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Home My WebLink About3407 GERANIUM ST - Building Permits.��fD% Co�E(L.ta'NLLUM Aoo��ant to fill in all spaces exceot thase within heavy Eartler lines antl sign all aovro0riate aeelarations. CI7Y oF COSrA MESA�/CONSIRUCTION PERMIT P�FMIT NO ,_ TRACT NO. LOT NO. UNIT NO. Project Address 3409 Geranium Applicant's Mailing Address ow�e�•sName Sreten Stovanovick pho�e 966-3050 Address 3409 Geranium Arch/Eng. License No. � Address Contractor'sNameCulligen Water COnd. Phone 750-2233. Address�mailing) 1911 S. Manchester Ci�y License No. LICENSED CONTRACTOR DECLARATION I M1ereby atfirm that 1 am licensetl untle� provisions of Charte� 9(commencing with section ]000) ot Division 3 of the BUslness antl Grofesslons Cotle, antl my license is in i II Porce antl eflect. �icense �iag_ �tt ��c nse No. 68763 oate � 519nature �WORKERS'COMPENSATION OECLA ATI I hereby aifirm that I have a certiticate of consent to selt-Insure or a certificate of Workers' Compensation Insuran<e, or d certilietl c0 y[hereol ($ec[ion 3800, Lab. C.�� /y7 PO(L� Pollcy No. '� �� Comoany �� Ce�tifletl ��ePy i5 t letlbwith IhChcrty � tl1',n� Dlvisio /�,/-. r Date �—�—�J APO��ant��/0%�/�%%//1'�` EXEMPTION F0.0M WORKERS' COMPEN ATIO DECLARATION (ThiSsection neetl not be completed it (he permit is for ane huntlretl (5300) or Iess�. I ceriity that in the oerformance of the work for which tnis perm�t is Issuetl I Shall no[ Gmploy any pe�son in any manner So a5 to becOme Subj¢CI to t�fG Workers' Compensation Laws oi Cali(omia. Date Signature NOTI[E: It, atter making this tleclaration, you shoultl becomn suoject to tha Worke�s' Comp¢nsatiOn Provisions ot the LaDo� Cotle, you must 10/thwl[h comO�Y �+�Lh such p�ovisions or thi5 permit Shall be tleemetl �evok¢tl. CONSTRUCTION LENDING AGENCV I he�eby allirm t�at there I5 a con5truction I¢ntlin9 a9enty tor the performante ot the work tor whl<h thiS p¢rmit is issu¢tl (Section 3097 Clv. CJ Lantler's Name Lentler's AGtlress OWNER BVIL�ER DECLARATION I hereby atfirm that I am exempt trom the Contractor's L�cense Law for the following reason (Section 7031.5 Business antl Professional Cotle: Any city or county which requi�es a permil t0 cOnst�uct, alte�, improve, �Cmolisn o� �¢palr any siructure, prlor to i[5 iszuance, also require5lhe applicant tor such permlt to file a signetl 5talement that he/she 15 licensatl pursuant to the provisions of •he Gontractor's �icense Law (Chapter 9(commencing with Sectlon 7000) oi livision 3 oi lhe Business antl Professlons Cotle) or that he/She is exempt .ierefrom antl tne basis for the allegetl exemption. Any violation of Sectlon d031.5 by any applican[ tor a pe�mit SubjeC[5 lne ap0�lcant t0 a Civil �enalty of not more tban tive huntlretl tlollarz (y500). 1, as owner ot th¢ property or my em0loyee5 with wag05 as thBlr sole compen5alion, will tla Ihe work, antl tlte sVUGtu/¢ is nol Intentletl o� offe�etl for saie (Section 7044, Businesz antl Protessional Cotle: The Contractor's License Law tloes not apply to an owner of a property wno builtls or Improves thereon, antl who Ooes such work himself/hmself o� through his o� her own employees, provltletl thal sucM1 improvements arn not Inlentletl or offeretl for sale. If, howeveq the bulltling cr impwvement i5501tl within one y2ar ot com- oletion, the owner will have tha burtlen of provin9 he/she tlitl noi bulltl or Im- ��ove for the purpose of sale). I, as owne� oi the proper[y, am exclusively cont�acting wltn liG¢n5¢tl Con- ttacton lo construct th¢ Project ($ection ]044, Bu5ine55 antl Professlons Cotle: The Contractor's License Law does not apply to an owner of p�operty who builtls or improves [hereon, antl wM10 contracts for such projects with a con- [ractor(s) license pursuant �to the Contructor's License Law). I am aware that proof o( [heir Worker'S Compensation insurance shoultl bC provltletl (O me. ❑ I am exempt untler SeCtion B. & P. C. tor thls reason Date Owner I hereby cerii/y that 1 have read thls applicatlon antl state that the above information is correct. I aqree to comply with all tlty antl county ortlinances antl state laws �elatin9 �o builtling wnstruCtion, and h¢reby authorlEe repre- sentatives oi this city to enter upon the above-mentlonetl property for in5pectian r s. Siynature �/,� 2//.�L/ s� 5-7-85 TVPE OF CONSTRUCTION LJ NEW U ADD U ALTERATION LJ REPAIR ❑ CONVEk510N ❑ OEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLOG. TVPE OF PERMIT GRADING ❑ FOUNDATION STRUCTV RAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 5c�. FT. oCCUaANCv CONSTRUCTION TVPE V.4LUATION $ ZONE GRADINGCU.VDS. ACRE$ Remarks: nk Preventer Irrigation tubs iking Fountains �r Drains �r Sinks Service Outlets Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fae $15 Bniler Duct- UnderGround Duct - Strucmrel Duct - Ventilating ExhaustSystem ❑ MWtiple Firepl/FacL BIL ICBO # Heating SVstem & Ducting ' ❑ ai oo,000 eTu O i oo,000 Drivers' License o 55 �` '� `� I I Reinspec[ion Fee I $15 CMF 0865-4fi, rev. 4/80 White - Builtling; Canary - Appliwnt Pink - Accounting; Goltlenrotl - A55essor Showers Service Sink " Sewer Cap Sewer Connection Solar Collecrors Solar Pipinq Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Issue Fee Hoodor Typel ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,OOOBTU ❑100,000 System Repair/Alteration ' luue Fee A.P. qIE S Main Buildi E T Front 6 Rear A C Right K Left $ Ping. Ref. # Planning Notes: 2764 �/10/i-16 Parking Req.IProvided ELECTRICAL Automatic Washer Transtormer ❑ 15-50 KW Constructior Pole Sub. ❑ 50 + KW Cooking Unit Dishwasher � � Dryers �Gas. �Elecvic Fan • F.A.U. � Fixture5 Device Boxes OuHets Switches Garbage Disposal Generator �0-5 KW �5-15 KW zo�e � Meter ❑up to 100 amps Merer ❑over100amps Sub Panel Motors �0-1 HP 01 %- 8 Inc. Solar �9-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor i c' FEES Z O N I N G R E Q M T S. $ 3 � , �a Reinspection Fee $15 Issue Fee $ 3 FEES . DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By Date Building Approved By Date Appliwtion luued By �W� ��;�✓SDate - SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ ` PERMIT PLUMBING $ Jf� �� ISSUANCE $ �� PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ � MICROFILM $ MECHANICAL 5 TOTALFEE $ S.00 $ 3 PLAN CHECK 25% $ ;.� CONSTRUCTION AND PLANNING ' P�� SPA APPROVALS Permit # Date Inspector � p�ppROVALS Permit # Date In:pector � 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 i �. '.5. Steel Reinforcement � 56. Rough Plumbing & Pressure Tes[ " 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE r ' 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. APPROVAL TO DECK 7 i. Property Sewer Line & House Connection 62. Backwash & Recep[or-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 1_6. Rough Electric Wiring 67. Fencing & Access Approval 17. ,Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. •Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Freming 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: $ fy �j- LK,/�'-Gq2p. L,�O 34. Final Heating & Air Conditioning 3-5 �j� _ L��-�q,2(� 35. Final Gas Pipe-Test � 36. Hood or Canopy � 37. Final Factory Fireplace 38. Final Plumbing aY3-7'� �t /'� j�s G�i 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 Fiegulations 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 ' Y��/��r /i� � . Q' 1`�C W�=`�`` ' � `'�02 ?wininq Laboratories �f =sou�E=n ��fo��, �.�. � 7J10 A�mort way / Maii�ng aCdress P.O. Bw <] / Long BeacM1. GA 9090f / �2101 a26-3955 / 12131 636-2386 / Ilt al 829�6aJ2 TESTING BBPNCM OFFICE �S�a-0 NO/t0 Susan si�eei i sa��a+�a ca enoo i m+� ss<�ze<s Aoril 8, 1985 Max Sitter P.o. eox 3�54 Fullerton, California 92637 Examination: SC85-2637 COMPRESSION TESTS ON GUNITE CYLINDERS aROJECT SWIMMING POOL & SPA aoDaESS 340; Geranium, Costa Nesa AfiCMITECT CONTRACTOR John Budd John Budd ENGINEER SUBCONTRAGTOR B.C. Adams D. J. Gunite SAMPLE FROM POOl & Spd MtX DATE CAST DATE TESTED SPECIMEN NO. COMPRESSION TOTAL LOAD. LBS. POUNOS PER S�. IN. 28•DAY AVERAGE, PSI COMPLIANCE SPECIMENS oi5rnieurioN: Max Sitter - 3 Lesta Mesa Bldg. �7 . 2- 7 3-26-85 SLUMP 4-5-85 1 10-Day 77,000 •:� � SPECIFIED' STRENG7H SIZE 4-5-$5 2 10-Day 65,000 2,300 10-Day tests comply with specifications. MPDE BY Lou bept./Scott Priegel OEIIVERED BY Max 2,000 psi f�1 5}"x12-3/4" �f2 6"X72}n 3,4,5 c 5"HELD IN FZELD" PECEIVED ON 3-28-85 ��, ,� .�1� /�'.%� � �� r Rick Hyden i %LL FEPORTS ,1PE SUBMITTEp ?5 iNE CONFIOENTIAL PROPEAT�" OF CIIENiS :UiHORIU�ION FOF vUEIICaiION OF OUA AEPORtS. GJNCWS�ONS.OA ESTRrLTS FROM pR aEG�PCING PwE.0 I$ RESERVE� �ENOIUG OUR W RitTEN aGooOV4L >$ � blUiUaL �AOLEC i IO.V i0 CLIENT$. 'ME oU9LIC %Np OI1R$ELYE$ ]30��2 bl AOP�icant �o fill in all svaces except those within heavY eortler lines antl sign aIl a� CiTY oF COSTA M'E1Sn CONSTRUCTION PERMIT -. PERMir No. � TRACT NO. . LOT NO. � Project Address 3"7'� � ��h� V� � — / � �� J � � � Appli�`anYs Mailing�Address + G �� TYPE OF CONSTRUCTION EW /aDD ALTERATION �L ❑ ❑ ❑ - Owner'sName .7K�/�i�ONIG� Phone - Address. 3�� GQ��'JN,� VY/� � � Arch/En9.7u�'fN� {�' .t�v�c.w �-4l�C�SL(.�i-. �cense No.'�� Address 2�3b��N•Glasscll.SE.M'��rr,e.,CtA�qLbbS . Contractor'sName��h��/�� Phone�p-7��'b ' Address (mailin9l��D �_�Q�{E�I �' M��=�G� 9�'-'� City License No_ ��3C) ��+ - ' . LICENSED CONTRACTOR OECLARATION ' � � ' I hereby affirm that I am licensetl untlet provi5ion5 ot Charter 9(commencinq with section ]000) ot Division 3 ot the Business antl Protessions Cotle, antl my license iz in full fo(�2 antl� fect. � re� , LICE052 CI �� L.i n5e No. �m Dale�B�� S9 t � �� WORKERS'COMPENSATION DECLARATION, '� � ,I hereby affirm that I nave a certificate oi consent to self-insure oi a certiticate � of Workers' Compensation Insurance, or'a certitietl copy thereof (Section 3800, Lab. C �� 4 : ; �� N&�u�7i�iv�;p� Policy No. ��- ��J�Compan ',�— �Certifietl copy is hereby furnlshetl. � ', � Certi(ietl c y is filetl with the iity �I m9 DI/r;,��sion. ��,{,�- �/�1/� Date�!�Q�� APPlicant 'J�' n �,il� -"'4^-`�� EXEMPTION FROM WORKERS' COMPENSNTION DECLARATION �- (This section neetl not be completetl if the�permit is for one nuntlfetl (E300) or less). � � I certify that in the pe�tormance ot Ihe wo�k fo� wltich this Oermit is issuetl, I shall�,not employ any pe�son in any maRne� so�as to become subject to the Workers' CompensatiomLaws of!California.� • . . . Date. Signature � � 'NOTICE: It, after makin9 this tleclaratibn, you shoultl become subject to the . Workers" Compensation provisions of the Labo� Cotle, you must torthwith comply wi[h' such provisions o� this permit sball be tleemetl revoketl.� CONSTRUCTION LENDING�AGENCV ' ' ' I nereby aifirm that there is a construction lentling a9ency for the performance � of the wark for- which this permit is lissuetl (Section 309] Ciy. CJ Lender's Name Lentler's-Atltlress' � OWNEH BUILDER DECLARATION I hereby affltm that I am exempt from the ConVac[o�'s License Law fo� ttm following reason (Section 7031.5 Business antl orotessional Cotle: Any cily or : county which requir¢s a permit to construct, alte�, improve, tlemolish�or repair � any structure, prior to Its issuance, also requires the applicant for such permlt ' to fiie a signetl statement that�he/she is licensetl pursuant to.the provisions of tM1e Contractor'S License l.aw (Chapter 9(mmmencm9 with'Section ]000) of.