HomeMy WebLinkAbout869 GOVERNOR ST - Building PermitsPfl0.IECTADOflES3: 8Ci(3 GOVERNOR ST
OWNEH'SNRME: LA DONNA RAPPPHILLIPS
. FODHES3: BC�9 GOVERNOR ST
COSTA MESA
� CA 92627
ppLHIENCINEER: � 7 1 q� 6 4 S— 6 9 7 O flF0.N0.:
ROOHESS:
UNIT:
UNR:
PE"Mrrt�E: LA DONNA RAPP PHILLIPS ( 714 ) 645-6970
noosess: g69 GOVERNOR ST
COSTA MESA CA 92627
110ENSEO CONTML70P OFCUM710N: I hereEy affirm Ihat I am Iicense0 un0er prmdsions of CtwD�er 9(wmmencinp with Section
70W) of Division 3 ot t�e 9usines5 an0 Profeuians Cotle, anU my license ¢ In full force ane ettect.
CITY LIC.: STATE 11L.: CUSS:
Date: Sipnature:
4(ONKEBS' COMPENSATION OECLAMTION: I hereEy atlirm IAai I have a certiticate oi consent ro ulf-insure ar a certifiate ai Woders'
Compensation Insurance, ar a certified copy thereof (Section 3800, Lab. C�.
�C1CY NO.: FXP. DRTE:
copy is Aereby fumis�ed. ❑ Cerli�ieE CODY i5lileE wiN [he ciry BullOinp �Msion.
Oate: Ap0licanC
EIIEMFfION FlIOM YIOBNEN3' LOMPFN&1TION OECWIATION: (1ha secuon �ed not Ue mmplete0 il ihe permil'a fm me hwqrW �5100) a less).
I certiry t�at in Ue Dertarmance ot tAe woM for w�ich this permit is issued, I shall nat empby any perwn in any manner so as to hecome
suble�t Io tlpre Workers' Compenpsatiw Laws oi Califomia. /1 �
Date: / ' /�� / � Siqnamre: � �w.a— � QIl..Ae
NOTICE: II, atter makinp tAis Eeclaration, you shoulG become su�lect to t�e Workers Compensation Or �ons ala i,�
Cotle, you must fonMrith comDty wit� such provi5ions or tNs permit shall Ge tleemed revokeA.
CONSTBUCTION LENUINO �GENCY: I he2W affirm itut Nere is a consiruciion lentling apency lar Ihe pedormance of the work lor
w�icA t�is permit is issued (Sectian 3097, Civ. C�.
LENOER:
ROONE58:
CITY OF COSTA MESA — HUILDING PERMIT PERM NO: E 048926
PERMIT NO; E 048926 PLAN CHECK NO: N GOVT: N SUPP: Y
CONSTRUCTION TYPE: 5—N PERMIT TYPE; ELE PURPOSE: OTH
JOH DESCRIPTION ; INSTALL NEW SREVICE/REWIRE HOUSE SQ FT:
CLAIM VALUE; CALC—VALUE: GROUP OCC; R-3 /
COMMENTS; REF E96096 ADD ABOVE GND HOT TUH
***��r�r�c**�r*x��r***�r��*�***�t**�r�r*�***�****�r*�**�r*�r�*�*��r��r+��r*�*+�******+r*�x���***�**
Z O N I N GS ERTEb�A�CIKRSE M E N T S
------------ MAIN HUILDING ---------- --------- ACCE5SORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL; 42243307 2NE: REF NO:
PLANNING NOTES>
>
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D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY ,
BUILDING APPROVED HY :
DATE:
DATE:
APPLICATION ISSUED B"• -- DATE: �D) I I�/O
iFiEi{'iFjl"Itifik�EdF*iE')%i4lE"Il"M'iE1i')i'i%'II'TF1�iF'SF')t ..�acF .')fi��;Fii��'iFil"IF9FiElEibiFil'1k�I'��;FiFiFjhif
itiEiklf�fiEfElE1t!l�Fi!?f�)kiEiElfiti(�ikjEi(�#1!il�fiflfilitiEiEikiFiF�....nif�k3f1� :ikiFiFiF�ltfElklEiElE7Ei(�ifif?EiElkiElElfiEillEiE�EiE�tiEif�lhikiE�EiFikif
LEGALIZATION;N F E E S U� M A R Y STRUCTURAL SEGM£NT:N
