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Home My WebLink About3303 FLORIDA CIR - Building Permits(714) 754-5273 • Faz (714) 75M1-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, GOSTA MESA, GA 92626 PLUMBING PERMIT Job Address: 3303 FLORIDA CI Suite No Vicinity: Parcel Nunmber: 13958147 Applicant: KHORRAMSHAHI; ALI '. Address: owner: KHORRAMSHAHI, ALI REZA Address 3303 FLORIDA CIR COSTA MESA, CA Contractor. Address: Arch / Eng : Address: Phone: 774342-0127 Zip: Phone: Zip: 92626 Phone: Zip: License: Phone: Zip: Y License: SCOPE OF PERMIT GAS LEAK REPAIR, REPLACE 100LF OF GASLINE. ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifier System Connec[ (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drein, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT 523.50 S0.00 $0.00 50.00 30.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $6.15 $0.00 50.00 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 . FEESUMMARY AMT Laundry Tub I Washer 50.00 Landscape Irrigation $0.00 P-Trep $0.00 Pressure Regulator $0.00 Process Piping (per 70 ft) 50.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Connect $0.00 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) 50.00 Spa (public) $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS / SPECIAL CONDITIONS Siatus: ISSUED Applied: 12I03/2001 Issued: 12/03/2001 ISSUEDBY: �� SumpPump Swimming Pool Trep Primer Urinal Vacuum Brkr BkFlow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe WaterService Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION TOTAL CALCULATED FEES AMT 50.00 50.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 529.65 aTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremeMs under Califomia statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or it work is suspended or abandoned for a period ot 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 required Inspeetlons and final epprovel must be obtained. Failure to obtain inspections and tinal approval will result in Ihe expiration of ihls permit. FOR INSPECTIONS CALL: (714) 7545828 zas-as �eroo� � � WORKEHS'COMPENSAnON DECLARAnON: I hereby eHirtn under penalry oi perjury one of Ihe tollowing deGarations: ❑ I have end wlll maintein e cenifirate of wnsent to self-Insure tor workers' compensation, es pravidetl for by section 3700 ot the Lebor Code, lor tha peAarmanca of the work tor which I�IS permit is issuetl. ❑ I have antl will maintain workers' compensation insurence, es requiretl by sectlon 3700 of I�e Lebor Code, for the parfortnance of the work for whic� Ihis pertnil Is issued. My workers' compensation Insurence cartie� antl policy number ere: Cartier: Policy Numbar: (lhis sectlon need nof be complefed /! fhe permif is valued et ane hundretl tlollers ($100) or less.) ❑ I certify thet in t�e pertormence ot the work �or which ihis permlt Is issued, I shall not employ eny person in eny manner so es to become subject to tha workers' wmpensetlon lews of Celilomia, antl egree that II I should 6ecome su��ect to Ihe workers' compensation provislons of Sactlon 3700 0l Iha Labor Code, I shall torthwith Comply with Ihese pravision5. Applicent Signeture: Dele: WAiiNINO: FAILURE TO SECURE WORKERS' COMPEN5ATION WVEMOE IS UNLAWFUL AND SMRLL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUN�HED THWSAND �OLLARE (5100,000�, IN ADDITION TO THE G�T OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECiION 3IW OF THE LABOR