Professional Cotle: Any city or countv which reouires a permit to cons(ruct. alter, improvE, tlemolish o� �epai� P-T�ap ' � i=.�.:.+.., r.�..r cr to its issuance, menf that he/s �n 3 of the Business antl Professions Cotle) o� tnat he/sne is exempl rom an0 the ba5i5 tor.the allegetl exemption-. Any violation�of Se[tion 5 by any� applicant tor a permit subjects the applicant to a civil y ot�not more than five huntlretl tlollars ($500).� -' � ' as owner of the property. or� my employees with wages as their sole n Roof Droins �Reinspection;Fee ' �15 License Law tloes not appry to an owner or a property wno owios or improves lher¢on, antl wM10 tloe5 Suth wo�k himselt/henelf or�through hi5 or het own - ' , , employees, provitletl [hat sucn imOrovement5 ar¢ noY intentletl o� ofteretl for BOil2� sale. If,;however, [he builtlingbr'improvement is sold within one year of mm- � pletion,rthe owner wilf have the burtlen of proving he/she tlitl not builtl or im- Duct - Under Ground � erove fur the purpose of sale). � - , � ' , LJ I, as,owner of �the property, am exclusiv¢ly contractinq with Iicensetl con- Duct -Structu�al t�actors to mnstruct [he project (Sectlon 7044, Busine55 antl Prote55ions Cotle: i � The..Contractor's �LicenSe LawAoes not.apply.to an own¢r of O�ope�ty wno - DuCt - VEntildting •- . -� builtls or improves thereon, antl.who contracts,for such projects with a com � tractor(s) license pursuan't�to tne, Contracto�'s License Law). I am aware that Exhaust System ❑ MWtiple ❑ proot of their Worket'S Compensation insurance shoultl be p�ovitletl to me. ❑ I am ezempt uotler Section B. & P. C, to� this reason ' Firepl/Fact BIt. ICBO.# � Date Owner� ' Heating System & Ducting � � -I neieby ceitify that 1 fiave reatl this application 5nd state that�the above� ❑0-t00,0006TU �t00,0006T1 intormation is cortecL I aqree to.comply w�th all city antl•munty ortlinances '� � antl state laws relating�to builtling construcHon, antl �hereby authorize repre- , , sentatives oi is� 't to ent r� upon the above-mentionetl property for ' , �, r in5pettiOn p 5 � � /_ ' SignaWre ' Date ' - YJ Orivers"�icense or 55 � ' �' Reinspection Fee $75 1F 0865-46, �ev. 10/84 White - Builtling: Canary - qppp�an[; Pink - Accounting; Goltlenrotl - Assessor ! ' Issue.Fee - iANICAL � Hood or� Type I � ❑ � Canopy Type I I ❑ ' Refrigeration Systein ❑0-100,000 BT U -� 100,01 System Repair/Alteration Fire Dampers Registers ( � ' � Issue Fee_ S Main Building:;. ' — E , T Front. ARear '- �• ' — C Rigfit . ' K Left — S ' — Ping. Ref. # Planning Notes: .. DG( i � Accessory Building:, . i � - , ' , . . , ,. I " ' Parking Reql/Providc ' � ' _ i F�vEo � � Automatic Washe�.� Construction PoleSub. Cooking Unit,�� ' �Dishwasher -, - --. Dryers lJGas Fan F.A.U. Fixtures' Device Boxes Outlets Switcher Garbage Dispo Generator �0 KW LJ5�15 KW IICAL ' � � Tramformer � 15,-50 KW � ❑ 50+KW Meter ❑up to 100 amps � Meter-�over t00amps� - Sub Panel Motors �0-1 HP O1'/: �8 � Inu�Solar,09-15 HP �16-15+ Pole Light Range Sign Standing�Sections Trash Compactor ' Reinspection Fee I $15 ' Issue FEES � DEVELOPMENTSERVICESREQUIREMENTS: � 2oning Approved By Building Approved By �\' BTUI- - '� Q i :: . M - T S FEES �� SUMMAHY OF FEES . � � � � ' BUILDINGPERNIIT : $ ' SMIP � $ � PLAN CHECK � � $ PERMIT � PLUMBING � $ � 'ISSUANCE , $ � PLAN CHECK �25% $ � ENERGY�P.C. $ ; ELECTRICAL � , $ • i GRADING '. $ � MICROFILM ; $ � PLAN CHECK '50%. $ , �� MECHANICAL ' $ � TOTAL FEE $ �'-' `! PLAN CHECK 25%� $ � � � � , ' . ' CONSTRUCTION AND PLANNING PG 9 SPA � �^ Date Inspector Date .Ins ector �:1 =' APPROVALS Permit # APPROVALS Permit # - P -.