OWNEBBULLDEROEClAlU1T10N: IAere�yailirmihatlamaxemptimmtheContractars'SlateLicensaLawiortAetollawinqreasan BLDG PMT PLDMHING ELECTRI� MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business an0 Pro;essional Cotle: My ciry ol counry wAich reVuires a permit ro construct, atter, imDrme, Eemolis4 or p ERM I T 1 1 � 1
repair any siructure, O�ior to its issuanre, alm repuires t�e applicant for sucA permit to file a signa0 s[atement that he/she is IicenuU
pursuant to ihe pmvisions af Ne Contractors' State License Law (Chapter 9(commendnp vnN Section 70W) of Divisbn 3 0l t�e Business 5 0 S M I P/ NON —RE S
an0 Prolessions CoOe) or Nat hNs�e k exempt t�ereirom aM t�e �asis for ihe allepe0 exempnon. My Nalatian of Sectlon 7031.5 by P L AN
any apDlicant far a DermA suble��s Ne apD�icant to a civil penalry of not more Ihan live �unCred dollars (5500). I S SUE FEE 4, rj �
�, u owner ot the D�opeM a� mY em IoyeeS with waqa as metr sole compensation, wiil Oo IAe xroM, an0 Me HUZLDING—DIV—> PEkMIT ISSUE PLAN—CHECK TOTAL PAID DUE
stmcture is not intendea or onerea for saie (�ecuon 7o4a, Business antl Pmtessional Code: ihe Contracmrs' Sute License Law TOTAL S---> 1 1. 0 0 4. 5 0 0. 0 0 15 , S � 1$. S � . 0 �
dces not apDN �o an owner ol a D�operry wtp builEs or impmves therem, anU wtw tloes such xroA Aimseti/herself ar ihmuq�
his or trer own employees, provi0ed that such improvements are not mten0e0 ar atleretl lor ule. It, however the Euiltlinp or
imprwement is solE w�ihin one year ot wmple[ion, Ne owner will �ave tAe bur0en ol D�ovinq �e/s�e Oi0 not builE or improve R E V EN U E D Z V I S I ON TOTAL S--> COL L EC T ED ; 1 S, S 0 OV ER / SHOR T; 0 0
�ormep�roosemsaie). HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMZP/TOT GRADING PLAN—CHECK
I, u owner al the pmperty, am exUusivery wniracting witA licensetl coniractors to wnsWct Ihe prolect (SecGon 70C4, Business 1 5, 5 0
� and Protessims CaOe: The Contradors Sute Liunse Law Eces not appy ro an awner ol property wtq Em'As or impraves Nerean ,
antlwhOCOnIrztl51of5Ut�DrojeclSytAaConitat�or(S�1icen580ursuanl�OlhefAnitatlar5'StateLicenseLaw�.lamaware itifiE#iE3tit3ljElEjEi6jfitiEi(-ih3EitiFi(.il.�(.3E�Eil.i(.�Eif-.lEx-3(.�.itit�(.i(.�(..�it..�.�3(.i(..K*i(.*�Ei(.�f.�(.�f..7E�t.�t..7E�1.�E.J�{�.,K.�.�.*..�,#.�.*,.�.��.�,�..�.**.�„�.
that prooi of tAeir Worker's Comperts:kon insurance 5Aou10 he D�%'�tle0 to me. 1 N D I V I D 0 A L F E E H R E A K D O W N
� I am exempt unaer Secnon: B. 8 P. C.
�orwsreason: p • TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
Date: �— u'� r a owner: �� �—�• �� ELE 1 MISC APPARATUS NOT LISTED REQ PERMZT 11 .00
I do herehy certiry ihat 1 am aware of an0 undersunE ihe repuiremenis oi Califomu Hea1tA anG Safety Catle Sections 25505,25533, ana END OF F EE S`
25534 anE tlut I ar any tuWre builEinp occupant wilVwill not (cirUe one) nretl to compry wit� sai0 sute co0es anU t�e rtyuiremenls lor a
permit for wnswction ar moEificatlm iram Ne Air Oualiry Manaqement D'atrice ReSiGentul wnsWctbn apptiwtlons are exempi irom
Ihese pmvisions.
