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Home My WebLink About403 FLOWER ST - Building Permits(714) 754-5273 • Fax (714) 75M1-4856 • www.ci.costa-mesa.c��s�MBING PERMIT n FAIR DFiIVE, COSTA MESA, GA 92626 .lob nddress:; 403 � FLOWER ST Status: �SSUED Suite No' s Qr � Applied: 08242006 �p,�� Issued: 0824I2006 Viciniry: DATE =30 � /[� QS� Parcel Nunmber: 11734201 ApD��cant: BARNES,DANIEL T 8 ELIZABETH A ISSUED B� Address: 403 FLOWER ST Phone: 949-722-7759 COSTA MESA, CA � Zip: 92627•2311 Owner: BARNES,DANIEL T& ELIZABETH A Address 403 FLOWER ST COSTA MESA, CA Contractor. O W N ER-BU I LDER Address: Phone: 949-722-7759 Zip: 92627-2311 Phone: Zip: License: 000000 SCOPE OF PERMIT REPAIR AND RELOCATE WATER LINE FOR SfD. ISSUE FEE BackOow irrigation Backflow Preventer Bathtub Clarifier System Connect (Ice,Soda,etC) Dental Units Dishwasher Drain, Floor Drain, Rainwaler Drain, Roof Drinking Founlain Expansion Tank Gas Earthquaka Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oiq Interceptors (Sand Auto ) AMT 523.50 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 oTv FEE SUMMARY AMT Laundry Tub / Washer 50.00 Landscape Irrigation 50.00 P-Trap $0.00 Pressure Regulator 50.00 Process Piping (per 10 ft) $0.00 Receplors - $0.00 Septic Tank 50.00 Sewer Cap for Demo $0.00 SewerConnect 50.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 � 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS I SPECIAL CONDITIONS SumpPump Swimming Pool Trap Primer Unnal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bk(low(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Ins� or Rep.) Water Re-pipe Water Service Water Soflener OTHER VIOLATION PLAN CHECK REINSPECTION AMT 30.00 50.00 50.00 50.00 50.00 50.00 30.00 50.00 50.00 $0.00 50.00 $0.00 50.00 39.80 50.00 $0.00 $0_00 50.00 50.00 TOTAL CALCULATED FEES: E33.30 Qn 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap accass requirements under Califomla statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned lor a perlod of 1 BO days. INSPECTIONS: In ortler for Ihe work authortzed under this permtl to be consfdered legal, such work must compty with all applicaDle cotles, and ell raquired Inapectlona and tinel approval must be obtained. Fallure to obtain Inspections and tinel approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5628 zaeee �eroo� � WORKERS' COMPENSATION DECLARAY�ON: -- I hereby ettirm unOer penalry ot peryury one a� Ne Idlowing dedaretlons: �� ~ 1 ❑ I heve end wlll malnWin e cenifirate ot consent to setl-Insure lar workers' compensetlon, as provltled tor by sectlon 3700 of ihe LeDor Code, (w the pertormence af itie work for which this permit Is issuetl. ❑ 1 have e�M wN malntain workers' mmpe�satbn Inwrence, es requiretl by section 3700 0l Ihe Labor Code, lor the peAwmance of the work for whlch Nls pertnil is Iswed. My workera' compensetlon Inwrance Gertler end pdiry number ere: Cerder: Pollcy NumEer. (Thls sec0on need nor be complered i/ the pe�n/t Is valueC er one hundred tlW/ars (5100) or less.) �--I'ceitify'Ihet in t�e pedormence oi t Work tor which Ihls permit is Issueq I shall not employ any person In any menner so es to become subject ro f�B workero' �—wmpensalion lews of Celifo t�at I� I ahaulA become sub�ect m the workers' compensetlon provislons at Sectlon 3700 0 �e Lebor Cotle, I s�all tort�with comply with these pravi� �' �/�� 'Appllcenl S-- �BneWre�� Dete:, WARNIN(3: FAI�URE TO SEW fiE WORKERS' �APENSATIOM COVEfUGE IS UNUWFUL AND SIULlSUBIECf Ml EMPIAYER TO CRIAUW�L PENALTIES AND CML FlNES UP TO ONE HUNDRED THOUSAND DOLLARE (f100.000), IN ADORION T07HE COST OF COMPEN9ATION, OAlMOES AS FROVIDED FOR IN SECTION 3]OB OF THE IABOR CODE, IMEREST, AND ATTORNEVS FEE9, LICENSED CONTRACTORS DECLARATON: 1 �oreby etfirtn Ihat I em IlcenseC unCer provlsbns ol Chepter 9(commend� wilh Section 7000) of DlNsion 3 oi the Business entl Professians CoCe, end my Iicense Is in lull lorce entl eflect. LJc. p Class q Contrectofs SipneWre: Dete: CONSTRUCTON LENDING AGENCY: ❑ I horeby ettlrtn thel there is a consWCUon lentlinp epency br Ihe DeAormence of t�e work tor whiCh Ihis permit Is issued. (Sec. 3097, Civil Cotlo). Lenders Neme: LenOers Address: