HomeMy WebLinkAbout2141 IRIS PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2141 IRIS PL
Suite No ,
Y
Vicinity:
Parcel Nunmber: 42615�32
Applicant: DUNN, JON
Address: 17886 LAKE SHORE DR
LAKE ELSINORE, CA
Owner: KRISTIANSEN, ERIK
Address 2�411RIS PL
COSTA MESA, CA
PLUMBING PERMIT
Phone: 800-727•0977
Zip: 92530
Phone:
Zip: 92627-'1805
Contractor: ALL STAR WATER HEATERS INC
Address: � 17886 LAKE SHORE DR
Arch / Eng :
Address:
Phone: 800-727-0977
LAKE ELSINORE, CA Zip: 92530
License: 812894
Phone:
Zip:
License:
SCOPE OF PERMIT
CHANGE OUT WATER HEATER
Status: ISSUED
Applied: 01/07/2004
Issued: Ot/07/2004
ISSUED BV:
FEESUMMARY
AMT QTY AMT QTY . AMT QTY
. ISSUE FEE $23.50 Laundry Tub / Washer $0.00 0 Sump Pump $0.00 0
BackFlow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
BackFlow Preventer 50.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Unnal $0.00 0
Clarifier System 50.00 0 Process Piping (per 10 fl) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors 50.00 0 Vacuum Brkr BkFlow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 � Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor 50.00 0 Sewer Connecl $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater 50.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $0.00 0
Drain, Roo( 50.00 0 Shower $0.00 0 Water Heater / vent $12.30 1
Drinking Fountain 50.00 0 Sink, bar 50.00 0 Water Piping (Inst or Rep.) 50.00 0
Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and relatad
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically ezpire and become void if work is not commenced within 1 BO days, or it work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred inspectlone 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� 754-5626
244Bd8 (8�00)
WORKERS' COMPENSATION DECLAAA7�ON:
I hereby eflirtn under penalry of perjury one of the following tledaretions:
❑ I have antl will maimain a certificate ot wnseni to self-Insure for workers' compensation, es provided for by sectlon 3700 of the Lebor Co�e, for the pertormance ol the
^�
work for which ihis permit is issue0.
.e" 1 have antl wlll maintain workers' compensetlon Insurance, as require0 by section 3700 of ihe Labor Code, for the pedormance oi the work for which ihis pertnit is iuuetl.
��My work rs' compensation Insurance cerrier and palicy num6er ere:
Carrier��T4'rE Fu^�� Poliqnlumber. �%�%Z2'%
(Tldssecfion need not be cromp/eted i/ (he permit is velued ef one hundred dallers ($100) or /ess.J �"
❑ I certify thet in the pertortnence oi he � for which this permit is issuetl, I shell not employ any person in eny manner so as to become subject to ihe workeB'
compensation laws oi Cellto 4 g e that Ii I should become sub)ect to the workers' compensatlon provislons ot Section 3700 af the Lebor Cotle, I shall torthwlth
comply with these provision ^�
�plicanhSlgneWre;� Date:__ / /�Q�'/
WARNING FAI� L—URE TO SE � O(ERS' �.�PENSnTIdJ COVERAGE IS UNLAWFLL PND SHAIL SUBIECT AN EMPLOYER TOCPoMINAL PENALilES 0 dVIL FlNES UP TOONE HUNDRED
THOUSAND DOLL4RE (SiO�j, IN AODf710N TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED f-0F IN SECTION 3TOfi OF THE lPB(]R CA�E, IMEREST, PN� ATT�PNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm that I em licensej�under pmvlslo
CONSTRUCTION LENDING
wit� Sectlon 7000) af Dlvision 3 of ihe Business e� Prolqcsions Code, end my license is In tull
❑ I hereby aNirm ihat Ihere is a cons��+�tion lending agency for the pedormence ot Ihe work for which this permit is issuetl. (Sec. 3097, Civil Coae).
Lender'S Name: Lentlefs Atltlr855:
Slgnatura:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby afflrm thet under penalry of per�ury ihet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Busineu end Professions
Cotla: Any ciry or counry which requires e permit to construc6 elter, impmve, demolish, or repair eny siructure, prior to its Issuance, elso requires t�e epplicam lor such pertnit
to Qle a signetl stetement that he or she �5 liceased pursuant to the provisions oi Ne Contrecbrs license Law (Chapter 9(commencing with Secilon 7000) ot Div,sion 3 oi the
Business antl Profeuions Code) or t�a� he or she is exem0� �hereirom and the basis for the alleged exemption. Any violetion of Sectlon 7031.5 by eny applicant for a pertnit
su6jects ihe applicant to a civil penalry o� not mora then fiva hundred dollars (5500)J:
❑ I, as owner oi the property, or my amployees with wages es iheir sole compensation, WILL DO TME WORK, antl ihe structure is not In�entletl or ofteretl tor sale (Sec.
704a, Business and Professions Gade: Tha Contractors License Law does not apply �o an owner ol properry who bullds or improves thereon, and who does such work
himself or �erself or through his or her own employees, provided that such improvements ere not Intended or oHeretl for sale. If, however.Ihe building or improvement is
soltl wit�in one year of completion, the owneo-builder will have �he burden of proving ihat he or she did not builtl or improve for purpose of sale.). '
❑ I, as owner of lhe property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to wnstruct the prolect (Sec. 7044, 8usiness and Professions
Code: The contractors License Lew does not appty to an owner ol property who builds or ImO�o�es thereon, and who contrects for such project with a contrector(s)
license pwsuant to tha Coniracmre �cense Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by dnver's licanse. ❑ �es ❑ No Driver's License No. Expires:
Vedficetlon of Ownership by (rype of daument, i.e. - pmperty tax blll or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTFICATION:
❑ I hereby cenily thet na excevatlon five (5) or more feet in depih into which a person Is required Io Cescend, wlll be made in connection with work authorizetl by Ihis
permit, and lhat no building sWctUre, scaHoltling, talsework, a demoUtion or tlismantling thereot, will 6e more than thirty-sIx (3fi) laet high. (Chap. 32, Gry 2, Art 2, Sac.
341, Tltle B, Celifomia Atlministratl�e Code).
❑ As awner-builaer, I will not employ anyone m tlo work which would require e permi� from the Division ot IndusMel SafeN. es noted ebove, unless such parson hes e
pertnit to tlo such work Imm the di�sion.
Signamre: Date:
Division of Industnal Sefery Pertnit NumUer.
CER7IFICATE OF COMPLIANCE AND A�MORVA710N OF ENTAV: I cenity under penelty of perjury ihat I heve read this application end state thet the inlormation given is
correcL I egree to comply with ell stete law end dry ordinances relating to bullding construction, antl authodze representetives ot the Ciry oi Costa Mesa to enter upon the
ebove-descnbetl D�operty for inspecyon py�p ses. I agree not to acupy or ellow occupancy of eny building authonzed by this permit until finel inspedion.
CODE �. ��Sp�=,{,yQy�p� �/ " PAg 1I�dL5
1816 Finetl S��em•Pinal Fira Prevenlion
/
1266 Pool Spe Final
200 Finel Re-Roof
201 Finel BIocWRetaining Well
202 Finel Fettory Flre Place
203 Final Sign
204 Final Demolition
CQUE� INSPECTIONTYPE
208 Final MechanlCel
208 Finel Plumbing
210 Final Electncal
212 Final Flre Preventlon
220 Final Plenning Approvel
222 Final Site
250 Finel Building/Occupancy
(714) 754-5273 • Faz (714) 754-4856 � www.ci.costa-mesa.ca.us
. BUILDING PERMIT
.�
JobAddress: 2141 IRIS PL
Suite:
Vicinity: KITCHEN AREA
Parcel Number: ` 42615132 �
Applicant WALKER, BARRY
Address: 730 WEST 17TH STREET
COSTA MESA, CA
Owner: CORKETT, STEFANIE L
Address 2147 IRIS PL
COSTA MESA, CA
Contractor
Address:
77 FAIH UHIVt, GOS IA MtSA, GA 9"Lti2ti
�
Status: ISSUED
Applied: 71/06/2001
Issued: 71/09/2001
� ;^' �,. .-:� i
Zoning: \
�ISSUED BY: � C'
Phone: 949-246-4085
Zip: 92627
Phone:
Zip: 92627
Phone:
Zip: License:
Arch : BARRY WALKER En9:
Address: 730 W 17TH ST � Address:
Phone: 949-246-4085
Phone:
COSTA MESA,CA
Zip: 92627 License: C79637 � License:
SCOPE OF PERMIT ,
REMOVE EXISITING FAU AND STORAGE CLOSET WALLS, RELOCATE FAU TO ATTIC, AND INSTALL NEW BEAMS,
REMODEL KITCHEN W/ NEW CABINETS AND EXTEND COUNTER IN KITCHEN AREA. INTERIOR WORK ONLY.
Plan Check: $90.51
Permit: $13925
SMIP Res: $0.70
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $230.46
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existinq: o
NOTES:
Rear 0-0
Rear 0- 0
Required: 0
FEE SUMMARY
Calc Valuation: S�,000.00
Claim Valuation: s�,000.00
PLANNING & ZONING
Left 0- 0 Right
Left 0- 0 Right
Proposed: 0
DII�]
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremants untler Calitornia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) �
EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandonetl
fa a period of 180 days. �
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, antl all
requlred Inapeetlona and final epprovel must be obtained. Failure to obtain inspections and tinal approval will resrlt:in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
244&48 (8/00)
WORKEHS'COMPENSAnON DECLARAnON:
I here�y eHirtn under penalry oi perjury a�e of the tollowing tleclaretions:
❑ I heve end wlll meintain e certiTica�e of consent to selt-Insure for workere' compensation, as providetl for Dy sectlon 3700 of the Labor Cotle, lor Ihe pertormence ai Ihe
work tor whiU Uis permit is issued.
,�] I have end wlll meintal wo ers' oomPe�setim insufance, es requiretl by secUon 3700 of the LeGor Code. tor Ihe peAartnanca ot the work for whkh Ws pertnit is Lswed.