Date: ApPlicant:
I h¢fCG% celfliy [hdt I IIdvE fEdO t1Y5 dpplip�011 LIU Sid�BIhZ� I�0 aG0V0 in10fI11dII011 I$ COrtECi. I dqR! IO GOmply WI[A 211 G�y dI1E fAull�y
ordinances an0 state Wws rzlating to baWinp consvuction an0 hereCy aNhorrze re0�ntatives ol Uus dry ro enter upan Ne a0ovrmentione0
property forinspeclion puryoses.
: �� CP i .
. Oate: � ' � Sipnature:
Drner's Liceme ar Sadai Securiry x: ,
16a1Je W�it�Bulltli�p; Groen—COAe Enbrcemant; Canary—Applica^t; Pink—Revanue: GobenroE—Avoswr
O1 DOOB4255-06059266 "B'��"
OATE- QS�i:519G TIPSE� 11•':5
I �
1 '
�
CONSTRUCTION ANO PLANNING - P PA
i ppPROVALS Dermit# Date Inspector APPROVALS Permii# Date Inspector
1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location "
i-
2, $oil Pipe-Undrgrnd. 53. Steel Reinforcement -�
3. Electrical Conduit Utility-Undrgrnd. 54. Forms � y'
4. Electrical ConduibUndrgrnd. ��, 55. Electrical Bonding �•
5. Sieel Reinforcement 56. Rough Plumbing & Pressure Test �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit�Undrgrnd.
8. Faundation *" 59. Gas Pipe, O Undrgrnd., Test '
9. Water Pipe-Undrgrnd. : � 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Suuctural Floor System 61. APPROVAL TO DECK -
1 i. Property Sewer Line & House Connection , 62. Backwash & Receptor�Final ��� �
12. Sewer Cap 63. Heater & Vent-Final
r
13. Roof Drains � - �
64. Plum6ing System • Final
14. Fough Plumbing - 65. Electrical-Final
15. Rough Electriwl-Conduit 66. Solar SYstem-Final '
16. Rough Electric Wiring 67. Fencing & Access Approval �-.�
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING .
18. Rough Electrical�T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL
19. RPugh Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace � APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 77. Product Piping OGas ❑Oil
23. Gas Pipe-flough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiiing ($tructural) & Monocoat 75. Dry Chemicaf
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding '� 77. FIXED SYSTEM FINAL
29. Insulation ��^i 78. FIRE PREV. FINAL
30. DrYwall Nailing r'� HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric I�IO�I •;� Notes:
34. Final Heating & Air Conditioning ��� '
� �.
35. Final Gas Pipe�Test � �-,� .'�
36. Hood or CanopY ; � +
37. Final Factory Fireplace � v�
38. Final Plumbing �
39. W&cer Service�Final ,
40. Gas Service-Final
41. Solar pomestio-Final
42. Backflow Preventer
43. Backflow Irrigation
44. L&ndscape Irriqation System
45. Sound Attenuation
46. H2ndiwp Regulations
47. FINALSTRUCTURE&BUILDING
48. FINAL PLANNING _
49. Elactric Release to Edison �+i
50. Gas Release to Southern California Gas Co �
51. C�RTIFICATE OF OCCUPANCY
No. Date
reaec�pno�r,�,s:- 8G9 GOVGRNQR S'I'
OWNEfl'SN�ME: L� llONNA RAPPPI�III,I.�IPS
�ooxess: �69 GUVERNOR �T
COSTA MES7�
CI� 92627
('114 ) 645- 6970
RHCNIENGINEEP:
►oonEss:
flE0.N0.:
uxrt:
uxiT:
PEPMITTEE: L,A DONNA RAPP PHILLI'PS ( 714 ) 645-6970
�ooness: IIG9 GOVERNOR ST
COFi'PA MEaA CA 92(i27
L10EN6ED CO ML70P OFCUMTION: I �areUy atfum Itut I am ficenSeG uMer D�ons ol CIwO�er 9(mmmendnB with Seclion
7000) ol �ivisi n 9 of I�e 9usiness anE Vwtessions CoOe, an0 my Ilcense k in fulllorte anE ottocl,
CITY LIC.: BinTE uC.: LUSS:
Oate: Si9namrt:
WOflKEHS' fAMPENSlITION OECUMTIOM: I �eaDy affirtn tlut I luve a certltc�te ot consent to uIN�¢um or � certitiwta ol WONsrs' ,
�mpensatian Insurance. or a cenilieU capy l�ereol (Section 3800, LaE. C�.
