HomeMy WebLinkAbout2251 FOUNTAIN WAY - Building Permits�
A MESn CONSTRUCTION PERMIT
a2s7 r-�vN� IN cv�y E��t
's
Owner's N�a1m,fe
Addreu `�"
AOP���ant to lill in all s0aces exeept lhose within heavy Eortler Iines an0 si9n all aporoprlata Oeclaralions.
Address �/ ��� "� � �
Contracmr's Nam hone
Address (mailing) �
Ciry License No.
�ICENSED CONTRACTOR DECLARATION
1 hereby attirm that I am licensetl untler orovislons oi Charter 9(commencing
with section ]000) oi Oivision 3 oi the Business antl Professions Cotle, antl
my license is in full torce antl etfect.
License Ciass License No.
�ate " Si9nature
WORKERS' COMGENSATION DECLA0.ATION
� nereby atiirm that I have'a'certificate of consent to selt-insure or a certificate
Norke�s' Compensatioh InSurance, or a certitietl mpy [hereot (Section
]. Lab. CJ . !�.
..ii<y No. ' Company
eCertifietl coOY is h2ieby fumishetl.
Certi/ietl copy is filetl with the city Builtling Division.
oate Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissection neetl not�be completetl if the Oermit is for one huntlretl ($300) or
less).
. 1 certify that in Ihe�perforrtiance oi the wo�k to� which this pe�mit is issued I
shall not employ any pe�son in any n nner so as to become 5ubjeCt [o t�e
Worker' C ensati n'Lawsof Calif ia.
�ate 1-P� R'� " Signature '
NOTICE: ((,—aftei m�king this tlecla ation, you shou tl become su je t o t
Workers' Compensation provisions ot the Labor Cotle, you must f- hwi[h
wmpty with SucM1 provisions or this p¢rmit shall be tleemetl �evokea.
CONSTRUCTION LEN�ING AGENCV
1 hereby affirm thal lhere�is a ronstruction lentling agency for the pertormance
of the work for which this Oermit is issuetl (Section 309] Civ. CJ
Lentler's Name '
Lender's Atltlress
OWNERBUILDER OECLARATION
I hereby atfirrn that I am exemp[ from the Contrat[o�'s License L.aw for [he
followinq reason (Section ']03L5 Business antl Professlonal Cotle: Any city or
counry whicn requires a permit to construct, alter, improve, tlemolish or repair
any 5[ructure, prior to its i55dance, also �equlres the applicant for such permit
to file a Slgnetl staiemen[ that he/she i5licensetl pu�suant to the provislons of
the ContractoCs License Law (Chapter 9(commencinq wi[M1 Sec[ion �000) of
Division 3 of the Business antl. Professions Cotle) or that he/sM1e is exempt
`=retrom antl the basis for the allegetl exemption. Any violalion ot Section
'LS by any ap0��cant fo� a pe�mit subjects the applicant to a civil
flty of not more than five huntlretl dollars (E500�. .
._. 1, as owner of the� P/operty or my employees with wages as Ihelr Sole
compensation,'will tlo the work, antl the StrUcture is nbt intentletl or ofteretl
ior �saie (Section ]044, Business antl Professional Cotle: The Contractor'S
License Law tloes not apply t0 an owner o( a property who bWltls or Improves
prOv¢ rorthe put0ose
1 as ownev of the
' ractors to construc[ tl
Tbe Contractor's Lin
builtls or improves tM1
tlactol(z) Ilcense purz
proof of Lb2iI WOYk¢
❑ I am exempt untler
Date '
� such work himseli/hersel/ or through his or her own
at such improvements are not intentletl o� offeretl for
uiltling or improvement is soltl witnin one year of com-
have the burtlen of p�oving he/she tlitl not bulltl o� Im-
f sale).
noperty, am eicclusively contractin9 with licensetl con-
� project (Section 7044, Busine55 antl Protessions CoEe:
ne Law does not appty to an owner oi property _who
reon, antl who coni�acts fo� such p�ojects witit a con-
ant to the Cont�actor4 License Law). I am aware Ihat
's Compensation insurance shoultl be provitletl to me.
Section—.,--� B. $, P.�. for this reason
Signature Yl✓_il
Drivers' License or 55 �
CMF 0865-46, rev. 10/84
Owner
have reai
ntl
r� a��3�i .�s-oi � i i �,s�3d,�
TYPE OFCONSTRUCTION NEW �'ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHE
D SCRIPTONOF,WO KUSEOFBLDG.7� i
�,�_. � � �. ��
TVPE OF PERMIT GRADING FOVNDATION STRUCTURAL '
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING � MECHANICAL
❑ OTHEF
PROJECT DESCRIPTION 50. FT. OCCVPANCV
CONSTRUCTION.TYPE� VALUATION 5 / ydU' `�
ZONE GRADWGCU.VDS. ACRES
Remarks: �C-#, t ('� ^
p�i
Bar Sink ,
Backflow Preventer - .