� My workers' com atl Insur�nge caM r antl pdi�y number ere: /� p,,��y�
Certier. r r Poli NumEer. � f1�tr'�
(Thls sectlon neeU no be comp/eted Afhe permit fs vefued et me �untlred CWlars ($100) or /ess.)
ty f J �\7•'•
❑ I cently t�at In t�e pertortnan t Ihe work tw w�ich NLa pertnit is issueA, I shall not employ any person in any manner so az to hecome sub�ect Io the workers'
com tlon lews at Celifo , 6n0 egree t�at ii I should became suh�ect to the workere' compensation provislons at Sactl n 3700 ot �heLLL..��9bor Code, I shall forihwith
p sa provisl / %.� — e /
t SI eture: �� I /
: FAILURE TO SEC OPNERS' COMPENSATION OOVEMOE IS UMAWFUL PND SHALL SUBIEGT AN CRIMINPL PENALTES AND CML FlNES UP TO ONE MUNDRED
TNOUSMJO DOLLARE (5100, nODITION TO THE Cq$T OF CAMPENSATION, DAMAGES AS PROVIDED FOR IN SECfION 3TCB OF TNE LABOR CODE, IMEPE5T, AND ATTORIJEY'S FEES.
LICENSED CONTRACTORS DECLARAnON:
9(pommendng with Sectlon 7000) of
Date:
Professions Catle, antl my Iicense Is in full
CONSTRUCTION LENDING AGENCV:
❑ I �ereby eHirm t�at Ihere is a cons��+ction lending egenq tor Ne pertortnanca ol ihe work lor w�ich this permll Is Issued. (Sec. 3097, Civll Cotla).
Lenders Neme:
Signature: _
OWNER•BUILDER DECLARATONS:
Lendef5 AddreSs:
Date:
I hereby eNirm ihat under Denelry of periury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW lor the following reason (Sec. 7031.5, Buslness enC Professions
Cotle: Any clry or wunry which requires a pertnit lo construct, elier, Improve, demolish, or repeir eny sWcture, pdor to its Issuance, also requlres the eOC���ent far such pertnil
b tile a slgnetl stetement thet he or she is Ilcensed pursuem m the provislons oi ihe Contractors IJcense Lew (Chepter B(commencing with Secllan 7000) ot DlWsion 3 of the
Business entl Pmfessions Cotle) or that he or she is e:empt therelrom antl tha besis for the elleped ezempllon. Any violatlon of Section 7037.5 by eny epplicant for e pertr+'
subjecis Iha epplicant to e civil penalry of �ot more then INe hundred dollars (5500).):
❑ I, es owner ot the properry, or my Bmployees wil� weges es their sde compensaUon, WILL DO 7HE WORK, end the strucNre Is not Intenaetl or oflerad tor sale (Sec.
7044, Busineu end Profassions Cude: The Coniractors Ucense Law does not appy to an owner of proporty who builds or improves thereon, end who does such work
himself or hereelt or throug� Ns or her or.n emplqrees, provided ihat such imprwements ere nat intendetl or ottered for sale. It, however, Ne building or improvement Is
solA wit�in one year of wmpletion, the owner-builder will heve Ihe burtlen ot proving �ha� he or she ditl not build or improve for purpose of saleJ.
❑ I, as owner ot t�e pmperty, am EXCLUSIVELV CONTRAGTING WfTH LICENSED CONTHACTORS to construct the projed (Sec. 7044, Business end Professions
CaOe: The contrecrors Llcense Lew tloes not eppy to an owner ot pmperry who builds ar impmves therean, entl who comrects br such prqect wIN e contraclor(s)
liCenSe pur5uent to lhe Con�rector5 V�ense LewsJ.
❑ I em exempt untler sec. Business entl Pmtessions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Ves ❑ No Dnvers License No.
Vadlication at Ownership by (type oi doGument, i.e. - O�aDerry taz bill or deed):
E:plres:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cerllty Ihat no excavation �we (5) or more feet In tlepth Into which e person Is raqulre0 to descend, wlll ba matle in connectlon wiih work euthorizetl by Ihis
permil, end Ihet no building structu�e, sceHolding, IalSewoM, or tlemolltion or dlsmamlinp Ihe�eof, wlll Da more ihen Ihirty-six (38) leet high. jC�ep. 32, Grp 2, Art 2, Sec.
341, Title B, Calilamie Administreirve Cade).
❑ As owner-bulltler, I will not employ anyone to Oo work which would require e pertnit trom the Dlvision of Industriel Sefery, es noted ebove, unless such person has e
pertnit ro do such work Irom Ihe dihs�on.
Signature: Date:
Dlvision ot IndusMel Safety Permil Number:
CERfIFlCATE OF COMPLJANCE AND AUTMOROAi10N OF EHTAY: I certity under penelry ol perjury that I have read this applicetian enA state �hat U�e infortnation given is
conect. I egree to compty with al1 state �ws end dry ances relatlng to Dullding conswctlan, entl euthodze representatives ot the Clry ot Costa Mesa to enter upon the
ebove-described property tor inspection purpaaes. I e��ot to occupy or allow occupancy of eny building aut�onzad by this pertnit un�il linel inspoclion.
GOOE I. INSPECTIONTYYE V QAIE UiS�ELS
1618 Fixed System Final Fire Praven�ion
1268
200
201
202
203
Pool Spe Final
Finel Re-Rool
Finel BIocWReteining Well
Final Fectory Fire Place
Final Sign
204 Final DemolWon
4QQg,( INSPECTIONTYVE
206 Finel Mechenical
20B Flnal Plumbing
210 Finel Electrical
212 Finel Flre Preventian
220 Finel Plenning Approval
222 Final Sl�e
250 Final Bulltling/Occupancy
�ff. It�
��z �
(714) 754-5273 • Faz (714) 754-4856 • www.ti.costa-mese.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2141 IRIS PL
Suite No
�..
Vicinity:
Parcel Nunmber: 42615132
Applicant: JEFFREY HUTTER
Address:
Owner: CORKElT, STEFANIE L
Address 2747IRIS PL
COSTA MESA, CA
Contractor.
Address:
Arch / Eng :
Address:
Bot-01772.
PLUMBING PERMIT
Phone: 949-646-0567
Zip:
Phone:
Zip: 92627
Phone:
Zip:
License:
Phone:
Zip:
License:
SCOPE OF PERMIT
GAS (1-4 OUTLETS) AND 1 KITCHEN SINK.
ISSUE FEE
BackFlow irrigation
BackFlow Preventer
Bathtub
Clarifier System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roo(
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1-4 outlets)
Gas (Over a outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceptors (Sand Auto )
AMT
523.50
50.00
50.00
50.00
$0.00
30.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
56.15
so.00
$0.00
$0.00
50.00
50.00
�
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
FEE SUMMARY
AMT
Laundry Tub I Washer $0.00
Landswpe Irrigation $0.00
P-Trap $0.00
Pressure Regulator $0.00
Process Piping (per 10 R) 50.00
Receptors 50.00
Septic Tank 50.00
Sewer Cap for Demo $0.00
Sewer Connect 50.00
Sewer Private Line $0.00
Shower 50.00
Sink, bar 50.00
Sink, commercial $0.00
Sink, Floor $0.00
Sink, kitchen $9.80
Sink, service/mop $0.00
Spa (private) $0.00
Spa (public) $0.00
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1•
0
0
0
Status: ISSUED
Appl ied: 7 7I09I2001
Issued: 17I09/2001
• � �t '.
ISSUED BY: '
Sump Pump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr BkFlow(5+)
Wash Basin
Wash Basin Set
Waste antl Vent System
Water Closet (Toilei)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Sokener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
AMT
50.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
so.00
50.00
$0.00
50.00
50.00
50.00
$0.00
50.00
50.00
TOTAL CALCULATED FEES: E39.45
. �
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorizad by this permit s a compy wi a ap c equirements under Calilornia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: Thls permit shall automatically expire and become void if work is not commenced within 180 deys, or if work is suspended or abandoned
for a period of 180 days. � .
�
INSPECTIONS: In order for Ihe work authorized under this permit to be considared legal, such work must comply with all eppliceble codes, and all
required Inapeetiona end final epproval must be obtained. Failure to obtain Inspections and final approval will result In the e� (ion of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
xaawe leroo�
WORKERS'COMPENSAnON DECLARAnON;
I here�y aflirtn under penalry of perjury one af t�9 �ollowing tleclaretions:
❑ I heve enA will maintein e certificate of con5ent to selFlnsure for workera' crompensation, es pmvitled for by section 3700 oi the Lebor Code, tor the paAormence of the
���/// work tor w�ich this pertnii Is issued.
I� I heve entl will m ippptain Acers' compensaU insurence, as requlretl by secUon 3700 oi Ne Lebor Code, for tha pertortnance of the work for which NIs pertnit Is iswetl.
\Myworkers'��nsati sur�ardB ntlpolicynumberare: /���py�, ,�
L. �Y Y
Certier. rt PolicyNumber. V67111
(Thls sectlon n ot etetl N/ e rM( Ls veluetl et one hundred Od/ers (3100J or less.)
❑ i certlty Ihet in the paAorma �9qf the work �a� which this pertnit b issueA, l shall not employ any person in any mflnner so as to become subject ro Na workers'
com ion laws ol Celif (a, entl epree �hat It I shaultl bacome sub�ect ta t�e workers' compensation provisiore of Secti/on 3700 of t�e L/ebor Code, I shall forihwlth
PN ese provisi i. � �/_� F!/
Iica i n ate: �
FAILURE TO SE (ERS' COMPENSATION COVEMGE IS UMAWM AND SWLLL SUBIECT AN EMPLOYER TO CRIMIrA� PENALTIES rW D CML FlNES UP TO ONE HUNDRED
TMOUSAND DOLURE (5100. N AODRqN TO THE �T OF ODIAPENSATION, OAMAGES AS PROVIDED WR IN SECTIqJ 3')OB OF THE UBOR CODE, INiEREST, AND ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLARATON: �
OflBCi.
(commencing wlih Sectlon 7000) ion 3 of ihe ness Prolessions Catle, entl my Ilcense Is in full
�CIB55 k � . -� _ )
��
CONSTRUCTON LENDING AGENCY: W
❑ I hereby aflirtn that there is a construcUon 10�Ai�8 epenty tor the peAortnance ol tha work lor which ihis pertnil is issued. (Sec. 3097, Civil Cade).
