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Home My WebLink About3233 IDAHO PL - Building PermitsMessage i s Page 1 of 1 Jeffrey Poland From: Alan Tuntland [ATuntland@corp.birtcher.com] Sent: Wednesday, March 29, 2006 2:06 PM To: jpoland@leesak.com Subject: RE: SCHFC - School Fees Attached is an American Land Title Association registered survey of the property existing prior to our demolition showing the existing building at just over 328,000 sf. See if Bonnie will accept this. From: Jeffrey Poland [mailto:jpoland@leesak.com] Sent: Tuesday, March 28, 2006 5:38 PM To: Alan Tuntland Subject: SCHFC - School Fees Alan, While at the Building Department, Bonnie Kubota requested that if we come up with an official document, showing what the square footage of the State Farm building was, then that number could be subtracted from ihe new building square footage in order to reduce the School Fees. She said it could be an old Tax Bill or something along those lines. let me know if there's anything I can do to help out. Thanks, jeffrey jeffrey poland Lee 8 Sakahara Architects AIA, Inc. 16842 Von Karman Ave., Suite 300 Irvine, CA 92606-4927 Phone: �949� 261-i 100 ext - 43 Fpx �949) 261-1144 E-moil; jpolpnd�leesok.com 3/29/2006 CITY OF COSTA MESA O�pMFS,P BUILDING DIV/SION a i „ ,,, � 77 PAIR DRNE, COSTA MESA, CA 92626 • Q14) 754-5273 • Fax p14) 754-4856 • www.ci.costa-mesa.ca.us : ,� � FOR INSPECTIONS CALL: (714) 754-5626 .��e � PERMIT NUMBER: BX10-00245 PERMIT TYPE B MISC STATUS: ISSUED • APN: 13908312 � DATE ISSUED: 11l10/2010 Zoning: , ISSUED BY: RMD � JOB ADDRESS: �,,,.3293�tDAHO'PL�CM�� Vicinity: ROOF TOP Primary Occ: SQ. FT: 0 . Valuation: � Se,000.00 SuitelUnit: . Const Type :?? SCOPE OF WORK: INSTALLATION OF A 1.840 KW ROOF MOUNTED PHOTOVOLTAIC SYSTEM WITH 8 PANELS; 160 SF; MISC CONDUIT, 2 DISCONNECT, 1 INVERTER AND SUB PANEL. OWNER: NGUYEN THUC X/DAM THAO T City/State: COSTA MESA, CA Phone: 714-754-1604 APPLICANT: KEMME, JENNIFER City/State: Phone: 800-794-1972 CONTRACTOR: Address: CitylState: Zip Code: ARCHITECT: Phone ENGINEER: Phone SUNBELT SOLAR SYSTEMS 26881 PRAIRIE DOG LANE MORENO VALLEY, CA 92555 FEESUMMARY Building Plan Check: Building Permil: Electrical Permit: SMIP Residential SMIP Commercial Bldg Std Admin Fund Address:: 3233 IDAHO PL Zip Code: 92626 Address: Unit Unit: Zip Code: License No. 530809 � ' Unit: Phone 1-800-794-1972 Cell: License No. . . License No. $99.61 $15325 $62.10 $0.80 $0.00 $1.00 TOTAL FEES $316.7E HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIV Monday thru Friday - 7:00 am thru 7:00 pm. Satrudays -9:00 am thru 6:00 pm. New Years Dav. Memorial Dav. Indeoendence Dav. Labor C ; CMMC Sec. 13-279 ,- Sundays and the tollowing Federal Holidays: NOTICE: The work authori2ed by this permit shall comply with all applicable handicap access requirements under Califomia staNtes and related regulations. (Ord. No. 92-28, § 1, 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 final approval will resWt in lhe expiration of this permit. OC pEt. INSPECTONTYPE DATE INIIiIALS CODEN INSPELTIONTYPE pATE INTITIpLS 7676 Fixed System Final Fire p�¢�enlion 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Elecirical i�' ��Z - 2-� - lC� �� 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Fac�ory Fire Place 220 Final Planning Approval 203 Final Sign 222 FinalSile '.. / 204 Final Demolition 250 Final Building/Occupancy i� ' Z �- � U� WORKERS' COMPENSq710N DECLARATION: I hereby aKrm under peqalty o( perjury one of [he (ollowing declarationsi . ❑ I have antl will maintain a certifcate of consen[ to selt-Insure for vrorkers' compensation, as provitletl tor by section 3700 of the Labor Code, for the performance of the vrork (or which �his permit is issued. ❑ I have and will maintain wnrkers' compensation insurance, as requiretl by section 3700 0( ihe Labor Code. for [he performance of the work for which ihis pertnit is issued. My workers' compensation Insurance carrier and policy numberare: � ,��;e�:T S'�Aw �,�,� (This sec(un neetl no( be �mplefetl ilfbe permR is valueE af one huntlretl tlollars (5100) or less.) PW�ty�Number: '�.i��0 ❑ I certify lhat in the performance o( the work for which [his permit is issued, I shall not mploy any person in any manner so as to become subject to the workers' c pe ation laws of California. and agree lhat if I should 6ecome subject t the qrkers' compensation provisions o( Section 3700 0( the Labor Code, I all k.nwith comply with these provisions. �•v 1 10 Cs. pnawre Dat WARNING FAIL` TO SEWRE WORKERS' COMPENSATIO`N�COVER4GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAI PEIWILTIES 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 CO�E, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aRrm that I am licensedA�nder provisions of Chapter 9(commencing with Section 7000) of Divisi�n 3� the Business and Pro(essions Code, and my license is in full torce an effe ��5'� G4� 1 0 r„Date �.� CONSTRUCTION LENDING"AGENCY: ❑ I hereby aKrtn thal [here is a construction lending agency for the pedormance of the work (or wfiich this pertnit is issued. (Sec. 3097, Civil Code�. Lender's Name: Lender's Add�ess: Signature Da�e OWNER-BUILDER DECLARATIONS: I hereby aKrm [hat untler penalry of perjury that I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Protessions Code: Any city or counry which requires a permit [o constmct, alter, imp�ove, demolish, or repair any strucNre, prior to its issuance, also requires the applicant for such permit to fle a signed statemen[ that he or she is liceqsed pursuant to the provisions of the Conhactors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Professions Code) or that he or she is exempt therefrom and ihe basis for lhe alleged exemption. Any violation of SeCtion 7031.5 by any applicant for a permit subjects the applicant to a civil penalry of not more Ihan five hundred dollars ($500).): ❑ I, as owner o( the property, or my employees with wages as �heir sole compensation, WILL DO THE WORK, and the structure is nol intended or offereA for sale (Sec. 7Q44, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or lhrough his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the ovmer-builtler will have the burden of provinq that he or she did not build or improve for purpose of sale.). - ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe project (Sec 7044, Business and Pmfessbns Code: The Contractors License Law dces not apply to an ovmer of property who builds or irriproves thereon, and who cont2cts for such projecl with a contractor(s) license pursuant to �he Cont2ctors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: 305]-A6 (3/0]) Owner ID verifed hy tlriver's license. ❑ Ves ❑ No Driver's License No. Expires: Verification�of Ownership by (type of tlocument, i.e. - property tax hill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: � ❑ I hereby certdy that no exwvation Me (5) or more feet in depth into wfiich a person is required to descentl, will be made in connection with work authorizetl by this permit, and that no building shucture, scaffolding, falsework, or demolition or tlismanHing thereof, will be more than thirty-six (36) (ee[ high. (Chap. 32, Grp 2, M 2, Sea 341, Title 8, Califomia Administra[ive Code�. ❑ As ovmer-builder, 1 will not employ anyone to do work vfiich woultl require a permit (rom Ihe Division of IndusRial Safe�y, as noted above, unless such person has a permit to tlo such work from �he division. Appbranl's SignaWre Division of Industrial Safe�y Permit Number, _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicanf or present or future building occupant neetl to file antl ceAify a Business Plan (or emergency response to release or threatenetl relea5e of a hazardous malerial? ❑ Yes ❑ No (Seclion 25505 0( Ihe Califomia Health antl Safery 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 during a reportetl year a ouantity of hazartlous materials equal ro or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperaWre and pressure�. 2. Does or will the applicant or present or tuture building occupant need lo fle a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of Ihe California Heal[h ane Safety Code, with some exceptions, requires regisfration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of awtely hazardous materials equal ro or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic fee[ o( compressed gas a� s[andartl temperature and pressure). 3. Does or will the applicant or present or fuNre building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazartlous materials�? ❑ Yes ❑ No (Section 25534 of Ihe California Health antl Safety Cotle provides that the Costa Mesa Fire Department may require Ihe preparation, certification antl filing with lhe Fire Department of an RMPP by businesses which are requiretl [o register acutely hazardous materials with the Fire Department. 4. If an. RMPP is presently required, has Section 25534 of the Califomia Health and Sa(ety Code been fully complietl with? ❑ Yes ❑ No 5. Does or will the applicant or present or fuwre builtling occupam require for the work which is the subject of this application a permit for such construction or modifcation fmm lhe South Coas[ Air Quality Management DisMct or trom any other air polW[ion control disUict or agency? ❑ Yes ❑ No (Section 658502 of [he Califomia Govemment Code requires that ihe requestetl information be fumished on applications for non-residential building pertnits�. 6. Will any part of the facility to be consVuctetl under lhis permit be within 1000 feet from Ihe outer boundanes o! a school? ❑ Ves ❑ No Qf "yes", the facility must meet the requirement of Sections 25534 and 42303 oi ihe Califomia Health and Sa/ery Code). 7. I( a permit from the South Coast Air Quality Management District or other air pollu[ion control district or agency is requiretl for the work which is the subject of this application, have all of the tlisclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If "yes", attach certifcate of compliance from ihe appropriate air pollution control affcer). � CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the information given above is correcL I�agree to comply with all state laws antl city ordinances�regarding Hazardous Materials and Emissions. SignaWre Date CERTIFICATE OF COMPL7ANCE AND AU7HORIZA710N OF EN7RY: I certify under penalty o( perjury that I have read this application and s[ate Ihat the information given is correcL I agree to comply with all state laws and city ordinances relating to building constmction, and aWhorize representatives of the City of Costa Me to enter upon the above-tlescribetl property for inspection purpos . I ee not to occupy or allow occupancy of any building authorized by this erm� ntil fnal inspection. Sig � 81 L Owner(s) Dale ..0 10 �pnd(acqui �qpptlran��` ��Oa e'�'� �� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIq DRNE, GOSTA MESA, GA y26L6 JobAqdress: 3233 IDAHO PL Suite No Vicinity: Parcel Number: 13908312 - Applicant: SHOBE, CONNIE Atldress: 32331DAH0 PL. , , COSTA MESA, CA ' � - � Ownec SHOBE, DAN P Atldress: 3233 IDAHO PL COSTA MESA, CA Contractor: OW N E R-BU I LD ER Address: " MECHANICAL PERM�T Phone: 7�4-540-2801 Zip: 92626 Phone: Zip: 92626 Phone: Zip: License: 000000 Status: ISSUED Applied: 07/12/2005 Issued: 07/12/200 ISSUED BY: . SCOPE OF PERMIT 1 HOUR OF INSPECTION IN ORDER TO REINSTATE PERMIT #M8995 FROM ig83. ISSUE FEE Inst FAU <100 k BTU Inst FAU >1b0 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU . Refng Sys >100 k BTU 6as Piping ' Factory Fireplace Hood w/Mech Exhaust , VAV Box Vent Fan / Single Duct Appliance , , Fire Dampers � � Smoke Dampers ' � Inst or Relocate Appl Vent �� Air Handlers < 10000cfm � . Air Handlers > 10000cfm Floor FumaCe Floor or Suspend Heater �uantity $23.50 - $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 50.00 0 $0.00 . 0 � �$0.00 � 0 � � $0.00 0 $0.00- ,:0,, _$0.00 _Oc.-�,- $0.00�� 0"� ' $0.00 0�- $0.00�, 0; � $0.00 0 $0.00 0'. $0.00 0_ FEE SUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventlllation System Evaporative Cooler Commercial I n cinerator Domestic Incinerator � � Campressors / Absomtion Svstems Upto3,hp/t00kBTU - 3To15hp/500kBTU - 15 To 30 hp I 1,000 k BTU . - � 30 To 50 hp I 7,750 k�BTU � ' Over 50 hp / Over 1,750 BTU � Boilers ,Up to 3 hp � - � " � 3To15hp � . � . , , 75 to 30 hp 30 to 50 hp Over 50 hp 'Other Mechanical Fee Investigation Fee . � . Plan Check Fee . Reinspectlon Fee TOTAL CALCULATED FEES �uantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 $49.50 $0.00 $73.00 NOTICE: The work authorized by ihis permit shall comply with all applicabla handicap access requirements under Calilornia statutes and related regulations. (Ord. No. 92-28, § 1, 12•21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. INSPEC710NS: In order for Ihe work authorized under this permit to be considered legal, such work must comply with all epplicable codes, and all required Inapeetlons and tinel approvel must be obtained. Failure to obtain inspections and final approval will result in tha explration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaaere(woo) l�� b r, � WORKERS' COMPENSA710N DECLARATION: � I hereby ettirm under penalry ol perJury one of the following declarations: ❑ I heve entl will maintain e cetlificata of consent to self-Insure for workers' compensation, es provided for by section 3700 of Ihe Lebor Code, for the pertartnence of the work for which this pertnit Is IssueO. ❑ I have arM will maintain workers' campensation Insurance, as required by secUm 3700 ot Ne Lebor Cotle, for the perfortnance of the work tor which ihis pertnit is issued. My workers' compensation Insurenca wMer end poliry number ere: Cartier. Policy Number. (Ihls section need not be complete0 i/ Ne pertnit is velued et one hundred tlollars ($f 00) or less.) jRj— I cetlity that in the peAormence of Ihe woAc for which this pertnit is issued, I shall not employ eny peraon in any manner so as to become subjecl to the workers' compensatlon laws Califomla, and agree that If I should beco e ub�e to Ihe workers' compensatlon pmvisions oi Section 3700 of the Lebar Cotle, I shell forihwlih complywithihes p visions. � �Ms�a�e��a: (�y( �dl a o J . �ta� 7�l � d5 WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAOE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CR� PENALTIES AND CIVIL FlNES UP TOONE HUNDRED TlqUSAND OOUARE ($100,000�, IN ADDITIIXJ TO TME COST OF COMPENSATION, DAMAGES AS PROVIDED WR IN SECTION 3]O60F THE IABOR CODE, INrEREST, AND ATTORNEY'S FEES. LICENSED CONTFiACTORS DECLAHATION: I hereby attirtn ihat 1 am licensed under provisions of C�apter 9(commenung with Section 7000) of Division 3 of ihe Business antl Prolessions Code, and my license is in full force end eflect. Lic. k - Class x Conireqors SlgnaWre: Date: CONSTAUCTION LENDING AGENCV: ❑ I hereby eNirm ihat ihere is e conslruction lending agency for the peAormance of ihe work for whlch ihis permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Adtlress: Slgnature: Date: OWNER-BUILDEFi DECLARATIONS: I hereDy el(Irtn Ihat under penelry of perjury the� I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business entl Professions Cotle: Any ciry or counry which requires a partnit to consWct, eller, improve, tlemolish, or repair eny structure, prior to its issuance, elso requires Iha a001icant for such permll ro Ille a slgneG statement ihat he or she Is licensetl pursuent to t�e pmvlsions oi the Comractors Llcense Law (Chapter 9(cammenUnp with Section 7000) of DlNslon 3 of ihe Business entl Profeuions Code) or that he or she is ezempt therefrom end