CODE, IMEREST, AND ATTORNEI"5 FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm t�et I em licensed under provision5 of Chapter 9(commencing wiih Section 7000) ot DiWsion 3 ot Ihe Business end Professions Code, entl my license is in tull torce end ettect. Lic. 4 Class k ContractoYs Signeture: Date: CONSTRUCTION LENDING AGENCV: ❑ I here�y eflirtn �hat there is e construction IB�tling agency for lhe peAormance of �he work for which this pertnit is issued. (Sec. 3097, Civil Cotle). Lende/s Neme: Lender's Address: Signeture: Date: OWNER•BUILDER DECLARATIONS: I hereby eMlrtn ihat under penelly of perjury Ihat I am EXEMPT FROM 7ME CONTRACTORS LICENSE LAW tor Iha tollowing reeson (Sec. 7031.5, Buslneu and Pmfesslons Code: Any ciry or counry which requires a pertnit to construct, elrer, impmva, demolish, or repair any strucWre, D�or to its issuance, also requires the epplicant for such permit to File e signetl stetement �het he or she Is licensed pursuent lo the provisions oi Ihe Contractors License Law (Chepter 9(commencing wlth Sedlon 7000) oi Dlvislon 3 ot the Business en0 Professions Code) or Ihet he or she is e:empt iherefrom end ihe basis for the elleged exemption. Any violatlon of Sectlon 7031.5 by any epplicent for a Denr+. subjects the epplicant m e civil penalry of not mora than five hundretl dollars ($500).): ❑ I, es owner oi the property, or my employees wfth wages as their sole wmpensaHon, WILL DO THE WORK, end Ihe structure is not Intendetl or oHered tor sele (Sec. 7044, Business and Protessions Cotle: The Conirectors Ucense Lew tloes not apply to an owner of property who builds ar improves iheraon, entl who does such work � �Imself or harselt or through his or �er own employees, pmvitled �hai such improvements are not imended or oNeretl for sele. It, �owever, Ihe builtling or improvement Is soltl within one year ot complation, ihe ownd�-builtler will heve the burtlen ol proving that he or she did not builtl or improve for Durpose of saleJ. ❑ I, as awner of the pmperty, em EXCLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to consWct the project (Sec. 7044, Business and Professions Cotle: The cnntreciors IJcense Law does ntlt apply to an owner ol property who bullds or improves thereon, end who contrects tor 5uch project wlth e coniracbr(s) license pursuaN to the Contradors Licensa ws.). ❑ I am exempt un r sec. Business end Professions Code for ihis reason: Signature: .q� � Date: �a-o-i—e1 � Owner ID verified drivers license. ❑ Yes ❑ No Dnvers Ucense No. /Eapires: Mwdt s o03 Verificatian at Ownership by (type of tlocumant, i.a. - property tez 6111 or deed): DIVISION OF INDUSTRIAL SAFETY PERMR CEAnFICATION: ❑ I hereby ceNiy ihat no excavation five (5) or more feat in deplh into which e person is required to descend, will be matle in connection with work euthonzed by this permit, end Ihat no building stmcture, scaHolding, falsework, or demolitlon or dismemling thereo( will be more than t�irty-six (36) feet higR (Chap. 32, Grp 2, Ar12, Sec. 341, Title 8, Celllornia Administretive Code), ❑ As ownerbuilder, I will not employ anyone to do work which would require e permit fmm the Division of Indusinal Seley, es notetl ebove, unless such pereon has e pertni� Io do such work irom ihe division. Signature: Deta: Divisian ai Industnel Satery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND A YATON Of V: I ceniy under penalry ot perjury that I have read this ep0lication end