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Home My WebLink About3411 GERANIUM ST - Building Permits(7t4) 754-5273 • Fax (714) 754-4856 • �wiw.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: $411 GERANIUM ST Suite No Vicini[y: Parcel Number: 41237302 Applicant: Address: HURLIMAN, PATRICK 3152 E LA PALMA SUITE E ANA, CA Owner: HICKERSON, TODD Address: HICKERSON, TODD S COSTA MESA, CA 3411 GER4NIUM ST Contractor: Address: MECHANICAL PERMIT Phone: 714-666-8477 Zip: 92806 Phone: Zip: 92626 HURLIMAN HEATING AND AIC INC. 3152 E LA PALMA SUITE E Phone: 714-6658477 ANA, CA Zip: 92806 License: 694681 ISSUED BY: Status: Applied: Issued: SCOPE OF PERMIT REMOVE EXIST. FAU AND REPALCE WITH A NEW ONE UP TO 100 K BTU. INSTALL 1 NEW AC UNIT. ISSUE FEE Inst FAU <100 k BTU Inst FAU >700 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Re(rig Sys >700 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers . Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm Air Handlers > t0000cfrn Floor Fumace Floor or Suspend Heater $23.50 $14.80 $0.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 $0:00 $0.00 50.00 $0.00 50.00 $0.00 Quantity t 0 0 0 0 0 0 0 0 0 0 0 0 ', 0 0 0 D 0 0 FEE SUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillation System Evaporative Cooler Commerci al I n cinerator Domestic Incineretor Compressors / Absorption Svstems Up to 3 hp / 100 k BTU 3 To 15 hp / SOO k BTU 75 To 30 hp I�1,000 k BTU 30 To 50 hp / 7,750 k BTU Over 50 hp / Over 1,750 BTU Boilers . ' � Upto3hp . - . . � 3To15hp , � � . � - 15 to 30 hp 30 to 50 hp Over 50 hp Other Mechanical Fee Imestigation Fee , � - Plan Check Fee , , Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS ISSUED OS/02/2007 05/02/2001 Quantity 50.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 50.00 So.Oo 538.30 NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9240, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply vnth all applicable codes, and all requlred Inepeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration oi this permit. FOR INSPECTIONS CALL: (714) 7545626 2d46�d8 (8�00) WORKEflS'COMPENSAnON �ECLARAnON: '� I �ereDy eHirm under penelry of perjury one oi ihe following declaretions: ❑ I heve entl wlll maimain e certiticeta af consent to se&Insure for workers' compensetion, es proWtletl for by section 3700 0l ihe Lebor Cotle, for the peAormance ot the work for whlch IhiS pertnil is issuetl. I heve end will meintain workers' compensation Insurance, as required by sectlon 3700 of Ne Lebor Code, lor Ne perlortnance ol Na work br which ihis pemtlt is issued. My workers' compensatlon Insurance carrier entl policy number ere: Cartior: Policy Number: (TAis secNon need no! be comp/eted ll Ne pemut ls valued et one hundred dd/ers (3100) or /essJ ❑ I certify t�et in t�e ertortnance oi the work compen ' aws o elif �d agr i t e ro i nt Slgneture: INO: FAI O SECURE WORKERS' COMP RE (5100.000), IN qDDRIIXJ TO LICE BED C! RACTOR DECLARATON: I reby a' m Ihat I em II nsetl under prov�'sion oma e eHect. Llc. a 6 tor whiU this partnit L5 issued, I shall not employ eny pereon in eny manner go es ta Decome sub�ect lo Ihe workers' ee Iha II I sh ul become sub�ect to Ne workers' compansetlo provisions o1 Section 3700 0l the Labor Cotle, I shell foMwith � Dat S—Z—�I ATION OYEMGE IS UNLAWFl1L AND SH�LL SU ECT AN EMPL TO CRIAUNAL PENALTIES AND dNl FlNES UP TOONE HUNDRED CQSTOFCOMPENSATIqJ,DAAMGESA$PROVIOE ON3]080FTHEUBOROOOE,INTEHEST,qNDATTORNEY'SFEES. 9(commencing wiih Section 7000) ol Class Date: Protessions Cotle, end my license Is in full CO RUCTON LENDING AGENCY: ❑ I hareby eMirtn that Ihere is e consiruction lending agenry far ihe peAartnence of t�e work tor which Ihis permit is iuuetl. (Sec. 3097, Civil Code). LenAers Name: Lentler'S Atldress: Signeture: OWNER-BUILDER DECLARATONS: Date: I hereby ettlrm Ihat unGer penelry of perjury Ihet I am E%EMP7 FROM TME CONTRACTORS LICENSE �AW for ihe following reeson (Sec. 7031.5, Buslness entl Professions Code: Any ciry or counry whic� repuires a permit to construtl, alter, improve, demolish, or repair any slrucWre, D�or to Its Issuance, elso requires the eOPlicam tor suc� permit to tlle e signed statement thet he or s�e is Ilcensetl pursuant to t�e provislons of the Contrectors License Lew (Chapter B(commencing wllh Sectlon 7000) 01 DiWsion 3 oi the Business end Proleuions Code) or thet he or she is exempt Iherefrom and the �asis for the elleged exemption. Any violation of Sectlon 7031.5 6y any epplicant for e pertnit subjects Ihe aOPlicent to e civil penalry ot not more than five hundretl Aollars ($500).): ❑ I, es owner of the pro0erty, or my employees with wages as thelr sole compensetlon, WILL DO TME WORK, end the structure Is not Intended or oHeretl lor sale (Sec. 7044, Business entl Professlons Code: The Contrac�ors License Law does not epPly to an ownar of proporty who builds or improves ihereon, end who tloes such work himseN or hersell or through his or har own employees, provided Ihat such improvemenis are not Intended or oHared lor sale. If, however, the builtling or improvement is sold within one year of completion, ihe owner-builder will have the burden of proving that he or she did not build or improve for purpose of sele.). ❑ I, es owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmct Ihe project (Sec. 7044, Business antl Prolessions Cotle: The contractors Llcense Lew does not apply to an owner of properry who builtls or Impmves thereon, end who cromracts tor such project with e comractoqs) license Dursuant to ihe Contractors License Laws.). ❑ I em exempl undar sec. eusiness and Prolessions Code tor this reason: Signature: Dale: Owner ID venfiad by drivers Ilcense. ❑ Yes ❑ No Dnvers Licensa No. Vedfication at Ownarship by (rype ol document, i.e. - pmperry ta�c bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICA710N: Expires: ❑ I hereby certlty Ihet no excavatlon flve (5) or more feet in tlepth Into which e persan Is required to descenQ wlll be mede In wnnectlon wlth work euthonzed by this permi6 end that no building siructure, scaHolding, falsework, or tlemolition or dismantling thereol, will be more than t�irty-slx (38) leet high. (Chap. 32, Grp 2, Art 2, Sec. 3d1, T1Ue 8, Califomla Atlminlsirative Cotle). ❑ As owner-Duiltler, I will not employ enyone to do work which woultl require e permit from Ihe Division of Intlustrial Salery, es noted ehove, unless such person �es e pertnit to do such work Irom �he division. Sipnature: Date: �ivision at Industdel Sefary Permit Number. CERTIFlCATE OP COMPLIANCE AND AUTHORVA710N OF ENTRY: I certity under penalry of perjury that I heve reaC Nis applica�ion entl state lhat �he intormation given is correcl. I egree to comply wilh ell slate laws enC city ordinances relating to builtling construction, end authodze representatives of Ihe Gry ol Coste Mesa to emer upon the above-described propehy lor inspection purposes. I egree not to occupy or allow acupancy ol any building euthorized by this permit until linal inspection. Legel •� . � ' MI•� �' 1616 Fizetl System Final Fire Prevention 1266 Pool Spa Final 200 Flnel Re-Rool 201 FIne181ocWRetaining Well 202 Flnel Factory Fire Place 203 Finel Sign 204 Finel Demolition �$ 40DE1 INSPECTIONTYVE 206 Final Mechanical 208 Final Plumbing 210 Final Elecirical 212 Final Fire Preventian 220 Final Plenning Approval 222 Finel Slte 250 Finel BulltlingiOccupancy �Q�� (714) 754-5273 • Fax (714) 754-4056 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner Address Contractor: Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a ' Service to 1000a � Service over 1000a Motors to ihp Motors to tOhp Motors to 50hp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole 3411 GERANIUM ST 41237302 HURLIMAN ,PAT 3152 E LA PALMA SUITE E ANA, CA ISSUED BY: Phone: 714-666-8477 Zip: 92806 HICKERSON, TODD HICKERSON, TODD S COSTA MESA,CA Phone: 3411 GERANIUM ST Zip: 92626 HURLIMAN HEATING AND A/C INC. 3152 E LA PALMA SUITE E ANA, CA 1 AC UNIT. $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 � so.00 so.00 $0.00 $0.00 - $0.00 $0.00 $12.30 �� $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 0 0 0 0 0. p. �, 0 0 1 0 0 0 0 0 0 0 0 0 Phone: 714-666-8477 Zip: 92806 License: 694681 SCOPE OF PERMIT FEE SUMMARY Status: ISSUED Applied: 05/02/2001 Issued: OS/02/2001 - _ - Quantity Temp Dist System / Lighting $0.00 0 Busway /100 ft $0.00 0 Standing Sedion • $0.00 0 Misc Electrical Equipment $0.00 0 Transformers up to 1 kva/kw $0.00 0 ................up to 70 kva/kw $0.00 � 0 .............:...up to 50 kva/kw $0.00 0 .:........:......up to 100 kva/kw _ $0.00 � 0 ..._ .............over 100 kva/kw ": ` � $0.00 0 � Low Voltage Equipment $0.00 0 Low Volt Wiring System / Ckt -;$0.00 , 0 Misc. Conduit " � '� $0.00 '� 0 Misa Conductor � � $0.00 ' 0 Circus ( gen or ride) $0.00 0 Circus (mech ride or lights) ."