Backflow Irrigation . . i,
Drinking Pountains
Floor Drains •
Floor Sinks �
Gas Service Outlets
I nrerceptors
Kitchen Sink � /
P—Trap
Roof Dra
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collec[ors
Solar Pipin9
Solar Tank
Swim ' g Po01 w/Spa
Warer Closet
Water Heater
Water Service
AutO�WeSh
Laundrv Tra�
FE
ReinSpaMion Fea � $15 (�, I luue Fee I $ 3
Boiler
Duct - Under Ground
Duct-SVucmral '
�uct-Ventilating �
ExhaustSystem_O �MWtiple ❑
Firepl/Fact BIL ICBO #
Heating System & Ductin �
❑0�100,OOOBTU O,OOOBT
Rainspection Fee _ � � $15
White - Builtlin9: Canary - Ap0licant; Pink - Accounting; Goltlenrotl,- Assessor
fioad or Type I ❑
Canopy Type I I ❑ �
Refrigcration System :
❑0-700,000 BT 100,000 BTU
Syste epair/Alteration
Fire Dampers ' .
Registers�
laua Fee . $ 3
A.P. � vs1� — �.�y' O %
S Main Building: ' ��
E f //
T Front U O
B Rear
A
C Fight �0/��/i%v %jl��
g Lef[ , Z.j � CJ�i 7'
Ping. Ref. #
Planning Notes: �Q ,,,,� , ,
Automatic Washer
Cansttuction Pole Suh.
Cooking Unit
Dishwasher �
Dryers ❑Gas ❑Elec1
Fan
F.A.U.
Fixtures
Device Boxes .
Outlets
Garbage Disposal
Generator �0-5
� Reinspection Fee
�
DEVELOPMENTSER
Zoning Approved By_
Building Approved By
Application luued BY.
� U'17�1� � I/a3/B7
Accessory Building:
Req./Provided
? 39e28 TL
Zone — �
ELECTRICAL -
Trans(ormer ❑ 15�50 KW
❑ 50+KW
Meter LJup to 100 amps �
Meter �over100amps
Sub Panel
Motors00�li1-1 ❑1Yh-8
Inc. Solar�9�15 HP 016�15+
Range
Sign
Standing Sections
15 KW Trash Compactor
$15 Issue Fae
RE�UIREMEN7S: .
FE
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
S
SUMMARV OF F�ES `�
BUILDING PERMIT �$ 23• Sd SMIP �$ . SU
PLAN CHECK $ � �� � � PERMIT '
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C.. $ '
` ELECTRICAL § GRADING $ -
PLAN CHECK 50% $ � MICROFILM $
i �-
MECHANICAL $ TOTAL FEE $ 3 ` -
PLAN CHECK 25% $ � �
��
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location . '
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding � '
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE ,
7. Footings . 58. Electrical Conduit-Undrgrnd.
S. Foundation � 59. Gas Pipe, O 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
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 ApproJal
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 O 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. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Firepiace
38. Final Plumbing ;
39. Water Service-Final -
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigacion System
45. Sound Attenuation • �
46. Handicap Regulations �
47. FINALSTRUCTURE&BUILDING �� �_ �J �G M./_
4� 0�
48. Special Requirements Completed '
49. Electric Release to Edison .
50. Gas Release to Southern California Gas Co , .
51. CERTIFICATE OF OCCUPANCY
No. � Date . , �
MV )
W
1
N
�
AOP�icant to fill in all spaces except those wit�in heavy GorOer linaz antl si9n all appro0riale tleelarationi.
CITY OF COSTA MESA CONSTRUCTION PERMIT
S/22S 2z 2 7 ee nin �� �
Project Address a �
Applicant's Mai-li�ng Address � Q �
Owner's Name -��r ��� ^ � Phone
Address
Arch/Eng: License No.
Address
Convactor's Nam - Phone � � 1
Address (m '�' 1�O (��-{ l � Fi-[-�j \�_� L(Z
City License No. ��� � �� ���
IICENSED CONTRACTOR DECLARATION
I M1ereby affivm thal I am licensetl untler provi5ion5 of Charter 9(commencing
with section ]000) ot Division 3 ot the Busine55 antl Protessions CoOe, antl
my Iicense i5 in ful Orcc tl effect. �
License'tC�la License o
Dale� �— 5'9 t ,l�LL�-� n �
WORKERS' COMPENSATION DEC ARATION .