Sipnature: Date: OWNER-BUILDER DECLARATIONS: I hereby etllrtn Ihet under penalty of perjury thet I em El(EMPT PROM THE CONTRAC70RS LICENSE LAW lor ihe tollowing reason (Sec. 7031.5, Business and Professlons Cotlo: Any clry or counry which requires e p9�� to consiruct, elter, improve, demolish, or repeir eny structure, prlor lo Its Issuance, elso raquires the eDD��nt for such pertnit to tllo e signetl stetement ihet he or she Is Iiteosetl W rsuent to Ihe provlsbns of ihe Contraaora LJcense Lew (Chepter 9(commendng wiU Sectbn 7000) ot Dlvlsion 3 M Ne Business entl Profeuions Code) or Ihat he a� she Is exempt t�erefran and the 6asis for Ihe ellegatl exemptlon. Any violatlon of Section 7037.5 by eny eppllcent for e pertnit s�ub1�e��c1is iha epplkant to e dvil penalry ot rwt more than frve hunEred ddlars (5500).): ,LIHY es owner ol Ihe property, or my employees wlih wages es iheir sde compensatlon, WILL DO TFiE WORK, and the structure Is not intendetl or ofleretl tOr sale (Sec. 4/ 1/ 7�044, Business end Professions Code: The ContraIXors Licensa Lew does not appty to an owner ol property who builds or improves theraon, entl who doea such work himself or hersetl or Ihwugh his or her �'n empbyaes, provided lhat such impmvements ere rw� Intended or oNered tor sale. If, however, ihe buiking or imprwement is d within one year oi completion, the w+nerbuilder will have Ue Durden of proving thet he or she did not builtl or improve for purpose of sele J. es owner of Ihe properry, flm EXCLUSIVELV CONTRACTNG WrtH LICENSED CONTHACTORS to construcl tha project (Sec. 7044, Business entl Pratesslons Code: Tha contrectors License Law tloes ot eppty to en owner at pmperry who builds or impmves Ihereon, end who cantracts for such proJect wiih a conirectar(s) license oursuant to the Con(ractors Licen e Lews.). ❑ I em e:e sec. � Business end Professions Code for this reason; Signeture:-�� , /�1 . Owner�ID V6n11eC Cy ddvers Ilcense. Yes � No Dr�vers License No.� Vedficetlon of Ownershl b of tlacument, I.e. - ro �r p y(rype D PeM tac bill or dead): DIVISION OF INDUSTRIAL SAFE7V PERMR CERTIFICATON: ❑ I hereby certify Ihat no excavation tive (5) or more feet in depth into which e person Is requireC to tlescentl, will be made In wnnectlon with work euthaAzetl by this permlt, enE t�at no builtling sWMure, s�eflddinp, fal9ewwk, or tlemWltion or dismamling thereof, wlll be more than Ihirly-slx (36) feet Ngh. (Chap. 3.2. Grp 2, Art 2, Sec. 301, Tille B, CBIi}Omla Atlminl5iretive Cade). ❑ Ae owner-bulltler, I wlll not employ enyone to do work which would reQuire e pertnit trom the Division ot IndustAal Satery, es notetl ebove, unless such peraon hes e permil to Co such work trom t�e tlivision• Sipnature: Date: Dlvislan of Industrial Selery Pertnit NumOer: CERTIFlCATE OF COMPLIANCE AND AUTHOR¢A710N OF EMAY: I ceNty untler penalry of perjury Net I heve reatl this epplicetion and stele that the intormauon given is wrrect. I agre6 to ly with ell steta laws entl dry ortllnences relatlng to ouiltling wnstruqlon, entl authodze represeNatives ot Ine Clry ot Costa Mesa to enter upon Ne above-desc ' o ' pection pury�es. I agrea not to occupy or ellow occupency of eny bulldinp euthorizad by Ihis pertni� til fjn; nspectjon.� / o•'y� Signature OI L I Owner(s)_____ _,_ --- Date AnNOr Authorizetl Appllcanl Date y00E 1. INSiEGTIONT'PE OAIE V�ELS 7878 Fixotl System Final Fire PrevenNon 1288 Pool Spe Final 200 Flnel Re-Rooi 201 FInaI BIocWRet&Ining Well 202 Final Fectory Fire Place 203 Finel Sign 204 Finel Demolitlon CODE I INSPECTION TYPE 208 Finel Mechanicel 20B Final Plumbing 210 Finel Electdcel 212 Flnel Fire Prevention 220 Final Plenning Approval 222 Final Site 250 Final Builtling/Occupency � 11�� Anolicant to fill in all soaces exceot those within heavr bortler Iines ana sisn all avoroDriate aeelarations. ITV OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. Project Address '�o� F�m� e r Strce t�i � �� ' 71 68 B/28/84 I d.3D TL AppliCant'S Mailin dress O � OtN CL �F• 'l Z.re Z% TYPE OF CONSTRUCTION NEW .qDD ALTERATION REPAIR OK/)-� �• DieK S / z�p /7 � CONVERSION ❑ DEMOLISH ❑ OTHER q,p,�6 Zo�g Owner'sName �' Phonc�'� iA �t719A�G5 a, DESCRIPTION OF WOFj