- Oivision 3 ot the.Business antl Professions Cotle) or that he/she is exempt 'herefrom antl tne basis for the allegetl exemption. Any.violation of Section '031.5 by any applicant for a permit subjects tne aOPliwnt:to a, civil ��enalty ot no[ more than five huntlretl tlollaro ($500). I, a5 owne� of the. prape�ty'or my employee4'with wages as their sole wmpensaBon� will tlo the work, antl the structure is not intentletl or ofteretl ,.. , e r o� �.... �nen wi�cinaac antl. Profeszinnal Cntle:. The Contractor's employces, provitletl thbt SucM1 imprnvements are not Inten0e0 or aiterea ro! sale. If, however, tne builtling or improvement is soltl within one year ot com- pletion, the owner,will have�the burtlen of proving he/she tlitl not builtl or im- ' erove�for Ibe purpose ot sale). •` ' ' - LI I, as owner oi the p�operty, aT exclusively cont�acting with licensetl con- tractors to mnstruc[ the project (Section ]044, Business antl Protessionz Cotle: ' The Contractor's License Law tloes not appry to an owner of property who builtls or im0�oves thereon,'antl who conVaclS for such projects with a con- + tractor(s) license pursuant�ta the�Conbactor'S License Law). I am aware that proot of the'rr Worker'S Compen5ation insurance shoultl be provitletl to�me.l ❑ 1 am exempt untler Section 8. & P. C. for this rea5on Date Owner -_ I hereby' certify that I' have reatl lhis informatlon is corretL I agree to compl antl state laws relating to builtlinq con5 sentatives of-this city to ent�r,upon inspection 0 �po e . Si nature repre- y for Ceclarations. � _ REPAIR= � � CONVERSION DEMOLISH � OTH - Ap # � "DESCRIPTION OF WOftK/USE OF BLDG. - p�r�� - %��{.C�Zi � , '�� .« S Main I TVPEOFPERMIT GRADING � FOUNDATION OSTRUCTVRAL! T F�Ont �.❑ TENANT ❑ ELECTRICAI ,❑ PLUMBING ❑ MECHANICAL g ❑ OTHER � � � ' A Rear PROJECT DESCRIPTION 5Q. F7. �� r O oCCUPArvcv � C Right CONSTRVCTIONTVPE ' ��N VALUATION$ �G��E3 � g Left � 20NE � GRADINGCU.YDS. ,ACRES' PionRef.# ng No Remarkz: ' BarSink � Backflow Preventer Backflow Irri9aticn ' ' Bathtubs ' � Clarifiers ' Dishwasher � � � Drinking Fountains Floor Drains Ploor Sinks , Interceptors Kitchen,Sink' �� Lavatories i P-Trep . Root Drains � ReinspeMion Fee "�; Boiler Duct - UndeuGround Duct - Strucmrel FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank ' Swimming Pool w/Spa Urinal - -� � - Water Closet � � Water-Heater - Auto-Wash . � Laundry Trays ' � � - �$15 . . Issue Fee $'3 Exhaust System ❑ Multiple ❑ FirepUFact Blt. ICBO # Heating System & Ducting ' ❑o-ioo,000 sru �iao,aoosr I 9 . _ _ , -- ' - . ' I . I ReinsPection Fee � Drivers' License or 55 � CMF 0865-66, �ev. 10/84 White - Bulltling; Canary - qpplicanq Pink - Accounting; Goltlenrotl - Assesm� Hood or Typel ❑ Canopy , Type I I ❑ , ' � Refrigeration System + ❑aioo,000eru ❑ioo,000eru System Repair/Alteration I Pire Dampers ' � Registers ' � $15 I I � Isue Fee i I $ 3 - ; _ . a��, a�oa�, .;,- — �-,� , � _ ' < ' " -._ __ ✓I .� . ing: Accessory Buildini F G HT" - ! r - ��, /-' , Automatic Washer ' Construction Pole Sub. Cooking Unit � Dishwasher � Dryere �Gas• DElectrii Fan � F.A.U. � Fixtures ' , Device Boxes ' Outlets Switches Garbage Disposal Generator �0-5 KW �5� Zoning Appraved By1 Building Approved By Aoolication Issued 8v_ � S 5KW Parking.Req./Provided � � Z o � N 1 N R ' E Q M - T S � FEES � � �Transformer LI 15-50 KW � . ' I ❑ 50+KW , Meter ❑up to 700 amps ' Merer ❑over 700 amps � Sub Panel , � Motors �0-1 HP 01 %- 8 Inc.Solar 09-15 HP �16-15+ '- Microwave ' - -" ' - �Pole Light Range � � ; $tanding Sections r Trash Compactor r $15 � �'Issue Fee - RE¢_�11jiEMENTS: /�/�L Z�. ' � ��■ .. . r : �. �� •. : ' ' . � . �MMARV OF FEES ' ' . � BUILDING PERMIT $ •-zg•'— SMIP� $ � '�� : , PLAN CHECK ' $ ��' �� PERMI7 ' PLUMBING � $ ISSUANCE $ � PLAN CHECK 25% $ ENERGY P.C. �$ ELECTRICAL $ ' GRADING $ PLAN CHECK 50°k $ � MICROFILM • $ I MECHANICAL $ � ' TOTAL FEE $ ��r 70 � PCAN CHECK ZS% $ � . � �CONSTRUCTIONANDPLANNING�/q� ' ' POO�.�SPA � APPROVALS Permit #�� Date Inspector AppROVALS Permit �i-` Date Inspec*m • F . r- 1. Tempo�ary Electrical Service or Pole 52. Pool & Equipment Location� 2. Soil Pipe-Undrgmd., ' � 53.�Steel Reinforcement . 3:'Electrical Conduit Utility-Undrgrnd. 54. Forms � 4' Electrical Condult�Undrgrnd. - 55. Electrical Bonding 5. �Steel Reinforcerrtent � f� �('j 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 Undrgmd., Test . 9rWater Pipe-Undrgrnd•. 60. Backwash Lines, P-Trap, � Undrgrnd. � 10. Structural Floor SYstem ' 61. APPROVAL TO DECK 71. P.roperty Sewer Line & House Connection 62. Backwash & Receptor�Final 12. Sewer Cap'� . 63. Heater & Vent-Final 73. Roof Drains �� - 64. Plumbing System - Final 74. 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. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Undergraund Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Raugh & 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 DEP7. REQUIREMENT 31. Plaster Brown Coat � 79. FINAL INSPECTION 32. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED � 33. Final Electric Notes: 34. Final Heating & Air Co�ditioning 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 Southem Califomia Gas Co � . - ' 51. CERTIFICATE OF OCCUPANCY , I Nn. � - Date ' � � � � Applicant to fi�l in all spaees iYOFCOSTA3M Sa_ICO,�VSTRUCTIONP.ERMIT , : F;+�jGFtAddress ��_�!�.�r1�� Applicant's Mailiny Address z�,p�j `C ��(�J'-�� s' �NY" St�`/�- Sio'cu�t ovfCLl a p �y ,�•- Owner's Nam1�e /+ �, hone ��' Address 3T�1, la'/'C—YLLhIU'1�'✓1 � � Q Arch/Eng. � n h ^��lt `'� icense NQ� z� � 1 Address. Z3%� . � � �G�LS.i�e�� '�'M UrZtYHI^�C_ �%2� Contracmr'sNam�� Phone � �� Address(mailinglz-�� N•GIas1`l( S �MC3�u✓10��k2�.� City License No. 2.�,-D 30 d GICENSED CONTRACTOR DECLARATION �I hereby affirm tha[ I am licensetl untlet provisions of Charter 9(mmmencing witn section ]000) of Division 3 of the Business antl Professions Cotle, an0 my license i5 in full torce antl effec[ �(� I�� Lice Class - � 'S License No. � � I Date�3—µ��' Signature � WORKERS' COMPENSATION DECLARATION � • ) 1 hereby affirm that I have a certificate oi consent to selt-insure or a certificate � of Wo�kers' Compensation Insurance, or a certifle0 copy tnereo( (Section ` PBOOY No. RLyB`I 5'31 3 Dcebie; S„gl„+� f� VJcI-�r Company Certifietl copy is M1ereby furni5hetl. . Certifietl c py is fileE with the city �u�ilQ-i{�g_ �ivi�i$n�.� � � Date 3-4'd�� qpplicant �^+'—"�• �`uv-^"^ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection neetl not be completetl it Ihe permit�is tor.One huntlretl ($100) o� less). I certify tha[ in the Oe�fo�mance of the work for whiGh this perm�t is i55ueQ I shall not empioy any person in any manner so �as ta become suGject to the Workers'�Compensation Laws ot Galifo�nia. ' ' '. Date Siynature �NOTICE: If, after making tnis tleclaratlon, you shoultl become subject to the Workers' Compensation provisions of the Labor Cotle, you must torthwith comply wiN such provisions o� this permit'snall be tleemetl revoketl. CONSTRUCTION LENDING AGENCY' � � �• � ' 1 he�eby affirm that there is a construction lentling agency for the perto�mance ot the work for which this permit is issuetl (Section 3097 Civ. C.) LenCer's� Name Lentler's Atl0�e55 OWNER BUILDER �ECLARATION ' I hereby affirm that 1 am exempt (rom the Contracfor's License Law tor the following reason ($ection ]033.5 Buslness antl Professional Cotle:�Any dty or county which requir¢s a permit to const�uct, aiteq improve, tlemolish or repair any structure, prior to its issuance, also requires the applicant tor such pe�mit to file a signetl statement that he/she is licen5etl pursuant [o the provi5ion5 ot � the Contractor'S License law (Cnapter 9(commenUng witn Section ]000) of. Division' 3 ot the Business antl Professions Cotle) or that ne/she is exempi ;,�Snerefrom antl the basis for the allegetl exemption. Any.vlolation'of Section ,3-�031.5 by any applican[ fo� a Oermit Subjects the appliCant to a civil '�enalty of no[ more tnan tive huntlretl tlollars (5500). ' �'❑ I, as owner of the P�oOerty or-my employees with wages as their sole .compensation, will tlo tne wark, antl the.structu�e Is not intentletl or otteretl for sale (Section 7044, Business an❑ Professional Cotle: The Contractor's License Law tloez not apply to an owner oi a prope�ry-who builtls or imp�ovez thereon, and.who tloes such work himselt/nerself or through nis or her own em0loyees, provitletl Ihat such imP/ovements are not intentletl or offeretl tor sdle. If, however, [he buildin9 or imp�ovemen[ is soltl wilhin one year of com- pletion, the owner will have the burtlen of O�oving he/she tlitl not builtl or im- p�ove fo�the purpose of sale). �❑ I. as owner ot the p�ope�ty, am exclusively cont�acting with licensetl con- Iractors to consV uct Ihe project (Section ]044, Business antl Professions Cotle: . The Contractor's License Law tloes not apply to an owner af property who builtls or improves thereon,�antl who coniracts for such projects with a con- ' tractor(s) licenze pursuant to the Contractor'S LitenSe l.aw): I am, aware that proof o�thelr Wo�ker'S Compensation insu�ance shoultl be p�ovitled [o me. ❑ I am exempt untler Section B. & P. C. fo� this reason . Date owner�� . 1 hereby certify that I have reatl this application antl state�that the above information is mrrect. I agree to comply with all city and munty ortlinances antl state laws relating to builtlin9 mnstruction antl hereby authorize repre- . sentatives ot this city to enter upon the above-mentionetl property for � � . inspectlon pur spp es�.� ^��. / p '- � 3 /� /O� Si9nature �aYti�•• '/�"T~'c��'�✓� Date O Drivers' 75 ' those within Neavy OorEer lines antl sign all approOriate tleclarations. � TYPE OF CONSTRUCTION LJ NEW LJ ADD L1 ALTERATION ❑ CONVERSION ❑ DEMOLISH ❑ OTHER- � DESCRIPTION OF WORK/USE OF BLDG. � � TYPEOFPERMI7 GaaoiNG FOUN orv ❑ 5Ta C7u ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ.FT. OCCUVANCI CONSTRUCTIONTYPE VALUATION$ I� ZONE GR�4DINGCU.VDS. ACRES- Remarks: _ _ �/ 7 � . 3ar Sink 3ackflow Preventer -� - - 3ackflow Irrigation 3athtubs Clarifiers Dishwasher � ' Drinking Fountains Floor Drains � � FloorSinks ' . . Gas Service Outlets Interceptors - Kitchen Sink � .