HomeMy WebLinkAbout3403 GERANIUM ST - Building Permits(714)754-5273 • Fax(714)754-4856
0
�
CITY OF COSTA MESA �
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
JobAddress: 3403 GERANIUMST
Suite No
Vicinity: GAR4GE AREA
Parcel Nunmber: 41237304
Applicant: LORIE GLOVER
Address: "
i
/;��' �
/.
Owner': �� GICLINGS, BRUCE D�
Address �� 3403 GERANUIM ST�-- : �
`,
� COSTA"MESA, CA
PLUMBING PERMIT
Phone:
Zip:
NUMBER
P99-00537
77 FAIR DRIVE, COSTA MESA; CA 92626
Status: ISSUED
Applied: 09/75/1999
Issued: 09/1511999
ISSUED BY: � � ° /
::
Phone:
Zip: 92626
Contractor: COAST ROOTER PLUMBING HEATING & AIR COND
Address: 2737 S. CRODDY - : � �- . � ; ' �
SUITE D _, �Phone: (714) 247-1414 �
SANTAANACA'� - . "- Zip: 92704 � �
� � � � License: 529127 � . �
ArchlEng:
� �Address:.
Phone:
Zip: %
License:
SCOPE OF PERMIT `
WATER HEATER CHANGE OUL -�� . ,'
ISSUE FEE
Backtlow irrigation
BackFlow Preventer
Bathtub
Clarifier System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater �
Drain, Roof
Drinkin9 Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1-4 outlets)
Gas (Over 4 oullets)
Gas Repipe
Gas Service
Interceptors (Grease, Oip
Interceptore (Sand Auto )
AMT
523.50
50.00
$0.00
50.00
50.00
50.00
$0.00
so.ao
50.00
$0.00
$0.00
$0.00
so.00
50.00
$0.00
50.00
50.00
$0.00
$0.00
$0.00
QTY
FEE SUMMARY
AMT
Laundry Tub / Washer $0.00
Landswpe Irrigation 50.00
P-Trap � . $0.00
Pressure Regulator $0.00
Process Piping (per 10 N) $0.00
Receptors 50.00
Septic Tank $0.00
Sewer Cap for Demo � 50.00
SewerConnea $0.00
Sewer Private Line � - 50.00
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) 50.00
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
� AMT
Sump Pump $0.00
Swimming Pool $0.00
Trap Primer . $0.00
Unnal $0.00
Vacuum Brkr Bkflow(1-4) $0.00
Vacuum Brkr Bkflow(5+) $0.00
Wash Basin �0.00
Wash Basin Set 50.00
Waste and Vent System 50.00
Water Closet (Toileq 50.00
WaterHeater/vent $12.30
Water Piping (Inst or Rep.) $0.00
Water Re-pipe 50.00
Water Service $0.00
Water Softener $0.00
OTHER $0.00
VIOLATION $0.00
PLAN CHECK $0.00
REINSPECTION $0.00
TOTALCALCULATEDFEES: $35.80
0
QTY
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
NOTICE: The work authorized by this permit shall comply vnth all applicable handicap access��e}r'ements under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 1, 7241-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections end final approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSATION DECLARATION:
I herehy eHirtn untler penalry ot perjury one ot the followinq declarations:
❑ I heve antl wlll maintaln e certificate of consent to self-Insure for workers' compensetion, as providetl for by section 3700 af the Lebor Code, for the peAortnance oi tha
work for which this pertnit Is issued.
� I have and will maintain workers' compensation Insurance, as requiretl by seqion 3700 of Ihe Lebor Code, for the peAormence ot Ihe work for which ihis permit is issued.
My wo ars' compensetion Insurence carner antl policy number are:
Cartier: ' '
. lr - O.vl �.h+. Pplicy Number. N�l drp g�
(This section need nof be campleted it e permit is veluetl at one hundred dollers ($100) or /ess. J
❑ I certity thet In Ihe paAormance of the work br which Ihis permit is issued, I shall not employ any person in eny manner so es to become subject to the workers'
compensation laws of Califomia, and egree thet if I should become subject to the workers' compensation provisions at Section 3700 of the Labor Code, I shall fonhwith
comply wi�h �hese provisions. � q
Applicent Signamre�,��� Date: /'�J - 9 7
WARNING: FAIWRE TO SECURE WORNERS' COMPENSATION COVERAGE IS UNLAWFUL AND SNALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AN� CIVIL FINES UP TOONE HUNDRED
THOUSAND DOILAPE �5100.000). IN ADDITION TO THE COST OF COMPENSATION, OAMAGES PS PROVIDED FOR IN SECTION 3)O60F THE L4BOR WpE, INiEREST, AND ATfORNEY'$ FEES.
LICENSED CONTRACTORS DECLARATION:
I heraby aflirm thet I em licensed under provisions oi Chapter 9(commencing with Section 7000) of Division 3 of the Business entl Professions Code, end my license is in full
torce end ettect. ua a S� S� a^1 Ciass a C3�v
Contracmrs Signeture: �J �� - Dete: 9�-`J Y
CONSTRUCTON LENDING AGENCY: .
❑ I hereby aHirm thet thare is e construction lentling egency for the pedormance of Ihe work for which this permit Is issued. (Sec. 3097, Civil Cotle).
Lendefs Name: LentleYs Atltlress:
Signawre: Date:
OWNER•BUILDER DECLARA710NS:
I hereby aHirm that unCer penelry of pe�ury that I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any ciry or counry which requires a pertnit to consWct, alter, improve, tlemolish, or repair any structure, prior to its issuance, also requires Ihe epplicant for such pertnit
to tile e signed stetament ihet he or she is licensetl pursuant Io Ihe D�ovisions of ihe Contractors License Lew (Chapter 9(commencing wlth Section 7000) of DiNslon 3 of the
Business antl Professions Code) or that he or she Is exempt Iherefrom and Ihe basis tor Ihe elleged exemption. Any violatlon oi Sectlon 7031.5 by any applicant for a permit
sub�ects the applicant to a civil penalty ol not more than /ive huntlretl dollars (5500).):
❑ I, as owner of �he property, or my employees wlih wages es their sole compensation, WILL DO TME WORK, entl the structure is not intentletl or oRered lor sale (Sec.
7044, Business entl Professions Cotle: The Contractors License Law does not apply to an owner of property who builds or improves ihereon, end who tloes such work
himselt or herself or ihrough his or her own employees, provided ihat such improvemenis are not intended or oflered for sele. Ii, however, the building or improvement is
soltl within one yaer of completion, ihe owner-builder will have the hurden of pmving ihat he or she did not build or impwve for purpose of sale.).
❑ I, es owner of the property, am EXCLUSIVELV CONTRACTiNG WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Buslness antl Professions
Code: The conirectors License Lew does not epply to an owner af properry who builtls or improves thereon, antl who coniracis lor such praject with a conirector(s)
license pursuant to the Coniractors License Lews.).
❑ I em ezempt under sac.
Signature:
Owner ID verified by drivers license. ❑ Ves ❑ No
Businass and Professions Cotle for this reason:
Verificetion ot Ownership by (type of tlaument, i.e. - property tax bill or deedj:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATON:
Driver's License No.
Da�e:
Expiras:
❑ I hereby cenity ihat no excevation flve (5) or more feet in depih into whlch a person Is requlred to descend, will be made in connec�lon with work authorized by ihis
permit, antl ihat no builtling sWcture, scaHolaing, felsework, or demolition or dismantling Nereoi, will be more than ihlrty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Ttle B, California Atlminisirative Code).
❑ As owner-builder, I will not employ enyone to do work which would require a permit from the Divislon oi Indusirial Sefety, es notetl ebove, unless such person has a
permit to tlo such wark irom the division.
Signature: Data:
Division of Industdel Satery Permit Number.
CER7IFICATE OF COMPLIANCE AND AUTHORVATION OF EMRV: I certity under penalry of perjury Ihet I heve reetl ihis application antl sta�e Iha� Ihe intormation given is
correct. I egree to wmply with all state laws and ciry ordinances relating to building construction, antl euthorize representatives of ihe City of Costa Mesa to enter upon ihe
above-tlescnbed properry lor Inspection purposes. I egree not to occupy or allow occupancy of any bulltling aut�orizetl by ihis pertnli until linal inspection.
���Ignetu f Legal Owner(s) o �ate
� /-/J %i
An r Au�honzed Applicant Date
COOE �. INSVELTIONTYPE
7616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining Wall
202 Finel Fectory Fire Place
203
204
2948 dfi
Finel Sign
Final Demolition
pRTE IMRI�
CQOEI INSGECTONTYPE
206 Final Mechenical
20B Final Plumbing
210 Final Electriwl
212 Final Fire Prevention
220 Final Planning Approval
222 FinalSite
250 Finel BuiltlinglOccupancy
Q� MTRIALS
V� �
GITY OF COSTA MESA .
CflNSTR�UCTION PERMIT
�� `� AVP���ant ttl fill in all spaceZ'except thosa
PLAN 4 El ev. B Pegr�nir rvo. „ ri
ProjectAddress �$3--iep$•n1Ui�� S�.�rzE�.�05�d, �Q25.a
Applicant's Mailing Addreu �_.M
Owner'sNames�a��a� n....;c.,. r,..... Phone��.��
Address T�v�J-MaE�r+�}tt}p--[}}tl�.
Arch/Eng. License No. ��3
Address
e
Contractor's Nam S�o �+ "Phone
Address ( mai I i ngl
City License Nb. G� yG
LICENSED CONTRACTOR OECLARATION
I hereby affirm that 1 am licensetl untler provisions of Charter 9(commencing
with sectlon 7000) ot DIVISion 3 ot [he BuSin¢zs antl ProfeSsions COtle, antl '
my license is in (� II orce antl efiect.
License Class - u-� ens 248042
Date �%w� r+-RZ Signature
'ORKERS'COMPENSATION OECLARATION '
:ereby atfirm that I have a Certiticate of consent to selttin5ure or a certificat¢
�i Workers' Compenwtion Inwrance, or a certifietl, copy thereof (Section
3800, Lab. C. ' . �
,or,�„ No. W�-84-225-856 comaa�,Fremont Indemnitv
eCertified copy is hereby (umishetl. �
Ce�tltietl cop i5 filetl with the city Builtling Division.
o„e »_t�_na vPPu�,�t Standard P.acific •
EXEMPTiON FROM WORKERS'�COMPENSATION DECIARATION
(This zettiOn neetl not Ee com0letetl it the permit is (or one huntlretl (5100) Or
less). .