K/USEQ F BLDG. Address �'�� r�bwe�n S'�. i�i�5fi4/'/�A �.Q�2�2 /�Q -��/ - S MainOuilding: AccessoryBuilding: � E Z Arch/Eng. License No. TYPE OF PERMIT Gcta�ING OUrvDA7iorv STRVCTuaAL T Front p Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAI A Rear N ❑ OTHER Contractor's Nam PhOoe PROJECT DESCRIPTION 50: FT. �� OCCUaAniCv C Right N Addresslmailing) O•m� S Left - G . CONSTRVCTIONTVGE VALUATION$ � G� R City Lic¢n5¢ NO. ZpNE GRl1DING CU. VOS. ACRES E LICENSEp CONTRACTOR DECLARATION Pin9. ReL # - Parking Req./ProJided � 1 bereby attirm that I am Ilcensetl untler provisions of C�arter 9(commencing Remarks: Planning Notes: M witll 5¢CLiOO 7000) Ot DiViSIO�Of Lh BU5111¢55 dOtl Pl0}¢SSiOf15 COtl¢, antl my license is in full force antl ec . T License Class License No. S� Date Signz � - PLUMBING FEES „�v!,QRKERS' COMPENSATION DECLARATION '^'S reby aitirm that I have a certlficate of consent m selt-insure or a certificate Bar Sink Showers ELECTRICAL FEES �r'�i."Workers' Compensation Insurancq or a certitietl copy thereoi (Section gackflowPreventer ServiteSink '�oo, �ao. C.) Automatic Washer Transformer �❑ 15-50 KW Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. ❑ 50 + KW eC¢rtifietl coOY B hereby turnishetl. _ Certifietl copy is filetl wi[h the city Building Dlvision. Bathtuhs Sewer Connxtion Cooking Unit Mete� ❑up to 100 amps Date � APplicant EXEMGTION FROM WORKERS' COMPENSATION OECLARATION Cle�ifi¢f5 SOId� C0112CL0�5 Dishwasher Meter ❑O�C� 100dmpS (Thissection need not be completatl If the p¢rmit Is for one huntlretl (E100j or iess). Dishwasher Solar Piping Dryers ❑Gas ❑Electric � Sub Panel I ce�Hfy that in Ihe perto�mance OI the wo�k tor which Ihis pe�mR is i55uetl, 1 �shall not employ any person in any mann so as to bccome subject to the Drinking Fountains Solar Tank Fan Motors 00.1 HP O1 �- 8 Workerz' ompensa��i�oJy Laws of Cali�fy rn' ` ^ A� QV� Date �c�X- X�Signature 7�' U � Floor Drains Swimming Pool w/Spa F.A.U. NOTICE: If, a}Yer maiting this tlaclaration, you shoultl become subject to the ' Inc.Sola� 09-15 HP �16-15+ Workers' Compen5ation provision5 of the Labo� Cotle, You must Porthwith FI00�Slnki U�indl ' Fixtu�¢5 comply wiN such p�ovision5 or this permit shall be Ceemetl /evoketl. MiCrowdv2 CONSTRUGTION LENDING AGENCV - • � C,ias SerViC¢ Outl¢ts Water CIOSet D¢viCe BOxeS I hereby at9rm that there i5 a ronstruction lentling agency for the performance ' Pole Light of tne work tor which Ihis permit i5.i55uetl (Section 3097 Civ. C.) Inl¢rc¢ptOrS ' Wdt¢r H¢dt¢r ' Outlets Range Ltntler's Name Lentler's adtlresz _ Kitchen Sink � Water Service Switches Sign OWNER BUILDER DECLARFTION� � I he�eby affi�m that I am exempt Irom the Contracto�'s LicenSe Law tor the lavatories (�id�bd ¢ Di5 OSdI tollowing reason (Section 7031.5 Business antl Vrofe55ional Cotle: Any city or 9 P Standing Section5 county whicb �¢qui�es a permit [o construct, alter, improve, tlemolish o� �epair P-T�yp ' . any structu�e, prio� to its issuance, also �equi�e5 the applicant (Or such permit Generator Q5 KW $-1$ KW T�25h COrtlpdCtO� to file a signea statement that he/she Is IicenSetl pursuant to the provisions ot Roof Drains � j,!Se Contractor's License Law (ChaO�er 9(commencing with Sectlon 7000) of [`-,�q�.;lsion 3 ot the Business antl Protes5ion5 Cotle) o� lhat Ite/she i5 exempt , ,e(rom anE the basis for [he allegetl exemption. Any violation of Section , . �„."'J3.5 by any ap0��cant tor a permit. subject5 the applicant to a civil I�I� �� "fLenalty of not more Ihan tive huntlretl tlollars (5500). ' $ 3 LJ I, as owner of tne property or my employees with wd9e5 as their sole ReinSpettiOn F¢e $15 Isu¢ Fee tompensation, will tlo tne work, antl the structure is not intentletl or offeretl Reinspection Fee $15 Issue Fee $ 3 tor sale (Section 7044, eusiness antl Protessional Cotle: The Contractor's . MECHANICAL . FEES License Law tloes no[ apply to nn owner of a property who builtls or imp�oves thereon, antl who tloes such work nimselt/herzelf or through his or her own Hood or T DEVELOPMENT SERVICES REQUIREMENTS: employees, provitletl that such improvoments are not intentletl or otferetl for BOil2f Yp¢ I ❑ sale. H, however, tne buiming cr improvement is soltl within one year ot mm- Canopy Type I I ❑ 2onin8 APProved By Date pletloq che owner will have lhe burtlen of proving M1e/sne tlia nol builtl or im- Duct - Under Ground - Building Appraved By Date � ¢ for the Ourpose o( sale). . ��{j.