IUCY NO.: IXP. D�TF:
I COMPRNY:
� CenifeE mpy a �ereUy Iumisne0. ❑ cenirm m�y �s nea �m me dn eweino oi�on.
uate: �� ApDlicanC .
IXEMPfION FlIOM WOXIfFA3'�fONPENS�iIOX OECIAMTION: (fA6 samn rce0 nol Ce mnryk40 d tlp partii'x ta are huntlrM (St00) a less).
1 ceniry Itut in Ne ce�ormdn[e ol I�e wOrk for wNU1111¢ pelmii s 55u¢G. I StuA nat empby alry ce� � ar7' �Mr So az to ECwrtk
SUEiect to tAe Workers' ComQensation Laws ol Cafilomia.
Date: Sipnawre:
xOTICE: Ii, aner maldnp.tlds eetlantion, you snoulC Oecome suhject ro Ine workers' Compe�xation o�ons al Ine LaOor
CoOe, yau must fonhwit� mmpry wiN suc� Drovisians w tlis permi slutl Ue CeemeE revakeE.
CONSTHUCTION IFNOIN6 �GENCY: I MreCy attum tlut Nere a a mirstructan IeiMinq apem.y tor the peAormance al t�e woM lar
wnich IAis permit is isSuM (Section 3097, qv. t6 �
lENOEfl: ' �
a00NESS:
OWXEB 6UIlDEB UECIAMTION: 1 hereby atlum Ilnt I am exemD� �rom tAe Coninctors' State Uce�se Law lar t�e IOIIwrinO reasan
(Section 7031.5 Business antl Pralessional CoOe: My tiry al counry wNcn repuires a Derrtut to cansimct, �Iter, impmve. aertwllsA, or
repair aM �Nnurc, priw ro its lssuuice, aho rryuves ttro apqiant Iw such perrtet to lile a 5'rynM sutemmt Itut Ae/she u IlcenseE
pursuam ro tne D�a��ons of tlrc Contractors' State Licenu Law (CMpter 9(commwonp vnt0 Section 7000) ol �ivision 3 0l tne Business
an0 Protessions CoGe) or ttwt MlsM b ewempt Nertlran aM the Wsis lor IM aoepeE exem0��� �Y �tion ot Section 7037.5 Oy
any appliWnt for a Dermit suElecls me appliCant lo a civll p¢nalry ol nat maro ttWn INe IwnGaA Eollars �SSqq.
I, as axner al ihe pmpetly or my amployees wllA wapes as e�eir sole comDensatlon, will da t�a work, anE the
.I siructure is no� NteMeE or otlere0 iw sale �Seciron 70an. Buvness �nU Pmfessional Co�e: TM fqntractors' Slate Licensa Law
I Aoes not apply to an ovmer ot a pmpeM w�o OuilOs or imD�s t�eiean, anA wM Coes wcb work Mmself/Aerull or IhroupA
�is or her own emdaRes, D��� �ti� ��mprovements are rwt IntenEW or otfemE lor ule. II. �owever Na 6uilaln0 or
ImOmvement is m10 miMn one year at camDletion, I�e ovmer will tuve e�e EuNan al provin0 �Us�e 010 noi OuiIE or Improve
,� �or me purpau o� u�el.
I, az awner of t�e DroDerty, am ekGusive1y wnlracilnp xitA IlcenSeE cantractors to consimct tAe pmlecl(Sectlon 701d, Buslness
� ana Pmleuions CaOe: The Contractors' State license Uw Ooes not apply ro an wmer of Dropeity wAo Gutlds or ImD�o'�es IAerean
an0 who contracts lar suc� prolec4 vAt� a contoctoqs�license pursuam to IOa Contractors' Slaia Licensa Lawl.l am aware
ihat 0�� a� thelr WarkCr's fAmpen5a11d1 Insuran[e slqul0 D! praviEed to me.