I certify'that in the performance of the work for wnlch this perm�t is issuetl I
shall not employ any perzon in any manner so as to become subject to t�e
Workers'. ComOensation Laws of California.
Date Si9na[ure -
NOTICE: It, after making this declaration, you snoultl Oecome subject to the
Workers'. CompensaUon provisionsbf [ne-Labor Cotle, you mus[ torthwlth'.
comply with such prOvislOns or this permit Shall be tleemetl revoketl.
CONSTAUCTION LEND�NG AGENCV . � '
I hareby aftirm tnat there is a mnstruction lentlin9 a9en<y for the performance
of the work ior ,which tnis' permit -i5 issuetl (SecHon 3097 Civ. C:),
Lentler's Name
l.entler'S Adtlress
OWNERBUILOER DECLARATION
I hereGv af(irm that I am exempt from the Contractor's License Law for the
s o�
of
ILS by any appllcan[ tOr a pElmi[ suOJec[z [tle appllCant to a clvll
alty of not more than five huntlrea tlollan (5500). .
I, a5 owner ot the property or my employees wlth wage5 a5 thelr Sole �
ipensation, will tlo the work, antl the structure Is not Intentlea or otferea
sale (Section 7044, Business antl Vro(e55ional Cotle: The Contractor'S
;nse Ww tloes not aoP�Y to an owner of a pwperty who builtlz or improves
reon, antl who tloe5 Su<h wOrk hlmself/hers¢It or th�ough his or �er own
>loy ee5, provltletl Ihdt zuth Improvoments aro not Intentletl or oH¢retl fOr
. If, hOwever, (he bUlltling or improvament is soltl wlthin One y¢ar Ot cOm-
�.lon, tne owner will have.tha burtlen of proving he/she tlitl nOt builtl or im-
ve fo� the pu�po50 of Sale).
I, a5 owne� of the prOperty, am exc1u51very contracting with IlcenSetl con-
:tors to construct the project (Section 7044, Business ana Protassions Cotle:
i Contractor's Licansa law tloes not apply to an ownar of property who
Itls or improves thereon, antl who contracts for such projects with a con-
:tor(s) Ilcense pursuant to tne Contractor's Llcense l�wJ.
I am exem0t untler Section B. & P.�C, for thl5 rGason
Date Owner
I hereby certiry that I have reaa this applkation anA state that tha above
Information is' corrett. I agree to comPlY-wlth all city antl county ortlinances
Signa[ure '/� � �C
Drivers' License or 55 � �
lines anC sign all aOG�opriate tlaclaratlans.
TVPE OF CONSTRUCTION ' U NEW U ADD LJ ALTERATION LI REPAIR
❑ CONVERSION ❑ OEMOLISH ❑ OTHER '
' DESCRIPTION OF WORK _
TVPE OF PERMIT LI GRAOING LI FOVNDATION LI STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
O OTHER
PROJECT DESCRIPTION SQ. FT. '�}CJe _ OCCVPAN�CqV(_� p
CONSTRUCTIONTYPE - VALUATIONS_�L.y_µi
ZONE GRA�ING CU. VDS. ACRES_
Remarks: ' �L, �{/.n �FQ a
Bar Sink
Backfiow Preventer
Backflow Irr:9ation
Baihtubs
Clarifiers ,
Dishwa5her ' '
Drinking Fountains �
Floor Drains '
Floor Sinks
Gas Service OuNets
Interceptors
Kitchen Sink �
�avatories ' -
P-Trap
Roof Drains
Reinspac[ion Fee $25
Boiler -
Duct-UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. BIL ICBO #
Heating System & Ducting
❑0.100,000 BTU � 100,000 BT
Rainspection Fee � $25
CMFOB65-46rev.7/83 White-Builtling;Canary-APPlicant;Pink-Accounting;Goltlenrotl-Assessor
Service Sink
Sewer Cap _
Sewer Connection
Solar Collectors -
Solar Piping
Solar,Tank '
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
laue Fee
Hood or Typa I ❑ '
Canopy Type I I ❑
Refrigeration System
❑a�oo,aoosru ❑ioo,000
System Repair/Alteration
Issue Fee
S 3
A.P. �Jp
S Main B�
E
T Front
B Rear
A
C flight
K Left
$
Ping. Ref. #
Parking Req,
Planning Notes:
5151 �
/ - �L� Zone
-d 9^/U�S
ded �
�
HOLD FOR
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Ga
Fan�
F.A.U.
Fixtures
Device Boxes
Park.Fees $
ELECTRICAL
1•
!r1VTS _
❑ 15-50 KW •'
❑ 50+KW,�
' - Meter LJup to 100 amps
Meter ❑over 100 amps .� �
Electric Sub Panel '= �
� � . MomrsO0.1 HPO1'h-8 .
� � Inc.Solar 09�15 HP �i6-15+
� Microuvave �
Pole Light �
Range
Switches �
Garbage Disposal
Generator DO-5 KW �5�15 KW
l.
Reinspection Fea
FEES .
PUBLIC SERVICES RE�
2oning APProved BY_
APPlica[ion APProved By
Aoolication Isued Bv—
$ 3
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK
ELECTRICAL '
PLAN CHECK
MECHANICAL
PLAN CHECK
FEES
Sign 1'
Standing Sections '
Trash Compactor
$25 Issue Fee $ 3
O
N
I
N
G
R
E
�
U
1
R
E
M
E
SUMMARV OF FEES
$ 485.50 SMIP s 8.46
$ 7R RQ PEfiMIT .
$ ISSUANCE $
$ ENERGY P.C. $
$ GRADING S
$ MICROFILM $
$ TOTALFEE $ S�Z.HS
$
� CONSTRUCTION AND PLANNING � PO. t SPA ,
Date Inspector Date Inspector
b , APPROVALS Permit # APPFiOVALS Permit #
� _� 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-Undrgmd. 55. Electrical Bonding
I 5. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test
�,. 6. Electrical UFER Grnd. . 57. APPROVAL TO COVER�GUNITE ' �
7. Footings 58. Electrical Conduit�Undrgmd. -
8. Foundation 59., Gas Pipe, O Unclrgrnd., Test .
,
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
i
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 Electriral-Conduit 66. Solar System-Final
76. Rough Electric Wiring . 67. Fencing & Access Approval
17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
i�
20. Rough Factory Fireplace APPROVALS Permit #
21, Ducts, in Structure 70. Underground Hydro
22. Ducts, Vencilating 77. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. floof Sheathing �/g 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing g � � �(/ 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation $�r'g ' 78. FIRE PREV. FINAL
/
30. Drywall Nailing =,� �{ �/C.i HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat v(�- 79. FINAL INSPECTION
32. Electrical Power Meter-Final B0. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test ��
36. Hood or Canopy .
37. Final Faciory 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 �
1 46. Handicap Regulations
� 47. FINAL STRUCTURE & BUILD�NG p 3p � v✓
, 48. Special Requirements Completed p �
i
` 49. Electric Release to Edison , �-
��� . .
50. Gas Release to�Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
�� No. � � Date
i
.�
Applicant to fill in all soaees exceo� those witnin heavY Oortler lines ana sign all aDVropriate aeclarations.
CiTv OF CosTA � s i,� NS�UCTION P RMIT
Project Address
Applicant's Mailing dress •� �
Owner's Na e P one
Address `r
Arch/Eng. License No.
Address �G�
Contractor's Nam Phone ---F f/—�
Address (mailing) _
City License No. •
LICENSED CONTRACTOR DECLA ATION
I hereby affirm tnat 1 am licensetl untler provisions ot Charter 9(commencin9
with zection ]000) of Division 3 of the Business antl Pr essions Cotl �,
my license's in f rt�� ntl eftect.
License ' ice o.
Date Signature � �_
WORKERS' C MP NSATION DECLAftATION �
�. hereby aifirm that I have a certificate of consent to If-insure or a certificate
':�-:9f Workerz' Compensation Insurance, or a certitie cooY ihereof (Section
�3P00, Lab. �^'/.'-10�j��'1 '
Policy No. �!1 Company �%
eCertifi tl c y is he�eby (urnished.
Ce filetl with Ihe city 8 i %
Daie APplicant (� .
EXEMPTION ROM WORKE0.5' COMPENSATION D CLARATION
(This section neetl na[ be cOmpletetl if tM1e pe�mit is fo� one huntlretl ($300) or
less)
I certify that in the performance of the work for which this perm�t is issuetl, I
shail not em0loy any person in any manner so as to become subject to the
Wo�kers' Compensation Laws of Calitornia. ,
Date Signature
NOTICE: It, afte� making lhis tletlara[ion, you 5houltl become subject to the
Workers' ComDensation provisions of the Labor Code, you must forthwith
�comply with such Orovisions or this permit shall be tleemetl revoketl.
CONSTRUCTION LENOING AGENCV -
I hereby a�9rm Ihat t e e is a construction lentlin9 a9ency fOr the pertormance
of the wo�k for i t i5 permic is Issuetl (Section 3097 Civ. G.)
Lentler's Name
l.entleYs AtJtlresz
OWNER BUILDER DECLARATIOIV -
I hereby affirm that I am exempt from the Contractor's �Icense law tor the
following reason (Sec[ian 7031.5 Business antl Professional Cotle: Any city or
county wM1ich requires a permit to construct, alter, improve, tlemolish or repair
any structure, prior to its issuance, also requires the applicani for such permit
to file a signetl slatement that he/she is licen5etl pu�suant to the provisions oi
the Coniractor's License Law (Chapter 9(commencing with Section ]000) of
)ivision 3 ot the Business antl Profesvons Gotle) or that h¢/She is exempt
herefrom antl the basis for the alleqetl exemption. Any violation of Section
7031.5 by any applicant for a pe�mit SubjeCtS the applicant t0 a civil
�nalty of not more than five huntlretl tlollars ($500).