� j`� - 8 f I as owner of the oroperty, am exclusively mntracting with Iicensetl con- Duct -SVuctural Refrigeration System � Application laued By 7� •�P' Dat � � ctorz to const�uct the projec[ (Seclion ]044, Bu5ine55 antl Prote55ion5 Cotle: � 7he ConVactor's License Law does noi apply to an owner oi pronerty who Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU . SUMMARV OF FEES builds or improves thereon, antl who contracts fo� Such ro ects with a con- Vactor(sl license pursuani to the Contractor's Liwnse Law) �I am aware that Exhaust System ❑ MWtiple ❑ System Repair/Alteration ' BUILDING PERMIT $ � g"�G SMIP $ • S� proot of ineir Worker's Compensatlon insurance snoum be provi0etl to me. PLAN CHECK $ PERMIT ❑ I am exempt unaer Section e. & P. C. for this reason FirepUFact. BIt. IC80 # PLUMB WG $ I$SUANCE $ �p t -Z�- O �( . Heating System & Duc[ing PLAN CHECK 25% $ ENERG�' P.C. $ I nereby certify that 1 have reatl lhis ap0��ation antl state thaF tne above ❑6700,OOOBTU �100,0008T ELECTRICAL ' $ GRADING $ Intormation is mrrecL I agree to comply with all tlty antl county ortlinances antl state laws relating to builtlin9 wns(ruction, antl hereby authorize reore- � P�AN CHECK 50% $ MICROFILM $ senta[ives of this tlty to enle� upon tbe��77 ab((o``ve-mentiOnetl Property fo� Inspection pur es. �n D� 8y MECHANICAL $ TOTAL FEE $ �� Signalure J��-.3� Date� Drivers' �E <c � Reinspec[ion Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMFO865-46,rev.4/84 White-Builtling:Canary-Applicant:PinK-Accountin9;Goltlenrod-Assessor \ CONSTRUCTION ANDPLANNING PO� SPA 1 -�APPROVALS Permit# Date Inspector AppROVALS 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. APPROVAC TO COVER�GUNITE � . ..7. Footings ' ' „ 58. Electrical Conduit-Undrgrnd. � 8. Foundation - 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. - 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final 72. 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 1�6. Rough Electric Wiring 67. Fencing & Access Approval 77. Raugh 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 . Rough Factory Fireplace APPROVALS Permit # . 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. Undergmd.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. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing • HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED , 33. Final Electric Notes: � 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test � 36. Huod or Canopy 37. Final Factory Fireplace � 38. Final Plumbing I 39. Water Service-Final � � - - � 40. Gas Service-Final 41. Solar pomestic-Final - 42. Backflow Preventer , 43. Backflow Irrigation � 44. Landscape Irrigation System � 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING p L 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces excev1 thase within neavy boraer lines ane sign all aoGrovriate tleclarations. 't ' PERry{ITIN .� �� TRACT NO. � LOT NO. � UNIT N6. CITV OE COSTA�M�S3 CQN�R �CT1�� FERMIT _ � �Y � �� 4J .. . Project Address . , � f W� TYPEOFCONSTRUCTION� NEW ADD ALTERATION REPAIR Applicant'sMaili�2/+ddra« �t73 %�OGr)Pi^.) • //I. . �� m��/.,�� ❑ CONVERSION ❑ DEMOLISH ❑ OT ER q p# Owner's Na�m/e �mN �' �� ` � � ��Cy�� y��__°�m�L7 D�SCRpPTION pF WORK/VSE,�,¢ BLDCy � ` �` C'--�� Address' '( D;r ��G f.V E'Y'' 'S •""-�"T /�'LC�/� l�l�' Arch/En9. License No., Address �/--�.