HomeMy WebLinkAbout3412 GERANIUM ST - Building Permits♦.
November 30, 1998
�.,.,
CITY OF COSTA MESA
CALIFORNIA 9262&1200 P.O. BOX 1200 �� �
DEVELOPMEM SERVICES DEPAR7MENT
Mr. Abdallah Morelli
3412 Geranium St.
Costa Mesa, CA 92626
RE: Block Wall Permit #B98-02107
Deaz Mr. MoRelli:
On November 20, 1998, a building permit was issued to Ben Concrete, principal Fetuli
Penitani, for the construction of masonry walls on your property. Unfortunately, it has
come to our attention that Ben Concrete lacks a State G29 license to perform masonry
construction. Pursuant to Sec. 106.4.5 of the 1994 edition of the Uniform Building Code,
the building permit issued to Ben Concrete has been �evoked as it was issued erroneously
by the City.
It shall be necessary for you to obtain the required permits for construction either by
obtaining an "owner-builder" permit or by retaining the services of a properly licensed
masonry contractor.
We apologize for any inconvenience this has caused. Should you need further
clazification or assistance, you may contact me at (714) 754-5615, Monday through
Friday between 7:30am and S:OOpm.
Sincerely,
��" / / '�'�/
U
Burt D. Morgan
Chief Plans Examiner
cc: Rick A. Brown
Victor Clift
T7 FAIR DRIVE
Builtling Divislon (714) 7545273 Code Enforcement (714) 754-5623 • Plenning Division (714) 754-5245
FAX p14) 754-4856 • TDO ptb) 754-5244
�(� M� 9
o �
>
�
J �
� fi;
�
(714) 754-5273 • Fax (714) 754-4856
CITY OF COSTA MESA
B11/LDING D/VISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
BUILDING PERMIT
JobAddress: .i41Z GERANIUM ST '
Suite:
Vicinity:
Parcel Nunmber: 4123i210 Zoning: R1 R1
Applicant FETULI PENITANI
Address: 1920 6ATSON AV
ROWLqND HEIGHTS, CA
Owner: MOR�LLI, ABDALLAH
Address MORELLI, SARAH A
COSTq MESA,CA
3472 GERANIUM ST
Contrector: BEN CONCRETE
Address: 1920 BATSON AV
UNIT y76
ROWLqND HTS.
�Arch / Eng :
Address:
Plan Check:
Permik
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
Phone: (626) 810-7694
Zip: 91748
Phone:
Zip: 92626
Phone: 626-870-7694
Zip: 91748
License� � 747709
���
PERMIT NUMBER
698-02107
77 FAIR DRIVE, COSTA MESA, CA 92626
�`
Status: ISSUED
Applied: 11/20/1998
Issued: 11/20/1998
Phone:
Zip:
� License: ..
SCOPE OF PERMIT
CONSTRUCT 6' HIGH, 171-FOOT LONG BLOCK WALL ALONG THE REAR (64 FT), AND SIDE (37 FT.
AND 76 FT.) PROPERTY LINES. 31' SIDE SHARED W/ 1005 BEGONIA; 76' SHARED W/3408��
GERANIUM; AND 64' REAR SHARED W/3407 FUCHSIA. ��
$56.71
$87.25
$0.00
$0.00
$0.00
$0.00
$143.96
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING Existina: p
NOTES:
Rear 0- 0
Rear 0-0
Reauired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Lek 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
$3,420.00
so.00
��'��I� �I��°��g
��
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or it work is suspended or abandoned
for a period of 180 days. .
INSPECTIONS: In order for the work authorizetl under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of Ihis permit.
FOR INSPECTIONS CALL: (774) 7545626
WORKERS' COMPENSATION DECLARATION:
I hereby aflirm under penalry of pe�ury one of Ihe tollowing declaretions: �
❑ I heve entl will maintain e certHicete ot consent to selFlnsure tor workors' compensation, as provitled for by section 3700 oi the Lebor Code, for Ihe pertormance of the
work tor whlch Ihls permit is issuetl. -
❑ I have antl wiil meintain workers' compensation insurance, es requiretl by seIXion 3700 of ihe Lebor Cotle, for ihe peAormance oi ihe work for which this partnit is issuetl.
My worker�' compens Insura%c���� er end po'cy number ere: '
Cerrier: �'�_� f�C�_�� Policy Numher. �
(This sectian need not be completed i! fhe pertnit is velued a( one hundretl tlollers ($700) or /ess.J ,
❑ I certify ihet In the peAormance ot the work for which ihis permit is issuetl, I shall not employ any person in any menner so es to 6ecome subject to the workers'
compensation lews ol Celifornie, d egree that If I should become sublect to the workers' compensation provisions of Section 3700 ot the Lebor Code, 1 shell fohhwith
comply wi�h IheSe provi ' - ' / /� �%
Applicanl Signeture: � �wf � Date: iy� �/ � ��"
WAFNING: FAILUPE TO SECURE WORKERS' COMPENSATION COVEPAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES ANO CIVIL FINES UP TOIXJE HUNDRED
TIIOUSAND Dq1ARE (5100.000�, IN ADDITION TO THE C0.5T OF CAMPENSNTION, DNAAGES PS PROVI�ED FOR IN SECTION 3]O60F THE LABOR COOE. IMEREST, AND FTTORNEV'S FEES.
LICENSED CONTRACTORS UECLARATION:
I hereby aRirm thet I em li�'�� qtler provisio�s of Chepter 9(commencing with Section 7000) ot Division 3 of the Business �pd Prolessiors Code, end my license is in tull
brce and eHec�. Lic. N /'/ �' � Class N r �i
Contreciofs SigneWre: �i - E. . �� Date: �"�� �- r —� f!
CONS7RUCTION LENDING AGENCV: �'
❑ I here6y eNirm thet there is a constmctian lending agency for Ihe peAormance ot iha wark for which this pertnil is issued. (Sec. 3097, Clvil Code).
Lender's Name: Lendefs Address:
Signature: Date:
OWNER•BUILDER DECLARATIONS:
I hereby eHirm ihet under penalty ot per�ury Ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the followinq reeson (Sec. 7031.5, Business entl Professions
Cotle: Any ciry or county which reQuires e permit ro constmct, alter, improve, demollsh, or repalr eny stmcture, pnor to its issuance, also requires the applicant for such pertnit
ro file e signed stetement that he or she is licensed pursuent to Ihe provislons of the CONrectors License Law (Chapter 9(commencing with Section 7000) of Division 3 ot ihe
Business and Prolessions Cotle) or Ihat he or she is exempt therefrom end the besis for the alleged axemption. Any violation of Section 7031.5 by any applicant for a permit
sub�ects the epplicent to e ciwl penalry of not more than five huntlretl tlollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sola campensation, WILL DO THE WORK, entl the structura Is not intended or oNered for sala (Sec.
7044, Busineu entl Professions Code: Tha Contractors License Law does not apply to an owner of properry who builtls or Improves thereon, and who does such work
himself or harsell ar through his or her own employees, provitletl t�at such ImD�ovements ere not intentletl or atfereA lor sale. If, however, the Cuilding or Improvement is
sold within one year ot completlon, Iha owner-builder wlll �ave the bur0en of proving that �e or s�e tlitl not bullU or improve for purposa of sela.).
❑ I, es owner ot the property, am EXCLUSIVELY CONTRACTING WI7H LICENSED WNTRACTORS to construct the project (Sec. 7044, Business end Professions
Code: The contrectors License Lew does not epply to an owner ot property who bulids or Impmves thereon, end w�o coniracts tor such prqect wlth e coniractor(s)
license pursuant to ihe Contractars License LawsJ.
❑ I am exempt under sec. Business antl Professions Code tor this reason:
Signature: Date:
Owner 1� venfied by driver's license. � Ves ❑ Na Dnver's license No. Expires:
Veritication of Ownership by (rype af tlocumenL i.e. - properry rex bill or tleed):
DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATON:
❑ I hereby certity that no ezcevatlon live (5) or more taet In tlepth into which e person is requlred to descend, wlll ba metle In connectlon with work authodzed by ihis
pertnil, end thet no bulltling structure, scaffolding, telsework, or tlemolitlon or dismantling Ihereof, will be more than ihirry-sin (3fi) feet hlgh. (Chep. 3.2, Grp 2, Art 2, Sec.
341, 71t1e B, Celitarnla Adminisiretiva Cotle).
❑ As owner-builder, I will not employ anyone to do work which woultl require a pertnit from the Division of Industnel Safery, es noted ebove, unless such person has a
pertnil to do such work from the division.
Signetura: Date:
DlNsion of Industrial Sefery Pertnit Numbec
CER7IFlCATE OF COMPLIANCE AND Al7T}IORVA710N OF ENTRY: I ceAity under penalry of perjury that I have read Ihis epplication and slate that ihe informetion given is
correcL I agree to comply with all state laws and ciry ordinences relating to builtling consimction, and authonze representetives of Iha Ciry of Costa Mesa lo enter upon the
e6ove-descn6ed property for inspection purposes. I egree not to occupy or allow occupancy of any building authonzed by Ihis permit until final inspection.
,�/�� 5�_�pyne�tyUre--O�f Legal Owner(s) � ��/ /y���� Da,te
/�Ct2�_/_�. n �7 - ! �
- AntllOr Authonzed Applicant Date
CODE I, INSVECTIONTYPE QAIE It�ALS
1616 Fizetl System Finel Fire Prevention
1266
200
201
202
203
Pool Spe Finel
Flnel Re-Rool
Finel BIaWRetaining Wall
Finel Factory Fire Place
Final Sign
204 Finel Demolition
2446-46
COOE� INSiECTIONTYPE
206 Final Mechanical
200 Final Plumbing
210 Final Elacirical
212 Final Fire Prevention
220 Final Planning Approval
222
250
Final Site
Final BuilAing/Occupancy
UAff U�dLS
�
�
�v�
�t tt� f �
�
I ,,� I
i'p/ sp�6 .z71- • � �
, � �, p,.. .� %/
� � f e,�,
y� / . ' j ' i�
� ., . . � . . � s , � �: I �
. i/i � :� � • '° � irY V I �
/v'_s �te il'/ � ' /� rr.as 1
�' 1t[
�� � �
I mffJ are � N ` � �. ; ' �� �� I ��I }� �� � h
, ff.�� k �X� �.� '. +c� n.�i� , II fi
� � .. ,J R . il
y� .S . �,) .SR � I D.
F-. t� a I ' '+o•
���;; �41 , . p _,__�� � �
���.� .� K�.o � o , ,� ��
„ ��
.: �c ,v • -.'�C l� �' � (
y'� - ---- . �� •,. ��
T� ,�-� .,•' e .
S tla � ..�� O �� �.� �' .�,�II II
. � � � � q -t=, y � �p �'f
�� �� �'�� Q ��
�
. . � �D � . i � � �� ' . � ��
� � �� j ' �
,� ` �� � "° ' u� � II
� � ' � ii I II
��/� � y I 11
� ry I �
I � � � 1 N:: +Y% � /' � 'rQ � � • • I I � ll \
� . '�s. ^ g
n' � � h p ; � � h ` �i
p . � J � � v �' ' : O � �, �: � :: ,� il
1 % \
� �J Q, '�_../ \DIVI N �9 ii � ��;� .
'.�.: l...s i..
��� � � ��/ J! � J `�
I �' � ,.. ;O fr _� —'�P''. ' / ' � �� � / �8
, —.. = I �� _
i I �y' � lzRs er�d s e�l�ktions MUST bq ni unf�h� J at a11 �enas end is untawtm ro
r ��--- —� �� arc�esaa..raziona�s�ren�mr.ta�j ioniromtheD' onofBuil�ay
�'F a �f'� : nd Satety� iry ot • h1e�.
� �. yy � u� a^.d specific�^lia�s SHA:11;Q� � fo o an approvel
� � :ol ' b� prov�s.ans of 2ny CBy oi Co�talM ; aRt an 'ur State law.
I �'Ns � � rm sl�aJexp�� y unilatic ,I ebiuldingor
+ , J!E Sv , �y. ti,� '��mmenca a�d rna;r,t�'�?:iive r r� 80 ��s of issuance.