the 6esis for the elleged exemption. Any violetion ol Section 7031.5 by eny epplicant for e pertnit suh�ects the applicant to e clvll penelty of not more than five huntlred tlollers ($500).): ❑ I, as owner of Ihe properry, or my employees with wages es their sole compensation, WILL DO THE WORK, and ihe siructure Is not Intended or otteretl for sele (Sec. 7044, Business and Professions Code: The Coniractors LJcense Law does not apply to en owner of properry w�o builds or improves ihereon, and who tloes such work himselt or hersetl or through his or her own employees, proNAed Ihet such imprwements ere not Intendatl or aHeretl for sele. II, hawever, �he building ar improvement is sold wiihin one year of completion, the owner-buildar will heve t�e burtlen of proving that he or she did not build or improve for purpose oi sala.). � � I, es owner of ihe properry, em E%CWSIVELY CONTRACTING WITH LICENSED CON7RACTORS to canstruct the project (Sec. 7044, Business and Protessions Code: The contrectors License Lew does nat appty to an owner ol property who builtls or Improves thereon, and who wntrects lor such project with e contrecror(s) license pureuant to the Coniractors License Laws.), . end Professions CaAe for t�15 rea5on: S?wnDr10'ventietl by dnvef5license. � Yes ❑ No Vedfication of Ownership by (lype ot tlocumem, i.e. - praperty ta: 6111 or DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATON: ❑ I hereby certify thet no excavetlon five (5) or more teet in depth into w�ich e person is required to descend, will be made in connectlon with work euthodzeC by this permit, entl Ihat no building structure, swttolding, falsework, or demolition or tlismantling Ihereot, will be mare than thirry-six (38) leet high. (Chap. 32, Grp 2, Art 2, Sec. � 341, Title 8, Califomia Administrative Code). ❑ As owner-6uilder, I will not employ enyone to do work w�ich would require e pertnit Irom Ihe Division of Indusinel Sefery, es noted above, unless such person hes e pertnit to do such work trom tha division. SigneWre: Dete: Division ot InduSldal Setety Pertni� Number. CERTIFICATE OF COMPLIANCE AND AU7HORVATION OF EMRY: I certify untler penalty ol perlury that I have read this epplication and stata ihat the Infortnetlon given is corce L I egree to comply with all stete lews and ciry oMinences relating to building constructlon, end euthodze representetives ot the Ciry ot Costa Mesa to enter upon the ebo -descnbed� ,p.pro_perry tor inspection urposes. a�ee� n�1�lo� occupy or ellow occupancy ol eny building authorized by th�is,p�"'it un Final inspection. /x`YL1 �L/(�.( AD J�J ,- ��7L1r1.�� "[[/ � �%�.-� Slgr�atGre.Ot.Legei'Ovi�er(s)" �a_ ! , Da(e. �_ c-- - AndOr Authodzetl Applicant Data CODE t. INSPECTONTYPE Qdg I�LS 1616 Fixed System Final Fire Preventlon 1266 Pool Spa Final 200 Finel Re-Rool 201 Final8lock/Retelning Well 202 Final Fedory Fira Place 203 Finel Sign i 204 Finel Demoltllan f�QQE,( INSPELTIONTYGE 206 Final Mechenical 208 Final Plumbing 270 Flnel Eleciricel 212 Finel Fire Prevention 220 Finel Planning Approval 222 Final Site 250 Finel Building/Occupency �� .:��' r , . �� a� C��ov,ta ��leaa �'uu.'du y Z�iui�iayi OWNER-BUILDER VER[FiCATtON Address: �.� 3,� 1�� l"%�STf� ��S,i Permit #: �� p 501� A ciry 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 completion and require the retum of, an owner- builder venf cation. � Attention Property Owner: An `owner-builder' building pertnit has been applied for in your name and bearing your signature. Please complete and retum this infomiation in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No buildine permit will be issued un[il this verification is received. l. I personally plan to provide the major labor and materials for construction of the proposed property improvement. (� Yes ❑ No 2, I(have/have not) signed an applica[ion for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address _ Phone ( ) City _ Contractor's Lic. No. 4. [ plan to provide portions of the work, but 1 have hired the following person to coordinate, supervise and provide the major work: Name Address _ Phone ( ) City _ Contractor's Lic. No. 5. 1 will provide some of [he work but I have contracted (hired) the following persons ro provide the work indicated: IVame 10a2-46 (Rev.11ro<) Address Phone Type of Work ♦ �� - I hereby affirm that 1 have received a copy of the infortnation set forth in Section 19830 of the State of Califomia Health and Safety Code and have completed the above information to the best of my personal knowledge, in compliance with this State law. Si6med: �/ wl � y��IAA � Name: l:_fJ%i�oS'�1E'�� /'"L' ��/,Fi (Prinred or'lyped) C.D.L. # OR S.S. # � Date: � ✓, �J For more information call City of Costa Mesa Building Division at (714) 754-5273. toa].a6 (Rev.11/aa) , , , � ; �, ,. , // Z Oos %%��` L:61 �,��,, / � � ' � � ,'1� � - % � , � . �, �� . .�z.3.� � �,�. G�� .� �� , �- � �✓�� -� � � ` �.�� , �� ; �-- i� ; � �z �� Co� i��i G'% 9z �z� f{� �� y�-s`-y4 - z�a l �'� i/y�J�4s 6/7/ 1 aCPlicant to !ill in all �Cacee c�cept tho:e m•itr.in M1eavy Corae� lines xnd :ian cl! aCP�np�ixte Ceclarz:ians CITY OF COSTA MESA CONSTRUCTION PERRIIT Project Address Applicant's Mailin �Address rA/�Y�I��,C Owner'sName ��'"AiS��%f�s=phon ��' � Address -sA Arch/Eng. License No. Address Contractor's Name � �� ' Phone Address (mailing) / City LicPnse No. LICENSED CONTRACTOR DECLARATION I bereby aHirm tbat I am licensetl untler provisioni ot Charter 9(commencing with sec[ion 7000) oi Division 3 0/ the Buziness antl Professions Cotle, antl my license is in full force antl ellect. License Class License No Date Signature 'ORKEHS' COMPENSATION OECLARATION M1EfQ�y d1i�IlT Ihd� I M1dVP d CE�II(ICd[¢ O� COOSEO[ SO SCILiO50fE OI d CPIIIiICd[¢ of Workers' Compensation Insurance, or a certifietl mpy tbereof (Seclion 3800, Lab. C.) Poiicy No. Company 8 Certitietl coPy is hereby (urnishetl. Certifietl copy is filetl with the city Builtling Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thisse<tion neetl not be completetl if the permit is for One huntlretl ($]00) or less). 1 certity [hat in the per/ormance of tM1e wor lor which this perm�t,/is iss��JJ eo, I Shdll not ¢RIp10Y dn p¢I50�1 i0 dn man �50 d510 b¢COT¢ $l�y ed�0 lhe Worke�s' COmpenSallYon laws of CalAomi r ..,\ /� Oate O�'��/t! 5 Si9nature k ��r��'1� !�'- v ri.Z" �C� NOTICEZIt,�3fter makinq lhis tle�laration, you shoultl bewme subject to lhe Warkers' Compensalion provisions ot the Labor Cotle, you musl forthwith comply witM1 sut� Provi5ion5 or tnis permil 50a11 be tleemetl revoketl. CONSTRUCTION LENOING AGENCV I hereby aitirm [hat t0ere is a construclion lentling a9enty lor the performance of ihe work �or wry �m jJ s_ psrmit is issuetl (SecHon 3097 Civ. CJ LenaeYs Nama. � G Lentler's Atltlress OWNERBUILDER DECLARATION I hereby af/irm that I am exempt from [be Contractor'S License Law tor tM1e fonowing reason (Section 7031.5 Buzinezs ana Professional Cotle: Any ciry ar munty wbich requires a permit t0 tOnstruct, alteq improve, tlemolish or repair any sVuclure, prior to it5 issuance, also requires Ne applicant for suth permit �o flle a signetl statement tha[ he/she is licensetl pursuant to ihe provisions ot 1e Contractor's License Law (Cnapter 9(commencin9 wiln Section 7000) of ivisfon 3 oi the Business an0 Professions Cotle) or lhat he/she is ezemp[ .ne�eirom antl the basis for lhe allegetl exemption. Any violation ot Section ]031.5 by any applicant for a permit subjects Ihe applicant lo a civil �e alty of no[ more than five huntlretl tlollars ($500�. 1, as owner of the property o� my em0�oyees wlih wagez as their sole mm0ensation, will tlo [he work. antl the sbucture is not intentletl or offeretl 10I SdIC ($CCII00 i044. BlI5ipC55 dlld PlOfE55100d1 COdC: ThQ [OOVdCt0f�5 Llcense Law tloes not apply to an owner of a property who builtls or imp�oves i lM1ereon, antl who tloes suc� woik himself/herself or througM1 bis or M1er own i employees, proviaetl lM1a[ 5uch improvemen[s are mt intentle0 or of5eretl for I sale. If, noweveq the builtling or improvement is soltl witbin one year al com- plefion, tbe owner will �ave t�e burden of Oroving he/sbe tlitl no� builtl or im- prove for tM1e purpose of sale). ❑ I, as owner of lne proper�y, am exUusively mntracting witn lirenseo con- Vactors to wnsvuct tne oroiect (Section ]o4a, Business ana Pwfessions Cotle: The Con[ractor's Llcense Law tloes not aDP�Y lo an owner ot property wbo builtls or improves lM1ereon, antl wM10 con:racts for such projects wi[h a con- Vactor(sj license pwsuant lo lh¢ Contrac[or'S L�cense L.awj. ❑ I am exemp[ untler Section�— B. yj. P f.,yo�sir�nn til - �''7 % 5 TYPE OF CONSTRUCTION � CONVERSION ❑ D DESCRIPTION OF WORK LJ NEW L' ADD Y�ALTEP.AT.ION IJ REPHIR � 7L H ❑ OTHER q.p, # ,�tn� �� J.:ij�iJ �.'�'�� _ S Main Building: E TVPE OF PERMIT LI GRFDING FOUNDATION ❑ STRUCTURAL T F�Ont ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING �MECHANICAI A R¢d� ❑ OTHER C qight PROJECT DESCRIPTION SQ. FT. oCCUPANCv K CONSTRUCTIONTVPE VALUATIONS $ �e}1 ZONE GRADiNG CU. VDS. ACRES p�ng. Ref. # qemarks: �.�� ,// Parkin9 Req.iPrOvided (U Use of Building: PLUMBING FEES Planning Notes: Date " Owner E,i�� = _ / • / /L'f.C�L��, � I here�y rert'd tY�a[ I have reatl this applicelion antl state tpa[ the above � information is correcL 1 agree to comply wrtn all city and munty ortlinances dlld SIdtE IdwS fEldll�B l0 bUildlO COf15y 11 d C y 3UlhOfi22 IEplE- senta[ives o( Ibis/.ity to en[er9upyrJ e'abo -lneryC�netl Dropqty �nr S�9nawre / L1�SA Drivers' License� Prevencer Irrigation Dishwasher Drinking Poumains � Floor Drains � Floor Sinks Gas Service Outleu Imercepmrs Kitchen Sfnk Ldvdt0�125 P—Trep Roof Drains Reinspection Fee � g25 Boiler Duct - Under Ground Duct - Svucwral Duct - Ven[ilating Exhaust System ❑ Multiple Firepl/Fact. BI[. IC80 ?�- � % Heating System & Ducting �0-100,000 BTU C710G,000 Reinspection fee � 525 �.�..__—, _ _ CMF OHGS-�6 rer. 1;63 Wnite - E iildiny; Canary - Applicarrt; Pink - Attountine; Goldau oa - Assasscr $hOWEfS Sen�ice Sink Sewer Cap Sewer Connection $olar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Waier Service i Issue Fee 1ANICAL Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0-700,OOOBTU ❑100,000 System Repair/Alteration /,. i�/ `�w v_ Issue Fee Auromatic 1Nasher ConsVuction Pole Sub. Cooking Unit Oishwasher Dryers ❑Gas ❑Elec� Fan F.A.U. Fixlure5 Device Box�s O utlets Switches Garbage Disposai Generator �0.5 KW � I 2one Accessory Fuilding: Park.Fees 5 ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over100amps 5-15 KW Sub Panel - Momrs OO-1 HP �7 %- 8 InuSolar �9-15 HP 016-15+ Mfcrowave Pole Light Range Sign Standing Sections Trash Compacmr �—+—� Reinspection Fee 525 Issue Fee FEES PUBLIC SERVICES REQUIREMENTS: Zoning Approved 6y Application Approved By - P.ao��on Issued BY �— r�-- 5 3 BUILDtNG PERMIT F�AN CHECK � PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK �1ECHPNICAL PLAN CHECK FE $ 3 SUMMARV OF FEES � � S SMtP 5 $ PERMIT S - ISSUANCE $ � ENERGV P.C. S $ GRADING $ £ MICROFILM $ � —�-�-'��` TOTALFEE $ �y �—� S �.r,o— . . .. ., , CONSTRUCTION AND PLANNING APPROVALS Permit# 1. Temporary Electrical Service or Pole 2. Soil Pipe-Undrgmd. 3. ElecVical Conduit Utility-Undrgrnd. 4. Electrical Conduit-Undr9md. 5. Steel Reinforcement 6. Electrical UFER Grnd. 7. Footin9s � 8. Foundation 9. Water Pipe-Undrgmd. 10. Structural Floor System 11 . Property Sewer Line & House Connection 12. Sewer Cap 13. Roof Drains 14. Rou9h Plumbing 75. Rough Electrical�Conduit 16. Rough Elecvic Wiring 77. Rough Wirinq Sign 18. Rough Electrical-T Bar Ceilin9 19. Rou9h Heating & Air Conditioning 20. Rough Facrory Fireplace 21. Ducts, in Svucwre 22. Ducts, Ventilating 23. Gas Pipe-Rou9h & Test 24. Roof Framing 25. Roof Sheathing 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing 28. Lathiny & Siding 29. Insulation 30. Drywall Nailing 37. Plazter Brown Coat 32 Electrical Power Meter-Final 33. Final Electric 34. Final Heating R Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbiny 39. Water Service-Fiwl 40. Gas Service�Final 47. Solar pomesticFinal 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irripation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to EAison 50. Gas Release to Southem California Gas G 51. CEFTIFICATE OP OCCUPANCY ' NO. Date Date PO. & SPA Inspector AppROVALS Permit # 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVALTOCOVER-GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, � Undrgmd. 61. APPROVAL TO DECK 62. Backwash & Receptor-Final �63. Heater&Ve�t-Final � ' 64. Plumbing SVstem - Final 65. Electrical-Final 66. Solar System-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT Z/9t� APPROVALS Permit # 70. Underground Hydro 71. Product Piping O Gas ❑ Oil 72. Undcrground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overheacl Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINALINSPECTION 80. FOOD CERTIFICATE ISSUED Notes: S-.�i_ry 77`.� L_.____.7'` � �1� T . Date � Inspector � (714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 3233 IDAHO PL Suite No Vicinity: Parcel Nunmber: 13908712 Applicant: SHOBE, DAN P ��'�� e_ Address: 32331DAH0 PL, - � � , ` . ; . -� Phone: .. . , COSTA MESA, CA ' Zip: 92626 � � �M:: �,�' ,�,,. � .. ,.. ,. �:� ,..- _. �+; 'r , � i:". - `i` 6 Owner: " SHOBE, DAN P Address 32331DAH0 PLr--'• � . � . �;.`'�::� - Phone: - r COSTA MESA, CA Zip: 92626 Contractor: Address: ,'r,�,- . � � . a � Y��r � , Phone: Zip: License: , � � _ . ��>""" �"`"�- � SCOPEOF�PERMIT�� - i,�REPLACEMENT PERMIT FOR #BEP 5016 AND AND #BE 7838 .; t ' _,,, , m . � � -�t • REF BOS-01225 ` Status: ISSUED Applied: 07/25/2005 Issued: 07/25/2005 ISSUED BY: 3, e. a.�.. � s� i., { . . , , . ,'.,. � � b_ „ � �: � E::` � - � FEE SUMMARY -�� . . ....- AMT QTY --�AMT .; �QTY � - - .. � .AMT ISSUE FEE ' � � �$23 50 : � Laundry Tub / Washer �$0.00 `-�� 0 Sump Pump -- $0.00 Backflow irrigahon $0.00 's0. ' Landscape Irrigalion „ $0.00 0 Swimming Pool P ��$0.00 BackflowPreventer" $0.00 •'�0 � P-Trap , �,.$0.00 0 Trap�Pnmer v-"$0.00 jr Bathtub - �,_-$0 00 , , �0_ , Pressure Regulator �`-`LL� $0.00 0 Urina6 � ,s�t $0.00 Clarifer System `��'•50 00 �,_� �0 ' Pmcess Piping (per 10 ft), .$0 00 _0 Vacuum Brkr�Bkflow(7-4j s' $0.00 Connect pce,Soda etc) $0 00 �' D 'Receptors, •' � : $0 00 ;0� > ��•Vacuum Brkr Bkflow(5+) $0.00 Denkl Units `�� $0.00" �� 0 �,, ��$eptic Tank ,� =. $0.00 �0 �� -- Wash�.Basin �ti� $0.00 Dishwasher a-� $0:00 -.' 0, s� -Sewer Cap fo� Demo r, �$0.00 �, 0 - Wash�Basin Set '- $0.00 Drain, Floor � =s50:00 0 �� `Sewer•Connect W�� $0.00, :0 . Waste and Vent System $0.00 <� Drain,Rainwater :-.�$0.00 -� 0 . Sewer.PdJateLine -, $0.00' 0 " �x"�WaterCloset(Toilet) $0.00 Drain, Roof -°i$0.00 '��0 � ' " "-:�Shower • - � __ -$0100� 0 ^''�/Vater Heate�/`vent $0.00 Drinking Fountain $0 00 • 0 �.3ink bar �� $0.00��0� ,-- Water'Fiping (Inst or Rep.) $0.00 Expansion Tank SO 00 .