$0.00 0 Christmas Tree Stand , � $0.00 0 Fireworks Stand . . $0.00 0 Other Electrical Fee � $0.00 Investigation Fee, , " � $0.00 Plan Check Fee $0.00 Reinspedion Fee $0.00 TOTAL CALCULATED FEES E35.60 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically ezpire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2da6-46 (W00) WORKERS' COMPENSATION DECLARATION: � �� I hereby aftirtn under penalry ot perjury one ot the tollawing tleclaratlons: ❑ I have antl wlll maintaln e certificate at wnseN to salf-Insure tor workers' compensatlon, es provided br by section 3700 of Ihe Labor Cotle, for Iha peAormance of the work tor which this pertnit is issuetl. I have and will maintain workers' compensfltlon insurence, as requiretl by secilon 3700 of �he Lebor Cotle, tor tha perfortnance of ihe work for which this permit is issued. y workers' compensetlon Insurance carrier antl policy number ere: Carrier: Policy Number: (lhis secfion neetl not be �mp/efed A(he permi! is vafueU et ane hunOred dW/ers ($100J or less.) ❑ I certi rtortnance ot the work for which Ihis permit is issued, I shall not employ eny person in any manner so es to 6ecome subject to ihe workers' pensation laws o alifomia, d egree that i shoulA ecrome sub�ect to t�e workers' compe ''ons ol Sectlon 3700 of the Labor Cotle, I shall forthwith mp wit rov ions. / camSignature: /Date: ��— % — D � W INO: FAIL SEGURE WO ERS' COMPEN N VERAGE IS UNLAWFUL AND SHALL SUBJEGT AN O CRIMINAL PENALTIES AND CIVIL FlNES UP TO IXJE MUNORED E(5100.000), IN ADDITION TO THE COST OF CAMFENSATIqJ, DAMAGES AS PROVIDED FOR IN SECTIIXJ 3�O60F THE LABOR WDE, INiEREST, ANO ATiORNEY'S FEES. by ettirtn at I em end e ct. Lic. a 9(commencing with Section 7000) ol Class entl my license is in full �H ❑ I hereby aRirtn that there is a consiruction lending egency lor the peAormence of lhe work tor which this permit is issueC. (Sec. 3097, CiNI Code). Lender's Name: Lentlor's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eflirtn that under penelry ot perjury thet I em EXEMPT FROM TFIE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professions Code: Any ciry or counry which requires e pertnit to construct, alter, Improve, demolish, or repair any structura, prior to its issuance, also requires the aOD��nt for such pertnit to lile a signed statement ihet he or she Is licensed Dursuant to the proNsions of Ihe Comrectors License Lew (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Cotle) or thet he or she Is e:empt therelrom end the basis tor the allegetl exemption. Any violation ol Section 7031.5 by eny applicant tor a pertnit subjacis ihe apDllcant to a clvll penalty ot not more ihen five huntlred tlollars ($500).): � I, as awner at Ihe properry, or my employees with weges es their sale compensation, WIL� DO THE WORK, antl �he structure is not intendetl or oMeretl for sale (Sec. 7044, Business and Professions Code: The Comrectors License Law does not apply m an owner of pmperry who builds or improves thereon, and who tices such work himselt or herself or Ihrough his or her own employees, provided that such impmvements ere not Intended or oHeretl tor sale. If, however, ihe building or improvement is sold within one year oi cOmpleti0n, the owner-builder will heve ihe burdon ol proving that he or 5�e did not build or improve lor purpose oi Sale.). ❑ I, es owner ol the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Pmtessions Code: The contractors Licensa Lew tloes not epply to an awner ot pmpehy who bulltls or Impmves Ihereon, and who contracts br such project with a cantrector(s) license pursuant to the Coniractors Llcense Lews.). ❑ I em ezampt under sec. Business end Prolessions Cotle for Ihis reason: SignaWre: Date: Owner ID venfietl �y dnvefs license. ❑ Yes ❑ No Drivefs License No. Expiras: Verification of Ownership by (typa of document, i.e. - praperty tex bill or daed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby cehify Ihet no excavetion five (5) or more laet in depih into which a person Is required to descend, will be metle in connection with work authonzed by this permit, and that no building simcWra, scefloltling, falsework, or demolition or dismantling thereol, will be more �hen ihirty-siz (36) fee� high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title B, Celifomia Atlministralive Cotla). ❑ As owner-builder, I wiil not employ anyone to tlo work which woultl require a permlt irom ihe Division of Industnal Setety, as noled ebove, unless such parson has a permit to tlo such work from the division. SignaNre: Date: Division of Intlustrial Satery Permit Number: CERTIFlCATE OF COMPLIANCE AND AlffFiORIZATON OF ENTRV: I cenity under penalty ot perjury that I have read ihis eppliwtion and stale ihat Ihe intormation given is correcl. I agree to comply wit� all state laws and ciry ordinances relating to building constmction, antl euthonze representatives of ihe Ciry ot Costa Mesa to emer upon ihe above-descnbed property for inspection purposes. I agree no� to occupy or ellow occupanty of eny building authorized by ihis permit until final inspection. Appli[ent COOE I' INSPECTIONTYPE �� 1616 Fixetl System Final Fire Prevention 1266 Pool Spa Final 200 Finel Re-Roaf 201 Final Blxk/Retaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition INTRIALS CODE� INSPEGTIONTYPE 206 Finel Mechaniwl 20B Final Plumbing 210 Final Electncal 212 Flnal Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuiltlinyOccupancy pl.\1�C11LL�1F7 �/1 �/:�! ± Aoplicant to fill in all soaces except tnose within neavy boraer lines ana si9n all appropriate aeclarations. S,ir-v oF cosTA rrt�� Plan 4 E1 ev, AR CON$TRUCTION PERMIT Lot 16° P�'djec[Address ;411 �ppapium StrPet Applicant's Mailing Address i 565 W N1a.c_o�thur B1 vd ow�er'sName $TANDARD PACIFIC CORP pho�e 546-1161 Address SAME A,�niE�9.Adams/Streeter �;Ce��No. 25083 Address 17981 Skv Park Circle. Irvine Contractor'sNam $ee Owner vhone Address (mailingl � Ciry License No. �l!}�� LICENSEO CONTR CTOR OECLARATION I hereby aifirm Ihat I am licensetl untler O�oviSions of Chdrter 9(commencing with section 7000j of Divislon 3 of the Business antl Profe55ions Cotla, antl my license Iz in full for e tl eHecL ' � LJcenze Class �-� ns o 248042 Date %-� F-Ra Signature r " 'Of2KER5'GOMPENSATION DECLARFTION hereby aifirin that I M1ave a cerUflcate ot consen[ to selt-insure or a certi(lcate of Workers' Compensatlon Insurance, or a certHietl coOY thereot (Sectlon 3800, l.ab. C ) ,a,;�v No. WP-84-225-856 com,a�v Fremont Indemnitv eCeriifietl coOY is �ereby tumishetl. ' ' ' XCe�tj�tieqgoDyls flletl w�i�tPPlicantY u'Itlin9 Divi �°7.