1.� ior/ � �' � !t! � � �--� .
. �
� . �- � ° � . R � ` , $9�_ !0 7
� ' ��
:_ � � �x,au
��p � � � � I Q[�
1 � � '�. � . .,, ��
7 • J� Y
� �I,TY Of COS� D vESA _
PLANNIN� REG.
p BLDG. DEPT• '
. SUBJf �T�
� DATE
� w
. � b o�
� �_ �_
�r �
TYFICAL 6�� CONCRETE BLOCK FENCE
Cemenl Copirg Opdonal —
Channel Bbck W ith 7��JB �
Horiio�ul Top ol all
f ences
Fo� Fcnces 5' or less
Ven. Bars 3/8"4S at 4' �0" O.C.
for Fencea Higher Than 5'
Vart. Ban 3/B"� at 32" O.C. �
Fill Ce��t Solid With Grout
W here Steel Occurs
Rr.�nl.rrcing Slne� Shall
Cunlotm tn Sec.A�15-79
A.S.T M.
Ail Stce{ to be Upped
24" alto Code
NATURAlGRAOE
TWO 7/e"'O BARS �-1
CONiINU0U5TOP �
b BOTTOM .
MOQIiS�EEI MUS( B£ (IEU IN
PLACE A� TIME OF TRENCM
INSPECTION.
L
VI h
4
��
n 'p i�
., n - '
D I
F-+-- N' I DT M
p SEE CMt
� BEIOw
�I.
W�DTH
THICKNESS
DEPiH OF EARTHTOOTH
SPACING OF EARTHTOOTH
I 4"
I O"
2 4"
12'
N�
FOOTING RE�UIREMENTSICHART
I4" .
10''
20"
14' . ,
BUILDING DIVISION
:,,;�:
12-
e•
16"
16'
GENERAL- NOTES
MORTAR: pne Parf Plasfit Cemenf�
Three Parts Sund
GROUT: One Parl Cemenf TNee ana
One HOIt Ports S�and
COPING: One Par1 Cemenf, T�ree
PartS Sand
CONCFiETE: Well M�aed 1:2-I/2:3-I/2
Moi ol 7-V2 GoNans of
Woler Per Sock of Cemenf
GHOUT MAY dE POUqED FHOM THE TOY
OI' TMC FENCE IN CELLS WHIqE S�EEL
OCCURS.
l'! LLS ANO AREASOF f10NIZON7Al NEIN
FOHCEMENT SHALL BE CIEAN, CLEAN 6
FREC OL ALL MOPTAq OEBH15, ETC.
�� t.�' C4FTHTCOIH
VJ �riE HE�GTn Of i'ENCE
B�IOW BOTTOM Oi FOGT�NG
SCALE: 1l2�� = I'
12"
9"
12"
i6'
�.
,
�. //
- y'�Q' 6�p/ _ep,s .arr- ' � i
/ + � 4`' �' ��p r � ',. .' I!
i /. � P . � � . � � , II
� � . � ���g• 6 Na.r � � • N� j � rr.us �� � �
1 �� o. " �t[ 0
r � ��,� �• 1� i m,�r, .�re ` �d ;. e • .. • �v �i� I
� � Wi ; ff.�., � .�.�� :T �� ;,� ,�,� ; � � II � h II
+ �. : s , s� �• ,� � � �'i (I II
/ I � F}� '� A1 � �' I �` e
/� zo
' r! .; Q� �
I �.s�'� ,. ' I
) I s.� , ��`� ..�, K�•Q � O I ���� ��
.s ;; '� �'�. �7' x' T�L l� :m' � tP''' I I
� II
._
� y .^ oo+ �:t .,s. e ..
0 � � w 1.� ' � IwA/�
°,, `�, � I
e �_ � , {«-
� � � �� � �� + � �� �� � ��
.,,�..u,,,�.� � r C1 �` ` . .�� � �� �� , � ��
-� l�F . . � � �A � , , , II II
��' ` �° II
. 9 ,� � �
�- � � � � �� � � , i ; �� I l�
� �� ��
a '.�;: � � '�� 1Q � . . � � ��
� • N ,� : �; � `
.i� 13 n e�' � � se• �� � � �
�. �'' "'� s. � v ° h �i � � a v. a .� II 3�\
'. � � � r_. �.�_ % \ c� * _ �
" _/ r
�N �. � • �Y
' � �- ,,,� �O �� ,, %aake� °� and �: ��'� � � —
� ^ 1'
� �{� o� a.,e. ro'p� SMUSr� I ll —
i � �, 71re Cosla�, s3��+k��e�at� � ,
1re
�r �r
p, -r � -�'— -'1 v,; �kP�g �a,r�,Pe� 9r;r�s- 1
!�r �F r �py� rdF.anl'P;o Aciir�qW,��� I �D �?is �;aK"q�to
� � �^ r�,�en m+il �, !e an% Ci1Y of ��'Oi(�, to �� �tlrJ ' 1
3/! �� bYliin+�,��- �ad,r��r
��•��i:,. � , j 1 �30 %r ♦ nd"7''''''ti:f � � � v2; O
� j� {Q io�i �. � � � ��U3� ��?'h -'��Sta ldW. A
� � � �� L� tlal�c(�,S w f` a
y � ' `�" • ,; , �. ��
s W � � � '� � �x�ar
,
f c� �,,� r • � r � �
� ' � � kr. ,, v�
_ _ 4 � � �
� �r+ . � � �--
���� �--- ' o.'�
CITY OF COSTq MESq + � � ���� �' I
PLANNING � • � Q � �
SUB ECT TO DIV. ^ k
` ��� 1
BY � � `
� ,� � _DATE ��
6' ,fI` �° °'eA - �ea.,,�4'��.er � \
Gament Copinp Optional �'
Channel0bck With 1�3/8�
Ho�i:ontal Top ol all
Fencn
For Fencea 5' or Less
Vert. Bars 318"Q+at <' �0" O.C.
For fences Higher Than 5'
Ve�t. Ban 3/8"Q at 32" O.C. �
Fill Cells SoliG With Grout
W hete Steel Otcurs
qcinlorcing S��N SAall
Conbrm lo Sec.A-15-39
A.S. T.M,
All Sleel lo be Lappad
24" or to Code
TYPICAL 6�� CONCRETE BLOCK FENCE
LL
�e
z
�O
NATURAIGRADE
,�,, � :.
�;'lll.. C�<�� , . � .�^e N
o _
7W07/B"OBARS - n�
CONTINUOUS TOP I
6BOTTOM . .-�y �µ�DTH
� SEf CMA
NOR1iSTEEL MUST BE TIED IN ', BEIOW
Pl4CE AT T1ME OF TRENCH I
INSFECTION. y L
I WIUTH . . . . .
THICKNESS
�� OEPTH OF EARTHTOOTH
SPACING OF EARTHTQOTH
i`.' • ..
FOOTING RE�UIREMENTS CHART
6 : 5. : ; 4.
I V" . . . . . � _.14'. . . . . : . � 12�
I O�� ' 10'� g "
24' 20" . . , 16��
i 2' -14' . _ . .:{,6 �
� . . . . ��; ,
BUILDING DIVISION � ` .
GENERAL- NOTES
MORTAR; One Parf Plastic Cement, onE
Thret Parfs Sond
GROUT; One Port Cemenf Tlvee ana
One HOIf Poris S�and
COPING: One Part Cement, T�ree
Parts Sand
CONCRETE: Weil Mued 1:2- V2: 3- I/2
Ma■ of 7-If2 GoNens ot
Waler Per Sack pf Cement
GNOVT MAV BE POUHED FPOM THE TOP
Oi 1NC FENCE IN CELLS WHEqE $TEE�
OCCUNS.
CEL1.51�ND 4AEASOF HORIZONTAL REIN
FONCEMENT SNALL BE C�EAR, CLEAN 6
fREE QF ALL MORTAR OEBRIS, ETC.
H C1 C4RTNTCOTH
VJ �ME HEiGTM O� FENCE
BTLOW BOTTOM Of fOGT�NG
< : .
�� i� . . �.
SCALE: 1/2'� = 1'
12
8"
12"
t6'
�� O MFS
t �
0
, _
�
0
.�`' ��
�+Ao
(714) 754-5273 • Fax (714) 754-4856
CITY OF COSTA MESA
BUILDING DIYISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
Jobnddress: 3412 GERANIUM ST
Suite:
Vicinily:
Parcel Nunmber: 41237210
Applicant: HOPOI, SULIANA
Address:
owner: MORELLI, ABDALLAH
Address � MORELLI, SARAH A
COSTA MESA,CA .
3472 GERANIUM ST
Contractor: SULIANA MAILIA HOPOI
Address: 110 E 68 ST �
BUILDING PERMIT
Zoning: R1 R1
Phone:
Zip:
Phone:
Zip: 92626
� � PERMIT NUMBER
698-02166 �
77 FAIF DRIVE, COSTA MESA, CA 92626
Status: ISSUED ' "�
Applied: 12/03/1998
Issued: 12/03/1998
� Phone: 562 296-0089
LONG BEACH, CA 2ip: 90805
� License: 639249
Arch / Eng : � -
Address: - �
Phone:
Zip:
License:
SCOPE OF PERMIT
TO PERMIT BLOCK WALLS ALREADY ISSUED PREVIOUSLY BUT REVOKED DUE TO CONTR4CTOR LICNSE
PROBLES, REF:698-02107: CONSTRUCT 171 BLOCK WALL - ALONG REAR (64 LIN FT) ALONG SIDE
(31 LIN FT AND 76 LIN FT.).
PLANNING APPROVED UNDER 898-02107 �
FEE SUMMARY
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$48.59
$74.75
$0.50
$0.00
$0.00
$0.00
$123.84
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING existinq: o
NOTES:
Rear 0-0
Rear 0- 0
Required: 0
PLANNING & ZONING
Left 0- 0
Left 0- 0
Pr000sed: 0
Calc Valuation: sz,sao.00
Claim Valuation: So.00
Right 0-0
Riqh[ 0-0
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 1 BO days. .
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inapaetions 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) 754-5626
WORKERS' COMPENSATION DECLAppTION:
I hereby aHirtn undar penalry of perjury one ol the following declarations:
❑ I heva end will meintain a certifica(e of consent to self-Insure br workers' compensallon, as providetl for by section 3700 of the Lebor Code, tor the pertormence oi the
work lor which this permit is issuetl.
❑ I have entl will maintain workers' cpmpensation insurance, as required by section 3700 0l the Labor Code, tor the peAortnanca of ihe work for which Ihis pertnii is issued.
My workers' compensation Insurence cartier entl policy number are:
Cartier: Policy Num6er.
(ThIs secfion neeU not be crompletetl i/ the permi( is ve/uetl e! one hundred Oollars ($100) or Ie55.J
❑ I certify thet in the peAortnance af ihe work tor which this pertnit is issueq I shall noi employ any person in any manner so es to become sublect to the workers'
compensetion lews of California, e�d egree ihat il I sh uld become subject to the warkers' compensation provisions ol Sec on 00 of lhe Labor Cotle, I shall forthwith
comply.wllh ihes � visi�j�'��,� �,/ /9��, � �% /
Applicanvignet . y( .� y/ • �/'�C/� •-ps�e: /2 �
WARNING: FAI RE TO SEEURE WORKERS' �pMPENSATIIXJ RA IS LAWFUL nND SHALL SUBJECT AN EMPIOVER i0 CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNORED
TiqU$ANO OOLLAflE (E100,O00�, IN AOOIiIOry TO THE COSi OFfAMPEN$A � N, DANAGES AS PFOVIDED FOR IN SECTION 31O60F THE L400F fAOE, IMEFEST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm thet I em licensetl untler provisions ot Chepter 9(commencing with Section 7000) of Divislon 3 of the Business�^ d Professior�s Coda, entl my license is in full
force entl eNecL Lic. N Class q � 1
CoNrecior6 S` �=et�� �i w(Y4 .'//. �_ Date: i2
� _
CONSTRUCTION LENDING AGENCY: "'
❑ I hereby aMirm thet there is a consimction lentling agoncy tor the peAortnance ot the work for which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Signeture: _
OWNER-BUILDER DECLARATIONS:
Lenders Address:
Data:
I hereby attirm Ihet under penalty ot perlVry Ihet I em EXEMPT FROM THE CONTRAC70RS LICENSE LAW tor the following reason (Sec. 7031.5, Business end Professions
Cotle: Any ciry or counry which requlres a permit to consimcL alter, Improve, demolish, or repeir any stmcwre, prior to its issuance, elso requires ihe applicam for such permlt
to file e signetl statement that he or she Is Ilcensed pursuant to the provisions of the Contrectors License lew (CheD�ar 9(commencing with Sectlon 7000) of Division 3 of the
Business antl Protessions Coda) or that he or she is e:empt therefrom and tha besis tor the alleged exemption. Any violatlon ot Section 7031.5 6y any applicant for a permit
sublects the epplicant to e civA penalry of not mare Ihan five hundred dollars ($500).):
❑ I, es owner of the properry. or my employees with weges as iheir sole wmpensation, WILL DO THE WORK, antl the structura is not intentled or oMered far sale (Sec.