='0,� _�.Sink'comme�cial , 0.00 � 0 Water e-pipe 0.00 Gas Earthquake Valve 50 00 `�'0� -Sink, Floor i :' $0.00 - i0' .,, �_; Water Service $0.00 r Gas (1-4 oullets) $0.00 0 �`" T„�Smk, kitchen` - •. $0.00 0 '�=-Water Softener $0.00 Gas (Over 4 ounets) $0.00 0 � �= Sink,, service/mop ,$0 00 �� .0 . � � OTHER $0.00 Gas Repipe 50.00 0 Spa (private)-._ �_� $0 00' '��''0 �� VIOLATION $0.00 Gas Service 50.00 0 Spa (public) --- "`-` $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $49.50 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related � regulations. (Ord. No. 9248, § 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 requfred Inapeetlona and tinal epproval must be obtained. Failure to obtain Inspections and final approval will result in the ezpiration of this permit: FOR INSPECTIONS CALL: (714) 7545626 � WORKERS' COMPENSATION DECLARATION: I hereby affirm under penelty of perlury one of the following declarations: ❑ I heve and will maintain e cenificete of consent to self�lnsure tor workers' compensation, es provided for by section 3700 ot the Lebor Code, for the pertortnence of the work for which this permit is issuetl. � 1 have and will maintain workers' compensation Insurance, as required by section 3700 ot the Labor Code, for t�e peRo1mance of the work for which this pertnit is issued. My workers' compensatlon Insurence carner and pollcy number ere: � Cartler: (This s� one Policy Number: or less.) -�''�Lcenity that in the peAor�nce ot the work for which thi 's issued, 1 shell not employ eny person in eny manner so as to become subject to the workars' J�cbmpensation laws ot i omia, antl egr 6 that i Id b me subjact b the workere' compensation provislons of Sectlon 3700 of ihe Labor Code, I shell forthwith comply wit� Ihese pr , sio's. � Applicnnt'SlgnaNre:: ,;�ey 7/2.i��iT �WAqWIJ(3:�FAILUHETOSECU ORKERS'CAMPENSATIONCOVERAGEISUNIAWFULPNDSHALLSUBJECTANEMPLOYERTOCRIMINALPENALTI SANDGVILFlNESUPTOONEHUNDRED TFqU5AN0 �OLLAHE ($100,000�, IN ADDRION TO THE CQST OF COMPENSATION, DANAGES AS PROVIDED FOR IN SECTION 31O60F iHE L4BOR CODE, INTEHEST, AND ATTORNEV'S FEES. LICENSEU CONTRAC70RS DECLARATION: I hereby affirm ihat I am licensed under provisions of Chaptar 9(commencing with Section 7000) of Division 3 ot Ihe Business end Professions Code, antl my license is in full force antl ettect Lic. N Class A Coniractofs Signature: Date: CONS7RUCTION LENDING AGENCY: ❑ I hereby eHirtn that there is a construction lentling agency for �he performance ot the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: LendeYs Atltlress: Signamre: Date: OWNER-BUILDER DECLARA710NS: I hereby attlrm that untler penelry of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW forlhe following reason (Sec. 7031.5, Business end Professions Coda: Any ciry or counry which requires e pertnit to consimct, alter, improve, demolish, or repair any strudure, pnor to its issuance, also requires the epplicent for such pertnit to file e signetl statament ihet he or she Is Ilcensed pursuent to the pmvlslons ot ihe Contractors License Law (Chepter 9(commencing with Sectlon 7000) oi Divislon 3 ot Ihe 8usiness and Professions Code) or thet he or she is exempt therafrom and the besis for the alleged exemption. Any violation of Section 7031.5 by any aOPlicent for a permit subjects the applicant to e civil penalry oi not mora then five hundred dollers ($500).): ❑ I, as owner of the properry, or my employaes with weges as their sole compensation, WILL DO THE WORK, end the strucWre is not intended or oHered for sele (Sec. 7044, Business and Protessions Code: The Contractors License Law dces not apply to an owner of property who builds or improves ihereon, end who does such work himself or herseH or through his or �er own employees, provided that such improvemants are not intended or oRered for sale. If, however, ihe building or improvement is suld within one year of completion, the owner-builder will have ihe burden ot proving ihat he or she ditl not build or improve tor purpose of sele.). ' �I; as owner oi ihe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consWct the project (Sec. 7044, Business antl Professions �Code: The contractors License Law does not apply to an owner ot pmperty who bullds or improves thereon, antl who contracis for such project with a contractor(s) license purgpaqt to iha Contraqbrs Licens�.C3�;.)? Business and Professions Code for this reason: Owner ID venfie drive�s license� � i'es ❑ No Venfication of O nership by (type ot daument, i.e. - property tax bill or DIVISION OF INDUSTRIAL SAFE7V PERMIT CERTIFICATION: ❑ I hereby certify ihat no excavation five (5) or more feet in depih into which e person is required to descend, will be matle in connection with work euthonzed by ihis permit, and ihat no building siructure, scaHolding, falsework, or demolition or dismantling thereot, will he more than thirty-si: (36) feet high. (Chap. 32, Grp 2, Art 2, Sac. 341, Title 8, Califomla Atlminisirative Code). ❑ As ownervhuiider, I will not employ anyone to do work which would require e permit from ihe Division of Industriel Sefety, es notetl above, unless such parson has e permit to do such work fmm the divislon. SignaNra: Date: Division of Industrial Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVJ1T10N OF EMRV: I certify untler penalty ot perjury that I have read this applicafion and state ihat the information given is correct. I gra to comply with II siate law ordinances rela�ing m builtling constmction, end authorize representatives of t�e Ciry of Costa Mesa to enter upon the above- �Erib d property f s i� s. agree no� to occupy or allow occupancy of any building authorized by this permit until finel inspection. � --w-- Z�ZS�O.� . S' _ ege � wner(s)�=;_ �� Date R And/Or Authorized Applicant Date COOE �. INSVECTION TYPE O�TE 1676 Fixea System Final Fire Prevention 1266 200 Pool Spa Finel Final Re-Roof 207 Final Block/Retalning Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demoiition . IMRIALS � GODE I INSPECTION TYVE 206 Final Mechanical 208 Final Plumbing 270 Final Electricel 212 Final Fire Prevenlion 220 Final Planninq Approval 222 Final Site 250 Final Building/Occupancy PA7E � (714) 754-5273 • Fax (714) 754-4856 • www.ci.cosla-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinily: Parcel Nunmber: 3233 IDAHO PL 13908312 Applicant: SHOBE, DAN P Address� 3233 IDAHO PL \' Stams: ISSUED Applied: 07/25/2005 Issued: 07/25/2005 �.;�/ . - o�� Phone n- . ...,....� , COSTA MESA. CA F �,?'..:�. - �-� -Zip . ��92626 � ' ' . . 5� �i. a � " _ � . . ,. . �;,.t r� _ i 3i ' � Owner. SHOBE, DAN P �� "'s .,�� , `��''�� `-� a: - `-' t� Address 3233 IDAHO PL �� „��' "' '��'" � , °'�'�� , _; � Phone: ��.� . ., COSTA MESA,_GA Zip: 92626 � s�' Contractor. � - � � > Address: � � � � . �.',� �; . - ,,' _ .. � _ �.�� - �� Phone.-�. � ' . - -.Zip: ' ', y , r License: � � ` �, " -' SCOPE OF PERMIT . = � . -- REP.LACEMENT PERMIT FOR #BEP 5016 AND AND #BE 7838 �� : , � �:�� wB�� .; s , .:: r.a .:. . � -'REF BOS01225 -,. -'�u--s� � _. __ < � _�... : . ,�-_ -., _ , . ... _. ,:, � . r_; - F., , °-`r FEESUMMARY�:` ` . . _ _ ,� ' - ' '�' _ ;.d , � . ��:' Quentity-- � ... � � . . . .... � � QuantitY, , . . . - ISSUE'FEE � - � �;$23.50 .. Temp Dist System / Lighting $0.00 � 0 � ` . - Temp service test � _ $0.00 "";" -� Busway /100 ft '$0.00 �0 ' . , � Res. a/c package _ ,�.$0:00 - Standing Section . $0.00 - - 0 - NewRes(7-2umts), '� '`*$0.00 ' 0 MiscElectricalEquipment $0.00- =_0 �` New Res (3+units) ' � $0.00 `,� 0 Trans(ormers up to 1 kva/kw $0.00� ��' 0 , Pool / Spa �, �,�$0 00.:- 0 �'� --�� `' �....up to 10 kva/kw .�,$0.00 0 , Lighling Fixts'� _ - •. $0.00 'i 0 �� :" up to,50 kva/kw ' `$0.00: , 0 f , � � Recept Outlets - '� � $0.00 - � 0 y � � � �� up�to ��100 kva/kw � �.. $0.00 0 '" � Switches $0.00;'e 0'�x�°� �,:"r �'..:,. ....overµ100kva/kw,,;�� ,� $0.00 0 Non Res Appl $0.00 0 % �Low Voltage Equipment "`` $0.00 ' 0 �� ' � Res Appl � � $0.00 • 0 � ,,'� �Low:Volt Winrig System ! Ckt�� $0.00- .-. 0 �� -��' Service to 200a �""' $0.0,0- 0'� - ' Misc. Contlwt $0.00 � ,QO� ., = Service to 1000a _ �-�,, $0:00. � 0 • ,�Misc'�Conductor:» •�� ,.�, $0��.00 '"0 � Service over 1000a �$0.00 � , 0"� � ��r-'� Circus (�gen or ride) $0 00 �"' �- 0 Motors to 1hp $0.00,,. �0�:,: -� , Circus (mech ride'�or.lights) �� $0.00'-' 0 Motors to 10hp $0:00 .. �0'� � �� Christmas Tree��'Stand? -.--�$0.00 0 Molors to SOhp $0 00'"" y�,., -0 ,,,y. �-"FireworksStand� ` `^.��$0.00 0 Molors to 100hp $0.00 0��, ., "Other Electrical Fee $0.00 Molors over 100hp $0.00 0"+^ • . � -,,�-� ; ' :�� Communicationdrops $0.00 0 " �- _ i�.�`In4"estigation�Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $49.50 � _ ' - � � i �y� � j� NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulalions. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 1 BO 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-afl� requlred Inspections and final approval must be obtained. Failure to oblain Inspections and final approval will result in the expiration of is pe mit FOR INSPECTIONS CALL: (714) 7545626 eaco-an �vuu7 WORKERS'COMPENSAnON DECLARAr�N: I hereby eHirm under penalty of perjury one of ihe following tleclarations: ❑ I have and will maintein a certificate ot consent to self-Insure for workers' compensation, as providetl for by section 3�00 of the Labor Code, for ihe pertortnance of ihe work for which ihis permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for ihe perlortnance of the work tor which ihis pertnit is issued. My workers' compensation Insurance cerriar and policy number ere: Canier. Policy Number (fhis section neetl not 6e completed il the p�� is valued et one hundretl tlollars ($100) or less.) of ihe work for which this p a�qit i issued, I shall not employ any person in any manner so as to become subject to lhe workers' �„ antl ag�e iat if I sho b C e subject to tha workers' compensetion provisions of Section 3700 of the Labor Cotle, I shall fotlhwith roate: —. �/2oS�/OsS' RS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYERdO CRI NAL PENAL IES AND CIVIL FINES UP TOONE HUNDRED 'ION TO THE COST OF CAMPENSATION, OAMAGES AS PROVIDE� FOR IN SECTION 3]Ofi OF THE LABOq CAOE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS �ECLARATION: I herehy aHirm that 1 am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 ot ihe Business and Pmfessions Code, and my license is in full force antl ettect. Lic. N Class # Contrector's Signature: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby aflirm ihat there is a constmction lending agency tor the pedormance of ihe work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: SignaW re: Data: OWNER-BUILDER DECLARA710NS: I herehy affirm �ha� under penalty of perjury Ihat I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW tor �he following reason (Sec. 7031.5, Business and Professions Cotla: Any ciry or counry which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the epplicant for such permit to file a signed statement ihat he or she is liGensed pursuant to ihe provisions of the Coniractors License Law (Chapter 9(commencing with Section 7000) of Divislon 3 of the Business end Professions Code) or ihat he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicent for a permit subjects the applicant to a civil penalty of not more than tive hundretl dollars ($500).): ❑ I, as owner of ihe propeny, or my emplPyees wi�h wages as their sole compensa�ion, WILL DO THE WORK, and the structure is not intended or oHeretl for sale (Sec. 7044, Business and Pmfessions Code: The Contractors License Law doas not appty to an owner ot property who builds or improves ihereon, and who does such work himself or herself or through his or her own employaes, provitled ihat such improvements are not intended or ottered for sale. If, howevar, the building or improvement is _� /sold within one year ot completion, ihe ownerbuilder will have the burden ot proving ihat he or she did not build or improve for purpose ot sale.). ' '� 'qes owner of Ihe property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct the prolect (Sac. 7044, Business and Professions —Co'de: The contr�ctors License Law doQs not apply to 0 ot property who builds or improves thereon, and who coniracts for such pmject with a contrector(s) license oursuaoFForhe Contractors Lilanse ❑ lam license. �'7es ❑ No Verification ot Ownership by (type of document, i.e. - property taz bill or DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: and Professions Code tor this reason: ❑ I hereby certify ihat no excavetion five (5) or more feet in depth into which a person is required to descend, will be made in connection with work euthorized by ihis permit, and that no building stmcture, scaRolding, falsework, or demolition or dismantling thereot, will be more than Ihirty-six (36) feet high. (Chap. 32, Gry 2, An 2, Sec. 341, Title e, Calitornia Administrativa Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit trom the Division of Industrial Safery, es noted a6ove, unless such person has e parmit to do such work irom the division. Signature: Date: Division of Industrial Safery Permit Number: CERTIFICATE OF COMPLIANCE AND AIJfNORIZA710N OF ENTFiY: I cetlify under penalry of perjury Ihat I have read this application and state �ha� �he infortnation given is correct (ree to comply wi� all state 1 d'! ordinances relating to building consVuction, and authorize representatives of the City of Costa Mesa to enter upon Ihe above sc ibed property�l�Fins ion rp . gree not to occupy or allow occupancy of any building authorized by ihis permit until tinal inspection. � �/2�/0 � �Signature Of Le9ai Owner(s) -�-��` � Date „"�„_—�. 9. And/Or Authoriaed Applicant ' �- Date CO�E A. INSVELTIONTYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Finai Fadory Fire Piace 203 204 Final Sign Final Demolition GAIE INTRIAL FQQ�N INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 2i0 Finaieiectncai 212 Finai Fire Prevention 220 Finai Planning Approval 222 Final Si�e , 250 , Final Building/Occupancy pT INTIfIRLS Z6 --.,.,. . T - --... me.�'A, CA 9 Viclnity; ` ArimaryOcc: R-3 piyellings/Co � Parce! Numb n9 Res c Status: ISSUED er: 73908312 �Q '4Pplied: 0)/2 T9Pe of Construction; V-N �005 App�icant: gHOBE pA� p Zoning: �ssuetl: p7�P5�005 Atltlress: 3233 IDAHO PI, COSTp MESA , CA , �Phone.-,. 'ISSUED BY: �_ Ownec SHdQE, DqN.p , 2iP: ' 92626 ;. Atldress 3233 IOAHO P� . . . . , . - ' � -. .., - ._ .. �, , COSTA MESq �q �� , x < PhORe: . � .c� . - - '§s.` u _ . Contractor�' OWN ^�'° Zi ; ER-BUILDER P �szs2s � � Adtlress �- �` , - '..> �- �� , - Tip.-�.." � . . Phone: � � Arch.; . - . __� . . Atldress: � - ��nse: Op00pp . '. , - - - ' , - Eng � , �; Zip � - Phone: . . �x,: -Address: � . , . � i Lice�_., . _.. x, , -� . , _'_�_�� ra,�: - nse: - . - �. . Pfione: REPL,qCEMENT PERMfT FOR t{66P '.' , :. � ,- . .. F � . � 5016 AND�AND #BE �SCOPE OF P�RM7T ��:. L�aense: � �� 7838 k _ � ;. SBi71P rmit ,$000 F�SUM�y ; z• Res. � $0 50 �� _ � ,., SMIP �om � Cafc Valuahon: $0 00 � Other. " �$0 DO � � , �Ctaim �Valuatron $o.00 InspEction: . $0.00 - � ^� $0.00 Total: � �;ir-� , � $0.50 �: _ .�' ;s�� SETS , ` �' &z'`�` ACKS �a � � a t�,, r. MAIN STRUC7UF2E Front � p��NING ? � � ' �� ^-,.,� ACCESSORY � s Re2r' D 0 � ��'`�' � ��'�- Front�_ `�p. p � �` .,�r . . .. Left p_� ` ,,�r>` 7'�4RKING Rear `= " R�ght p.p � �- 0 .e<:; `. Exi��i�g. " Q r: �.: m �� LeR p_0 �,._:. �; � ,>�: NOTES: Re ut�etl' �.'p ,.. rx . R�9hf 0-:0 r.`:�� ' �., Pr� °Sed:r;�0.-�, .. -`- �_ --_,-- , ".�` .. YCE: The work 'aiions. fOro. No, a�2edzed by this permit shall com I 92- § 1 � 12- RATION: 7 27•92) PY with all a ��s permN Aplicable handica �eriotl ot rgp pa�. Shafl au[omaticalfy exp(re a P access require �tl lnspecttong ee� �� he �rk autho � � bec Work is ommenc 8pmen�s untler Califpr��y statut S a� �el CTIONS: °m� void i! not c ed within 7 B ated nd ilnsl gAProval m nzetl under this pBr�it to daYs, or it 'SPECTIONS C ust be apfyin � con ' work is susparbe ALL: {714) 75q. �. Failure to o srde� �ega7, such work a or ab�ndonetl �� 5626 btain in SPec6ops and final y musf co the ezpirffilon �eS- antl.all I PProval will resuk in +th all �Plicable / of fhia�ne.... �v WORKERS'COMPENSAnON DECLARAnON: I hereby aNirtn under penalty ot perjury ona ol the following declaretlons: ❑ I have and will maintain a certifiw�e of consent lo self-Insure for workers' crompensetlon, es provideC for by section 3700 at Ihe Lebor Code, lor the peAormanca at the wark br which ihis pertnit is issued. ❑ 1 have antl will mflintain workers' compensation insurence, es required by sectlon 3700 of Iha Labor Coda, for ihe peAortnance of Ne work for which t�ls pefmit is issued. My warkers' wmpensatlon Insurence carrier end policy number ere: Cartier. one or less.) Policy NumDer. I'certity �hat in t�e peAo iance of the work f r which this per 1 i yyyssTTTjjjyyy 8tl, I shall not employ eny person In any manner so as to becoma subJed lo Ihe workers' compensallon laws oi a foml,a, end egre at H �6�ect to the workers' compensetlon pmNsions of Sectlon 3700 oi the Labor Code, I s�all forthwlih comply with these pr isi ns. ,�/Z.