stete Ihel the infortnation given is correct. I egree to co ly with ell stat w nd city ord' es releting to bullding construction, end authorize representatives of the Ciry of Costa Mesa to enter upon the ebove-descnbmtl pr rty tor inspecf oses. I a not to occupy or allow occupency of any building authorized by this permit until tinal inspection. / i2 �03-d � Finnatinn Ot Lwnxl OWOBfIS) Oa�B COOE1. INSPECTIONTYPE PdI& INTRIALg 1616 Flxetl System Final Fire Prevention 1266 200 201 Pool Spe Finel Finel Re-Roof Final BIocWRetaining Well 202 Final Factory Fire Place 203 Finel Sign 204 Final Demolition CO�E� INSPELTIONTYiE 206 Final Mechanical 208 Final Plumhing 210 Final ElecMcal 212 Final Fire Prevention 22o Final Planning Approval 222 Final Sita 250 Final Building/Occupenty PAIE lI�A6,4 � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIF �RIVE, GOSTA MESA, C;A 92626 BUILDING PERMIT Job Address: 3303 FLORIDA CI Suite: Vicinity: FLAT PORTION OF ROOF Parcel Number: 13958147 npp�icant: ENRIQUEZ, MIGUEL Address: 1420 E EDINGER AV #111 - SANTA ANA, CA Owner: KHORRAMSHAHI, ALI REZA Address 3303 FLORIDA CIR COSTA MESA, CA Contracror. BEST VALUE ROOFING Address: 7420 E EDINGER AV #111 SANTA ANA, CA Zip: ; 92705 Arch : Address: Zoning: Phone: (714)542-5222 Zip: 92705 Phone: Zip: 92626 Phone: (714)542-5222 License: 715903 Eng: Address: Phone: ISSUED BY: Status: ISSUED Applied: 03/20/2001 Issued: 03/20/2001 Phone: Zip: License: License: ' SCOPE OF PERMIT REROOF FLAT PORTION OF ROOF AT REAR OF EXISTING SINGLE FAMILY RESIDENCE (11 SQ). TEAR OFF EXISTING , 8 INSTALL NEW BUILT-UP ROOF SYSTEM. . " � - PlamCheck: $0.00 Permit: $83.25 SMIP Res: • $0.50 SMIP Gom: $0.00 Other: $0.00 Inspection: " $0.00 Total: $83.75 SETBACKS MAIN STRUCTURE Front 0- 0� ' ACCESSORY Front ,0-0 , PARKING Existinq: o NOTES: Rear 0-0 Rear 0- 0 ' Required: 0 FEE SUMMARY PLANNING & ZONING Left - 0- 0 Left , 0- 0 Proposed: 0 Calc Valuation: j , $3,000.00 Claim Valuation: ; gs.000.00 � ' � �� , i _ , ' � � % � ; �;, . �, f� �'� , <,� / / � �j Right �-0-0 - - � Right -0--0 - NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiremants under California statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In orde� for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspectlons and final approval must be obtainetl. Failure to obtain inspections and final approval will result in the ezpiration.of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446d8 (fY00) WORKERS' COMPENSATION DECLARATION: � ' I hereby attirtn untler penalty of perjury one of the �ollowing declaratlons: ❑ I have and wlll maintein a certificate ol consent to self�lnsure tor workers' compensation, es providetl for hy section 3700 of ihe Labor Code, lor the pertormanca of the work tor which ihis permii is issuetl. � "�I have and will maintain workers' compansetion Insurance, es required 6y sec0on 3700 of the Labor Code, for the peAormance of the work for which this pertnit is issued. My workars' compensatlon Insurance carde� entl pp liyv number are: ca�ae�: ---L�, �.r � c a.rr C� s l,c a. l fi4 ao�� N be� - a`I ZB,S�'! Y 3�7 (This secfion need nat be completed il the permit is velue t ane hundred dollers ($100) or /ess.) '�-�—^ ❑ I certity that in the performance ol the work for which Ihis permit is issueq I shall not employ any person in any manner so es to bacome subject Io ihe workers' compensetlon lews of Celifornia, end egree thet If I should 6ecome