Lendels Name:
Signature: _
OWNER-BUILDER DECLARATIONS:
Lender's Aatlreu:
Date:
I hereby eHirtn Ihat under penelry of periury t�et I am EXEMPT FROM THE CONTRACTORS LICENSE LAW lor ihe following reason (Sec. 7031.5, Business anO Proless�ons
Cotle: Any Gry or counry which requires e permit �o construct, elter, improve, demolish, or reDelr eny StrucWre, O�or to Its Issuance, elso requires the epplicant for such pertnit
to ille e signetl stetement Ihat he or she is Ilcensad pursuant to the provislons of Ihe Contrectors License Lew (Chepter 9(wmmencing with SecUon 7000) ot Dlvislon 3 ot Ne
Business entl Professions Code) or thet he or she is axempt therefrom and the basis lor the ellegad ezemption. Any violatlon at Sectlon 7031.5 by eny epplicant for e pertr+'
suhjecis the apP���enl to e dvil penalry of not more than Ma huntlretl tlWlars (5500).):
❑ I, es owner ot Ihe properry, or my emplqrees with weges as their sde compenselion, WILL DO THE WORK, and the structure is na1 intende0 or otteratl tor sale (Sec.
7044, eusineu end Professlons Cotle: The ContraMors Licensa Lew tloes not eDDh �o an owner oi property who builtls or improves iheraon, and who does such work
himsetl or herselt or ihrouqh Ns or her own emplqrees, provided that such imprwements ere not intendetl or oHered for ule. II, however, Ne building or Unprovement is
soltl wit�in one year ot wmpletion, ihe owner-builder will have ihe burden ol proving Ihat he or she ditl not build or improve for purpose of sale.).
❑ I, es owner of the properry, am E%CLUSIVELV CONTFiACTNG WfTH LICENSED CONTAACTORS to consiruct the pmject (Sec. 7044, Business end Professions
Code: Tha contrectors Llcense Lew does n0� aP7ry �a an owner ot pmperry who 6uiltl5 or impmves thereon, end who contracts br such prqect wlih e contractor(s)
license pursuant to ihe Contractors Licanse L.ews.).
❑ I em ezempt under sec. Business end Prolessions Cotle for this reason:
Signature: Date:
Owner ID verltietl by driveYs license. ❑ Ves ❑ No Drivefs Licansa No.
Vedfication ot Ownership by (type oi tlaument, i,e. - D�operry laY bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMR CEN7�FICA710N:
Explres:
❑ I hereby cenity that no ezcavatlon INe (5) o! more faet in depth Into which e person L5 required to descend, wlll be mede In wnnection wllh work euthorizad by Ihis
permit, entl t�at no builtling sin,dure, scafl0�ding, falsework, or demolition or tlismanUing thereol, will be more �han ihirry-six (36) fae� �ig�. (Chep. 3.2, Gry 2, Art 2, Sec.
341, Tltle B, Califomla Atlminlsirative Cotle)•
❑ As owner-builder, I will not employ enyone lo do work which would require e pertnit Irom ihe Divislon ol Induslriel Safery, es notetl above, unless such person hes e
pertnit to do such work from the division.
Signeture: Date:
Division ol Intlusidel Safety Permit Number.
CEHfIFlCATE OF COMPLIANCE AND AIfTHORIYI�7�ON OF EMRY: 1 certify untler penelty oi perjury �ha� I have reetl �his appliwtion and state that the infortnetlon given is
correct. I egrae to comply with all stete laws end Gry ordinances relaNng to bulltling constructlon, entl authodze representatives af the Clry ot Cosfa Mesa to enter upon the
ebova-tlescribetl proper�y tor inspection pur{ases, I egree not to acupy or ellow occupency of any building authorized Dy Ihis Oermit un�il linel inspeclion.
COOE I. INSPECTIONTYPE V OAIE 1[�IELS
1818 FIxeG System Final Fire Preventlon
1286 Pool Spe Final
200 Finel Ra-Roof
201 Final BIocWReteining Well
202 Flnal Faciory Fire Place
203 Finel Sign
204 Flnel Demolliion
jQQF2 INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing
210 Finel Eloctricel
212 Finel Fire Prevention
220 Finel Planning Approval
222 Finel Slte
250 Finel Bullding/Occupency
PAIE II�
6-)9-Oa �r
(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.coste-mese.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2141 IRIS PL
Suite No
Vicinity:
Parcel Number; 42615132
Applicant:
Address:
Owner.
JEFFREY HUTTER
CORKETf, STEFANIE L
Address: 21411RIS PL
COSTA MESA, CA
Contractor.
Address:
MECHANICAL PERMIT
Status: ISSUED
Applied: 11/09/2001
Issued: 11/09I2001
ISSUED BY: ' � '
'i
Phone: 949-646-0567
Zip:
Phone:
Zip: 92627
Phone:
Zip:
License:
SCOPE OF PERMIT
Bot-o1772.
1 FAU AND i GAS PIPING. 1 KITCHEN HOOD.
ISSUE FEE
Insl FAU <100 k BTU
Inst FAU >700 k BTU
RepairlAlt CoolinglHeat
Inst / Rep. Recess Wall Htr
Refrig Sys <700 k BTU
Refrig Sys >100 k BTU
Gas Piping
Factory Fireplace
Hood wlMech Exhaust
VAV Box
Vent fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < 10000cfm
Air Handlers > t0000cfm
Floor Furnace
Floor or Suspend Heater
523.50
$14.80
50.00
$0.00
50.00
$0.00
$0.00
$6.75
50.00
510.65
50.00
50.00
50.00
50.00
50.00
$0.00
$0.00
50.00
$0.00
$0.00
�uantity
1
0
0
0
0
0
1
0
1
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Repair I Alt Absorbtion Unit
Repair I Alt Refrigeration Unit
Ventillation System
Evaporalive Cooler
Commerci a l I ncinerator
Domestic Incinerator
Compressors / Absorption Systems
Upto3hp/100kBTU
3 To 75 hp I 500 k BTU
15 To 30 hp I 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Up to 3 hp
3To15hp
15 to 30 hp
30 to 50 hp
Over 50 hp
Other Mechanical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
TOTAL CALCULATED FEES
COMMENTS / SPECIAL CONDITIONS
Quantity
$0.00 0
30.00 0
$0.00 0
50.00 0
50.00 0
50.00 0
50.00 0
50.00 0
$0.00 0
30.00 0
50.00 0
50.00 0
50.00 0
50.00 0
50.00 0
50.00 0
50.00
50.00
50.00
555.10
NO710E: The work authorized by ihis permit shail comply with all applicable handicap access requiremenis under Calitornia statutes and ielated
regulations. (Orcl. No. 92-28, § 1, 12-21-92) f
EXPIRATION: This permit shall eutomatically explre and become void Ii work is not commenced wlthin 780 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work authorized under this permit to be consideretl legal, such work must comply with all appliwble codes, and all
requlred inepectlone end 11na1 epproval must be obtained. Fallure to obtain Inspections and final approval will result in the expirallon of this permlt.
FOR INSPECTIONS CALL: (714) 754-5628 ���
zaae�e �am�
WORKERS' COMPENSATION DECLAFiA710N:
I hereby efllrtn under penalry of perjury one of Iha tollowing tleclaretions: �
❑ I have end will melntein e certiflcate of consent to self-Insure for workers' crompensatlon, es proWtletl for by section 3700 oi the Lebor Cotle, for the pertormance o1 the
work lor whlch this pertnit is issued.
S7�Thave entl II a' t in workers' cOmpenSaUon insurence, as requiretl by sectlon 3700 of tha Lebor Code, for Ihe pertortnance of Ne work Iw wh�h Nis pertnit I5 issued.
\ My wo satlo ureP�mer and poliCy num�er ere: /�,�q �/„s _�
rvrsv�I�
Certier. .( . � PolicyNumber: v 1 �V
(Thls secflon �tl of be awnpleled i! Ne perM1 fs valuetl ef ine hundred dd/ars ($100) oi less.)
❑ I cenily that In t�e pertormance a work lor which Ihis pertnit La I55ue0, I shall not employ any person in eny manner so es to become suD�ect to the workers'
wmpensetlon laws of Califomi � d egree Ihat If I s�ould become sub�ect to the workers' wmpensatlon provisions ol Sectlon 3700 0l Ne Lebor Cotle, I ahell torthwith
��e�P«,a� — —�l
S� �a: ,a:
FAI�URE TO SECUR (ERS' COMPENSAiION COVEM�E IS UMAW FUL AND SHALL SUBIECT EMP�OVER TO MINAL PENALTIES AND CML FlNES UP TO ONE HUNDRED
THOUSPNOO�ILARE(5100,WU UfT10NTOTHEWSTOFCOMPENSATON,OANAGESPSPF�Yl0E0FORM1 THEIAEOFCODE,INTEREST.ANDATSORNEI"SFEES.
LICENSED CONTRACTORS DECLARATON:
I�ereby
torce ery
9(commencing with Section 7000) ol DIvlslon 3 o /��p d Prolesslons Code, anA my Ilcense Is In full
CIBSS�LJ A Y
D t ��
•
CONSTRUCTION LENDING AGENCV: (I
❑ I hereby eHirtn tha� there is a cons��+ction lendinp egency tor t�e peAortnance ol Ihe work for whlch this permit Is issued. (Sec. 3097, CMI Cotle).
Lentler's Neme: Lender's Atltlress:
Signature:
OWNER-BUILDER DECLARATIONS:
Date:
I herehy eBirm thet untler penalry of per�ury Ihel I em E%EMPT FROM THE CONTRACTORS LICENSE LAW lor the following reason (SecJ031.5, Business antl Pmtessions
Coda: Any ciry or wunry which requires a permit to construct, elter, improve, tlemolish, or repair any sWcture, pdor to iis Issuance, also requires Ihe epplicam tor such permit
b tile a slgned slatemem thel ha or she is ficensaU poreuent to the provisions of the Contrectore License Law (Chapter 9 icommencing wlih Section 7000) 01 DlWsion 3 of Ihe
eusineu entl Professions Code) or thet he or she Is exempt theretrom antl the basis for che ellegeG axemptlon. Any violation of Sectlon 7037.5 by any epplicent far a pertr+'
sub�ects the epplicent ta e chril penalry of �ot more Ihen flve hundred dollare (5500).):
❑ I, es owner ol the property, or my 0mployees with weges es their sole compensatlon, WILL DO 7HE WORK, antl the structure Is nat Intentled or offaretl for sale (Sec.