I, as owner ot the property or my empioyees with waqes as their sole
compensation, will tlo tne work, antl the s[ructure is not intentletl or off¢retl
for sale (Section J044, Business antl Professional Cotle: The Gontractor's
License Law tloes not apply to en owner of a property who builtls or improves
thereon, ana wno tloes sucn work himsclf/narselt or tnrough his or her own
employees, provitletl tnat such improvements ave not intentletl or offered fo�
sdle. If, howeve�, the builtling c� improvement is soltl within on¢ yea� ot com-
pletion, tne owner wlll�have lhe burtlen of proving he/she tlitl not build or im-
�rove for the purpose of Sale). '
I, as owner of the D/operty, am exclusivery coM�acting with litensetl con-
Iractorsto construct the project (Section 7044, Busine55 antl Professions Cotle:
The Contractor's License Law does not appry to an owner oi oroperty wno
buildz or improves thereon, antl who contracts (or suth projects witn a con-
tractor�z) Ilcense pursuant �to the Cantractor's License �aw). I am aware that
proof ot their WorkeCs Compensation insurance shoulC be provitletl to me.
❑ 1 am exempt unGer Section B. & P. C. for this reason
Date —
I hereby ce
intormation
and state la
sentatives c
inspectlon p
Signa[ure
Orivers' Lio
— Owner
I have �ead this application antl state thai the above
I agree to ply with all city antl county ortlinances
to buil n9 c nstruction, and hereby autho ae epre
� to n up n th above-mentionetl pr per fo
5 � LJ
Date /
TYPE OF CONSTRUCTION L7 NEW U ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q.p, #
DESCRIPTION OF WORK/USE OF BLDG.
S Main Building:
E
TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Ffont
❑ TENANT ❑ EIECTRICAL ❑ PLVMBING MECHANICAL B Rear
❑ OTHER %�
C Right
PROJECT DESCRIPTION SQ.FT. OCCUPANGV K.
CONSTRUCTIONTVPE VAWATION$ S L¢ft
LONE GRApING CV. VDS. ACRES P�ng. Ref. #
Remarks: //5�� � Planning NoLeS:
Sink
Preventer
IrriQation
Dishwasher �
Drinking Fountains
Floor Drains
Floor Sinks ' .
Gas Service Outlets
Interceptofs
Kitchen Sink
Lavatories
P—Trap �
Roof Drains
Reinspection Fee � $15
Boiler
Duct- UnderGround
Duct-Structural '
Duct � Ventilating
Ezhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
` Heating System & Ducting
� � 00,000 BTU � 100,000
�S ���� I � Reinspection Fee
CMF 0865-46, rev.4/84 White - Builtling; Canary -APPlicant; Pink -Accounting: Goltlenroa - ASsessor
$15
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Piping
Solar Tank
Swimming Pool w/Spa.
Urinal
Water Closet
Water Heater
Water Service
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑o-ioo,000eru ❑ioo,000
System Repair/Alteration
Issue Fee
FEES
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Pixtures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generator �0.5 KW �5-15
3605 7/06/84
Zone
Accessory Buildin9:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-SOKW
❑ 50+ KW
Meter Llup to 100 amps
Meter ❑over100amps
Su6 Panel
Mo[ors �0-7 HP O1 %- 8
InaSolar 09-15 HP �16-15+
Microwave
Pole �ight
Range
Sign
Standing Sections
Trash Compactor
$� __
fleinspectian Fee $15 luue Fee
FEES
�DEVELOPMENT SERVICES RE�UIREMENTS:
Zoning Approved By
Buildin9 Approved By
Aooliration laued Bv
$ 3
BUILDINGPERMIT $
PLAN CHECK 5
PLUMBING $
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL �7;Cq�
PLAN CHECK 25% $
B.Of: 71
Z
O
N
I
N
G
E
n
M
T
S.
FEES
$ 3
OF FEES
_ SMIP $
— PERMIT
ISSUANCE $
ENERGV P.C. $
_ GRADING $
� MICROFILM $ �
— TOTALFEE $
CONSTRUC710N AND PLANNING " PO� S SPA
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. �Electrfcal UKER Grnd.� � . 57. APPROVALTO COVER-GUNITE
J. Footings , - 58. Electrical Conduit-Undrgrnd.
8. Foundation � - 59. Gas Pipe, � Undrgrnd., •Test
.9. Water Pipe-Undrgmd. -' . � 60. Backwash Lines, P-Trap, � Undrgrnd.
-_10. Structural Floor System � � 61. APPROVAL TO DECK '.
11. Property Sewer Line & House Conneciion , 62. Backwash & Receptor-Final
12. Sewer Cap � � 63. Heater & Vent-Final -
13. Roof Drains : � 64. Plumbing System - Final ' - -
14. Rough Plumbing , 65. Electrical�Final --
15. Rough Electrical-Conduit 66. Solar System-Final '
.76. Rough Electric Wiring 67. Fencing & Access Approval -
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning 71��/i..i ���J FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # �
27. Ducts, in Structure 70. Underground Hydro
22.-Ducis, 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 Naiiing ' 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 10 i(lk�G L��
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 STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison •
50. Gas Release to Southern California Gas Co .-
51. CERTIFICqTEOFOCCUPANCY �
No. Date
�
a
�
�
�
" Appllcant to flll In all spacaz exeept lhose wit�in heavy Gortlar Ilnes anE sl9n all apDropriate tleclanlions.
CITY OF COSTA MESA PERMIT NO TRACT NO. LOTyQ BLD . •
CONSYRUCTION PERR9IT ��/4�! � ('�j�s3 vs� ' .
PfojeCt Address . � TVPE OF CONSTRUCTION NEW .°.DD ALTERATION REPAIR
ApplicanYSMailin Adtlreu ❑CONVERSION'❑DEMOLISH ❑OTHER q,p,q�6
Owner'S Nam2 hon DESCRIPTION OF WORK
(/.{�/ .f— `� iiC� � r� U/� E Main Buildin9:
Addreu TVPEOFPERMIT , �anoiNc FOVNDATION STRUCTURAI: T Front
Arch/Eng. �n-S�i� Pf.� Licenu No.
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Reor
Address _ ❑ �o7FiER A
Addreulrt(aiTiyl� �'—' n.�+�isv�//.0 �// iin � i��
City License No. �
LICENSED CONTRACTOR DECLARATION
1 M1ereOy aflirm tha[ I am Iicensetl untler provisions of C�arter 9(commencing
wlth section 7000) of Dlvlsion 3 of the Busineu anE Professions Cotle, antl
my Iicense is in tull r<e �ryqof(ect. �O�
Licens Clas —��� - � Li ense o'�
Oate �—� Slgnature 6
IORKERS' COMP NSATION DE LARATION -
hereby affirm tnat I have a cerHficate ot mnsent to selt-inzure or a certificate
of Workers' Compensatlon .InSurance, or a cer[ifietl copy [hereot.(Sectlon
3800, Lab. C.jri7 /��/ �j Company � ����
PaIICY No. c9 / '7' 'S
CertHietl cyopy is hereby mishetl. �
�ate li}ttd / Q% is fifd APPI tani�Y Bui ing � vi4
[O O /
EXEMPTION FROM WORKE0.5' COMP SA ION OECLARATION
(Tnis seccion naetl not be complete� if the permi[ iz tor one nunEretl (E100) or
IC55).
I certity that in [�e pGrtOrmdnce Ot Ihe work fo� which this p!/T�t is Is5U0tl I
shall not employ any person in any manner so as ta become subject to t{�e
Workers' ComOensatlon LawS of Califomia. �
Da[e Signature
NOTICE: 11, aile� makin9 this tleclaratlOn, You s�oultl become subject to lh0
Workers' ComDenulion provisions of t�e Labar Cotle, you must (or[nwith
comply with such provl5ion5. or this Dermil shall be tleemetl revoketl.
CONSTRVCTION LENDING AGENCV
1 hereby attlrm that there I5 a cons[ruction lentling agency tor [ho performance
ot tM1e work for whlcb t�is permi[ is issuetl (Seclion 3097 Civ. C.)
Lontler's Name
LenOer's Atltlross - �
OWNER BUILDER DECLARATION '-
I hereby a}ti�m thet I am'Oxompt ttom tfin Cont�acto�'s LICOn58 Law fOr th0
following roason (Settion 7031.5 Businesi antl Profes5lonal Cotle: Any city or
county whlcb requiras a parmlt'to construtt, alter, improve, tlemoli5h or rapah
.any structure, prlor ta Its Issuance, also requires tne applicant for such pormit
to filo a.sianotl statemant that ho/sne is licensetl oursuant to tho orovlslons o1
ne allagetl ezemption. Any violatlon o! 5<
r.a parmit subjects tha apoikant to a
airy oi nai more man nve nunaroa oonars �gouu).
1, as owncr ot ihe�proPerty or my employeas wltM1 wa9e5 as thelr solo
ipensatlon, wlll tlo the work, antl Ihe structure is not IntonaeG or oHewtl
salo (Section 7044, BuSinezs anU Professional Cotle: The Coniractor's
tnse ldw tlOcs not apply lo an ownar of a Droper[y�who Duiltls o� Improvus
raon, antl,who tloes such work him5elf/herself or tnrough hiz or ner own
aloy ees, pfOvlU¢tl [h8t SUCh imprOVBT¢nts ar8 nOt Int¢ntletl of oHofetl'lol
, If, howevar, tne builtling or Improvement is soltl within one yoar of com-
�.loq tho ownor will have tha burtlon of proving he/sha tlitl not bulltl or Im-
ve for [hc purpose O1 zalo).
I, as ownar ot tha property, am exclusiveiy contracting with Iitensetl con-
Aors to construct tne oroject 1Settion ]044, Business anC Rofessions Cotlo:
� COn[�attOr'S LJC¢n58 Law does not apply to a� ow0er o7 property who
Itls or improves tnereon, antl who contracts for such pro�ects with a con-
:tor(s) Iicensa pursuant to tne Conlractor's License L.aw).