�f 1 fl C � Da[e � I h }54 Y EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section neetl no[ be completetl if the p¢rmit IS f0� One hunOretl (5100) o� less): ' � 1 certify that in the performance of the work tor whlch thls perm�t is IssueQ I sball not employ any person in any'manner so as to become subJect to lhe workers' CompensaHon Laws of California. Date Signature NOTICE: It, atte� mdkln9 tnis tlecla�ation, you shoultl becOme subject to Ihn Workers' Compensation provisions of th¢ Labor Catle, you musl forthwl(h comply with such provisions or tnis permlt shall be tleemetl revokea. CONSTRVCTION LENDING AGENCY I hereby affi�m tha[ [here is a mnst�uction lentling agenty fOr [he parfo�mance of tne work tor which this permit V5 Issuetl (SecHon 309] Civ. C.) LPntler's Name Lentler's Atltlrezs OWNER BUILDER DECLARATION I hereby atfi�m that I am ex¢mpt frOT Ihe Cont�acto�'S Ucense L.aw fo� the following reason (Section 7031.5 Business antl Profe551onal Cotla: Any city or mimh wnicn reauires a oermit fo construcf. alter. imorove. tlomolisb or reoalr to tfle a s�gnetl 5[a[¢ment tba[ Oe/5lle Is IlcensaO pur5uant Io [ne proviS�Ons ol the Contractor's Ucense Law (Chapter 9(Commencinq wilh Section 7000) of Divizion 3 ot the Business antl Professions Cotle) or that he/she is exempt thereirom antl t�e basis for the allegetl exemptlon. Any violatlon of Section 7031.5 by any applicant tor a permit subjects the applicant to a civil �enalty ot not more tnan five huntlretl tlollars (E500). I, as owner o( the property.or my amD�oyees witn wag05 as Iheir Sole , compensation, will tlo the work, antl the structura is not intantletl or ofteretl for sale (Section 7094, Business anG� Professional Cotle: The Contractor's License Law tloes not apply [o an owner of a property who bulltls or improves thereon, antl who tloes sucn work hlmseli/ncrseH or �throuqh his or ner own emO�oYeeS, prOvitletl that such imprOvements ate not Intentletl O/ otfe�e0 fo� sale. It, however, the builtling or Improvement is soltl withln one year of <om� pl¢tion, Ihe owner will have the burtlen of proving he/she tl10 not bulltl o� Im- �rove tor the pu�pose of sale). I, as owner of the property, am exclusivuly contractin9 wltn II<ensetl con- tractors to mnstruct Ne proJect ISection 7044, Business antl Pwtessions Cotle: The Contractor's License Law does not apply to an owner of proper[y who .. builtls or improves thereon, antl who contracts for such projects wlth a con- Vactor(s) Iicense pursuant to t�e Contrat[or's Licanze Law), ❑ I am enempt untler Section B. & P. C. tor this reason ' I hereby certi/y ihat 1 information is correct. I antl�state laws relating t seniatives of his city inspectlon � Signature Drivers' License or 55'� CMF 0865-46 rev. ]/83 Owner hava rea upon l/� U i�u/ / /(D � TVPE OFCONSTRUCTION NEW . ADD ALTERATION REPAIR� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK TYPEOFPEflM1T GRADING FOUNDATION STRVCTVRAL • ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER (1n PROJECT DESCRIPTION SQ. FT. Zlyl, oCCUPnNCv - CO N STRVCTION TYPE VALUATION §_111, $fi4 ZONE GRADING CU. VDS. ACRES Remarks: Sink Prevencer Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Intereeptors Kitchen Sink . lavatories Root Drains Reinspec[ion Fee � $25 Dutt - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating Syscem & Ducting ❑ ai ao,000 eru O i oo,000 eT� Rainspection Fea W hite - Bul Itlin9� Canary - Applicant; Pink - Accounting; Goltlenrotl - AsSessor P Showers Service Sink Sew¢f Cap SewerConnection � Solar Collecrors� Solar Piping � - SolarTank �,' Swim`ming Pool�w/Spa � Urinal Water C�OSEL Water Heaterv Water Service ' � Isue Fee Hood or Typel� ❑ Canopy Type 11 ❑ Refrigeration System ❑o-ioo,000sru ❑�oo,000 System Repair/Alteration luue Fee � A.P # �a — S Main Building: T Front ARear �� C F7ight � gLeft Ping. Ref. #'� -� Parkin9 Req./Provid Use of Building: � Planning Notes: _ AUtOTdtIC W85f1Qf ConstructionPoleSub. ' Cooking Unit Dishwasher Oryers ❑Gas OElectric Fan F.A:U. Fiktures Device Boxes 5163 3/OI/B4 ��. Zane ' Accessory Buildin9: Z O N , I N G R E � - ark.Fees $ � �� n U I q E M E 9 tCGlt t Ylh1V ;�� N T ELECTRICAL �Transtormer � 15-50'KW ^ ❑ 50+,KN1�� - Meter- �up to 100 amps ' Meter �over100amps . Sub Panet • � � Motors �0.1 HP 01 h- 8 Int.Solar 09-15 HP �16-75+ Microwave Pole Light . ' Range , Switches Garbage Disposal Generaror 00.5 KW �5-75 KW � $ 3 Standing Sections Trash Compactor Reinspection Fee ' $25 Issue Fee � � �$ 3 FEES �� PUBLfCSERVICESRE0UIREMENT/,�/� /� /_� Zoning Approved By ��/ ��U � Date�a-7�.�a� Application Approved By Date APoliration Issuad Bv -�� Dat a � $ 3 BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK MECHANICAL PLAN CHECK SUMMARV OF FEES S 485_..5Il_ SMIP g R_46 $ ��._$� PERMIT ' $ ISSUANCE ' $ $ ENERGV P.C. $ $ GRADING ' $ $ MICROFI�M $ $ TOTALFEE s 572.85 $ C�PNSTRUCTION AND PLANNING PO�� & SPA . Date Inspector Date Inspector : -APPROVALS Permit # APPROYALS Permit # . v 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ,� 2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement 3. �Electrical Conduit UtilitY�Undrgmd. -- ' 54. Forms' - ` 4. Electrical Conduit-Undrgrnd. �� 55. Electrical Bonding - � 5. Steel Reinforcemeni 1� � ' , 56. Rough Plumbing & Pressure Test . � 6.- Electrical UFER Grnd.� � 57. APPROVAL TO COVER-GUNITE ' 7. Footings � 58. Electrical Conduit-Undrgrnd. - 8. Foundation ' 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. �.. ' 60. Backwash Lines, P-Trap, 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 75. Rough Electriral-Conduit � 66. Solar System-Final 16. Rough Electric Wiring � 67. Fencing & Access Approval 77: Ftough Wiring Sign � 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling: . � 69. POOVSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. DuCts, in Structure ' 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test � 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing S�{ Biv( 74. Overhead Hydro 26. T�Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. FrameandFlashing l�/ 76. DryStandpipe 28. Lathing & Siding ' 77. FIXED SYSTEM FINAL 29. Insulation g�p (/L 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 --y-/ �. m^�f�a 35. Final Gas Pipe-Test /O�d �, 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 o� C� 48. Special Requirements Completed . /�9 � 49. Electric Release to Edison � � 50. Gas Release to Southern California Gas Co . . 51. CERTIFICATE OF OCCUPANCY ' , No. Date � � /�n i, r� �//,e — s�pP � m��•-r- [Y �'"� / f�' Aov��cant to /ill in all soaees except [M1ose wit�in heavy boraer lines antl sign all avPropriate Oeclarations. C�Ta OF COSTA ME�S/q CON TRUCTION PERMIT�,1 � PER IT NO. TRACT NO. LOT NO. UNIT NO. � . _ Project Address �7 �� %�� M� � K� � ApplicanYsMailir�P�drNss ' - TYPEOFCONSTRUCTION ; NEW ADD ALTERATION REPAIR Owner's Name �y��/ / hone�� I � CONVERSION ❑ DEMO ISH ❑ OTHER q,p, # . Zona ��y �^� �i . DESCRIPTION.OF WORK/USE OF BLDG. . Address /� K* � S Main Building: Accessory Building: Arch/Eng. � License No. TVPE OF PERMIT GRAOING FOurvoATlorv ❑ STRUCTURAL T Front ' p Address � ❑ i"ENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL A Rear � ' � N ��l��S�,��j/� ❑ OTHER Con[ractor's Na Phone/1��— . C Ri9ht . , N Address Ima'I'nn1�J�� ✓ � �� PROJECT DESCRIPTION 54. FT. oCCUaANCv K Left� � G CONSTRUCTIONTVPE VALUATION$ $ City LicenSe No. �� ZONE GRADING CU. VDS. � ACRES � ' R LICENSE� CONTRACTOR DECLARATION - Piny. R¢F. # Pa�king R2q./P�Ovid¢d E I hereby aftirm Ihat I am �j�ensetl untler provisions ot Charter 9(commencing Remarks: ' Planning Notes: � - � M with section ]000) of Division 3 of the Business antl Proi¢ssions Cotle, antl _ , T my license is in ful orce e ffect, /�� a ' : � $. License ass �" icerse rya��L�i(O�', ,,_,�� % pLUM61NG FEES Date �� — Siqnature � J �iL ' WORKERS' COMP NSA710N DEC ARATION Bdr Sink ' ShOWers � � ELECTRICAL ' FEES 1 nereby affirm tnat I hav¢ a certificate of mnsent ro self-insure or a certiticate of Workers'� Compensati0n Insurance, or a ceriifie coOY thereof (Section gackflow Prevente� ' Service Sink ' ' • 3800, Lab. Automatic Washer . 