7004, Business and Prolessions Coda: The Contractors Licensa Law tloes not aOPN �o en owner ot properry who builtls or improves thereon, anA who does such work
�Imself or hersetl or Nrough his or her own employees, providetl �hat such impmvements ere not Intended or oHered for sale. If, however, Ihe building or improvemeni Is
sold within one year of completion, the owner�builder will have the hurden of pmving that he or s�e did not build or improve for purpose ot sale.).
❑ 1, as owner oi ihe properry. am E%CLUSIVELV CONTRACTING WI7T1 LICENSED CONTRACTOFS to construct the proleci (Sec. 7044, Business end Professions
Catle: The contraclors License Lew tloes not eppty ta an owner ol Oroperty who builds or Improves thereon, antl who wMracis br such pm�ect with a contractor(s)
license pursuant to ihe ContradorS V�ense Lews.).
❑ I am exempt under sec. Business and Prolessions Code tor t�is reason:
Signatura: Date:
Owner ID verltietl by Orivers Iicense. ❑ �es ❑ No Drivels License No. Expires:
Vedlicallon ot OwnBrship hy (ryye Of document, I.e. - properry I� 6111 or deetl):
DIVISION OF INDUSTRIAL SAFETV PEAMR LER7IFICA710N:
❑ I hereby certlty thet no ascavation live (5) or more feet in tlep�h Into which e person Is requlred to tlescend, wlll be mede In connectlon wlth work euthonzad by �his
permi[, and Ihal no building siruciUre, scerioidinp, felsewolic, or Oemolition or tlismantling thereol, will be more then ihirty-six (38) teel hlgh. (C�eO� 3.2, Grp 2, Art 2, Sec.
341, Tltle B, Calilomla AdminlsiratNe Code).
❑ As owner-builder, I wili not employ enyone to do wark which would require e permlt irom ��e Divlsion of Industriel Setery, as noted ebove, unless such person hfls e
permit to do such work fram the di�sion.
Sipneture: Date:
Division of Intlustnel Satey Pertnit Number.
CERTIFlCATE OF COMPLIANCE AND A�ORQATON OF EHTAV: I certify under penalry ot perjury ihef I have reatl this appliwtion and state that the infortnation given Is
correcl. 1 egree Io compty with flll state I s antl Gry or0lnances relating to building constructlon, end euthodze representatives ol t�e Clry of Coste Mese to enter upon Ue
ebove-descnbed pmperry lor insDection�ryoses. I agree not to occupy ar allow occupency ot eny building euthorized by this pertnit until linal inspedion.
GODE �. INSVECTIONTYPE
161fi Fized System Final Fire Preven�lon
1266 Pool Spa Finel
200 Finel Re-Raot
201 Finel BIocWRetaining Well
202 Finel Factory Fire Place
203
20d
Flnal Sign
Final Demolition
PA7F 1li�dLi
cooe� wsvecnoxnae
206 Finel Mechenical
208 Finel Plumbing
210 Finel Electrical
212 Flnel Fire Preventlon
220 Finel Planning Approval
222 Final Site
250 Final Bullding/Occupanry
PAg u�eLfl
G,-�9-0� �r
(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa•mesa.ca.us 77 FAtR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Viciniry:
Parcel Nunmber:
Applicant:
Adtlress:
Owner:
2141 IRIS PL
42615132
JEFFREY HUTTER
CORKETT, STEFANIE L
Address 2741 IRIS PL
COSTA MESA, CA
Contractor:
Address:
ISSUE FEE
Temp service test
Res. alc package
New Res (7-2 unils)
New Res (3+units)
Pool / Spa
Lighting Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to 1hp
Motors to tOhp
Motors to SOhp
Motors to 100hp
Morors over 100hp
Communication drops
Sub panel to 200a
Pole Liqht Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
soi-omz.
4 LIGHTS, 1 SWITCH.
$23.50
$0.00
50.00
$0.00
50.00
$0.00
$4.40
$0.00
$1.10
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
50.00
$0.00
50.00
50.00
50.00
50.00
$0.00
$0.00
50.00
50.00
Quantity
0
0
0
4
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
ELECTRICAL PERMIT
Phone: 949-646-4567
Zip:
Phone:
Zip: 92627
Phone:
Zip:
License:
SCOPE OF PERMIT
FEE SUMMARY
Temp Dist System I Lighting
Busway /100 k
Standing Section
Misc Electrical Equipment
Transformers up to 7 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipmen;
Low Volt Wiring System / Ckt
Misc. Conduit
Misa Conductor
Circus ( gen or ride)
Circus (mech ride or lighls)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Status: ISSUED
Applied: 11 /09/2001
Issued: 11/09I2001
ISSUED BY: ! n� '
$0.00
50.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
50.00
$0.00
50.00
50.00
$0.00
50.00
$0.00
$0.00
50.00
50.00
50.00
$0.00
TOTAL CALCULATED FEES 529.00
COMMENTS / SPECIAL CONDITIONS
Quantiry
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Calitomia statutes and related
regulations. (Ord. No. 92-28, § 1, 72-27-92)
EXPIRATION: This permit shall automatically expire and become voitl it work Is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days. "� .
�
INSPECTIONS: In order for lhe work euthorized under this permit to be considered legal, such woik must comply with•all applicable codes, antl all
required inspectlona and finel approvel must be obtained. Failure to obtain inspections and final approval will result In�the expiration of this pertnit.
FOR INSPECTIONS CALL: (714) 754-5626
2aaaaelerool
WORKERS' COMPENSATION DECLARATION: '
I �ereby ettirtn under penalry ot perjury one of the lollowing tleclarations:
❑ I have and will maintaln e certllicete ot consent to self-Insure for workers' compensation, es provided for by section 3700 at the Labor Code, for the performence of the
work tor whith thi5 pertnit is issueA.
�1 have and ' mai tain workers' compensation insurance, es required by sectlon 3700 ot the Lebor Code, for Ihe perfortnance � t�wq�k� permit is Lswed,
� �fv1y work m ns9tion-7,1w�,urance mer end Doliq number are: �
Cartier. � i—i ) Policy Numbec
(Trils secNon need nof be compl te il e pertni(!s va/ued et one hundred dollars ($100J or Iess.J
❑ I cetlify that In the pertormanc Of the work for which t�is permit is issued, I shall not employ any person In eny menner so as to become subject ta the workers'
�c pensatt0�ft0WS alll nd agree that tl I shoultl become sub�ect to ihe workers' camp nse oS�—t n p�ro�I5lonac Section 3700 oi the Lebor Cotle, I shell forthwith
yw'�'�j��•F X :� �� ��Zb�
Applicant Signetu ele:
WA ILURE TO SECU ORKERS' COMPENSATIIXJ COVEMGE IS UNLAWFUL AND SMFLL SUBJECT AN E LOYER TO CRIMIN ENALTIES AND GVIL FlNES UP TOONE HUNDRED
USANO Wl1ARE (5100, , I� DfTION TO THE CQST OF COMPENS4TIIXJ, DPMAGES A5 PROVIDED FOH M 5E R CpDE, INiERESi, AND ATTORNE'f5 FEES.
LICENSEDC ACl
I her9by e� ihat I em
lorp�e eHect. Lic. M _
9(commencin9 wl�h Sectlon 7000) of Dlvision 3 of the
Date:
Cotle, end my license Is in full
C6ASTRUCTON LENDING AGENCY: "� / ��
❑ I hereby aflirm t�et there is a consiruciion lending egency tor the pertormance ol ihe work br which this permit is Issuetl. (Sec. 3097, Civil Coda).
Landafs Neme: Lender's Address:
Signeture:
Date:
OWNER•BUILDER DECLARATIONS:
I hereby eftirtn that undar penalry ot perjury thei 1 em EXEMP7 FROM TME CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business end Professions
Cotle: Any ciry or county which requires e partnit to construct, alter, Improve, tlemollsh, or repair eny s�ructure, prior to its issuance, elso requlres Ihe applicant lor such pertnit
to file e signed stetement Ihat he or she is licensed pursuant to the provisions of the Comrectors License Law (Ghepier 9(commendng wlth Seclion 7000j oi DlNsion 3 of ihe
Business and Professians Code) or that he or she is exempt therefrom entl the basis for Ihe elleged examptlon. Any violatlon of Section 7037.5 by eny applicant for a pertr+t
subjecis the epD�icant to a clvil penalry of not more ihan five hundred dollers ($500).):
❑ I, as owner ot the properry, or my employees with wages es their sole compensatlon, WILL 00 THE WORK, and the siructure Is not intended or oHeretl for sale (Sac.
7044, Business and Professions Code: The Coniractors License Law does not apply to en owner of propehy who builds or improves Ihereon, and who does such work
himself or herself or through his or her own employees, provided �hat such improvements are not intended or oflered tor sale. If, however, the huilCing or improvement is
sold within one year oi completion, Ihe owner-builtler will heve the burden of proving that he or she did not build or improve for purpose ot sale.).
❑ I, as ownar ot Ihe properry, am EXCLUSIVELV CONTRACTING WITH LICENSED CONiRACTORS to constma the prqect (SecJ044, Business and Protessions
Code: The conlractors License Law does not appty to an owner oi property who bullds or improves thereon, and who contracis for such prolect with a contractor(s)
license pursuant to ihe Coniractors License Lews.).
❑ I am exempt untler sec.
SiqnaWre:
Owner I� verifietl by tlnver's license. ❑ Ves ❑ No
Business and Professions Cotle for this reeson:
Verification ol Ownership by (rype oi tlocumen�, i.e. - properry lax bill or tleetl):
DIVISION OF INDUSTRIAL SAFETV PERMR CERTFICATION:
DriveYs License No.
Date:
Ezpires:
❑ I hereby certify t�a� no axcavatlon five (5) or more feet in depth into which e person is requlred to descend, will be made in connectlon with work authorized by thls
permii, and that no building siructure, sceMolding, talsework, or demolition or dismantling Ihereol, will be more �hen ihirty-six (36) feei high. (C�ap. 32, Grp 2, AR 2, Sec.
341, Tule B, Califomia Adminisirative Cotle).
❑ As owner-hullder, I will not employ anyone to do work which would require e permit Irom the Division of Intlustrial Sefety, as nated ebove, unless such persan hes e
permit to do such work Irom Ihe diNsion.