1 am exempt untler Section B. & P. C. lor this roason
Date
I hBr¢by certi
-intormatlon is
antl state laws
sentatives of
inspectlon pur�
Si9namre�
Drivers'�LlcenS
_ Owner
that I have reai
rect. I aoree ta�
�
above
PROJECT DESCRIPTION� SQ. F7. oCCUPANCv
CONSTRVCTION TYPE VALUATION S
20NE GRADINGCU.VDS. 'ACRES
Rcmarks: � Q i/ri0 '
Preventer
Irrigation
Dishwasher --
Drinking Fountains
floor Drains
Floor Sinks '
Gas Service Outlets
Interceptors�
Kitchen Sink
Lavatories
Poot Druins� -'
Reinspaction.fae � $25
Duct � Under Ground
Duct - Structural
Duct - Ventilating
Exhauzt System ❑ MWtiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting �
❑ai oo,000 sru O i oo.000 sr
Reinspection Fee � $25
CMF 0865-46 r¢v. 7/83 White - Builtlin9: ��ary - Appli�nt; Pink - Accoun[ing: Goltlenrotl -�Assessor
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors '
Solar Piping
Solar Tank
Pool w/Spa
Urinal
Weter ClOse[
Water Heater
Water Service
Issue Fee 5 �3
1ANICAL FEE
Hoodor Typel ❑
Canopy Typell ❑ '
Re6igeration System
04100,000 BTU 0100,000 BTU
Sys[em Repeir/Alteratian
Isiue Fee � $ 3
C Righ[
S Le([
Ping. Ref. � -
Parking Req./Provided
Use of Building:
Planning Notes:
A11tORIdtIC �NdShCf
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers �Gas ❑Elec
Fan
F.A.U.
.3014 6/27/84
Zone'
.=o,� e�;
Park,Fees $
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+ KW
Device Boxes
Outlets '
Switches
Garbuge Dispoul ,
Generetor DO-5 KW �5�75 KW
Meter �up to 100amps
. Meter ��ver 100 amps , /
�Sub Panel . /
Morors�al HPG�}T^,S-8
Inc.Solar �9-15 HP 016-15+
Pole Light � '
Range
Sign
Standing Sections � '
Trash Compactor
�16e . . �.
FEES
O
N
I
N
G
R
E
�
U
R
E
M
E
N
T
I Roinspection Fee � I$25 � �ssue Feo � I $ 3 I
PUBLIC SERVICES RE�UIREMENTS: .
Zoning Approved By Date '
Appliution Approvad By Data�
Appliwtion Issuad 6y ��� Date�J'�
. SUMMARV OF FEES
BUILDING PERMIT � $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK $ ENERGV P.C. $
O GRADING S �
ELECTRICAL ' $ �
PLAN CHECK � $ O�` ��' �MICROFILM S
MECHANICAL $ - TOTAL FEE $ G " "�
PLAN CHECK � $
��
'CONSTRUCTION AND PLANNING , PG� _ & SPA
APPROVALS Permit# Date Inspector p�ppROVALS Permit# Date Inspector
� 1. Temporary Electric2l 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 Bondinq
' 5. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation .+ 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11., Property Sewer Line i§ House Connection 62. Backwash & Recepror-Final
12. Sewer Cap � 63. Heater & Vent•Final
/13. Roof Drains ' 64. Plumbing System - Final
74. Rough Plumbing . 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final '
16. Rough Electric Wiring 3. �� 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 77. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas � Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. 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. 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. FINALSTRUCTURE&BUILDING �
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY �
No. Date . � .
•
' fiT D/�"V�/ / KJ AOG��<ant to fill in all space�eyt'Fhofe v.{thin healY �ortle�es anG Si9n all apDropriale Eeclarations.
cirx OF coSTA CONST CTION PERMIT '
Project Address ��Q � �����/ �
ApplicanYs Ma�' ' �res �
Owner'sNamA�.�G�A � �� Ph Y%��J/
Arch/Eng. License No.
Address _ __
lConvactor's Na � d Phon ��
. Address (mailingl%��i1� �/j-�-/�� 4� _
�City license No. �p._! f
LICENSED CONTRHCTOR DECLARATION
I hereby aftirm that I�am Ilcensetl untle� p�ovisions ot Chart¢r 9(wmmCnCin9
�� with sec[ion 7000) of DivisiOn 3 of [he Business and Pwtessions Code, antl
Imy license.is in fu�ic tl(fecL ��
�`!\�. License lass ice se E�
" Date � �%7 S'9 t
'NOR ERS'COMP NSNTION DECLARATION
hereDy atiirm that I have a certificate ot consent to sel -insure or a certiticate
of. Workers' Compens5tion Insurance, or a ce�tifiB copy tnereof (Section
3800. Lab. �1'!'' ���71�/
PolicY No. fj%{/�! Company
ertifietl c�opy �is ,hJe�reby fumishea. ,
ateer � Y�WAOPhcary�'I���/nn/�.(
(Thissection neetl not be com0�etetl if the permit is for one huntlretl ($300) or
less).
I certify that in Ihe Pertotmance of tM1e work tor which Nis perm�t is issuetl, 1
shall not employ any pe�son in any manner so as [o become subject lo the
Workers' Compensation Laws of CalitOmia.
Date Si9nature
NOTICE: 1/, a�te� making [his tleclaration, you shoultl become Subject to the
Workeri' ComOensz[ion provlsions of lne Labor Cotle, y0u must fortnwith
comply wilh suc� O�ovisions or .lhis permit shall De tleemetl revoketl.
CONSTRUCTION LENpING AGENCV
I hereby afflrm that tnere is a wnstructlon lentling agency'for the pertormance
of tM1e work for whicM1 this Oermit is Issuetl (Seclion 3097 Civ. C.)
lentler's Name
LenUer'z AUtlresz _
OWNER BUILDER DECLARATION
I hereby a/fi�m lhat I am exempt (rOm Me ConVattot's License Law fOr tM1e
following reason (Seclion 7031.5 Business antl Professional Cotle: Any city or
county wnich requires a p¢rmit to construct, alter, imOrove, tlemolish or repair
any structure, prior to its issuance, also reqWres the applicant tor such permit
lo tile a sign¢tl stalemenl Ihat h¢/She is Ilcensetl pur5uant to [Ite provi5ion5 01
the Contractor's License Law (Chapter 9(commancing with Seclian 7000) ot
Division 3 ot lhc Business antl PrOlession5 CotlC) o� tM1a[ he/sh¢ is exemp�
therelrom antl [he basi5 for [he allegetl ¢xemption. Any violatlon of $ecllon
]031.5 by any applitant tor a permit subjects Iho applicanl to a clvll
�enalty of mt more than five huntlretl Oollars (E500).
LJ I, as owner of tne property or my employees with wages as their sole
. compensation, will tlo ehe work, antl the structure Is not intentlea or oiferetl
for Sale (Secllon 7094, Busine55 antl Professional Cotle: The ContractOr'S
License Law tloes not appty to en owner of a properry who bullas or imoroves
tnereon, antl who Coes such work nimself/herself or tnrough liis on c�r own
employees, P�ovltletl Ihal such improvemen[5 are noI in[entl¢tl o� offeretl tor
sale. If, now¢ver, the OUlltling cr Improvemen[ is soltl wltM1in ona year o1 com-
pletlon, Ihc Owne� wlll have lhe burtlen of 0/ovinq ne/she tlitl no[ builtl or im-
QrOve lor llte Du�poS¢ Ot sale).
lJ I, as owner of the property, am exclusivety contracting with licensetl con-
fraC[0�5 to conStruC[ [he Drojecl (Seclion ]044, Business and Pwfessions Cotle:
The Contractor's License Law tloes not apply to an owner o/ property who
builtls or improves thereon, antl who contracts for such projects with a con-
tractor(s) Ilcense pursuanl�fo the ConVactor'S License Law). I am aware that
p�oof Of their WOrker'z Compensa[ion 4nsurance s�oultl De provltletl [o me.
❑ I am exempt untler Section B. & P. C. for this reason
Date � owner _
I hereby certify that 1-have reatl
info�mation is corr cL I agree to c
antl state laws e ing to builtling
sentatives ot i city to enter
insoectlon vur es
Signature .
Drivers' �irense or 55 �
above
TYPE OF CONSTRUCTION NEW U ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEM LISH ❑ OTHER p.p.�6
DESCRIPTION OF WORK/USE OF BLDG.
• • S Main Building:
E
TYPE OF PERMIT GRADIN FOuivDATION STaVCTURaL T Front '
❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL A Rear
❑ �OTHER C Right
PROJECT DESCRIPTION SQ. FT. - OCCUPANCV K
CONSTRUCTION TVPE VALUATION $ S Left
ZONE GRADING GV.YDS. ACRES p�ng. Ref. #
Remarks: , � �I...���� Plannin9 Notes:
Bar Sink
Backilow Preventer
Backflow Irrigation
Bathtubs
rinking Fountains
loor Drains '
loor Sinks
25$ENiC2 QIIt12L5
Kirehen Sink
Lavatories
P—Trap
Reinspection Fee
$15
Boiler
Duct - Under Ground -
Duct-Sttuctural �
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO �I`-
Heating System & Ducting
❑6100,000 BTU �100,OOOBT�
Reinspection Fee � $15
CMF 0865-46, rev.4/84 White - Builain9: Canary -Applicant; Pink -Accounting; Goltlenrotl -ASsesm�
Showers
Service Sink -
Sewer Cap
Sewer Connection
Solar Collectore
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Cbset
Water Heater
Water Service
Issue Fee I $ 3
Automatic Washer
Constructior Pole
Coaking Unit ,
Dishwasher —
. Zone
� Accessory Building:
Z
' - O
N
I
• N
G
R
Parking Req./Provided E
�
M
T
_ S.