- La'vatories ' P—Trap! Roof Drains � � 'Reinspectian Fee �'. $15 Boiler Duct�-UnderGround Duct - Ventilatin9 Exhaust.System ❑ Multiple ❑ FirepVFact. Blt. ICBO # Heating5ys[em & Ducting ❑0.100,000 BTU 0100,OOOeTi Reinspection Fee � $15 CMF o865-46, rev. 10/84 Wnite - Builtling; Canary�- Applicant: Pink - Accounting: Golaenrotl - Assessor Showers � ServiceSink - Sewef Cap Sewer Connection Solar Collectbrs Solar Piping ' Solar Tank Swimming Pool w/$pa Urinal Water Closet � " Water Heater Watec Service Auto-WasFi � laundry Trays Issue Fee IANICAL Hood or Type I ❑ Canopy Type I I ❑ 1 REPAIR A.P. � Z . � S Main Building: 4L T Front ARear C Right Z5 '� C7` g Left' � Ping. Ref. # Planning Notes: FEES . I $ 3 Refrigeration System � , ❑0-100,000 BTU ❑ 100,000 6T Sys[em Repair Fire Dampers Registers F Isue Fee � $ 3 Automatic Washer Consbuction Poie Cookin9 Unit Dishwasher Dryers ❑Gas ❑ Fan F.A.U. Fixtures Device Boxes Outlets Garbage Disposal Generotor �0-5 KW Fee DEVELOPMENTSER Zoning Appraved By— Buildin9 Approved By 8962 3/OB/�.:5 Parking Req./Provided 0 Zone ' ELECTRICAL � � � -��' - 7ransformer ❑ 15�50 KW �-' ❑ SO+KW ' ' Meter ❑up to 100 amps � Meter ❑over 100 amps ric Sub Panel Motors �0-1 HP � 1'/: - 8 Inc.Solar �9-15 HP �16-15+ " Microwave ' '- � Pole Light ' ' Range � . � ; Standing Sections 5 KW Tresh Compacror $75 'luue Fee ;. r,�� $ 3 SUMMAFLV��5l F FEES � � � BUILDING PERMIT $ �• �v SMIP: $ I��D S PLAN CHECK $ �� PERMIT PLUMBING •$ � i0•�O �SSUANCE $ ; PLAN CHECK 25% $� . i5 ENERGV P.C. $ ELECTRICAL � $ � Z�OU GRADING $ PLAN CHECK 50% $ U-� SO MICROFILM .$ MECHANICAL $ TOTALFEE $ �� PIAN CHECK 25% $ � � Z O N I N G R E Q M T S rt ' '` ¢ONSTRUCTION ANp pLANNING � P�� -�'�A f-� p�PROVALS Permit #�PF��!U3 Date , Inspector AppROVALS Permit # Date Insper.tnr � 1. Temporary Electrical $ervice or Pole 52. Pool & Equipment Location a} �/�'j 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. APPROVALTO COVER-GUNITE '�! Z/ . 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. APPROVAL TO DECK 11. Property Sewer Line & House Connection . 62. Backwash & Receptor-Final �� 12. Sewer Cap � 63. Heater & Vent-Final 13. Roof Drains � 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final � 15. Rough Electrical-Conduit 66. Solar System-Final � 16. Rough Electric Wiring 67. Fencing & Access Approval � 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING G'}l � 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL a� 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.StorageTank OGas ❑Oil 25. Roof Sheathing � 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe � 28. Lathing & Siding . 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notr.s: 34. Final Heating & Air Cbnditioning ��7 fs� p�jK o LO /Y 35. Final Gas Pipe-Test �a�� Gi7� . (N �/u as r-�-�. 36. Hood or Canopy . 37. Final�Factory F.ireplace - 38. Final Plumbing ' �, 39. Water Service-Final � � . 40. Gas Service-Final . � 41 . Solar pomestic-Final � . � 42. Backflow P�eventer ' 43. Backflow Irrigation . � 44. Landscape�lrrigation System � " 45. Sound Attenuation . ` � - 46. Handicap Regulations , � ' . 47. FIfVALSTRUCTURE&BUtLDING 48. Special Requirements Completed � � �. 49. Electric Release to Edison � ' ' 50. Gas Release to Southem California Gas Co � � � 51. CERTIFICATEOFOCCUPANCY � - - `E� � �Nn. � Date � - � , �-,. �� ,,� % "x 5 �� La� 6oH� - '� '� 3 '' - % _..__�_ _ .- ._-=- r• r% v!A �.Fenr_Fa ; � �� o.c' . V �!�e.�n _ �_ . . _ — --: - . ___ _ --- - : -_..— � �i__-, .� : � �'/../. � ,�, � r`7 ,: �- -��, ( " � �I � �.�'rt�K ��`n� �„ �,C, "�C Y � .....� ��.�....�e.v�rpe�.y..�(:Lti:i DiP?%f$Y' 1 ----� CAUTIO� �--_ � _vin�vnl u�r6 vL�-n��uvv� �.�..�.,...._�..`....., i . ,:. ;'�;CORDANCE WITH STATE SAFETY REGULATIONS, IF /, ",�,; :;UCTlON REQUIRE:i WORKERS, EQUIPMENT, CRANES �;; !;�rtS(IfVG DEVICES TO BE IN PROXIMITY OF OVERHEAD � FrT::ii`4� F. R UNDERGROUND ELECTRIC FACILITIES,CA OjJTHERNCALIFORNIAEDISONCOMNAr�r . ,I�:IMEDIATE�Y (�4� �5-0244 �'�T �N (NOT TO � �PPROVED City of Cbsta Mesa Building Dept. �. oA7EJs�--� — _ iNESE � S MUST BE ON JOB �T ALL 71ME5 OF DEPG — - - l v � THE ISStlANCF OR �IiPDA1NG �F A PERNET OR OVAL OF PLAyS MJD 9fi�IFICP710NS 9F1RLL N0� BE CON UED TO BE A PEPMIT FO � OF ANY OF THE PRO IONS OF THIS CODE. NO FfRMIi PRE• SUMING TO GlVE HORIiY TO VIOLATE OR CANCEL THE PROViatONS OF Tt1iS CO�E� 9F14LL BE YAI.ID, �. o` FAR AS THE WDIiK. USE NMICH li�.�j THE ISSUiWC Of A PERMI7 BASED Uf'OV FRAMS AND � SPECIFICRTIONS SHAL NOi PREVENT iNE EUILDIY;, OFFICIAC � FROM THEREAFfER R QUIMNG THE CORRCCTION C� ERROSS �, iY. SAID FIANS AND CIFICATIO�S C3 FR7M PREVENTING f;7LDINC OFERATION ' '"`� 19 �';^�,TICN OF THI$ COOE OR OF A;1Y OiHE3 0^OGt.�..�'i r-'::Z C:"/. \ 3�{O % G ee�a,n i �7 w, �� PROV�FD C OF COSTA MESA FLANNING DEPT, - wuecr ro e�na, oevr. � \ �-L49c�.,� `�'� �� = � y e+ � . � C 11Ral APPROVAC ONL � ATE PER� S ' ` PO i ELECTRfCAI, PLUM8IN , �1 TING. VEN'fILATING AND REFRIGERATION WORK _ - �'@'A8'�9� # 18 Z 7N)S Nf1M8ER MllST ACCOMPAN AlL INSPECTION REQUESTS FOR BUILDINGS WHEHE PERSONS ABf TO EMPLOYEO. WE SUGGEST THA7 TNE STATE CALtFORNIA O�VISION OF INOUSTNIAL SAFI BE CONSULTEO FOR ADOITION �� . i�rrr�Y . . � � � � � - y-, 1. . � ' � ' 4 } 4 � �'. �� jhi sli�f ..�� +t� �� , t �.�w i� f +�`4�'�1 I - � - � �. i�L ��r�l.�p L tigia ��; ��. ��. r �. i` Sx� t. „�f,t+ dj��. y��l�i� e � � y 1r �� I�% r- .. '� , tn'.�'. ��NOnt-Plt6E:��5�� ,'� {t:� , xo - !t � i � 'i',: ' i. � � -;.il g� , iq _ �1ir �; r : , _ ' i.' } t �d�ce!! hiiaii �r'Fytitrlt�y�♦ �:•3� ;��; . 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' � .%. . � J � `. 4� � � .,�; �� : �,t� � � �� , � ��P �� o�v:�E �, : , � � �� . �� 1. �� , .. � �� , . . y,#� <i — � �. �. ». �v ' 'f�CS�ibt'�+:`of�Costc Mesa Buildin Dep �� ' `i,�^`` � F��;y- .� u: S � ..$)� t i i.:�.. � � . � � r � . , . . , ; � �nl � � .C, �I r � r i .r, ,' � i �t:, .. 7 . : ' ' � ` �A � � � , � t� d.t� ',,nT t I� ' ' ' , � � t ' , ,THESE PLAN§ MUST,BE ON JOB '�ALL TIM + `l;�' ��'. �� r`^ � �'�'� ',�+Bq�k.Wrrsl_ 1 }'`OFDERO CHANGES WITHOUi.PRI :AP .OY , ` �4ry'. �. �� — � iHE ISSMtNCf OR f3W11`A1NG OF�A'PEHM OR3 , � VA � �t�,;` z ��,;� y � CF FLANS q{VD'�SPf�1EICfi710NS 9HqLL NW CON �UE ' r -- ,� �rC � �: � TO � &E� A PERMIi FOR, OR PN 'IppR0y1L OF i VI � , TI �, �� '� � r,{(� i' ' � CF ANY OF THE'PROYA6�ONS � THIS CODE N.rFRMI �PRE ' �� t j �r `° I{f4 �" , SLJMIMG TO G1VE AUTNORITY, ro vioini� d��ame '�ni "^ .� ; �°��F�� i �'" , PROV�IONS 06.T}IIS C0029HALL;BE VALID FXCEP IN t,..,, ;.; '� � I,�f' . _ -�'__ , 7'`R F,; TNE'WARI( OR USE WFiICH RAUTHORI `IS , IVFU ,� � a '�� +c � � � �' - .� THE ISSUfWCE Of A �ERMI ,.. ', Y PLA , �AN � �� !�. �• j . . , "� . � : FCCIC:CATIONS SHALL NOi PREVfA(I TH6BUI ING�O FICI � C . ,,°• ; ��.r; i ' - � �j. ' 4 � fCrrvn iuracen�o ornwaur_.ru�RFdJg � •nr, •,,� � '�k' �=';.I�. ' (,••�� i �, , .•' ��'��.. t4i , ; . , ,4, . �{. �.�� : ,;h <,.:4,,,_,�� a ��i' . OY Tf NY 0 N ORS �, •,�'i`1�;�H:'�i4 r.):SoLir.r,: -� .1N � a , �1 _� � 3U � �� _' �IZ'—�� I4� � .D ��r�s�°��-��"Z City of Gbsto Mesa Building Dept. � TFiESE PL4N5 MUST BE ON .108 AT AJ.�71 AKE NO CHAN6E5 WITHOIJ� PRIOR APPIIC OF DEP�. OR (�(i4�1TlNG aF A PERMT OR APPR� Gt PLA@IS RYJD IfICAiIONS 9FYY.L Ntif BE CQNSiF TO 6E A FERMI FQR, OR AN fVPltOVY OF, AMI YIO1F Of ANY (fF THE IONS CF TN1S CODE NO PCRMIP �ENMhYG TO Gi AUJtIORIJY i0 VIOIAiE OR CANCEL PRW'a'IONS OF IS COCE�9WtLL BE VAUD, EXCEPT 11 �e,R AS TFIE OR USE'SMHICM-R�AUT}IORIZES.IS IAM _—j� �_. THE ISS CE QF A PER171i BASFA UPON PUjH3 SPECIFICAT70MS NALL k0i PREVENt iHE BUIIDlNG OFF FROM THEREAfT flEQU1RING 7HE COERECTWN OF1EW � � IVD SPECIFICATIONS OR FROM PREYEN BUILDING OPERATIONS BEING CARRIED ON�THER4INDFR 4 �N 410LkTtCY OF TNIS CODE OR OF ANY OTHER ORDIC71 4E THg CLL. � .... ;{,..�;�;, ,:s,�;u��•�:;i �n . �- � •.�;S.�.Y,; � �,� �� i `Ya� ; t�.'��c �. ;i.l`': ;�a _ ;,t 1-)I �'��s�`.<' .::. ,. .._ ._� � ,�,.''�Lj � � 7�� 7� CE OF A PERMIT BaS� UPO:J PIA� SPECIFtCP710NS SHRLI. NOi P�� 1HE 6U��DING ( FRON THERFAFSCR REQU�CIFIC� NS�� M GRf 1N 541D FLANS ANO SPE eN� VOIf;TOClOF 14NSBEI�DE QR 0'FD4NYTOT�H£R O,a � C° TY,fi C:iY. _._,1...,,...,. _. ..�.,. _' � ' e � �' 1.° �.1"i i. ;'� i _ I �� .�._!.� _, �- I C� " - � ya "x �J u LQ� boits - 1 G" o C-. /, � ��y�,� , �� _ � � X� R�FTE� . .' i � _• _ — r- i v i�� ; � ,. ; ,, . ��,.. .� :. : �� .,:.� . Q��v ;�e�� S� C� .0 � � � ;,. � � �� or� avERxnNc 1� �; , � PLOT PLAN (NOT TO � �I 2 X�2„ � ��-� � a�PROVED ,n ��' � �S�a Mesa Bullding Depi, n�,v �►+�se vuNs Mu��'� �MAKE NO CHAM6 � BE ON JQB Ai ALL TI OF DEPr. � WITMOUT PRI01t APPItO iHE ISSNqN(� pR �� OF A PERhDi OR M�pRp TO 6E A p �F�� L NQf BE CONSTR! tamir ro2 os �rv �R� �, arrv viouir �� 0 Gl �+�5 � TM�S CODE. NO PERNIf R ''lONS OF �7NORITY Tp VIOlA7E OR CANCEC 1 FAR AS TkE WD iIS CODE 9FWLL BE yAUD D(CEPT IN �R USE W}��CH RqUTHORIZES IS WW� '•°�C�(ICATIONS g CE OF A FERMIT BASED UP09 PU1NS M �R�•N 7HEREAF7ER REQ11 RING HE COR ECTION I CF �E(ifi0q �� `-�-�=�g-�ANS A . SPECIFICA710�S OR Fft�jM ppE�r�ryilN ' NSBEING CARRIEOOY TFiEKq�Np� �yHE ;:°, "�!�TIC� OF THIS CODE OR OF A,��y pipE:? O.FJ7.' �• ;,; ,;ji: �,: ;�; �i, � • �v �AID FLpNS "` rc°�UIRING TF{E COR V��u�rvG OFFICN( t FJIIDINC AMD SpECIFICAT10Ri �Tl� OF OPERAilONS9£IN6 CqRRIE� OR FROM PRfl�� i'1 t7^�CTICN Of THIS CODE OR OF .4�v pHHR�ODa' yy�a '�=_++..�...,..,.,_�_�_,__`� 9tlGA ""-..�,-�-- �..._._ • e I' ' � Y � ( � r•. f, V� � I • 1 , 1 tl Z(a � I..��w� 1 �!� (,rre-�I.. rn o 0 -� u - . _ .... — �� E 1 ti �� n.. ' . . ! � �1 to, - ,s -- �- -- -�: ' � C�Ns2 � �- PA+;o ��e¢ E-5 _ - ,. � .� _ . � � ��;��0��5 --- `--- �p ��.� � a , Y � City of Cost .AA � ilding Dept i @Y �TF . 74„� ��S �De/ICL� THESE PUNS M Sf B pN Jpg pt q(1 n�qg MAKE NO CHAN6' WI O PRIp'� qppRpyqS OF DEPf. THE ISSIiP.NCE OR J �F RERMi OR APPROVAL OF PLNAS t,ND Sp{��FI qifOtJ L NW BE CONSTRUED TO BE A fERM1T FOR, R�AN QF, MVY VIOLAfION OF FNY CF THE FROUISI S LF hltS ODE NO pEfiMif, PRE. � SUMING TO CIVE AU7H g17Y VI TE OR CAfVCEC THE, � PRWi3ICNS CF THIS C DE LL B VALID, EXCEpi IN SO � FAR RS iHE WDRK OR U E WN1C R THORIZES IS IAWfUt; THE ISSURNCE 0� A PER 17 B ED UPON PIANS AryD SPECff+.CAi10�$ SHALL N T P(t ENT E BUIIDiNG OFFICIAL' Fii�M TNEfiC6FTCR REQU RING T IE CO RECTION Of ERRORS �N SGID fLNNS FND S CIEICATO�$ R FROM PREVENi1NG BUILGIK: pF��?p;' " NG f�A IED N THEREUNDER WHEN � �N ��=.`�i�k� ' Cl DE OR OF q y 07HFR Op,D�iJANCf � OF T _ � FI -t . � - � _I. ' . - � �n ;, ` � -r, ! cw RE�ro�H� � . 0 � � � � CI7Y OF cOSTQ��/r]j��SA C9 �NS_TMRUC�3T�IO�N PEcRM�IpT Project Addr¢ss ✓I`�7 YJ/G�/7Np(� `, / ti Applicants`tdailingAddress ��% Gi�-�2RNi�1vh �� Owner'sName ��ETc� �TOSg�p�ne ��6=3��= Address 3�7 ��1�%14{M .��T Arch/Eng. License No. Address Contracror's Nam N � Phone Address (mailingl City License No. LIC NSED CONTRACTOR DECLARATION I hereb �rm that I am li[¢nsetl untle� O�ovisions of Charte� 9(Comme�n '1�J wi[h S t' ' o' ' 3 f the B 5' S a tl P of «'••� E my I f II ( f t - Lice�se ciass _i irn�<n ryn, ApP��cant to fill in all ipaces exceDt ��ose wilhin heavy EorEer lines antl si9n all apPropriate tleclarations. PEF�MIT'O�n�(.0 TFAO`I LOTNO. UNITNO. AP# I Date^ �� Si9nature � '�ORKERS' COMPENSATION DECLARATION ereby aflirm tha[ I have a certiticate oi consent to self-insure or a certificate Workers' Compensation Insurance, or a certifietl copy thereof (Sectlon 3800, Lab. C.) ' Policy No. Company BCertifietl copy is nereby furnishetl." , Certi(ietl mpy is filetl with the tity BuiltJinq DlviSion. Date APplicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section nee0 not be comple[etl if [he permlt is for one huntlretl ($100) or less). I certify that in the performance of the work Tor which this perm�t is issuetl I shall not employ any person in any manner so as o become suCject to t�e Workers' `CG/!