�1. Temporary Electric8l Service or Pole 52. Pool & Equipment Location '2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement � 3. Elecvical Conduit Utility-Undrgmd. ,54. Forms 4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding ' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test , 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE � - 7. Footings � 58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, � Undrgrnii., Test _ 9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, O Undrgrnd. � 70. Structural Floor System 61. APPROVAL TO DECK i t. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap . 63. Heater & Vent-Final - 13. Roof Drains � 64. Plumbing System - Final . ' 14. Rough Plumbing 65. Electrical-Final ' 15. Rough Electrical-Conduit - - 66. Solar System-Final - � 16.�Rough Electric Wiring 67. Fencing & Access Approval � � ' 17.-Rough Wiring Sign , 68. APPROVED FOR PLASTERING 18. �Rough Electrical-T 8ar Ceiling 69. �POOUSPA SYSTEMS FINAL ' � 19:� Rough Heating & Air Conditioning , FIRE DEPT. REQUIREMENT 20. �Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush � � 24. Roof Framing � . '. 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing , 74. Overhead Hydro � 26. T.-Bar Ceiling (Structural) •& Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathin9 & Siding i 77. FIXED SYSTEM FINAL - 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing ,- ' � � , � HEALTH DEPT�. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED � �33. Final Electric � Notes: � 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-Test . � , � . 36. Hood or Canopy • 37. Final Factory Fireplace . . 38. Final Plumbing ^' � L� t+/i � • 39. Water Service-Final �� ' - • �••7 40. Gas Service-Final � ��-,.r 41. Solar pomesticFinal `�F . . ' r-� - 42. Backflow Preventer `. �� 43. Backflow Irrigation '••- . 44. Landscape Irrigation System r•.� ' , 45. Sound Attenuation i,� 46. Handicap Regulations � . �� 47. FINAL STRUCTURE & BUILDING . • � ' 48. Special Requirements Completed ' 49. Electric Release to Edison � 50. Gas Release to Southern Califomia Gas Co � � . 51. CERTIFICATE OF OCCUPANCY ' No. Date ' ' CITX OF COSTA M � ` Project Address � �ant's Mailing y4 MIT Arch/Eng. License No. � Address � � � ' '� ' ' Convactor's Name � n Ln' /� �! - P o'n/e �s_� Address (ma I'ng) /�lql{tt �� /LI T/�V �' City�LicenseNo. �lL�� LICENSED CONTRACTOR DECLARATION ' , I hereby affirrt� that I am licensetl untlet O�ovi5ion5 ot Charte� 9(commencing with�section ]000) of Division 3 of the Business antl Professions Cotle, antl my license is in fyh ter antl e�fect. . License C �' 'ce � Date ' Signature � "�� WORKERS' COMPENSATION DECLARATION ' �� • ' M1ereby a(titm tM1at 1 have a oertititate of consent to self-insure ota certificate �� Workers' CorR i n In r ce, or a certifietl ere t Sec' n l, �oo, �ab. c 1 (f�.