ELECTRICAI FEES
Dryers LJGas LJElectric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
$WitCh¢5
Garbage Dispoul
Generamr �0-5 KW 05-15 KW
❑ 75-50 KW
❑ 50+KW
Meter LJup Lo 100 amps
Meter ❑over 100amps
Sub Panel
Momrs � 61 HP � 1 X- 6
Inc.Solar �9-15 HP �16�15+
Microwave
Pole Light
Range '
Sign
Standing Sections
Trash Compacmr
� Reinspection Fee $15 luue Fee
IANICAL FEES
Hoodor T DEVELOPMENTSERVICESREQUIREMENTS:
YPeI ❑ Zaning APProved By
Canopy Type I I ❑
Building ApProved By
Refrigeration System
❑aioo,000eru ❑ioo,000
System Repair/Alteration
laue Fea � $ 3
$ 3
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK � $ PERMIT '
ELE�L � �� 1 R UANCE.C�
PLAN CHE 2 `��
drr��
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTAL FEE $
PLAN CHECK � 25% $
�
CONSTRUCTION AND PLANNING � FOt�� & SPA
vAPPROVALS 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 •i
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ~,
' 5. Steel Reinforcement •, � 56. Rough Plumbing & Pressure Test -�i �,
6. ElectricalUFERGrnd.- �� � �` 57. APPROVALTOCOVER-GUNITE
7. Footings �� ', � 58. Electrical Conduit-Undrgrnd. ��
8. Foundation � , 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd, ^ � 60. Backwash Lines, P-Trap, O Undrgmd. ,
' 40. 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. Rouyh Electrical�Conduit 66. Solar System�Final
16. Rouyh Elec[ric 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 Conditionfng FIRE DEPT. REQUIREMENT . -
20. Rough FactorY Fireplace . APPROVALS Permit #
27. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating , 71. Product Piping OGas ❑Oil
23. Gas pipe-Rough & Test �. , 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling �Struciurall & Monocoat 75. Dry Chemicai
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. /o�S�,�y ED
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing �(yl/q$Ll (.IED
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. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed ' . � �
49. Electrie Release to Edison
50. Gas Release to Southern California Gas Co ' � .
51. CERTIFICATE OF OCCUPANCY �
No. Date
f`�t�, AOVlicanl to fill In all
,l�(/ CITY OF COSTA MESA� •" .
"�, CONSTRUCTION P�RMIT • "
Prole�t Addre�
Applicant's Mailin Addre s ; /- /
Owner's Na 2�� � n'* /�� PAAInno']� � I b
Address ��� A�,l� ' - �1llD'a'�`-i
Arch/Eng. License No.
Address
Contrecror's Neme ho ,q5��C1
Address Ima'i'��1-) I I �i . Fu_�� ....� .— r�u..a i�ir. �rn n�
Clty License No �q� q,.
LICENSED CONTRACTOR OECLARATION
1 nereby atfirm that I am IicenSatl untler provislons of Ch rter 9(tommencing
wlth sectlon 7000) 01 Dlvlslon 3 ot tha Business antl ofeszions Cotle, antl
my Ilcanse I5 In tW (orca anq eHqct. (
Licans� Class ��'� ln I J 1 � i�a�se o�a�� ��
'�ate Si9nature' �=_
)RKERS'COMPENSATION DECLARATION'
�ereby attirm that I have a cerHficate of consent to self-inzure ora certlflwte
of Workers' Compensatian Insurance, or a certifieE copy Itiereof (Section
3800, Lab. C. . - .
POIItY No. �l��S�Oq�F� comaanv�
. aCertlfletl <opy�� furnl5h0a� � .
'L'b-CertlJlgacop I wlth the Ut uil ivislon. 4_ �. _ /�-
lJate��Q APPlicant /^• �-a dLCjZC/,���
EXEMPTION FqOM WORKERS' COMPENSATION DECLARATION
(Thlssactlan neatl not be completetl if the permit is tor one huntlretl (E300) or
lesz�. •
I certl(y that in�the pertormance of the work for which this perm�t Is Issuetl I
shall not employ any per5on In any manner so as to Gecome sub�ect to t{�e
Workers' Compensation Laws o/ California.
�ate Sl9natuYe
NOTICE: If,iafter makin9 this tleclaratlon, you shoultl become sub�ect to the
Workers' Compensation provlslons of the Labor Cotla, you muzt forthwlth
comply with such provislons or thls permit snall Ge tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby affirm that thare 15 a constructlon lantling a9ancy for the per�ormance
o� tM1e wark tar whlch thls permlt Is issuetl (SecHon 3097 Clv. CJ
Lentler'S Name
Lentler's Atltlress�
OWNER BUILDER DECLARATION � '
I hereby at(irm that I am axempt from the Contractor's License L.aw for the
following reason (Sectlon 7031.5 Business antl Profes5ional Cotle: Any clty or
countv whlch requlres a parmlt to construct alter improve Uemollsh or repalr
as
anC
antl
)Ilof t0 It5 ISSudntB, d150 fBqulr85 thG dppllc0nt (or Suth pafmlt
statement that he/she Is Ilcensetl pursuant to the provlslons of
5 Licanse Law (ChaOter 9(commen<in9 �+��h Sactton 7000) of
the BuSinesS antl Pro�e551on5 Cotle) or that he/she I5 exampt
tne basis for the allegetl examptlon. Any violation of Sectlon
/ appli<dnt TOr d permit Subj¢ct5 tha applicant to a<ivll
nOr! tnan 71vB hUnCrlG t1011ars (§500).
ot the property or my employees wlth wages as lhair sole
will tlo the work, an0 the structure is not IntenCetl or offere0
on 7044, Buslness antl Prote55ional Cotle: Tha Contractor's
�ez not apply to an owner of a property who Euiltls or impraves
rho Coes such work hlmself/herSeH or through his or her own
vltlatl tnat sucn Improvamants are not Intendetl or offaroa for
iq the bulltllng or Improvament I5 sold within one year o! com-
�ner wlll have tha burtlen of provin9 he/she tlitl not bulltl or Im-
npose af sale).
of the praperty, am excluslvely contracting with Iicensetl con-
truct.the pro�act ISectlon 7044, Buslness antl Profe551ons Coae:
"s Llcansa l.aw does not appry fo an owner of property who
oves thereon, antl who contracts tor such projects wltn a<on-
'�e pursuant to the Contractor's LicenSe taw1.
I am exempt untler Sectlon B. & P. C. for thls reason
Date Owner
I nereby certify that 1 nave reaE thls application antl'state t�at the above
intormatlon Is correct. I agrea to comply wi[h all city antl county ortlinances
an0 state laws relating to builUing conitructlon, anG hereby authorize repre-
sentatives of thls cily to anler' upon the above-mantlonea pr per f r
InSpe<tlOn pos � ., 9G�
Dat 2/
n
excepl t�osa wit�in �aavy GorEer Ilnes anG sign all aDProDriate eeclarations.
TYPE OF CONSTRUCTION
❑ CONVERSION ❑ DE
�ESCRIPTION OF WORK
TVPE OF PERMIT LJ GRADIN�
❑ TENANT. ❑ ELECTRICAL
❑ OTHER
PHOJECT DESCRIPTION 5a. FT._
ALTERATION LJ REPAIR
OTHER
FOUNDATION LJSTRUCTURAL
LUMBING ❑ MECHANICAL
CONSTRVCTION TYPE VAIUATION 5
ZONE GRADINGCU.VDS. ACRES
Remarks: � � //���
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks ' -
Gas Service Outlets
Interceptors
Kitchen Sink
Levatories
P—Trap
Roof Drains �
Reinspection Fee
Boiler
Duct - Under Ground
$25
Duct-Ventilatin9 -
Ezhaust System ❑ Multiple
Firepl/Fact Blt. ICBO �I`-
Heating System & Ducting
❑0700,000 BTU 0100,000
_ I Slqnature e
Drivars' Llcense or 55 � RainSpection Fee $25
�
� "2/83 White • Bulltling; Canary - APPliwnt; Plnk - Accountin9; GOltlenro0 - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connettion
Solar Collectors
Soler Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Isue Fee
Hood or Typel ❑
Canopy Typell' ❑
Refrigeration Sys[em
00.100,OOOBTU �100,000
System Repair/Alteretion
Issue Fee
FEES
A.P. �WW
S Main Buildi
E
T Fron[
B Rear
A
C Right
K Left
S
Ping. Ref. #
Parking Req./Pn
Use of Building:
Planning Notes:
Automatic Washer �
Construction Pole Sub.
Cooking Unit
Dishwasher •
Fan
F.A.U.
Fixtures ' �
Device Boxes
Outlets
Switches
Gar6age Dispoul
Generator �0.5 KW
5747 3/09/84
Zone
Park.Fees $
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100amps
Meter ❑over700amps
Sub Panel
Motors O0.1 HP � 1 X- 8
Inc.Solar �9-75 HP �16-15+
� Microwave
Pole Light �
I I Standing Sections
5-75 KW Trash Compactor
38:00 TL
Z
O
N
I
N
G
R
E
O
U
I
R
E
M
E
N
T
S
FEES
$ 3
Reinspection Fee $25 �ssue Fee $ 3
FEES
PUBLICSERVICESRE�UIREMENTS: • .
Zoning Approved By Date
Building Approvad By Date ��
Appliption laued By �� Dat �Q ��`�
, SUMMARV OF FEES , �
BUILDING PERMIT $ SMIP, � $
PLAN CHECK $ • � PERMIT , �
PLUMBING $ �I— ISSUANCE $
PLAN CHECK 25% 3 7� ENEFGY P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% �$ MICROPI LM $ �G —
' MECHANICAL $ TOTAL FEE $ ��
$ 3 PLAN CHECK 25% $ . ,
"CONSTRUCTION AND PLANNING ' . PO( SPA . � - .
- Date Inspector � ' Date � Inspector,
�'APPFjOVALS Permit # . � . _ APPROVALS . � .Permit # _ � :
�� 1�. TemporarY-Electrical Service or Pole � - 52. Pool & Equipment Location � ..