7044, Busineu entl Professions Code: The Coniractors License Law does not apply to en owner of properry who huilds or improves thereon, and who tloes such work
himself or herself or through his or her own employees, provided Ihat such Improvements ere not intentletl or offered lor sale. II, however, tha builtling or improvement is
sold within one year ot complation, the owner-builder will �ave the burtlen of proving ihat he or she did not builtl or improve for purpose of sale.).
❑ I, as owner of Ihe property, am EXCLUSIVELY CONTRAL7ING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business ana Professions
Cotle: Tha contractors License Law does not epply to en owner ot properry who builds or Improves Ihereon, and w�o coniracts tor such prolect wit� a contrector(s)
license pursuent to ihe Contractorg �cense Laws.).
❑ I em eaempt under sec.
Signetura:
Owner ID verified by drivefs license. ❑ Yes ❑ No
Business antl Pmfessions Code lor this reason:
Vedflcation of Ownership Dy (type of document, i.e. - property taa bill or deed):
Driver's License No.
Dete:
Ezpires:
DIVISION OF INDUSTRIAL SAFE7Y PERMR CERTIFICA710N:
❑ I �ereby certlly thai no excavation live (5) or more feet in depth into which a person Is requiretl to tlescend, will be mede In connection with work aut�onzetl by this
permit, end thet no builtling structure, scaflolCing, falsework, or demolition or tlismaniling t�ereof, will be more then thirry-six (36) feet hlgh. (Chep. 32, Grp 2, Art 2, Sec.
341, Title 8, Celitomia Adminislrallve Code).
❑ As owner-builtler, I will not employ gnyone to tlo work which would require a pertnit from �he Divislon oi Intlustnal Safety, as noted ebove, unless such person has a
pertnit to do such work fmm the division.
Signeture: Date:
Division ot Intlus�rial Setery Permit Number:
CERTIFICATE OF COMPLIANCE AND qlffHORVATION OF ENTFiY: I ceAity under penalty of perjury that I have read ihis application and state that Ihe iniormation given is
correct I egree to compty with all state laws and ciry ordinences relating to building construction, end euthorize representetives of the Clry ot Costa Mesa to enter upon t�e
ebove-described properry for inspectlon purposes. I agree not to occupy or allow occupancy of eny building authonzed by Ihis permit until tinel inspection.
Signature Of Lagel Owner(s) � ���
GODE �. IMSPECTIONTYYE
7616 Fixetl System Final Fire Prevention
1266 Pool Spe Final
200 Finel Re-Roof
201 Finel BIocWRetaining Wall
202 Finel Factory Fire Place
203 FinalSign
204 Final Demolition
2666-46
OAiF II�ElS
�/ �r
4Qf}(j INSPECTONTYiE
206 Final Mechenical
200 Final Plumbing
210 Final ElacMcal
212 Finel Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
PAg
U1D➢!LS
�
��vvr�
'Z 11►£'
�
�
, == I ,�
. . �2T1- ' � /
�0 r5
, �� �� `. � - I %/
� ' . � ,�,,
� � .. . �'.. • P � � I
/ � 1 �I
/ • i/ei P �.r 1 � te. � �� I�: I I �
. �C£B fJC O�ftl 0 ' /f �i.ui ��
I� o. °�. � • .•�,�/ l' �) � �
irxj .'�tE � ��, i' ��� � ��,I j II b I
� ff.�� �� s�sc��+ '• �GC R,�I (I � ��
� . ��
�,` S � �� SR � �I � � �I � o.
�'
�6"" �Q � -! ,
��.:
� '' , .
„ �t� '�� K�.O � � � ; II�,� I,
.:�- � ��. �' ,�� ,��c 1� �m' I s ��
�- ,
<<
. �n P°"f � I � •,• a + � �� . I I
�T
� }} s e° .��� o �M I i�
8 �' .`� ^�'i � , � ' � � M � q
�� °��� Q II
�
� ' ' a '�D � � 1 j � II � . � ��
��'` ' ° � � II
,. ��
� \ /" �: `' II � ll
�I � �:: �� L �� f4 � Y I I�'I �
� � � � a/S � �� , y � . •
M' 8 ^
� h i� � � �� \
s• � y �) rdc Q F BUI ��.
p!1�r i�� . ;l^
��� � y•F�.J \ Pi� Ro . .. /.
" q8
!`,t tc ' , y .� ' rla!q .
� � � 4O ' ,� r , �� � 1:1�'1hel;e�tontitisJobui0l! E� � �s " =—
yq»ng j1�a�r�nca ?�Nen:+,tenp=rms-ionf�m{I� Ns:and9
! f�-�_ � ry P.i:�.. �f� �� � `
T � �
I/ F � at . a��+�'s,;zci?' °t� ��I:� + NOTbt*i�'�+tp ;o0ua�appt !
� + „s„�-. ,: n C� oi Coste tEc:a :x in y^.�f Stffie te .
c�. lo�.ntes. znv i i
� �^ .I $P � 3�+A^I�7.r en:t!` Bp �}� ;:'I;f �L:.^• 9fid h6CMl:'l' � C! d �I�iMii9 I
, r� ('f� "L' r ,fS• ' �'r�.� iorF '+ �6 �MiJI��
fJ'.lzs �e � c: '" e� ✓ d ... . r Cs.:a..,, t,_. �:('�I'..I...,
1 ..� 3!d �� , �, O � �
1Q io�i! �' • ai� • , y l /MA[�✓
� � R I
� p�' � A 1
I \� . ���� �I � �'� � ,', �� � ( Q�N
��'(Y OF COSTA Mt�"
P�q�NING DIV.
1ECT T� BLDG. DEPT•
I� DATE�
rr �
�
s
TYPICAL 6�� CONCRETE BLOCK FENCE
Cement Coping Op�{o�al —
Channel Bbck With 1�3/8Ai
Horiaonbl Top ol all
Fences
For Fences 5' or Less
ven. Ban 3/8"¢ a� a' �0" O.C.
For Fences Higher Than 5'
Vert. Ban 3!8"� at 32" �.C, �
Fill Cells Solid With Groul
Where Steel Occurs
Rcinlnr<iog $Ivtl $hall
Conloim lo Sec.A�15�39
A.S. T.M.
All Sleel to be Lapped
24" or to Code
NATURAlGRAOE
TWO 7/B"� BARS L1
CONi1NU0U5 TOP f
b BOTTOM - _ri
HOQ1iSTEEI MUST BE TIEO IN
VL4Cf AT TIME OF TqENCH
INSPECTION.
a x
1� F
�a
Y W
c Z
> z
a
i �
w o
u r
4
��
n 'U N
e n - '
e f
F+—KI�TM
� SCE CMa
I � BE�Ow
0
WIOTH
THICKNESS
DEPTH OF EARTHTOOTM
SPACING OF EARTHTOOTH
10"
24"
12'
FOOTING REQUIREMENTS CHART '
14" ,f ,
10"
• zO^
14'
. �^ .
BUILDING DIVISI�ON
� _
GENERAL- NOTES
MOFTAR; png pprt Plastic Cement, and
TArtt Ports Sond
GROUT; pne Pcrt Cemenf TAree and
One Holf Ports S�and
COPING: One Parl Cemenl, TAree
Porls Sand
CONCRETE: Well Mired 1�2-I/2:3-I/2
Mo� of 7- I/2 Gol;cns of
Wa�er P�r Sack of Ceme��
GROVT MAV BE P'OUFED FROM THE TOP
OF iNC fENCE tN CEllS WMfRE STEEI
OCCURS.
CELLS ANO AREASOF MORIZONTAL NEIN
FOHCEMENT SHALL BE CLEAR, CLEAN 6
iNEE OF ALl MORTAH DEBNIS. ETC.
c
11 C/' C4RTNTCOTM
V? fnE HE�GTM Of �ENGE
BELOW BOTTOM OF �OG7iNG
SCALE: I/2'�= I'
- 12 - . . . . 12-.
9" 8'
16" 12"
16' t6'
��
rj ,
�a
CIlbOF�', STAMESA
COs'JSTRUC�,ION �FRMIT
Plan 3 ELEV 36
Lot 7
ADG�icant lo fill In all sPac�� ax hose wilhin M1eavy bo��er Iines antl sign all apPropriate tleclarations.
Project Address � Za1 Z Ceranl uRl STPPPY
Applicant'sMailingAddress 1F6� W MacArthur Bl�vd.
owne�•sName —$TANDARD_P_AC.I_F_I_C- Pno�e �4fi_11F1
Address Sa ,
Arch/Eng, n(��m5%$ty'getgP License No. ���R� '
Addressl%�$� �p��parN C�rrla Trvine
Contractor'sName See �wnar Ghone
Addreu.lmailingl p
city License No. �1! � 9G
LICENSEO CONTRACTOR DECLARATION
I hereDy aftirm that I am Iicensetl untler provisions of Charter 9(mmmentlng
with section ]000) of Dlvizion 3 of the Business and Profe551on5 Cotle, antl
my license Is ln fulllor e na etrect. 24HO4Z
License Class �—� `c .
Date_1-z_1.5_8Q Si9nat .
WORKERS' COMVENSATION DECLARATION ' �
`�ereby aHirm that 1 have a certificate of consent to seli-inzure or a certificate
i Wo�ke�5'-CompenSatiOn tnsurance, or �a ce�tlfied' copy thereof (Seclion
3eoo, wo. c.
Pou�v No. Wa-84-225-856 ,comPa�Y_Fremont Indemni,tv
eCertifietl copy is hereby fumishetl.
Certifiatl copy is tiletl wltn the city Bu�iltl�ing qIvislq n.�
oate 1'�-lb-$Q aoo�icant—JLA-l111d1"��'t1C]-f7C
EXEMPTION FROM WORKERS' COMPENSATION DECLHRATION-
(This sectlon nee0 not be completotl If the permit is for one huntlretl (E100j or
less). •
I certify that in Ihe performdnc0 Of the work tor which thi5 permk is issUetl I
xhalb not employ any pmson in any manner so'as to become subject to t�e
Workers' Compensatlon Laws o� California. , � .
Date Si9nature
NOTICE: It, atte� making thi5 tleclatatiOn, you shoultl becOme zubject to [he
Workers' Compenution provisions ot'tne Labor Cotle, you must forthwlth
comply with such provislons �or this ,permit shall Ee tleemetl revoketl.
CONSTRUCTION�LENDING.AGENCV� ' ' '
I hereby aftirm that thero is a construction IenOing agency for Ihe performance
ot the �work for which thls permit is issuetl (SecHon 3097 Civ. C.)
Lentler's Name , _ �
Lentler's Adtlress
OWNERBUILDER OECLARATION
I nereby afiirm that I am exempt from the Contractor•s License Law tor the
following reason. (Sectlon 7031.5 Business antl'Professionaf Cotle: Any city or
county wnich requires a permit to construct, alter, improve, tlemolish or repair �
any structure, prior to Its issuance, also requires the applicant for such permit
to file a'signetl statement that h¢/she Is Ilcensetl pursuant to [ne provisions o(
the Con[ra<tor's License Law (Chapter 9(commentln9 with 5e<tlon ]000) of
`ivision 3 ot the Business anG Profas5ions Cotle) or that he/she is exempt
ierefrom antl the bazls for'the allagetl exemplion. Any violation of Sectlon
,Wl-5 by any applicant for a�permit subjects [he applicant to a civil
�ena�ty of not more than five huntlretl tlollars (E500)..