SigneWre: Date:
Divislon of Industnel Sefety Permit Numbar:
CER7IFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENTTiV: I certity under penalry of perjury that I heve reatl this application anC state ihat ihe iniormation given is
correct I egree to compty wlth ell state laws entl ciry ordinances releting to builtling construction, and authonze represantatives of ihe Ciry ol Costa Mesa to enter upon t�e
above-descnbed property tor inspection yy'ryoses. I egree not to occupy or ellow occupency of eny building authorizad by this permit until tinal inspectian.
COpE 6 INSPECTIONTYPE �%�
(
7616 Flzetl Sysiem Final Fire
1266 Pool Spa Finel
200 Finel Re-Rool
201 Flnal BIocWRetaining Well
202 Final Factory Fire Place
203 Finel Sign
204 Finel Demolition
Qy/g �(�j �t INSVECTIONTYPE
206 Finel MeChaniCal
208 Finel Plumbing
210 Finel Electricel
212 Finel Flre Prevention
220 Finel Planning Approval
222 Final Site
250 Finel Building�Occupancy
pl.rl�
It�ELS
A
AOP�icant to fill in all spaces eacept those within heavy borEer lines an0 si9n all appro0riate tleclarations.
CITY.aF COS7A MESA CO�ISTRUCTION PERMIT
Project Address �,��� �/ 5 � P�
Applicant's Mailing Ad��ess g�-�n�i�• uti-L L% 1T��� .�i���.�.,.�
Owner'sName � !oJ�'� Phone�9
Address S�""
I_ Arch/Eng. h� ' LicenseNo.
��� Address ' /
� Contractor's Namem4c% P/r�n.b�� " Phone �.i%-��OS •
T Address Imailing) �
V
City License No. � i i S
I LICENSED CONTRAC70R DECLARATION '
1 hereby.affirm that I am licensetl untle� provi5ion5 of Charter 9(tommencing
wilh section 7000) of Dlvlsion 3 of the Buzinezs antl Protez5ion5 Cotle, antl
my license is in full forc¢ antl eftect.
Lic¢nse Class - License o. y�y-S�7
Oate 9I����`� 519nature .
� ORKERS'COMPENSqTION DECLARATION
.iereby a/firm that I have a certiticate ot consent to selt-insure or a certlflcale
Of WorkerS' Compenialion Insurance, or a cer[ifietl Copy ?tna�eot (SeGtlon
3800, Lab. C.) R / Jy�SuX _
ty ivo. GfS �3/�/O/ Company nbi�[
Certifietl copy i5 hmeby furnishetl.
Certilmtl co�py is flled with the city Builtlin9 Division,
Date Y—/ /—kN APPlicant LI'-�3--�� %%%[= / ��
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be completetl if Ihe permi[ is tor one buntlretl ($300) or
less).
I certify thal in [he peRo�mance o1 [he wo�k for�which this pe�m�t is izsuetl, I
shall not employ any person in any manner so as to become subject to,the
Workers' ComOensation Laws of California. �
Date � Si9nature
NOTICE: 11, after makiqg tnis tletlaralion, you s�oultl become subject [o ihe
Warke�s' Compen5atioq provizions o( the Labo� COCe, you must forthwith
comO�Y '�'��h such provl5ions or this De�mit snall be tleemetl �evok¢tl.
CONSTRUCTION LEryDING AGENCV �
I bereby afflrm tM1al ther¢ I5 a conStructlon lentling a9ency for the Oer(ormance
of tha ,work for wh��n this permlt is issuetl (Section 309� Civ. C.)
Lentler's Name
Lende.'s Aaaress �
OWNER BUIIDER DECLARATION
I hereby a/tirm thal I em exempt from the ConVactbr•s License Law tor the
followin9 reason (Section ]031.5 Bu5ine55 antl Pro(essional COtle: Any city or
county whlch requi�es � p¢rmit to Const�uct, altCr, improve, tlemolish or re0air
any structure, prlor to itz issuance, also requires the applicant tor such permit �
to tile a signetl Sia[emyp( that he/She i5 IicenSCtl pur5udnt to Ne provision5 of
!he Contractor'S License Law (CnaD�er 9_(commencin9 witb Sec[ion 7000) ot
Division 3 of the Bus��ess antl Protessions Cotle) or tha[ ne/she is exempt
theretrOm antl Ih2 basis for the allegetl exemptiOn. Apy violation ot Section .
7033.5 by any appllCant tor a Pe�mlt Tubjects the applicant to a civil
��enalty of nol more lhen tive huntlretl tlollars (5500). "
I, as owne� of lha p�o0erty o� my employees with wages as their sole
mmpen5ation, will tlo tM1e wo�k, antl tbe structu�e is not ini¢nCetl or offeretl
fOI SdIC ($CCi1011 7046, 811510¢55 dOd �(OiC5510f1d1 Gotle: The Contractor's
License'law aoes not .tppy to en nwner ot a property who builtls or improves
thereon, ana wno tloes such work nlmseli/herself or thwugh his or her own
employees, provitletl lhal such improvements are not intentleG or offeretl for
sale. It, howeveq the builtling cr improvement is soltl within one year ot <om-
Oletion, [he owner wlll have the burtlen 0f proving he/She tlitl not builtl o� Im-
��ov0 for the pu�pose qf sale).
I, as�owner of the p�o0erty, am e%clusively cont�aCting with IicenS¢tl con-
iractors to construcl lhe project (Seclion ]044, Busine55 antl Profe55ions Cotle:
The Conlractor's Licohse Law does not apply to an owner of property who
builtls or Improves tn¢reon, antl who contracts tor suth projects with a con-
Vactor(sl li<ense purs4ant'to the Contractor's License Law). I am aware that
proof of their Worker•5 Compensation insurance sltoultl be provitled [o me.
❑ I am exempt unticr 5eclion B. & P. C. for this reason
Date pwner
I hereby certity that I have rea
intormation is correct. � agree to
antl state laws relating [o builtlir
Sentatives O/ this city to ente�
inspec[ion pu pa s,
$i9na[ure
eby autno/ize �ep�e-
ionetl-O�o erty fot
Dare � �
TVPE OF C�NSTRUCTION LJ NEW IJ AOD LJ ALTERATION LJ REPAI R
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL
❑ TENANT �❑ ELECTRICAL �I PlUM81NG ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION Sa. F7. oCCUanNCV—
CONSTRUCTION TYPE VALUATION $
ZONE GRADING CU. VDS. ACRES_
Remarks:
Sink
Preventer
Irr'igation
Dishwasher '
Drinking Fountains
Floor Drains�
Floor Sinks
GasService Outlets
Kitchen Sink
Lavetories
P-Trap
Roof Drains
Feinspection'Fee $15
Boiler
Duct�UnderGround
Duct - Structural
Duct - Ventilating .
Exhaust System ❑ Multiple ❑
Firepl/FacL Blt. ICBO �1`-
Heating System & Ducting
❑0.100,000 BTU 0700,OOOBTi
Drivers' License or 55 yp I I Reinspection Fae
CMF 0865-46, �ev. 4/04 Wryite - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - AsSessor
515
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
UrinaP -
Water Closet
�Water. Heater�rs
Water Service � �
Issue Fee
Hood or Typel ❑
Canopy Type 11 ❑
Refrigeration System
❑o-ioo,000eTu ❑ioa,000
System Repair/Alteration
Issue Fee
FEES
A.P. #
S Main Building:
E
T Front
A Rear
C Right
K Leh
$
Ping. Ref. #
Planning Notes:
8782 9/24/84
Zone
Accessory Building:
Parking Req./Provided �
ELECTRICAL �
Automatic Washer , Transformer ❑ 15-50 KW -'
CanstructionPoleSub. � ' �50+KW
Cooking Unit ��
Dishwasher .
Dryers �Gas ❑ElecVic
Fan �
F.A,U. '
Fixwres -
Device Boxes
Outlets
Switches
Garbage Disposal
Generamr DO-5 KW �5-75 KW
Merer IJup to 100 amps
. Meter ❑over100amps ,
Sub Panel
Morors �0-7 HP � 1 h�,B
Inc.Solar 09-15 HP �16-15+
Mitrouvave - -
Pole Light
Range
Sign
Slanding Sections
Trash Compactor �
$ 3
Reinspection Fee $15 Issua Fee
FEES
� DEVELOPMENTS�ERVICESREQUIREMENTS:
Zoning Approved By
Building Appraved 6y
��
$ 3
5.70 T�
FEES
$
SUMMARV OF FEES �
BUILDING PERMIT $ SMIP • $
PLAN CHECK $ PERMIT
PLUMBING 5 5,�� ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ GRADING $
PLANCHECK '50% $ MICROFILM $
MECHANICAL $ 70TAL FEE $ 'S' VO
PLAN CHECK 25% $
Z
O
N
I
N
G
R
E
�
M
T
.CONSTRUCTION AND PLANNING PO� _ & SPA
':APPROVALS �Permit# Date Inspector qPPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole' 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53.- Steel Reinforcement � '
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
� 4. Electrical Conduit�Undrgrnd. �� 55. Electrical Bonding
�5. Steel Reinforcement ' - 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings . 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undr9rnd., Test
9. Water Pipe-Undrgrnd., � 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap � 63. Heater & Vent-Final '
13. Roof Drains ' � 64. Plumbing SYstem - Final '
14. Rough'Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit � 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign • 68. APPROVED FOR PLASTERING
18. Rough Eleariral-T�Ba'r Ceiling 69. POOL/SPA SYSTEMS FINAL .
19. �Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
, 20. Rough Factory Fireplace � APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating ' 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro ' �
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical .
27. Frame and flashing 76. Dry Standpipe
28. Lathing & Siding 77. F�IXED SYSTEM FINAL .
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric . Notes:
34. Final Heating & Air Conditioning
3�. Final Gas Pipe-Test
36. Hood or Canopy �
37. Final Factory Fireplace �
38. Final Plumbing ' 9 t9 (�p
39. Water Service-Final
40. Gas Service-Final
47. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation . , . .
44. .Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE & BUILOING
48. Special Requirements Completed
49. Electrie Release to Edison .
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY _ - ,
No. Date � ,
� �J — � 1 � Z Z Ap�fiwnw to'fill in� all patts ezceDt those within heavY borper Iines antl si9n all appropriate Eeelaralionz.