sub�ect to the workers' compensation provisions oi Section 3700 of the Labor Code, I shell iorihwith comply with �hese provision „ Applicent Signatu�e:-- � � �� Date:_ — 3� oi C� � � I WARNING: FAILURE TO SE E WORKEFS' MPEN6ATION CA � GE IS UVEFA NLAWFUT AND $HALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THW SAND DOLLARE ($1�000�, IN ADDITION TO THE f�T OF COMPENSATION, DAMAGES AS PROVI�ED FOR IN $ECTION 3�O60F iME LABOR CODE, IIJrEREST, AND AiiORNEV'$ FEES. LICENSED CON7RACTORS DECLARATION: I hereby attirm ihat I em.licensetl untler provision5 of Chepter 9(commencing with Section 7000) of Division 3 of�lhe Business and Professions Code, and my license is in full farce antl eHect. Lic_M. --� �$ Q �� Class q—J C� 3 9 ContractaYs Signeture: �i� De�—�=-02 �O ^ � I CONSTRUCTION LENDING AGENCY: ❑ I hereby aflirm that ihere is a consiruction lending egency for ihe peAormance of ihe work for which this pertnit is iuued. (Sec. 3097, Civil Code). Lentler's Name: ' LendeYs AOtlress: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirtn Ihet under penalry of perjury that I am EXEMVT FROM THE CON7RACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions Cotle: Any ciry or counry which requires e permit b consWci, atler, improve, tlemolish, or repair any structura, prior ro iis issuance, also requires t�e aOPlicam for such permit to file a signea statement ihat he or she is Ilcensetl pursuant to ihe provisions of the Contractors Licenso Lew (Chepter 9(commencing wi�h Section 7000) af Division 3 ai the Business antl Professions Cotle) or Ihat he or she Is exempt therefrom and Ihe besis lar the elleged exemption. Any violation of Section 7031.5 by eny applicant for a pertnit sublects the applicant to a civil penalry of no� mor� Ihan five hundred dollars ($500)J: ❑ I, es owner ol the propeny, or my employee5 with wa9es es lheir sole compensation, WILL DO 7HE WORK, and the structure is not intentle0 or oHeretl tor sale (Sec. 7044, Business and Professions Cotle: The Contractoro License Law does not appty to an owner ot pmpeny who builds or improves thereon, antl who does such work himseN or hersalf or �hraugh his ar her own employees, provided ihat such improvemenis are not intended or aHeretl for sale. If, however, the building or improvement is sold within one year ot complation, the owne�-builtler will heva the burtlen of proving lhet he or she did not build or improve for purpose of sale.). ❑ I, as owner ot Ihe property, am E%CLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to construct the project (Sec. 7046, Business and Prolessions Code: The conirectors License Lew tloes not eppy to an owner of propeny who 6uilds or impmves thereon, antl who contracis for such project with a contractor(s) licensa pursuant to ihe Contractors License �ews.). ❑ I em eaempt under sea Business end Prolessions Code tor this reason: Signature: Date: Owner ID veritiad by dnvefs license. ❑ Ves ❑ No Drivefs License No. Venfication of Ownership by pype of document, i.B. - property taz bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT C�ATIFICATION: Eapires: ❑ I hereby certify I�aI no excavation live (5) or more feet in tlepth Into which e person is required to descend, will be made in connection with work authonzetl by this permit, and that no 6uilding sWcture, scaHo�ding, falsework, or demolition or tlismantling thereof, will be more than thirty-siz (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 