'Transformer" 0 7&50 KW Policy IVo,��%C/�'�� Comoany �� Backflowlrri ation SewerCa . ❑ 50+KW 9 P Construction Pole Sub. Cer[rtietl copy is hereby fumishetl. � Date�er ' i opy's 'letl with the cit iiltlin Di fi. Bathtuhs � � Sewer Connection Cooking Unit _ Meter ❑up to 700 amps APPlica �G� ��-� ' - EXEMPTION FROM WORKERS' COMPENSATI N DECLARATION Clarifiers � Solar COII¢ct0�5 Di5hwd5hC� � M2L2� ❑ovB� 100 dmp5 � (Thissection neetl not be �ampletetl if the permit is for one huntlretl ($100) or iess). � Dishwasher . ' Solar Piping Dryers �Gas ❑Electric � � iSub Panel I certify,that in the pe�t4�mance of the wo�k tor which thl5 pe�m�t i5�issuetl, I shall not employ any person in any manner so as to become subject to-the � Drinkin9 Fountains ' Solar Tank ' Fan, - Motors �0-1 HP 01 h�8 ' Workers' Compensatiom �yws of California. - Date � Signature � Floor Drains � Swimming Pool w/Spa� F.A.U. Inc.Solar �9-15 HP �16-15+ NOTICE: If, after making this tleclaration, you shoultl becOme subject to tne Workefs' Compen5dtion provisions of the Ldbor Code, y0u must fofthwilh FIOOf SinkS ' ' Ufindl ' " FixtUf¢5 � - comply with such proviSiOns o� this pe�mlt snall be tleemetl revoketl. -Microwave CONSTRUCTION LErv41NG AGENCV � ' ' GasSErvice � OULIetS � Water CIOSet -- � � Device Boxei I heteby affi�m tM1at there is a construttion lentling agency fOr the pertormance P012 LiPub of Ihe wo�k for which thi5 pe�mit is issuetl (Section 309] Giv. CJ Interceptors ' � Water Heater . Outlets Range Lentler's Name - Lentler's Aetlress � � Kitchen Sink -� / Water Service. � �� Switches. ' Sign OWNER BUILDER DECLAf2AT10N�� ' � - ' I hereby aftirm that I am exempi from the Contractor's �icense Law for the � LdvatOYi¢5 • � � . (ollowing reason (Section 7031.5 Business anG Professional Cotle: Any city or _ Garbage Disposal ' Standing Sections coun[y whicM1 requires a permit to construct, alter, Improv¢, tlemolish o� repair P—T�yp . ' . (�i20¢/dt0� 0�-5 KW 05-1$ KW T�ash COTpdCtO� any 5[�ucture, prio� to it5 issuanc¢, alm �equires the applicant for such permit to file a signetl statement that he/she is Iicensetl pursuant to the provisions ot Roof Drains ' � the Contractor's Licenre �y�y (Cnapter 9(commencinq with Section �000) of ' Division 3 of tne Business antl Professions Cotle) or that he/sne is exemOt . .. • . therefrom anG the basis for Ihe alle9etl exemption. Any violation of Section . .' ' 7031.5 by any applicaht (or a permit subjects lhe applicant'to a civil �nalty of not more than five nuntlretl Oollars ($500). . LJ I, as owner of the property or my employees wi[n wages as their sole ' Reinspec[ion Fee $15 Issue Pee � 3 compensation, will tlo the work, antl the structure is not intentletl or offeretl Reinspection Fee � $15 Issue Fee $ 3 for sale (Section �044, Business antl Protessional Cotle; The Contractor's ' � MECHANICAL FEES Licanse Law tloes not appry to an owner ot a property who builtls or improve5 ' - t�ereon, antl who tloes such work himselt/herself or mrou9h his or. her own . DEVELOPMENT SERVICES REQUIREMENTS: employees, provitletl fhat such improvements a�e not intentletl or o(fe�etl far � BOil2� HOOd Of Type I ❑. , sale. If, however, tM1e builtlin9 �r improvement is soltl within one year of com- , Canopy Type II ❑ 2oning Approved By Date pletiOn, the owner will qave the burtlen ot proving hE/She tlitl not builtl or im- DuCt- Und¢� G�OUnd Building APP�ov2d 8y Dat@ ��Ove for the DurpoSe of sale�. I, as owne� of the property, am exclusivery contracting with licensetl con- Duct - St�uctu/dl , R¢ifig¢r2tiOn SySt¢m ApplitatiOn Issued By Ddt [ractors ro construct Ihe project (Sectlon 7044, Bu5ine55 and Professions Cotle: ' The Contracror's License Law.tloes not apply to an owner of.pronerty who Duct- Ventilating . ❑0�100,000 BTU ❑100,000 BTU S MMARV OF FEES • builtls o� improves lM1er¢on, antl who conVac[s tor Such projects with a con- tractor(sI license pursuaq� to�the Contractor's Lirense Law�. I am aware thaf ExhausTSystem ❑ Multiple ❑ � System Repair/Alteration BUILDING PERMIT $ SMIP $ oroor oi thev Worker's Compensation iniurance zhoultl be provitletl to me. PLAN CHECK $ ' PERMIT � ❑� I am exempt un0er 5@ction B. & P. C. fo� thi5 reason Firepl/Fact. BIL ICBO # PLUMBING �> $ � I N ///��$ y� Date ' Owner . Heating System & Ducting � p�qN CHECK 25%d� $ E R . 1///��\ 7/ �/ I hereby certify that I have read thi5 a'pplication and state that the above ❑0-ip0,000 BTU �100,000BT ' �-�G D 1$� ELECTRICAL inrormation is rorrect. I agree to comply with all city antl counb ortlinances �J� ��-�— antl state laws re tin9 to builain9 con ruction, antl nereby authorize revre- PLAN CHECK 50% $ MICROFILM $ Sentatives ot hi it to enter o the� aboy� mep tionetl p�o erty to� inspectlan pu L/. //� Y_1 / MECHANICAL ' Signature / �C-GIc/ Date � $ TOTALFEE $ Drivers' License or 55 � � Reinspectian Fee $�5 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0665-46, �ev. 4/04 White - Builtlin9: Canary - Applicant; Pink - Accounting; Goltlenrod - Assesso� � • �'CONSTRUCTION AND PLANNING ' POOL & SPA +APPROVALS Permit # � Date Inspector p�ppROVALS Permit # Date Inspector i. Temporacy Electrical Service or Pole �� 52. Pool & Equipment Location 2. Soil,Pipe-Undrgrnd. ' ' , 53. Steel' Reinforcement �� .� � 3: Elecvical'Conduit�Utility-Undrgrnd: � 54. Forms " � � 4. �Electrical Condui �Undrgrnd. - •, 55. Electrical Bonding ' 5. Steel Feinforcement�� 56. Rough Plumbing & Pressure Test 6.,ElectricalUFERGrnd.-- � 57. APPROVALTOCOVER-GUNITE �•� .7. Footings' . �� : � -�~ti � . � 58. Electrical Conduit-Undrgrnd. � % 8. Founiiation .;' �'�" 59. Gas Pipe, O Undrgrnd., Test �- 9. Water Pipe-Undrgrnd. � - i • � 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. SewenCap �. ✓' � 63. Heater & Vent-Final �, 13. Roof.Drains �� - 64. Plumbing System - Final 14. Rough Plumbing'- � 65. Electrical-Final . ' 15. Rough Electriral-Conduit 66. �Sol �S�stem-Final 76. 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 FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 27. Ducts, in Structure . 70. Underground Hydro 22. Ducts, Ventilating ; • � 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test � �. / 7�2: 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 .�, �, � 80l F,OOD CERTIFICATE ISSUED 33. Final Electric � Notes:� �, 'i 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test , 36. Hood or Canopy � . ' 37. Final Factory Fireplace � 38. Final Plumbing �cJiq%�4 Gr� � 39. Water Service-Final 40. Gas Service-Final ��1�'z�p� � 41. Solar pomestic-Final . 42. Backflow Preventer ' - ' 43. BackflowJrrigation : ,... � _. - � � 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations - 47. FINALSTRUCTURE&BUILDING � ' 48. Special Requirements Completed � � 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No, Date ' � ' �� CITY OF COSTA MESA • C�tNSTRUCTION PERMIT ' Applicant to fill in all spaces axcept t�ose within heavy Dortler Iines antl si9n all apDropriate tleclarations. Project Address� y"� � 1 .�� M a.. _ vc n. -�- 1 . � Applicant:n Maii?n Addr ss , C�c,�� Owner's Neme � `o, �� Address ��b��1L t{t+.. �� Arch/Eng. License No. Address !f� Contractor's Name Phon� Address Imailing) S4� City License No. � LICENSEO CONTRACTOR DECLARATION I hereby affirm that I am Ilcen9etl untlar provislons of C�arter 9(commencing with section 7000) of Dlvislon 3 of the Buslness antl Pr fesslons Cotle, antl TY ��C8f152 �S �O i I}Of e ntl effe< �aoan � Litensa Class ' — 'tense Oate Si9natura � WORKERS' COMPENSATION DECLARATION I heraby afflrm that I have a ter<lilcate o! consent to self-Insure or a certificate of Workers' Compen5ation Insurance, or a certifietl copy thyyy��eof (Sectlon-' 3800, Lab� C.�)��/ /�9`I-7/� � � , yPnyo'llcy No.