�CITY O� COSTA MESA CONSTRUCTION PERMIT PERfy11�T NO. „� _ TRACT NO. LOT NO. UNIT NO.
' Project Address Z� y� �� � S �L - GOS%A /1�SA
Applicant'sMailingAddress Z�9 L«C LN. GOS%�4 �'1�1f:
Owner'sName 'TV SE'PN w�� �T? phone ` �S3y%
Address Z�y� �✓��S f L- CD$r'q r'JI�fA�(�C�
Arch/Eng. License No.
Address /
Contractor's Name '�0" 7���� INSl.ZA/ phone ��v ��T��
Addresslmailingl �� L��< <`N� �5��✓�/�r-��'�'Z!
City License No. r� �JS �O �n
LICENSED CONT(3ACTOR DECLARATION
I nereby atfirm [hat I am licensetl under provisions of Char[er 9(commencinq
wi[h section ]000) ot DiviSion 3 OI the Bu51ne55 antl Prote55ion5 Cotle, antl
my Iicense is in tul�o�cp�aqtl eifect. ��` L�
License Class f 7 Liw(ose N
Date g' � 3� - c'onar rr /' i. K1i'
"'ORKERS' COMPENSATION DECLARATION
xeDy aiflrm that I have a certificate ot mnsent to self-insure or a ceriiflcate
Workers' Compensation Insurance, or a certifi¢tl Copy thereOf (SeGtiOn
3800, Lab. C.) 'p�
aoiicv No. ?�����y 7' Comoany Ni}TIdN wIOB /Ny,
�Certi�ietl mpy is bereby fumisbetl.
Cerfif1�etl m is f'lea witn the city B 9 Div" ion.
Date' �[ �' I��� Applicant M��
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl nat be cOmpletetl if the permit I5 fo� one huntlrEtl ($300) or
less).
I[ertify tM1at in the pertormance of the wOrk fo� which this p¢rm�t is issuetl, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensatlon Laws of California.
Date Signatu�e
NOTICE: I/, atter making this tleUaration, you shoWtl become subject to the
Worke�s' Compensation provisions of Ihe labor Cotle, you must fortttwith
comply with such p�ovisions o� this permit shall be tleemetl revoketl.
CONSTRUCTION LEtiDING AGENCV
1 heroby af/irm tha[ lheie is a con5truction lentling dgenCy tor the pertorman<e
of the work for whith fhi5 permi[ is issuetl (Secllon 3097 Civ. C.)
I.entler's Name
Lentler's Address
OWNER BUILDER OECLARATION
I hereby affirm that I am exem0� from [h¢ Cont�actoYS License Law for the
followinq reason (Section 7031.5 Bu5lness antl Pro(essional Cotle: Any city or
county whiGh requires a pGrmit to const�uct, al[¢r� ITprove, tlemolish or repal�
any s[ructure, prior to its issuance, also reqWres the aoD�icant for such permlt
to fi10 a slgne0 SldteM1Sent lhat he/Sh¢ IS IlcenseC pu�5udnt (O Ih¢ PrOvlsions of
�he Contractor's Licens0 Law (Cnapter 9(commOnGing with Section 7000) of
Hvislon 3 0/ the Business antl Professions Cotle) or that ne�sne is exempt
icreGOm antl the ba5is fo� tite all¢g¢tl ez¢mption. Any violatlon of Section
i031.5 by any applicanl for a permit subjects Ne apPlicant [o a civll
�enalty of not more than tive huntlree tlollars (E500).
I, as owna� of the property or my nmployees wit� wages a5 [h¢ir sole
ComOensalio0, will tl0 the wo�k, dntl the SVucW�e IS not Intentl¢tl o� offe�etl
for sal¢ (Sec[ion 7044, Business antl Proteisional COtlO: Tho Contractor'S
License l.aw tloe5 not apply to an owne� of a property who builtls Or Improves
tnereon, antl who tlocs such work nlmself/herzeli or Ihrough his or ner own
employees, prOvitletl that Su<h improvement5 ara not In[en0ad or oftaretl for
sale. If, however, the builUing or imprOvement I5 soltl wllhin one year of com-
o�etlon, the owner wiil have the burtlan of proving he/she tlitl not bW Itl or Im-
p�ov0 fOr the pu�pose Ot sale).
❑ I, as owner o1 the pro0erty, am exGlusively conVacting witn lic¢nsetl mn-
Iracto�s to wnstruct [he projeCt ISec[ion 7044, Busine55 dntl Profe55ions COCe:
The Contractor's License Law does mt apP�Y [o an owner of Droperty who
builtls or improves tnerean, antl who conlract5 tor zuth projecl5 witn a con-
tractor(sl�utense pursuant ro tne Contracmr's License Law�. I am aware Ihat
p�oof o( SM1ei� Wo�ker's CompensaHon insurance Shoultl be provitletl to me.
❑_I am exempt unaer Sectlon B. & P. C. tor ihis reason
Date Owner
I hereby certity'thai I have reatl this application antl state that the above
intormation �s mrreci. I aqree to comply witn all city antl county ortlinances
antl state �laws relating to builtling conSVuction, antl he�eby autho�iie repre-
sentatives of thls city to -e er upon the bOve-mentionetl property for
inspection purpos � � (y�' �Q�
Siqnature � ^ u'�` Oate��___
TVPE OF CONSTRUCTION LJ NEW IJ ADD LJ ALTERATION LJ REPAIR
❑ CONVEft510N ❑ DEMOLISH � OTy� ur �/
���S IP I N f W¢ RK/U E O p DG. !J�KUtl 0 WO N
��L� 3Uu � �iL4�S/P��i N W^.�A S
TVPEOFPERMIT GRADING FOVNDATIOryN{ ST,RUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING IL1lMECHANIGAL
❑ OTHER
PROJECT DESCRIP710N 5a. F7. oCCUaANc4
CONSTRUCTION TYPE VALUATION $ S� OU. �h
ZONE GRADINGCU.VDS. ACRES
Remarks:
Sink
Preventer
Drinking Fountains
Floor Drains
F loor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspaction Fea � $15
Boiler
Duct - Under Ground
Duct-Svuctural '
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBO #
Heatirig System & Ducting
❑ 0.100,000 BTU O 100,000 BTi
IDrivers' License or St �c •( I � Reinspaction Fee
CMF OBfi5-46, rev. 30/84 Wnite - Builtling; Canary - Applicanq Pink - Accounting; Goltlenrotl - Assessor
$75
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
SolarTank '
Swimming Pool w/Spa
Urinal
Wacer Closet
Water Heater
Water Service
Auto-Wash
Isue Fee
Hood or Typel ❑
Canopy Type I I ❑
Retrigeration Sys[em
❑aioo,000sru ❑ioo,000
System Repair/Alteretion
Fire Dampers
Registers
Issue Fee
FEES
$ 3
$ 3
A.P. �
S Main Bui
E
T Front
B Rear
A
C Right
K Left
S
Ping. Ref. #
Planning Not
Automatic Washe
Construction Poh
Cooking Unit
DISf1Wd5f12f
Dryers ❑Gas C
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generetor �0-5
+�-
Zona
�cessory Building:
i . Z
O
N
I
. .. N
G
R
'king Req./Provided E
Q
M
T
S
ELECTRICAL
Transtormer ❑ 15-50 KW .
❑ 50+KW
. Meter ❑up to 100 amps
Merer �over 100amps �
lectric Sub Panel .
Momrs �0-t HP �7'b - 8
' ' Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light �
. Sign
Standing Sections
KW �5-75 KW Trash Compacror
I Reinspection Fee �$15 I I luue Fee
DEVELOPMENTSERVICESRE�UIREMENTS:
Zoning ApOrovad By
Building Approved By .{�
Application Issued BY ����
FEES
S 3
G
e
SUM RY O FEES /��
BUILDWGPERMIT $- SMIP . $
PLAN CHECK $ - PERMIT
PLUMBING . $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING S -
P�ANCHECK 50% $� MICROFILM S �,� ��
MECHANICAL $ TOTALFEE .5 `dS1��
PLAN CHECK 25% $ �
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector AppROVALS Permii # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ,
6. Electrical UFER Grnd. . 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. �
8. Foundation 59. Gas Pipe, � Undrgrnd., Test ' �
9. Water Pipe-Undrgmd. 60. Backwash Lines, P-Trap, O Undrgrnd. -
10. Structural Floor System Gi. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final '
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT : �
20. Rough Factory Fireplace APPROVALS Permit # _
r.
` i� �,
21. Ducts, in Structure 70. Underground Hydro �,
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush '
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil ,�'
25. Roof Sheathing 74. Ove�head Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � '
27. Frame and Flashing 76. Dry Standpipe �
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL �
30. Drywall Nailing HEALTH DEPT. REQUIREMENT �
31. Plaster Brown Coat 79. FINAL INSPECTION � '
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED �
33. Final Electric Notes:
34. Final Heating & Air Conditioning ,
t
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
� •. r.
. '
42. Backflow Preventer • � . � ' ,
� �:43. Backflow Irrigation � � �
�44: Landscape Irrigation SVstem - -
'45. Sound Attenuation � � . � !
46. Handicap Regulations � � �r
47. FINALSTRUCTURE&BUILDING �• �� . y
48.�Special Requirements Completed • � ' � '
49. Electric Release to Edison � �
50. Gas Release to Southern California Gas Co " s '
51. CERTIFICATE OF OCCUPANCY
ti
No. Date ' -
Applicant �o fill fn all ipaces except those wit�in heavy borEer lines antl si9n all apProDriate Eeclarations.
CITY OF COSTA MESA CONSTRUCTIQN PERMIT PERM NO. TRACT NO. LOT NO. UNIT NO.
Project Address ? �
Applicant's Mailino Addrr« n2 � �
Owner's Name Phone �Q�
Address � � �
Arch/Eng. License No.
Address
Contractor's Nam �//� � hone//
Addresslm'I� g) � � L //� � / '
City License No. _�� 5
LICENSED CONTRACTOR DECLARATION
1 hereby attirm fhat 1 am licensetl untle� provisions ot Charter 9(commencing
with section 7000) of Division 3 0( the Busineu antl Professions Coae, antl
my Iicense is in tull �e a. tl eifect / �
License I 5 LI ense No.