�/s� :ant'Stgnatuie:.- A u—�� (Defer._ � INOhFAICURE TO SECU OFKEFS' CAMPENSATIIXJ COVEMGE IS UNLAW FUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED irVJD DOILARE (E100,000�, IN qDDRION TO THE CQST OF COMPENSATION, DMMGES AS PROVIDED FOR IN SECTION 3�080F TME UBOR CO�E. INTEREST, AND ATTOPNEY'S PEES. LICENSED CONTRACTORS DECLARATION: I hereby attirtn thet I am licansed under pmvisions of Chapter 9(commencing wlth Section 7000) of Division 3 of iha Business end Pmfessions Cotle, end my licanse is in full forte nnd eftacL Lic. a Cless a Contrnctofs SlgneWre: Date: CONSTRUCTION LENOING AGENCY: ❑ I hereby aNirm that there is a construction lentling agancy for the pedormance ot the work tor which ihis permit is issued. (Sec. 3097, Civil Code). Lentler's Name: Lentler's Address: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby aflirtn thet under penelty of perjury ihet I am EXEMPT FROM THE CONTRAC70R5 LICENSE LAW for Ihe followinp reason (Sec. 7031.5, Business end Professlons Code: Any city or counry whic� reQuires a permit to construct, elter, improve, demolish, or repair eny sWcture, pdor to its issuence, also reqWres Ihe epplicant tor such permit to file e signed stetament t�et �e or she Is Ilcensed pursuent to the provisions of the Contrectors Ucense Lew (Chepter 9(commendng with Sectlon 7000) of �Ivislon 3 of t�e Business antl Professions Code) or ihet he or sha Is exempt therefrom end the 6esis for Ihe ellegetl exemption. Any violetion of Section 7031.5 by eny epplicant for e permit subjects the epplicant to e civil penalty of not more then five hundred dollars ($500).): ❑ I, as awner at Ihe pmperry, or my employees wlth wages as their sole compensation, WILL DO TT1E WORK, antl ihe sWCWre Is not InterWetl or oflered for sele (Sec. 7044, Business and Professions Code: The Conirectors License Law does not apply to an owner of property who builds or impmves Ihereon, and who does such work hlmseN or hersalf or through his or her own employees, provided that such improvemenis ere not Intentletl or oflared for sele. If, however, Ihe bullding ar improvement is �d within one year ot completion, the ownar-builder will heve the burden ot Orovinp thet he or she ditl not build or improve tor purpose ot sele.). ' I; es owner of the property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct t�e projact (Sec. 7044, Business antl Professions ��Cotle: The co rectors Licensa Lew does no��►ply to an owner ol propeny who bulltls or Improves Ihereon, end who comrects lor such project wlth e comracbr(s) license pur nitothe ContractDrS Litensg4aw5�k/ ❑ lem Ilcense. ❑ Ves - ❑ No Business and Protessions Code for ihis reeson: Verificetion ot Ownership by (rype of document, I.e. - properry ta: blll or deed): DIVISION OF INDUSTRIAL SAFETY PERMR CER7IFICATION: ❑ I hereby cenify ihat no excevation tive (5) or more teei in depih Into which e person is requiretl to Oescend, will be mede in connectlon with work authorized by t�is permi6 and that no building strucNre, scaHolding, talsework, or tlemolition or dismantling theraoi, will be more then ihirly-six (36) teet high. (Chep. 3.2, Gry 2, Ar12, Sec. 341, Titie 8, Celifomla Adminisiralive Code). ❑ As owner-�uilder, I will nat employ enyone to do work which would require e permit irom the Division of Industriel Setety, as notetl ebove, unless such person hes a permit to do such work from tha division. SignaNre: Date: Division ol Indusirial Safety Pertnit Number: CERTIFlCA OF COMPLJANCE AND AIJfHORIZATON OF ENTRV: 1 cenity under penelry oi perjury Ihet I heve read Ihis epplicetion and state ihat the infortnetion given is correct. I ee o comply with �state�� eD � i {dinances relating to bullding construction, entl euthodze representatives ot 1he Ciry oi Coste Mesa to enter upon ihe above-d crib pro0erry to c Gse /ee not to occupy or ellow occupancy of eny building authodzed by Ihis pertnit until finel inspection. - ' - --��., �Z��Q-� 5`Ig�e.Of.Legel�OwneMs� Date - `� And/Or Authonzed AOPlicant Date COOE t. INSPECTIONTYPE 1676 Fixed System Final Fire Preventlon 1266 . Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Final Fectory Fire Place 203 Final Sign 204 Final Demolition Q� �¢ �QQ�( INSPECTIONTYYE 206 Finel Mechanical 208 Finel Plumbing 270 Finel Electricel 212 Flnel Flre Prevention 220 Finel Planning Approval 222 Final Slte 250 Finel Builtling/Oaupenty �g � p1a) 75a-5273 • Fau (7�a) 75a-4e56 • www.ci.costa-mesa.ca.us n rNin unrvc, �vair mwr, �., ��o�o BUILDING PERMIT Job Address: 3233 IDAHO PL Suite: Vicinity: HOUSE & ATTACHED GARAGE Parcel Number: 13908312 App�icant: SHOBE, CONNIE AddrEss: 3233 IDAHO PL COSTA MESA, CA Owner SHOBE, DAN P Address 3233 IDAHO PL . COSTA MESA, CA Contreotor: OWN ER-BUILDER Address: Zip: Arch : Address: Phone: Zoning: Phone: (774)540-2801 Zip: 92626 Phone: (774) 540-2807 Zip: 92626 Phone: License: 0 Eng: Address: ISSUED BY: Slatus: ISSUED Applied: 08I30/2000 Issued: 08/30I2000 Phone: Zip: License: License: SCOPE OF PERMIT REROOF EXISTING 2-STORY SINGLE�FAMILV RESIDENCE & ATTACHED�GARAGE (22 SQ). TEAR OPF EXISTING, INSTALL 1 LAYER OF 15# FELT UNDERLAYMENT"& REROOF WITH 25 YEAR COMPOSITION SHINGLES. Plan Check: $0.00 Permit: $69.25 SMIP Res: $0.50 SMIP Cqm: $0.00 Other: $0.00 Inspection: $0.00 Total: $69.75 SETBACKS MAIN STRUCTURE Froni Q- D ACCESSORY Front 0-0 PARKING Existinq: o NOTES: Rear 0- 0 Rear 0-0 Required: 0 FEE SUMMARY PLANNING 8 ZONING lek 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0-0 $2,000.00 sz,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ortl. No. 92-28, § 7, 12-21-92) EXPIRATION: 7his permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 1 BO 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 Inspeetions and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2406�66 (fV00) , WORKERS' COMPENSA710N DECLARATION: � I hereby affirtn under penelty of perjury one of iha following declaretions: ❑ I have end will maintain a certificete of consent to selt-Insure tor workers' compensation, as pmvitled for by section 3700 of Ihe Lebor Code, tor the pertortnance of the work tor which this parmit is issuetl. ❑ I have antl will maintain wo�ers' compensation insurance, as requiretl Oy section 3700 ot ihe Labor Code, tor Iha peRortnance ot the work for which this pefmit is issued. My workere' compensation Insurance carrier antl policy number are: Carrier: Policy Number: (This section neetl no! be comp/efed i! fhe permit is valuetl et one huntl�etl tlallers ($100) or /ess.) ❑ I cartiy that in the pertortnance of the work for which this permit is issued, I shall not employ eny person in any manner so as to becoma subject to the workere' compansation laws ot Califomia, end agree that if I should becoma subject to t�e workers' compensation provisions of Section 3700 of Iha Labor Cotle, I shall forihwith comply with these provisio�s. Applicant SignaNre: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATIIXJ COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CNIL FlNES UP TO qJE HUNORED THOUSAND DOLLAFE (5100,000), IN ADDITION TO iHE COST OF COMPENSATION, DAMAGES AS PRWIDED FOR IN SECTION 3]OB OF THE LABOq CADE, IMERESi, AND ATTORNEVS FEES. LICENSED CONTRACTORS DECLARATION: i I hereby aHirm that I am licensed under provisions of Chapter 9(commencing with Saciion 7000) of Division 3 of ihe Business and Professions Cotle, and my license is in tull forca antl eHect Lic. N Class M Contrectors Signature: Date: CONSTRUCTION LENDING A6ENCV: ❑ I hereby affirm ihat there is a cons�ruction lending egency for ihe performance oi lhe work for which this permit is issued. (Sac. 3097, Civil Cotle). Lender's Name: Lenders Atldress: SiqnaNre: Date: OWNER-BUILDER DECLARA710NS: I hereby aHirm thet under penalry of perjury Ihat I em EXEMP7 FROM THE CONTRAC70RS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Protessions Cotle: Any city or counry which requires a permit to consiruct, alter, improve, demolish, or repair any swcture, pnor to its issuance, also raquires the applicant for suCh pertnit to File e signed statement that he o� she is licensed pursuant to the provisions of tha Contractors License Law (Chapter 9(wmmencing with Section 7000) of �ivision 3 of the Business antl Protessions Code) or that he or she is exempt therefrom and Ihe basis for tha alleged exemption. Any violetion of Sectlon 7031.5 Dy any applicent for a pertnit �s �acts.the applicant to a civil penalry of not more than five hundred tlollars ($500).): I,�as owner ot ihe properry, or my employees with wages as their sole compensation, WILL DO THE WORK, and ihe simcture is not intended or oNered tor sale (Sec. 7044, Business and Professions Cotla: The Contrectors License Law does nol apply to an owner of property who 6uilds or improves thereon, antl who does sucn work himself or herselt or ihrough his or her own employees, provided thai such improvements are not intended or offereQ for sale. If, however, Ihe building or improvement is sola wit�in one year oi completion, the owner-builtler will have the burtlen ot proving ihat he or she did not build or improve for purpose of sale.). ❑ I, as owner of the properry, am E%CLUSIVELV CONTRACTNG WI7H LICENSED CONTRACTORS to consiruct ihe prolect (Sec. 7044, Business antl Protessions Cotle: The contrectors License Law tloes not apply to en owner of property who huilds or Improves ihereon, and who contracts br such pmject with e contractor(s) license pursuant to ihe Conirectors License Laws.). Business and Protessions Code for ihis reason: ID verified by driver's license. ❑ Ves � ❑ No Venfication ot Ownership by (typa of tlocument, i.e. - pmperry tarz bill or deed): DIVISION OF INDUSTRI/LL SAFETY PERMIT CERTIFICATION: ❑ I hareby certify ihat no exca�ation five (5) or more teet In depih into which e person is required ro tlescend, wlll be made in connection with wark euthorized by ihis permit, and thal no builtling siructure, scaflolding, felsework, or tlemolition or dismantling �hereof, will be more �han thirty-six (36) feat high. (Chap. 32, Grp 2, AA 2, Sec. 341, Ttle 8, California Administrative Cotle). ❑ As ownar-builtler, 1 will nol employ anyone to do work which would require a pertnit from the Division ol Industnel Safery, es noled above, unless such pereon hes a permit to do such work from Ihe division. Signature: Date: Division ot Industnal Safety Permit Number: CERTIFlCATE OF COMPLIANCE AND AUfHORVATON OF EMAY: I certify under penalry oi perjury ihat I have read this application and sta�e that Ihe infortnation given is corr C I agree to comply with ell state laws end ciry ordinances relating to builtling construction, antl authorize representatives of the City of Costa Mesa to enter upon the -tlescr� ,p� �or inspf'$yq�purpo�qs./j ag�ot to occupy or allow occupancy ot any huiltlin�t� r� by this permit until (r� inspection. �!� 1 / Yl J� Y 9A'1 /1 d Q, / l/ ! 1 }S.�'[t 7K/� O� (/t/V SignaNreOf�LegalOwner(s)-�-- _ � Date�— - AndOr Amhorized ApplicaN Date COOEt, INSPECTIONflPE 1616 Fixed Sys�em Final Fire Prevention 1266 Pool Spa Finel 200 Final Re-Roof 201 Final Block/Retaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demalition j1�jE INTRIpLS %'1�1-�� w6 ,� �lC CO�E I INSPECTION TYPE 208 Final Mechanical 208 Final Plumbing 210 Final Elactrical 212 Final Flre Prevention 220 Final Planning Approval 222 Final Site 250 Final BuiltlincyOccupancy �� o� �� %�2eda S'uiE'd� Di,uiQio� OWNER-BUILDER VERIFICATION A city or county, which is required to give notice pursuant to Sec[ion 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit,'require'the completion and requi�e [he retum of, an owner-builder verification. Attention Property Owner. An `ownerbuilder' building permit has been applied for in your name and bearing your signa[ure. Please complete and retum this information in the envelope provided at your eazliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building pemtit will be issued until this verification is received. I. 1 personally plan to provicje the major labor and materials for conswction of the proposed property improvemenL �'Q7 Yes ❑ No 2. 1(have/have not) _�li� UE signed an application for a building permit for the proposed work. 3. 1 have contracted with the following person (firm) [o provide the proposed construction: Namt _ Address Phone ( City — Contractar's Lic. No. 4. 1 plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Namc Address City Phone ( ) Contractor's Lic. No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work tOd2-d6 (REV.95B) ! I hereby affirtn tha[ I have received a copy of the informa[ion se[ forth in Section 19830 of the State of California Health and Safety Code and have completed the above information to the best of my personal knowledge, in compliance wi[h [his S[a[e law. / � i ' � � 11 I _� _�' I. I l,� '.�// _ �L `.� ' �l i r/ �(�.li � •' � .. u. / / ♦/ For more infarmation call City of Costa Mesa Building Division at (714) 754-5273. 