�� V � � Company L�Wertlfietl coPY �f h� eeb"`'APP ItantY�^� I� iFI%�n. /(�� /'�� . «� V �.IYP/�Q A!L/i EXEMPTIO----��RKERS' COMPENSATION DECLARATION ' � (Thls saction need not be comp101etl if the permlt is for one huntlrad (E300) or. iess). ' I certlty that Idthe periormanEa of the work for wfiich thls pe'rm�t is iSsuetl I, shall not employ any person I� any manner so as to become suGjec[ [o t�e Workers• Compensatlon Laws of Californla. ' Date SI9nB�ure -NOTICE: It,iafter making this declaratlon, you should bacome subject to tne Workars' Compensation provisions of the Labor Cotle, you must forthwith comply with such provision5- or. thls permlt , shall ba , tlaemetl revoketl: CONSTRUCTION LENDING AGENCY I hereby affirm that thera Is a�constructlon lentling agency (or the perfo�mance of the wark for wnlch [his Permit Is issuetl (Sectlon 3097 Civ. C.)' Lentlar's Name" � � Lentler's Adtlress . OWNERBUILDER DECLARATION ' - • I hereby afflrm that I am exemP� lrom the Contractor's Llcense Law tor the following reason (Sectlon 7031.5 Buslness ana Protessional Cotle: Any citY or county whi<h requires a permlt to tonstruct, alter, improve, aemolish o� repair anv St�uCtu�e. o�lo� to Its I55uaPce, alm �¢qui/¢5 the aOPllcdnt fo� such Pe�mit %iherefrom antl the ba5i5 for th0 alle 7031.5 by any appllcant for a p ' enalty of not more than five hUntlr� � I, as owna� of tha'p�Opa�tY o� compBnSdtloO wlll tl0 th8 wO�K, dni for sale�(Secflon 7044, BusinOss a Llcense l.aw tloes not apply to 5n oe thereon, antl who;tloes such work i emploY eas, proviEetl that such Impr sale. I(, however, tha bulltling ar im pletlon, Ihe oWner will have thB bur �rove lortha purpose of sale). I, as ownar of the property, am .tractorsto construct the O�oject (Se< T�e Contractor's Litanse Law doas bulltls or Improves thereon, antl wn tractor(5) Ilcense pursuant to,the Coi ❑ I'am exemp[ untlar Sectlon� Date Ownar�_ Any vlolatlon of Section :he appllcant to a clvil wlth wdge5 d5 tlt0ir So10 : not intendetl or ofte�etl opelq wn0 OUIIOS O! IfilPloves �elf or through hls or her own re not Intentlatl or offeretl for Is soltl wllhln One year•Of com- �In9 he/sha tlitl not bulld or im- tontracting wlth Iicensetl con- BUSIne55 antl Pfofessloll5 COtlB: to an owner of property who ' for such pro�ects with a<on- Icense I�w), — B. & P. C. for this reason 1 have rBaG tnis appllcatlon antl state that the'above I a9ree to comply with all city antl county ortlinances to bulld��9 construtllon, antl heraby authorize reDre- � t0 ente! upan Ih8 dbOve-TentlOnetl ��prop/p�!fY� �f�O(l � ��t Date_ �/(i1/�T T� TVPE OF CONSTRUCTION �NEW U ADD LJ ALTERATION "LJ REPAIR ❑ CONVERSION ❑ DE LISH ❑ OTHER ' - A p # . DESCRIPTION OF WORK � • S Main Building: TVPE OF PERMIT� GRADIN FOUNDATION ❑ STRUCTV RAL T Front ❑ TENANT, ❑ ELECTRICAL PLVMBING ❑ MECHANICAL g q¢a� ❑ �OTHER ' � %� PROJECT DESCRIPTION SQ. FT. � oCCUaANCv C Right � CONSTRUCTION TYPE VALUATION $ , g Left ZONE GRAOING CU. VDS. � ACRES �Ping. Ref. # Remarks: � . ' � parking Req./Provided � Use of Building: PIUMBING FFFC Planning Notes: Bar Sink BackfloW Preventer Backflow Irrigation 0 Clarifiers � . Dishwasher Drinkln9 Fountains Floor Drains Floor Sinks GasService� � Citchen Sink � Lavatories � � � ?—Trap Roof Dreins ' � Reinspection Fae $25 Duct - Under Graund Duct - Structural Duct - Ventilating ExhaustSystem ❑ Multiple❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting � ❑Q100,000 BTU 0100,OOOBT ��Y��atwe � Q Drivers' Ucense or 55 � ,�, _ I I Rainspection Fee , I $25 CMF OB65-46 �ev. 12/83 WhitB - Builtlinq; Canary -�AppiicanL Pink -Atcounting; GOltlenrcC -,,;sassor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet � Water Heater Water.Service , _ laue Fee 0 Hood or Typel ❑ Canopy Typell ❑ , Refrigeration System ❑0-700,000 BTU ❑100,000 BT.0 System Repair/Alteration . laue Fae 0 $ 3 Automatic Washer Construction Pole Sub. Cooking Unit � Dishwasher � Dryers OGas ❑Electric Fan F.A.U. FixtOres Device Boxes . Outlets Switches Garbage Dispoul Generator DO-5 KW �5-15 5745 3/09/84 Bu Fees $ � 38.O�i fL 2 O N I N G R E i Q U I R E M E N T S FEES Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over100amps Sub Panel' � Momrs OO-1 HP O1 %- B : Inc.Solar �9-15 HP 016-15+'. Microwave � . Pole Ligh[ Range Standing Sections Trash Compacmr '�Rainspection Fee I$p5' Issue Fee ' I $ 3 I PUBLICSERVICESREQUIREMENTS: � ' � 2aning Approved By Date Building�Approved By Date I/ Applintion laued By �� Date Q g Y � � SUMMAHV OF FEES : BUILDING PERMIT $ SMIP '$ PLAN CHECK � $ - � PERMIT • PLUMBING � '$ � ��UANCE $ PLAN CHECK 25% $ '� ENERGV P.C. '$ ELECTRICAL $ GRADING $ PtAN CHECK 50% $ _T_ MICHOFILM $ � �j — MECHANICAL $ �� TOTAL FEE $ � PLAN CHECK �5% $ � , � �?ONSTRUCTIpN AND PLANNING , • . �POG_ � SPA � _ • . - Date Inspector � � _ � Date � Inspebtor '� APPROVALS , Permit # APPROVALS � Permit #. • ' 1. TemFprary-Electrical Service or Pole - 52. Pool & Equipment Location - _. � - ,� � �2. Soil�Pipe-Undrgmd. �, L��ilr (,� 53. Steel Reinforcement , � ti �:' , �� 3. Ele�rical Contluif Utility-Undrgrnd. � L - �� - � 54: Forms - ' . � � ' ' � . , `- '� � 4. Electrical Conciuit-Undrgmd. � ' 55. Electri�cal Bonding- � � � " ' - ?' 5.� Steel Reinforcement - � 56. Rough Plumbing & Pressure Test � � �� 6. Electrical UF�R Gmd.� ' . � - 57. APPROVALTO�COVER-GUNITE _ _ � ' ' ,- � 7. Footings �' , .� � �� 58. Electrical Conduit-Undrgmd.^;. �� _ ' - , . - ' ` 8. Foundafion �-� '. _ -7 - 59. Gas Pipe, O �Undrgrnd., Test . - ' '� , � - i, 9. Water PipelUndrgrnd. Z�/yt�� /�- 60. Backwastr Lines�, P-Trap, O Undrgmd. - - " . i 10. Structural F,loor System _�� " 61. APPROVAL TO DECK -- � . 11. Property Se'wer Line & House Connection brp 62. Backwash & Receptor-Final `- " _,2 - , G/ .�{, � '12. Sewer Cap', `.. ' � 63. Heater & Vent-Final " 'i� � �, , 13. Roof Drains ' . _ � �64. Plumbing System -�Final � - - � � " 14. Rough Plumbing �� • � 7 �!t ��/ G(n 65. Electrical-Final � ` - � -) 15. RoughElectrical-Conduit , 66.-Solar_System-Final ' ' �-' -' - '."" 16. Rough Electriry�iring . � '� 67. Fencing & Access Approval . : -. ' - "' - - . 17. Rough Wiring Sign - , 68. APPROVED FOR PLASTERING �'- �- 18.'�Rough Electrical-T Bar Ceiling „ � 69. � POOL/SPA SY-STEMS FINAL ! r�' ''° `� � 19. Rough Heating & Air Conditioning '� FIRE DEP,T. REQUIREMENT' � ' • 20. Rough�Factory Fireplace APPROVALS Peimit # i�� ' 21. Duc[s, in Struc[ure 70. Underground Hydro ! � ' �:22. Ducts, Ventilating ,� � 71. Product Piping �Gas- ❑Oil � ' � i 'Q3. Gas Pipe-Rough & Test . •- � 72. Underground Flush „ . ! t � � 24. Roof Framing - � 73. Undergrnd. Storage Tank O Gas �❑"Oil ! . ', -'25. Roof Sheathing 74. Overhead Hydro � . 26. T-Bar Ceiling (Strucwral) & Monocoat 75. Dry Chemical � --�" I �' ' 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. PlasterBrownCoat 79.�FINALINSPECTION � � 32. Electrical Power MeterFinal <� �' j 80' FOOD CERTIFICATE ISSUED � � � 33. Final Electric � � . Notes' � � � . , , ' 34. Final,Heating & Air Conditioning � � � � ' � 35. Final Gas Pipe-Test (b�%1��G( (�/f� ' � ' . � - - . 36. Hood or�Canopy � ' � ' - � . ' _ 37. Final Factory Fireplace ' . . �- `�� . � 38. Final Plumbing , �d��t.� L�1 � � � • ' .' ' 39. Water Service�Final � ' - . , ", ' 40. Gas Service-Final : � - � � ' � `" 41. Solar pomesticFinal • �- �- - � . . � - 42. Backflow Preventer � ' � . � _ _ � � � . 43. Backflow Irrigation ' ' � '- , � � ' � � . i .. 44. .Landscape Irrigation System i ' ' � . ' � I I, -� 45. Sound Attenuation • � ' � , ' . - " - 46. Handirap Regulations ' � �. ' � � . - � 47. FINALSTRUCTURE&BUILDING . - . � � � c •- 48. Special Requirements Completed. ' i � ' . ' � ; � � ' � ' ' � � 49. Electric Releaseto Edison � � ' - � �� il � �� -+ � ' � . i 50. Gas Release to Southern Califomia Gas Co ' � �' � � i � 51. CERTI'FICATE OF OCCUPANCY ' - • � ^i � No. Date � ' • - - - ' . AGP��ant to f(II in all spaees axcept ihose wil�In heavy porGer lines antl s19� all appropriale Eaclaratlons. - CITV OF COSTA MESA - PER IT NO. TRACT NO. LOT NO BLD . . -- - �CONSTRUCTION PERIl91T Lj� (� �j8 �� l0 30l6 6/�7/84 83. �: T� PrOject Adtlress TYPE OF CONSTRUCTION NEW ADD ALTERATION REPA�R � Applitent'S Mailin Addre ❑ CONVERS�ON ❑ DEMOLISH ❑ OTHER p,p, �. Zp�a Ownef'S Nam � on2 DESCRIPTION OF WORK / /" M� r��Un E Main Building: ActesSory Building: Z Addreu u� �� ./� TVPEOFPERMIT GRADING FOUN�ATION� STRUCTURAL T Front . �y I Arch/Eng:_ YL—LtCenSC No. ❑ TENANT ❑ ELECT0.ICAL ❑ PWMBING ❑ MECHANICAL B Rear ' � Address ❑ �o7HEa � A N Contracmr's Nam y /@ /, PROJECT DESCRIPTION 50. FT. OCCUanrvCv C Righ[ ' � ' G � Addresslm'I' g��/__'' �Q� � —!