��G,,,� Contractor's Name Phone -Sb-±[1--1 �) Address Imailinq) � Cicy License No. LICENSED CONTRACTOR DECLARATION " I hereby affirm tnat I am licensetl untler provislons of Charter 9(commencing wilh section 1000) of Division 3 of the Business antl P�otessions Cotle, antl my license is in full torce ntl effect. License Class icense No�� ate Signature WORKEftS' COMPENSHTION DECLARA I � hereby affirm tM1at I have a cer[ificate of con5ent to self-insure or a certificate �f Workers' Compensation Insurance,� or a certitietl coOY thereof (Section d800, Lab. C.) , ' " Policy No. COmpany eCertifietl copy is hereby fUrnishetl. Certifietl copy is filetl with the city Builtling Divisian. Date � APPlicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Tnis section need not be mmpletetl if tne permit is for one huntlretl ($300) o� less). I certity that in the performance of tM1e work for which this permit is i55ueQ I shall not employ any person in any man so as to be mj �ybject to the Worker�Compe_nsatip}I_j,yw5 ot Califom' ��/]J / �_ ' Q \NOTICE: If, after making this tleclaration, you shoultl becoine subject to fhe � tNorkers' Compensation provisions ot the Labor Cotle, you must forthwith comply witn such provisions o� this permit�5hall be tleemetl revoketl: CONSTRUCTION LENDING AGENCV 1 hereby affirm that there is a consV uction lentling aqency fo� the pertormance of the -work tor hi h this ermlt ' i ue ectio 309� Civ. C.) Lentler's Name Lentler4 Atltlress -yV � �� OWNERBUILDEKOE LARATION I hereby af�irm that I am exempt irom the Contractor's license Law for the followinq reason (Section ]031.5 Busine5s antl Professional Cotle: Any city or county w�ith requires a pe�mit to construct, alter, improve, demolish or repai� any structure, prior to its asuance, also requires the applicant tor sach permit to tile a 5iqneC statement that he/she is licensetl pu�suant to the provisions of the ConVactor's License Law (Ghapter 9(commencing wi[h Section ]000) of rJivision 3 of the Business antl Professions Cotle) or that he/sne is exempt ierefrom antl the basis for the alle9etl exemption. Any violation of Section 031.5 by any applicant fOr a permit subjects the appliwnt to a civil `� alty vf not more tnan five huntlretl tlollars ($500�. �ll, as owner of the pro0erty or my employees witn wages as thei� sole �m«Tpensation, will tlo the work, antl tM1e struc[ure is not intentletl o� otferetl tor sale (Section 7044, Business antl Professional Cotle: The Contractor'S License l.aw does not apo�Y to an owner of a property who builtls or improves tbereon, antl wha tloes such wo�k himself/be�seii or [hrough his or her own employees, provitletl lhat sucM1 imprwemenis are not intentletl or offeretl to� Sale. If, boweve�, the builtling or imp�ovement i5 Soltl wlthin one year ot com- oletlon, the owner will have the burtlen oi proving he/she tlid not builtl or im- prove fot the pu�pose of sale). �� ❑ I, as owner ot the property, am exclusively cont�actinq with licensetl con- '� Vactorsto construct the project (Section ]044, Business antl Professions Cotle: The Contrattor's licen5e law tloes not apply [o an owne� of property wM10 builtls or improves ihereon, antl who mntrac[s fo� such p�ojects with a con- Vactor(5) Ocense pwsuant�to [he Conbactor's License Law). I am aware [hat proof of [peir Worker's Compensa[ion insurance sM1oultl be provitletl to me. ❑ 1 am exempt untler Section� B. & O. C.Ifqr thi5 rea5on \I D t �' Z� o � I hereby certify that I have reatl this application antl state that the.above information �s wrrect. 1 agree to comply wrth ail city antl county ortlinances antl state laws relating to builtling ronstruction, antl hereby authorize repre- sen[atives Of t city to enter upon e above-mentionetl property t r inspectionpur es. �`�C�� ate�� Signature TVPE OF PERMIT LJ GRADING LJ FOUNDATION L�4�TRUCTV RAL ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL ❑ OTHER " PROJECT DESCRIPTION 5a. F7. occuaarv[C/v� �� CON STRUCTION TVPE VALUATION $� vv ZONE GRADINGCV.VDS. ACRES_ Remarks: � ' Sink Preventer Irrigation Drinking Fountains Floor Drains . Floor Sinks Gas Service Outlets Intercepmrs Kitchen Sink Lavatories � P—Trap Roof Drains Reinspection Fee ' � $15 Duct- UnderGround Duct-Structural � Duct - Ventilating ExhaustSystem ❑ MWtiple fiiepl/Fact. Blt. ICBO # Heating System & Ducting ❑ o-i oo,000 eTu O i ao,00a Reinspection Fee �� $15 CMF 0865-46, rev. 10/84 White - Builtling; Canary - Applicant; Plnk - Accounting; Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Watet Closet Water Heater Water Service Issue Fee Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ' ❑0.700,OOOBTU ❑100,OOOBTU System Repair/Alteration FireDampere � Registers Issue Fee FEES S Main Bwldmg: E T Front A Rear C Right K Left S Ping. Ref. # __ Automatic Washe Construction Poli Cooking Unit , D ishwasher Dryers ❑Gas � Fan F.A.U. Fixtures Device Boxes � Outlets Switches Garbage Disposal Generamr �0-5 Electric 8041 ' �/2E/g5 Zone Building: ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up m 100 amps Mete� ❑over700amps $ub Panel Motors O0.1 HP Oi'/: � B � Inc Solar �.