I, as awner of the proper[y or my employees wi[h wages as their sole
comoen5dtion, will tlo the work, antl lhe structure Is not intentletl or otferetl
for sale (Section 7044, Businezs antl Pro(essional Cotle: The Contractor's
licen5¢ ldw tlOes nOt apply to an owne� o( a p�ope�ty who builAs o� im0�ove5
the�eon, antl who tloes Such wo�k hlm5¢If/h¢r5¢It Or th�ouqh his or her own
employeez, provitletl Iha[ such lmprovements are not intentlatl or o�feretl for
Sale. If, howover, the bulltling or Improvement Is soltl within one year, of com-
pletion, tbe owner will have the bwCen of proving he/she tlla not builtl or im-
�ravefor Nc purpose of sale). -
1, d5 Owner Of ihe property, am exclusively Cont�acting with IlcenseC con-
tractors ta construct the project (Sectlon 7044, Business antl Professions Cotla:
The Contractor's. License law daes no[ aOPly to an owner of property who
�uiltls or improves thereon, antl who tontracts for such projects wrtn a con-
tractor(s) Iicense Dursuant to the ConVactor's License Lzw):
'� ❑ I am exempt untler Sectlon B. & P. C. for this reason �
Date
antl state laws relalin
SCII(dIIVCS Oi S �
Inspection e
S�gnature
Orivers' License or55
_ Owner
I have reaa this applicaHon antl siate that the above
1 agree to comply with all tlty antl county ortlinances
to builtling construction, antl hereby authorize repre-
��e�ny��u pOn th2 abovC�mentionetl p� erty fo�
�v T � Date �
TVPE OF CONSTRUCTION LXI NEW LJ ADD LI ALTERATION LI REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
OESCRIPTION OF WORK �
TVPEOFPERMIT GRADING FOUNDATION ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ ,OTHER
PFOJECT DESCRIPTION 5�. FT. ��QQ oCCUanNGV
CONSTRUCTIONTVPE VALUATIONS �d_�_,AiF�n_
ZONE GRADING CU.YDS. ACRES
Ramarks:
Bar Sink
Backflow Preventer
Bxckfloyv Irr:ga!ion
Bathtubs
Clarifiers �
Dishwasher ' -
Drinkinq Fountains
=1oor Drelns .
Floor Sinks
u25$CfVIC2 �lIL�2i5
In[erceptors
Kitchen Sink -
Lavatories �
P—Trap
Roof Droins
ReinspeRion Fee $25
BOiI¢r
Duct=UnderGround
Duct - Sttuctural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑ ai oo,000 eTu O i oo,000
s I I Reinspec[ion Fae
CMF 0865-46 rev. 7/83 White - Bulltlin9: �nary
Pink - Accounting; Goltlenrotl - Assessor
$25
Showers
Service Sink
Sewer Cap
Sewer Connectian
Solar Collectors�
Solar Piping
Solar Tank . �.� �
Swimming Pooi w,
Urinal
Water Clout
Water Heater
Water Service
FEES
e! „�:
, ;.%;;; i.'
�; � � . .
♦. b� �
'
.ti, �;
�a_ .. �
Issue Fee S 3
�ANICAL - FEES
Hood or Typel O '
Canopy Typell ❑
Refrigeration System "
❑aioo,000sTu ❑ioo,000aru
System Repair/Alteration
laue Fee � $ 3
A.P. # � � - �-
S Main Building:
E �
T Front
ARear �
C Right �
gLeft 5 /
Ping. Ref. # ��%� -
Parking Req./Provided
Use of Building:
Plannin9 Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher '
Dryers OGas� �Electric
Fan
F.A.U.
Fixtures
Oevice Boxes
Outlets
Switches
Garbage Disposal
Generetor �65 KW �5-15
5i50 3l01/qk
� za�e �:/
Accessory Building:
� T �al.Yfark.Fees $��5��
i
�.�:+mi '�'eGlS�Yt
ELECTRICAL � '
Transformer ❑ 15-50.KW,-�i
❑ 50 + KW'. - •
Meter IJupro�100amps '
Meter ❑over 100 amps �
Sub Panel
Motors 00.1 HP 01'/: - 8
Inc.Solar �9-15 HP �76-15+
Microwave
Pole �ight
Range
Sign
Standing Sections
Tresh Compac[or �
,�
Z
O
N
� I
N �
G
R
E
0
U
�
R
E
M
E
N
T
S
FEES
— Reinspection Fea $25 Issue Fee $ 3
� PUBLICSERVICESREOUI�REµM�ENTS: [J� ^
2oning Approved By �Lq K�TU✓ Date�S�
Application Approved By Date�A2`�
Application laued By � I Dat
SUMMARV OF FEES
BUILDINGPERMIT $ 54F_�i(1 SMIP �$ �Q_.�_
— PLAN CHECK $ QR f,a PERMIT �
— PLUMBING $ ISSUANCE $
PLAN CHECK $ ENERGV P.C. $
EIECTRICAL $ GRADING $
PLAN CHECK $ MICROFILM $
— MECHANICAL $ TOTALFEE $ 644.26
PLAN CHECK $
� �� CONSTRUCTIQN AND PLANNING
{ � APPROVALS� Permit#
r 1. Temporary Electrical Service or Pole
� 2. Soil Pipe-Undrgrnd. � � �
r
3.� Electrical Conduit Utility-Undrgrnd.
�3. Electrical Conduit-Undrgrnd.
5: Steel Reinforcement "
6. Electrical.UFER Grnd. .
7. Footings '
S. Foundation 5 ra.�
9. Water Pipe-Unqrgrnd.
10. Structural Floor System '
11. Property Sewer Line & House Connection
12. Sewer Cap '
13. Roof Drains
14. Rough Plumbing
15. Rough Electrical-Conduit
1.6. Rough Electric Wiring
17. Rough Wiring $ign
18. Rough Electrical-T Bar Ceiling.
19. Rough Heating & Air Conditioning .
20. Rough Factory Fireplace -
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing
25. Roof Sheathing '
26. T-Bar Ceiling ($tructurel� & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat
32. Electrical Power Meter-Final
33. Final Electric
34. Final Heating & Air Conditioning �
35. Final Gas Pipe•Test
36. Hood or Canopy �
37. Final Factory Fireplace ,
38. Final Plumbiny :
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. FINALSTRUCTURE8iBUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Date
i0
0
POG SPA
Inspector � �pppROVALS Permit#
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
� 56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER-GUNITE �
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P�Trap, O Undrgrnd.
61.- APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar System�Final
. 67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit # '
70. Underground Hydro
71. ProductPipingOGas ❑Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
� 74. Overhead HYdro
75._Dry Chemical
�jl� 76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
� HEALTH DEPT. REQUIREMENT
� 79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes: a
, �-n ' � /, a �,,�-
L C�
n
�
Date Inspector
ApOlicant to till in all spaces eiceo< tnose witnin heavy bortler Iines ana sign all appravriate qeclaratians.
CiTv oF COSTa MESA CONSTRUCTION PERMIT
ProjectAddress "�412 Gerani�um SL.
Applicant'sMailingAddress �
Owner'sName Standard Pacific Cerp Phone�]_]_(]_�
Address
Arch/Eng. License No.
Address
Contracror'sNam Neu P1ume�,,.�Ph�2R_llAfl
Addresslmailin9) ����? ��. �ee ��+� ��'+�hoim
City License No. �'�2$]�
LICENSED CONTRACTOR DECLqRATION
I hereby atti�m that 1 am licensetl u��er provisi ns of harter 9(commencing
with Section ]000) of Division 3 of tne Busin ss an Profe55ions Cotle, antl
my license is in tull force ntl eftect.
�ice�se ciais — ce se No. 426109
Date � n /��� Signahre
WORKERS COMPENSATION DEGLARAT ON '
nereby aifirm that I have a certific8te of consent to self-insure or a tertificate
,t Workers' Compensation Insuran�e, or a certitietl copy thereof (Section
3800, Lab. CJ �r n �
Policy No.PWC—�7/��`�� Company Home
Certifietl copy is hereby furnished,
�ertitietl co is filetl with tne city Builtling Division.
o,te�niini#�qpplican[ (�p�Pniimhin9
E%EMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be completetl {( the permit i5 fot One hund�etl (5100) or
less).
I certify that in IhE Perfo�mance of the wo�k tor which this permR is issuetl, I
sM1all not employ any pe�son in any manner so as to become subject ta the
Workers' Comoensation Laws oi Calitornia,
Oate Si9nature
NOTICE: If, after making this tleclaratiOn, you shoultl b¢come subject to the
Workers' Compensation provisions of the Labor Code, you must torthwith
comply with such prOvisions o� this permit shall Ce tleemetl revoketl.
CONSTRUCTION LENDING AGENCV '
I hereby aftl�m thal thEre is a conSVuction lentling agency to� the pertormance
ot the wo�k for wnicn this permit is issuetl (Section 3097 Civ. C.)
LenEer's Name
Lentler's Atltlress � '
OWNER BUILDER DECLARATION�� -
I hereby atfirm that I am exempt Irom the Contractor's License Law for the
(ollowing reason (Secfion 7031.5 �usiness antl �rofessional Cotle: Any cicy or
county whiclt �equires a permif to Construct, alter, improve, tlemolish or repai�
any structure, prior to it5 issuance, a150 /equires the applicant tor such pe�mit
[o file a signetl statement thal tte/xhe is IicenSetl pu�suant to the provisions of
: tne Contractor's License l.aw (Chap�er 9(commencing with Section �000) of
;v';�)ivision 3 of tbe Business antl Professions Cotle) or that he/5he is exempt
=?;nerefrom antl the basis for Ihe alle9etl exemption. Any violation of Section
�'. "5031.5 Cy any applicant for a p¢rmit subjects the applicant to a civil
��enalty of not more than live nuntlYetl tlollars ($500).
LJ I, as owner of the property qr my employees witn wages as their sole
" compensation, will tlo the work, arytl the structure is not intentletl or otieretl
' tor sale (Section 7044, Business antl Professional Cotle: The Contractor'S
License Law tloes not apply to an owner of a property who builtls or improves
thereon, antl who tloes such work himself/herselt or through his or her own
employees, provitletl [hat such improvementz are not�intentl¢tl or offere0 for
Shce. If, however, the builtlinq cr iRiprovement is soltl witM1in one year of com-
oletion, the owner will have the b4rtlen ot proving he/she Citl mt build or im-
�OVB i0l Lb2 p11�pO5C Oi Sd�C�.
I, as owne� ot the property, art� exclu5ively contracting with licensetl con-
trac[orsto construct the project (Section 7044, Business antl Pro�essions Cotle:
The Contractor's License Law tlo@s not apply to an owner of property who
builds or improves thereon, antl who contracts for such projects with a con-
tractor(5) liten5¢ pursuant�to the Contractor'S License Law). I am aware that
p�oot o( tM1ei� Worke�'S Compens8{�on insu�ance Shoultl be prOvitletl to me.
❑ I am exempt untler Section B. & P. C. for this reason
Dale
InSpe<[ian purpose5��
Signature
Drivers' License or 55 �
�this application antl state 1
omply with all city antl cou
construction, antl nereby a
upon the above-mentlonetl
�
abave
IdlIC25
rep�e-
Y tor
TYPE Of CONSTRUCTION XQ�J NEW L-� ADD LI IiLTERATION LJ REPAIR
❑ CONVERSION ❑ OEMOLISH ❑ OTHER p.p, #
DESCRIPTION OF WORK/USE OF BLDG.