�oGpy� ion Laws of Calitoutja�' `�� Date �C „]�—Kb Signature � NOTICE: If, after making this tleclaration, you shoultl be me subject to the Workers' Compensalion provisions of�the Labor Cotle,�y u must forthwith comply with Such prOvisions or this p¢rmlt shall be tleeme0 �evoketl. CONSTRUCTION LENDING AGENCV 1 hereby affirm that'lhere is a ronstruction lentling agency for the performance af the.work for which this permit is issuetl (Section 3097 Civ. CJ Lentler's Name Lentler's Atltlresz OWNEH BUILpER OECLARATION � I hereby aHirm lhat I am exempt from the Contractor's License Law tor the following reason (Secfion ]031.5 Business antl Professional Cotle: Any city or county which requires a permlt to consiruct, alter, improve, tlemolish or repair any structu�e, prior [o its issuance, al5o requires Ne appliCant to� such permit to file a signetl s[atement tnat he/she is licensetl pu�suant to the p�ovi5ions Of 'he Contractor's License Law (Chapter 9(commencing with SecHon �000) of ivision 3 of the Business antl Professions Cotle) or tha[ he/she is exempt iereirom antl the basis tor the alle9etl exemptlon. Any violation of Section JC91.5 by any ap0�itant fo� a Oe�mit Subjects the appliGant to a civil �p nalty of not mo�e than five huntl�etl tlolla�s (§500). I, as owner oi Ihe propevty o� my employee5 with waqes as their Sole earp0en5atiOn, will tlo the work, antl [he structure i5 not intentletl or-oft¢retl for sale ($ection ]044, Businesz antl Profe551onal Cotle: The Contractor's Llense Law tloes not apply to an owne� of a proD¢rty who builtls or imprOves thereon, antl who tloes such work himself/M1erSElf o� t�rOugh his or h¢r own empio ees, provitletl tM1at such improvements are not intentletl or offeretl for sale. IY, nowever, tne bulltling or improvement is soltl within one year of com- pletion, the owner will have the burtlen of proving he/she tlitl not builtl or Im- p�ove for ihe Ou�poSe of sale). ❑ I, as owner ot the property, dm exclusively Contracting with Iicensetl Con- tractorsto consiruct tne pro]ect (Section 7044, Business antl Professions Cotle: . The Contractor's License Law doe5 mt apply to an owner ot property who ''� builtls or improves thereon. and who contracts ior such oroiects wrth a r.on- " tractor(s) 1¢ense pursuane m tne Con[ractor'S License Law). 1 am aware that �oof of their Wotker's Compensation Insu�ance Shoultl be providetl to me. I am exemp[ untler 5ection 1 , B. & P. 0. tor this reason Date /D�SI-tf3 1 hereby certify that I information is correct. 1 antl s[ate laws relating � sentatives of ,ihis city Inspection pur 5. Signature Orivers' �icense or 55 # Owner _� have reatl tnis a /9 IYPE OF C�NSTRUCTION I� NEW LJ ADD LJ ALTEHATION LI REPAIR ❑ CONVERSION ❑ DEM6LISH ❑ OTHE[i� [}ES%RIPTIQN OF nORK/SJ$E OF B`DG. �Ve /` S-/ /�� - � TVPEOFPERMIT LJ GRADING FOVNDATION STRVCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 5 OCCUaArvCV CONSTftUCTIONTVPE _ VALUATION$ 3.QZD��' ZONE GRAOINGCV.Y�S. ACRES Remarks: I�O. _ _i _ /I � i � � . . .. � Bar Sink Backflow Preventer eackflow Irrigation Bathtubs Clarifiers Drinking Fountains Floor Drains Floor Sinks GasService Outlets Interceptors Kitchen Sink Lavatories P-Trap Roof Drains ReinSpection Fee � $75 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. �CBO # Heating System & Ducting ❑0.100,000 BTU �100,OOOBT Heinspec[ion Fee � $15 0865-46, rev. 5/88 White - Builtling; Canary - Applicant: Pink - Accountin9; Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Sglar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Issue Fee Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fae S Meirt�6aifU"r E T Front B Rear A C Right S Left Ping. Ref. # Planning Notes: FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures Device Boxes �Utl¢t5 Swii[h¢5 Garbage Disposal � Generator �0.5 KW C Fee — U ,� zo�a �p_,(,(,p Accessory Building: Parking Req./Provided ELECTRICAL � Transtormer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over100amps Suh Panel '�(• � Morors 00.7 HP 01'h � 8 IncSolar 09-15 HP �16-15+ Microwave Pole Light Range Standing Sections 5�75 KW Trash Compactor $15 Issue Fee FEES $ 3 O N I N G R E Q M T S. $ 3 DEVELOPMENTSERVICESREQU�F2E_MENTS: ,O'?�` Zoning Approved By �� Date� FEES Building Approved By Date � Applintion Issued By _ �Date lO� $ 3 BUI�DING PERMIT $ PLAN CHECK � PLUMBING $ � PIAN CHECK 25% $ �� ELECTRICAL $ , PLAN',CHECK 50% $ MECHANICAL $ � PLAN CHECK 25% $ SMIP $ a� PERMIT ISSUANCE $ ENERGV P.C. $ GRADING $ MICROFILM $ � TOTALFEE $ Ji a�otE212-0�7013'214 Tr_�T it�4.45 DAiE: SO/32/88 TII7E� ±1:30 . 1 �y � CONSTRUCTION AND PLANNING ' P� �` SPA � '�APPROVALS Permit#' : Date Inspector qppROVALS Permit# Date Inspector � 1;�•� emporary Electrical Servic'e or Pole � 52. Pool & Equipment Location i � 2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement � �3_ Electrical Conduit Utility-Undrgrnd. ' 54. Forms � '4.' Electrical Conduit-Undrgrnd. �� 55. Electrical Bonding 5.L Steel Reinforcement '� 56. Rough Plumbing & Pressure Test -� � 6; Electrical UFER Grnd. '� 57. APPROVALTO COVER-GUNITE ' ' ' � Footings ,-•� � '� a$ 58. Electrical Conduit-Undrgrnd. - 8� Foundation .,/�. :• � , 59. Gas Pipe, � Undrgrnd., Test � ' � Water Pi�pe-Undrgrnd. � ' 60. Backwash Lines, P-Trap, O Undrgrnd. ' . � � 70. Structural Floor System ' 61. APPROVAL TO DECK i� 11. �Property Sewer Line & House Connection 62. Backwash & Receptor�Final . , 12.iSewer Cap � � 63. Heater &�Vent-Final i 73. Roof Drains � 64. Plumbiog System - Final ' . 74. Rdugh Plumbing 65. Electrical-Final , � 15. Rough Electrical-Conduit - - 66. Solar System-Final 1_6�'�Rough El�ctric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign� 6S. APPROVED FOR PLASTERING 18. Rough�2ectrical-T Bar Cei�ip 69. POOUSPA SYSTEMS FINAL � � �19. Rough Heating & Air Condifioning FIRE DEPT. REQUIREMENT 20. Rough,Factory Fireplace ��,� APPROVALS Permit# 21. Ducts, in Structure !} 70. Underground Hydro 22„ Ducts;-Ventilating �� i 71. Product Piping O Gas ❑ Oil � 23. Gas Pipe-Rough & Test ��(r 72. Underground Flush 24. Roof Fr�ming � 73. Undergrnd. Storage Tank � Gas � pil 25. Roof Sheathing :; 74. Overhead Hydro 26. T-Ba� Ceiling (Structural) &'M9nocoat 75. Dry Chemical ...,, 27. Frame and Flashing 76. Dry Standpipe � 28. Lathing &,Sic�ing � 77. FIXED SYSTEM FINAL 29.'Ins lation �;'� 78. FIRE PREV. FINAL 30. Dryw II Nailing �^' � ' HEALTH DEPT. REQUIREMENT .�.: 31. Plaster Brown Coat�( 79. FINAL INSPECTION i. .:, 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED � -. 33. Final Electric "�� ' Notes: 34. Final Heating & Air Conditioning ,/ ^� �� ' - S/�O / c>I� V 35� Final Gas Pipe-Test � . � 36� Hood or CanOpy � C� 6 .- O l o v7� // 37.`- Final Factory Fireplace 38. Final Plumbing � • 39. Water Service-Final - r ' ; 40. Gas Service-Final ;�i-,� 41. Solar pomestic-Final �{- 42. Backflow Preventer ' � �� . 1'� 1 43. Backflow'Irrigation � � • �� 44. �Landscape Irrigation System �,,;�; t 45. Sound Attenuation� • � � �, i 46. Handicap Regulations , . ' � 47. FINAL�STRUCTURE & BUILDING �� , 48. Special Repuirements Completed 49. Electric Release to Edison � ., 50.`Gas Release to Southern California Gas Co �� , ! 51. CERTIFICA7E OF OCCUPANCY '' � � ';.� . No. Date � ;:1 � i33als lMhlc��'— _ C a��- �ofi�' o � � N I �]M701t7tl � 7�M]OIB�Y � � v „1�h ti i r r. ;^+; 8 � ({n A"� �e��€'�@.�� a` YxK. c',�y: o� cc�rw r,R-��ry ��iar��; D�or. �, e�r �cr�L��l. i��% _ j��.___._ ... THESE PLANS F.�US i 6c ON 1!�S ioT AlL ?!AM1E$ F:1AKE �'.. NO CHRiJGE� \NiiHOU; !`itiOR R?P;?OVA: Ot ✓EPT. , iHE(755UANCE 02 GRANTING OF A PER:N!i QR AAO�tpVAl OF PLANS AND SPECIfICATIONS SHktl NOT BE CONSTRUED TO BE A PERMR FOR, OR AN AGPROVAI OF, ANY VIOtATIOV OF ANY OP TME PROVISIC4^15 OF THIS CODE. NO PERMIT PRESU`dING 10 GIVE AUTMORIiY TO �IOLnTE Ofi CANCEL 1HE P?OV!SIONS OF THIS CO� SHnLL 9:'JACID, f,XCEPT W 50 FAR AS !HE WOFK OR USE WHICH 1( Al,4MORtZES IS ikWFUi. 7HE 1`.SIii:YCe �' = PERir!ii 5RSED 6�r"�iW ,n• cKSt'AND `�?FCIFiC;-�6.^.t � 5Pb�'l ieC•i F:?.YcK! '.• FU!U)I?:G O'rHCIiQ F:ON� 1'ScF.F_..FfE:: F.�iiii�l�' : T;i° ::C4;:,`.P�i;J Of E" �UI;S IN �:.ID Ft.;:� :ti0 c?fCi7:Cp.T��n'r Cfi r;,:•., r.,,:,ve�nr�G (tl:1GIPn'b i_.::�.qi:0Y5 E:Iv�• �wt+IEJ ;1id iHcAELNUcR W4[N I,J v�p! ATl:yt CF i Hij GOUE OR 'vF AP1'; OIHc"4 (hipINANCc OP 1H_ CIT,':. . FOR iNSp�CiB�NS CALL 754-5626 or 754•5627 Permit # � r� THIS NUiNBER MUST ACCOMPANY ALL INSPECTION REQU"t5TS p�T 3 1 5986 N � � '1 77Mi01i7tl � , , , � ��- OF tOSTA MESA PLANNING D6PT, QU81KT 70 BLDG. OfpT, QE'0. � DAT 1Q•E..� 31-g,�' L � OP PLANNINO I�1 C..�, �o [ � ADDITlOWS, l�ELETlONS, OR CO.;.'.�CTID�iS SNALL BE APPROVED B'i TtIE PLa�t;:ii;� �EPAnIN1ENi Cement Coping Ootionel -^ Channel8lock With 13/8� Horizontal Top of a�l Fences For Fences 5' or Less Ven. Bars 3/8"�+at 4' -0" O.C. For Fences Higher Than 5' Vert. Bars 3/8"� at 32" O.C. Fill Celis Soiid With Grout Where Steel Occurs Reinforcing Steel Shall Conform to Sec.A-75-39 A.S.T.M. All Steel to be Lapped 24" or to Code NATURALGRADE TWO 3/8"$ BARS '� CON7INUOUS TOP & BO7TOM " - J�{ORlZSTEEI MUST BE TIED IN PLACE AT TIME OF TRENCH INSPECTION. TYPICAL 6�� CONCRETE BLOCK FENCE n F-� W 10T H o� � � SEE CHL ��1- BELOW DIn FOOTING REQUIREMENTS CHART GENERAL— NOTES MORTAR: pne Part Plastic Cement, and TAret Parts Sand GROUT: One Part Cemenf Tlvee and One Hu{i Ports S�ond COPIN�: One Parf Cement, Three Parts Sand CONCRETE: Well Mixed 1:2-I/2:3-I/2 Mar. of 7- V2 Gollons ot Water Per Sack of Cement GROUT MAY eE POUHED FROM THE TOP OF THE FENCE IN CELLS WHERE STEEL OCCURS. CELLS AND AREASOF HORIZONTAL REIN- FORCEMENT SHALL BE CLEAR, CLEAN & FREE OF AlL MOqTAR DEBRIS, ETC. H OF EARTHTCOTH I/3 iNE HEIGTH OF FENCE FBELOW �60TTOM OF FOOTING SCALE: I/2°= I'. 1 VVNLL r��v�� - .i : Y J 1.. ' , . WIDTH . . . 14" 14': . . . . . . . . . . i._12",_,_. .: : 12��•'' THICKNESS . . . . . . . . . . . .10'�. . . . . . . . . . . . 10" . . . . . : . . . g ". . 8 ,� . , DEPTH OF EARTHTOOTH . . . 24�� . . . . 20�� . . . . . . . . . . . 16��. . . . . . 12�� SPAC�NG OF EARTHTOOTH. . 12' . . . . . . . . . . .14� . . . . . . . . . . . 16�. 16� OWNERS NAME: _ _ _ _ _ City of Costa Mesa California �OB ADDRESS _ _ _ _ _ _ _ _ _ _ � _ _ ` � FERMIT NUMOER;_ _ Building Department SIGNATURE _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ -.. � . . _. ,_. _ . zevr5eo �-tov. 8z � : ;�� .t : r�ia5a �iIS AC�tEIIi�Nf, made ard entered into this o? (oT� day of D GTD R��' , 1988, by and beh+een �-E VE STo TA � o v 1 GW heteinafter referred to as •I.At� Oi+�[t", and �! � 1�C� G� hereinafter teferred to as 'ADJA(i2Jf PliLPEli1Y ad�lER'. It is hereb� agreed that a party wall will be oonstructed m the prcperty li� be�reen .