345, Title B, Calitomia Adminisirative Cotle). � As owner-builder, I wiil not employ enyone �o do work which would require e pertnit trom the Division ol Intlustrial Safery, as notetl ebove, unless such parson has e permit to do such work Irom tha division. Signature: Date: Division of Industnal Safery Permil Number: CERTIFICA7E OF COMPLIANCE AND AU7HORIIA710N.OF ENTRY: I cenify under penalry of perjury that I have read ihis application antl state that the infortnation given is correct. I egree to wmply with all state laws end city ordinences releling to building construclion, end authorize represen�atives ot ihe City of Costa Mesa to enler upon Ihe flbove-described property tor inspection purposes. I agree not to acupy or allow occupanty ot any building authorized by this permit until linel inspection. COOE I. INSPECTION TYPE 1616 Fixed System Final Fire Pravention 1266 Paol Spe Final 200 Final Re-Roof 201 Final BIocWRatai�ing Well 202 Final feciory Fire Place 203 Final Sign 20A Final Demolition PdIE� INTRIALS � � � CO�E� INSPECTIONTYPE 206 Pinal Mechanical 208 Final Plumbing 210 Final EleCtrical 212 Final Fire Prevention 220 Final Planning Approval 222 FinalSite 250 Final Building/Occupanry 3--��-o i `oare— � ADP��ant to fiil in all GTY OF COST'A MESA �PERMIT �NC_ CONSTRUCTION PERMIT I �E Address Address Address ✓" "- •/ �'"' � LICENSED CONTRACTOR DECLARATION 1 hereby attirm that I am licensetl hntle� provl5lon5 of m¢ntln9 with SeCtiOn 7000) of Dlvislon 3 ot th Pro(esslons Cotle, antl my Iicense is in full for �I ""� ice se No�, . Signa[ure SATION DE LARATIO I have a<ertlTi<ate of consent to i' COmpensatlOn Insurance, or a within �eavy bortler lines an0 si9n aIl apD/oprial :larat'or TRACT NO. �q �T NO. � �BLDG. NO. • . �fi s 'a TVPE OF CONSTRUCTION :�'NEW ❑ ADD ❑ ALTERATION . ❑ REPAIR ❑ CONVERSION ❑DEMOLISH ❑ OTHER DESCRIPTION OF-WORK TVPE OF PERMIT ❑ GRADING ' ❑ FOUNDATION ❑ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHAN 9 (com- ^ss antl ❑ OTHER ,ett c . pROJECT DESCRIPTION. Y 5Q. FT. � - � � OCCUPANCV_CONSTRUCTION TVPE ure or a. VALUATION ZONE � :d copy GRADING CV. VDS. ACRES � 'YNo.a.y �.�-am�"r ComPanY✓i iiii i �,rvr .ertifietl copy is hereby furnishetl. �.J CertifieC copy is filetl with.the ci[y Builtling Division. EXEMPTION FROM WORKERS' GOMPENSATION DECLARATION (This sec[Ion n¢!tl not b¢ complet¢tl it the p¢�mlt IS fo� one huntlretl (�LQ�� Of 1255). I certify t�at in t�e pertormance ot the work for which this permit Is issue�, 1 zhall no[ ¢mploy any pe�son in any manner so as to becOme subject to the Workers' Compensation L,aws of Callfornia. Date Sl9natur0 NOTICE: If after making this tleclaration, you shoultl become subject to Ih¢ Wo�kers' COmpenza[ion prOvisions O� Ihe Labor Cotle, you must tOrthwith comply with such p�ovi5ion5 0� tnis pe�mit s�all be tleemetl �evok¢tl. CONSTRUCTION LENDING AGENCV I hereby affirm that there is a construction lentling agency /or the Oer- formdntE ot the wo�k tor whiGh this permit is iszuetl (SeGtion 309] Civ. C.). . ��`�.