�9-15 HP � i6-15+ Microwave � � � Pole Light . Range KW LJ5-75 KW ', Standing Sections Trash Compactor $ 3 Reinspection Fee $15 luue Fee FEES �DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By Building Approved By ApplicatiOn IssUed By $ 3 Il,pq T�_ Z O N I N G R E Q M T S FEES �-r $ 3 � SUMMARY OF FEES �-1 BUILDING PERMIT $ �0�� SMIP $ ' ��./ PLAN CHECK $ •((� PEFMIT , PLUMBING $ ISSUANCE $ � PLAN CHECK 25% $ ' ENERGY P.C. $ ELECTRICAL $ � GRADING �$ PLAN CHECK 50% $ � MICROFILM $ MECHANICAL $ TOTALFEE $ 17.D� PLAN CHECK 25% $ CONSTRUCTION AND PLANNING P�� ` S°A APPROVALS � Permit# - Date Inspector AppROVALS Permit# Date Inspector '�4. Temporary Electrical Service or Pole 52. Poo(& Equipment Location � � 2. �Soil.Pipe-Undrgrnd. 53. Steel Reinforcement . 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4.�Electrical Conduit-Undrgmd. � 55. Electrical Bonding 5. Steel�Reinforcement 56. Rough Plumbing & Pressure Test . '6.' Electrical UFER Grnd. ' � 57. APPROVAL TO COVER-GUNITE � . 7. Footings , 58. Electrical Conduif-Undrgmd. . � 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 11. Property Sewer Line & House Connection ' 62. Backwash & Receptor-Final . 72. 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� 78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19,, flough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT . 20. Rough FactorY Fireplace APPROVALS Permit # 21. DuCts, in Structure 70. Underground Hydro 22. Ducts, Ventil2ting 71. Product Piping 0 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) & 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 Nailin9 � . HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat � , 79. FINAL INSPECTION 32. Electrical Power MeterFinal - 80. FOOD CERTIFICATE ISSUED 33. Final Electric � Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or CanoPY ' 37. Final Factory Fireplace � , 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final � . 41. Solar pomestic-Final �i 42. Backflow Preventer ' 43. Backflow Irrigation � 44. .Landscape Irrigation System � 45. Sound AttenUation ; � 46. Handicap Regulations � 47. FINALSTRUCTURE&BUILDING j,��r . � 48. Special Requirements Completed , 49. Electric Release to Edison � . 50. Gas Release to Southern California Gas Co ' � 51. CERTI FICATE OF OCCUPANCY . No. � Date , '� � Applicant to iill in all spaces except those witnin heavy bortler lines antl sign all aoo�avriate aeclarations. CITY OF COSTA MESA ��STRUCTION PERMIT PEFl�AJT NO. _ __ TRACT NO. LOT NO. UNIT NO. Proiect Address �� ?� �-�%4-K-- ' � �1+3 /'^/i�.�rr �:�'� l.jil� Applicant's MailiIn/9 Address Owner's Name F hN ri �� i� r L� �( e� Phone/ �O ��/C��I/7 Address �fd '� 1= ln u i�a i• .`� !• C n.7r} r1(c%rl (�� Arch/Eng. License No. Address Contracmr'sName �""'_^—'`-"'"T"�TT" Phone_��„��"� Addresslmailing) � � City License No. �- � �' LICENSED CONTRACTOR DECLARATION 1 hereby atfirm that I am licensetl untler provisions of Charter 9(commencing wi[h sec[lon 7000) of Division 3 of the Business antl Professlons Cotle, antl my license is in (ull (orce antl effect. r y,^� License Class ' — '��_ License No. Date Signature ( i � WORKERS' COMPENSATION DECLARATIONJ ' � hereby affirm that I have a certificate ot consent to selPinsure or a certificate R Worke�s' Compensation Insu�ance, Or d certitietl copy tM1ereof (Section 3800, Lab. CJ . - Policy No. ' Company 8 Certifietl capy is hereby (umishetl. Ce/tifietl [opy is filetl with the City Builtling Division. �ate Applican[ EXEMPTION FROM WORKERS'�COMPENSATION DECLARATION (This section neetl not be completetl if the permit is for one huntlretl ($100) or less). I certify tbat in the performance of the work fot which thls Oe�m�t i5 i55uetl, I sball not employ any person in any mann�r) so as to become subject to tM1e Workers' Compensation Laws ot California. p /�'/T. 7\ C . Date 7 - �� '� � Signature �'�� l{ ( � /,' J(! f �NOTICE: If, afte� making Ihis tleclaration, you shoultl become subject to th¢ Workers' Compensation provlslons ot the Labor Cotle, you must forthwith comply with such p�ovision5 or tnis pe�mit shall be tle¢metl �evoketl. CONSTRUCTION LENDING AGENCV I hereby atfirm that there is a construction lentling'agency for the performance of [he work tor which Ihis pe�mit i5 issuetl. (Section 3097 Civ. �C.) Lender's Name �� T�i � ��. Tlf /%/P•ir�� Lenaers natlress �'` / y `/ %'% /'% �� ' OWNER BUILOER DECIARNTION I hereby attirm ihat I am exempl i�om the Cont�actor'S Lic¢nse Law for the tollowing reason (Section ]031.5 Business antl Pro(essional Code: Any city or county which �equires a pe�mit to const�uct, alt¢r, imp�ove, tlemolish or repair any structure, prior to its issuance, also requires the applicant for such permit to tile a signetl statement that he/she is licensetl pursuant to the provisions ot tne Contractor's License l.aw (Chapter 9(commencing with Section 7000) of Oivision 3 oi the Bu5ine55 antl Professions Cotle) or that he/she is exempt �erefrom antl tM1e basis tor the allegetl exemption. Any violatlon ot Section 031,5 by any applicanc for a permit subjects the applicant to a civil �enalty ot not more than five M1untlretl tlollars (E500). , I, as owne� oi the p�ope�ty or my employees with wa9es as their Sole com0ensation, will tlo the work, antl the structwe is not intentletl or offeretl for sale (Section 7044, Business ana Professional Cotle: The Contractor's LicenSe law tloes not apply t0 an ownEr Ot a p�operty wlto builtls or imp�oves thereon, antl who tloes such work himself/herself or through his or her own employees, p�ovitletl that such Improvements ar¢ not in[entletl or offered for sale. If, however, the builtling or improvement is soltl within one year oT mm- . pletion, the owner will M1av2 the burtlen of 0/oving he/she Citl not builtl o� im- � prove fo� the pu�pose oT sale). ❑ I, as owner of the property, am exclusively contractinq with licensetl con- t�acforsto construct the Oroject ($ection ]044, Business antl PrOfe55ion5 Cotle: Tho Contracto�4 License Law tloes not apply to an owner ot property who bui!tls or improves fhe�eon, antl who wntracts tor sucM1 p�ojects with a con- trac[or�s) license pursuan[�to the Contractor'S License Law). 1 am aware that proof u� their Worker's Compensation insurance shoultl be provitletl to me. ❑ I am exempt untler Seciion B. & P. C. for thi5 reason / � h i 1 oate 't �/_ L� ii,"� Owner d4+-+a�,t.' _t �.i_�. - C^- 1 hereby certity that 1 have reatl this application anE state that the above information is correct. I agree to comply with all city antl county ortlinances antl state Iaws relating to builtling construction, antl hereby authorize repre- sentatives of � this city to enter upon �the above-mentiOnetl p�ope�ty for inspectionpu�poses. � Z��G� Signature �%"'�- . � � � ' � � ' �1 Dafe Orivers' Li<ense or 55 � � �� TVPE OF CONSTRUCTION LJ NEW LJ AD� LJ ALTERATION L`J�REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ pTHER DESCRIPTION OF WORK/USE OF BLDG. �' ' � I. � TYPEOFPERMIT GRADING ❑FOUNDATION '�STRVCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ' ❑ OTHER PROJECT DESCRIP710N 5a. FT. OCCuanrvcv CONSTRUCTION TVPE � � ' ' '• ' VALUATION $ �" f ZONE GRADWGCU.VOS. ACRES Remarks: Bar Sink � Backflow Preventer Backflow Irrigation Bathtubs king Fountains ir Drains ir Sinks Service Outlets Kitchen Sink Lavamties P-Trep Roof Drains Reinspection fee � $15 3oiler Duct� Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact.6lt. ICBO # Heating SVstem & Ducting ❑ o-i oo,000 aru O i oo,000 er Reinspaction Fee I $15 CMF OB65�46, rev. 10/84 Whife - Bulltling; Canary - Applicant; Pink - Accounting; Goltl¢nvOd - AsSessor FEES Showers Service Sink Sewer Cap Sewer Connection $Old! C0112CtOI5 Solar Piping Solar Tank Swimming Po01 wlSpa Urinal Water Closet Water Heater Water Service Auto-Wash Laundry Trays Issue Fee � $ 3 FEES Hood or Type I ❑ Canopy . Type I I ❑ Refrigeration System ❑o-�oo,000aru ❑ioo,000 System Repair/Alte�ation Fire Dampers Registers laue Fee I $ 3 A.P. # S Main Buildin9: E T Front ARear C Right K g Left Ping. Ref. # Planning Notes: i �. / Zone Accessory Building: ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW Cooking Unit Dishwasher ' Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator �0.5 KW 05-15 KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors�0.1 HP�1'/:-8 Inc.Solar �9-15 HP �i6-15+ Microwave ' Pole Light Range Sign ; Standing Sections Trash Compactor I.o..