�y0 7 3�6/ Gie2HtJi ym �-?7�. v in the City of Casta Mesa, Caa�ty of Orange, State of California, as per map reG,�:,Ed in bo�yc , Page of Miscellaneous !laps, in the office of the Co�ty Reoorder of �aid Co�nty. Rt�e party w*all shall be permitted to encroadi IN WI�IISS i�F�RE.bF, the parties have entered into this Agreement the day ard year fiLst above written. I14ND (SiNER (Sl HtJd' 5T� �� ToTA ns o v i ci-� Nam�e ( or ?r inte� ) . ,3y�7 �ER�N1Nrn Si � (Adc�ess) OCT 3 1 198Q AOJAC.FIdf PftLP =��'�i�� ( S 1gfldtlS2 ) /�,�U2/ � C�}O N��e ( or Prin ) 3�t// -��'�,C.�,viU,� �- (Wkhess) � - - -----_ -- - - - - - - . y r� � r.• a�a �a �Ls na��xr. maae ara e�terea i�m rhis c� � Ty aay of �GTOF3 �_�_, 19�, by ard 6eb+een _STEVE S�--OTH�U V i GV-i hereinafter referred tn as •L11AtD R+��R', and �(jL� �/(�(�[/J(., � hereinafter referced tro as 'AATACia7i' PACPERTS( ad1II2"• It is hereby agreed that a party wall will be oonstructed on the praperty line beLaeen -,j5`� a 3 ��, ��n in the City of t:osta 1�esa, �o�nty of Aranye, 5"sate oi California, as per map reoocded in Hook , Page of Miscellaneous Maps, in the o�fice of the Cat�ty Rewrder of said Co�ty. TY�e party wall shall be permitted Lo encroad� IN WI�SS �EOF, the parties have entered into this Agree�nt the day arci year ficst aba�e written. or �sw� �E�.�NIUM S�-,� (Ad�ess) • . • �a • •,� • �•. • i a�- �, b ' ' i��r (Slgnat�se) �vc� r). G�u.� ni � S ti�e (Zyped or Printec3) 390� ��rv�-, S7. (Adchess) OCi 3119�� 11�5 +�"��c� , .. . �. . . �, 617V OF COSTA MESq PLAN 3 El ev CR CONS'rRUCTION PERMIT LOT 17 AOP�icant to fill in all spaces excev� lhose within heavy eoraer Iirtes ane �sign all appro0��ate tleelarations. ProjectAddress :44(17 �('�eren�um S+reeY.., Cost�fJn�a ApplicanYsMailingAtldrees 1FfiF W Ma�Arthiir Rl�iri f M Owner's Name - hone,rjQ.��}. Address Sdf116 � � Arch/Eng. License No. �� ' � Address UQ�I��P�r� 6irsle-,—Irvine Contractor's Name' �eQ ��_Phone' , Addresslmailing) � � ; City LicPnse No. ��G LICENSED CONTRACTOR DECLARATION I herebyaffirm that I am I��ensetl untler provislons o( Charter 9(�ommencing with seclion 7000) of Division 3 oT the Business antl Profe55ions Coee, antl my license is In �ull jorce antl effect. ' License Class I se M-248042 Da[e �_� �_�_�—o� Sigqature�� WORKERS' COMGENSP.TION DECIARATION , 1 he�eby atfirm that I have d<¢rtificate of consent to Self-insur¢ Or d C¢rtiflcat¢ of Workers' Compensation Insurance, or a-certifietl copY thereof (Section 3800, Lnb. C.1 ' ' aouty No. WI'-R4-225_R56 comPaoy Fremnnt Tnriamnit� e Certltietl copy is hereby (urnlshetl. • Datee^tlf2 tl co Rs;tiletl wAh th¢ City Builtling DIVISIon. , /li% pplicant R Standard-Pacif'� EXEMP710N FROM WORKERS' COMPENSATION OECLARATION (This section neetl not be completetl it tha permit is for one hunqretl (5300) or Ie55J. , I cerHfyRhat in the perforMance of the work for'which this perm�t Is Issuetl I shall not employ any perspn in any manner so as to become subject [o t�e , Workers'.Compensation LaWs of Galifornia. Date $ignature NOTICE: If, alter making this tlecla�atlOn, you snoultl b¢COme Subl¢Ct to the Workers' Compensation provisions of the� Labor Cotle, you must forthwith comply with' zuCh p�ovisjons o� this permlt shall be tleeTetl revokEtl. CONSTRUCTION LENDING AGENCV � � � I hereby'atflrm that there is a constructlodlentling agency for the performance of [he work-for which this permit is.issuetl (SecHon.3097 Civ. CJ Lentler's Name Lentler's Atltlress ' � OWNER BUILDER DECIqRAT10N - I hereby affirm tha[ I am exempt from the Con4ractor's,License Law for the following reason (Sectlon �031.5 Business antl Protesslonal Cotle: Any tlry or County wttich r¢quires a pe�mit to cOnst�uct, alt2r, improve, tlert�olish�o� repai� -any structure, prior to its issuance, also reqWres [he applicant for such permit �to file a slgnetl statement that he/she is Iicensetl pursuant to thC provislons of ',f.P,�e Contractor'S License Law �Chapter 9(commencing with Section 7000) of � �'��.uislon�3 of the Business antl Professions Cotle) or that he/iM1e is exempt :?jy?brefrom antl the basis for the allegetl exemption. Any vlolation of Section ��i031'.5 by any applican[ for a permit subjects the applicant to a civil eenalty of not more than tiye huntlretl tlollars ($500). � LJ I, as owner of the property or my employeez.with wa9es as their sole tompensation, will tlo the y,�ork, and the structure is not intentletl or offeretl for sale (Section 7044, Business antl. Protesslonal Cotle: The Contractor'S License Ldw tloes not apply to an owner of a proparty who builtls or improves thereon, antl'wno Does suqh work hlmself/hers¢If or through his or h¢r own aTployees, prOvltletl that s��h Improvements a�e not int¢ntletl or offe�etl to� saie. H, nowever, tne bulltling or Improvement IS Soltl wlthin on¢ yea� of com- pletlon, the owner will have the burtlen of proving he/she tlitl not build or im- �love tor Ih¢ purpose of sale). , L..I I, a5 owner o/ the prop¢�ty, am excluSiJBly Contracting wlth Iicensetl con- tractorsto constructthe prpj¢�t (Section 7044, Business antl Protessions Cotle: The Contrattor's License l��y does not apply to an owner of property who builtls or imProves thereon antl who contracts (or suc� projects wlth a con- tracior(s)Iicense pu�suant to the Contractor's License Law). � ❑ I am exempt untler Section B. & P, �, for [his reason Date Owner I hereby ttrtlfy [hat I hay¢ rea ��iltOlma[iOn I5 cOfrCGt. I agree to a�tl state laws relating to builtlir SaP,tatives 0f thi5 clty ty� enter Inspec[lon u��eC` ,�/ T Signature �/ �� 7iV�� Drivers' License or SS � _!,� Y this applicatlon antl state that the above comply wlth all city antl counry ortlinances 9 con5truction, antl hereby autho iie re re- upon the above-mentlonetl r pert for � Dat ______ �� 9' TVPE OF CONSTRUCTION�LJ NEW U ADD LJ ALTERATION _LI REPAIR ❑ CONVERSION ❑ D OLISH C�OTFIER �DESCRIPTION OF WORK\ - � \ TYPE OF PERMIT GRADING FOUNDATION ❑'STRUCTVRAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING• ❑ MEGHANICAL ' . ❑ OTHER _ � PROJECT DESCRIPTION 5ca. FT. oCCUVANCv � CONSTRUCTIONTVPE VALUATION$ �44yrj3O 20NE GRA�INGCU.VOS. - ACRES Remarks: /� �:3/D- Bar Sink Backflow Preventer � eackflow Irr:gation � Drinking Fountains Floor Drains' � Floor Sinks GasService � Outlets Interceptors Kitchen Sink _ - ��21l15 1BING FEI Showers Service Sink SewefCap 'S-, ' � "� � ce,.,e.'c..,...o.rc.,� . . �. Solar Collectors Solar Piping Solar Tank � Swimming Pool w/Spa Urinal Water Closet . Water Heater Water Service � i' Reinspection Fee ,$25 IssueFee $ 3 Boiler Duct- Under Ground Duc[ - StrucNral Duct - Ventilating Exhaust System ❑ Multiple �, Firepl/Fact BIt ICBO # Heating System & Ducting ❑0-100,000 BTU O 100,000 BTl Reinspection Fee � $25 CMF 0865-46 tev. 7/83 White - Builtling; Candry - Applicant; Pink - Accounting; Goltlenrotl - As5e55or Hood or Typel ❑ Canopy TypelP ❑ Fefrigeration System ❑o-ioo,oaoeru ❑ioo,000 System Fepair/AI[eration laue Fee � $ 3 5�52 9I01/84 A.P. #-. � � 7/ �� ' � Zone � �' S Main Building: � Accessory Building: , E � . T Fronh - B Rea � A C Rigtit 1 -� ' K I nfr ' 1 / � - . ,- Ping. Ref, # �-� Parking Req./Provided UseofBuilding: n Planning Notes: Automatic W Construction Cooking�Unit Dishwasher Dryers ❑Ga Fan F.A.U. Fixtures Device Bozes �-L�/1�1 Park.Fees $ . ELECTRICAL . `•,;_��, Transformer ❑ 15-50 KW , �^ 50i�KW�,=. " � Meter �up to 100 amps � Meter ❑over 100 amps � lectric � SubPanel "��r � ' Motors DO-1 HP �1 %- 8 � InaSolar�09-15 HP 016-15+ � Microwave � ' ' �Pole'Light Range Garbage Disposal Standing Sections Generator 065 KW 05-15 KW • • Tresh Compactor �!i .c`• T 2 O N I N G R E � _ Q U . 1 R E , M E N T S FEES , I Reinspection Fee I$25I Issue Fee� . � I $ 3 � PUBLIC SERVICES REQUIREMENTS� ZoningAPProvedBY '2Y=-�� Date�'�I�' Applica,tion Approved By Date��,�/�� Appiicatian Issued By �� 1 DateGl!_�.0�— �' � SUMMARV OF FEES ' �BUILDINGPERMIT $ FaF Ffl SMIP � $ �� PLAN CHECK $ R�— PERMIT PLUMBING $ �SSUANCE $ PIAN CHECK $ ENERGV P.C. $ _ ELECTRICAL $ GRADING $ ' P�AN CHECK $ MICROFILM $ MECHANICAL $ TOTAL FEE $' F+da iti PLAN CHECK $ , ,.. ' 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 & Hause Connection 12. Sewer Cap 13. Roof Drains 14. Rough Plumbing . 15. Rough Electrical-Conduit � 1,6. Rough Electric Wiring . 17. Rough Wiring Sign ' iS. Rough Electrical-T Bar Ceiling 79. 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 Flashing 'y(e , 2S. 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� 3S. 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 R�elease to Edison ' 50. Gas Release to Southern California Gas Co 51. CERT.IFICATE OF OCCUPANCY No. Date Date � Inspector G�' PO� :SPA APPROVALS 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, � Undrgrnd., Test 60. Backwash Lines, P-Trap, � 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/SPASYSTEMS�FINAL FIRE DEPT. REQUIREMENT APPROVAIS Permit # 70. Underground Hydro 71. ProductPiping�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: ?�/9'�r/ Y:.o-�� N . \ -�- Date Inspector 0 j�,i��i � �e2 AOD��antmfillinalls er�Y OF COS7A �peSa,� CON� RUCT�MI� Project Address 3`� Applicant's Ma� �n Addre s Owner's N/a r� an� 4/G � Addres��i.� /-12QG � �� Arch/Eng. License No. Address Contractor's Nam Pho �iy� Addresslmailing) ��02 1 �L+�• s� City License No. � �) LICENSED CONTRNCTOR DECLHFATION � � � I hereby alfirm that I am licensetl untler provisions of Charter 9(commencin9 with section ]000) 01 Dlvision 3 of the Business antl Protezsions Cotle, antl my license is in full rc n eftect. Licens Iazs �i�o n, iirnn.c¢ o. � �I/f �ate � 519 t WORKERS' COMPENSHTION DECLARATION I hereby affirm Ihat I have a certiflcate ot consent to self-insure or a certificate of Workers' CompanSatiOn Insurdnco, or a certifietl c py t�ereof (SeCtion 3800, Lab. C�j / � t� J Policy No.��lJ �- J / � Company �rtitietl copy is hmeby furnlsnetl. Cer[ifi i5,fi��e� wl[h the city$y il mg DI i Date___��yy APPlicanl/(�i/��l�s� E%EMPTION FROM WORKERS' GOMPENSATION DECLARNTION (This seclion neetl nat bo completetl It the permit is for one huntlretl (5100) or , less). I certify Ihat in the Oe�fo�mance of thC work fot whlch this permit is'issuetl, I shall not emPloy any Oerson in any manner so as to become subject to.the - Workers' Compensatiom Laws of CalNornia. Da[e Si9nature NOTICE: If, atter making tnis declaration, you snoultl become subject to tne Wo�ke�s' COmp<n5alion P�ovi5ion5 Of Ihe Labo� Cotle, you must forthwi[h comply with sucb p�ovi5ion5 or Ihis Oe�mit Shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV ' � 1 hereby a/flrm that [here is a constructlon lentling agency for the performance of the work far whi<h tnis permit is issuetl (Section 3097 Civ. CJ Lentler's Name � Lentler's Adtlrezs ' OWNER BUILDER OECIARATION � I hereby affirm that I am ezempt lrom fhe ConVac[or's l_icense L.aw for the tollowing reason (Section 7031.5 Bu5ine55 antl Professional Cotle: Any city or county whlcn requires a oermit to construct, alter, improve, tlemoiisn or repair any SVucture, p�Ior to Il5 i55Uance, also requires lhe apPlicant fo� such pe�mit to fiie a si9netl statement tnat ne/she is licensetl pursuant to tne provisions o( '� -.the Contractor•5 License Law (Chapter,9 (commencing witn Section 7000) oh '��-„]iviSiOn 3 of lhe Bu5ine55 antl Professions Cotl¢) ot thal be/she is exempt � ',:=he�etrom antl th! Dazis 10� the allCgetl exemption. Any violation of $ection ' '�7031.5 by any applicant for a permit subjec[s �the applicant to a civil �enalty of not more tnan tive huntlretl tlollars (E500). 