' M1ere�y atfirm [hat I nave a certilicate of consent to Self-insure or a certlficate
' Workers' Compensation Insurance,�or a cer[ifietl coOY hereof (Section ,
d00. Lab. C.) �� r ( � �
Policy No. � � Company
�crti/ietl mpy is hereby furnishetl.
rtit� co a filetl with the city �R�i$9 Divislon��./�c,G�
Date� APPlicant �// '=.���eZ'� ��.
EXEMPTI N FROM WORKERS' COMVENSATION DECL RATION
(This sec[ion neetl mt be com0�etetl if the permit is tor one huntlretl (E100) or
less).
I[ertify that in lhe Performance of lh¢ work fo� wnlch this pe�m�t i5 issuetl, I
shall not employ any person in any manner so as to become subject to the
Workers' Comp¢nsatlon LawS ot California.
Date Si9nature
NOTICE: Ii, aiter making this tleclaration, you zhoultl become subject to the
Workers' Compensation provisions of Ne Ldbor COCe, you must torthwith
comply wiih' such orovlsions or this permit snall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV �
1 bereby afflrm Ihat lnere is a cons[ruction lentling a9ency tor the performance
af the work tot whiCh thiz pe�mit i5 i55u¢tl (Sec[ion 309] Civ. C.)
Lentler'S Name
Lentler's Atldress _ _
OWNER BUILDER OECLARATION
I he�eby af(Irm'that I am exempl lrom [he Con[�actor'S License Law (or the
iollowin9 reason (Section ]031.5 Business antl Profe55ional Cotle: Any city or
coun[y which r¢quires a perml[ to con5trucl, alter, iTprove, tlemolish m repolr
any struclure, prlor to i[s issuance, also requires the applicant for such permit
to �Ile a signe0 statement tha[ he/She I5 litensed pu�suant to lh¢ pwvi5ions ot
the Contractor's Li<ense Law (Chapter 9(commencing wlth Sectlon ]000) ot
„ DiviSion 3 of the Business antl Profe55ion5 Code) or that he/she is ex¢m0�
'.'�;^�e�efrom antl the basis tor the allegetl exemplion. Any violation of Sectlon
,}�"gd31.5 by any applican[ �o� a p¢rmll SubjeGts llte aOP��cant to a civil
.; ^�9enalty of not mor¢ lhan five huntlretl tlollar5 (E500j.
❑ I, as owner of tlte Droperty or my employees with wages as thCir sole
Compensation, will tlo the wO�k, antl [he st�ucture i5 nOt Intentletl Or ol�eretl
for sale (Section ]044, Business anE Pr0/¢ssional Cotle: Tho Contractor's
License �aw tloes not appty to dn ownet ot a property who builtl5 Or implove5
thereon, antl who tloes su<h work himselt/nerseH orytnrougn his or ner own
emplOyees, provltletl [hat sucb imProvements are no[ Intentletl or offeretl for
sale. If, howev¢r, the builtling cr improvement IS soltl within one year of com-
pletion, the Owner will have the burtlen of provfn9 he/5tte tlitl no[ builtl or im-
.�rove fOr the purpoSe Of sale).
LJ I, as owner of [he pro0erb, am exclusivery contracting with IicenSetl con-
'i [racto�s to consiruct the projeot (SCCllOf1 �/044. 6U51l1¢55 dOd PfO1Q551DO5 COGE:
The Con[ractor's Licenze Law does not aPply to an ownet ot Ptope�ty who
builtls o� imp�oves [hereon, antl who contract5 for such prOjects with a con-
tracror(51 Ilcense pursuant�to the ConVaciOr'S Litense Law). I am aware that
D�oOf o( th¢ir Wo�ke�'s Compensation Insurance Shoultl be provltletl to me.
❑ I am exempt untler Section B. & P. C. for this reason
Date Owner
I hereby certity that I have rea
information is rorrecL I a9ree Io
antl siate laws relatinq to builtlir
senlatives of this city to en5e�
insoection oyWoses.e+ /A_ /
the above
ortlinances
, ���'� 31 Z I ....._. .._. I -- - I .,,�.