�/ Lentler's Name 'Y" Lentler's Atltlress .DER DECLARATION � that I am exempt hom.the Contractor's License law for reason (Section �031.5 Business antl Pro�esslons Cotle: tounty whlch requi�es a pe�mit to Consbuct, alte�, Hish or repair any structure, prior to its issuance, also re- Ilcant to� Suth permi[ to Tile a si9netl s[atement that he "asiness anG �Professions Code) or that he is exempt there(rom antl th¢ is for the alle9etl exemption. Any violation of Section 7031.5 by � aooi��nt to� a pe�mit subjects the applicanl [o a clvil penalty . not more than five huntlretl tlollars (E500). ❑ I, a5 owne� of the property, or my ¢mployee5 with wa9es as thelv sol¢ Conlpen5ati0n; will tlo th2 work, antl the st�uctu�e I5 not intentletl or ofttretl for zal¢. (SeGtion 7044, Busine55 antl Professions Cotle: The Con[ra[[or's License Law tloes not apply to an owner ot a property who builtls o� imp�oves tM1ereon, antl wh0 tlOes such wo�k himselt or through his own employees, provltletl tba[ such improvemen[5 are not intentleE or of�eretl tor sale. It, howeveq the Cuil�ing or improvement is soltl wi[hin one year ot comple[lon, (he owner will have tne burtlen ot provinq he ❑itl not builC or improve for the Ourpose of sale). ❑ 1, as owner of the prope�ty, am ezUusively conVacting with licensetl mntractors to construcl the project (Section �044, Business antl Professions Cotle: The Contractor's License Law tloes not apply to an owner of prOp¢rty who builtls o� imprOVEs iheteon, antl who con- [racts from sucb pro�e[ts with a mntractor(s) Ilcesnetl pursuant to the Contractor's License Law). �� ❑ 1 am exempt unGer Section B. & P. C. for this reason Date Owner I hereby certity that 1 M1ave reatl this applica[ian antl state [hat the above information is correct. I agree to mmply with all <ity antl county o�tlinances antl state laws �elating to construction, an0 hereby authorize representatives of tbis ci[y (o enter pon the above mentionetl m REMARKS: PLUM6ING BATHTUBS LAVATORIE$ DOUBLE L KIT.SINKS DISHWi SERVICESINKS SU P FLOOR SINKS DRAINS DRINKING FOUNTAI INTERCEPTORS CLARIFIERS SWIMMINGPOOL PTRAP WATER SERVIGE ALTERATION GASSERVICE OUTLETS WATER HEATERS BTU OUTPUT SEWERCONNECTIONS `SOLAR TANK � COLLECTORS 4 $OLAR PIPING SVS. �— ISSUE FEE MECHANICAL a�ArvCNECK HEATING SYSTEM 0-300,000 BTU_ ANDDUCTING 100,000+BTU_ REFRIGERATION 0-300,000 BTU_ SVSTEM 100,000+gTU_ BOILERS BTU SYSTEM REPAIR,ALTERATION . EXHAVSTSVSTEM MULTIPLE propa.rty for ep4i pw s Signature ��• 2 Date �� Drivers' License or 55 � ISSUE FEE CMF OB65-46 White-Builtling; Canary-Appliwnt; Pink-Accountlng; Goltlenrotl-Aszessor A.P. = ZONE REAR VARD (TO PKG. SPACE REQ. STREET.WIDTH 7773 II/03/81 iNING REGULATIONS PLNTGp. R�EJF. � PROPE'RT�VNLI N E _) PROVIDED PARK FEE $' IAL CONDITIONS: L PLAN CHECK TRANSFORMER 0-1 KW_1-30 KW _ APPLIANCE 30-SOKW_SO+KW_ MOTORS 0-1 HP 1-30 HP _ (INC. SOLAR) 30-50 HP SO + HP _ FIXTURES OUTLETS SWITCHES GAS TUBE SIGNS POLE LIGHTS PANELS MAIN - SUB SERVICE AMP ISSUE FEE APPLICATION /aPPROVED BV 15.50 TL' �ATE SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT ISSUANCE 5 PLUMBING E „ GRADING S PLAN CHECK $ ' ELECTRICAL $� $ PLAN CHECK S MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK $ LE55 AD- VANCE PC $ FINAL FEE $ �� _v � _ CONSTRUCTION AND PLANNING - � .a POOL & SPA. . �. � - ' "0�'� � ' � � Date Inspector -� � Date Inspector APPROVALS Permit�# � APPROVALS Permit# 1. Temporary Electrical Service or Pole _ 43. Pool & Equipment Location • - 2. Soil Pipe-Undrgrn - 44. Steel Reinforcement ' 3�. Electrical Conduit Utility-Undrgrn - 45.- Forms � ' ' 4. Electrical Conduit-Undrgrn' - 46. Electrical Bonding � � � � � � . tee ein orce - 47. Rough Plumbin & Pressure Test 6.- Electrical UFER Grn - � - " . ' ' 48. APPROVALTO COVER-GUNITE. 7. Footings - - - �49. Electrical Conduit-Undr m � � ' 8: ' Foundation ' --- � � 50. Gas Pipe, ❑ Undr rn, Test �"' 9. Water Pipe-Undrgrn 51�.