1, as owner of lhe property or my employe¢s with wage5 as thei� sole compenSatiOn, will Eo lhe work, antl the struc[u�e is not inlentletl o� offeretl for sale (Section 7044, BuSiness antl Professional Cotle: Tne Con[rac[or's License Law Uoes nol apply lo dn ownet Ot a p�ope�ty who builtls or improves thereon, ana who tloes such work nimself/herself or through his or her own employees, provitletl tnat sucn imorovements are not intenaea or offeretl tor � sa1e, Ii, however, the builtling cr improvement is soltl within one year ot com- , O�etion,.the owner will have the burtlen Of Proving he/she tlitl mt builtl or im- �rove �or the purpose ot sale). I, a5 owne� ot tbe properry, am exclusively conttaciing wlt0 Ifcensetl Con- tractors to construct the projec[ (Seccion �044, Business antl Protessions Gotle: T�e ConVactor's License Law doCS not apply [o an own¢r ot property who builtls or improves thereon, ana.who contracts for such projects with a con- t�actor(sl license pursuan[�to thC Contractoi's LicenSe Law). I am aware that proof o( Iheir Worker'S Compensation insuranCe shoultl be provitletl to me.' ❑ I am exempl untler Section � 8. & P. Q for this reason Date Owner I hereby certify thal I have reatl info�mation is correcL I agrGe [o � antl state laws el in9 to buildin� sentatives ot i It to enter in5pectlan pu� Signature Drivers' License or 55 � _�( CMFO865-46,rev.4/04 White-I above all ^_ antl si9n all avoroDriate tleclaratians. �0� UNIT NO. TVPE OF CONSTRUCTION NEW IJ ADD LJ HLTERATION LJ REPAIR ❑ CONVERSION ❑ DEM LISH ❑ OTHER q,p, # DESCRIPTION OF WORK/USE OF BLDG. . S Main Buildi E TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL � PLUMBING ❑ MECHANICAL A Rear O OTHER C Ri9ht PROJEC7 DESCRIPTION 5�. FT. oCCUPANCv K CONSTRUCTION TVPE VALUATION $ g Left ZONE ` GRADING CV. VpS. ACRLS Ping. Ref. # Remarks: I � Planning Notes: Sink Preventer Irrigation tubs Drinking Fountains Floor Drains Floor Sinks Gas $ervice Outlets � � Intercep[ors Kitchen Sink Lavatories � P—Trap Roof Drains Reinspectian Fee � $15 Boiler Duct - Under Graund Duct - Strucwral Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑0.100,000 BTU �100,000 ��-_ I_ I Reinspec[ionFee I $15 Itlin9: Canary -Applicant; Pink -Accountin9: Goltlenrotl -Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors 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 Sys[em ❑6100,OOOBTU ❑100,000 System Repair/Alteration laue Fee FEES $ 3 $ 3 Automatic Washer Construction Pole; Cooking Unit 'i% Dishwasher ' Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generewr �0.5 KW Zone Accessory Parking Req./Provided ELECTRICAL . Transformer ❑ 15�50 KW ; ❑ 50+KW � Meter ❑up to 100 amps ' Meter ❑over 100 amps Sub Panel Motors�0-1 HP�ih-8 Inc.Solar 09�15 HP 016-15+ Microwave , Pole Light Range I I Standing Sections 5�15 KW I�Trash Compacmr FEES Z O N 1 N G R E Q M T $. I Reinspectian Fee I$15 I I luue Fee ' I $ 3 I DEVELOPMEN7 SERVICES REQUIREMENTS: Zonin9 Approvad By Date Building Approved By pp�� Date� Applintion Isued Bv 71"`^� Date —1 / vC� SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ �/� /�G� SU � PLAN CH 5% S �� y I�E,.ry�E P� � ELECTRICAL $ f `�_�%�� ` "^A� $ � PLANCHECK 50% $ MICROFI�M $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ �� CONSTRUCTION AND PLANNING PO(. . SPA APPROVALS Permit # � Date Inspector qppROVALS Permit # Date . Inspector i . 1. Temporary Electrical $erviceor Pol^ � 52. PooP& Equipment Location 2. Soil Pipe-Undrgrnd. � � 53. Steel Reinfarcement • - 3. Electrical Conduit Utility�Undrgrnd. j 54. Forms ' 4. Electrical_ConduirUndrgrnd. •�.� ��. 55. Electrical Bonding � 5. Steel Reinforcement � � � 56. Rough Plumbing & Pressure Test , 6. Electrical UFER Grntl. 57. APPROVAL TO COVER-GUNITE i 7. Footings� ' ' � ' � ' 58. Electrical Conduit-Undrgrnd. " . � 8. 'Foundation � n. j, 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. � � 60. Backwash Lines, P-Trep, O Undrgrnd. � 10. Structural Floor System � 61. APPROVAL TO DECK . 11. Property Sewer Li,rne'& 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 Wiriny 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 �nditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# , 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil 23. Gas Pipe-Rough & Test i' r 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 Metsr-Final i 80�. FOOD CERTIFICATE ISSUED ,.� 33. Final Electric Notes: -� 34. Final Heating & Air Conditioning . 35. Final Gas Pipe-Test r��j�( C,FfJ 36. Hood or Canopy . 37. Final Factory Fireplace � 38. Final Plumbing r��r�/�<( (��iQ 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 Etlison ' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF QCCUPANCY No. Date �(� / . Appllcant lo flll In all spaces axcept t�ose wit�tn �eavY �orEer Ilnas antl sign all appropriate Eeclaratians. �./ �� CITY OF COSTA MESA ' � 'CONSTRUCTION PERMIT Prqect.Addres5 -'�4�% Applicant's Mai`l�'� }g—Ad�d�r s ; � Owner's Name �.�"� ho Addreu � �� Arch/Eng. - License No. Addreu C Contractor's Nam one AddreSs (m 'i' � � � I � � �-� �/�.� }� Ciry LiceMw Ne .� � - - LICENSED CONTRACTOR DECLA0.ATION I nereGy af/1rm t�at 1 am IlcanSaC untler provislons of Chartar 9(commencing wlth secfion 7000) o( Divislon 3 ot tne Business antl Profesilons CoCe, antl my Iicense Is In fu for e ntl eifect, LJcenu Class � Licensa Data Slgnahre ' WORKERS' COMPENSATION D CLARATION � 1 hareby affirm that I have a certificate of consent to sal}•Insure or a certiflcale ot Workers' Compenution Insurance, or a certifletl copy the eof (Sectlon. aeao, ue. ��51Uq470c,mca�v PoliCy No. �Certi(letl coOY �s hereby furnishetl. ertlfie Co Iletl wilh the tlty 9yiltling-0 T o . - bate_ =�y�_ APPllcant !�-�^� - EXEMPTI N RO WORKERS'COMPENSATIONDECLARATION (Tnis section naetl not be completetl if Iha permit is for one huntlretl ($300) or less). �' I certlfy that In the pertormance of the work for whlch thls OermR ii is5uatl A shall not employ any person In any manner so az to become sub7ec[ to t�e� Workers' Compensatlon Laws o} Californla. Data Si9nature NOTtCE: If,�after makln9 thiz tleclaratlon, you 5houltl become 5uE7ect to tne Workers' Compenutlon provislons o( the Labor Cotle, you must forthwlth tomply wlth' such provisions or this permi[ 5hall be tleametl revokatl. CONSTRUCTION LENOING AGENCV I hereby atflrm that there Is a con5truttlon Ientling a9ency for the performance of the work for whith thls permlt Is Issuetl (Sectlon 309� Clv. C.) Lentler'S Name . L.entler'S �Atltlress OWNER BUILDER DECLARATION - I hereby atfirm t�at 1 am exempt from the Contractor's License Law for the U 1, as owner oT thi compensation wlll tla tor sale (Sac�lon 704 Lltense Law tloes not . thereon, antl who tloe employ e¢s� provldetl ❑ sale. If, however, the 1 pletlon, tha owner wll �rove for the purpose i I, as �owner of tha tractorstb constructtt The Contractor's Llce bulltls or Improvas th� tlactol(s) Ilcenie pUlSu ❑ I.am axempt untlar Date that erty or my employae5 wlth wage5 d5 IhBlr sale ork, antl the structure Is not Intentletl or ottaretl ;Ine55 antl Professlonal Cotle: The Contractor'i :o an owner of a proparty who bulltls or improves • work hlmseN/herselt or tnrough his ar her own ;h Improvemants aro not Intantlatl or o}}eratl for g or Improvement 15 soltl wlthln one year of com- [ne burtlen Ot proving he/She tlitl not bulltl ar Im- ty, am excluslvely tontratting with Ilcensetl con- � 3c[ (Sactlon 7044, Bu5lness antl Professions Cotle: w tloes not appry to an owner oi O�operty who and who contracts for such projec[s with a con- the Coneractor's Llcense Law). n B. S P. C. for thls reason Ownar ng conz I_ upon above TVPE OF CONSTRUCTION ❑ CONVERSION ❑ DE DESCRIPTION OF WORK TVPE OF PERMIT tJ GRaoiN ❑ TENANT ❑ ELECTRICAL ❑ OTHER PRQIECT DESCRIPTION Sq. FT._ C O N ST RUCTI ON TV PE_ ZONE GR Remarka: � /. Sink Irrigation Drinking Foun[eins Floor Drains Floor Sinks - Gas Service OuUets Interceptors � Kitchen Sink ' Levatories , P-Trap Roof Drains Reinspection Fee � $25 Duct - Under Ground Duct - Structurel Duct - Ventileting Exheust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO q'k Heating System & Ducting ❑6100,000 BTU 0100,000BTi '�y11°`�" - "'"��- peinspection Fae $25 Drlvers' Llcanze or:55 � ' CMP 0865-4fi rav. 12/83 Whlte - Bulltlln9� Canary - Appllcant; Pink - Accounting: Goltlenrotl - Asse55or P J ADD LJ ALTERATION' Ll REPAIR OTHER FOUNDATION LJ STRUCTURAL LVMBING ❑ MECHANICAL OCCUPANCV _ VALUATION S _ CV.VDS. ACRES_ Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 . Solar Tank Swimming Puol w/Spa Urinal ' Water Closet � Water Heater Water Service Isue Fee Hood or Type I ❑ Canopy Type I I ❑ Refrigeretion Sys[em ❑6100,000 BTU. 0100,000 BTU System Repair/Alteration � A Issue Fee FEES A.P. # S Main Buildi E T Front B Rear ' A C Right K S Left Ping. Ref. dk Parkin9 Fieq./Pn Use of Building: Planning Notes: Automatic Washer Constructi0n Pole Sub. Cooking Unit Dishwasher 5762 3/09/84 Zone Accessory ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Fan F.A.U. F i xtures Device eoxes Outlets Switches . Garbage Disposal Generator �0�5 KW �5-15 KW Meter ❑up Lo 100 amp5 Meter ❑over100amps Suh Panel MotorsOP7 HP��iX-8 Inc.Solar �9-15 HP �16-15+ Microwave Pole Light Range �Standing Sections Trash Compactor 40. �.. i Z O N � N G R E � U � R E E N T $ 3 Reinspection Fee $25 luue Fee ' $ 3 fEES PUBLICSERVICESREQUIREMENTS: , . - Zoning Approved By Date Building Approved By Date ' Applintion Issued By Dat� SUMMAqV OF FEES . BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PIUMBING $ �.3 — _ ISSUANCE $ PLAN CHECK 25% $ �ST� ENERGV P.C. '$ � ELECTRICAL $ GRADING $ : ' PLANCHECK 50% $ ' N1ICROFILM $ MECHANICAL $ TOTALFEE $ � •SO $ 3 PLAN CHECK 25% $ . ' " - - POQ . SPA �,' CONSTRUCTION AND PLANNING ' � . � � . � � �- �� - . --APPROVALS Permit # Date Inspector p�ppROVALS Permit #� - � Date'' Inspector '_ � : . _ � 1. Temporary'Electricgl Service or Pole � 52. Pool & Equipment Location, ' � �� . 2. �cil Pipe-Undrgrnd. .�L�/j�. ` 53: Steel Reinforcement � � ., ' � 3 � Electrical Conduit Utility-Undrgrnd. • 54.. Forms � � - - , �. ,�4. Electrical Conduit-Undrgrnd. � 55: Electrical Bonding � " � 5..Steel Reinforcement i� � � ' 56. Rough Plumbing & Pressure Test ' ' 6. Electrical UFER Grnd: � •' 57.'APPROVAL TO COVER-GUNITE � � i': � 7. Footings � . 58. ElectricalConduit-Undrgrnd. , ` � r��_ . 8. Foundation '" � ' 59. Gas Pipe, O Undrgrnd., Test' � - � � �_ 9'. Water Pi�pe-Undrgrnd. �7� �(�� 60. Backwash Lines, P-Trap,�0 Undrgrnd. � .. ��'I 10. Structural Floor System � � 61. APPROVAL TO DECK � . 11. Property�Sewer Line &' House Connection 6�b��,y�� G� 62. Backwash & Receptor-Final " � „ 12. Sewer Cap . � 63. Heater & Vent-Final ., 13. Roof Drains � 64. Plumbing System - Final , ,. 