� CONSTRUCTIONTYPE VALUATIONS S L2([ E City Litnnaa No �� TONE GRADING CU. VDS. ACRES Ping. Ref. d/+ Park.F2e5 $ � n U LICENSED CONTRACTOR DECLARATION Remarks: Parking Req./Provided �' 1 h¢reby atfirm that I dm li[enSetl untlet p�ovi5ion5 of C�art¢r 9(cOmmen<I09 R with section �000j o( Division 3 of t�e Business antl Profassions Cotle, antl , //S /� Use Of Building: � E my Iicense is in i W rce �etfect. . ![� ��/�� - lJcense azz � License �v'r "_� U �'"'_ PLUMBING � FEES Planning Notes: M Oate ' � nature E WORKERS' COMVEN ATION DECLARATION ��- � Bar Sink Showers N T I nereby atfirm tnat I bave a certifiwte ot consent to self-inzure or a certlficate y gackflow Preventer Service Sink S of Worke�s' Compensation Insu�ance, o�-a �certiti¢tl copY the�eot (SBction - � 3800, Lab. C. Beckflowlrrigation SewerCa ELECTRICAL • FEES ��%� cT �U/J� - o , � Policy No. Company�+ -' nM _Certifietl copy is hereby turnishetl. , Bathtubs � Sewer Connection /'Automatic Washer Transformer ❑ 15-50 KW Ifd�Certifie 9cop til vj h the city B in D(rhJpp. n f� Date `��PPliwnt �� Clarifiers ' SolarCqllecmrs ConsvuctionPoleSub. ❑50+KW —��—>— f i � L� EXEMPTION FROM W RKERS' COMPENSATION OECLARATION DiShNldShEf ' � 5013! Pi I!1 (This sec[ion neetl not be completetl if the permi[ ii tor one huntlretl (S100j or P 9 � CAoking Unit ' ' Metet ❑up'to 100 amps less). ' Drinkin Fountains / fT I certity [M1at �in tM1e Oeffolmance of the work for which (hi5 perrtl�t i5 i55u2tl I' 9 ' $018I Td111( / � �IShWdSh¢I M¢tE1 �{.�6V¢f 100 amps sball not employ any per5on In any manner zo as [o become su0ject to t�e . Workers• Compensation Laws ot calieornia.� , Floor Diains Swimming Pool w/Spa � Dryers ❑Gas� �Electric Sub Panel Date Si9nature - . NOTICE: If, atter making lhis tleclaration, you s�oultl �ecome sub�ect to the FIOOr Sinks ; Urinal Fan / ' Wo�kets' Compensation proW5i0e15 Ot tht CaEor Code, you muzi forthwitn � _ Motors OO-1 HP �if -8 comply wiU such provisions or �[his Oermi[ shall be tleemetl revoketl., Gas Service • � OuUets . Water Clout F.A,U. Ina Solar �9�15 HP 07615+ CONSTRUCTION LENDING AGENCY � I her¢by aftlrm tha[ [here is a.con5t�uctlon lentling a9ency fOr th¢ perforrtiance IniC�C¢pt0�5' � W3t2� H¢dt¢� �Fi%[U�¢5 / MiC�Ow3v¢ � of Ihe 'work for whlch this Dermit is issuetl (SecHon 3097, qv. C.) �entler's Name - Kitchen Sink ' Water Service Device Boxes Pole Light � Lenaer's Atltlress ' - OWNER BUILDER DECLARATION ' . , LevaLO�i¢5 � - Oull2t2 � RBn9¢ � 1 hereby affirm that 1 am exemp[ from the Contractor'S LI<anse Law (or the p_T�a - following reason (Section 7031.5 Businasz antl Professlonal Co40: Any clty or P � ' $witches $iy� � wunry w�ich requires a petmlt lo con5trucq altei, Improve, tlamoli5h or repdir �any structure, oNor to its issuante, also requires lhe�applitant for tuch pormit Roof DrainS� ' - Garbege Dispo521 • Standing Settions to file a si9netl statement tnat he/she is Ilcensetl punuant to lha provislons ot �, the Con[racror's License Law (Chapter 9(commencing with Soctlon 7000) 01 � G2neretOr �0.5 KW �5-15 KW Traih COtn tto� Oivlsian 3 of [he Business antl Prote55ion5 Cotle) or that �e/she is exem0� � ' � theratrom antl [he basis for.t�e allegea exemption: Any vlolatlon of Soction . 7031.5 �y any applicant for a permit subjects tne apP��nt -to a clvll Reins ctian Fee 3 �enalry of nol more [�an five huntlretl tlollars (5500). PB, $25 Issue Fee S I, as owner ot the oraperty or my amployees wilh wa9es as t�eir sole ' MECHANICAL Rainspaction Fee $25 Issue Fee S 3 compensatlon, will tlo the work, antl the structuro Is not intantletl or olterotl '" FEES for sale (Section 7044, Business antl- Prot¢ssional CoCr. The Contraclor's PUBLIC SERVICES REdU1qEMENTS: Uc¢nse Lew tloes not aDP�Y to an owner O} d p�operty who builtls o� imp�oves BOiI¢f . HOOd O� TypC I ❑ the�eon, antl'who tloez Tuth wo�k hlmselt/he�selt or Ih�ougn h15 or hor own ZoninB Approved By DOte omployees, provitletl ihat such improvements ara no[ Intentlod or offeratl for Canopy Typa I I ❑ ' sale. If, however, the builtling or Improvement is soltl within ono year of com- Duct - Under Ground Applieation Approved By � DatO pletion, tne owner will have the burtlen ot proving he/sho tlitl not bulltl or im- �rove for the purpose ol sale). Duct - Structural Re(rigeration System Applitation Issued By- �� Dat Z- I, as owne� of the prop¢rty, am eXclusively contrdcting wlth 1(c<nsetl con- ❑�-IOO,O00 BTU ❑IOO,OOO BTU L tractors to construct the project (Section ]044, Business antl Pro/essions Cotle: Duct - Ventilating SUMMARV OF FEES ' The Contracior'S License Lsw tloes not apply [o an owner of property who BUI�OING PERMIT builtls or improves tnereon, antl who contracts for such projects wlth a com Exheust System ❑ Multiple ❑ System Repair/Alteration $ SMIP, ' $ tractor(s) lic¢nse pursuanc to,the Contracmr's Licensa Law). PLAN CHECK $ PERMIT . ' ❑ I am exempt untler Section e. 6 P. C. for thls reason - Firepl/Fact, BIt. ICBO # � PLUMBING $ ISSUANCE $ Date ' � Owner � Heating SVstem & Ducting PLAN CHECK $ —��-�/. � ENERGV P.C. $ I hereby certity tnat I have r¢atl mis application antl state that the above ❑0.100,OOOBTU �100,0008T � �(pi 7�/ GRADING $ information is correct. I agree to comv�Y w�tn a I city antl county ortlinances - ELECTRICAL $ �^ , antl state laws relatlng building con uctio , antl,hereby aut�oNze repre- . .../ MICROFILM $ sentatives ot this 'ty o r upo he ove-mentlonep orqp rt o PLAN CHECK $ � inspectlon purpose / �_/� �,� MECHANICAL $ TOTAL FEE $ � � S�gnature af� Reinspection Fee $25 Issue Fee § 3 PLAN CHECK '$ Drivers' LicenSe o�,5 � CMF 0865-46 rev. 7/83 - White - Builtling; Canary - Applican[; Pink - AccounHng; Goltlenrotl�- Assossor . . . _ _ . _ _ . . ' �` CONSTRUCTION AND PIANNING ' POOL & SPA E Date Inspector Date Inspector APPROVALS Permit # APPROVALS Permit # 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement 3."Electrical Conduit Utility�Undrgmd.� . 54. Forms 4: Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. - 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, � Undrgrnd., Test •9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, O Undrgrnd. � 10. Structural Floor System • • 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap ` 63. Heater & Vent-Final -1�3. Roof Drains 64. Plumbing System - Final 14. �Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit ' 66. Solar System-Final �16. Rough Electric Wiring �& �i 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 77. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. fioof 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. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning . . • . �.. � ,. 35. Final Gas Pipe-Test � 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final � 42. Backflow Preventer " � � 43. Backflow Irrigation 44. ,Landscape Irrigation System , 45. Sound Attenuation 46. Handicap Regulations ' 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed � 49. Electric Release ro Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY ' No. Date � Aoo�icant to fill in all spaces except those within heavy bortler lines ana sign all aoorovriate tleclarations. Ci7Y oF COSTA MESa CON TRUCTION P MIT Project Address r � Applicant's Mailing r ss Owner's Name �� Ph � Address � ' Arch/Eng. License No. Address Contractor's Name � '�'Phone Address (mailing) Ciry License No. LICENSED CONTRACTOR OECLARATION ' � 1 hereby affirm that I am licensetl untler provisions of Charter 9(commencin9 with zection 7000) of Division 3 of the Business antl Protessions Co ,pntl my licenseI s in fulyypr antl effect. �y/a' �� Licenze,E�IP �� icens L�� Dafe-- �� 7 —�� S'g t � WORK RS'E COMPENSATION DECLARATION � hereby aifirm that I nave a certificate ot mnsent to It-insure or a certiticate of Workers' Compensation Insurance,-or a certifie copy thereyt (Sectlon 3800, Lab.