� Backwash Lines P-Tra ❑ ndr rn 10. Structural Floor System�'" - � - 52. APPROVALTO DECK 1�1 .� Property Sewer Line & House Connection. � 53. �Backwash & Rece tor-Final � `' 12. Street Sewer Connection � 54. Heater & Vent-Final - 13. Rough Plumbing � � ' ^ , 14. � Rough Electric-Conduit � �' � � �56. Electrical-Final � ' ' 15. - Rough Electric-Wiring 57. Solar SYstem-Final - � _ 16. Rough Heating & qir Conditioning . Fencing & Access Approval . 17. Ducts, in Structure • 59. APPROVED FOR PLASTERING �" " 18. Ducts, Ventilating ' - 19. Gas Pipe-Rough &7est ' • . 60. POOL/SPASYSTEMS FINAL� _ � - - . . 20. Roof Framing � 21. Roof�Sheathin � ' . , , 22. •.Frame and Flashin ' � � NOTES: � � '� 23. Insulation � � 24. Lathing & Siding �� 25. Drywall Nailing � • - 26. Plaster Brown Coat � ' � 27. Electrical Power Meter-Final - ' � � 28. Final Electric 29. Final Heating & Air Conditioning - � � �� 30. Final Gas Pipe-Test ' � 31. Final Plumbing ' - � 32. Water Service-Final � � � 33. Gas Service-Final ' � 34. Solar pomestic-Final � � � 35. Landsca e S rinklin 5 stem � 36. Sound Attenuation 37. Handicap Regulations ' �- 38. F�NALSTRUCTURE&BUILDING • 39. Special Requirements Completed � � 40. Electric Release tq Edison " 41 . Gas Release to Southern California Gas Co. - - 42. CERTIFICATE OF OCCUPANCY " � ' No Date From: ❑ Finance 'Q Building Safety ❑ Planning ❑ Public Services O Leisure Services ❑ Other r REFUND REQUEST FORb. `'�j�, 1 i• l/�1 V �0� � � � _r � � �;�� ;'1,; �2/ , , ', f�.i l '� ,.� � Permit # %��_ — �� % 3 Amount $ � n � Account � Dept. Head Signature Date Name and address of applicant: - �� ' — -, -- � . �� / � - ., � � ,. � r� , �i j �j % r� _ -`/ Reason for refund: � % � ' ' ' " � � � � SSS °�r� r>� ` 9 5� ` fr'. (" 4 ❑ Finance Director ❑ City Manager ❑ City Council REMARKS: , CMF 0644-22 � i � a .. . s�// , ! � i /%/ 7.�1 x i.� /.;�9J�F��. App mant s �gnature a[e� RECOMMENDED ACTION �gnature Approved ❑ ❑ O Disapproved ❑ ❑ ❑ �_ White � Accountin9i Canary - Department Copy r• CITY OF COSTA MESA, CALIFORNIA COUNCIL POLICY SUBJECT REFUNDS PURPOSE POLICY EFFECTNE NUMBER DATE PAGE ]00-I ]0/17/77 1 of 1 The purpose of this regulation is to delegate ]imited auYhoriYy for the authorization of refunds and to establish guidelines for refund procedures. PO LICY Limi[ed authority for refund authorization shall be delegated to the City staff. The refund form must be signed by the department head of the initiating department and then forwarded to either the Finance Director or the City Manager for their countersignature. The Finance Director shall be al(owed to authorize any amount up to $1,750; the City Manager shall be allowed to authorize any amount up to 53;500, and any amount over $3,500 will require City Manager's "approval with City Council concurrence. PROCEDURE , I. Refunds are to be researched'by the initiating department. 2. The initiating department will then fill out a Refund Request Form and submit �`' it to either: a. The Finance Director for any amount under $1,750; b. The City Manager up [o and including $3,500; c. The City Manager with City Council concurrence for any amount over $3,500. 3. The approved form will then be forwarded to the Finance Department for payment. 4. A separate list of refimds contained on the warrant list shall be provided to the City Council by the Finance Department. CITY OF COSTA MESA REQUEST FOR OCCUPANCY TRACT NO,�� DATE�Z- / �9 LOT NO.