Date Si9nature
�RKE 5'COMPENSATION DECIARATION
iereby affirm tnat I have a certi(icate of consent to selhinsure or a certificate
of Workers' Compensation Insurance, or a certitietl copy thereof (Secti/o'n
3800, Lab. C.L ��/J�, /� Company �� ��^ ���� l!�
PolicY No. s f G/ 4'
� Ce�tifietl�Y!s �IetlbwithrtnehctY B /�µLn+ng �nnn/rrh��i�FF�� /�/�/
Date��� Applicant�y �� ��y �
EXEMPTION ROM WORKERS' COMPENSATION DECLARATION
(Thissection neetl not be completetl if the permit is tor one huntlretl ($100) o�
Iess).
I certify thal in the performance of the wo�k tor which this perm�t is issuetl, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of Califomia.
Date Signature
NOTICE: If, after makinq this tlecla�atlon, you shoultl bewme subjec[ to [he
Worken' COmp¢nsa[ion provisions of the Labor Cotle, you must torcnwim
comply with such p�ovisions or this pe�mil snall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby affirm that there is a construcUon lentling agency for Ihe performance
of thu work for whicn this permit is i55uetl (Sectlon 309]�Civ. C.)
L.entler's Name
Lentler's Htltlress
OWNER BUIL�EH DECLARATION
I hereby atfirm that I am exem0� from the ConVactOr'S License Law for the
following reason (Sec[ian 7031.5 Business antl Professlonal Cotle: Any city or
county which requires a permit to consVuc[, al[er, Improve, tlemolisn o� repair
any sltucWre, prb� lo its issuance, also reqW�es ihe applicanl for Such pmml[
to file a signetl SWlement thal he/she I5 Ilcensetl pursuanl to lhe prOvisions of
the ConbactoYs License Law (Cnapter 9(commencing with Section 7000) of
Division 3 ot Ihe Bu5ine55 antl P�o(es5ion5 Cotle) or thal h¢/zhe is exempl
theretrom antl the basi5 t0/ tne allegetl exemptlon. Any violation of Secllon
7031.5 by any applican[ for a permit Subjec[s the applicant to a civil
�enalty of mt more Ihan five huntlretl tlollars (5500).
I, as owner of the property or my employeCs with waqes a5 [heir sole
wmpensation, will tlo the wo�k, an0 lhe slrUctuie I5 not inlentletl o� ofle�etl
for sale (SeCtlon ]044, Business antl Protessional Catic: The Contraclor's
License 12w tloes not apply to an owne� of a property who builtls or imoroves
[pereun, antl who tloes such wo�k him5elt/herielf or through bis or her own
em0�oyees, provitletl that suGh Improv¢ments are not IntentloC or oHereO for
sdle. If, howev¢r, the bulltling or improvemenl Is soltl within one yea� of com-
pletloq the owne� will have tne burtlen oi proving he/she tlitl not builtl or im-
p�Ove forthe purpose of sale).
❑ I, as owner ot tne prooerty, am exclusivery conVatting with Ilcensetl ton-
tractors to const�uc[ Ihe projecl (Section 7044, Business antl ProfeSsions Cotlo:
The Contractor's License Law tloes not apply to an owner oi property who
builtls or improves thereon, antl who coniracts tor such pro�ects with a mn-
tractor(51 ucense pursuant to the CaniraCtor's License Law). 1 am aware that
proo( of their Wo�ker's CompensaHon insuranGe zhoultl be ptovitletl to me.
❑ I am exempt un0er Section B. & P. C. for Ihit rea5on
Date Owner ,
I hereby certify ihat 1 have reatl this applica[ion and 5[ate that the above
information is mrrect. I agree to comp!y with all city antl county ortlinances
antl state laws relating to builtling consGuction, antl hereby autnorize repre-
sentaUves oi this cify lo en%/ter� /�)po�n the a�bove-mentionrtl property �t(o?rp
in5pettion Our es. C/-/ ✓ v✓ ��,5 0 G
Signature Date
Drivers' Licens or 55 � ___
� �3980
TYPEOFCONSTRUCTION NEW ADD ALTERATION REPqIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICHL � PLVMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ.FT. oCCVaarvcv—
CONSTRUCTION TVPE VALUATION 5
ZONE GftAOINGCU.YDS. ACRES_
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
eathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
floor Sinks
GasService Outle[s
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Feinspection Fee $15
Boiler
Duct - Under Ground
�uct - SVuctural
Duct - Ventilating
ExhaustSysrem ❑ MWtiple
FirepVFacL BIL ICBO #
Heatin9 System & Ducting
❑0.100,000 BTU 0100,000
ReinspeMion Fee � $15
CMF 0865-46, rev. 30/84 White - Builtling; Canary - qppllcanf; Pink - Accountinq; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
laue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-t00,0008TU ❑100,000
System Repair/Alt¢ration
Fire Dampers
Regiiters
Issue Fee
A.P. #
S Main Building:
E
T Front
A Rear
C Right
S Left
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
_ Zone
Accessory Building:
#gl�@p'�ZC�'9'E FcEC. "i�'F
,.Ui �:� -I,_ ",�C a' Tn� °
��
Parking Req./Provided
ETLECTRICAL FEES
� Transformer ❑ 15-50 KW
❑ 50+KW
Fan
F.A.U.
Fixtures
�evice Boxes
Outlets
Switches
Garbage DisUosal
Generator �0-5 KW �5-15 KW
Meter IJup to 100amps
Meter ❑over100amps
Sub Panel
Motors OO-1 HP Ot %- 8
Inc. Solar �9�15 HP 016-15+
Microwave
Pole Li9ht
Standing Sections
Trash Compacror
Z
N
G
R
E
Q
M
T
S.
$ 3 I
�— Reinspection Fee $15 Issue Fee $ 3
FEES
DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved 8y Date
8uilding Approved By DateT y� �p�
Application Issued By r_Data___LQ�p (�p_
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK � $ —�-�— PERMIT
PLUMBING � � $ -� �UV ISSUANCE S
PLAN CHECK 25% S ENERGY P.C. $
ELECTRICAL $ GRADWG $
PLAN CHECK 50% $ MICROFILM 5�
MECHANICAL 5 TOTALFEE S �
$ 3 PLAN CHECK 25% $
CONSTRUCTION AND' PLANNING POOL & SPA ' _
APPROVALS Permi{"# Date Inspector AppROVALS Permit # Date Inspector
1. Temporary Electricaf�Service or Pole 52. Pool & Equipment Location . .,
v.
2. Soil Pipe-Undrgrnd. 53. Sreel Reinforcement ��'
3. Elecvical Conduit Utility-Undrgrnd. 54. Forms �
4. Electrical Gonduit-Undryrnci. 55. Electrical Bonding `
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ,
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE "'
:+.I
7. Footings 58. Electrical Conduit-Undrgrnd. .
8. Foundatinti �,.' 59. Gas Pipe, O Undrgrnd., Test �-�
t�'
9. Water Pipe=Undrgrnd. , 60. Backwash Lines, P-Trap, O Undrgrnd. `�
10. Structurel 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-Fina�
15. Rough Electrical-Conduit 66. Solar System-Final -
16. Rough Electric Wiring 67. Fencin9 & Access Approval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling �69..POOL/SPASYSTEMS FINAL �
19. Rough Hegting & Air Conditioning t� �' .�� F/IjiE DEPT. REQUIREMENT
20. Rough Faotory Fireplace . ,. APPROVALS Permit # ._
21. Ducts, in Structure 7� Underground Hydro
22. Ducts, Ventilating 77. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush .
24. Roof Framing ' 73. Undergrnd. Storage Tank � Gas ❑ Oil •
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural� & Moaocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe � .
28. Laihing & Siding 77. FIXED SYSTEM FINAL '
29. Insulation ' 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT .
31. Plaster BroWn Coat 79. FINAL INSPECTION '��
32. Electrical Power Meter�Final 80. FOOD CERTIFICATE ISSUED :"�'
33. Final Elect�ic Notes: � • -
34. Final Heating & Air Conditioning ��-'
35. Final Gas PiPe-Test �
36. Hood or Canopy
37. Final Factory Fireplace ' .
38. Final Plumbing �`�s! (��0
39. Water Service-Final � -
40. Gas Service-Final �
41. Solar pomBstic�Final �
42. Backflow Preventer
43. Backflow Irrigation �
44. Landscape Irrigation System
45. Sound Attenuation
4�. Handicap Regulations �
47. FINALSTRUCTURE&BUILDING - �
48. Special Requirements Completed
49. Electric Release to Edison ,
50. Gas Release to Southern California Gas Co -
57. CERTIFICATE OF OCCUPANCY ' � - ,
No. Date
ADGlicant to fill in all spaces exceDt those wilhin heavy bortler lines anE sign all apOroOriate Ceclaralionz.
Ci7Y OF COSTA mEsn CONSTRUCT PEpRMIT
ProjectAddress � `,�
.4pplicant's Mailingq/�� d�r/es) s ' 3 � //
Owner's Name ✓ `"�----✓� Phone 7
Address
Arch/Eng. License No.
Address
Contracror's Nam Phone S
Address Imailing) _ � �
Ciry Licenca No L a
LICENSED CONTRACTOR DECLARAT�pry
I hereby aftirm that I am licensetl untler brovislons of Charte� 9(commencin9
wilM1 section ]000) ot Oivision 3 of the gusiness antl Pwtesslons Cotle, antl
my license is in tull f ceantl eftect.
License Clas LIGf� C Np.
Date ' Si9nature �
`"/ORKEHS' COMPENSATION DECLAftq710N
ereby aHirm that I have a certi(icate of �onsent to mlbinsure or a certificate
Worken' Compensation Insurance, Or a certifietl <opy thereof (Seclion
�800, Lab. C /� n �i �,/' ����/
Pnolicy No. �y �N�� �n Cort�pany �F� ���
XJ�Certll ietl COPy I5 fil¢tlbwithrthehcrtY in9.�'y i�s
Date�.:��_ .4oDi��ant �/�i��� ��( /
E%EMPTION FROM WORKERS' COMP�NSATION DECLAftAT10N
(This seclion neetl mt be completetl it the pe�mit i5 tor on¢ huntlred ($300) or
lezs).
I certify lhal in the Perto�mance o( [he Wp�k for which this perm�t is issuetl, I
sM1all no[ emPloy any person in any mahner So as to become suble�t [o the
Workers' Compensation Laws of Californ{a.