�r)�n /o o/�{(/� � PolicY No.� {��1'.� � �I) ComPany 8 Certif" tl y i M1ereby �urnishetl. Ce ' y s filetl with the city ' ' . G Oate � Applicant � EXEMP 10 F OM WORKERS' COMPENSATIO DECLARATION (This sectian neetl not be mmpletetl if the permit is for one huntlretl ($100) or less). ' 1 certlfy that in tM1e performance of the wo�k to� which this perm�t is issuetl, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws ot California. Date Si9nature NOTIGE: It, after making this declaration, you shoultl became subject to the Wo�kers' ComOensalion provisions of the LabOr Cotle, you must to�thwith wmply with such provisions or thi5 permit shall be tleemetl rewketl. CONSTRUCTION LENOI� AGENCV I hereby afFl�m ihat there i a onst�uction lentling agency fo� the pertormance of the work tor whic �rmit is issuetl (Section 3097 Civ. C.) Lentler'S Name Lentler's Atlaress _ OWNERBUILDER DECLARATION I hereby a�firm that I am exempt from the Contractor's License Law for the followin9 r¢ason (Se[tion ]031.5 Business antl Professional Cotle: Any city or county whicn requires a petmit to tonst�uct, altet, improve, tlemolish o� repair any structure, prior to its issuance, also requires the applicant for such permit to file a si9n¢tl statemen[ [hat he/she is licensetl pursuant to the Provisions of 'he Contractor'S LicenSe law (Chapter 9(commencing with Section 7000) of )ivi5ion 3 of the 8usiness and Professions Cotle) or tM1at he/she is exempt .herefrom an0 the basis for the alle9etl exemp[ion. Any violation ot Sec[ion 7031.5 by any applican[ for a permit subjects the applicant to a civil penalty of no[ more than five hundretl tlollars ($500). ❑ I, as owne� of the property or my employees with wage5 as thei� sole com0ensation, will tlo the work, antl the structu�e is not intentleG or oft¢retl for zale (Section 7044, Business antl Professional Cotle: The Contractor's License Law Coes not apply to en owner ot a property who builas or improves thereon, ana who tloee such work M1imselt/hereelf or through M1is or her own employees, p�ovitletl that such improvements a�e not intentletl or ofteretl fo� sale. If, �owever, the buildin9 cr improvement is soltl within one year of <om- Oletioq [he owne� will have tne burtlen Of proving he/she tliE no[ builtl or im- �ove for the purpose of sale). LI I, as owner of Ihe property, am exUusively contracting witn licensetl con- fIdC�0I5t0 COI15fIUC[ fhC D�OjCCL ($¢CII00 J�44. BI1510E55 dOt� PIOfE5510O5 COdE: The Contractor's Li[ense Law tloes not apply to an owner of property who builtls or improves thereon, antl who contracts for such orojects wiih a con- tractor(sl license pursuant�to the ConVacto}'s License Law). 1 am aware that proof oF their WOrkev'S Compensation insurance shoultl be provitletl to me. ❑ I am exempt untler Section B. & P. C. for this reason Date Owner 1 hereby certity that 1 have rea� informatiOn is corr cL I agree to antl State laws e tin9 to builtlir sentatives of t' city to en[er ins0ectian purp s. � Signature Drivers' Licenze ar 55 � _� CMF0865-46,rev.4/84 Whi[e- TYPE OFCONSTRUCTION �NEW U ADD LI AI.TERATION IJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,# DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi TVPEOFPERMIT GRADING FOVNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING �CHANICAL 6 Rear ❑ OTHER A PROJECT DESCRIPTION 5[3. FT. ocCuvnNCV C Right K Left CONSTRVCTIONTYPE VALUATION$ $ 20NE � GRADING CU. VDS. ACRES p�ng. Ref. # Remarks: ,Uj ��,� Planning Notes: Bar Sink Backflow Preventer Backtlow Irrigation Bathtubs � Floor Drains Floor Sinks Gas Service Interceptors Kitchen Sink � Lavarories P—Trep . Roof Drains ReinspeMion Fee Outlets $75 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # � Heat g System & Ducting -100,000 BTU O 100,000 BT Heinspection Fee n9; Canary -APPlican[; Gink -Accounting: Goltlenrotl -Assesso� $15 P Showers Service Sink SeWer Cap Sewer Connection Solar Collecmrs Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Cloret Water Heater Water Service - Issue Fee Hood or TYPe I ❑ Canopy Type I I ❑ Refrigeration System ❑0-100 000 BTU ❑100,000 B7 System Repair/Alteration luue Fee FEES $ 3 FEES $ 3 Automatic WaSher Construction Pole Sub. Coaking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. , Fixtures Device Boxes Outlets Switch¢S Garbage Disposal Generator �0-5 KW 3603 7/06/84 Zone Accessory Building: Parking Req./Provided ELECTRICAL ' ,Transformer ❑ 15-50 KW ❑ 50+KW Merer ❑up to 100 amps . .Meter ❑over100amps Sub Panel Moton �0.1 HP O7 %- 8 Inc.Solar �9-15 HP �16-15+ Microwave Pole Light Range ' Standing Sections 15 KW Tresh Compacror I Reinspection Fee I$15 � � Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By 8uilding Approved By �.,r�1�, APpliwtiOn IauOd BV �YY"i� BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL %�L$ PLAN CHECK 25% $ 60011 Tl Z O N I N G R E Q M T 5. FEES $ 3 OF FEES ' _ SMIP $ _ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ _ MICROFILM $ � — TOTALFEE $ �� CONSTRUCTION AND PLANNING PG, .& SPA - APPROVALS Permit# Date� Inspector p�ppROVAIS Permit# Date Inspector 1. Temporary Electrical Service or Pole .. 52. Pool & Equipment Location 2. Soii Pipe; Undrgrnd. ' � 53. Steel Reinforcement - .� 3. ElectricalCondui4Utility-Undrgrnd. ' 54. Forms � . 4. Electrical Conduit-Undrgrnd. - . 55.: Electrical Bonding ' 5. Sreel Reinforcement ' 56. �Rough Plumbing & Pressure Test 6• �Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE � 7. Footings� .� �- 58. Electrical Conduit-Undrgmd. � - ��8. Foundation ' � 59. Gas Pipe�, � Undrgrnd., Test � 9. Water Pipe-Undrgmd. ' � 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 Plumbin9 65. Electrical-Final � 15. Rough Electrical�-Conduit � 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 77. Raugh Wiring Sign 68. APPROVED FOR PLASTERING . 18. Rough Electrical-T Bar Ceiling ' 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning 7/ �r� �p FIRE DEPT. REQUIREMENT � 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil � 23. Gas Pipe-Rough & Test 72. Underground Flush ' 24. Roof Framing � ' 73. Undergrnd. 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 �D�/Y%pk �-�� 35. Final Gas Pipe-Test - ' � 36. Hood or Canopy ' - � 37. Final Factory Fireplace . 38. Final Plumbing . � 39. Water Service-Final . 40. Gas Service-Final - 41. Solar pomesticFinal , _ , 42. Backflow Preventer . . 43. Backflow Irrigation , . . 44. .Landscape Irrigation System 45. Sound Attenuation ' 46. Handirap Regulations � � 47. FINALSTRUCTURE&BUILDING � � . , 48. Special Requirements Completed � 49. Electric Release to Edison � -� • 50. Gas Release to Southern California Gas Co , 51. CERTIFICATE OF OCCUPANCY � No. Date .. } Applicant to fill in all spaces excep[ those wilhin heavy borCer lines antl sign all aOP�opriate tlecla�alions. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. ,� _ � TRACT NO. LOT NO. UNIT NO. ProjectAddress 3411 Geranium St. �ApplicanYs Mailing Address Owner'sName Standar� Pacif�c COY��1- Phone54F-��h� Address ��65 W MacArthur Costa Mesa q2�26 -�� Arch/Eng. License No. Address - ' Contracmr'sName—j\Q{eJ DI�T,hin�n Phone�]�4.a ' Addresslmailingl 719� N. Fee i�pd 'An�heim � ' � City License Na. ��R71 - LICENSED CONTRACTOR DECLARATION � ' � I hereby afflrm that I am licensetl untler p�ov ons of.Charter 9(commencing with sectian ]000) ot Division 3 of the Bu iness ntl Protessions Cotle, antl my license is in full fo ce tl eff c � License class �'�� cense No. 426109 � oate �(1/�SEa Signature � � �ORKERS' COMPENSATION DECLARA ION I • � . hereby �affirm that I have a certi(icate bf consent to selt-insure or a ce�tificate of Workers'_Compensitioq Insurance, or a certifietl, copy thereof (Section 380Q Labp. ) l - Poi��v NQW�' 177�� 4� � Company 'Nome ❑ CertiTietl copy is hereby furnishetl. ' � � � �I �r,(rt,i cj� is tiletl with the city�g uiltli Divi �op. i at .W.f ��/�� APPlicant NPW `�'1 um�i ng EXEMPTION FROM WORKERS' COMPENSATION OEGLARATION (This section neetl nat be completetl it the permit is for one huntlretl ($100) or " Iess), : 1 certify that in the performance of tne work for which this permk is issuetl, I shall'nof employ any person in any manner so as to become subject to the Workers' Compensation Laws of Calitornia. � Date Signature ' NOTICE: If, afte� making this tleclaration, you shoultl become subjedt to the Workers' Compensation provisions ot the Labor Cotle, you must forthwith wmply with sucit p�ovisions or this permit Shall be'tleemetl revoketl. CONSTRUCTION LENDING AGENCV. � I bereby affirm that there is a mns[ruction lentling agency for the performance of tne work for which this permit is issuetl (Section .3097 Civ. C.) Lentler's Name Lentler's Atlaress � OWNER BUILDER DECLARATION I hereby atfirm that I am exempt from the Contractor's'License Law for the followin9 reason (Section �03L5 Business antl�7roTessional Cotle: Any ciTy ar county which requires a pe�mit to construct, alte�, impwve, tlemoli5h or repai� any structure, prior to its is5uance, also requives the applicant for sucti pe�mit !o file a signetl statement that he/sM1e is licensetl pursuant to the provisions of he Contractor's License Law (Chapter 9(commencing with Section ]000) of Jivision 3 of the Business antl Protessions Cotle) or that he/she i5 exempt � therefrom antl the basis tor the alle9etl exemption. Any violation of Section 7031.5 by any. applicant tor a permit subjects the� applicant to a civil eenalty of not more than tive huntlretl dollars ($500j. � LJ I, as owner of the property o� rtiy employees witM1 wages as their sole compensation, will do the work, antl the structure is not intentlea or ofteretl for sale (Section ]044, Busines5 antl Professional Cotle: The Conkractor's License'Law does not apply to an owner ot a prope�ty who builtls ar imp�oves Ihereon, antl, who tloes such work him5elf/he�self or th�ou9h his or her own em0�oyees, provitletl that such improvements are not intentletl o� otteretl for Sale. It, howeveq the builtling cr improvement is soltl within one year oi com- pletion, the owner will' have the burtlen of proving he/she tliC not builtl or im- prove tar the purpose of sale). ❑ I, az owner of the property, am exclusivery contracting witM1 licensetl con- tractors to mnSVuct the praject (Section 7044, eusiness antl Protessions Code: The Contractor'S License Law tloes not apply to an owner ot property who builtls or improves thereon, antl who conVacts tor Such projects with a con- tractor(i) license pursuant-to the Contractor's License L.aw). I am aware,that pvoof ot their Worker'S Compensation insurance ShoWtl be provitletl to me. ❑ 1 am exempt untler Section B. & P. C. for this reason Date Owner - I hereby certity that I nave reatl Kis pplication antl state that the above intormation is correcL I agree to S�mpl with all city antl county ortlinances Signature � Drivers' License ar 55 � TYPE OF CONSTRUCTION �.%NEW U ADD LI ALTERATION LI REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPE OF PEHMIT � LJ GRADING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICALx� PLUMBING ❑ MECHANICAL ' ❑ �OTHER � � ' ' • PROJECT DESCRIPTION 5r3. Fr. occuPANCv_ CONSTRVCTION TYPE VAIUATION $ ' ZONE GRA�ING CU. VDS. ACRES_ marks: , _ Sink <flow Preventer -- cflow Irrigation Dishwasher � � Drinking Fountains ' Floor Orains ' FloocSinks . GasService 6 Outletsi Interceptors� - Kitchen Sink ' LdVdLOfIES - . P-Trap Roof Drains � Showers Service Sink� � $ewer Cap � � Sewer Connection Solar Coilecmrs Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet . � Water Heater � Water Service � n EES A.P. # S Main Building: E T Front A Rear _ C Fli9ht K g Left Ping. Ref. # Planning Notes: " iiOLOfi13LIC W35f1E1 � — Construction PoleSub, Caoking Unit . Dishwasher . ReinspeMion Fee I $15' I Issue Fee I $ 3 Boiler Duct - Under Ground � Duc[ - Structural Duct - Ventilating . Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ' ❑0-700,000 BTU 0100,OOOBT� Reinspection Fee � $15 CMF0865-46,rev.4/84 White-Builtling;Canary-ApplicanqPink-Actounting;Goldenrotl-Assessor Hood or Typel ❑ Canopy Type I I ❑ Refrigeration Sys[em ❑0-100,OOOBTU ❑700,000 System Repair/Alteration Issue Fee � $ 3 uryers uoas ut Fan F.A,U. � Fixtures . . Device Boxes Outlets Switches Garba9e Disposal Generator �0-5 KN lectr oii2 I�/12/84 �.�o r�. Zone ' Accessory Buildinq: ' . Z � O �' . N � . N , • G ' R � Parking Req./Provided E� Q M T S. ELEC7RICAL � . Transformer ❑ 15-50 KW- ' ❑ 50+ KW Meter ❑up to 700 amps � ,Meter ❑over100amps; Sub Panel . Motors DO-1 HP �1 %- 8 - Inc. Solar �9-15 HP �16-15+ Microwave ' . _ Pole Li9ht LI' Standing'Sections 5-15 KW Trash Compacior FEES � Reinspection Fee �$15 � I Issue Fee � I $ 3 I DEVELOPMENTSERVICESREQUIREMENTS: Zonin9 Approved By Date '� Building Approved By Date � ' Application Issued By Date SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT � PLUMBING $ .�i.�D ISSUANCE $ PLAN CHECK 25% $ ' ENERGV P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ r��7li PLAN CHECK 25% $ . � �- CONSTRUCTION AND PLANNING . P� �& SPA , APhROVALS Permit#� � Date � Inspector p�ppROVALS �� Permit# "" Date Inspector.. -1. Temporary Electrical SerJice or Pole � . ' , 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. �- 53. Steel-Reinforcement � �� 3. Electrical�Conduit U[iliry;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-GUNIiE � 7. FOotings - � �ti., - - . 58. Electrical Conduit-Undrgrnd. , 8. Fpundation, � _ ' , , 59. �Gas Pipe, O Undrgrnd., Test - � �il f 9. Nlater Pipe-Undrgrnd. �� , � � 60. Backwash Lines, P-Trap, O Undrgrnd. - r, i. • 10. Structural Floor System -' � 61. APPROVAL TO DECK , . � 1�1. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final " .. 12. Sewer Cap ' - 63. Heater & Vent-Final - - � 13. Roof Drains � , �. 64. Plumbing System � Final -, _ i ' 14. RougFiPlumbing _ 65. Electrical-Final � • . �) 15. Rough Electrical-Conduit � � � - - - � - 66. Solar System-Final '- � - 16. Rough Electric Wiring � - � � � 67. Fencing & Access �Approval . � 17.� Rough Wiring Sign , ' i� 68. APPROVED FOR PLASTERING 18.,.Rougli Electrical-T Bar Ceiling ' 69. POOL/SPA SYSTEMS FINAL 19. f?ougfi Heating & Air Conditioning . FIRE DEPT. REQUIREMENT � 20.� Rough Factory Fireplace , � - APPROVALS Permit # 21: Ducts, in Sfructure � � ' ' . 70. Underground Hydro '' . . 22. Ducts, Ventilating - �- � , � 71. Product Piping O Gas ❑ Oil �� 23. Gas'Pipe-Rough & Test - , � , 72: Underground Flush � . 24. Roof Framing � . 73. Undergmd.StorageTank �Gas ❑Oil � � 25. Roof Sheathing ' '74. Overhead Hydro 26. T-Bar Ceiling (Siructural) & Monocoat � " 75, Dry Chemical � 27. Frame and Flashing � . , . . 76. Dry Standpipe � 28� �athing & 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-Te'st ��, �Q��Y (,�l�� ' .. 36. Hood or Canopy � � � � ' . � ' , � � � 37. Final Factory Fireplace . , ' � ' 38. Final Plumbing � � , i 39. Water Service-Final ! � . 40. Gas,Service-Final � � . � 41. Solar pomestic�Final ' .' � I ' � ' 42. Backflow Preventer � � � - ' � 1 43. Backflow Irrigation � . - � ' � . 44. �landscape Irrigation System - � ' 45. Sound Attehuation � 46. Handicap Regulations ' 47. FINALSTRUCTURE'&�BUILDING � � � 48. Special Requirements Completed ' � � . i 49. Electrie Release to Edison � � . ' � - � - � 50. Gas Rele'ase to Southem Califomia Gas Co ' ' � . � 51. CERTIFICATEOF.00CUPANCY , 1 . � . No. � � Date ' �, ' �