�L.__ ADDRE5S��_�� LC/yGe-P C�� " �( The developer of the above entitled tract desiYes to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City oi Costa Mesa . The undersigned, by executing this agreement, acknowledges that �(�a%e-they) (� wer.e advised that this txact has not been given final inspection nor has it been accepted by the City oi Costa Mesa as having complied with the conditions of approval which were imposed by the city at the time the final tract map was approved. The city assumes no liability ior the enforcement of the conditions necessary for approval other than those conditions protected by s urety bond, The undersigned agrees to indemnify and hold the city harmless from any cl�im resulting in damage or personal injury to the undersigned by reason of the aforementionefl uncompleted condition. ie3'� cna Developer ancl/orJauthorized representa�ve � Lender .... .. Ii�ttf�1C�J LLYri'lAlYMC�! . . ... ' _� JOB ADDRESS �Zf14 FlnriAn Cir�rlP BUILDING PERMIT NO. R[1(1q2 AP No. _ LOT T I1� �CTIONS s. GAS -�-�_ WATER ROUGH PLUMBING PROP. SWR, �INE HOUSE CON. SPftINKLIN6 SVSTEM MISCELLANEOUS ROUGH HEATING AN� AIF CONDITIONING TEMPORARY SERVICE OR POLE UNOERGROUN� Q POWER � ROUGH WIRING 7AENCHES FOFMS IYI STEEL REINF. I�I �F BONO BEAM n STE SHEATHING FRAME AND FLASHING LATHING � IN ( PLASTER.BROWN COAT H NG, V P. .dING, EIECTftIC, 9UILOING, SPECIAL Rp REFF AND ENTS � � SUBCONTRACTOR Z . o- U HZ ZQ ON a m J � J N [t1 J . ¢] J a U � 2a W � p_ w WZ J Q m Z J � W w � _ Z F W � �o � z Q U J a a Q � H N z � H U � � F y z c-4 �"'� 30 92 COSTA MESA BUILDING-SAFETV OEPARTMENT P.O. BO% 1200 COSTA MESA, CALIFORNIA 92626 Fo� Applicant to Fill in Completely BUILDING ��m � �� // _ _ . � /� ` A ADDRESS. (/ 7�Zr.c-2..u-s�C�-�e-�-E.� OWNER Hermes liBV• ri0. MAIL , _ _ _. _ . _ CITV BRANCH 190 Broa ADDRESS sQt1 IY10 TEL. NO. �jL}]�7i tes National Bank Avenue elifornia TEL. c-.c , CONTRACTOR �qyje=' ADDRESS TEL. CITY NO. STATE CITV ��. No. 25z5(p LIC. NO. SIZE C/� INOWONLO� O OF LOT LOO X�v I USE OF EXI5TING BLDG. SIZE OF NO. OF NEW BLOG. 1 SZ 6. S�t.ROOMS STOFIES 1 EXTERIOR WALL ROOF OIDPO OT COVERING StllCCO COVEFING HOOd USE OF BUILDING ANO WORK TO BE PERFORMED I heraby ncknowletlpe [hat I have reatl this epplication antl stare that the ebave information is correct antl apree to tomply with nll lows regulatlnB builtlinB �ansvuction, antl I shell not amploy nny Oerson in violation ot tha warkmen's compansatlon lews of the Ste�e of Californie. I hereby cerUty that I am properly Iicensetl es a contractor untler the Stata of Calitom(a Buzinass antl Professlons Cotlo, Dlvlsicn 3, Chepter 9, ontl chex wch liwnsos nre in full forco nntl eftoct, or I am uxampc trom the provisions of Ne $tn[e of Cellfornia BuSinon antl ProtesSiona Cotla, visio 3. Cbe or 9. / Sipnature ot \ / Perminae � i�'/'�-/�� Auffiorizetl ABent APR 24-69cnsaO01286� ��* 137.25 APPLICATION FOR BUILDING PERMIT fiECE . D bV OATE RECEIVED nnTc �cc�n A.P. NO. BUII.DING ADDRESI FIRE � � ZONE ` APPROVED � � 7E NO.OF � PLAN$' VARDSAPPROVED �❑ PEflMIT N USE OF NF BUILDING VARDS REAR G FT.? DISTANCE BET. BET. MAIN & MAIN BLDGS. AGCEffi. BLD C URP. �y'+ �" � S� �p Q qppROVED : IiOLD � � / O�(S� FT � THE AMpUNTSH01 THE PURPpSE OF E5 VALVATION $a�;��- � 3'3 °� o VNDER VA�UATION IS FOR j LISMING A PERMIT FEE ONLV: m ¢ m RMIT FEE $ O j 1'� m AN CHECK 5 • / E `o N LL TOTAL FEE $ �� • OI