TYPE OFCONSTRUCTION NEW ADD ALTERATION REPHIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPEOFPERMIT GRADING FOVNDATION STRVCTURAL
❑ TENANT ❑ ELECTRICAL �Pf;UMBL^ �N� 0 MECHANICAL
❑ �OTHER ���"h+"AK/
PROJECT DESCRIPTION SQ. FT. OCCUPANCV
CONSTRVGTION TVPE VALUATION 5
ZONE GRAOINGCU.YDS. �ACRES
Remarki:
Bar Sink
Backflow Preventer
Backflow IrrigaLon
Clarifiers
Dishwasher
Orinking Fountains
Floor Drains '
Floor Sinks '
Gas Service Outlets
<itchen Sink
Lavatories
7—Trap
Roof Drains
Reinspection Fee . � $15
Boiler
Duct - Under Ground
Duct - Structurel
Duct � Vantilating _
Exhaust System ❑ Mul[iple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑0�100,000 BTU 0700,000
Drivers' Lic nse or SS $ �— I I�einspection Fee I $15
CMF 0865-46, rev. 4/84 White - Builtling: Canary - Appliwnh Pink - ACmunting; Goltlenrotl - Asse55or
$howers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
W2LCl C1052L
Water Heater
Water Service ...A
Issue Fae
Hoodor Typel ❑
Canopy Type I I ❑
Fiefrigeration System
❑aioo,000eru ❑ioo,000aT
System Repair/Alteretion
Issue Fee
$ 3
$ 3
A.P. #
S Main Building:
E
T Front
B Rear
A
C Right
K Left �
$
Plne. Ref. #
Plannina Notes:
Auromatic Washer
Construction Fole Sub.
Cookin9 Unit ,
Dishwasher '
Dryers �Gas ❑Elec'
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0-5 KW C
0660 4/04/85
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
� Transformer ❑ 75-50 KW
❑ 50+KW
Meter LJup to t00amps
Meter ❑over]OOamps
Sub Panel
Motors �0.7 HP 01 %- 8
Inc.Solar �9-15 HP �76-15+
Microwave
Pole Light
Range
'Standing Sections
5 KW Trash Compacror
\
!]e� � \ T�
FEES
2
O
N
I
N
G
R
E
Q
M
T
5.
I Reinspection Fee I$15 � I Issue Fee I $ 3'
DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved By Date
Building Approved By Date �
Application Issued By � � Dat�
� SUMMARV OF FEES
BUILDINGPERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ �. OC% ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ GRAOING 5
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTAL FEE $ � D�
PLAN CHECK 25% $
CONSTRUCTION ANb PLANNING
APPROVALS Permit #
1. Temporary Electrical $ervice or Pole
2. Soil Pipe-Undrgrnd.
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Untlrgrnd.
5. Steel Reinforcement
6. Electrical UFER Grnq, '
7. Footings .
8. Foundation
9. Water Pipe-Undrgrnd:
10. Structural Floor System
11. Property Sewer Line & House Connection
12. Sewer Cap ,
13. Roof Drains �
14. Rough Plumbing
15. Rough Electriral-Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign ,
18. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air �nditioning
20. Rough Factory Fireplace
27. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test �
24. Roof Framing
25. Roof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing
28. lathing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat
32. Electrical Power Meter-Final
i
33. Final Electric �
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 Attenuation
46. Handicap Regulations
47. FINAL STRUCTURF & BUILDING
48. Special Requiremen[s Completed
49. Electric Release to Eqison
50. Gas Release to Southern California Gas Co
51. CERTIFICATEOFQCCUPANCY
Date
Date
POOL PA
Inspector p�ppROVALS Permit#
52. Pool & Equipment Location.
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER�GUNITE
58. Electrical Conduit�Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd. �
61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar SYstem�Final �
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
0
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush -
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe �
77. FIXED SYS7EM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes:
Date � Inspector
�
.A
ADp�icant lo fill in all ipaces except Ihose within heavy Eortler lines an0 sign all appropriate tleclarations.
CITv oF coSTA MESA CONSTRUCTION PER^M`�IT
ProjectAddress 22�/ �"�(%���1lt� �/�___y ����
Applicant's Mai�fig Address ''`�C,n,,
Owner'sN�ame T�C r�-�:��i�� �i2—Phonep�T��
Address 2y�� i3.�(��i.� %ii�l% S�(li�� �0ti C(�i�AAI/�.
Arch/Eng. _�� L /'�1 Q /L�iqense No.
Address �
Contractor'sName uA�? BRos. eLfsutl�,o�e S9S___._�_�__Att�?
Addresslmailing) 2�6�2Q ACHc2A QOWL[•{�/0 N6�/jI'
Ciry License No. �.Lq��
LICENSED CONTftACTOR DECLARATION
I hereby af/irm Ihat I am lic¢nsetl untle� provision5 ot Charter 9(mmmencing
witM1 sectlon ]000) of Division 3 Ot [he Businesg antl Professjp f�o�¢�tl
my iicense is in ipu1 �force antl HectY� y i
License Clas 1� �� `'-�� L'C n e No V��
Date��Iq Si9nature �b�
wORKERS'COMPENSATION DECLARATION
�e�e�y atflrm ihat I have a certificate of Wnsent (p seli-insure or a certifiCdte
Workers' Compensation Insurance, or a certifiatl copy thereof ($ectlon
_d00, Lab. CJ
Policy No. Company
eCer[ifietl coOY is hereby lumishetl.