S Main Buildi
TYPE OFPERMIT ❑ GRADING �❑]� FOUNDATION ❑ STRUCTURAL T Front
❑ TENANT ❑ ELECTRIGAL �[J.PLUMBING ❑ MECHANICAL 6 R¢a�
❑ OTHER A
PROJECT DESCRIPTION 54. FT. � ocCUPArvcv C Right
K Left
CONSTRUCTIONTYPE VALUATION$ S
ZONE � GRADING CU. VDS. ACRES Ping. Ref. #
Remarks: +' S� PI !�(� � Planning Notes:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service c Outlets
I ntercepmrs
Kitchen Sink "
Lavatories
P—Trap
Roof Drains
Reinspection Fee � $15
SOiler
Duct-UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
FirepVFact. Blc ICBO #
Heating System & Ducting
❑ 0-100,000 BTU � 100,000
Reinspection Fee � $15
CMFOB65-46,rev.4/84 White-quiltling;Canary-APO�icant;Pink-Accoun[inq;GOltlenro0-Assessor
NG
Service Sink
Sewer Cap •
Sewer Connection
Solar Collecrors
Solar Piping
Solar Tank �
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Issue Fee
FEES
$ 3
Auromatic Washer
OI73 10/12/84
ZonB
Accessory Building:
Parking Req./Provided
EIECTHICAL
T�ansformer ❑ 15-50 KW
� 50+KW
Caoking Unit ' +
Dishwasher ,
Dryers ❑Gas ❑Electric
Fan •
F.A.U.
Fixtures
Device Boxes �
Outlets
Switches
Garbage Disposal
Generator �45 KW �5-15 KW
Meter LJup to 100amps
Meter ❑over100amps
Sub Panel `
MotorsO0�1 HPO1'/:-8
IncSolar 09-15 HP 016-15+
Microwave
Pole Light
Range
Standing Sections
Trash Compactor
Reinspection Fee �$15 luue Fee
IANICAL FEES
Hood or Type I ❑ DEVELOPMENT SERVICES REQUIREMENTS:
Canopy Type II ❑ 2oning Approved By
Building Approved By
Refrigeration System
❑0-700,000 BTU ❑100,000 BTU
System Repair/Alteration .
laue Fee � $ 3
5.50 T�
FEES
$ 3
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $� PERMIT
PLUMBING $ .SiSO ISSUANCE $
PLAN CHECK 25% $ ENERG� P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTAL FEE $ S-:S O
PLAN CHECK 25% $
Z
O
N
1
N
G
R
E
Q
M
T
5.
CONSTRUCTION AND PLANNING � PO� � SPA
' APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location �
�2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement
�
3. Electrical Conduit Utility�Undrgrnd. � 54. Forms
i4. Electrical Conduit-Undrgrncl. 55. Electrical Bonding � � �
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test .
6. Electrical UFER Gmd. � . . 57. APPROVAL TO COVER-GUNITE .
7. Footings �. 58. ElectricalConduit-Undrgrnd. ��
8. Foundation i' 59. Gas Pipe, � Undrgrnd., Test "�
t
9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, 0 Undrgrnd. ��i
10. Structural Floor System " 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final � %
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final '
� 14. Rough Plumbing � 65. Electrica6Final �
15. Rough Electrical-Conduii - 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval -
17.,Rough Wiring Sign ` 68. APPROVED FOR PLASTERING �
78. Rough Electriral-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. Prod'uct Piping OGas ❑Oil
23. Gas� Pipe-Rough & Test 72. Underground Flush �
24. Roof Freming � 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. Eleciriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning �
35. Final Gas Pipe-Test p f �y L� �
36. Hood or Canopy . � ,
37. Final Factory Fireplace � .
38. Final Plumbing 'b �q/j�� C�SG/�
39. Water Service-Final ',
40. Gas Service�Final
41. Solar pomestic-Final
42. Backflow Prevenier �'
43. Backflow Irrigation . . - � `�
44. Landscape I�rigation System
45. Sound Attenuation
46. Handicap Regulations � ' .
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electrie Release to Edison
50. Gas Release to Southern California Gas Co
J
51. CERTIFICATE OF OCCUPANCY �
No. Date
�/// /[ (1���/�//�� ---
('�p�o/� �/✓ APplicant to fill in all spaces exce t tl�Os� Within eav Gortle�es antl si9� all apPropriate tleelaratians.
c�.7YOF COS7,a��{y] ES CON�i T,R^U-C-T�ION PERMIT
Project Address -�� ���u��� � �
Applicant'sMai' Addr
Owne��C- pm����C '7jPh� ��G
IAddres ^ �)�G� d'Ji`- ��%,��"
/'� Arch/Eng. . License No.
(�y�1� Address
, j Contractor's Narp Pho � ���
� Addresslr^ � ���h� � �� /�—�
� City License No. �12��')
�"' LICENSED CONTRNCTOR �ECLARATION , �
I hereby aftirm that I am licensetl untler provislons of Charter 9(commencing
with section ]000) of Dlvision 3 of the Business antl Protesslons Cotle, antl
my Iicense is in (ull (orc�tl te t. ' � /
Licen lass — Li ense 6.
Date � Si9nature
VORKERS'CO ENSATION DECLARATION
. hereDy aftirm Ihat I have a certiticate of consent to selt-insure or a certificate
of Worke�s' Compensi[iOn Insu�ance, or d certlfie�oP�t�ereot (Section
3800, lab.� ) ^ // y" �
. Policy NOJ ,�fU /�/ �� " / Company � / •v�-
❑ Certifietl copy is M1e�eby iurnishetl. '
���certifi W �s WAPPhcantY . .n9�i i�. .
L
EXEMPTI�N,FROM WORKERS' COMPENSA ION DECLARATION _
(This section neetl not be completetl if the permit is tor one huntlretl (5300) or
less�. ,
I ce�tify that in the pe�formance ot ihe work fOr whith thii p¢rm�[ is issuetl, I
shall not employ any perzon in any mann¢r so as to become subject to the
Work¢rs' Compensation Laws of Califarnia. ,
Date Si9nature
NOTICE: If, at[er making this tleclaration, you shoultl bewme subject to the
Workers' Compensation provisions of the Labor Cotle,-you must forthwith
comply ,with' such provisions o� thi5 permit shall be tleemed revoketl.
CONSTRUCTION'LENDING AGENCV � -
I hereby affirm that there is a construction lentling agency for the pertormance
of the work tor which thi5 permit is issued (Section 3097 Civ. C.)
� l.enCer's Name _
Lentler's Atltlress'
OWNER BUILDER DECLARATION
I hereby atfirm that I am exempt trom the Contractor's License �Law tor the •
following reason (Section 7031.5 Business antl Professional Cotle: Any city or
county whicM1 requires a pe�mit to cons[ruct, alter, improve, tlemolish or �epair
-any structure, prior to Its issuance, also requires the applicant for such permit
to tile a signetl 5tatemenLthat he/she is licens¢tl pur5uant to th¢ Provisions of
the Contractor's License Law (Chapter 9(commencmg with.5ection �000) ot
Division 3 of the Business antl Professions Cotle) or that he/5he is exempt
theretrom antl the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant tor a permi[ subjects the applicant [o a civil
'� enalty ot not more than five huntlretl tlollars (5500).
I, as owner of the property o'r my employees with wages as their sole
compensation, will do the work, antl the structure is not intentletl or offeretl
tor sale (Section �044, Business antl Protessional Cotle: The Contractor's
License Law tloes not applY [o an owner of a property who builtls or imOroves
theteon, antl who tloe5 such work M1imself/herself-or throu9h his or he� own
emDloyees, provitletl Ihat such improvements are not intentletl or o(te�etl tor
sale. If, howeveq the builtlin9 or improvement is soltl witnin one year oi com-
pletion, the awner will have the burtlen ot proving he/she tlitl not builtl or im-
�rOve for the purpose of sale).
1, a5 awne� ot the p�operty, am exclusively contracting with licensetl con-
tracforsto construct tM1e pro�ect (Section 7044, Business antl Professionz Cotle:
The Cont�acto�'s. Litense Law tloes not ap01y to an owner of prOpe/ly who
builtls or improves tnereon, antl who contracts for such projects with a mn-
tractor(s license pur5uan[�[o ttte Contractoi's License L.awJ. I am aware that
. proof o� thei� Worker's Compensation in5urance shoultl be provitletl to me.
❑ I am exempt untler Section B. & P. C. for this reason
Date Owner _
I hereby certify that I have reatl this
information is correct. I aqree to comp
antl state laws relJ ting to builtling wn
5entatives of,�hij pity to enter upo�
Si9nature l��--GL/[�!/n
Drivers' License or 55 � �
above
TVPE OF CONSTRUCTION lJ NEW U ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER-
DESCRIPTION OF WORK/USE OF BLDG. ,
TVPE OF PERMIT IJ GRADING LJ FOUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTftICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION $Q.FT. OCCUPANCY
CONSTRUCTION TVPE -VALUATION $ _
ZONE � GRADINGCU.VDS. ACRES_
Remarks: � � � � � ,
Bar Sink
Backflow Preventer
Backfiow Irrigation
Bathtubs
Jrinking Fountains '
Floor Drains
Floor Sinks
GasService Outlets
Interceptors "
Kitchen Sink �
Lavamries , � •
P—Trap
Roof Drains
Rainspection Fee � $75
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating . �
Ezhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑ 6100,000 BTU � 100,000 BT
Rainspec[ion Fee � $15
CMF 0665-46, rev.4/84 White - Builtling: Canary -Applicant; Pink - Accounting; Goltlenrotl -Assessor
Showero
Service Sink� -
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal '
Wa[er Closet �
Water Heater �
Water Service
Isue Fee
I
FEES
$ 3
A.P. #
S Main Buildi
E
T Front'
B Fear
A
C Fli9ht
K Left
S
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole.'�
Cooking Uni[ �`
Dishwasher �
_ ' � Zone
/Provided
ELECTRICAL �
� � Trensformer ❑ 15-50 KW
❑ 50+KW
Dryers LJGas LJElectric
Fan �
F.A,U.
Fixwres
Device Boxes
Outlets
Switches
Garbage Disposal '
Generawr �0�5 KW �5-15 KW
Meter ❑up to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors �0-1 HP 01'/:-8
Inc.Solar �9-15 HP 016-15+
Microwave
Pole Light
Ran9e
Sign
Standing Sections
Trash Compactor ,
' ' Reinspection Fee �$15 Issue Fee
IANICAL FEES
HooJor Typel ❑ DEVELOPMENTSEHVICESREQUIREMENTS:
Canopy Type I I ❑ Zoning Approved By
Building Approvad 6y �
❑0-100,OOOBTU ❑100,000
System Repair/Alteration
Isue Fee � $ 3
Z
O
N
I
N
G
R.
E
Q
M
T
S.
� FEES ; I�
$ 3
SUMMARV OF FEES
BUILDING PERMIT $ � SMIP $
PLAN CHECK $ PERMIT
PLUMBING � �S;r�f� "SSU�A�NCE $�
_— y a1., d
PLA �...a`K 25° � `_ f
ELECI$1LF�L 4 �
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTAL FEE $
PLAN CHECK 25% $ �
� CONSTRUCTION AND PLANNING ' PO..� & SPA .
..� 'APPROVALS Permit # Date Inspector� qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole i ,�' 52. Pool & Equipment Location
2. Soil Pipe-Undrgmd. .,, � 53. Steel Reinforcement . '.�
3. Elect'rical Conduit Utility-Undrgrnd. . . 54. Forms '
4.'Electrical Conduit-Undr`gind. . , 55. Electrical Bonding - -
5. Steel Reinforcement. �� ' 56. Rough Plumbing & Pressure Test � r'
.
6.. ElectricahUFER Grnd-.- 57. APPROVAL TO COVER-GUNITE �.
�
7.,Footings � ' . -�� '� 58. ElectricalConduit-Undrgrnd.
� 8. Foundation j -%� ' 59. Gas Pipe, O Undrgmd., Test
9. Water Pipe�Undrgrnd. �� .` .,t 60. Backwash Lines, P-Trap, O'Undrgmd. �
10. Structural Floor System ' �. �� -61. APPROVF�L TO DECK � �
11. Property Sewer Line & House Connection , 62. Backwash & Receptor-Final
72. Sewe.Cap � ' ' � . 63. Heater & Vent�Final - ,
13. Roof.�Drains • � �
�� �_. 64. Plumbing System - Final
.