1042�6 (REV.B/98) PROJELT AOOHESS: 3 Z Z j IDAHO PL � � owxensname: 3223LIDAHO pLEMISTOKLIS aooness: COSTA MESA. CA 92626 557-5352 AFCM/ENGINEEfl: ADUflESS: UNIT: NEG.NO.: UNIT: PEflMIT1EE: ROH' S ROOFING ( 714 ) d92-5397 aoonEss: 17097 VAN DYKO LN A.B. CA 92647 LICENSEO CONTBACTON UECLAflATION: I here�y allirm iha� I am licensed un0er provisions of C�apter 91�ommencing with Section �000� oi Div� ion 3 of the Business and Pmlessions Code. antl my li n rs m full fome antl efiec� cirv uc.: � 5119 5 srnre uc.: 5 3 2�f��, CF79— X P: 10 / 9 4 �Oa�e: �� Signature WOBREFS'COMPENSATIONOECLAPFTION: I�ereOyat�irm��allhaveacetlificaieofcon5 t elf-in5urearacerti�icaleo�Worker5' ComDensalion ISs��g� $�cglple�c9pY �hereof (Section 3800. La�. �(3 / O I/ roucv r+o.: STAT E E%P. DFTE: COMPRNV: �( � Cenifietl copy is hereby furnishe4 Lf Certi�iea ih Ih ci Buildi Divi ' n. ate: � —�� AP�IIca�� c E%EMPTION FBOM WOFREBS' COMPENSATION DEQAflpTION: (This section neetl not be comple�ed il ermil is far ane huntlred ($100) or less�. I certity Ihai in Ine oerformance ol tne work for which ��is permit is issueJ. I shall not employ any person in any manner so as Io 6ecome sublect Io i�e Warkers' ComOensalion taws of Califomia. Daie� SignaWre�. NOTICE: I�. a�ier making tAis tleclaraiion. you 5hou10 become su�lect lo the Workers' Compensa�ion provisions of the Labor Cotle, you musi tonhw�th compry with such pmvisions or ihis permit shall be Oeemed revoke0. CONSTBUCTION LENUING AGENCY: I here�y affirm Iha� tAere i5 a tonstmttian 1¢ntling agenCy �or Ihe peAo�manCe ot ��e work tor whlch thls permit Is Issued (Sec�ion 3097, Civ. C�. LENDEH: aooREss: OWNEP 6WLOEH OECUBpiION: I hereby attirm tna� I am ezemv� ��om Ihe Contractors' State license Law for �he followinA reason (Seciion 7031.5 Business antl Pmlessional Code'. Nny ciry of county which requires a permit ro consiruct, alter, improve, tlemolish, or reDair any SlmcNre. prior to ils issuance. also requires �he applican� lor such permit to �ile a signetl s�a�emen� �hat helshe is IicenSeU pursuan�iothe pmvisions o��e Contraciors' Slaie License Law�Chap�er9(commencing wi�� Seclion 7000�of0ivision 3 o�the Business an0 Prolessions Cotle) or Iha� �elshe is exempt therelmm anA Ihe basis lor �he allegeG exemDtion. Any violaiion oi Sec�ion 7031.5 by any applicant �or a permi� su�jec�s the aDPlicani Io a civil penalty o� no� more Ihan five hunOred tlollars (5500). � I, as owner of �he pmperty or my emyloyees wilh wages as �heir sole compen5aiion, will tlo �he work, antl �he I ❑ slmclureis nolintended oroffered forsale(Section 7044, Busmess and ProleSsionalCode: The ConVactor5' State License Law tloes not apply lo an owner of a pmDehY who builtls orimproves ihereon, antl who does such work himseli/herself orihrough his or her own employees. Dmvide0 Iha� such improvements are no� imentled or o��ered �or sale. I�, however the buil0ing or impmvemeni is 5oltl within one year oi cDm01e�i0n, ihe owner wili �ave Ih¢ Durden ol pmving he/She did not bui10 Or imD�Ove for I�e Durpose o� sale�. I, as owner of �he proper�y, am exclusivery coniracting wilh licensea contraclors �o cons�mcl Ihe prole�t (Section 7044, Business ❑ and Pm�essions Code'. The Contrac�oR' State litense Law tlaes nol apply lo an owner of Dmperty who builtls or impmves thereon antl who coniracts lor such prole��s wit� a contracbr(5) license pursuant Io the Conlraciars' Stale License Law�. I am aware �hat proo� o� Iheir Worker'S Compensation insurance 5�ou10 be pmvided to me. � I am exempi undcr Sec�ion�. B. B P. C. lor Ihis reason: Oa�e. Owner I ao hereby certily that I am aware al ana undersiand I�e reQuirements o� Calilamia,Health antl Salely CoOe Seclions 25505, 25533, and 25534 anOlhat I or any IUWre Dwiding occupant wllllwill not (circle one) need to comply wi�h saitl s�e�e cotles antl Ihe requirements for a permi� lor conslmciion or mo0ilicaiion fmm Ihe Air Oualiry Managemen� DisVicL Pesitlential cons�mction applications are exemp� �mm I�ese pmvisions. Da�e'. Applicanl: I neBby cetlify Ihal I have read t�is applicalion antl s�a�e � mfor ion is correct. I agree �o compty with all ciiy and couniy artlinancesantlslatelawsrelalingtobutlUingcons�mctio ndhere�yau rizere ema�rve thiscityloemeruDoniheabove-mentionetl prop�rtY lo '^Pe� PurPases. � / Da�e: Signamre: oriver's �icense or Socia� Securiiy n: �6ui a6 W�ue—Builamg: Green—CoOe Enlorcemeni; Ganary—Applicant; Pink—Fevenue; Goldenrotl—Assessor CITY OF COSTA ME$A — BUILDING PERMIT PERMIT NO: B 068568 PLAN CHECK NO: N CONSTAUCTION TYPE: V—N PERMIT TYPE: STR PERM NO; B 068568 GOVT: N SUPP; N PURPOSE: ALT JOB DESCRIPTION ; T/OFF, REROOF W/COMP. SQ FT: 3,900 CLAIM VALUE; 3,900,00 CALC—VALUE: 3,900,00 GROUP OCC; R-3 ! COMMENTS: SMOKE DET REQ PER 91UHC �r*�r-��r��x-�-*�t****-�r*�r***-�rx-+r*�r-�t**�r�-�t�-�-��*�r*x�****-x��n*-��r****�t�r**�-�r��c*�r*-�c�-��**�t�r�-�-x-�r*�x-�x-�- Z O N I N GS ERTEBQAUCIKRSE M E N T S ------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT; FT IN REAR; FT IN ERNT: FT IN REAR: FT IN LEFT; FT ZN RGIiT; FT IN LEFT; FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 13908314 ZNE: REF NO: PLANNING NOTES> �, i x��tx�*x��rx��r*�r�t�t+ri�x�x�*�r*�r*it�tir*�rx�+t+tx�+r�r*ic��r*+�+r*�rirx��r�r+t*x�*x�+r+t-*x�x�**+�+r�c-i��r*�r****�r**�r+r�r*x�x-**�t D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N'T' S ZONING APPROVED BY � DATE: BUILDZNG APPROVED BY ; DATE; APPLICATION ISSUED BY; DATE: u` �`" itiEi4itililiEiEiEkitlfillEiEihiFiEitlEiliE ffifitiEiEiEiEfElEif�i� iE� ilklflEfEkifiEifififiElElEiEiEiEiEifiEiEiliEiEfEiEflkiEiE iE illEiEifltiEiElE4iE iEiEiEillEiEiEifiEiEMififiEfEiEiEiFififiEiEiEifikifiEiEfEjfiEiE1E LEGALIZATZON;N F E E S U M M A R Y STRUCTUAAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECAANIC FIRE~ SMIP/RES GRADING PERMIT 63,00 - .50 � SMIP/NON—RES PLAN � ISSUE FEE , BUILDING—DIV—> PERMIT ISSIIE PLAN—CHECK TOTAL PAID DUE TOTALS----> 63,50 0,00 0,00 63.50 63,50 ,00 REVENUE DIVISION TOTALS--� COLLECTED: 63,50 OVER/SHOAT: ,00 HLDG PMT PLOMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 63,00 .50, iE 1f 1E k fE k it it if 1E 1E fE 1f !E iElh 1k if �E 1! iE ft 1E if iElE 1f if i! ik tf iF it iE fE 7f iF 1f !f iElE fElFlF 1E ff ff k iFlt iE iE if 1ElF it ik if jE k fE k ik ik fklE iE 1f it if ff iE fE k 1E iE fE fE fE I N D I V I D U A L F E E H R E A K D O W N TYPE SFR QTY 3900 D E S C R I P T I O N UNIT COST REROOF BY VALUE RESIDENTIAL NOZONE 1'.00 END OF FEES TOTAL COST 3,900.00 � i3f OO1dS4 14-00 1664 15 T�7tT DATE: OS/22/94 TI17E: 14:29 ti3.50 C�NSTRUCTION AND PLANPJING � I POC SPA -�- -' � A�PROVAlS Permit# --�--- _ Date I�spector APPROVALS Permit# Date In`specmr 1. Temporary Electrical Service o� Pole , • 52. Pooi & Equipment Location � 2. Suil Pipe�Undrgmd. ' ., . i 53. S[eel Reinforceme�t 3.� Ef2ctricai Conduit Utility-Unci�'grnd.. � t 54. Forms � ;4. Electrical CondUit-Undrgrnd. - 55. Electrical Bonding ' 5. Steel Reinforcement 56. Rough Plumhing & Pressure Test _ - 6. �kectricat U�E-R Grnd. 57. APPROVAL TO COVER�GUNITE 7. Footings -� '' S8. Electricai Conduit-Ur.drgrnd. �8. Foundation � - , 59. Gas Pipe, � Undrgmd.. Tes[ , 9. N:'ater Plpe-Undryrnd. � I 60. Backwash Lines, P�Trap, C7 Undrgrnd. � .1D. Structural Floar System ., 67. APPROVAL TO DECK �1 S 1. Property Sewer line & House Connection �� 62. Backwash & Receptor�Pinal � 12. Se,ver Cap 63. Heater & Vent-Final 13. Roof Drains � .' 64. Plumbing System � Final � 74. Rough Plumbing - 65. Eiectrical-Finai 15. Ronyh Eiectrical-Conaurt 66. Solar System�Flnal j � 76. Rough ElectricWiring � 67. Fencing & Access Approva! I 17. Rough Wiring Sign 68. APPRQVED FOR P�ASTERING 78. Rovgh Electrical-T Bar Ce�ling 69. POOUSPA SYSTEh7S PINAL 19. Ro�gh Heating & Air Conditioning FIRE DEPT. REQVIRENIENT 20. Rou9h Factory Fireplace - . ' ' . �APPRQVALS �� Petenit # ' - • � � _ 21. Duc,ts, in Structure , ��. . ; J0. Under9rounGl Hyclro 22. Duits, Ventilating i . . " �. � 71, produc(,Piping O�ius C70i1 23..,Gas;P�pe�Rough & Tes. - � • 72. Underground Plush ; , � 24. Aoof 'rramin�g � � .' 73,� Undergrnd. Smra�e l'ank O Gas u Oil 25. Ro`dt Sheathino '.R Z3-�(.r<'�i(,:/�L- � 74 � Overhead'HVdro� �� [i 26. T-8ar Ceiling (Structurell & Monocoat � � 75. Dry Chemicai � ' n 27. Frame and Plash(rig � ;_ 76. 6ry Standpipe .- ' ' 28. � Lathing & Siding . ��, , � ' �• � ••' 77." FIXED SY9TEM FINAI • 29. Insulation '' .. .. . ' i i i` . 78.� FIRE PREV. FINAL . . � 30. Ory�vall Nailino -. � � � � �� . - HEALTH DEPT. REQUIft�EMENT � 37. P�aster Brown Coat ' . � �' � .79.' FINAL INSF!GCTION . � . � �32. Ekectricai Pow2r Metec-Final . i ' � 80. FOOD CERTIFICATE ISSUED .33.,Fin, i Elec,ric � - �� Nojes: -� . +34. Pinal Neating & Air Conditien,�g� i � � � . ��• � � � � � .. 35. Final Gas Pipe�Test � ' � � - �, - ' ' � t . .. -_1_` , ---- 36. Ho�od or Canopy . � � � . ' �•� + _ - �,37.'Final FactorV Fireplace � , �' ' „ �� , 1`: �• .�38. Pindl Plum6ing I � .- . � 39. Water Service-Final � - i � �` . ' . 40. Ges Service-Final - . , ! �. � � ' "41. Solar pomestic-Final � - . � , � 42. Backflow Preventer " ' � I- Q Z�� L>�� `�,� L�� a C fL 43. Backflow Irrigation � ' � ' �� f,. _ �,'„��' ,�� , �G�. /��. av 44. Landscape ir'rigation Systzm � . ' ^ � 45. Sound Attenuation , � . �. � . '=•46.. Handicap. Regulations ' • , 47. FINALSTRUCTURE&BUILDING ��0� /'w � • v 46..FINAL PLANNING � . � - , 49.�Hectric Release to Edison � � �� ' . � 50. Gas fieiease to Southern Califor,nia Gas Ca � � i• y- • . , . 51. CERTIFICATE OF OCCUPANCY � No. Date i` ?VQ��Can� to �ill in all spaces wilnln heavy boracr lines anA zi9n all appropriate tleclarations. . CFTY OF COSTA MESA PERMIT NO. ' TRACT NO. LOT NO. BLDG. NO�. - �_ . ... CONSTRUCTION PERMIT g�-7g�$ '�0�-5 " 1732 7/06/83 46.85 ,projectAddress 23 Q � TVPE OF CONSTRUCTION - � � • , .owner p Phone ❑ NEW �iADD ❑ ALTERATION � ABdress 3� 33 R' d (K� - ❑ REPAIR ❑ CONVERSION ❑DEMOLISH � 'Arch/Eng. �j.i f- A Sp L�Z� � OTHER `o A.P � ^OING REGULATIONS icense No. DESCRIPTION OF WORK Addre55 ' ' - h � Q ZONE PLNG. REF. � Contracror ' Q W ,G Phone � TVPE OF PERM �l� �.'Ll_OSGT B o To BU1 LpING Address � ❑ GRADING ❑ FOUNDATION SETBACK C 15T. PROPERTY LINE �,STRUCTURAL LED TVARD .L G �LICENSED CONTRACTOR DECLARATION - . _ ❑ TENANT ❑ ELECTRICAL OPLUMBING ❑MECHANICA 5IDE VA I hereby dHlrm that I am IlcanS¢tl untl¢r prOvi5ion5 Of Charter 9(com- . qIGHT � mencing wlth �section ]000) of Division 3 ot the Business antl ❑ OTHER ' REAR VARD (TO P/�) Professlons Cotlo, ana my Ilcanso Is in tull torce ana e(fect. PROJECTDESCRIPTION License Class Llcense No. - PKG. SPACE REQ. '-- PROVIDED Da[e Signature - ' - Sa' FT' �� p - � ,,,�- STREET WIDTH PARK FEE E WORKERS'�COMPENSATION DECLqRATION •� OCCVPANCVy-�CONSTV SICTION TVPE I hGreby atfirm that 1 hav¢ a ce�tlfic8te of con5ent lo self-Insu�e or a VA�UATION IS��' I ' ZONING APPROV D C¢rtifirate o( WOrkers' COmpensatloq Insurance, or a Certifietl copy - ZONE ��+ereof (Sectlon 3000, Lab. C.). �GRADING�CV. VDS. � ACRES SGECIALCONDI ONS: ' - - :YNo. ComPany .-��.—_�.-�-."" . . . :ertifietl copy li hereby furnlshetl. . . . . ' REMARKS: ' �. p LJ CertlfieG copy is filea with the tlty Builtling Division. '� ' —" n "r� r� � �- - � � - EXEMPTION FROM WORKERS' COMPENSATION DECLARATION �' �� ' (This sectlon neetl not De completetl If the permit is for one huntlretl , � , • . . . S5100) or less ' � " ' Ce�tify thdt �n the pe�formanGe Ot the work for whlch thi5 permit'Is ISsuetl, I sM1all nOt�¢mploy any p¢r5on n any manny r 5 5 b ome ".PLUMBING PLAN CHECK ' ELECTRICAL - PLAN CHECK suEject to the Workers' Compensatlon ��'f C�JJf6mi Date ' Signatur¢ �� ti�� BATHTUB$ SHOWER$ NOTICE: If aftar making this tleclaraUon, you shoultl become subject TOILETS- VRINALS GENERATOR 0-1 KW_1-10 KW' - to the Workers' Compensation provisions of the Labor Cotle, you must TRANSFORMER , torthwith comply wi[b such prow510n6 or this permit shall b¢ tleemed LAVATORIES DOUBIE LAVS APP�IANCE 10-50 KW_50 + KW � revokeC. � CONSTRUCTION LENDING AGENCV � � KIT. SINKS ' DISHWASHERS � MOTORS 0-1 MP__1-30 HP I hereby aitirm that ihere is a conSlry�tion lentling agency for the perv SERVICE SINKS SUMPS' - . (�NG SOLAR), 30-50 HP 50 + HP . fo�mance of Ih¢ wo�k tor whith this p¢rmit is I55uetl (Section 309] Civ. C.�: �Q�� - FLOOR SINKS '� FLOOR DRAINS ' FIXTURES �OUTLETS� SWITCHES � Lentler'S Name Lentler's Atltlress - � -- ' DRINKING FOUNTAINS ' -• -GAS TUBE SIGNS -� - - OWNER BVILDER OECLARATION ' - INTERCEPTORS' CLARIFIERS " ' ' '- - POLELIGHTS � 1 her¢by atti�m that I dm ¢xempt t�om (h¢ Cont�actor'S License Law fot the tollowing reason (SecHon 7031.5 Business antl ProfessionS�Cotle: SWIMMINGPOOL PTRAP' - Any city or coun[y whlch require= a permit to conztruc[, alter, PO�ES - METEREO SVB ' improve, tlemolish or repair any s[ructure, priorto its Issuance, alzo re- y.�qTER�SERV ICE " - ALTERATION '- - PANELS MAIN SVB � quires the applicant for suth pe�mit t0 lile a signetl sta[ement that he Is Iicensetl oursuanc to'tne provislons ot tne Contractor's License Law GAS SERVICE � �� - OUTLETS " SERVICE � - � � - AMP � (Chapter 9(commencing with Section �000) of Division 3 of [he P^alne55 antl Professions Cotle) or that he is exempt tnerefrom antl the � yyqTER HEATERS - BTV OUTPUT - - -- - � . ' for tne allegetl exemption. Any ��olation of Settion 7031.5 by appliWnt for a permit su�jects [he dpplicant to a civil penalty SEWER CONNECTIONS ` - - � �- - � - �- .o[ more [nan fiv¢ huntlretl tlollars (E500). ,va� I as owner ot ihe properly, or my employees with wages as their SOLAR TANK ' COLLECTORS � 'S01¢ compen5ation, will tlo tM1e wOrk, and lhe.struGture is not intentletl or offeretl tor sale. (SeGtion 7044, BusinMs antl Aofessionz Cotle: The SOLHR PIPING $VS. �� SSUE FEE � - 3 e. Contractor's License Law does not appry to an owner of a DroOerty APPbICATION APPROVED BV . OHT wh0 builtl5 or improves thereon, antl y,•ho tlOes Such wo�k himself or ' ISSUE FEE � �� 4 through his Own.employee5, ptOvltletl {hat such Improvements are not - intentletl or oHeretl for sale. It, howeyeq tne builtling or improvement MECHANICAL PLAN CHECK - � SUMMARV OF,FEES ' � is soltl wilhin one year oi completlon� th¢ Owner will nave th¢ burtlen of proving he tlitl nol builtl o� ImprovC for the Purpase of Shc2). ' � BUILDING �+SJS� ' ' .. 0;�0 HEATING $VSTEM 0-100,000 BTU PERMIT $ K SMIP $� � I; as owner o/ tbe property, �am exGusively con[racting with. qND DVCTING - ' � � ' �' � . licensetl rontractors to conilruct lhe projec[ (Section �044, Business 100,000+BTU PLANCHECK 5� PERMIT. antl Professions Cotle: The Convactor's License Law tloes not apply to . _. ... ISSUANCE E' an owner of property who builtls or improves thereon, antl who mn- qEFRIGERATION 0-300,000 BTU i PLUMBING $ . tractsfrom�such projecls•with a contraGtor(s) �licesnetl pursuan[ to SVSTEM ' 100,000+BTU - PLANCHECK� -�� GRADING E ine Cantractor's Licenie Luw). . $ � �¢ -p , . � 0 I�am exempt unde(Sectlon B. & C. for tM1is BOILERS BTU - ELECTRICAL $ L_ ' S �-- reason - - - ' .. . , _ _ � MICROFILAA $ Date �� `R � Owner SVSTEM REPAIR, ALTERATION PLAN CHECK � S� „TOTAL FEE S�� I hereby certifythat I have reatl this a lication antl state that [he above EXHAVST SVSTEM MULTIPIE MECHANICAL S , � •� PLAN CHECK S CE55 AD- , information Is mrrecL 1 aqree- lo cOmpty wlth all city antl county ' VANCE PC E ortlinances anC state laws relating lo consV tion, antl hereby authorize . . repre5entative5 this City O kr he above' mentlonetl � ' property_ for n ection p ose . '� �j 3 Slgnature Date 1��, � p . FINAL FEE E� � �—� ISSUE FEE L+-6.+�5 Orivers' Licens or SS � ' ' ' CMF OB6S-9b WM1ite-BWltling: (:dndry-AppllGdn[; Plnk-AttounUng: tuoiaenroa-t+sse»o� CONSTRUCTION AND PLANNING - �.. -.- ,`%?OOL & SPA • ; � Date Inspector � `� � , �Date,. . Inspector APPROVALS Permit # APPROVALS . . Permit � � � _ _ _, , �. -� �i. Temporary Electrical Service or Pole 43. Pool & Equipment Location -- '� " �'� '" - 2.. Soil ipe-Undrgrn 44. Steel Reinforcement � ' ' � ' � " ' ' 3. Electrical COnduit Utility= ndrgrri .� �� - '> > , ', . 45. Forms - " " • " ' ' �" � 4. Electrical Conduit-Undrgrn . . 1� ; �. �'��•��_'• � : 46. ? Electrical-Bonding . tee ein orce �--�'� �.�' - ' ' ' •� 47.�` Fiough Plumbin & Pressure Test - ' " " � � y' � � " � 6. Electrical UFER Grn `;� ,' �.r'-- �' 48. APPROVAL TO COVER-GUNITE ]. .Footings,, �.. Ll `.' 49. Electrical Conduit-Undr rn 8. � Foundatioti� + • � 50. Gas Pipe,. ❑�Undr rn, Test 9. Water Pipe-Undrgrn - 51. Backwash Lines P-Tra ❑ ndr rn 70. Structural Floor System ' 52. :AP,EROVALTO DECK ' �11. Property SewerLine:&�House Connection .'5'3: � Backwash & Rece tor-Final ' �� 12. Street Sewer Connection� " 54. Heater & Vent-Final 13. Rough Plumbing - � -' 14. Rough Electric-Conduit � 56. Electrical-Final . • ' 15. Rough Electric-Wiring /-g%8 �� - 57. Solar System-Final 16. Rough Heating & Air Conditioning � � � encing & Access Approval ' 17. � Ducts in Structure � APPROVED FOR PLASTERING - 18. Ducts,Ventilating ' - . � , .. .� , 19. Gas Pipe-Rough 8i Test � 60. POOL/SPA SYSTEMS F INAL , ' � 20. Roof Framing � - 21. Roof Sheathin - - � ' � 22., Frameand�Flashin . NOTES: � �, 23. � �nsulation - ` � � � •' . �_ . 24. Lathin & Siding - - ' � - - - � 25. Drywall Nailing � - � 26. Plaster Brown Coat � 27. Electrical Power MeterFinal � �- � � 28: Final Electric - - � � � 29. Final Heating & Air Conditioning � 30. Final Gas Pipe-Test � - � 31. Final Plumbing � � 32: Water Service-Final � 33. Gas Service-FinaF .:�-34.. Solar pomesticFina(=,,. . ' ' � � � 35. ' Landsca e S rinklin� S"stem � 36. Sound Attenuation - � � � 37. Handicap Regulations � ' - 38. FINALSTRUCTURE&BUILDING _. 