Date Si9nature
NOTICE: If, afler makin9 this tleclaration, you shoultl become subject ro tne
Worke�s' Compen5ation provisians of th¢ �bor Cotle, you must forthwith
comply with such provi5ion5 or this permit shall be tleemed revoketl.
CONSTRUCTION LENDING AGENCV
I hereby affl�m tha[ Ihere I5 a consVuctioq I¢ntling agency for the peito�mance
of lhe work for wbich thi5 permit is ISSUCE (Section 309].Civ. CJ
Lentler's Name
Lentler's Atltlress
OWNER BUILOEN OECLARFTION
1 hereby affirm lhat I am exemP[ from [he Contracror'S License L.aw for th¢
following reason (Sectlon ]031.5 Business antl Protessional Cotla Any city or
counly wnich rlqui�es a permit Lo wnztruct, alt¢r, improve, tlemolish or repai�
any strutture, prlor to its issuance, also requires tne applicant for such permit
to tiie a siqnetl Statemenl Ihat he/stte is ���ensetl pursuant to Ih¢ proVision5 of
. the ConVactor'S Llcense ldw (Chapter 9 ��ommencinq with Secllon"]000) of
E::�erefrom and the bazis for the allege0 exemptlon. Any vlolaLon ot Sec[wn
�--'.'031.5 by any applicant for a permit subjects llte applicant to a civll
� pendlty ol not more lhan five huntlretl tl011ar5 (E500).
❑ 1, as owne� of [he property o� my employee5 witb wage5 as their sole
compensation, will tlo the work, antl the structure is not intentletl or offeretl
}OI Sd�E ($BCIIOII %044� BIISIlIB55 dOtl blOfC551011d1 Cotle: Tne COOffdCI0l�5
License Law tloes not apply to an owner ot a property wno builtls or improves
tnereon, antl who tloes such work himselt/herselt or throu9h his or her own
employecs, provitlotl Iha[ sucM1 improvert�ents are not intendetl or offeretl for
sdle. If, howevEr, lM1e bulltling or improvemen[ is soltl wltM1in one year of com-
pletlon, lhe ownor wlll have the bu�tlen ot proving he/She tlltl not builtl or im-
prova fo� the purposC ot sale).
❑ I, as owner of the property, am exclusively contractlng wi[M1 licensetl con-
tracSors to construct the project (Section 7044, Business antl Professions Cotle:
The ConVaCto�'S License Law tloes not appry to an owner of property who
builtls or impwves tM1ereon, antl who cOntracts for such proleGts with a mn-
Vaclor�sl ��cen5e pursvant to LM1e Con[rdcto�'S LlcenSe L.aw). 1 am aware tM1at
proof of thelt Worker's Compensation insurance shoultl be Orovitletl [o me.
❑ I am exemp[ untler Settion 8. & P. C. for [his �eason
Date Owner
1 h¢r¢by <ertify that I have rea
informatiOn iz corteGt. I agree to
antl State IawS relating to builtlir
sentatives ot this City to enter
inspection Ou� . 5.
Signalure
Driver5' License ar 55 � �
] this 8pplicalion antl s[at¢ [hat [he above
wmply N.ith all City antl county ortlinances
9 cons�rucNon, antl hereby autho�ize repre-
upOn the above-men[iOnM O�operty for
Datu���
.
TYPE OP CONSTRUCTION LI NEW IJ ADO LI ALTERATION LJ REPAIR
❑ CONVEftSION ❑ OEMOLISN ❑ OTHER A p �6
DESCRIPTION OF WORK/USE OF BLDG.
�/ S Main Building:
TVPE OF PERMIT GRADINc ll FOurvDATIOrv STRUCTVRAL T Front
❑ TENANT ❑ ELECTRIGAL ��PLUMBING ❑ MECHANICAL A Rear
❑ OTHER
PROJECT DESCRIPTION 5q. F7. OCCUPANCv C Right
K Left
CONSTRUCTION TVPE VALUATION $ $
ZONE GRADING CU. VDS. ACRES p�ng. Ref. #
Remarks: , , . , Planning Notes:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Dreins
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee � $15
B011er
Duct - Under Ground
Duct - Sttuctural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact.6lt. ICBO #
Heating System & Ducting
❑0-700,000 BTU �100,000
Reinspection Fae � $15
CMF 0865�46, rev. ]0/84 White - 6uiltling; Canary - Applicanh Pink - Accounting; Goltlenrotl - Azsessor
FEES
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Piping
Solar Tank
Swimming Pool wlSpa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fee I $ 3
Aummatic Washer
Construction Pole
Cooking Unii
Dishwasher
�ryers ❑Gas ❑
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbaqe Disposal
Zone
Parking
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up m 100 amps
Meter ❑over 100 amps
Sub Panel .
Motars �0-1 HP O1%,-8
Inc.Solar �9�15 HP �16-15+
Microwave
Pole Light
Range
Generator �0.5 KW 05-15 KW
Standing Sections
Trash Compactor
� Reinspection Fee �$15 luue Fee
IANICAL FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Hood or Type I ❑ Zoning Approvad By
Canopy Type II ❑
. _ Building Approved 8y � _
Refrigeration Sys[em
❑o-iao,000eTu ❑ioo,000
System Repair/Alteretion
Fire Dampers
Registers
Issue Fea � $ 3
.SUMMARV OF FEES
BUILDING PEFiMIT $ SMIP
PLAN CHECK S �� PERMIT
PWM8ING $ �`�'r .��DD ISSUANCE
PLAN CHECK 25% 5
� ENERGY P.C.
E4ECTRICAL $ GRADING
PLAN CHECK 50% 3 MICROFILM
MECHANICAL $ TOTALFEE
PLAN CHECK 25% $
Z
I
N
G
fl
E
�
M
T
$
FEES
$ 3
CONSTRUf.TION AN y LANNING POOL & SPA �
APPROVALS Perrtiit.,# � Date Inspector qppROVALS Permit# Date Inspector
i, �emporary Electrical'Seivice or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
r� .
3. Electrical Conduit Utility-Undrgmd. 54. Forms �t�
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding '��� �
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test � .
�
6. Electrical,UFER Grnd. 57. APPROVAL TO COVER-GUN.ITE •
7. Footings ;�, 58. Electrical Conduit-Undrgmcl��1 '•
8. Foundation y 59. Gas Pipe, � Undrgrnd., Tesc;:"
9. Water Pipe'-Undrgrnd. � 60. Backwash Lines, P-Trap, O,tl'ndrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK :"1
-11
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final •
12. Sewer Cap 63. Heater & Vent-Final t
13. Roof Drains 64. Plumbing System - Final '
14. Rough,Plumbing 65. Electrica6Final �
15. Rough Electrical-Conduit G6. Solar SYstem-Final •
16. Rough Electric Wiring 67: Fencing & Access Approval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING � -
78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning ��FIRE DEPT. REQUIREMEIVT
20. Rough Factory Fireplace APPROVALS , Permit # _
21. Ducts, in Struc[ure 70. Underground HYdro �
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro ��I
.:
26. T-Bar Ceiling (Structural�, & Monocoat 75. Dry Chemical . -; �
27. Frame and Flashing 76. Dry Standpipe `'�;(
fC
28. Lathing & Siding 77. FIXED SYS7EM FINAI „
29. Insulation 78. FIRE PREV. FINAL if%�
30. Drywall Nailing HEALTH DEPT. REQUIREMENT � �`
31. Plaster Brown Coat 79. FINAL INSPECTION ' ' ��I't
32. Electrical Power Metef-Final 80. FOOD CERTIFICATE ISSUED .. •;�
33. Final Electric Notes: - � �
34. Final Heating & Air Conditioning .�= �
35. Final Gas Pipe-Test �
36. Hood or Canopy ,
37. Final Factory Fireplate y
38. Final'Plumbing ��� �� �
39. Water Service-Final
40. Gas Service-Final � � � �
41. Solar pomestic-Final •
42. Backflow Preventer • .
43. Backflow Irrigation _ -
44. Landscape Irrigation 5Ystem �
45. Sound Attenuation � I
46. Handicap Regulations _ �
47. FINALSTRUCTURE&BUILDING - � �
A8. Special Requlrements Completed
49. Electric Release to Edison . ' - -
50. Gas Release to Southem California Gas Co . a �
51. CERTIFICATE OF OGCUPANCY � - .
No. pate ' � •
`, ` \ ,`
� ���52
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 91Y COBTA MHBA. CALIFORNIA
For Applicanf fo Fill In Completely
TYPE OR PRINT
COSTA MESA. CALIFORNIA
�vinR C. . Jordan
poz't Beach No�oR38811
D. Southworth NEoI,I85161
�i08tH I`�69& �
'0vmez�-- �. �.._
Same
-825q47 �Eo' oR3 8811
(Y' f % I I(/ I NO. OP BlDGB. O
f 1 NOW ON lAT
■ 68TBACK LIN6 PROM
� BUILDING
Plan
� O II I C � Q �I
LEFT RIGHT l
DESCRIPTION OF WORK
I X IIALTERATION I IIAODITION I
OF
TO BE PERFORMED
t � O_ A___�A�A �P_
I 1675 s<
3
ft.
��� ���C��'�,.��
APR 26Y:.S1
aFINF�f�CE DEPT.
CITY Of COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
neceirr NO. 1 [XPMIT
er Io�� � c�ive�/I �R 2 8u196
1
'��81
COSTA MESA. CALIFORNIA
PIRE
ZONING '
ZON[ NO. OP U88 OP NHW
_ R�1 I PLAN9 2 I BUIIDINO W/ att f
�°�`,..,,,,, Lot ,�11 Tr. #3856
L1N8 HT.)
I HBPEBY ACNNOWL8i1GC THAT 1 MAVB 0.8AD TH19 MPIJGTION THE �M011NT BNOWN UNOBR VALUATION IB POR TX6
ANO 9TAT8 THAT THE ABOVH 18 CORHELT AND A6RE8 TO COM-
PUPP088 OP H9TABLI6HIN6 A PERMIT I88 ONLY.
PLY WITH AlL CITY O��NANCH9 AND 9TAT8 L�WB P80ULATIHO
eUi�DINO CONBTRUGiION. /'� r.r.,� VALUATION
61GNATURB OPTJI lt �. n1 I�. 1 I�.�—�O . PERMIT FEE $ �%� OC
$ 17,133
� AUTHORIZED
w
e
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