Cer[ifi¢tl mpy is filed with [he city Builtling DiViSiOn.
Date APplicant
EXEMPTION FROM WORKERS' COMGENSAT14N DECLARATION
(Thisseciion neetl not be comD�etetl it the permit is for one huntlretl ($]00) or
less).
I certify [ha[ in the performance of tbe work fOr Whicn Ibis perm�t is ISiuetl, I
zhall not em oy ny pe�son In any mdnne� o as lo beGome�subjeCt [o the
Wo�ke�s' Q iQn Laws of Calitomia. /Ll I/ �'
Date J��1.��..(1_Signature ��tjt J, Gi�TI^_v ✓
NOTIGE: It, �ter making this tleclaration, you sitoultl become sub�ect to the
Worker5' Compensation provisions Oi [he Labot Cotle, you must forthwith
romply with such provisions or tM1is Oe�mit shall be tleemetl revokeU.
CONSTRUCTION LENDING AGENCV
1 hereby atiirm that there is a constrvction lentling a9ency tor the performance
ot N¢ work for which thls permit is is5uetl (Sectian 309] Civ. C.)
LenCer's Name
Lentler's Atltlress
OWNER BUILDER OECIARATION
I hereby affirm that I am exempt from the Contractor's License Law tor the
tollowin9 reason (Section �031.5 Business antl Professional Cotle: Any clry or
munry which requires a permit lo construcq alter improve, tlemolisM1 or repair
any siruGlure, p�ior [o its issuante, also requires the ap0��tant fo/ such permit
to ti�¢ a siqnetl statemenl thdt he/she ii licensetl puRudnt to the provisiOns oi
the Conlractor's License Law (Chapter 9(commeqcing with Sec[ion 7000) of
Dlvision 3 ot Ihe Busin¢55 antl Pro(essions Cotle) o� tha[ he/she is exempt
[nerefrom and the bazis for the allegetl exemptipn. Any violation of Sec[ion
�I031.5 by any applicant for a permit Subjects the applicant lo a civil
�enalty of not more than five nuntlretl tlollars (5500).
1, as owne� of the Droperly or my employpas wilh wa9es as their sole
wmpensation, will tlo the work, antl [he Structuhe i5 not intentletl or o/(ered
for sale ($ection 7044, Business antl Professiohal Cotle: The ConVactor'S
LicenSe Law tloes not apply to an owner ot a property who builtls or improves
thereon, antl who tloes such work nimzelt/herseli or througn his or her own
employees, provltletl tbat such imprOvements are nOt Intentletl or offeretl tor
zale. If, however, t�e builtlin9 or improvemen[ is soltl within one year ot com-
pletioq Me owner will nave tha burtlen oi proving he/she tlitl not builtl or Im-
prov! 10� ine purpose of sale).
❑ I, as ow r of llte property, am exclusively conl�actin9 with licensetl con-
t�actoR [�struct Ihe p�oject (Section ]064, Bpsino55 antl Professions Cotle:
The ConVactor's License Law tloes not apply to an owner of property who
builtls or improve5 the�eon, antl who contracts for SucM1 0/ojects with a con-
tractor(s�:;.cense pursuant to the Conlractor's Li�ense Law). I am aware that
proof o� Worker'S Compensation insurance shoultl be Provitletl to me.
❑ I am ee [ untler Section B. & P. C. for this reason
Date owner
I hereby certity that I nave reai
intormation is correct. I agree to
and state laws relating to builtlir
sentatives oi thi city [o en e
inspeCtion purpo 5.
Siqnature �
Oriver5' License o� 55 �
repre-
y for
= 32z S _.
TYP^E OF CONSTRUCTION NEW P.DD ALTERATION REPAIR
iJ CONVERSION ❑ DEMOLISH ❑ OTHER qp #
DESCR PTIO WORK/USEp F BLDG.