39. Special Requirements Completed � � �40.' �E�ectric Release� to Edison ' �- - 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY � - � _ � No Date , . . . . .` ��vC.��3 �Jc%f�o (�'CP��cant to fill in all soaces within CiTY�OF-COSTA MESp pERM1T NO. � CONSTRUCT'ION PERMIT BEJ� �/ G License Address GorOer lines antl sign all aoorooriate aeclaratior TRACT NO. LOT.NII. BLDG: NO. TVPE OF CON$fRUCTION f� ❑ NEW ❑ ADD ❑ ALTERATION �� 1 ❑ REPAIR ❑ CONVERSION ❑DEMOLISH ❑ OTHER DESCRIPTIONOFVJORK ��< Contractor w Pho�e ' TYPE OF PERMIT Address - � O GRA�ING ❑ FOUNDATION ❑ STRUCTURAL LICENSED CONTRACTOR. DECLARAT�ON ❑ TENANT ❑ ELECTRICAL ❑PLUMBING-OMECHANI I hereby aftirm thtt 1 am licansetl untler rrovision5 Ot Charte� 9(com- mencin9 �+�th section 7000) of Divi5lo� - 3 of [he Bu51ne55 antl ❑ O7HER Professions Cotle, antl my license is �n (uu force antl eitect. PROJECT DESCRIPTION . License Class L.icense No. ' ' ' Da[e St9naWre' ' - _ ___ SQ. FT. ' � �( - WORKERS' COMPENSATION DECLARATION • OCCUPANCV r- � CONST^CTION TV I hGr¢by d(firm that I have a certiflcate Of con5ent to selt-insure or a VALUATION OQ ZONE Cer[IfiwlB of Work¢r5' CoTPensation In4urance, or a certifietl copy . � ?of (Section 3800, Lab. CJ. GRADING CU: V�S. ACRES y No. Company � - � Certlfl¢d COpy is hereby fumishetl. � REMARKS: . , ❑ Certltietl copy is filetl with the cfty Builtling Division. . , EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - � � ' (This 5¢ctlon neetl not be completetl if the Pe�mit Is fov one huntlrCtl . � , - • , SS100) or leu). - . - ' certify that In Ine pe�fo�mance of the work /o� whi h[h'S p t issuotl, I shall not employ any Oers n any mann o s- e e PLUMBING ,,PLAN CHECK subject e W rkers' Compensati ws oi ia. � Date ,��9,�Si9nature � BATHTU85 Q✓ OWERS S( �NOTICE: If af[er makinq this tleGidr iOn, You shOultl become SubjOct TOILETS � URINALS' - "- to the Workers' Compensation provisions Ot the l.abor Cotle, you muzt turthwith comply with such provisions or this permit snall be tleemeC LAVATORIES Z DOVBLE �HVS � revoked. CONSTRUCTION IENDING AGENCV � KIT. SINKS ' Di5HWA5HER5 " 1 hereby afti�m thai there is a construcOOP lentlin9 agenty tor lhe p¢r SERVICE'SINKS SUMPS -� ' formance ot the work for which tnis permit is issuetl (Sectlon 309] Civ. C.�. FLOOR SINKS � FLOOR �RAINS - Lentler's Name - � _ ^¢ntl'NS Atltlresf^ ^" ^^^_ ^- ^ � DRINKtNG FOVNTAINS ' ' the followin9 r¢ason (Sec[ion )031 Any city or county which �equ iTprove, tlemOlishqr repair any str quires IhC ap� licant (o� such permi' Is Ilcen5e0 pursuant to the piovisio �Cy�dO�e� 9 (cOmm¢ncing with $e c�ess ana RWessions>Cotle) or t p^F=�^�tor the ailegetl exemption. A :.'::�appliUn[ for a permiY subjeG ot`nol mOre lM1an live huntlretl tlol ❑ I, as owner af the property, or sole Compensation, will tlo'the wor or ofteretl tor Saie. (Settion ]044, Contractor's Li<ense Law�tloes not who builtls o� improves thereon, a ot provinq ne tlitl noc bulltl or impr ❑ 1, as owner bf�the �property, am licensetl conGac[ors fo construct the p antl Professions Cotle: The Conttaclo�'S an owner of pro0erty who builtlz or in [�acts from Such projecl5 wi[h a Cant tne Contrac[oYs License Law). x❑:I.am exempt untler.5ection �' �; �� Q W H � � rea son. ` DaSe Z zOwner I h¢rGbyCErtifythat I have reatl thisappll informatlon is correct. 'I agree to cort ortlinances antl state laws relatina to com a�Pe�mit lo COnS[ruct�, alter, SWIMMING POOC re, Prlor to its issuance, also.re- yyqTER SERVJCE ({ig a signe0 5[a[ement tha[ he 'tpe ContrSc[or's Liconse Law- -GASSERVICE �.7000) ol Division 3 ot [he - he �s'exempt therefrom antl [be .yyqTER HEATERS �iolaLon�of Sectlon ]031.5 by �e� applicant to a clvil Oenalty SEWER CONNECTIO �ygoo). err�0loyees with wages as their SOLAR TANK � � itl the structure Is not in[entletl iess antl Profes5ions Cotle: The SOLAR �IPING SVS. Jy to an owner of a property . vh0 tloes such work himself or ISSUE FEE � ut such imorovements are no[ CLARIFIERS PTRAP " ALTERATION OUTLETS BTU OUTPUT COLLECTORS -- '"y "`^PfO°r'^`"`. MECHANICAL•.i �oLANCHECK Hill_fiave.tne burtlen e purpose ot sale). HEATINGSVSTEM Od00,0008TV y contracting with -qND DUCTING ' tion 7044, Business_ ]00,000 t BTU .w tloes not apply to � �.reon, antl who con- REFRIGERATION 0-100,000 BTU tesnetl pursuant to SVSTEM � . . , � 300,000 + BTU - g+�$FY4�Y4"� BOILERS � d �'4 �'BTV "" SVSTEM REPAIR, ALTERATION statethattheabova EXHAVSTSVSTEM MULTIPLE Signature �� 1e ISSUE FEE ' Driver5' License or SS � ' ' r. —MF 0865-46 White-Builtling; Unary-APPliwnt; Pink-Accounting: Goltlenrotl-Assessor A.P. � 2oNE ..�. •,/.'�,/. NING REGULATIOM1 � — �� _ PLNG. REF. yt H�It;HT�RV �O REHR VARO (70 P/L) PKG. SPACE REQ. ' STREET WI�TH ZONING APPROVED BY .SPECIAL CONDITIONS: � EL'ECTRICAL ':16.:7 TL PROVIDED-�� PARK FEE b . � PLAN CHECK I �� GENERATOR p.l KW_ 1-10 KW TRANSFORMER APPLIANCE 30�50 KW_50 t KW MOTORS ' p�l HP_1-30 HP (IN0.50LAR�- 30-SOHP 50+HP FIXTURES �, OUTlETS� SWITCH GHS'TUBE SIGNS � POLE LIGHTS' ' PANELS - MAIN SUB _SERVICE ' F �IPPLICATIONAPPROVEDBY L�(i.��/DATE9/9b /� /� S�fUM/MARV OF FEES - PERMIT G g rfE,aOO � e��/ SMIP b �•^�2 PLANCHECK §�Ld_!iJ PERMIT PLUMBING E�� SSUANCE S P�ANCHEGK $ � � GRADING $ - . ELECTRICAL � $_Ld._�2_O ' $ , PLANCHECK' S MICROFIUN $. � MECHANICNL $ TOTAL FEE S..y_�? PLAN CHECK $ LE55 AD� - VANCEPC S_— _ FINALFEE $_!.'/G�97 �\ — CONSTflUCT10N AND PLANNING APPROVALS Permit # - 1. Temporary Electrical Service or Pole 7V. Structural rloor System � �' �-1.1... Froperty Sewer.Line & House Connec[ion .. .-•t�2.�.Street.SewecConnection__ � �_ ..1.3..._Rough.Plumbi'ng . i 14. Rough ElectrioConduit ^ , 15. Rough Electric-Wirin - � � 16. -Rougfi'Heating'&"Air Conditioniny� � -"' "'-' 17. Ducts in Structure � 18. Ducts, Ventilating � 19. Gas Pipe-Rough &Test ' � 20. Roof Frartiing 21. Roof Sheathin ' - 22. Frame and Flashin - � 23l insulatiorT - - - - '` - - ' 24. Lathin & Siding " - � 25. Drvwall Nailina Final Heatinq & Air 32. � Water-Service-Final �_ - � 33.• Gas $ervice-Final - 34. . Solar pomestioFinal � 35.= �Landscape SPrinkling SYstem-'� 36. Sound Attenuation 37. Handicap Regulations�'' • �� 38. FINALSTRUCTURE&BUILDING .40. Electric Helease to ttlison 41. Gas Release to Southern California 42. CERTIFICATE OF OCCUPANCY � ' No Date _ • •� � 'i . . . - ! . POOL & SPA. " � ' �' � - . Date Inspector '� • �' � Date � lnspeeto� i. APPROVF�IS Permit# ' 43. Pool & Equipment Location" ' � - " ' � •' 44• Steel Reinforcement " ' " ' � - " '..45. Forms ' ' ' ---� 46. _Electrical.Bonding • i � -- 47. Rou h Plumbin & Pressure Test -- � ' " - - ' - � - ' 48. APPROVALTOCOVER-GUNITE 49. Electrical Conduit-Undr rn ' ' � ' ' 50. Gas Bi e, ❑ Undr rn, Test 51. Backwash Lines P-Tra ❑ n r rn 52. AP2ROVALTODECK �53.`- Backwash & Rece or-Final ' ' � � - 54. Heater & Vent-Final - ' - ''�56. 'Electrical-Final � � ��. - 57.� Solar System-Final ' � _ • encing & Access Approyal, . ' . APPROVED'FORPLASTERING �.,..... ' . . , .. • � _ :. . . _.. . .� . .. . ._ . 60. POOI/SPA SYSTEMS FINAL � - � ]:� � 2 / • � . _ NOTES: . > c 1! -'.) 2- i �l L.r cn,[ /.' i`Kru. Cvls61- bars.�. Y-ti H .. _, Applicant lo fill in all spaces excev� those within heavy Eoraer Iines ana sign ali aoPropHate tleclarations. � CITY OF COSTA MESA CONSTRUCTIONPERMIT Project Address Applicant's Mailin Address ��p Owner's Name hont�T� -4O_�l Address sA Arch/Eng. License No. Address Convacror's Nam 0 � g Phone Address (mailingl City Licanse No. LICENSED CONTRACTOR DECLHRATION I nereby affirm tnat I am licensetl unaer provislons ot Charter 9(commencin9 with section 7000) of Division 3 of the Buslnezs ana Professions Cotle, antl my Iicense is in full force antl eifect. Llcense Class License No. Dale Si9nature 'ORKERS'COMPENSATION DECIARATION nereby affirm that I have a wrtificate of consent to Self-inzure or a certlflcate of Workers' Compensation Insuran<e, or a certlfletl copY thereot (Se<tlon 3800, Lab. C.) Policy No. Company Certifietl copy is hereby fumishetl. Cerlifietl copy is tlletl with the city Builtling Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION OECLARATION (This section neetl not be completetl if the permit is tor one huntlretl (5300) or less). • I certity that in the pertormance ot the wor or wnich this per i Is iss etl, 1 shall not empl Y any person in any man r so as to become ect the Workers' m en fion L2ws of Califo[tji A'v Dace Si9nature S___. NOTIC . It fter making this tlecla�atlon, you ShOUItl become sub7ett to the Worker ' C mpensation provisions of the Labor Cotle, you must torthwith comply with such provisions or th{s Oermit shall be tleemetl revoketl. CONSTRVCTION LENDING AGENCV I hereby atfirm that there {s a construction lentlin9 a9ency for the Oeriormante ot the work tor which�� s_ p�rmit is issuetl (SecHon 309� Civ. C.) LPntler's Nama �� - Lentler's Atltlresz � - OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt trom the C6ntractor's Llcense Law for the following reason (Section 7031.5 Business antl Professional Cotle: Any clty or County which �equi�es a Oe�mit to const�uct, alter, imp/ove, tl¢molish o� �epal� -any st�uclu�e, p�ior to it5 i55uance, also requires the applicant to� such pe�mlt �o file a signetl statement that he/she is Ilcensea pursuant to the provisions of �e Contractor's License Law (Chapter 9(commencing with Sectlon 7000) ot ivision 3 of the Businesz an0 Protessions Cotle) or thaf he/she iz exempt ..iereirom antl the Gasis for the allegetl exemption. Any vlolation of Section 7031.5 by any applican[ for a. Oe�mit subjects the appllcan[ to a Civil qey atty ot not more than five nuntlretl dollars ($500�. Id.l, as owner of the property or'my emplOyees with wages as their sole tompensation, will tlo the work, antl the structure is not intentletl or ot(eretl fOf SdIC ($CCfiOn 7044, BUSiO¢55 dOtl PfOf¢SSi0Od1 COtlC: Th¢ COlIt(dCtOf'S License Law tloes not apply to an owner of a property who builtl5 or improves IM1e�eon, antl who tloes such wo�k himself/M1e�s¢I/ ar tn�ough his or h0/ own employees, provitletl tM1at sucM1 improvements are not infentletl or otteretl tor sale. If, however, the bullCing or improvement is soltl wlthin one yoar ot com- pletlon, tM1e owne�' will have the burtlen of p�oving hE/sbe tlitl not builtl or iT- �rova tor the purpose of sale). I, as awner OI [he property, am exclusively cont�acting with licensatl con- tractors to construct the project (Section 7044, Business antl Pro(e55ion5 Cotle: The Contractor's License Law tloes not apply ro an owner of property who builtls or improves thereon, antl who conVacts for such projects wit� a con- [fdClOf(5) IICEOSE pUlSlldfl[ f0Ih2 Contractor's LICBOSE LdW�. ❑ I am exempi untler Section--�—_B. L P.l�pr is ¢a�on . !/ C— ii Date " Owner iE,b �'� /' ' / /(/( fLTd�. I hereby certit that I nave read this applicatlon antl state that the abova information is mrtect. I a9ree to compty with all city ntl county ortlinances antl state laws relati to builtling <ons u o� ar7� r y authorize repre� Sentatives of fh15 �' to enter up e�6o E- e netl 0/op ty � inSpeCtiOn putpo y Siqnature �e / Driv¢rs' License or 5� Reinspee[ion Fee Builtling; Canary - Appliwnt; Pink - Accounting: GOltlenroU - Assessor /./i -`d % / � TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMO}��9 H❑ OTHER A.p, # DESCRIPTION OF WORK /jfy t�' �� L��/Z-/ T�%% S Main Bullding: 12E� 3'eyc 'I' �2�� E TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRIGAL ❑ PLVMBING IF�MECHANICAL A Reaf ❑ �OTHER C Right PROJECT DESCRIPTION Sp.FT. OCCUPANCY K CONSTRVCTIONTVPE VALUATION$ g Left ZONE GRADING CV. VOS. ACRES p�ng. Ref. # � Remarks: ��....SO Parking Req./Provided Use of Building: PLUMBING FEES Planning Notes: Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation � Sewer Cap Bathtu6s Sewer Connection Clarifiers � $olar Collectors Dishwasher ' Solar Piping Drinking Fountains - Solar Tank � Floor Drains � Swimming Pool w/Spa Floor Sinks � Urinal GasService Outlets- WaterCloset . Interceptors Water Heater Kitchen Sink Water Service Lavatories Roof Orains Reinspection Fee $25 Boiler Duct- UnderGround Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. 81t. ICBO # Heating System & Ducting � � 6100,000 BTU 0100,000 CMF 0865-46 rev. 7/83 $25 / laue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration Sys[em ❑aioo,000eru ❑iao,000 System Repair/Alteration Issue Fee Auromatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers �Gas ❑Elec � Fan F,A,U. Fixtures Device eoxes Outlets Switches ' Garbage Disposal . � Generator �0.5 KW C 6943 I U/U7/F]� Zane Park.Fees $ ELECTRICAL Transformer � 15-50 KW ❑ SO+KW Meter �up to 100 amps Meter ❑over 100 amps Sub Panel Motors �0.1 HP �1X-8 Inc.Solar �9�15 HP �16-15+ � Microwave - Pole Light Range Standing Sections , 5�15 KW Trash Compactor $ 3 �� ; Reinspection Fee $25 Issue Fee FEES ,PUBLIC SERVICES fiEDU1REMENTS: 2oning Approved By . APPlication APProved BY � Aoolication laued Bv — — i � • BUILDING PERMIT PLAN CHECK �,',� PLUMBING PLAN CHECK ELECTRICAL �� PLAN CHECK MECHANICAL $ 3 PLAN CHECK � FEES $ 3 SUMMARV OF FEES . ' � $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGV P.C. $ $ GRADING $ $ � MICROFILM $ $ I��m� TOTALFEE $ Ig�oo. $ S�oO O N I N G R E Q U I R E M E CONSTRUCTION AND PLANNING PC & SPA APPROVALS Permit # Date Inspector AppAOVALS Permit # Date Inspector 7. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement . `, � 3:�Electrical Conduit Utility-Undrgrnd. - 54. FormS 4.-Electrical Conduit-Undrgrnd. . 55. Electrical Bonding � 5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test • 6• Electrical UFER Gmd. �� 57.� APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. �- 8. Foundation 59. Gas Pipe, � Undrgrnd., Test � ' 9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, O Undrgrnd. ' 10. Structural Floor System 61. APPROVAL TO DECK - � 17. 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 76. Rough.Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ' 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace ' �/ �{ APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22�. Ducts; Ventilating �' 71. Product Piping � Gas ❑ Oil 23. Gas�Pipe-Rough & Test 72. Underground Flush 24. Roof;Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof �Sheathing , 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27° Frame and Flashing 76. Dry Standpipe 28. Latliing & Siding ' 77. FIXED SYSTEM FINAL 29. Insulation - 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plasier Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: �_ _�� " a 34. Final Heating & Air Conditioning � �x• 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory FirePlace 38. Final Plumbing � 39. Water Service-Final • 40. Gas Service-Final 41. Solar pomestic-Final - 42. Backflow Preventer 43. Backflow Irrigation ' 44. .Landscape Irrigation System � 45. Sound Attenuation 46. Handirap Regulations . 47. FINA�STRUCTURE&BUILDING � 48. Special Requirements Completed ' 49. Electric Release to Edison � � 50. Gas Release to Southern California Gas Co ��1 � 51. CERTIFICATE OF OCCUPANCY � No. ' Date � AOP��eant to fill In all s0aees exeept thoze wit�in haavY Dortlar lines anC sign all approoriate Eeclantions. � CITV OF C�STA�N{tSA �, � � , ' � pE MIT NO. � 'TRACT NO. , LOT NO. 