��/ � 'L Policy No: �r_ Company �� eriifietl cooY is hereby fumishetl. � • � Certifie a p is filetl with'the City B}�in '+ij�loP'./7// �/ // .t . Date Applicant / (/ -� o ��" 1 EXEMPTION FROM WORKERS' CO�ENSATION DECLARATION � (TM1issection neetl not be complet¢tl if [he permit i5 /or one Ituntlretl ($300) or Icss). � I ceRify that in the performance Of the work tor whlch thls permk is is5uetl I snall'not em0loy any person in any manner. so as to become subject to-[�e Workers' Compen5ation Caws of Califomia. Date ' Signature � ' ' .NOTICE: If,after makinq_this declaration, you shoultl become„subject to the i Workers' Compensatlon provi5ion5 of the Labor Cotle, you must forthwith ' mmply with such' provisions o� tbis' permit shall be tleemetl revaketl. CONSTRUCTION IENDiNG' AGENCV '�•+� 1 M1ereGy atfirm that there is a construction lentling agency for the peiformance af the work for.which this permit is issuetl (Section 3097'Civ. C.) lPntler's Name Lentler's AtlO�ess � ' OWNER BUILDEH DECLARATION ' � � i I hereby af(irm that I am ezempt from the Contratto/'s Litense Lawifo� tM1e following reason (Section 7031.5 Business antl Professional Cotle: Any city or ' wunty which requires a p¢rmit to const�uct, alte�, improve, tlemolish or r¢pair ' any structure, prior to its issuance; also requires the applicant for such permit to file a signetl 5[atement that he/She is Iicensetl pursuant to the p�ovisions'of [he Contractor's License Law (Chapter 9(commencing with Section 7000) o( II 'livision 3 of the �Business antl-Profession5 Cotle) or thaf he/she is exemp[ erefrom antl the basis for the allegetl exemption. Any vlolation of Section 31.5 by any applicant tar a permit su0ject5 the applicant to'a Civil •nalty�of not more than five huntlretl tlollars ($500). • i ❑ I, as' owne� ot the p�operty o� my employee5 with wages as thei� sole � � mmpeniation,�will tlo.the work, antl Ihe Structm¢ i5 not intentletl o� offeretl � for.sale (Section� ]044, Business antl Professional Cotle: The Contractor'S License Law tloes noLapply to an owner of a property wno builtls or improves lhereon, antl who tloes Such work himself/herself or through his o� her own empioyees, provitletl that such improvements are not intentletl or o(feretl tor wle. Ii,-however„tne builtling or improvement is soltl within one year ot com- � pletion, the'owner will have the burtlen o( provinq he/she tlitl not builtl or im- : prove for tne purpose of sale).' • ❑.I, as owner of the prOper[y, am exclusivery cont�acting with liGensetl con- : irac[ors td construct tM1e prqect (Section 7094, Business antl �Professions Co�e: The Contractor's License Law doez no[ apply_to an,owner.of property_who builtls or �improves'thereon, and who,cont�acts�for Such projects with a+con- � tractor(s) Iwense pursuant So the Cantractor's L'icense'Law). I-am aware that- ' proof of their' Worker's Compensation,insurance shoultl be provitletl to mer ❑ I�am exempt untler Section , B. & �. G'for this reason ' r � Date� � � ' Owner � � . eplicant to /i11 in all spaces exceot tnose within heavY bartler lines antl si9n all aoP�ooriate tleclarations. P MIT N�y �� TRACT,NO. . LOT NO. -UNIT NOi ' ' ; � .�.1 � ' , . v -� � � � � ' i TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR � • ❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ A.P. # � DESCRIPTION OF WORKIUSE OF BLDG. ' j � - � S Main Buildi TVPE OF PERMI,T cRaoiNc FOUnIDaTIOrv STRUC7uRAL ' � 7 Front •❑ TENANT' O ELECTRICAL PLUMBING � MECHANICAI. B R2d� S� ❑ OTHER � ' ' ' A PROJECT DESCRIPTION ,5�. F7. � oCCUParvCv C A�ght � CONSTRUCTIONTVPE � -�- � VALUATION,$ � g LeFt ZONE � GRADING CU. VDS. ' ACRES' p�ng. R¢f. # r Remarks: i� � . � � ' : , Planning Note9: , 4 Bar Sink � �' ' Backflow Preventer ' � eackflo�v Ir}igation Bathiubs ' : Clarifiers; : � Dishwashec " Drinking Fountains � Floor Drains ' Floor Sinks � ' Gas Service � Outl Interceptors • Kitchen Sink_' _ Lavatories ' P-Trap Roof Drains ; � � ReinspeMion fee � Boiler � , , i + PIUMBING i . - ' Showers . ' ' � � ServiceSink = ' - Sewer�Cap ' _ - ' - � � Sewer Connection � � Solar Collectors ' � � ' Solar Pipin9 , . � � $olar Tank � ' Swimming Pool w/Spa - , �s . Water Closet ' Water Heater ' _..Wacer Service � i Auto�Wash . . ' Laundry Trays 1.