14. Rough'Plumbing� ' 65. Electrical-Final . ,
15. Rough�Electriral-Conduit 66. Solar,System-Final
. i
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 � 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 � HEAI.TH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final �. -n.� 80: FOOD CERTIFICATE ISSUED
33. Final Electric . Notes: ,' r• �
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test /���y L,Qp '
36. Hood or Canopy �
37. Final Factory Fireplace �
38. Final Plumbing �O�/u�y�4 Lccn , �
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 Southem California Gas Co �
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill in ail spaces ezcept those within neavy GorGer Iines anA sign all appropriate tlaclaretions.
� CITYpF COSTA MESA
� _ C�JI�STRUCTION PERMIT
�
Projec�Addi¢ss
Applicant's Mailin Addre ' ' - ' �
Owner's Name ��
Address ���I�J � �Ui�.w �� L� U �-Q r1iC�
Arch/Eng. License No.
Address
Contractor's Name
ne s o 1
Address (mailingl �
City Licen N '�. �i� �
LICENSED CONTRACTOR DECLARATION
1 hereby affirm that I am Iicensetl untler provi5ion5 of Charter 9(commencin9
with section 7000) ot DIvlSion 3 of the Business antl Professlons Cotle, antl
my Ilcense is in ull (orte antl ette . ��,�� � y
LlcanSe,Cla55 � License �'f
'�ate Si9natura
IORKERS'COMPENSATION D CLARATION
� hereby aftirm that I have a carUfltate of consent to sel(-in5ure or a<ertlficate
of Workers' Compensation Insuranca, or a certifieC copy ereot (Sectlon,
3800, Lab. C.) �` - n'I�, � "
Po11cY No. 1�� 5( �� ��O ComPanY�+�' .
,[]�Certitietl copy is here�y furnishetl. . "'
L.� f.ertl 'e o i filed wlth the tlt uy�8 IIWrnJlq 5 n.
Date_.�Pf� APPIIcantF-vL.V Yr?�
EXEMPTION ROM WORKERS• COMPENSATION OECLARATION �
(This section naetl not be completeA It the permit Is for one huntlretl (E300) or�,
less). • -
I certlfy that in the pertormance of the work for whlch this parm�t is Iszuetl 1'
shall not employ any person In any manner so as to betome subjact to t�e
Workers' Compansation I.awS Of Californid. , �
Date Signa[ure ��
NOTICE: If,iatter making thls tleUaratlon, you'ShoWE become subJect to the
Workers' CompensdtiOn prOvisions of the Labot COCe, you muSt�tOrthwith
comply with zuch provisions or this permlt shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV ' '
1 hareby aftirm that thare I5 a construction Ientlin9 agency tor the partormance
of tne work for whlch' thls Dermit is Iszuetl (Sactlon 3097, Clv. C:)'
L¢ntler•z Name- -
LEntler'z ACGrass �
OWNER BUILDER DECLARATION '
I hereby aftirm that I am exempt trom the,Contractor'S License �aw for tha
followin9 reason (Sectlon 7031.5 Business anU Protesslonal Coda: Any city or
county which raquira5 d permit t0 COnstruct, alter, ImprOVB, tlemollsh or repair
any structure, prlor to Its Issuance, also requlraz tne applicant for such permit
to tile a slgnetl statement that he/she is Iicensetl pursuant to the provlslons ot
the Contractor'S.LicenSe Law (Chapter 9(commencing with SecNon 7000) of
Divlsion 3'ot the BuSiness antl Profession5 Cotle) or that ne/she Is.exempt
therefrom antl the basis for the allegetl exemption. Any vlolation of Section
7031:5 Gy,any applicant for a permlt subjects tM1e applicant to a civll
�enalty oi not more than five huntlretl tlollars (E500).
I, as owner ot tne property or my employees with wages as thelr sole '.
cnrqpensation wlll tlo tha work anC the structure is not IntenGetl or offeretl �
sale (Secflon 7044, Busine55 antl Professlonal Cotle: The Contractor'S ,
3nsa Law does not apply to'an owner ot a proparty who bulltls or Improves ,
�eon, antl who tloes such work.tilmself/herSeH or througn hls or her own
�loyees, provltletl that such Improvements are not intentletl or o(teretl (or �
If, however, the builtlin9 or Improvement I5 soltl wiihln one year o/ com-
lon, Ihe owner' will nave the burtlen of proving he/5he tlltl noc bulltl or im- ,
veforthe purpose of sale). '
1, as owner ot tha property, am excluslvely contracting with II<ensetl con-
�.tors td construct the pro7ect (SectionJ044, Buslness antl ProfesslonS.GoAe:
� Contrattor'S LI<ense Law does noc apply to an owner ot property who
itls or Improves thereon, antl who contracts for such projects wlth a con-
:tot(5) Ilcense pursuant to the Contractor's Llcense Law).
I am exempt untler Section B. & P. C. for thls reason
oate
tnat
Signature K-�M-V`
Drivars' LI<ense or SS �
have reatl Ihis application antl•state tnat the abova
agrea f0 Comply with dll city dntl COUnty ortlinanC85
o builtling con5truction, antl hereDy authorize repre-
to enter upon the above-mentlonetl pro ert to
Date'�
—pf'���
TVPE OFCONSTRUCTION� 'NEW P.DO ALTERATION REPAIR �
�0� CONVERSION ❑ DEMO ISH ❑ OTHER .q,p. #
DESCRIPTION OF WORK � �
S Main Buildi
TVPEOF;PERMIT GRADING � FOUNDATION STRUCTURAI T F�Ont
❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL , A Rear �
❑ OTMER
PROJECT DESCRIPTION Sq. FT. nrriicnrvCv C Right
K Left
CONSTpUCTION TYPE VALUATION$ $
ZONE GRADING CU. VDS. ACRES ping. Ref. #
Remarks: � Parking Req./Pn
, Use of Building:
� PLUMBING FEES Planning Notes:
Bar Sink Showers '�
Backflow Preventer
Backflow Irrigation
Bathtubi
Clarifiers
Dishwssher '
Drinking Fountains
Floor Drains
FloorSinks ��
Gas Service Ou2lets
Interceptors
Kitchen Sink .
Lavatories "
P-Trap
Roof Orains
� I Reinspection �Fee �I $25
Boilef
Duct - Under Ground -
Duct-Structural ' '
Duct-Ventilating .
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑6100,000 BTU �100.000
peinspection Fea � $25
CMF 0865-46 rev. 12/83 W��fe - Bulltling; Canary - AGpllcant; Pink - Accounting; Goltlenrod - Assessor
ServiceSink �
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet � �
Water Heater �
Water Service �
Issue Fee
1ANICAL
Nood or Typel ❑
Canopy Type I I ❑ � �
fiefrigeration System �
❑0-100,000 BT U. � 100,000 B
System Repair/Alteration
i
Issua Fee
Automatic Washer '
Construction Pole Sub.
Cookina Unit �
Dishwasher
'. �5761 3/09/84
- Zone `
Accessory Buildin9: �
Park.Fees $
ELECTRICAL �
Transformer ❑ 15-50 KW
❑ 50+KW
Fan
F.A.U.
Fixtures
Device eoxes
Outlets
Switches
Garbage D,isposal
Generator �U5 KW �5-15 KW
Meter ❑up to 100amps
Meter ❑over100amps
Sub Panel
Motors O0.1 HP O1 %- B
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light
Range
Standing Sections
Trash Compactor
i 40.5� TL
O
N
I
N
G
R
E
I
R
E
N
E
$� Reinspection Fea $25 Issue,Fee � $ 3
FEES
PUBLIC SERVICES REUUIREMENTS:
Zoning Approved By �ate
Building Approved By ' Dat�.�
, Application Issued By �� � Dat
, ' SUMMARV OF FEES . �
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT , '
PLUMBING, $ � ISSUANCE $
� P�ANCHECK 25% $ '-+'i/) ENEFGVP.C. $ -
ELECTRICAL $ GRADING $
PLANCHECK 50% �$ � MICROFILM `$
MECHANICAL '$ TOTAL FEE .$ �
S 3 PLAN CHECK 25% $ � ,�
i
�
'�CONSTRUCTION AND PLANNING . _ POO� & SPA : - �
�"APPROVALS Permit # Date Inspector qpPROVALS Permit #� � Date Inspector.
J7. Temporary Electrical Service or Pole 52. Pool & Equipment Location -
4
2. $oil Pipe-Undrgmd. _ � �� 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 � ,
�
7. Footings � � �' 58. Electrical Conduit-Undrgrnd. ' ',
8. Foundation . � 59. Gas Pipe, O Undrgrnd., Test � � � �
y -
9. Water�Pipe:Undrgmd�: 3 d/!� (�(� 60. Backwash Lines, P-Trap, O Undrgrnd. . . _
10. Structural Floor Sysxem i 61. APPROVAL TO DECK -
11. Property Sewer Line & House �nnection �/b � L� 62. Backwash & Receptor-Final ' -
�.y
72. Sewer Cap . 63. Heater & VenbFinal - ��
13. Roof Drains 64. Plumbing'SYstem - Final �
14. Rough Plumbing ' � 7��q/�j�/ (�� 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 Fireptace APPROVALS Permit #
. 21. DuCts, in Structure � � 70. Underground Hydro '
22. Ducts, Ventilating � 71. Product Piping O Gas -, OOiI
23. Gas Pipe-Fough & Test . ' 72.���Underground Flush ,
"
24. Roof Framing ,^ � � ' 73. Undergrnd. Storage Tank O Gas �O pil -'� ;
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. FI�RE 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 �p s' �k �� ' � .
36. Hood or Canopy , �, � - �
37. Final Factory Fireplace , - � , � - , -
38. Final Plumbing 1��� �y,� �/) �
39. Water Service-Final � ' •
40. Gas Service�Final
41. Solar pomestic-Final _ ' . �
42. Backflow Preventer , � �
43. Backflow Irrigation � �
44. Landscape Irrigation System , _ � � �
45. Sound Attenuation . . � . - � �
46. Handicap Regulations � . � _
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed � , , '
49. Electric Release to Edison - '
!•
50. Gas Release to Southern California Gas Co � : ' �
51. CERTIFICATE OF OCCUPANCY
No. Date
^ .�/,�� � Avvlicant to till in all soaees except tnose within neavy eortler lines ana sign all aoPropriate tleclarations.
�
CITY oF COSTa m?ESI,q CON7ST��R,UCT19N PERM(IT/ /�
ProjectAddress �L'�T� UT'%�/%�/[�/%i%� C �
Applicant's Mailing A�dYess
Owner's Name,{ Phone
Address � J A��(/I� �
Arch/Eng. ��(L� _fI P�� ;�a„�a N�.
Address
Contracror's Name io �
r
Address Ima'1' gl
City License No � n �
LICENSEO CONTRACT00. DECLARATION
I hereby�affirm that I am licensetl untler provisions ot Charte� 9(commencin9
with section 7000) o( p��{slon 3 of Ihe Business antl Professions Cotle, antl
my license is in t torc9 a tl effect. '7 ^S A r"'
License lass. — Li n p3�3 �� �
Date - � $ignaWre _
�WORKERS' COMP SqTION DECLARATION �
I hereby affirm that 1 haye a certi(itate ot consent to zelbinsure or a certificate
ot Workers' Compen5ation Insu�ance, or a certifietl cOpy thereot (Section
3800, Lab. Ca�y � / ry / � �
Poliry No, s�L_t 7�� CO GomPan .
Certifietl copy is hereby urnishetl. C
rC ietl is til th the citY Bui mg iy
Date � � Appliwnt � .
EXEMPTION FROM W RKERS' COMPENSATION DECLA0.ATION
(This section neetl not b@ completed if the permit is /or one huntlretl ($100) or
less).
I certity that in the periormance ot the work for whicn tnis perm�t is issuetl, I
shall not employ any per50n in any manner so as to bewme subject to the
Workers' Compensation Laws of Califomia.
Date Siqnature '
NOTICE: If, after making tnis tleUaration, you shoultl become subject to the
Workers' Compensation provisions of the Labor Cotle, you must torthwith
mmpty with such pr4visions or thi5 permit shall be deemetl reyoketl.