'BLD . � � � � r421D �2/L:i/�1:, - � � . .IUo � I � CONSTRUGTION PERMIT: ' ' ( ` � % , , � ' I P�PPlicent's Mailin �A dreu � ' - n'PE OF CONSTRUCTION-. NEW ADD � ALTERATION -. � REPAIR , . ' � � � . , � ' ' ' PiOjeCt Addre55 r ° ' � ❑ CONVERSION ❑ DEMOLISH� OTHER . ' � ', � � � ' � , � DESCRIPTION OF WORK' ' , Owner's Na e n „r _ .. �Z IN EGU I NS :• - i Address . , 'TVPEOPPERMI � GRADING FOUNDATION ' ��STRUCTURAL A.P.9k ZONE 1 " " � ' ' AfthJEng. , , . - , LiCens¢ No. _ " � O TENANT�LECTRICAI ❑ PLVMBING. � MECHANICAL PLNG. REF. # - �BUILDING ' � � , Addreu -�' � ` � ' � ❑ �OTHER � . . ' � �' TO.BUILDING= � - �qEAR VARD (TO P/U • ' �+ ' i PRQIECT DESCRIPTION i SQ. FT. • � OCCUPANCY P PE V LINE: , C6ntractor's Nam ' hone _ � � . i ' - ' . ' � ' � LEFTSIDEYARD ' ' � RIGHTSIDEVARD _ '� �' ' AddfEss�fn3iling) ' ' ' ' � CONSTRUCTIONTVPE VALUATION$ - , . . . ._ . � . , . i � ' , , - . _. ZON� �� GRADING CU. VDS. ACRES � PKG SPACE REQ PqOVIDED , . i Cicense No: ..__ � _ ' - � . . . � � ' - . LICENSED CONTRACTOR DECLARATION � � � � � � Ramarks: c � � '� � ' - ' 'STREET WIDTH ' • ' ' � PARK FEE,$ : � � 1'hereEy afflrm tnat I am Iic¢nsetl unCer provizlons of Charter 9(commencin9 - .• , � -. with, sectlon 7000) of Dlvislon 3�oT t�e Businais antl Professlons Cotle, anG ' , , � , • . SPECIAL CONDITIONS: � - my Iicanse�is in Tull force antl effect. i ' " � ' ' , . . . • � Licerise q5sz , License No. � � � � � � PLUMBING '� ' � ! ' � � ' � � �ate ' Si9nature ' � 1 �. � � Bar Sink : � Sewer Cap , , . ' • ' ' ELECTRICA . � . ' .�7RKERS COMPENSATION DECLARATION � _ , . _ '"%reby aHirm tnat.l.hava a eertlficate,of conzent to selt-insure.or a<eqtiflwte . _ gackflow Preventei - - Sewer Connection' �� - _ � Automatic Washer � Metei over 10b amps , -.�/, Jfi Workers' Compensation Insurance, or a certitietl copy t�ereof (Se<tlon � � - . , . 3800, Lab. C.) • ' ' � � , � • Backflow Irrigation Solar Collectors � . . . Construction Pole �' Sub Panel • Policy No. ' � � Company � ' ' . �� CookingUnit � � SubPole � � � � , eCertlfletl coOY �s hereby furnistietl. � . ' � : Bathtubs . $olar Piping � ` .' . � ' � CerHiletl covY is flle0 witFi the city Bulltling Dlvision. j Dishwasher MotOrs �0-1 HP ❑7%-8 � Date � '� ' ApGllcant ' � ' � Clarifiers . ; SolarTank _ . , 1,' EXEMPTION,FROM WORKERS' COMPENSATION �ECLARATION Di5hwa5h2f ; ' i � SWlmmin Pool w/S � ' '�OryerS �Gas ❑EleCifiC ' " IncSolar,�9°75'HP 01645+' '�- ' I ,(This soc[ton neaC not be comD�etetl ii the permit I5 for one �untlretl (E100j or j � 7 -_ _ 9 Pa ' "+ . . . . I less): i + ' ' ' ' Drinkin Fountains � � ' Urinal � • Fan, � � • �Microwave � �� ' ' I certify that In the perfOrTdnca of the wOrk for which t�ls perm�t is ISSuetl I 9 ... i . � sball not employ any parwn in any manner so'as to become subjectto t�e � . - • F.A.U. � • . Pole Light - Workers• Compen5dtion•Ldws of Californla. ; � , ' Floor Drains I , Water Closet , - � % ; Date� � Signature ' � � , , ' - � � , � � - NOTICE:It,aTter�making this tletlaratlon,you�sliould'become-sub7ect to-the- � - � FloorSinks �. ----_-� ' -- . Water.Heater�__ .. I Fixtures � � � Range � � 1 Workers" Compensation provi5ion5 oi the LaGor Cotle,.you must fort�with , , , , , campty .with' such provisions-,or this h � ' :� Device Boxes , . � ;permlt,shall be aeemea ravokatl.. , GasService,' �Outlets� . �� WateLService _ , Sign' CONSTRUCTION'LENDING�AGENCV ' ' � ' ' ' ; � , I hereby affirm that there Is a constructlon lentling agericy.for the performance . Interceptor5 ' � _ � - �;- �- Outlets � ' �Standing Sections � ' of the work for which- tnis, pe�mit -IS �ISSuetl (Sectlon � 3087: Civ. C:) ' _ , � � , , Lentler's Name'� ' ' ' Kitchen Sink '� ' • � � . . . . Switches i Trash Compactor LenCer's' AOtlresz' ' � ' ' � ' � - - - -.. , ' • � .I � ' , i � i . � - • Lavatories, � � � " ; � � - GarbageDisposal � . OWNER�BUILDER DECIARATION ' ' " � " ' ' � ' I heraby(atflrm that I am exempt from tne�Contractor's License Lavi Tor tha ; � - � � _ . Generator DO-5 KW �5-15 KW I following reason (Se<tlon 7031:5 Buslness antl ProfeSsional�Cotle: Any ciry or , ' P-;Trep� • � � - � ' �. ,county which requires a permit to construct, alter improve; tlemollsh or'repalr „ - _ , , , � any sbucture; prlor to ItY.issuance,�alsq reqWres t�e.applicant for such permlY �-� Roof Drains � � Transformer �75-50 KW ! � file a signetl sfatement that he/she is Iicenutl pursuant to the provisions of . ,' �'� � . : � � �5U+ KW� �peinspection Fea + � $75' � . Contractor's License Law (Chapter 9(commencing wlth Section 7000) of � ' � 4'' .i � Reins ct�an Fee 1 ' ' ' ;�,:,'izlon 3 ot the Business antl. Profeulons Cotle) or, that he/she is exempt : . Showers � . � P� $ 5 , yarefrom antl the basis !or the allegetl exemptlon: Any violation' of Sectlon '' , ,, ." Meter up to 100�amps ,lesue Fee � ��$ 3 ' ,J031�.5 by any apPlicant for a�permit.suEjects the applicant to a clvll , � �� ' i � --_ - � � �alty of not more ehan five hunAretl tlollars (y500): , r t�,. � Service Sink '� �� '' � Isue Fee - I $ 3 Zoning Approved By ' • � � Date � � I, as.owner of; the�property or my emPloyees'with wages!as theii sole ; ' MECHANICAL � � � � � � � � mpensatton will tlo the work, antl the structure is not Intentletl or otferetl � , " � , Applifation App�oved By � ' �ate ' for wle �(Sec�ion 7044, Business' aritl' Professlonal Cotle:t The Contractor's � . i . License Law tloes no[ aDPb to an owner of a property who builtls or linproves , Boile� , �� Refrigeration System � ��{ � � ' ' thereon,'�antl .who'tloes;such work.himself/herself or through his or her own � � � '� � " • - -� • � ' � Applintion IsSUed By � �^" � • � DetB ��-� �� employ ees, provltlea tnat sucn improvemants are'not intontlea or ofieretl,for � i ❑6700,OOOBTU ❑100,OOOBTU - . � ule, Ii, however, the builtlin9 or improvament Is soltl within one'year�ot com- i Duct - Under Ground � 7 , , . . , ' � , � SUMMARV OF FEES l � pletlon, tbe owner wlll bave tha burCen of proving he/she tlIC not builtl or im- , . . � ' ' , , � rovefoithepurposeofsaie). ; � � : '. + � , , Duct-Structural � SystemRepair/Alteration � BUILDINGPERMIT $ � j SMIP � � $' r .� 1, as owner ot the property, am excluslvely contractin9,with Iicensetl con ' � � . , � � r � tractorstaconstruct the.project (Section 7044,.Business antl.Professions Cotla: ' Duct- Ventilating � ' � ` ' j � � PLAN CHECK $ PERMIT - • Tbe Contra<tor'S Licensa law does not apply to an owner ot DroOerty who ' - . � � � - ', ' � - - � . � builtls or impraves thereon, ana who contracts for such projects with a con- j , Exhaust SyStem �,MWtiple �, � ' ` 'PLUMBING • $, ISSUANCE ' $ tractor(z) Iicense pursuant to tha Contractor's License l.aw): ' � PLAN CHECK, $_m_ . GRADING - ;$' � � I am exempt untler Section - � i B. & G. C. for this reason ' Fi�epl/FaCt. Blt. ICBO # � i . � � �� Ji� ; � � ,' $; ' � Y � : Heatin S stem & Ductin 1E�ECTRICAL� t $ JlCY_ j • � Date ' Owner� ' � - 9� V 8 ' . � - � � MICROFILM I-heraby-certi/y 4hat I have' rea0 thVs%applicatlon antl state ttiat tFie above-� ❑6100,000 BTU-�Od00,0008T � � PLAN CHECK� � $ � � ,$ � � ' informatlon is correc4 I agree to comply with all ciry antl county ortlinances .. � . . ' ' , !� I � ( � � � ' TOTAUFEE :$ t � antl state I s relaiin9 to bulltling construction,!antl hereby authorlie repre- Hood oi Type I ❑� i ' � MECHANICAC � $ � � � �, sent5tives this�cit 'to enter�upon th ov mentionetl property ptor � �yno T ell ❑� ReinspectioriFaei $15 'pLANCHECK . $ : ' : � LESS - � � . insDecNo r ases. { --c7";7— ; r _ . . : : . ADVANCEDPC � $ � Signature Date � i � � � i I v � _ � Registers Issue Fee $ 3 i , � ? � Drivers' Licensa or 55 � I � I PINAL FEE'� �$�� . , , � _ '. " "' " "" '... _. . _ ._ _.�.. . __ . .'""_' '_" " ". . _ ....' _" ._ _._ . � . - � .. . . CMP 0865-66 rev. 12/82 Wnite - Builtling; Canary - Appliwnt; Pink - Accounting; Goltlenrotl - Assessor , . - - - ""'" " ' - ' -" -' ' - �- - ^� - - � � - - -^- „��CONSTRUCTION�AND,PLAN I G� �� ' � ' ' � � � _ � . � � �� SPQ,� . _ . � , � ` o�` �� , _'�Date � � �Inspector � . Date � lospecfor . > -APPROVALS Permit,#��, � f'APPROVALS.• Peimit # �� :J ? i. . . . - , _ - � �� ,t; Tempora;ry't�Electrical Serwce orEPole � ' ., '�52 � Pool &Equipment Locetion � ' f� � 2; ,Soil�Pipe.'-Undrgrnd." � r .-' : ° ` y ' ;: - _ �- : � . . ✓ - . , - _ : � , , �53:' Steel Reinforcement � ' � .. 3: Ele�trical..ConduiL Utilitv Undrgind. - . � ' '�54. Forms �- ' � �. -_ ` ',vE'4: Ele�rical Conduit-U�ndrgrnd: � . _�, �- ' 4 �. ° ;'� �55, Electrical Bonding . „ . . � . � _ .'i , : . .� �. . . . �., '" .�r 5: $i�_ Reinforcement � � � . �,' : ,-; � i -. " •• 56; Rough �Plumbing & Pressure Test ' � - � �+�� 6: iEle�.�4rical-UFER Grnd.! i`- ;' ;� `" � 57."- APPROVAL TO COVER-GUNITE �. "':'�'� 7. Fo�ings ; ' � � �� _ q ; 4� ; ' :; .- � � � �-�58: .Electrical �nduit-Undrqror�. . - r"` 1 - 8!Fo.�datiori _ ' � � � .� : I '�' V - '59. GasPipe,�� Undrgmd.,Test'�` . � � . �" - 2 9:•,W�aier;Pipe�UnBrgmd. 1 ! _ ' ' ~ � �' . - �;60. BackwasFi Lines,P-Trap,�O�Undrgmd. ��: ' '� ;• ��;'i �, tO.:Strdcturel Floor System ' ��'o _ , , ' 61. APPROVAL TO.DECK ' -; ' � : , � ! , _ � � _ 7-, 71. Pr'operty Sewer Line &�House Connection r � ; � . 62. Backwash & �ReceptorFinal ' � : . ' i , i i� ' �2•'?e''ve� CaP'y � i ' � ' � � i _ ' i = � � � 63. Heater &' Vent-Final - � "' �� ' • 5 i. 13:�Roof�Drain's � � � : � ' `" � , , � ;64. Plumbing-,Syste'm-;Final :' " - � . , .�� i � 14. 'Rough_Plumbing ' � � � ' ' � - � �65. �Electrical�-Final , ' � ' � ' � � - � ' ' �� 15`rRou`gFi �Elect7ical-Cond"uit T , � „-' ; � i � ' �- " , �� 66: �Solai Sysfem-Final' ;- � - � ' �' � �' '- " �" �' '?76'�Rough.ElectricWir.ing, ^ I s i i �i='� - ' �:'� �i:='�'i67,�Fencin9&AccessApproval� - . , i ' - - b - .17� Rough��Wiring Sign'`.' :� � " I ; ' i - I � . � _ . ' �68. APP.ROVED F.OR PLASTERING _ . � � ' 2 - �. ' ��18. �Rougfi�Electrical-T Bar Ceiling' � � � �. � , , � "' i � ' '' ' � 69. POOUSPA SYSTEMS FINAL . � • � _. 19.,Rough'Heatir�g�&�Air,.Conditionin9 �� I � i a'' ' ' , , , _ ' , , � .., i ; FIRE DEPT.,REQUIREMENT , ; i . ..- ;. , , � � • 20.,.Rough Facto'ry Fireplace � � � �� ' ; � � � APPROVALS" � Permit # ' � ' ?� •.' � . y � 21.;Ducfs,�in Structure� �j ' I^{„� ,� �� ; : � � �70. Underground Hydro � ' _ ' ��. ,. , �- r, � � r ' , ' - � �,22. Ducts; Ventilatmg._ � ,� � , � � � . I � � 77: product Piping � Gas ❑ Oil , • '. ' .��'23.�Gas'Pipe-Rough & Test 3 �,C !In `. � � I 4 ; i72; Underground Flush � � �� 24.'Roof Ffaming � ; ' j � � � , - � ; _ , � �73. Undergrnd.StorageTank,�p�Gas.��0i1 -�- �� . , . . � 25 _,RooP Sheathing � . 1 J �n ; ', � � � ` � '' � �74,, Overhead Hydro � • � . i � ' ' : ; _26. T-Ber Ceiling`(Str,uctural)� �&`MonOcoet� I � � ' � r � r ^ ; �75. Dry Chemical , . . � . , - :�27.`Frameand'Flashi'n9 _. � i�� .. '� � � � "� ' � f � �76� DryStandpipe� :. � ' � . � - . � 28. � Latliing�& Sid�ingi ;� ^� ' � , � . � � 'i ; j � .77. FIXED SYSTEM�FINAL - � ' � � � 29.��Insulation-; = '. - �� ! � � j' ' � i � � �78. FIRE PREV. FINAL . . ..� . � �• - , ,� , , ,. , , , � � � � :�30.�,Drywall�Nailing , , � � �, j� I � � �, � j 'Notes; � � � i , �� , i ' o " i � � � .�. _ i . _. _ - . . ' '." _ ." . ' ' � .31.�;P,lasterlB�own Coat� ' � '. ; � � � � ' , � � • �32. Electiical Power Meter-Firial jj . � '�_�_�3 �. � , � � � � • i �� ' 33.,�Final Electric � � i 1� ' � ' � ; ' � ' � ; , • � > . - - :. ... �. '._, � -- -- � �. ' � . ' �. ;�_ � - � � 34. Final Heating & Air Conditioning , �,. � ' ' � � � 4'� � � c: i 35. Final Ga"s Pipe';Test'� �� , ' � � (? l '` � , � � � � � - _ i+ ' � ' -- i � � . . . . . 36. Hood�OrCanoPY'; ��' " n • ' - t" . � � .� ' - . � 'f� - r� y � -1- �'�"� . `R .. 37. Final Fa'ctory F,irepl2ce _ � � � , ' � � � 1 ' ; � � _ � ' �- � ' . ' � 38. Final Plumbing� � ^ ' - � ' i ' , ` ' „ I � 39. WaterSeivice-Final , � � , � � � ' � . ! � � , , � 40. Gas Serv,ice-Final � � . � � . � i � � � i � i ' ' � � � � � 41. Solar�DomesticFinal I � � : ' � ' ' � � • � ' ,� 1 - r -- -. ..i-- - � 42. Backflow Preventei,� � � I ' .. i ; � ' '. j � . � � • � , �. . . - - - - � . � � � ._ �v . - . , . . 43. Backfloiv li�igation ; , i � ' � < f ' �. , ' ' i ��_ � 1^ 44. Landscape IrYiga4ion�System� � �•'i•- ;' - �° I � � � , • - 45. SoundcAttenuation.r � � . � � I . ' . I �'- ' ' i ? i ; � ' - 46. Handicep Regulations� � � ' � '; � . � ' � � ' � ' i �� 47. FINALSTRUCTURE!&BUI�LDING, t , � �j , ' ' ' � � , , , ' .. i 48. Special Requirements;Completed i � ' � � � : , ' ! . � i � � i . ' : . : . � � � � 49. Electnc Rel� . . - " � � : . � ' { � � � . � ease to4 Edison � r ' - -- - - r--y - - -- - . ., ; �� 50. Gas Release.to Southem California Gas�Co � ' � � ' � ' � � � � � 1 i 4 1 j I i � 'Ir� . . . 51. CERI'IFICATE OF OCCUPANCY '.! ` _,. I . �__: ! . �._. _. �. . __ _. ' � . � No, `� � ,Date ' i _.1__l.. : � �� . ' � � , �.�Gi .R'�' ..._.• -: .T. •�.+..�� ....�. �L ._ _ _ _ _ ___�. . � � :' if Appllcant to till in all spaeea e:cept t�osa within haavy borEar Iines anE sign all apPronriata tleclantions. . _ . _ . .. _ _ _. _. , CITY OF COSTA MESA. � PE IT O TRACT NO. LOT NO. BL ' � CONSTRUCTION PERMIT ,�jO� ApplicanYs Mailing `Addreu , � - TVPE OF CONSTRUCTIOM NEW ADD� �ALTERATION ProjeCtAddfess /^J,�A,N� { -�� ¢� . � CONVERSION ❑ DEMOLISN n❑ OTHER _ OWn2f'S�NemB le�L..' ��+ hOn2.iflL�fL�// ' ' DESCRIPTION OF WORK � R!CKQ�.� ' AddfBss� �( G�' ' ' TYPEOFPERMIT. � GRADING ' POUNDATION STRVCTUR AfCh/Eng. LtCen52 NO. ❑ TENAN7 ❑' ELECTRICAL ❑ PLUMBING ❑ ECHANICAI AddfOu - � �;�OTHER ' " , . Contractor's Nem Phoue PAaECT DESCRIPTIONi Sa. F7.- OCCUPANCv_' AddfeSs�meiling) � C�NSTRUCTIONTVPF ' VALUATIONS '�`%�� _ - 20N� GRADINGCU.VDS. ACRF� ' Licante No. ' � GCENSEO CONTRACTOR DECLARATION � Remarks: ' . ' . I hereGy affirm that I am Iicensetl unOer pravislons oT C�arter`9 (<ommancing , . , with sectlon 7000) of Olvlsion 3 0! the Busi�eu anG Profeislons COAe, antl � � '' � my IkenseAS in /uli /orce antl eifect. . ' � ' ' IJcense Class � Licanse No.' � � � ' PLUMBING ' ' - ' � Dale Signa[uro ' � ORKERS'GOMPENSATIONDECLARATION � . BefSink SewefCap , �ereby.aftirm that I have a tt�Utiwte o! conient to selt-Insure or a certifl�ate ' - Backflow Preventer Sewe� Conn2ctiOn "' - '� of Workers• Compensatlon Insuranca, or a Gertllletl' copy t�ereof (Sectlon - 3800, LaD. C.) ' ' � ' , Backflow Irrigation Solar Collectors � . Pollcy No. - � Company � .' � - eCertiiletl coDY �s �ereDy furnishetl. I , � � Bathtubs ' � Solar Piping � ' CertifieG coDY �i iilea wit� the ci[y Builtling �Ivlslon. oate qppuwnt Clarifiers - Solar Tenk � � EXEMPTION FROM VYORKERS' COMPENSATION DECLARATION � ' , ' (ThiSseCtiOn neBO not De ComD�etoU if tha perT�t Is 1or one huntlretl (5300� or DiShwaihef � SWirt�ming POOI W/$pa � I cerHfy�that �In the per/ormance ot tne work for whic� this OermR is �issuetl I� � Orinking Fountains � Urinel ' � � . snall not employ any permn in any manner so as to become subjectto the ' - � . � . Workers`Comoensation�Laws of Giifornia. � I � Fluor Drains Water Goset � ' Oate ' • c�g�atura � � ' ' � . - -� . - NOTICEe If,�after maklrig�t�is Cecla�atlon, yoU shoultl Eecome Subjett to the ,� FIooI Sinks �--- -- -- WetepH2ateL � -' -- Workers' Compansatlon provislons,oi the Labor Cotle, yau must fortnwith : � �� comDly wlth SUth prON5IOn5 O� Shls DGrtI?�� Slfdll Da .tleemea' revokea: Gas SerJice ' Outlets - Water Service . ' �'. �,CONST0.UCTION'lENO1NG AGENCV ' ' - ' I h¢r¢Uy df}IrT [hdt thaf0 IS a constluctlon lehd��9 agency fof the peltOfmanCB InL¢fCCptOfS ' - • ' 1 • • of the work for whichrthis permit is,issuetl (Se<Uon 30B7' Civ. C.