� G-�o,_y P� ,r _�� ` S Main Building:
•s�z�_ E
TVPEOFPERMIT�( GRnDING LJ FOUNDATION STRUCTVRAL T Front
❑ TENANT L^ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear
❑ OTHER %�
PROJECT DESCRIP710N Sp. FT. OCCUPANCV — C Right
K
CONSTRUCTIONTVPE � VALUATION$ g Left
20NE GRADING CU. VDS. ACRES p�ng. Ret.�#
Remarks: ,,,, � �, •� ���� ��� , � yd,� , �j Planning Notes:
Bar Sink
Preventer
Irrigation
Clarifiers
Dishvrasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service
Kitchen Sink
Lavamries
Reinspection Fee � $15
Boiler
Duct � Under Ground
Duct - Structural
Duct � Ventilating
Exhaust System ❑ Multiple ❑
FirepVFact. BIL�ICBO #
Heating System & Ducting
00.100,000 BTU O 100,000 BT
Reinspection Fee • � $15
8{Ep 65-46, rev. 10/B4 White - Builtling: Canary . qpplicant: Pink - Accounting; Goltlenrotl - AssesSor
Showers
Service Sink �
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping �
S r Tank
Swimming Pool w/Spa
Urindl
Water Closet
Water Heater
Water Service
Auto�Wash
Laundry Trays
Issue Fae
Hootlor Typel �
Canopy Typell ❑
Re(rigeration System
❑o- o oao aTu ❑ i oo,000 aru
System Repair/Alteration
Fire Dampers
Regizters
Issua Fee
FEES
$ 3
$ 3
Automatic Washer
Construction Pale Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
5398 2/l9/8[I
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Met¢r ❑up to 100 amps
� Merer �over100amps
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �65 KW �5-15 KW
Sub Panel
MotorsO0�1 HPOth-8
Inc.Solar �9�15 HP �i6-15+
Microwave
Pole Light
Range
Standing Sections
Trash Compacmr
Fee �$15 � � luue Fee
DEVELOPMENT SERVICES RE�UIREMENTS:
2oning Approved 8y
Building Approved 6y
Aoolifation Issued Bv �
BUILDING PERMIT $
PLAN CHECK $
PLUMBING S
PLAN CHECK 25% S
ELECTRICAL $ �3'-Sb
PLAN CHECK 50% $
MECHANICAL $
PLAN CHECK 25% $
3:�0�:, 11
2
O
N
I
N
G
R
E
Q
M
T
S
FEES
SMIP $
PERMIT
ISSUANCE $ -
ENERGV P.C. S
GRADING $
MICROFILM $
TOTAL FEE $ 33'S�
CONSTRUCTION AND PLANNING
APPROVALS Permit # '
1. Temporary Electrical�.Service or Pole
2. Soil Pipe-Undrgrnd. �
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement' ,'
6. Electrical UFER Grnd.
7. Footings � �
8. Foundation �
9. Water Pipe-Undrgrnd�
�.
10. Structural Floor SYstem
11. Property Sewer Line�& House Connaction
12. Sewer Cap
13. Roof Drains
14. Rough Plumbing
15. Rough Electriral-Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign
18. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough FactorY Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing
25. Roof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and F.lashing
28. Lathing & Siding
29. Insulation �
30. Drywall Nailing
31. Plaster Brown Coat
32. Electrical Power Meter�Final
33. Final Electric
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 pomesticFinal
42. Backflow Preventer �
43. Backflow Irrigation
44: Landscape Irrigation System
45. Sound Attenuation
46. liandirap flegulations
47. FINAL STRUCTURE & BUI LDING
48. Special Requirements Completed
49. Electric R se-to�dison
50. Gas Release to Southern California Gas Cn
51. CERTIFICATE OF OCCUPANCY
Date
Date
,_ POOL & SPA
Inspector qppROVALS Permit#
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical8onding
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER-GUNITE
56. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVAI TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL(SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT -
APPROVALS Permit # -
70. Underground Hydro y
71. Produc[ Piping O Gas ❑ Oil
72. Underground Flush �.,
.`.
73. Undergrnd. Storage Tank O'Gas ❑ Oil
74. Overhead Hydro ,
75. Dry Chemical �
76. Dry Standpipe
77. FIXED SYSTEM FINAL � �
78. FIRE PREV. FINAL � '�
HEALTH DEPT'. REQUIREMENT
�
79. FINAL INSPECTION � . �
80. FOOD CERTIFICATE ISSUED
Notes:
0
Date �Inspector
i.� �
�
�,
I
�i � � .
. i . �
->
�Btni DING SA.'''ETY DEPAR.TMENT NO �� O� �
; 'Boa No. 317 0
Costa Mesa, California
Date y'- r C �
CITY OF COSTA MESA ,
CERTIFICATE OF OCCUPANCY
Building Permit No. Electrical Permit No y ,Plumbing Permit No.
Use of Buildinp, Ll '�� r Y A PT �(/ i � h i v+
O
Ttie 6uilding located ar `��-�,-�'�"''Q'�"'�'su� "� /� vP
Legal Descrlptio� �
(See reverse side tor Metes and Bounds)
�has been inspected and found to comply�w1ith the provisious of all City of Costa Mesa Ordin-
� applicable thereto for a Group /"� "�' T Occupancy.