� � $75 � V ' � Issue Fee uucc- unaer �rouna . �uct-Sttuctural � Duct-Ventilating � � Exhaust System� ❑ Multiple Firepl/Fact. Blt. ICBO # � Heating System & Ducting� ' I hEr�eby certi(y that I have �eatl [his apWlication antl state that the a�ove ❑a100,�00 BT.0 �1 � 1I1/Olfildl1011 IS WIIECL. I dU12Elt0 C[�mnlv itn au tlty and county ortlinances - - �' am state �aws relaiing to building'const : sentaiives •of his dty' to :enter upon ; in5pectiom r o - � Slqna[ure Orivers' License or 55 CMF 0865-46, rev. ]0/04 - White - Builtling; ntl hereby authorize repre- , i - - e-menHonetlrproperty'for; i � y . , t , ; . , � Date _ /• ��"%. ' ' � . ' ' _ . . � ; Reinspection Fee • , i $15 Applicant; Pink - Accounting; Goltlenrotl - As5e55o� Hood or � Type I ❑ � Canopy Type I I ❑ Refriyeration System ❑ai oo,000 eru' � i oo,oao E System Repair/Alteretion ; Fire Dampers � _ � Registers� - - .. _ � � � laue Fee . FEES � � FEES � ' ` �2041 2709I87 ' , �5o0U ,TL' , ' ' � ' , " _' ' ' ' � - Zone_ _ t _' Automatic Washer . Construct iori. Pole Sub_ Cooking.Unit � - Dishwasher Dryers ❑Gas ❑Elect Fan . F.A.U.'" ' � � Fixtures . � ' Device Boxes Outle[s Switches Garbage Disposal Generator 00.5 KW ❑ ' � Accessory Building: � ' � � , , ' i � '�GE I , . _ 6 ! ' � ' I' Parking Req '- ._.._--'7 0 E � Transformer ❑ 15-50 KW . � �� 50 + K W `, Meter �up to 100 amps Meter �over100amps ' - Suh Panel ' Momrs OO-1 HP O i%� 6 Inc.Solar 09-15 HP �16-15+ Microwave � Pole Li9ht. Range Sign � " � 1 2 O N I N" G R E Q M T S � Standing Sections � 5 KW Trash Compactor , I Reinspection Fea I$75 I' I Issue Fee _ I $ 3 DEVELOPMENTSERVICESREQUIREMENTS: ' � 2aning Approved By � ' � Date—j— —� �- Building Approved By � — � , , � Date�/�G � - � � ' SUMMARV OF�FEES ' ' � . � ' � � BUICDING PERMIT - $ � . � SMIP � - $-: . . PLAN�.CHECK - '$� �l�— PERMITp � ` ., � _ PLUMBING . � $ �o � ISSUANCE $ . _ ' ' PLANCHECK � 25% $_ � � ENERGV.P;C_ $i � . ELECTRICAL " � � $. GRADING � $ � � � � MICROFILM�. $ � , ., � PLAN CHECK ;50%� $ : , ' MECHANICAL $ � _ � TOTAL FEE $ �0 � � , � PLAN CHECK =Z5%..�:$- � ' � � J � CONSTRUCTION AND PLANNING � POOL & SPA . APPROVALS Permit # ' Date Inspector qpPROVALS Permit # Date �� Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' � 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' � ; 3. Electrical Conduit Utility-Undrgrnd. 54. Forms � � � � � 4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding �� 5. Steel Reinforcement . � 56. Rough Plumbing & Pressure Test ' 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 4,.� 7. Footings � � 58. Electrical Conduit-Undrgrnd. V � 8. Foundation � 59. Gas Pipe, O Undrgrnci.; Test '-'•� 9. Water Pipe-Undrg�nd. . 60. Backwash Lines, P-Trap, � Undrgrnd? 10. Structural Floor SYstem 61. APPROVAL TO DECK .�. '�'; 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Fina� � 12. Sewer Cap , � 63. Heater & Vent-Final � � 13. Roof Drains , . . � 64. Plumbing SYstem - Final ' 14. Rough Plumbing - 65. Electrical-Final 15. Rough Electrical-Conduit � � 66. Solar System-Final 16. Rough Electric Wiring , 67. Fencing & Access Approval 17: Rough Wiring Sign 68. APPROVED FOR PLASTER�NG ' 18. Rough Electrical-T Bar Ceiling - - . 