� ' � , . Lentler•s rvame � Kitchen Sink ' - l.entler's' Atltlreu ' • ' •� Levatories � � - ' OWNER BUILDER DECLARATION � � � � � - � . � ' I hereby afiirm that I am exempt from the Cp��ractor's Licenia Law tor the � p_Tra ' �' ' tollowln9 reason (Se<tbn 7031,5 8u:ineis and Professlanal'CoOe: Any city or P - • � as a perm�[ suoleccs ma appm oarea qouar: (asoo). � „ i or my amployeas with wag � Showerz 1 . ' i Service Sink � =. - � , . em0�oY aes, proviaetl that such ImDrovumants �ru�noe mxonaea or otteraa tor Duct- Under Ground ' sale. If, however, the Euiltling or imProvemant I5 SOIG within one year o! com- pletlon, the owner wlll have tha bwaen of pro��9 he/she tlIA not bulltl or Im- '� �rova for the purpose of sale). ' � Duct - Structural � � I, ds ownei of the pioperty, am excluslvely <onlracting,wlM(Ilcensetl con- tractorsto construct the project lSection 7064, Business antl Profesilons Cotle: � Dutt - V2ntilating __ � The Contiactor's License Law does no[ apply to an ownnr ot property who . builtls or improves thereon, antl who contracls for suth projecti with a con- ' Exhaust Syztem ❑ Multi tractor(s)Itcense pursuantto ine Contractor•s L�cense Ldw): � � - - i � fam axempt uniler Sactlou B, & P. C. tor thls reason ! Fiiepl/FaCt. Bit. IC80 � i • ' . � Date � � owner' � ' Heating Sysrem & Ducting �, I nereby, certlty-that 1 have reaC this applicatlon-antl state �that the above , ❑6700;000 BTU �100,( . Informdtion is wrrect. I a9rea �to Comply wltM1 all Uty� antl county ortllnant05 . � • � antl �rtate 1 5 relating to builtling constructiOn, antl hereby authorlEe repre- i Hood O/ TypO I ❑� sentatives [his cl y,to enterupon th bov -mentionaE pro arty tor . inspectlo Lrposas, a�o�83 ��o T e il ❑ Signatur � � Date ' . Drivers• License or 55 � - - � I � Registers' CMF 086546 rav. 12/82 While - Builainq; Ca�ary - qppllcant; Plnk - Accounting; Goltlenrotl - AssesSor i �. � � Reinspection�Fea � � � I laue Fee L . ' MECHANICAC , - ' ' • Refrigeration System � �o-ioo,000sTu ❑ioo,000eru ' System Repeir/Alteration -� i le � ' � • 1 i � � � Reinzpection Fee - laue Fee � � A. P. Ae ' . . PLNG. REF. # �TO'BV I LDI NG P PE Y LINE � LEFTSIDE VARD PKG.SPACE REQ. , STREET WIDTH SPECIAL CON�ITIONS: . _ Automatic.Washer . Construction Pole , . Cooking Unit Dishevasher � Dryers ❑Gas ❑Electr Fan; F.A.U. Fixtures ` • . Device Boxes ti34H b/ I U%�I:J � ; ' �� ` � BUILDING - - S6TPnr �Le�r REAR VARD (TO P/L) RIGHTSIDE VAfiD PROVIDED ' PARKFEE§ Sub Paneb � � � Sub Pole � , Motors �0-1 HP ❑ � �Inc.Solar 09-15 HP 'Microwave Pole Light Range. . Sign ' StandingSections Trash Comoacror Generator 00-5 KYV C15-75 KW Transformer 015-50 KW � . ❑SU+KW S75 ' - Meter ❑up to 100 amps a 3 2oning ApProved BY � � ApPliration Approved By (_�� Appliption laued By _l-1- � � � 5+ - ' � SUMMAqV OF FEES ' � , � � �J�, � !BUILDINGPERMIT $ ��_� ,.SMIP � $ �' � 'PLAN CHECK� � $, ' � � � PERMIT ' � � �PLUMBING ' ' $ � � � ��UANCE l $ � �PLAN CHECK $. ' � GRADING ! $ � �� $ � I ELECTflICAL�, , $ � � . . �PLAN CHECK, � _ $� MICROFILM i $ . ' TOTAL'FEE� . �$ ' �MECHANICAL $� � � � .PLAN CH'ECK� � $� � � ; LESS I � ! + � i � ADVANCED PC f $ '��_ . ' , � , , � � � FINAL FEE � � $ � vI0 -- i �3 �?CONSTRUCTION AND PtANNING -. � . -L, `3 ,c,'- - ` !,',�' � - �n_; POC SPq;,,� ' ' : - - �, � - � `Date � - �Inspector • ' � - �� Date ^ Inspector �> :=APPROVALS n P.ermif# - � - �.APPROVALS',- -Permit:#' - , �. - . . - �. Temporary,'Electcical Service or?Pole , �� _ ` � �� : 52: �Pooi & Eguipment Loration ' . , . '�',; s' - n i ,� �. . . . , '_ " ' _ . - - . . •�� 2: Soil Pipe-Llndigrnd.� V - c ' r - �� •53C Steel �Reinforcerri,ent � � - � - � I ' - i � �3: �Electtical Conduit Utilitv-Undrgrnd. � - � - _ ` � �_; , .54�'Forms - - � • � � � _ ' - - -� �� - - .` 4� Electiica,IConduit-Undigmd�.��.�'t ' � >> ? E„��_� 55^�Electrical,Bonding,�' ' r 5: �teel!Reinforcement �- ' ' , � � = ; ` '�� • -56. Rough Plumbing & Pressure Test - ' •� ' � � i. i ' � � � . � � i � a ,,, : r „• � ., , ,. . 6. Eler.frical UFER Grnd.� � � j � ; _ „'•> � � _ ,57=' APP.ROVA'LTO.COVER-GUNITE ' - � • i. 7. Footings � � I � , ' ' � � ' , - - . �. 58. 'ElectricaPConduit-Undrarnr�. _ ?� ' - i r ^'� C Z 8. Foundation ' � , � _ ' ` • •.59. �Gas'Pipe,�O'.Undrgrnd., Test � ' ' � . _� , � , _ 9. Water Pi'pe=,Undrgrnd. �� _ L'''� n � � '.60. BackwasFi Lines; P-Trap, O Undrgrnd:-. �, � i' 10. 9tiuctural Floor System I - . � � � � � � _ - 61. 'APPROVqL TO DECK - ' �' ` ' 77. Property Sewer Line & House�Connect.ion : � a' � 62. 'Backwash &'Receptor-Final: �' • , • � 12. Sewer Cap' � � � � _ _ � - '- � � 63. Heater & Vent•Final � � . � ' - 13. ,Roof. Drains � � � � �� ' � `` , � "- -64. Plumbiny.System.- Final�- � � � " � , , 14. �Rough Plumbing � � _ � ' - - � '85. Electrical=Final -� � � - - � �� ,`15: Rough Electrical-Conduit T � ' � ',_-'' � � --" � - - -"'r"'� ' 66. Sola� Sysfem-Final ' . � ' " � a16`.,Rough�Elec[ricWiring, H i ` '! : 1;�-�-, -- .. , -'- ' � - - - - . ` ' -, � , > ; � a � �� 67.'�Fencing & AccesrAppinval � �'� ,, "'17.IRough'Wiririg Sign�� ' � ^ � ;� ' � �= � � _ �� I6g! qppROVED FOR PLASTERING � � � • � i � i � , 18� Rough�Electrical-T'Ba� Ceiling' j � . � ' � ", ' � ' � 69. POOUSPA SYSTEMS FINAL . � . � � ' 19. Rough`Heating &�Air Conditioning : � , ; - , :FIRE DEPT. REQUIREMENT � - _ ' 20.'Rough�Factory Fireplace � . � � � ; � ! � APPROVALS Permit# � � ' � . 21. Ducts; in Structurea �, � � ;f , ' ; ,70. Underground Hydro ' � 22. Ducts,,Ventilating • �; I � �� , , � 71. Product Piping O Gas ❑ Oil ' �23. �Gas Pipe-Rough & Test . � � �� , t � ' � � �J2.� Underground Flush� 24. •Roof,Framing �� , �' � , '!a f° - I, � ; • • � . , , � � � 7.3: Undeigmd. Storage Tank O Gas ❑ Oil � ` � � �' � 25. Roof Sfieathing I � � �i�, j. � � � ;� � I ,�,� !7q i Overhead Hydro � �� ' ' � � � � ' � 26. �T-Bar Ceil,iri (Structural�� & Monocoat � � � a � ` � '. . � 9 , i � � 175 � D'ry Chemical � � ,�_27. Frame and �Flashing ' � i , �' i ' ; ' � � � 76. Dry Standpipe r ' . ' 28. Lathing & Siding� : : � � � �� i , ' � 77.� FIXED SYSTEM FINAL : , ' i ,. _ j_29.; Insulation � •` ' � ' ,i . , � , ' 7g' FIRE PREV. FINAL � : � � . . � . i r, ` .t . . : ` i � � ' ' : . : . 30. Drywall Nailing i >- ' ' ; 'Notes: � . , � � � _ ' , . .t ._,._ . . .. . _ � �31. �Plaster Brown Coat -� �, � � � � . . • � : 32.'Electrical Power Meter-Final � � ' � � � � ' � � � � ' � ' � � � � - 33. ,Final Electric � � � � �' ' � � � i r ' Jw � � ' � . � - 34. Final Heating &�Air Conditioning ~ � ' � � � ' � ! : ; ' � ' a �tn�t � � t � � 35. Final Gas Pi,pe=Tesi; � ' �� . „� �' .� ,i � � � �� t a � . . � � � � � � _ _ ' y , ., � � 36. Hood or �CanoPY.''� :. ` ; - -, I . ' ' - . , . . ` . . � ' � �- - i i - � a n ��- �i - - � _ . . . 37. Final Factory Fiieplace� ' - - � � = � . � ' �' ' �� i � �� _ ' ' .. .� _ ' . � � . 38. Final P,lumbing � i i � 4; � � . , � � . 39. Water Sei-vice-Final I � ; � , - , ' � 1 � . � . 40. Gas Service-Final ' ' � j i . � . ' � - ' ' • t i 41. Solar pomesticFinal ( , � ' � � � � - � -i' - - --- - - - - - • 42. Backflow�Preventer� m � ' I ';'! , r-� _ - � -- ._; . _ ----� _ . - ...� ,, ,_' I ` ', , 1'yl; :�; _ v .. � � 43. Backflow, I�riga(ion : � 7 � � ' , � � 44. Landscape IirigationSystem � � �' � � 'T � = i � ��. � " ' ' � ; '� . � � - �� i.�i � ". : - ' i - ' : . ' , i . . � . . - � , , . . . 45. Sound: Qttenuation Q � ,; � � � � y � : j i � � ' f • � � ' ' '. " 46. Handicap Regulations � � � � " ��. � ' . ' � '` � � � " '� (' i 47. FINAL STRUCTURE & BUILDING', � � j„/ �' � � , : � i� , 48. Special Requirements Completed � , � � 1 ' � � ' � � ,. . . • . 49. Elec[ric Release;to �Edison� ' � _. ;. _' _ .�. _ _ _ �. � • � - _ � ' , ., 50. Gas Release to Southern California Gas Co �' . � , , �� ' 51. CERTIFICATEOFOGCUPANCY � I- � ;--. ' -'-__�_ '" .- 1 • No. Date ti ! � ' _� � � ApPlicant to flll in all spaces within CITY OF COSTA MESA PEifM1,T�q CONSTRUCTION PERMIT S 5 d"�� Address �ANG AS A�OUE Arch/Eng. Litense No. Address r Cantracmr ' �G UILD Phone Address I hGreDy affirm lhat I am Iicenietl untler provislon5 ot Chdrter 9(com- rtlancing wIIM1 s¢t[lon ]000) of Divlslon 3 ot the BuSiness antl Protesslons Cotle, anC my Iicense is In full (orce antl effe<t. Lltenze Clasz License No. Dat¢ $I9nature WORKERS'COMPENSNTION DECLARATION � I hereby affirm that I have a certificale ot <onsent to selt-insure or a certitifzie ot Workers' Compensation InSurance, Or a certlfietl copy 'hereof (Sectlon 3800, Lab. CJ. !iCyNO. Company� Gertitietl copy is nereby furniznetl. � ❑ Certifie� copy Is fllea with the city Builtling Divislon. E%EMPTION FROM WORKERS' COMPENSATION DECLARATION (ThIS Section n¢etl nol b0 Complet¢tl if (h¢ p¢rmit IS for one huntlretl SS300) or less�. C¢rtify Mat in tFie perfarmance qt the work tor which 1hi5 permit is issuetl. I zhall not emolov anv oQtSon In anv manner so a67tn-become Date llcl�L [L.[lL7j..LL_519nat ur.K1 � `• ° ••'!S=�'1-,:Li�IS• , ""� NOTICE� If a(t¢r making [his tleclaratiOn, y0u zhOultl b¢come subj¢ct to [he Wo�ke�s' Compensation p�oNslons of the Labo� Cotle, you must torthwith tomply with such provislons or this permit shall be tleemetl �evoketl. �� - � . _ . - CONSTRUGTION LENDING AGENCV I hereby aflirm that th¢r¢ is a ConstruttlOn I¢ntling a9ency (or the per- formance of [he work for which this permit is issuea (Section 3097 Civ. C.1. � . . " . , LenCer's Name Lentler's Atltlress OWNER BUILDER DECLARATION - " ' I hereby atfirm [hal I am ¢xempt from Me Con[rattor'S Lic¢n5e Lnw for the tollowing rea5on (Section ]031.5 6u5ine55 dntl Profe551on5 Cotle: Any ciry or county which requires a permi[ to <onstruct, alter, improve, tlemolish or repair any structure, pNor to its issuance, also re- qW�es the appliWnt tOr such permit to file a signetl Stat¢mCnt that hC is licensetl'pursuant to [M1e provisions of [he Contra<[or's License Law �Chapter 9(commencing with Section 7000) of Division 3 of the �isiness antl Profession5 Cotle) or that he i5 exempt therefrom antl th¢ 'is for the alle9etl exemp[ion. Any violatlon o/ Section ]031.5 by I apPlicant for a Dermit sub�ecls Ihe applicant to a clvll penalty .'not mOre than �iv¢ huntlretl tlollats (E500). ❑ I, as owner o/ lhe property, or my employees wi[h wa9es as t�ei� 501¢ compensation, wlll tlo the work, antl the sVucture is.not inlentletl or olteretl for Shce. (SeCtiOn 7044, Buzin¢ss antl ROf¢ssions Cotle: ThC � ConGac[or'S Licenso Law tloes nol appry to an owne� oi a property who builtls or improv¢5 th¢reon, antl who tloes such work him5elt or t0�ou9h-his own employees, provi�etl Ihat such improvements are n01 intentletl or offuretl lor sale. It, however, [he builtlin9 a� imp�ovemen[ Is soltl within one year ol complefion, the owner will have the burtlen of provinq he tlitl nOt builtl or improve fo� the purpose ot sal!). ❑ 1: as owner 'of Ihe oraoertv: am excluSiveN contrattina with ana rro*essions cooa: - i ne convacrors ucense i.aw ooes noe appry w an owner of prOperly who builtls or improves thcreon, and who con- traCts from�such projeGts'wi[h a'cont�act �(s) Ilcesned pursuant to [he ConVactor'S License L.aw). ❑ I am TxBfqpt untler SeLtio/i O � �B. & P. C.�'Tor t^i5 �r�i�,cri � ir reason ' 54��— i —X i�— lhat I have �eatl Inis appliWtion antl state that the cortecL I agree to comply wlth all city antl c �tale laws relatin9 �o cons(ruction, antl hereby aut o( this ciiv to ente9 .uoon. tM1e above men Signat urAC.L(l�Q�q.f,.i Drivers' License or 55 � bo�tler lines anE sign 'I appropriate tlecl:rations. TRACT NO. L�' NO.. r BLDG"�NO. , c. TVPE OF CONSTRUCTION ❑ NEW �ADD ❑ ALTERATION ❑ REPAIR ❑ CO ER ION ❑ E� ❑ OTHER ��SCRIPTIqN OF_WORK TVPE OF PERMIT ' � - ❑ GRADING ❑ FOUNDATION ❑ STRVCTURAL ❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHAI ❑ OTHER PRO�ECT DESCRIPTION SQ. FT. � . OCCUPANCY CONSTRUCTION TVPE � VALVATION�ZONE ' "' GRADING CU. VD��'�� ACRES REMARKS: � ��//) ��}"� / . . PLUMBING . PLANCHECK BATHTUBS SHOWERS TOILETS VFINALS LAVATORIES DOUBLE LAVS KIT.SINKS � �� DISHWASHERS� SERVICESINK$ SVMPS FLOOR SINKS FLOOR DftAINS DRINKING FOUNTAINS INTERCEPTORS CLARIFIERS SWIMMINGPOOL PTRAP '- WATERSERVICE ALTERATION GASSERVICE OUTLETS SEWER CONNECTIONS - SOLARTANK' COLLECTORS '"� SOLAR PIPING SYS. ISSUE FEE MECHANICAL PLAN CHECK HEATING SYSTEM 0-100,000 BTU ANDDUCTING �p0,000+gTU REFRIGERATION 0-300,000 BTU SVSTEM 100,000+gTU BOILERS BYU SVSTEM REPAIR, ALTERATION EXHAUST SVSTEM MULTIPLE ISSVEFEE ' ' -� CMF 0865-46 Whlte-8uiltling; Canary-ApPliwnt; Pink-Accounting; Goltlenrotl-Assessor • IBIL 12/16/02 ZONING REGULATION A.P. � ZONE PLNG. REF. � REAR VARD (TO P/L) �PKG. SPACE REQ. STREET WIDTH SPECIAL CONDITIONS: ELECTRICAL PROVIDED PARK FEE $ DATE PLAN CHECK GENERATOR' 0-1 KW_ 1-lO KW _ TRANSFORMER APPLIANCE 30-50 KW_50 i KW _ MOTORS 0-1'HP_1-10 HP _ (IN0.50LAR) 10-50HP_SO+HP-_ FIXTURES 'OUTLETS SWITCHES" GASTUBE'SIGNS � POLELIGHTS --' ' PANELS ' MAIN SUB SERVICE � AMP ISSUE FEE APPLICATION 23o0U TL DATE SUMMARV.OF FEES BUILDING� ,' �^ ' � . sO PE0.MIT , E—�-/� SMIP E PLAN CHECK $ •�PERMIT - Q j'j � ISSUANCE -$ PLUMBING $ � � GRADING" .$ PLAN CHECK S , ' ELECTRICAL �$ � ' ' ' $ - PLAN CHECK g - MICROFlI,M S MECHANICAL S TOTAL FEE S PLAN CHECK g� � . LE55 AD- _ - VANCE PC $ FINAL FEE E ( I6 . ''� _ CONSTRUCTION AND PLANNING �-p � '` POOL & SPA ' , ' ' APPROVALS Permit# ��'�7/�� Oate - Inspector qppROVALS , . Permit# i. Temporary Electrical Service or Pole 43. Pool & Equipment Location �� 2. Soil ipe-Undrgrn - ' . ' 44. � Steel Reinforcement 3. Electrical Conduit.Utility-Undrgrn � - • 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bonding- ...---. � _ _ ' _ . tee ein orce 47. Rougli'Plumbin & Pressure Test- 6. Electrical UFER Grn � 48. APPROVALTO COVER-GUNITE 7. Footings - � 49. Electrical Conduit-Undr rn 8. Foundation . _ _ � 50. Gas Pipe. ❑ Undrqrn. Test 9. Water Pipe-Undrgrn. 10. Struaural Floor System 11. Property Sewer Line & Hou 12. Street Sewer Connection 13. Rough Plumbing 14. Rough E�ectric-Conduit 75. Rough Electric-Wiring 16.� Rough Heating & Air Condi 17. .Ducts, in Structure 18. .Ducts, Ventilating 19. Gas Pipe-Rough &Test 20. Roof Framing' 21. Roof Sheathing ' 22. Frame and Flashing 23. Insulation � � 24. Lathing & Siding . 25. . Drywal� Nailing 26. Plaster Brown Coat 27. .Electrical Power Meter-Fina 26. Final Electric 29. Final Heating & Air Conditi 30. Final Gas Pipe-Test 31. Final Plumbing 32. Water Service-Final 37. Handicap Regulations ' �' 38. FINAL STRUCTURE & BUILDIN 39. Special Requirements Completed 40. Electric Release to Edison 41, Gas Release to Southern California 42. CERTIFICATEOFOCCUPANCY Date 0 - � ' ' ' �56.- ��Etectrical-Final � - 57. Solar System-Final encing & Access Approval 5 . APPROVED FOR PLASTERING ' .60. POOL/SPA SYSTEMS FINAL � NOTES: • " Date Inspector LOT 4y - �RACT joc7 �. ' �� COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 COBTA MEBA. CALIFORNIA For Applitanf to Fill In Compleiely � TYPE OR PRINT � su�L�iNc 3�33 �DAHO PLACE ADORESS CA5TA MESA CALIFORNIA oWNE[t KENKOL CONSTRUCTION C0. nDORESs � PLACENTIA AVENUE ��Ty NEWPORT BEACH N�: MI 6-3� ARCHITECT TEL. CONTRACTOR K.W. Ko�� ADDRES6 �555 PLACENTIA AVENUE C�Ty NEWPORT BEACH s � No. 6 i t 9 No: M I 6-3227 s�:E „r 6s X t oo � �o�oP a�as. o � SETBACK YN6 PROM C(� 1 'f.^i f DESCRIPTIOtd OF WORK 1671. EXTERIOR WAL1�, ROOF ^"`"� "" "•"� "' COVERING JTUCCO COVERING USE OF BUILD�1 G AND RK TO BE PERFORMED SINGLE-YAM�LY ESIDENCE AND ATTALHED GARAGE LAN - ��.-.. .�.r=��r�"�� ,- ��._ .r �� _ ��, i h la. � 'J � � G.. �.. .. � J St-� s-�3-t�� ; L=11JkiLC�: �c:°��; � �I�Y Of ^CSTa: C:i�� APPLICATION FOR PERMIT . _ "'� BUILDING For Office Use Only FECEIPT NO. ( PlRMIT NO_ � C05TA MESA, CALIFORNIA APPROVED ZONING NO. OF USE OF NEW PLANB � BUILDING , �eaw� YARDS APPROVED (C6MHR LINE 9TJ EVES FT. r I I HEPEBY ACKNOWME�GB THAT � HAVE READ THIB �PPLIWTION }�{g AMOUNT HXOWN UNOER VALIIAiION IB FOR THE ANO BTATE THAT THE ABOVE IB COPRECT AND AOREB TD COM- pURPO6E OF E6TpBL�BHING A PEftMIT FEE ONLY. PLV WITX ALL CITY OR�MANCES AND BTATE UWS RH6ULAT1N6 BUILDING CONBTRu��oN. VALUATION �� ti SIGNATURE OF ' PERMIT FEE $ PERMITTE ^ � � �^�� $ /� S�� J PLAN CHECK $ /� l AUTHORIZED AGE /V � � �'1 TOTAL FEE � �