14. Rough Plumbing '- .. 7�tr �y L� 65. Electrical-Final - � - � 15. Rough Electrical-Conduit 66. Solar System-Final � ' `- - � - i6: 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. RoughFactoryFireplace APPROVALS �Permit# 21. Ducts, in Structure , � 70. Underground Hydro � � ' ' / "22. Ducts,Ventilating . 71. ProductPipingOGas ❑Oil . . i " 23. Gas Pipe-Rough & Test � � - - � 72.' Underground Flush � � � 24. RoofFraming � 73. Undergrnd.StorageTankOGas-�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 • � S0.' FOOD CERTIFICATE ISSUED �' 33. Final Electric ' � Notes: � , � 34. Final Heating & Air Conditioning - ' 35. Final Gas Pipe-Test � � �� (�i) . , . 36. Hood or Canopy - � , . � � ' - , 37. Final Factory Fireplace � r � 38. Pinal Plumbing , p ��j (�fj � �. 39. Water Service-Final ' � _ - 40. Gas Service-Final - ' ' . T - ' ' 41. Solar pomestioFinal � - , - �- - • � - � 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 Southem California Gas Co , , - , � 51. CERTIFICATE OF OCCUPANCY - ' ' • No. � Date - , ' ' ' - - ' . ' - ' , CIT`Y OF COSTA MESA / � � . CONStRUCTION PERMIT �/�'/) Project Address Applicant's Mailing Address Owner's Name //�, P one Address �� e fT//� U^ � Arch/Eng. -S fi� I_ir_, ca Nn, � Address� ' - ' Contrector'sName ��f f% �C p�/�/y��/� ��/��//� Address (m "�� ! � �"� � ` City Licen N J U� LICENSED CONTRACTOR DECLARATION I hereby aftirm that 1� am licensetl untler provisions of Gharter 9(commencing with section 7000) of Division 3 of the Business antl Professions otle antl my license is in tullLf�'ce �detfect. � �� (1�� Licens Cla �� icen No. 4 Date - Signature WORKERS'COMPENSATION DECIARATION 1 hereby aitirm that I have a certificate of consent to self-insure or a certificate' of Workers' Compensation Insurance, or a certifietl copy thereof (Section 3800, Lab. G��//�� . � T �� Poli6y No. � Company � ertifietl copy is hereby fumishetl. /� Certi{ietl cq,py is if�il¢�with the city Bu�fding i�� / Date lA /7 /l� APPlicant—y ��— '�� qr-� EXEMPTION FROM WORKERS"COMPENSATION �ECLARATION (This section neetl not be completetl if the permit is for one huntlretl ($100) ar tess). I certify that in the performance of the work tor which this perm�t is issuetl, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Lzws of California., � � Date Si9nature NOTICE: If, after making this tleclaration, You shoultl become subject to the Workers' Compensation provisions of 4he Labor-Cotle, you must fortbwith comply with such provisions or this permit shall be tleemetl revoked. CONSTRUCTION IENDING AGENCV ` � �. ' I hereby affirm that the�e is a construction lentling agency to� the performance ot the work tor which this permit is issuetl (Section 309] Civ. C.) Lentler's NamP Lentler's Atltlress ' � � OWNER BUILDER DECLARATION ' � I hereby attirm that I am ¢zempt from the Contractor'S License Law tor the foilowing reason (Section 7031.5 Business antl Professional Code: Any city or counry whicM1 requires a permit to wnstruct, alter, imp�ove, tlemolish o� �epair any structu�e, prior to it5 is5�ance, also requires the applicant tor Such pe�mit � �o tile a siqnetl statement that he/she is licensetl pursuant to the provisions oi he Contractor's License Law (Chapter 9(commencing with Sectiom7000) ot Jivision 3 of the Business antl Professions Cotle) or that ne/she� is exempt therefrom antl the basis for the allegetl exemption. Any violation of Section ' ]03L5 by any applicant fo� a permif subjects the applicant to a' civil ; .Qenalty of not more than five huntlretl tlollars ($500). � � LJ I, as� owner of tne property or my employees with' wa9es as their sole ; compensation, will tlo the work, antl the structure is not intenGetl o� offeretl Por sale (Section 7044, Business antl- Protessional Cotle: The Contractor's License Law tloes not appty to an owner of a property who builtls or improves , tM1ereon, antl who tloes such work himselt/M1erseN-or tM1rough his or M1er own empioyees, provitled that such�improvements are not intendetl or offeretl for sale. It, however, the builtling or improvement is soltl within one year of com- pletion, the owner will have the burtlen of proving he/she tlitl not builtl o� im- , �rove tor the purpose ot sale). I, as owner ot the property, am ezclusivety mntracting with licensetl con- tractors to mnstruct the project (Section �044, Business antl Professions Cotle: ' The Contractor'S License Law tloes not apply to an owner of property who builtls or improves thereon, antl who contracts tor such projects wlth a con- tractor(s)license pursuantto the Contractor's License Law). ' ❑ I' am exempt untler Section B. & P. C. for this reason Applicant to fill in a11 spaces exeeot those within heavY bortler lines ana sign all appropriate tleclarations. PERMIT NO. TRACT NO. LOT Np._ BLDG. . Date Owner � I hereby certify that I have reatl this application antl state that the above intormation is correct. I agree to comply with ali clty antl county ortlinances antl.state laws relating t b iding construction'antl hereby author¢e repre))) sentatives of this city 0 n on e aY ve-mention Pr�erty� fyr inspection purposes. / / e'j � Signature � Da e Drivers' License or55 � �' C 1385 � I I /% I TYPEOFCONSTRUCTION NEW ADD ALTERATION .REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK . TVPEOFPERMIT LJGRADING LJFOUNDATION LJSTRVCTVRAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER � PROJECT DESCRIPTION 5Q. Fr. 'ocCUPANCv_ � CONSTRUCTIONTVPE � VALUATION$ ZONE � GRApINGCU.V05. ACRES— Remarks: _ ' � � I � � . Bar Sink � Backflow Preventer Backflow Irrigation Bathtubs �rinking Fountains �loor Drains Flaor Sinks ' Gas Service 'Outlets Interceptors Kitchen Sink • - Lavatories P-Trap Roof Drains _ _ Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar.Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service FEES A.P. # S Main Building: E T Front ARear C Ri9ht K Left S Pln9. Ref. # Parking Req./Provided Use of Building: Planning Notes: - � "�=' � Automatic Washer � ConstructionPoleSub. Cooking Unit D ishwasher Dryers ❑Gas ❑Electric Reinspection Fee � $25 I I� laue Fee - I $ 3 Boiler Duct - Under Ground Duct - Structural Duct- Ventilating Ezhaust System ❑ Multiple �' FirepVFact. Blt. ICBO # Heating System & Ducting � ❑0-100,000 BTU 0100,000BT1 Reinspection Fee � $25' CMF 0865-46 rev. ]/83 - White - Builtlin9: �anary - Applicant; Pink - Accounting; Goltlenrotl - Assessor Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑0-t00,0006TU ❑100,000 System Repair/Alteration luue Fee $ 3 Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 3015 6/27/8l Zone 8uildinq: Park. Fees $ ELECTRICAL - Transformer ❑ 15-50 KW ❑ 50+ KW Meter �up to 700 amps / Meter �a4er 100 amps Sub Panel , � Motors�0-7 HP&1'/:-8 Inc.Solar��9-15 HP �16-15+ �� Microwave Pole Light Ran9e � Standing Sections 5-15 KW � Trash Compactor I Reinspeaion fee �$25 � Issue Fee PUBLIC SERVICES REQUIREMENTS: Zoning Approved By Application Approved By � Aooliption Issued Bv N1.1,� BUILDING PERMIT PLAN CHECK PLUMBING ' PLAN CHECK � ELECTRICAL PLAN CHECK MECHANICAL PLAN CHECK 83oB5 TL Z O N I N G R E Q U I H E M E N T $ 3 SUMMARV OF FEES ' � $ SMIP $ $ PERMIT $ ISSUANCE $ , $ �--/--�y� ENERGV P.C. � $ g .7(o i 7V GRADING $ $ � MICROFILM $ � $ , TOTALFEE $ J + 3 $ • CONSTRUCTION AND PLANNING ' PC.-� & SPA APPROVALS Permit# Date Inspector p�ppROVALS 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-Undrgmd: ' � - � 55. Electrical Bonding 5. Steel Reinforcement � - 56. RougFi Plumbing & Pressure Test � 6. Electrical UFER Grnd. ,� 57. APPROVAL TO COVER-GUNITE '. 7. F,00tings ' � � 58. Electricai ConduibUndrgrnd. � - � � 8. Foundation � 59. Gas Pipe, O�Undrgrnd., Test 9. Water Pipe�Undrgrnd. � 60. Backwash Lines, P-Trap, � Undrgrnd. 70..Structur,al 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 � 30 �D 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 Condi[ioning � FIRE DEPT. REQUIREMENT - 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheathing , . 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. DrY Chemical 2�. Frame and Plashing � 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. Electriral Power Meter-Final, / 80. FOOD CERTIFICATE ISSUED 33. Final Electric � y 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. • - •-' r" No. Date � • j� J � ADolicanLto fili in all spaces except those within neavy eortler lines antl zign ali aDoropriate aeclantlons. CITY OF COSTA MES 'U S I U I ON YtFi Project Address � u'rn Applicant's Mailing ress ' � Owner'sName tTPh � Address — Arch/Eng. License No. Address Convactor's Nam �bne — Address (mailingl City License No. � LICENSED CONTRACTOR DECLARATION I hereby affirm thal I am Ilcensetl untler provisloqs of Charter 9(comm¢nclnq with 5ection 7000) of Dlvislon 3 ot the usiness antl Protessions Co aptl my license' in lul O�tl effect. �� i �JCCl15C�C1 I� OSC O Oa[e Signalure _ WORKERS' COM ENSATION DECLARATION 1 nereby alfirm that 1 have a certificate of consent to sei/ insure or a certillca[e ot Workers' Compensallon Insurance, or a cer(�(jetl opy Ihereo (SeCtion 3&00, LaD.�],yl/�C��/� ComPanY � �-�' "" . Policy NO. ��L 0%b �l / � Cerlifie C y I5 er¢by fumishetl. / �/�, Ce '" tl �5p�� 5'letl wrth the city / I _/. Date � " ApO�icant ek�� L.�%h�.� EXEMPT ON FRO WORKERS' COMGENSHTIO DECLARATION (Tnis section neetl not De completetl it the permil Is fot One huntl�etl (E300) or less). I cErtlty that In t�e pertOrmance ot the work tOr which Ihis pe�m�t Is ISsuetl, I shall not employ any person in any manner so as to becoma subjett to the Workers' Compensatlon l.aws of Calitornia. Date $i9natur¢ NOTICE: Ii, atter making [his �eclaration, you shoultl become subjec[ to the Workers' Com0en32tiOn provisions ot Ihe Labor Cotle, you musl forthwith comply with such p�ovl5ion5 or [Itis petmit shall be tleemetl �evoketl. CONSTRUCTION IEND NG AGENCV- 1 hereby at(irm that t� i5 a construction lentling agency fOr [h¢ Pe�lo�mance ot tne work for w' IAMh�permi[ is issu9tl (Section 3097 Civ. C.) Lentl¢r's Name V/ L Lentler's Htltlre55 OWNER BUILDER DECLARATION� � 1 hereby af�i�m that I am exempt trOm Me Contracto�'S llcense Law tor the following reason (Sectlon 7031.5 Business antl Professional CoOe: Any ciry or munty wM1iGh reqWres a permit to construct, altB�, improve, Gemolish ot repair any'structure, prlor to its issuance, also requi�es the applicant for such permit to file a signeC sWtement that he/she Is IicenS¢tl pu�suant to [he O�ovi5ion5 01 the Contractor'S Ucense Law (ChaO�er 9(commencing wi[h Sectlon 7000) of Division 3 ot Ihc Business antl Protessions Cotle) or that he/she is exempt � theretrom antl Ihe ba5i5 br lhe allegetl exem0�ip�, Any violalion 01 SecHon 7031.5 by any applican[ tor a permit subjeCts the applicant to a civil �enalty ot no[ more [han (iv¢ huntlretl tlollars ($500). I, as owne� of the Orop¢rty o� my employ¢e5 with wd9es as lheir sole comp¢nsation, will tlo the wo�k, antl the si�uct4re is not in[entletl o� ofteretl tOr sale (SeGtion 7044, Busine55 antl Professiqpal Cotle: The Con[rat[or's LicenSe Law tloes not apo�Y to an owner ot a property wno Duiltls or Improves Iher¢on, antl wh0 tlaes Sucn work hlmself/hers(If oi through his or ner own employees, provitletl lltat sucb Improvements a�0 not intentletl or otte�etl for sale. II, hOweve�, the bulltling o� improvement iA soltl within one year 01 com- pletion, tne owner will have the burtlen ot provin9 he/she aIC not bulltl or im- �rOve for the pu�pose of Sale). I, a5 ownCr ol the prope�ly, am exclusively Cont�acting with lic¢nsetl con- traclorsto wnsfruct the project (Section 7044, guzine5s antl Pwfessions Cotlu: The Contractor's �icense Law does not apply to an owner of Property who builtls or imowves thereon, antl who mntracts for such projects wlth a con- trac(or(sl license pursuant�ro the Con[ractor'S �icense �aw). I am aware [ha[ prooi o� their Worker's Compensation insuranCe shoultl be provltle0 [o me. ❑ I am exempi un0er 5ettlon B. & P. G. �or this reason Date Owner I hereby certily hat I have reatl Ihis application antl state thal lhe above Information is c ect. I agree to ly with all city antl county or Inances antl ztaf¢ laws r lating to builtl� 9 con uction� antl h¢reby authori e re r0- sentatives ot t is ciry to ente on the bove-mentionetl n�ly jor inspectlon pur � � Signature �ate Drivers' License or 55 � ..r. � �� ,.,,,.