. 2. Srill Pipe-Undrgrnd. . :`�///7/� 53. Steel Reinforcement ' �. � : ,
- 3: El,ectrical Conduit Utility'Undrgrnd. '�. � �54. Forms .. � � ' _ � . - .'<
4: Electrical Conduit-Undrgrnd. ' 55. Electrical Bonding �.-, �� ' •
5 Steel Reinforcement . ' 56. Rough Plumbing & Pressure Test ' •- ,�� '
��6. Electric`aIUFERGrnd'T � � �_ 57. APPROVALTOCOVER-GUNITE - • _
�
7. Footings ' ; � 58. Electrical Conduit-Undrgmd. � - ' ��y
8. Foundation. .' 3 ' _� 59. Gas Pipe, O Undrgmd., Test
9. Water Pipe-Undrgrnd. �' 3/i7(8Y_ �EJ 60. Backwash Lines, P-Trap, O Undrgrnd. ' � .
10. Strucwral F,loor System �.' 61. APPROVAL TO�DECK `• - � '�
11. Property Sewer Line & House Connection � 6• � �p 62. Backwash &'_ReceptorFinal . ' _ �
72. Sewer Cap '� �° 63. Heater & Vent-Final - - "
13. Roof Drains . , � �� 64. Plumbing.System - Final � � �
. 14. Rough Plumbing � � � '�'/� Be' �n 65. Electrical�Final - - � � �
� 15. Rough Electriral-Conduit ' �66. Solar Sy,stem-Final . �'" � - - � " " '
16. Rough Electric Wiring 67. Fencing &-Access Approval � � � - _
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING -- -
18.•flough Electrical-T Bar Ceiling . 69. POOUSPA SYSTEMS FINAL -� � ' �
19.'Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT
i
� 20. Rough Factory Fireplace ; APPROVALS � Permit # �,� I�
21. DuCts, in Structure 70.' Underground Hydro . �
22. Ducts, Ventilating �� � � � 71. Product Piping �Gas' OOiI � � � �
23. Gas Pipe-Rough & Test . � r - - � 72. Underground Flush ; � � � �
24. Roof Framing � 73. Undergrnd.StorageTank �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 Nailing � HEALTH DEPT. REQUIREMENT ;
� 31. Plaster Brown Coat . 79. FINAL INSPECTION .
32. Electrical Power MeterFinal . ' � 80:' FOO.D�CERTIFICATE ISSUED � � �
33. Final Electric Notes: , � .
34. Final Heating & Air Conditioning , � � ' - � �
35. Final Ga's Pipe-Test ' JO S��y (,f[/J . -. - -
36. Hood or Canopy " � , �
37. Final Factory Fireplace � � , - " � „ � , -
38. Final Plumbing , / q y� L� � � � - - -
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. Handicap Regulations ' � � � + - �
47. FINALSTRUCTURE&BUILDING , � � � '
48. Special Requirements Completed - . - ' ' 'd . ' -
49. Electric Release to Edison ' � � � � ; , ' •
50. Gas Release to Southern California Gas Co , �
51. CERTIFICATE OF OCCUPANCY � - . .
No. ' Date - � _ i � _�. . � . 4
Aov��cant to fill In all spaces exceo� those within heavy eorder Ilnes ana sign all aporopriate declarations.
ciTVOF coS7a mESA CONS7RUCTION PERMIT
ProjectAddress 3403'Geranium St.
Applicant's Mailing Address �
ow�e�•:Name Standard Pacific CoY'p. vho�e 546-1161
Address 1�6F W Ma Ar h ir os a M ta 9 6 6
Arch/Eng. License No.
Addreu
Convactor'sName New P���mhing Phone S?8-1140
Addresslmailing) 71p� d_�� Ana Anahaim
Ciry License No. �ZR��
LICENSED CONTRACTOR DECLARATION
1 hereby altirm lhal I am Ilc¢nsetl untler Provisi �arter 9(commencing
wi[h section 7000) o/ Divislon 3 oi the Busl ess antl rofessions Cotle, and
my license is in Wu to�ce�$a et< 426109
License Class ice No.
oate ��O��O�R4 $i9natu�e
WORKERS' COMPENSATION DECLAFp.TlO ' �
hereby atfirm that 1 have a certificate o� consent to self-insure or a certiflcate
f Workers' Compeniation Insurance, O� a certifieG copy thereof ($ectlOn
3800, Lab.,�,)„_.177714.� Home
Policy No. YW�' Cornpany
Cer[ifietl copy I5 hereby furnishetl.
at���i%� j�y 14 tiletl wi[h [he tity qiltli ivi ion. ' '
� V��T APPlicant I�ew `I��um�i ng
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thls section neetl not be com0�etetl ii the Permit is for ane hvntlred (E300) or
less).
I certily that in the performanC¢ of [he h'o�k fo� which [his perm�t is is5uetl, 1
s�all not employ dny perSOn in any mA��er so as to �ecome subject to the
Workers' Comp¢nsatlon laws of Califon�la.
Date Si9na[ure
NOTICE: H, after making this tleclaratlon, you shoultl become subject to the
Workers' Compensalion Orovisions of lde Labo� Cotle, you must torthwi[h
mmOb "/�th such provi5ion5 or Ni5 Permit shall be tleemetl �evoke�.
CONSTRUCTION LENDING AGENCV
I nereby aifirm that there is a constructio� lentling agency tor the performance
ot Ih¢ work for which this Dermit is Issuetl (Section 3097 Civ. C.) �
Lenaet's Name �
Lentler's AdCrezs
OWNER BUILDER DECLARATION� �
I hereby aftirm that I am exempt from the GonVactor's License Law for the
following rea5on (Section 7031.5 BusinBss antl Prote55ional Cotle: Any city or
county which requires a Oe�mil to con5[�uc[, alter, improve, tlemolish o� repair
any struc[ure, O�lo� to it5 i55uanCe, also r¢qWres tne applicant tor Such permit
to file a signetl 5talemCnt Iha[ he/she Is Ilcensetl pur5uant to th¢ 0/ovislons o(
,the Contractor'S License Law (Chapter 9,Icommencing witn Section 7000) ot
i-Jivivon 3 of Ihe Bu5ine55 anU Profess�on5 Cotl¢) or tha[ he/she is exempt
�='nerefrom antl the basis for the alle9etl exemption. Any violation of Section
'7031.5 by any applicant for a perm�� subject5 [he applicant [o a clvll
�enalty of not more tnan five ltuntlreC tlollars (y500�.
LJ I, as owner of the property or my empioyees with wages as their sole
Compensatlon, will tlo lhe work, antl ihe sVucture is not intentletl or off¢r¢tl
for sale (Section 7044, Busine55 antl Professional Cotle: The Cont�acto�'s
Lirense Law tloes not apply to an owner of a property who bulltls or imprOVCS
thereon, antl wM10 tloes sucM1 work him5elt/herself or fhrou9h his or hOr Own
employees, provitletl tM1at such improve�nents are not intentletl or offeretl tor
sale. If, �owever, the builtlinq cr improVement is soltl withln one year of com-
pletion,�the owne� will have the burtlen ot proving he/she tlid not builtl or im-
��ova fo� lhe purpose O/ Sale).
I, as owner of the properiy, am exclusively contracting with licensetl con-
tratto�s to conztrucl the project ($ection �044, Businesz antl Profession5 COtle:
Tne Cantractor's License Law doe5 n0� apply to an owner o( proPerty wno
builtls or improves thereon, antl who cO�Vacts lor such projects with a ron-
tractor�s) 6cense pursuant�[o�[he�Contr9ttor's License law). 1 am aware that
proot o( their Worker's CompensaHon insurance shoultl.be provitletl to me.
❑ I am exempt untler Section B. & P. C. for tnis reason
Date Owner
I hereby Certity tha[ I have reatl [hls PP��cation antl st
Information is correct. I agree to compl with all city antl
antl s[a[e laws rela[inq t0 Duiltlip 9 con �uction, antl herel
sentatives of this citv to enteA uoo the above-mentl<
Signature
Drivers' Litense or SS
CMP OB65-46, rev. 4/84
TVPE OF CONSTRUCTION XVSJ NEW �J ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p#
DESCRIPTION OF WORK/USE OF BLDG.
S Main Buildi
TVPEOFPERMIT GRAOING FOUNDATION STftUCTURAL , T Ffont
Q TENANT ❑ ELECTRIGALX� PLUMBING ❑ MECHANICAI B� R28!
Q OTHER A
PROJECT DESCRIPTION 5�. F7. OCCUPANCv C Right
CONSTRUCTIONTVPE VALUATION$ S Left
ZONE GRADING CU. VDS. ACRES Ping. R2f. #
Remarks: ��' ��� IP �, �(�n � Planning Notes:
Sink
Preventer
Irrigation
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service 6 Ouelets
Inlerceprors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Rainspeaion Fea � $15
Boiler
Duct - Under Ground
Duct - Strucmral
Duct � Ventilating
Exhaust Sysrem ❑ MWtiple ❑
FirepVFact Blc ICBO #
Heating System & Ducting
❑ ai oo,000 eru O i oo,000 ar
�ate 6�L
�� Reinspection Fee
White - BuiltliP9: Canary - Applicanh Pink - Accountin9: Goldenrotl - ASsessor
$75
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecrors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
�JflOdl
Water Closet
Water Heater
Water Service -
lesue Fee
Hood or Typel ❑
Canopy Type II ❑
Refrigeration System
04100,OOOBTU ❑100,000
System Repair/Alteration
Issue Fee
FEES
$ 3
$ 3
Auromatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryefs ❑Gas ❑Electric
Fan
F.A.U.
Fixture5
Device Boxes
Outlets
Swi[ches
Garbage Dispoul
Generator 00.5 KW �5-'�
0169 10/12/84
zo�e
Accessory Building:
Parking Req./Provided
ELECTRICAL
- Trans(ormer.0 15-50KW
❑ 50+KW
Meter LJup to 100 amps
Meter ❑over 100 amps
Suh Panel
Motors DO-1 HP � 1%- 8
Ina Solar �9�15 HP 016-15+
Microwave
Pole Light
Sign
' Standing Sec[ions
5 KW Trash Compacmr
5.50 'TL
FEES
I ReinSPection Fee I$15 ' I Issue Fee I $ 3 I
DEVELOPMENTSERVICESREQUIREMENTS: '
Zoning Approvad By Data
Building APP�oved By Date
Application laued By Data_1 li� 1 U
SUMMARV OF FEES
BU�LDING PERMIT S SMIP $
PLAN CHECK 3 PERMIT
PLUMBING S ��w�SO ISSUANCE $
PLAN CHECK 25% S ENERGY P.C. $
ELECTRICAL $ GRADING $
PLANCHECK 50% $ MICROFILM $
MECHANICAL $ TOTALFEE $ ���
PLAN CHECK 25% $
Z
O
N
1
N
G
R
E
Q
M
T
S.