CONSTRUCTION IENDING AGENCV
I he�eby afflrm that th¢re is a con5truttion lentling agency for tM1e pertormance
of the work tor which this permit is issuetl (Section 309� Civ. C.)
Lentler's Name
Lentler's Atltlress
OWNER BUILDER DECLARATION� �
I hereby+ affirm that I am exempt from the Contractor's License Law for the
� following reason (SectiVn 7031.5 Business antl Professional Cotle: Any city or
munty which �equires 8 pe�mit [o construct, alter, imp�Ove, demolish or repai�
any strutture, priOr to its is5uance, al5o require5 the applicant fo� such petmit
to file a signetl statement thabne/she is licensetl pur5uant to Me provisions of
fhe Gontractor's Licensp �y�y (Chapter 9(commencin9 witfi Section 7000) ot
DiviSion 3 ot the Business and Professions Cotle) or that he/She is exempt
Iheref�om dntl the basis for th¢ allegetl exemption. Any violation of Section
]031.5 by any applicant for a permit subjects the applicant to a civil
�enalty of not more than five nuntlretl tlollars ($500).
LJ I, as owner of the property or my emo�oyees with wages as their sole
compensation, will tlo the work, and the structure is not intentletl or otferetl
for sale (Section 7044, Business antl Professional Cotle: The Contractor's
License law tloes not apply to nn owner ot a property who builtls or improves
th¢le00� dntl' wt10 DOeS SUCM1 wolk him5elf/h¢fsClt oI fhlougtl his or hef own
em0�oyee5, provitletl tM1a[ such improvemenl5 are not intentletl or ofteretl for
sdl¢. If, however, [be bulltling cr im0/ovement i55oltl within one year of mm-
pletion, the owner will nave [he burtlen of proving ne/she tlid not builtl or im-
�ove tor the purpose ot sale).
I, as owne� of the prOperty, am exclusivery contratting with licensetl con-
tractorsto construct th¢ projec[ (Section 7044, Business antl Professions CoOe:
� The Contractot's Liceqse law tloes no[ apply to an oWner of property who
builtls or impraves thereon, antl who contracts for such projects with a con-
tractor(zl license pursuent�to the�Contractor's License Law). I am aware that
proof of Ihei� Wo�ket`s Compensation insu�anGe shoultl be provi0etl to me.
❑ I am ezemp[ untler Sec[ion B. & P. C. for this reason
Date Owner
1 hereby cer[ity [hat I have reatl this application antl state tha
information is correct. I agree [o comply wi[M1 all city dntl counq
antl state laws rela�g�� g co�uctio , antl hereby auU
sentative5 of this y up the ove-mentionetl P
inspection purpose /�
Signature DatP'
TVPE OF CONSTRUCTION LI NEW U A�D LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,# �
DESCRIPTION OF WORK/USE OF BLDG.
S Main Buildi
E
TVPEOFPERMIT GRAOING FOUNOArION ❑57RVC7uRAL T Front
� TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear
d OTHER
PROJECT DESCRIPTION 50. FT. OCCUPANCY C Right
K Left
CONSTRUCTION TVPE VALUATION 5 S �
ZONE GRAOING CU. V�S. ACRES Ping. Ref, �
Remarks: � //��'7 Planning Notes:
Bar Sink
Backflow Preventer
Backtlow Irrigation
Clarifiers
Dishwasher
Drinking Fountains
Floor Dreins
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavatories
P-Trap
Roof Drains
Reinspection Fee $15
Boiler
Duct - Under Ground .
Duct - Structutal
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact Blt. ICBO #
Heating System & Ducting
❑ o-i oo,000 eru �� oo,aoo er
Reinspectian Fee � $�5
�""'^-.Builtling: Canary - Applicant; Pink - Accounting; Goltlenrotl -Assessor
FEES
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
V`/dtEf CIOSCt
Water Heater
Water Service
Issue Fee � $ 3
Aummatic Washer
Construc[ion Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A'.U.
Device Boxes
Outlets
Garbage Disposal
Generator �0.5 KW �5-15
3017 6/27/84
Zone
Accessory Buildin9:
Parking Req./Provided
ELECTRICAL �
� Transformer ❑ 15-50 KW
❑ 50+ KW
Meter ❑up to 100 amps
Meter �Sver 100 amps
Sub Panel
Motors 00.1 HP �TY,-8
IncSolar �9-15 HP 016-75+
Microwave • -
Pole Light �
Range
Sign
Standing Sections
Trash Compacmr '
� Reinspection Fee �$15 Issue Fee
IANICAL FEES
ypel ❑ DEVELOPMENTSERVICESRE�UIREMENTS:
Hood or T Zoning Approved By
Canopy Type I I ❑
Building Approved By
Refrigeration System
❑o-�oo,000sTu ❑ioo,000sT
System Repair/Alteration
Issue Fee � $ 3
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PI.AN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ i O GRADING $
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTAL FEE $
PLAN CHECK 25% $
B3.C5 (�
FEES
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
S.
CONSTRUCTION AND PLANNING . � POOL & SPA �
APPROVALS Permit # Date Inspector p�ppROVALS Permit # Date Inspector li
7. 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, O Undrgrnd., Test
9. Water Pipe-Undrgmd. '' _ 60. Backwash Lines, P-Trap, O Undrgmd. .
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12: Sewer Cap � 63. Heater & Vent-Final
13. Roof Dreins ,. 64. Plumbing SYstem - Final
14. Rough Plumbing 65. Electrical-Final �
15. Rough Electrical-Conduit � 30 �7� 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 O 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
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 /B 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 �
t
42. Backflow Preventer � � . �
43. Backflow Irrigation . .
44. .Landscape Irrigation System �
45. Sound Attenuation • .
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING �
48. Special Requirements Completed ' �
49. Electrie Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date , � '
Aoo�icant to fill in all spaces ezceo� tnose within heavY �ortler lines an0 sign all aoVropriate tleclarations.
CITY OF COSTA CO STnR�UCT�I�O,�N/� P IT PERMIT NO. TRACT NO. LOT NO. UNIT NO
Project Addren � L�w� � �
Applicant's Mailin dress '
Owner's Na ho e
Address �
Arch/Eng. License No.
Address - T
Convactor's Nam ione � V
Address (mailin9) �
City License No. `
LICENSED CONTRACTOR DECLARATION
I h¢reby affirm that I am licensetl untler provisions of Charte� 9(commencing
wlth section ]000) of Division 3 of the Busine55 antl Professions Cotle, ntl
my lice�� in (ul p2 ntl eitect. ,� �
Licens a c nse
Date�� 5'9 t
WOHKERS COMPENSATION DECLARATION
hereby aftirm that I have a certi(icate o( wnzent to se f-insure or a certificate
� Workers' Compensation Insurance,�or a certifietl copy thereo ction
lB00. Lab. $'))�//J IOG�� ComPany �� �
PolicY No. YI'V �/� 0 .
BCertifi m y is reby furnishetl. /q( /
Ce� etl with the city B�f� ^`/LQC'
Date APPlicant - /
E%EMPTIONFRO WORKERS'COMPENSATION�DECLARATION
(Thi55ection neetl not be completed if the'permit is for one hund�etl ($100) or
less).
I certify [hat in the perto�mance ot tha wo�k fo� which thi5 perm�t is issuetl, I
Shall not employ any pe�son in any manner so as to betome subjeGt to the
Workers', Compensafion Laws of Califomia.,
Date Si9nature
NOTICE: 1f, after making this tleclaration, you shoultl become subject to the
Wotkers' Compensation provisions of the Labor Cotle, y0u must (orfhwith
comply with sucn provisions or tnis permit shall be deemetl revoked.
CONSTRUCTION LENDI AGENGV '
I hereby affi�m thal there'S a construction lentlinq agency to� the Oerto�mance
o( the work tor whi qryiy�permi[ is issued (Section 309] Civ. CJ
Lentler's Name , d� ��-�
Lentler's Atltlress
OWNER BUILDER DECIARATION
I he�eby aftirm that I am exempf from the ContractoYs License Law tor the
following reason (Section ]031.5 Business antl Professional Cotle:�Any city or
county wnich requires a permit to construct, alter, improve, tlemolish or repair
any sVucture, prior to its issuance, also requires the applicant for such permit
to file a signetl slatement tha[ he/she is licensetl pursuant to the provi5ion5 ot
the Contractor's License Law (Chapter 9(commencing with Section 7000) of
�ivision 3 of the eusiness antl Professions Cotle) or tna( be/she is ezempt
teretrom antl the ba5i5 for the allegetl exemption. Any violation of Section .
,031.5 by any applicant for a permit subjects [he applicant to a civil
�nalty ot not more than five huntlretl tlollars ($500).
LJ I, as owner of the property or my employees witn wa9es as their sole
tompensa[ion, will Ao the work, antl the struc[ure is not intentletl or offered
for sale (Section ]044, Business antl Protessional Cotle: The Contractor's
LicenSe Law tloes not appty to un owner of a property who builEs or improves
thereon, antl wno tloes such work nimselt/herself or through his or her own
employees, provitletl Na[ such Imp�ovemen[s are not intentlatl or offeretl for
sale. If, howevCr, Ihe Eulltling cr improvement is Soltl within one year of mm-
pletioq the owner will have [he burtlen ot proving M1e/she tlItl not builtl o� im-
�ove for the purpose of sale). ' �
LI I, as owne� of the property, am exUusively cont�acting with licensetl con-
LIdCIO(S IO COOSLIUCI Lh2 plOj2CI ($ECLIOfI %�44. BU51l1¢55 dfld PlOf25510l15 COd2:
The Contractor's License Law does not apply to an owner of Oroperty who
builtls or improves thereon, antl wno <onVacts for such projeccs with a con-
tractor(sllicense pursuant-to�the-Contractor's License Law). I am aware that
proof o1 their Worker'S Compensation insu�ance shoultl be provitletl to me.
❑ I am exempt untler Section B. & P. C. for tM1is reason
Date Owner —
I hereby certify ihat I have reatl tnis a
Intormation is cor ct. I agree to com
antl state laws r ating to builtling nst
sentatives o� � s ciry to ente� p�n
Signature
Driver5' Licen or 55 $
CMF 0865�46, rev. 4/84
m i�c� /— �
TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A,p, #.
DESCRIPTION OF WORK/USE OF BLDG.
S Main Buildin9:
TVPE OF PERMIT ❑ GRAOING ❑ FOu�vDA7�orv 5�'aUCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL B Rear
❑ OTHER A
C Right
PROJECT DESCRIPTION SQ.FT. OCCUPANCV K
CONSTRUCTIONTVPE VALUATION$ S LeFt
ZONE GRADING CU. VDS. ACRES ping, Ref. #
Remarks: . //� / �) Planning Notes:
Sink
Preventer
I rrigation
Dishwasher .
Drinking fountains
Floor Drains "
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
ReinspeMion Fee � $15
Boiler •
Duct - Under Ground
Duct - Structurel
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
/Heating System & D,,.u,ct�ing
❑0.100,000 BTU L7'T9I/,U00 BT
peinspectian Fee � $15
Applicant; Pink - Accounting; GoltlenrOtl -Assesso�
Showers
Service Sink'
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
�Water Closet
Water Heacer
Water Service
Issue Fee
Hood or Typel ❑
Canopy Typell ❑
flefrigeration Sys[em
❑0-100,OOOBTU ❑700,000
System Repair/Alterotion
Issue Fee
$ 3
$ 3
Automatic Washer.
Construction PoleSub.
Cooking Unit �
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generamr �0.5 KW �5-15
3602 7/06/84
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL •
Transformer ❑ 15-50 KW
❑ SO+KW
Meter ❑up to 100 amps
Meter ❑over100amps
Sub Panel
Momrs � 0-1 HP � 1%- 8
Inc.Solar 09-15 HP �i6-15+
Microwave
Pole Light
Range
Standing Sections
Trash Compactor
� Reinspection Fee �$15 ' I Issue Fee
�
DEVELOPMENT SERVICES REQUIREMENTS:
Zonine APProved Bv
Building Approved By
Applicatian Issued By
BUILDING PERMIT $
PLAN CHECK $
PLUMBING $
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL $
PLAN CHECK 25% $
�J'.25 TI
Z
O
N
1
N
G
R
E
Q
M
T
S.