� i� F.EES Z O N I N G R E Q M T $ Reinspeciion Fee $15 luue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date � � Buildin9 APProved BY f"/'� '.��— Date "- �% ,�FJ . Application Issued By ' Date SUMMARV OF FEES BUILDING PERMIT $ SMIP $ � PLAN CHECK $ PERMIT PLUMBING $ � ISSUANCE $ � PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK ZS% $ CONSTRUCTION AND PLANNWG � � POI. t SPA APPROVALS - Permit# Date Inspector p�ppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' i 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. AP.PROVAL TO COVER-GUNITE . 7. Footings . 58.� Electrical Conduif-Undrgrnd.. 8' Foundatio� 59. Gas Pipe, � Undrgmd., 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. BackwasFi & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains � � 64. Plumbing System - Final 14. Rouqh 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# 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. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insuletion . 78. FIRE PREV. FINAL 30. Drywall Nailing � � _ HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat � 79. FINAL INSPECTION 32. Electiiral Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning - - 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace � 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer , 43. Backflow Irrigation 44. Landscape Irrigation SYstem 45. Sound Attenuatlon 46. Handicap Regulations _ 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed . 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co � 51. CERTIFICATE OF OCCUPANCY . � N�. Date 36507 _- �aa;c a;.;rt��r � "q 1a-7 �... ('�i��3�� .5� COSTA MESA BUILDING-SAFETY DEPARTMENT ' P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 A P IC TION FOR BUILDING PERMIT For Applicant to Fill in Completely FEC I V D V D TE R%E� DATE ISSUED BUILDING /'O3 ��Z SfC" _ ADDRESS -J OWNER �/J.�M/GI d / A.P. NO. I��— 3 �— O/ PERMIT NO. MAIL f� %�� 2y� � qDDRE $ O� rLOWGV\ �r( Z ADORE55 L{O•, C� aU CITVG��. ,�y No��G42�y4F TRACT �S LOT � BLOCK ZZ Q CONSTflUCTION W A O � LENDER am J � BRANCM �� J N OwNER mJ ADORESS � m ^ VAIUE 0 J Q ARCHITECT TEL. S' N $ � OR ENGINEER i/� N �'� y�+yL U Q FIRE W� ADDRESS ZONE TVPE GROUP ' - aw APPROVED J Q CONTRACTOR y� BY DATE mZ P..F_Si7sWTA� J Q ADDRESS p W TEL. ZONE NO.OF USE OF NEWG ��,� � Q('+` Z� CITV NO. P�� BUILDING � � STATE CITY �'AROSAPPFOVED VARDSAPPROVED y� LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BVILDING �� SI2E NO.OF BLOGS. ( M C/L STREET) � �/J/�—� OF LOT ) NOW ON LOT FRO FT. '�� FT. O'��"Y�^ USE OF * - ExISTINGB�DG. eM d K SI FT I— SIZE OF NO. OF Z NEWBLDG. 0 ROOMS I STORIES I L.SIDE FT. U EXTERIOR WALL � ROOF COVERING ' �1GGO COVERING Fa� S�/ REAF FT. FT. J VSE OF BUILDING AND WORK TO BE PERFORMED a i DISTANCE T. BET. MAIN & a � /1h �. MAIN B ACCESS. BLDGS. lri Q VAF.# DATE O q, O� L.U.P.# APPROVED yAPPROVED �v � � v / z 1 0 VI heraby acknowletlge tha[ � have raetl [his applicetiOn antl stat0 /�U � thet the above informacion is corract antl aBrea m comply with 'n �� all lows reBulating builtling consnuetion, antl I shall not amploy �Q�pr F any person in violation Ot the wOrkmen's compensatlon lews ot y [he State of Califomla. opO m d � z I hereby certlfy that I am properly licansetl as a conbactor �ntler SQ. FT, o the State of Celifomia Busi�ass antl Profassiom Cotle, Dlvislcn 3, THE AMOUNT SHOWN UNDEF VALU N OR ^ Chap[er 9, antl thax wch li�enzes ara In lull forea antl effect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT ONLV: m am exempt (rom ttie provi4ions of the Staro ol Cellfornia Businass � VALUATION antl Protessions de, Division 3, Chapter 9. �� r /�'� PERMIT FEE 5 ] Signetura of Q,/rr „/ L�_ � f/y�'�{.� � Q�V m Permittea ^ "�� 5`-/J� P�AN CHECK $ �� E � `o LL Authorized Agant TOTAL FEE 5 