' PO� Y SPA
CONSTRUCTION AND PLANNING
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-Undrgmd. ' 54. Forms � -
4. Electrical Conduit-Undrgrnd. � 55. Electriral'Bonding
5. Steel Reinforcement. 56. Rough Plumbing & Pressure Test '
'6. Electrical UFER Grnd. . 57. APPROVAL TO COVER-GUNITE �.•
7. Footings �� , 58. Electrical Conduit-Undrgrnd. -" .�
8. Foundation � .�, , 59. Gas Pipe, � Undrgrnd., Test
9. Water, Pipe�Undrgrnd. . ���� 60. Backwash Lines, P-Trap, O Undrgmd.
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 Elecvical�Conduir 66. Solar System�Final -
16. Rough Electric Wiring 67'. Fencing & Access Approval �
77. 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 OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush �
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing - ' 74. Overhead Hydro �
26. T-Bar Ceiling (Str�ciural) & MOnocoa[ � 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 �` �Y (,Gl� "
36. Hood or Canopy ' .
37. Final Factory Fireplace
38. Final Plumbing . �p`(.�,��'�( (i�
39. Water Service-Final
40. Gas Service-Final •
41. Solar pomestic-Final . �
42. Backflow PreventeF . '
43. Backflow Irrigation . _ -
44. Landscape Irrigation System �
45. Sound Attenuation �
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING '
48. Special Requirements Completed .
49. Electric Release to Edisori
.50. Gas Release to Southern California Gas Co �
51. CERTIFICATE OF OCCUPANCY � ' - /
No. � � ' Date ' ' /I
ApOlicant to fill in all spaces except inose within heavY border Ilnes anG sign all approv��ate tleclarations.
C�TY oF COS7A ME�� ofy$TRUCTION PERM-IT{� � .
Project Address qLfe� ✓�lV� 1 .
Applicant's Maili�n/o� �AAArezc . Z7�_-��. $SC
Owner's Name .L��r- ��O�rt' Ldnt phone
Address� ��3 ��-T<�"v�lV�
No.
Address 1�—,���� ��� �� � - -�'� <
Contractor's Nam � n n /f��y o�n,e
U �
Address Ima I� g) � 3�� m I, ( `� `-'v�NC7� �� �
o � �
City License No. ����L�'J
LICENSED CONTRACTOR DECLARATION
Lhereby allirm tnat I am licensetl untlar orovisions of Charter 9(commencing
with section ]000) Ot OiviSion 3 of the BuSiness antl PrOfedslons Cotle, an0
my license is in full fg�[epf�Q�effecL p, n
Liceni¢ f�/Ys 'i L •L ! � e y�, t a
oate 9���� n s�e t 7� �.�
'WORKERS' COMPENSATION DE� ARATION
I hereby afllrm that 1 have a certi/icale of cOnSenb[o self-in5ur¢ or a CerNfica[e
ot Workers' Compensation InsurSnce, or a certitietl <ooY Ihereoi (Sectlon
3800, Lab. ) p � �
PoIicY No.�O �000 � / � ComPanY .ZEN/ '�
erii(ietl co y is her¢by furnished. �)
Cer 'i' ��}�� filed with Ne citY-�} qI/n�q D�'v)5Iory�� �(/I
Date'!P��[�r��q �- —.AOPlicant(„�(�/,/F �i_ I JKI.CL
EXEM 10�•�FROM WORKERS' COMPE�SA ON DECLNRATION
(This section neetl not be completetl i! the permit I5 for one huntlretl (E300) or
less). .
1 certify that in Ine Oertormance of the wOrk tOt whlch tbis perm�t I515sueQ I
shall not employ any person in any manner so as to become subjecl to the
Workers' Compenzation Laws of California.
Da[e' Si9nature �
'NOTdCE: If, after makin9 this tleclaration, you shoultl become subject to the
Workers' Compensation provisians of the Labo� Cotle, you must Porthwith
compry with such provisions o� thi5 permil Shall be'tle¢metl revoketl.
CONSTRUCTION LENDING"'AGENCV - -
1 M1e�eby affirm that tnere is a construction lentlin9 a9ency for the perfarmance
of t�e work tor which Ihis permit Is Issuetl (Section 309] Civ. C.)
ttntler's Name
� Lenae.'s Htlaress -
OWNER BUILOER DECLARATION � ' -
I her¢by affi�m that I am exempf from the COnVdctor's Llcense Law for the
followinq reason (Section ]031.5 Business antl Protessional Cotle: Any city or
counly which r¢quires a permit lo con5truc[, alte�, Improve�, tl¢molish o� �epair
any structure, prior to its,issuance, also requlres Ihe appliwn[ for such permi[
to tile a signetl statement thdt he/zlte is licens¢tl pursuant to the provisions ot
the Convactor's Liwnse Law (Chapter 9(commencing wilh Section 7000) of
Division 3 ot lhe�8u5ine55 an0 Protessions CoOe) or that he/She is exempt
therefrom antl [he' basis tor the alleqe0 exemption. Any violation o� Settlon
]031.5 by any applicant for a Oe�mlt� subjects Ihe aOP�ltant lo a tivll
�enalty ot not more than five nuntlretl tlollars (E500).
LJ I, as,owner o(. the property or my employees with wagos as their sole
compensalion, will do the work, antl [he'struc[uro Is no[ intentletl or offeretl
' tor sale ($ection ]044, Business antl, Professional Cotle: The ContratlOr's
' Litense Law tloes not apply to an owner of a property wM10 builtls o� Impioves
thereon, antl'who tloes such work nimself/herseli or tnrou9h nls or her own
employees, provitletl tM1a[ such improvemenfs are not intentletl or ofleretl fo�
sdle. If, M1owever, [he Ouiltling or improvement is soltl within one year ot mm-
, pletlon, the owner will M1ave Ihe bwtlen of proving he/She tlitl not builtl or im-
,, prove tor the purpose of sale).
�❑ 1, as owner of the proper[y, am exclusively conl�acting with licensetl con-
� traclorsto construtt the project (Section ]044, Businessantl Professions Cotle:
The Coniractor's License Law does m[ apply to an owner ot properW who
bui105 or improves thereon, antl who contracts�(or such prOjects wllb a ion-
tractor(s1 license pursuanc to tne Contractor's Lirnnse Law). I am aware that
proof o4 [heir Worker'S Compensatlon insurance Shoultl be provltletl to me.
❑ I am exempt untler $ection B. & P. C. tor this rea5on
Date Owner �
1 nereby-certify that I have reatl this application antl state tnat the above
information is wrrecL I a4ree to comply with all city antl counb ortlinanCes
antl state laws relatin
senta[ives hIs �cit
inspection ur s
Signature
DriverY LI se or 55
a
�- l8 Sz �. � 2� � 1 2c� "��
TVPE OFCONSTRUCTION: NEVJ ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' ' � A.p �y /L
DESCRIPTIONOFWORK/USEOFBLDG: 9 �o r�iK_��
. � S Main Buildin�gJ:
TVPE OF PERMIT GRADING FOUNDATION $TRUCTVRAL T Front u.n
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MEGHANICAL B Rear
❑ -OTHER A
PROJECT DESCRIPTION Sq.FT. � OCCUPAN���(( - C Right
CONSTRUCTIONTVPE VALUATION§ "/�O�O S Lett �
ZONE GRADING GU. VDS. ACRES ping. Ref. �k
Remarks: ' NFI�O COVER P�CC TO L�E FNCI(1CC � PlanningNotes:
PC: 29�3-BSs�uu�1 ,�!�Hi�i ��R!'PFR PFR',tlTa� -
nk - Showers
ow Preventer � Service Sink -
low Irrigation Sewer Cap �.
ibs Sewer Connection
ers Solar Collectors
asher � � Solar Piping
Drinking Fountains Solar Tank
Floor Drains Swimming Pool w/Spa
Floor Sinks , Urinal
Gas Service Water Closet �
Inrercepmrs . Wacer Heater
Kitcfien5ink ' � WaterService
Lavatories � � � - Auto-Wash .
P-Trap
Roof Drains
Outlets
-Rainspection.Fee �
Boiler
$15' � Issue Fee
MECHANICAL
IHood or Type I . ❑
Canopy . Type I I ❑�
Duct - Structural
Ouct-Ventilating �
Ezhaust System ❑ Multiple
Firepl/Fact.Blt.IC80# '
Heatin9 Sysrem & Ducting
- ❑0.100,000 BTU 0100,000
Reinspeetion Fee
CMF 0865-46, �ev. 10/84 White � Bullding: Canary � Applicant; Pink - Accountin9: Goltlenrotl - ASsesmr
$15
Refrigeration System
❑0-700,OOOBTU ❑700,
System Repair/Alteretion
Fire Dampers
Registers '
luue Fee
Automatic Washer
Construction Pole Sub.
Cooking Unit ,
I 521 � 4/ 1,9/85
1
' 83.cc fL
Zone �
I Parking Req.IProvided
� ,
EIECTRICAL
� Transformer ❑ 15=50 KW
❑ 50 �KW
Dryers CIGas ❑Electric
Fan � �
F.A.U. �
Fixtures
�Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0-5 KW �5�15 KW
= $ 3
Reinspaction Fee
FEES
DEVELOPMENT SER
! � � Zoning Approved By_
Building APProved ey
Appliwtion Issuad 8V_
$ 3
$15
BUILDINGPERMIT '$
PLAN CHECK $
PLUMBING $
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL � $
PLAN CHECK 25% $
'meter uup to lUOamps
�,Meter ❑over 100amps �
�Sub Panel �' '
,Motors �0-i HP 01 Yh'- 8
Inc.Solar 09-15 HP �16-75+
Microwave' ` � '" ' '
Pole Light ' �
Range
Sign
', Standing Sections
Trash Compactor ,
luue Fee
$ 3
OF FEES •
2 SMIP $ Q��
z PERMIT
_ ISSUANCE $
� ENERGY P.C. $
GRADING $
MICROFI�M $ O
= TOTALFEE $ v3•S2-
CONSTRUCTION AND PLANNING . ,� POu� & SPA j
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspectnr �
1. Temporary Elecirical Service or Pole � . 52. Pool & Equipment Location •
2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement �
3. Electrical Conduit Utili[y�Undrgr�d. 54. Forms
4. Electrical Co�duit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement : � 56. Rough Plumbing & Pressure Test �
6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE
7. Footings � r �� 58. Electrical Conduit-Undrgrnd.
8. Foundation , 59. Gas Pipe, O Undrgrnd., Test
9.� Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Flaor 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 Syslem - Final '
14. Rough Plumbing � 65. Electrical-Final
15. Rough Electrical-Condui[ 66. Solar System-Final
�i 6. Rough Electric Wiring • 67. Fencing & Access Approval
•� , .