FEES
$ 3
OF FEES
— SMIP $
— PERMIT
ISSUANCE $
ENERGV P.C. $
GRADING $
_ 'MICROFILM $ �
— TOTAL FEE $
� �
CONSTRUCTION AND PLANNING POl .SPA
� Date Inspector Date Inspector
APPROVALS Permit # APPROVALS Permit #
1. Temporary Electrical Service or P.ole � �; 52. Pool & Equipment Location.
2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement �
8. EleCtrical Conduit Utility-Undrgrnd. '" 54. Forms
4. EleCtrical Conduit-Undrgrnd. ' ' 55:`Electrical Bonding
. 5. Steel Reinforcement � - 56. Rough Plumbing & Pressure Test
6. Electrical UFER Gmd. � . 57. APPROVAL TO COVER-GUNITE -
7. Footings - �� ' _ 58. Electrical Conduit-Undrgrnd.
S. Foundation • ' 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System � , 61. APPROVAL TO DECK
1,1. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap �. 63. Heater & Vent-Final
13. Ro4f 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. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning 7/ ���p FIRE DEPT. REQUIREMENT
20: Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22r Ducts, Ventilating ' , 71. Product Piping O Gas ❑ Oil
23.- Gas Pipe-Rough & Test 72. Underground Flush
24. Ro�f Framing - 73. Undergmd. Storage Tank � Gas ❑ Oil
25. Ropf Sheathin9 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding , � 77. FIXED SYSTEM FINAL
29. Insulation � 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
37. PlaSter Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning ' �p��q�y�er �f>
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 � �
�I
42. Backflow Preventer . �
43. 8ackflow Irrigation _ ' �
44. -Landscape Irrigation System
, 45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUI�DING
48. Special Requirements Completed � ,
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co � �
51. C�RTIFICATEOFOCCUPANCY' .
No. Date ' �
ADO���ant ta fill in all s0aees exce0t t�ose wlinin �eavY �orGe� lines antl si9n al1 aporooriate tleclarations.
Ci{y�oF COSTa MESA ONSTRUCTION PERMIT
�� !�
ProjectAddress ��pt '��P�iU�UI'Ic�.r•
�+pplicant's Mailing Address S H�
Owner's Name � � hone �9 `��
Address 3N�� �7��iN�UN ��T•
Arch/Eng. License No.
Address ^
Contractor's Nama r�L � / �� �1��Phone a�ti��
Addresslmailing) _3NIc�, 1��2�UtvN S�
City License No.
LICENSED CONTRACTOR DECLNRATION
I hereby al/irm ihal I am Iicensetl untlar provislons of Charler 9(commencing
wi[h section ]000) of Division 3 0( the Business antl Professions Cotle, antl
my Iicense is In full force antl eftect.
License Clazs License No.
Date Si9nature
WORKERS'COMPENSATION DECLARATION
hereDy aHlrm that I have a certificate o/ consent to seH-insure or a certltiwte
f Workers' Compenwtion Insurance, or a-certi(letl copy thereot (Section
3800, Lab. C.) -
PoliCy No. COmpany
Certifietl copy B hereby fumishetl.
Ce/[ifietl copy Is (iletl with the city BWltling Divislon.
Date APplicant � -
EXEMPTION FFOM WORKERS' COMPENSATION OECLARATION
(T�is section neetl mt be campleted it the permi[ is for one hundretl ($100) or
less).
I cartify tM1al in th¢ pertormance Ot th¢ wOrk f0/ wh ch [his plrm�t i5 ISSuetl, 1
shall not Cemplo�yw �aenUy perzon in any manne o a come subject to [he
Date er��''�P��vK 5gnatu elifomla.� , —
NOTICE: 1/, after making this tleclaration, you shoultl bec e subject to the
Workers' Compensation provisions ot the Labor Cotle, you must (orthwith
comply with suc� p�ovisions or thi5 p<rmit Shall b¢ aeemeA �evokeC.
CONSTRUCTION LENDING AGENGV V
I hereby ai/lrm Nat there is a mnstruction IenOin9 a9ency for the performance
of the work for whith this permit is I55uetl (Sectian 3097 Civ. C.)
Lentler's Name
Lentler's Atltlress
OWNER BUILDER DECLARATION
I hereby aHlrm lhat I dm exem0� Trom Ihe ContrdGtOr'S Ucense Law for the
tollowing reason (Section 7031.5 Buziness antl Professlonal Cotle: Any city or
county whith rlquires a permit t0 const�utt, altlr, Improve, tlemolish o� repair
any s[ructure, prbr to itz izsuance, also requires the avP���ant for such permit
lo tile a siqnetl Stalement that he/she i5 Ilcensetl pursuant to lhe provisions of
the Gontractor's License Law �Chapter 9(commoncing with Section 7000) of
�ivision 3 of the Business anU PAptessions Cotle) or that ne/she is exempt
herefrom antl lhe basis for thevl(S9ea exemption. Any violatlon of Section
/031.5 by any applicant tor a pe�mit subjects th0 appliCant lo d civil
penalty ol not more than five huntlrea tlollars (5500).
�I, as owner of tne o�operty or my awMo922S�v�th wa9es as their sole
cdmpensatlon, will Co the work, and the s(ru<fure is not intentled or of(eretl
for sal¢ (Section ]044, Busine55 antl Profeislonal Cotl¢: The ContraCtor'S
License Law tloes not apply to an•owner ot a property who builtls or improves
tnereon, antl who tloes Such wa�k himself/hers¢It o� through his o� her own
' employees, yrovitletl that such ImOrov¢Te�LS are not IntentleC Of offefetl for
�� sale. 1/, hOwevet, the builtling or improve�mSnt IS Soltl wl[hin one year ot cOm-
pletion, ihe owner will nave the burtlen of provin9 he/she tlitl not buiia or Im-
prove fortne purpose of sale).
❑ I, as owner oi the property, am exclusively cantracting with licensetl <on-
tractOR to COnztrucl the project (Section ]044, Busine55 antl Pr0(e55ion5 COtle:
Tbe Contractor's License Law does nOt appty IO an owne� Of proper[y who
builtls or improves [hereon. antl who mntracts to� such oroie<ts with a con-
tractor(sj Lcense pursuan[ to me ConVac[or's Licanse I�w). I am aware [hai
prOof O( thei� Wo�ker's Compensation InSurance snoultl be p�ovitle0 to me.
❑ I am exempt untler Section B. 6 P. C. for this reason
� �
Date i���o•v"
I hereby cerlity that I
informaHon is correct. I
antl state laws lating
sentatives of t i t
Inspectian purp s
Slgnature
O�ivers' License or 55 9/
0865-46, rev. 5/88
Owner
upon
1 ztate that
antl cauntv
abov¢
�ances
repre-
v for
(3ME 3lv28,6 I(ZDII . I 7 I"""-
TYPE OF CONSTRUCTION NEW P.DD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLOG. � ��a R- �
TVPE OF PERMIT LJ cRADirvG
❑ TENANT �ELECTRICAL
❑ OTHER
PROJECT DESCRIPTION 54.F7._
1 FOUNDATIOfy CJ STRUCTURAL
PLUMBING �� MECHA ICAL �
� �n. r�� ct °_
CONSTRUCTION TVPE VALUATION $
ZONE GRADINGCU.VDS. A(
Remarks:
Y C� � I �Ct� �
P
Sink
<flow Preventer
cflow Irrigation
rtubs '
ifiers
iwasher -
Drinking Fou
Floor Drains
Floor Sinks
Gas Service
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Outlets
Reinspection Fea I $15
3oiler
Duct- UnderGround
Duct - Struccural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. iC80 dk
Heating System & Ducting
❑ 0.100,000 BTU O 100,000 BT
Reinspection Fee $75
White - Builtling; Canary � Applitant; Pink - Accountlng; 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
Auto-Wash
Issue Fea
Hood or Typel O
Canopy Typell ❑
Refrigeration System
❑aioo,000eTu ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
A.P. � Z +
S Main Building:
E
T Front
A Rear �
C Right GJ
g . Left
Ping. Ref. #
Planning Notes: n
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
$witCh¢5
Garbage Dispoul
Generator �65 KW C
� Zone
Accessory Building:
Z
O
N
I
N
G
R
Parking Peq./Provided E
_ Q
M
T
S.
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
/
Meter ❑up to 100 amps=
Meter ❑over 100.amps
Sub Panel
Motors �0.1 HP �1:5 - 8
InaSoiar 09-75 HP.�16�15+
Microwave .
Pole Light �
Range
Standing Sections
5 KW Trash Compacmr
FEES
Reinspection Fee $15 Issue Fee $ Q
$ 3 DEVELOPMENTSERVICESREQUIREMENTS: Q / Q
2oning APProved BY 4p Date ��� 1 Z7'DP
FEES Building Approved By Date
Appliqtion Issuad By nate �� —\`".i— O S?
SUMMARV OF FEES �
BUILDINGPERMIT $ �2:0. a SMIP $ �
PLAN CHECK $ � pERMIT
PLUMBING S ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL g 2 J_7S GRADING $
PLAN CHECK 50% $ MICROFILM $ �
MECHANICAL $ Iq•� TOTALFEE $ •�• �p
PLAN CHECK 25% $
$ �
01 00019885-000193$9 T4T ' ' ��
DA7E� 11/18/$+3 TItlS: 03�5� �+
COI�STRUCTION AND PLANNING POG . SPA
�APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole .�- 52. Pool & Equipment Location ,
2. Soil Pipe=Undrgrnd. 53. Steel Reinforcement ' ^
i
3. Electrical Cond'uit Utility-Undrgrnd. 54. Forms •'
4. ElectricahConduit-Undrgrnd. 55. Electrical Bonding ''
r
5. Steel Reinfojcement 56. Rough Plumbing.& Pressure Test '
�
6. 'ElectrScel UFER �rnd. 57. APPROVALTO'COVER�GUNITE ,
r•
7. Footings •. 58. Electrical Conduit�Undrgrnd. . '�
r
8. Foundation �'� 59. Gas Pipe, O Undrgrnd ; Test �
i �' .i
9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, 0 Undrgrnd. � � '�
10. Structural Floor System i-�� 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection �I�' 62. Backwash & Receptor-Final � � �
12. Sewer Cap � 63. Heater & Vent-Final � - �
13. Roof Drains 64. Plumbing System - Final . 1
14. Rough Plumbing� 65. Electrical-Final
15. RougFi Electrical=Conduit 66. Solar System-Final '
16. Rough Electric Wiring n li Lv 2 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTER�NG
18. Rough Electrical-T Bar Ceiling. . 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning �'1��/ (�� 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 Frarhing � . 73. Undergrnd. Storage Tank O Gas ❑ Oil
25.'Rbof Sheathing , /��� 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. ,Frame and F,lashing 76. Dry Standpipe
28. Lathing & Siding 3�Q fJ� 77. FIXED SYSTEM FINAL
29. Insulation ., 78. FIRE PREV. FINAL
30. Drywall Nailing • Cf L 3 � O�� HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat "�� � J �� 79. FINAL INSPECTION
. �-
32. Electrical Power,Meter,Final 80. FOOD CERTIFICATE ISSUED •�,
33. Final Electric _ - Notes: � 3o F& �'
34. Final Heating & Air Conditioning Jyb-�c{ �-` �
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final,Faaory,Fireplace
38. Final Plumbing' -
39. Water Service-Final '
40. Gas Service-Final �
41. Solar pomestic-Final �
42. Backflow Preventer � . . .
43. Backflow Irrigation � , �
i
44. .Landscape Irrigation System
45. Sound Attenuation �
46. Handicap Regulations ,
47. FINALSTRUCTURE&BUILDING 3 �
48. Special Requirements Completed
49. Elec[ric Release to Edison
50. Gas Release to Southein California Gas Co _ '
51. CERTIFICATE OF OCCUPANCY � .
No Date . • _ '