�. 3 TVPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q.p, # DESCRIPTION OF WORK/USE OF BLDG. . S Main Building: TVPE OF PERMIT GRADING FOUNDATION STRVCTURAL T FfOnt ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING MECHANICAI. A Reer ❑ OTHER PROJECT DESCRIPTION Sc7. FT. ocCUvarvCV C Right K Left CONSTRUGTIONTVPE VALVATION$ $ 20NE GRADING CV. VDS. ACRE$ ping. Ref. # Remarks: /� �i� � Planninq Notes: Bar Dishwasher Drinking Fountains Floor Dreins -' Floor Sinks Gas Service Outlets Intercepiors Kitchen Sink - Roof Drains Reinspection Fee � $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. IC80 # Heating System & Ducting . 00.100,000 BTU �7dG,000 BT Reinspection Fee � $15 CMF 0865-46, rev. 4/84 White - Builtlin9: Canary - qppi{cant: Pink - Atcounting; Goltlenrotl - Asse55or Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Hearer Warer Service � Issue Fee Hood or Typel ❑ Canopy Type II ❑ Refrigeration System ❑o-ioo,000eru ❑ioo,oaoer System Repair/Alteration Issue Fee FE 3604 7/06/9G i„ Zone Acceuory Building: 2 O N I N G R Parking Req./Provided E � M $. ELECTRICAL Automatic Washer Transformer ❑ 75-50 KW Construction Pole Sub. ❑ W+ KW Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generetor �65 KW �5-15 KW Meter ❑up to 100 amps Meter ❑over100amps Sub Panel Motors �0.1 HP O1'/. - 8 Inc. Solar �9-15 HP � i 6-15+ Microwave ' Pole Light Range Sign Standing Sections Trash Compacmr $ 3 Reinspection Fee $15 Issue Fee FEES DEVELOPMENT SERVICES RE�UIREMENTS: � 2oning Approved By Building Approved By Aooliration luued Bv �� S 3 BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK Z5% $ FEES $ 3 SUMMARV OF FEES � SMIP $ PERMIT ISSUANCE $ ENERGV P.C. $ GRADING $ �MICROFILM $ � TOTALFEE $ � CONSTRUCTION AND PLANNING POOI & SPA APPROVALS Permit # Date Inspector p�ppROVALS 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�GUNtTE , �7. Footings� � 58. Electrical Conduit-Undrgrnd. 8. Foundation , • 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgmd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. , 10. Structural Floor System , 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final , 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/SPASYSTEMS FINAL 19. Rough Heating & Air Conditioning �/LG,� ��G�%f FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22.,Ducts, Ventilating 77. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test � 72. Underground Flush . 24. Roof Framing 73. Undergrnd. Storage Tank 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 _�n . 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&BUILOING 48. Special Requirements Completed � � 49. Electric Release to Edison �. 50. Gas Release to Southern Califomia Gas:Co 51. CERTIFICATE OF OCCUPANCY " No. Date Applicanl to fill in all spaces exeept tnose within heavr oortler I(nes ane sign all approorlate tleclaratlons. CITV OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. ,�. �_ �,a TRACT NO. LOT NO. UNIT NO. FrojectAddress 3407 Geranium St. Applicant's Mailing Address Owner'sName Standard Pacifi�prp�anone 546-1161 Address 11.65�_.�dC�iL"t.�]ll.�CII$.t��PSt7_926� Arch/Eng. License No. Address Contracror'sNamr New Plumbing Phone-.�iiR-1140 Addresslmailing) 7�n% N^Fe�Ana Anaheim City Licerise No. 3Z$]� LICENSED CONTRHCTOR DECLARNTIOf�I I hereby altirm tnat I am Iicensed untlar prov ons o C�ar[er 9(commencing with section 7000) Of OlvisiOn 3 ot lne B iness a Pr0lesslons Cotle, an0 my II<ense Is in fun (q�ce�pa eft 426109 License Class �' � LI nse No. Date 1(1/_..�, 7.��(1/RQ 9gnature - WORKERS' COMPENSATION DECLARA ON ' hereby aHirm that I have a cer[ilitate ol wnsent to sell-insure or a certiflcate f Workers' Compensation inm�ance, o� a certifiltl COpY thereol ($ectlon l800, lab. C.) PoIicY N�I.lof _l7�_ Trt_71A� ComPanY k{0(pe � Cert[ilietl� coPY is tile� witbrthehc tY �Itlin9 vlsi n. Da�CSL ��"T AppliGant �eW f�"Yum�i ng E%EMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection ne¢tl nat be completetl it lhe plrmit i5 fOr One �untlreG (E100) o� iezz). I certity lhat in the performance ol Ue work tor which thls perm�t Is Issuetl, I snall not employ any persan In any manner zo az to become subject to [he Workers' Compensation LawS ot CdlifOmia. Da[e Signaturo NOTICE: I/, atter making this tleclaration, you shoultl become subject to the Workers' CompensaUon provi5ion5 oi tne Labo� Cotla, y0u must lorthwltb comO�Y wilh suth prOvlSions or thi5 p¢rmit s�all be Aeometl rovokCtl. � CONSTRUCTION LENDING'AGENCV I nereby afflrm that there Is a construtUon len<ling agnncy for the par(ormance of the wOrk for wtlich this permit is Issuetl (SattlOn 3097 Civ. C.) L.entler's Name Lentler'S A�d�e55 OWNER BUILDER DECLARATIOfJ� � I hereby atflrm [haI I am exempl 1rOm tho Contrdttor4 Lic¢n5o Law lor tho following reason (Section ]031.5 Buslnoss antl Profossional Cotlo: Any cily or county which requires a permit to conSVuct, alt¢q improve, tlemOliih or re0air any structure, prlor to Its Issuance, also reqWres the appllcant lor sucn permit to file a siqnetl statemenl ttlat h0/She I5 IICCnSOtl pufsuant tOlha provlSionS 01 lhe ContraClOr'z Ucense Law (Chapter 9([ommenUng wlth Seclion ]000) oi 'izlon 3 0/ Ine Busine55 antl ProfeS5iOn5 Cotlo) or lhdt h0/She ii exnmpt e/rom antl [ho basis 1or Ihu allegatl exemptlon. Any violation o1 Suctlon .1.5 by any appliGan[ ior a p¢rmit subjetti ttfa apP��ant l0 a dvll Q�enalty ot not more lhan Ilve huntlrca tlollars (5500�. u I, as owner o1 lhe property,or my ¢mPloyeas with wag05 as their sola compensation, will Co tha work, antl tho structura is not Mtentletl or olfnretl 10� sale (Seclion 7049, Busine55 an0 P�ofa55iOnal Cotlo: The ConlraCtOr'S License ldw tloez noc apply to en owner oi a proo�rty wno bulltls or Improves thereon, antl who tloes sucn work nimsell/hcrsolt or throu9h nls or he. own emplOyees, provltleG [hat such improvamentz a�e not IntentlBtl O� ollaretl for Sa10. If, �owevar, Iha builtling m improvoment is soltl wl[hln On0 Yaar 0/ com- platloq [M1c owner will hav¢ lhe bur0an ol prOving he/sha tlltl not builtl or Im- �rove for the purposo o/ salc). I, as owner ot lM1e propor[y, am excluslvory contracBng wlth Ilcensetl con- tracrors to construct the project (Sectlon 7044, Businezs antl Protessions Cotle: The Contraclor'S LicenSe Law doas nOt appry to an owner of propor[y who builtls or improvaz lhereon, antl wno conlracts for such projOcts wlth a con- t�actor(51 license pursuant�t0 the Contrdttor'i License Law�. I am aware Iha[ proo/ o( [heir Worker's Compensation InsuranCe shoultl ba O�ovitletl to ma. ❑ I am exem0� untler $ection B. b P. C. for this rcason Date cer[ify >n is ci Signature �' Drivers' Llcense or 55 � 1 state that the above antl county ortlinances ereby authorize repre- mlionetl oraoertv tor TYPEOFCONSTRUCTION CCXNEW LJADD LJALTERATION LJREPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,dj6 DESCRIPTION OF WORK/USE OF BIDG. S Main Buildi E TVPE OF PERMIT GRAOING FOUNDFTION STRUC7uRA� T Front ❑ TENANT ❑ EIECTRICAL �PLUMBING ❑ MECHANICAL - A Reaf ❑ �OTHER C Rlght PROJECT DESCRIP710N Sc�. Fr. oCGUPANCv K CONSTRUCTION TVPE VALUATION 5 S L¢(L ZONE GRADING CU.YDS. ACRE$ Ping. Ref. # Remarks: � � � C, �L^ r �-�Q�Q� Planning Notes: Sink Irrigation Dishwasher Drinking Fountains Floor Drains Floor $inks Gas Service 6 Interceptors Kitchen Sink Lavarories P-Trap Roof Drains Reinspection Fee Showers Service Sink Sewer Cap Sewer Connection Sofar Collectors SOlar Piping Solar Tank Swimming Pool w/Spa Urinal Outlets Water Clazet Water Heater Water Service $15 Duct- UnAerGround Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑0-100,000 BTU 0100,000 Rainspec[ion Fee � $15 CMF 0865-46, rev. 4/84 White - Builtling; Cana�y - APPIiGdnt; Pink - Atcountin9; Goltlen�otl - A552s5or Issue Fea Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑o-ioo,000eru ❑ioo,000 System Repair/Alteration Isue Fee FEES Automatic Washer Construction Pole Sub. Coaking Unit ' Dishwasher Dryers �Gas ❑Elec' Fan F.A.U. Fixtures Device Boxes � Outlets SWIIChCS Garhage Disposal Generator �0-5 KW � OIJO IO/I2/O4 Zono Accessory Building: Parking Req./Provided ELECTRICAL Trensformer ❑ 15-50 KW ❑50+KW Meter ❑up to 100 amps Meter ❑over 100amps Sub Panel Molors�61 HP�1h-8 Int.So�ar �9�15 HP �16-75+ Microwave Pole Light Range ' Standing Sections 5 KW Trash Compactor o.,i. T� FEES $ 3 I � Reinspection Feo $15 �ssuo Fea 5 3 FEES DEVELOPMENTSERVICESRE�UIREMENTS: . Zoning Approvad By Date Building APP�oved By � (� Date Application luuad By �dd}.) Date �� ( Z $ 3 SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING S �S.�SO ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTFICAL $ GRADING 5 PLAN CHECK 50°h $ MICROFILM $ MECHANICAL $ TOTAL FEE $ 3�SO PLAN CHECK ZS% $ Z O N I N G R E � M T S. � CONSTRUCTION AND PLANNING �� POC SPA APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector 7. Temporary Elecirical 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 Rein(orcemeni. 56. Rougfi 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, O Undrgrnd. , 10. Structural Floor System " 61. APPROVAL TO DECK i t. Property Sewer Line & House Connection 62. Backwash & Receptor•Final 12. Sewer �p 63. Heater & Vent-Final '� 13. Roof qrains 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 & 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 � �p1 �4' (,�Q - 36. Hood or Canopy ' 37. Final Factory Fireplace . 38. Final piumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final � ' 42. Backflow Preventer � 43. Backflow Irrigation . , � 44. Landscape Irrigation System 45. Sountl Attenuation 46. Handicap Regulations . 47. FINAL STRUCTURE & BUILDING 48. Special Requiremen[s Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co . 51. CERTIFICATE OF OCCUPANCY No. Date