17. Rough Wiring Sign ; 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling '� 69. POOUSPA 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 OGas ❑Oil
23: Gas Pipe-Rough & Test 72. U�derground Flush
- 24; Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing � 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27 � Frame�and Flashing 76. Dry Standpipe
28. Lathing &�Siding 77. 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 Metei-Final ' 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test .
36. Hood or CantlPY
i,
37. Final Factory FireplaFe
38. Final�Plumbi�g �
39. Water;Service�Final � 1
40. Gas Service-Final �
41. Solar pomesticFinal . •
�� '.
42. Backflow Preventer � ''
43. Backflow.lrrigation _ � � •� .
44. -Landscape Irrigation System . ,
45. Sound Attenuation '
46. Handicap Regulations � ,
47. FINAL STRUCTURE & BUILDING � �'�
48. Special Requirements Completed ,
49. Electric Release to Edison , � - ' � � � �
50. Gas Release to Southern California Gas Co �� � �
51•. CERTIFICA7E OF OCCUPANCY ! ,
�n. � Date � . �
Aop�icant to (ill in all spaces except tnose within neavy bortler lines antl sign all aoProvriate aeclaratians.
CiTY OF coSTA gq p�0 STR �� 1� PERMIT
Projec[ Address � f �
Applicant's Mailin9 AI re s '�' b�' '' ���
Owner'sName �1' � P ne7 _"— �
Address � � � �
Arch/Eng. � License No.
Address �\
Contracror's Nam ho/,��e— �/�"U
Addresslmailingl— ��. � •"' "
�
City license No. ,
LICENSED CONTRACTOR DECLA ATION �
I hereby af(i�m that I am-Ilcensetl untler provisions of Charte� 9(commenCing
with sectlon 7000) ot Division 3 of the Business antl Professions; oye, pntl
my license� i� in fu � ntl effect. i/('/r
LJcense �Ja�� � Lic nse o � T6 `('
Date «'� 5'9� � � �
WORK RS' COMPENSATION DECIARATION
I ner¢by affirm [hat I have a cer[iticate of consent to s binsure or a certificate
0/ Wo�ker5' Compensation InSurante, o� a ce� copy the�eof ($ectlon
3800, Lnb. �J��n /.n�L'jO/�' Comp ny
PolicY No. f'V�t�arilZ/07
•
8 Certi I tl c p I5 hereby furnishetl. �
Cer I �flletl with the city Bui I s ��
Date ' Applicant
EXEMPTIO FROM WORKERS' COM SATION CLFRATION '
(T�is section neetl not be comple[etl if the permit is for one huntlretl (b100) or
less):
I certlfy tltat in Ihe pertormdnCe of the wo�k for which thi5 perm�t is i55ueQ I
sM1all not employ any person in any manner so A5 to become suDject to the
Workers' Comoensation Laws of Calitornia. ,
Oate ' Signature �
NOTICE: If, afler making this tleclaration, you shoultl become subject to the
Workers' Compensatlon provisions of the Labor Cotle, y0u must forthwith
comply with' such p�Ovisions or this permit Shall be tleemetl revoketl.
CONSTRUCTION LENDI G AGENCV
I hereby affirm that there s cons ruction lentling agency tor the per(ormance
ot lha work for whl f�l��it is ISsuetl (Section 3097 Civ. G.)
Lentler's Name _
Lentler's Atltlress -
OWNER BUILDER DECLARATION '
I hereby atflrm Ihat I am exempt (rom tne Concractor's Licanze Law for the
followin9 reason (Sectlon �031.5� Business antl Professional Cotle: Any city or
county which r¢quires a p¢rTit to con5truct, al[e�, improve, Cemolish or �e0air
any St�uCture, ptlo� to i[5 issuance, also �eQui�es the applicanl fOr such Oermit
to file d Sign¢tl Statement that he/she is licens¢tl pursuanl lo the provisions ot
t�e Coniractor'S License Law (Gnapter 9(commennng with Section ]000) ot
Division 3 of the Business antl Professions Cotle) or thal he/sne is ezempt
-'here/rom antl the basis fOr the allegetl ezemp[ion. Any violation of Section
/031.5 by any aOPlitanl tor a permiL 5ubject5 the appllcant f0 a civil
eenalty ot not more than tive huntlr¢tl tlollars (E500).
LJ I, ai owner of the property oi my employees with wages as thair sole
Compensation, will EO lhe work, antl the s[ructure is not in[entletl or afferetl
for sale (Section 7044, Business antl Professional Catle: The Contractor's
l.icense Law tloes not appry [o en owner of a Property who bulltls or improves
thereon, antl wha tloes such woik'himself/herselt or�tnraugh nis or ner own
emplOyees, p�ovitletl lhat such improvements a�e not intentlatl or offeretl for
Sale. If, however, tne builtling cr imp�ovement i5 zoltl wl[hin one yea� of Com-
pletioq [he owner will have [he burtlen of proving he/zha tlId not builtl o� Im-
'� �rove for the purpose of sale). '
I, as own¢r ol Ihe Oroperty, am exUusively cantractlng wilb Iicensetl <on-
ttactor5 t0 const�uct thC project (Section 7044, Business antl Protes5ion5 Cotle:
The Cont�actOr's License Law tloes nol apply to an own¢r of prope�ty who
ouilas or Vmo�oves thereon, ana who contracts tor such orojects with a mn-
tractor(511icense pursuant�to�tne Cmtrac[or'i License l.aw). I am aware that
proof of Iheir Worker'S Compensa[ion insurance zhOultl be prOvlOetl to me.
❑ I am exemOt untler Sectlon 8. b P. C. tor this reason
Date Owner _
1 hereby certi(y tha[ I have reatl tnis
intnrmatlnn Is mrreEd I aaree to comD
ta[e that the above
y COIIO�y OldllldllC25
:by au[horl e repre-
ionetl pr rt f
� �
Date
TVPE OF CONSTRUCTION LJ NEW LJ ADD LI ALTERATION. LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q.p, y�
DESCRIPTION OF WORK/USE OF BLDG.
- S Main Building:
E
TVPEOFPERMIT GRADING FOVNDATION STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL ' A Rear
❑ OTHER C {'{j9ht
PROJECT DESCRIPTION SQ. FT. oCCUPANCv K.
CONSTRUCTIONTVPE VALUATION$ ' g Left
ZONE GRAOING CU. VDS. ACRES Ping. Ref. #
Remarks: . � � �� ' Planning Notes:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink �
Lavarories
P—Trap
Roof Drains
Reinspaction Fae � $15
Boiler Lf-(�
Duct- Under Ground
Duct - Structurel
Ducl - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact.8lt. ICBO #
Heating System & Ducting
❑aioo,000 sTu Oioo,000
Orivers' �icense r 55 � I I Reinspaction Fee
� —
_ CMF 0865-46, rev. 4/B4 White - Builtling: Canary - Applicanh Plnk-- Accounting; Goltlenrotl - ssessor
$15
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping �
Solar Tank
$wimming Pool w/Spa
Urinal
Warer CloseT
Water Heater
Water Service
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑aioo,000sru ❑ioo,000
System RepairlAlteration
Issue Fee
$ ;3
$ 3
Automatic Washer
Consvuction Pole Sub.
Cooking Unit
D ishwasher
Fan
F,A.U.
Fixtures
Device Bozes
Outlets
$wi[ches
Garbage Dispoul
Generator �65 KW �
IL26 pl181�5 13,t�
Zone
Accessory Building:
ELECTRICAL '
Transformer. ❑ 15-50 KW
❑ 50+ KW
5KW
$15
Meter IJup to l00 amps
Meter ❑over100amps
Sub Panel � '
Mowrs 00�1 HP �1 %- 8
Inc.Solar �9-75 HP �16-1
Microwave
Pole Li9ht
Range
Sign
Standing,Sections
Trash Compactor �
luue Fee
DEVELOPMEN7 SERVICES REQUIREMENTS:
Zoning APProved BY .
Building Approved By _ _
SUMMARV OF FEES
BUILDING PERMIT $ SMIP
PLAN CHECK $ PERMIT
PLUMBING $ �SSUANCE
PLAN CHECK .25% 3 ENERGY P.C.
ELECTRICAL $ GRADING
PLAN CHECK 50°� $ MICROFILM
MECHANICAL S TOTALFEE
PLAN CHECK ZS% I$ B •
$
FEES
$ 3
�/ �!� � � «T�_
2
O
N
I
N
G
R
E
Q
M
T
S.
CONSTRUCTION AND PLANNING POO_ �. SPA
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 Conduif Utility-Undrgrnd. �- 54. Forms � � '
4. Electrical Conduit-Undrgmd.� � � ' - 55z �Electrical Bonding
5. Steel Reinforcement 56. �Rough Plumbing & Pressure Test
6. Electrical UFER Gmd. , 57. APPROVAL TO COVER-GUNITE �
7. Footings , - � ' 58. Electrical Conduit-Undrgrnd. � �
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System � . 61. APPflOVAL TO DECK
i t. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final .
13. Roof Drains 64. Plumbing System � Final - .
14. Rough Plumbing ' 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final �
16. Rough Electric Wiring - 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace • APPROVALS Permit #
21. DuCts, in Structure � 70. Underground Hydro
22. Ducts, Ventilating . 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Tesi 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 Nailing � . HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � ' . - 79. FINAL INSPECTION
32. Electrical Power Meter-Final ' 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: f� /j��$' ��:r�.c.�n
34. Final Heating & Air Conditioning �f�s d� C��
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 STRUCTURE & BUILDING
48. Special Requirements Completed �
49. Electric Release to Edison � � .
50. Gas Release to Southern Califor'nia Gas Co
57. CERTIFICATE OF OCCUPANCY "
No. ' Date