' 'iED TO: � �
City Building Official
.�l_ r_-. �?og��rso✓ i�
(Owner of Building) By � �+,�n- � I(4.{�./ti,R,i,�J7 .
i
CC: ❑ Original—Owner ❑ lst copy—Gas Co. ❑ 2nd copy—Edison Co. ❑ 3rd cop�— ile
Form 208 SB P 1M 1-60
s
To ?dhon It t•fay Concern:
. _ , --�--.,
�t ..
i,u�us[ 9, 1978
7'his is to in,io�;:: ;on �.,a2 ..�., o•. :. , _ ' :i..;o�: :.�;:� ^r. :�naremcnts I am
aware o[ the combination of copper an�l gal.vanized piping used in partial
repipes in individual apartments.
I am al&o aware of the possiUiiity of advanced corrosion due to Cliis
combination.
t_
T. Pol s, Owner
— - - - _ .----- - - - - , - - - - - -
. ., ' . � ..� ''_ _ .
�M ��. '
GOSL95iME$A B'�11LDIN,.6lSAFETY DEPARTMENT
P.O. BOX 31] COSTA MESA. CALIFORNIA
�i4, Y�de.i? �'v �-�M-•
� p _ � �, � s-r�
FINA�!CE DEPT. ��v
FOR APP[/CANT TO F/[L /N COMPLfTELY APPLICATION;iFORxPERMIT
TYPE OR PRINT ,��(/J� � 1 BUILDING
Z.ZS/ SJ S 1 Y:J � (,Ol -�/ -
ADDRE�ssG �2-2-SG-Atta�ltE-im-AVe[3uE � .
!
COSTA MESA. CALIFORNIA fOR OfF/CE USE ONLY
Paul S R�bertson Inc I FECEIPT NO. I�(P�RMi��_
OWNER V�
MAIL ' ��1 We6t IIIC neceiVED 9Y OATE RECEIVED �qTE ISSIIED
ADDRE55 1 �W! ' -6- /o-i�
C08t8 M2B$ BUILDING
CITY TNO. �1661 pODRESS
ORCHITENEER Wa Jordan `,.',o: C-1449 COSTA MESA. CALIFORNIA
ADDnc55 /71 WeBC 19th Costa �s8 FIRE
ZONE TYPE� GROUP �/'
CONTR��RE Roberteon IIIC �ICTNTp J�WOVO B?PROVED � DATE/O��" /
ADDRE55 ��� we$t 19th Coata �B8 ZONING .
IEGNL � - I LOT �10 I I �{[�� ZONE ., I NO. OF I O6E OF NEW
DESCaIPiioN NO. 1O BLOCK / TRA� � PLANS BUILDING
A.P. NO. By�'ROV ;� DATE ��—� J
OF LOT 6% .64 X�.35 I rvOw Orv �OTS YARDS YE
REOUIRED ALLOWEO
USE OF (CENTEP LINE ST.1
EXISTING BLDG. FRONT � FT. IN.
SETBACK LINE FFOM �p '
CENTER OF STREET aA S REAR YARD 6O R. SIDE FT, IN.
SIDE YARO ILEFT LS.S3 IRIGHT �LO L.SIDE S �FT. IN.
DESCRIPTION OF.WORK
REAR S�� J �N.
NEY I $IALTERATION I IIADOITION (
REPAiN I IIMOVING I IIDEMOLISH I
BUILDING 32 % 55 NO.OF ({ 2 �
SIZE ROOMS STORIES
EXTERIORW��•I�.L.Q IROOF .Built u
COVERING COVERING P
VSE OF BUILDING AND WORK TO BE PERFORMED �
�F U t ta
�
1 HEREBY ACKNOWLEOGE THAT I HAVE R AD TMIS APPLICATION THE AMOUNT BHOWN UNDEH V�LU4TION IS FOR THE
•ND STATE THFT THE ABOVE IS COR NND AGREE TO COM- pURP08E OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY OR�INqNCES qND TATE LAWS REGOLATING
euLLDiNG coNslrsuciiorv. VALUATION
SIGNATURE OF PERMIT FEE $ � ���
PERMITfEE �� /J /� j _
7, PLAN CHECK S� y�
AUTHORIZED AGEN TOTAL FEE $ �
:�
. - �' �.;�;�9
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 31] COSTA MESA. CALIFORNIA
FOR APPL/CANT TO F/LL /N COMPLE7E[Y
TYPE OR PRINT
nooR�s"s —Z256 Anah�Y� enue
COSTA MESA. CALIFORNIA
L �]49CP�.1
LIC.
STATE
LEGAL I LOT u I I ���1
o[scaivnorv NO. LO BLOCK TR
A.P. NO.
OF LOT 6/ . Vy x 135 I NO. OF BLOGS.
NOW ON LOT
USE OF
EXISTING BLDG.
SETBACH LINE FROM (�
CENTER OF STFEET JO REAR YARD 2.