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT � 20. Rough Factory Fireplace � �� APPROVALS Permit # 21. Ducts, in Struciure 70. Underground Hydro � 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil � 23. Gas Pipe-Rough & Test � � 72, Underground Flush . 24. RoofFraming � � 73. Undergrnd.StorageTankOGas ❑Oil 25. Roof Sheathing . �� 74. Overhead Hydro � � � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � 27. Fra�me and Flashing - 76. Dry Standpipe � " 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation ' ' � 78. FIRE PREV. FINAL 30. Drywall'Nailing HEALTH DEPT. REQUIREMENT 31., Plaster Brown Coat � 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80.- FOOD CERTIFICATE ISSUED ' 33. Final Electric . Notes: 34.� Final Heating & Air Conditioning � 35. Final Gas Pipe-Test . 36. Hood or Canopy . 37. Final Factory Fireplace . � 38. Final Plumbing ' �• •7 � ` - ' 39. Water Service-Final . ' ' � � 40. Gas Service-Final 41. Solar pomestic-Final � 42. Backflow Preventer 43. Backflow Irrigation 44. .Landscape Irrigation System . . ' 45. Sound Attenuation . 46. Handicap Regulations . 47. FINAL STRUCTURE & BUILDING . � ' .48. Special Requirements Completed 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co ' S1. CERTIFICATE OF OCCUPANCY No. � � - Date �d l F� d 6Wi d y � S F A W F w Q 7 � � C � C. �i 6� Z til S 3 8044 7/02/81 46.5� Tl COSTA MESA BUILDINGSAFETY DEPARTMENT pPPL[CATION FOR'STRUCTURAL PERMIT "� ' o n nnv ��nn rncre nncee re� irnnnun o�<�e .._' _'"' '__' _'_......__... -.._.. _....._""_' REC ED BV PERMIT _ � _ /� . For Applicant to Fill in Completely — Use Ink Only �f BUILDING A.P. NO. � Z�� ADORE$$ / %% �`/ , BUI LDI NG T�E AN OR., ( ./ I/, l'��- ,� ADDRE55' L� - J� L � /T [ C UNIT OR ADDRE 5 /�� SPACENO. �� ' � - TR.NO. � , LOT .O BLK. a �cvs7� f�T�'fi',T TEI. l��l� CITV �+ NO. (� � . NEW ADD ALTE REPAIR MOVING DEMOLISH CANSTRUCTION � X LENDER /VD E BFANCH ' OWNER /,� i �/� .�� ADDflESS. ' VALUE �./ ARCHITECT TEL. USE U IF� n.7!/O $ "/� OR ENGINEER /j �/ ADDRESS � ZONE L• TYPE GROUP W1 —I APPROVED �j CONTRACTOR �/ . %% lC.PS BV DATE 7� Q� ADDRESS V �L+ J � TEL. CITV ,� ' E �• q NO. !� STATE CITV ' <1PPROVEDSETBACKS - ' L10. NO. ' 76� -(� UC. NO. SIZE ' NO.OF BLDGS. (FROM C/LSTREET) OF lOT �)( 7� NOW ON LOT � FROM USE OF ' � � �� EXISTING BLOG. �f�-/ � ��F � � >> Separate permits are required for � �. sioe Fr. Q electric, plumbing and heating work: / �./ %� REAR %U FT.V USE OF BUILDING AND WORK TO BE PEPFOFMED PLqNNING ACTION - j / � DATE /D .00 ! YD �' I�C . APPROVED APPROVE � _ �.@ t� I hereby ecknowletlge that I have reatl this application and rtata ��N(�D 7/Z�/j�� that the above information is correct antl agrea to comply wlth all laws regulating building construction, and I shell not employ � any persan In violation of the workman's compensation laws of v Me State ot California. / ' �; SO.. FT. [� � I hereby certify that I am ptope�ly licensetl as a contractor untler ihe Staie of Californla Business antl Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that sueh licenses are in full force and effect, or I THE PURPOSE OF ESiABLISHING A PERMIT FEE ONLV: e am exempt trom the provisions of the Stata of California Business VALUATION PERMIT FEE b ^p � q and Professions Cotle, Division 3, Chapter 9. . �( 1. � / ro Signatvre of ��//��y� /� T PLAN CHECK $ �� "� Permittae � �/.�JiLlC�G�1//��'�p`�^'✓ $ V TAX E LL AuthorizetlAgant Date �� '�'7—�/ (�� TOTAlPA1D 5 �O V db ' I 1 e �