SIDE YARD ILEFT V.G IRIGHT 19.14
DESCRIPTION OF WORK
NEV I X IIALTERATIONI IIADOITION I
REPAiH I II MOVING I II DEMOLISH I
S Z�E DING .�,t X�O ROOMS STORIES j
EXTERIOR WALL ROOF
COVERING O COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
oven caruort with closed storaee
1 HENEBY ACKNOWLEOGE THAT 1 HAVE REpO THIS APPLICFTION
AND STRTE THAT THE ABOVE IS CORRECT AND RGREE TO COM-
PLY WITH ALL CITY ORDINpNCES AND STATE LRWS FEGULqTING
BUIL�ING CONSTRUCTION.
SIGNATURE OF
PERMITTEE
1'
AUTHORIZED A NT
� .
. , �..�" _ ....
(o-�R-s�1
,-1� `,P:CE DEP1. � `�
,��.. nnnvt a4GCl1
APPLICATION FOR PERMIT
�Q� BUILDING
FOR OfF/CE USE ONLY
� FECEIPT NO. �_ RERM�T
: ISSUEU
..I G <j
COSTA MESA. CALIFORNIA
FIRE
ZONE TYPE � GROUP
APPROVED
BY DATE /
' ZONING �
ZONI� _i I I P ANS � I BUELDFNGEW /�] .
(CENTER LINE ST.)
FRONT
REAR
a�
uce
THE AMOUNT SHOWN UNUER VALl1AT10N IS FOR THE
PURPOSE OF ESTqBLISHING A PERMIT FEE ONLY.
VAWATION /�
^ /� �� PERMITFEE $ l{�• ��
$ P' �G'O PLAN CHEGK $ v ��
TOTAL FEE S /�S—
. . I �_ 3.91:4�1;
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Comp/etely
ADDRE55 /Ci �4 �� /'OU�T /i✓ W �A
OWNER ��EO7J�E OG S
MAIL CiS'C.'�1J'JA/✓A�rEl�'%E.vT
Z ADDRESSoY �Z • G.e9N SUITE ��
a U CITV �/fA/r/.} ry�/} NO�. S�7 S%
Z2
Q CON5fRUCTION N O n/ L
Q N LENDER
am
J � BRANCH
J �
a ��� ADDRESS
a
J ARCHITECT TEL.
N OR ENGINEEfl
U Q
w 2 ADDRESS
aW
J O CONTRACTOF �„/SUQ I�C'[� EPAi.e �nG •
m Z �-r �
J Q ADDRESS � 3Q� G./ O/17CW/g'
W w TEL.
Z� Ci7v SANTA No. S,�S �/�
w � STATE ] CITV
j O LIQ NO. p� �p � LI0. NO
SIZE NO.OF BLDGS.
OF LOT NOW ON LOT
USE OF /
E%ISTING BLDG. . $�
H SI2E OF NO. OF
Z NEW BLDG. ROOMS STOFIES
U EXTERIOF WALL ROOF
COVERING COVERING
J USE OF BUIIDING AND WORK TO BE PERFOFiMED
aatu w ��u,:
1CT 23-74�M�.Q07007� 6b.Y,%
APPLICATION FOR BUILDING PERMIT
A.P. NO. �S —�p I�' ZQj r
BUILDINGnn �a
ADDflESq�� �
TRACT �� LOT ^�I
FIRE
ZONE
APPROVED
NO. OF
PLANS
VAFOSAPPROVED
VAR. �
p F.2Am n/ .��u.n,s�.v E� cT ic9�- c.u.P.,w
F � P.PPFOV ED1 � `
y Efltii✓ �,e Lu GL .��G • w L�Ii
z
0
UI hereby acknowledge thet I hava reatl this application end stete
= thet the ebova information is correct antl aBrea to comply with
� all lews regulating builtlinp consttuction, and I shell not employ
F any Oerson in vlolatlon of the workman's compensation lawa of
y tha State ot Celifomie.
? I hereby certify that I am properly licensetl as a contractor untler SQ. FT.
the State of California Business antl Profesz(ons Cotla, Dlvisicn 3, THE AMOVNT SHi
Chapter 9, anC thet auch licenaes are in tull force antl eftect, or I TNE PURPOSE OF E
am ezempt irom the provisions of the State of California Buslnacs VALUATION
entl Professions Cotle, Division 3, Chapter 9.
Si8^eture of / %� ��Fy^�=C.CYLCtthC/ �
Pe�mlttae � 5 cI5'p0
n�mori:oe aaooc
BIOC
USE OF NEW '� 3'�
BUILDIN�i��
VARDS APPROVED
BEf. MAIN &
�23�
9
STATE \
1
TAX o
F VA�UAT IS fOF '
3 A PERMIT FEE ONLV: �
¢
n
'EE S � �
5CK S �� E
=E $ ��� � �/ o
LL