� I am exemD� un0er Sectlon: 8. 8 P. C.
lor t�is reasan: , .Q
Date: 7—,...T�� � Owner:2Li� •/^�-'7� � ��
I Eo AereEy certiN ��at I am aware a� anC unOerstan0 tna reuuimments al Caiitomu Health anA Sa4lety CoUe Sec ions 25505, 255 , antl
25534 anG that I or any lutum DuilOinp occupant wilNvill not (drela one) nee0 to wmpty wit� uiE state coaes an0 ihe repuiremenis for a
permit for consimction or maEificatian Imm I�e Air�ualiry Manapement D6inct. PesiCential constmction appliwtions are exampt Imm
tnese o�%'i�ons. �f ^,/
Date: 2��.3 �� O pppliant �j�2.� L:3 l.�C�Q�-^ .
I here6y certity tlwt I hava rea0 Nis apDliwuon and state tMt t�e above inlormation is wrrect�l a0rea ro wmply witn all city an0 counry
ordinances anE siate Wws reWtinp to Ouil6np cansinrction aM �ereby auttq� reD�nbtNes ol tNs dry to enter upon t�e a0ore�rtcentloneC
pmpetly �or inspection purposes. /� /]� � �
oate: 2--/ R. —� O Si9nature: �u�" �a-�.�o ' 1
Driver's License or Social Secunry x: ��
�6ab48 W�i[�BuilOina: Green—COEe Enlorcamanl: CanW—Auo��wnt: Pink—Revanua: GOIEenroE—Asseawr
�- ..-;
CITY OF COSTA MGSA - BUILD7NC: PERMIT PERM NO: F. OQ6040
PERMI'I` Ni7: E U46040 PI,AN CbTF.CK NO: N GOVT: N SUPP: N
CONSTRUC'CION TYPE: 5-N PERMIT TYPE: �LE PURPOSE: OTA
JOD DESCRIPTION . INSTALL NEW SRGVICE./REWIRE bIOUaE ;Q FT:
CLAIM VALUE: CALC-VALUL•': �GROUP OCC: R-3 /
CUMMEN'PS :
�t��u�u�*��-�r***�t?�*�-*�r. **�t*��**����r�t**+t*x �r�r***x-ie*x�**�e*+e*�+t�t+r+rx��**�t�r#+ri�**��*ir�t�-�t*�r*�����t
Z O N I N C R E Q U I R E M E N T S
s L T B� c x s
--------- t4AID1 BUILDING ---------
FRNT: PT IN REAR: PT TN
I.EFT': FT IN RGHT: FT IN
- ACCESSURY BUILDING - -
FRNT: FT IN REAR: F'T IN
LEFT; FT I'N RGHT: FT IN
PARKING RE�: PROV: PARCEL: 4224730"/ 2DlF.: REF NO:
PLANNING NOTES> .
> . .
iE ik iF iE iE if:lE # 3f iE iE 3(� iF if 3E i( 3i iE iE it iE iE # k�F �% if iE # iF iE iE 3c� iEJE fFk iE if�lE if iE iE iE iE iE iE iF i(1E K� iE iE �1(- iE if 3E iE k iE iE if� 3f # iE iE �IE iElf 3F iE IE �F iE if iF if ih 3F
D E V E L O P M E N'T S E.,g V I C E 5 R E Q U I R E M E N T S
t
7,ONING APPROVED BY - _ DATE:
BUILDING APPRUVED BY,: �' ' _ llATE: _
APPLICATION ISSUEU BY: ' � . �������� DATE: ����t�
�E3t�E�tit�K�rt*��;tiEx;�nf*?��xx�t�"iF'�.k��ii� r � � i . �� 'iF'3FiF��IE��!c*itjtir�titir x� �t
***#�it*#i�i��r�tft�r�f�*�*ii�t**�exari��-�t***�t*�t�fat�ri�er �tx� y itir�rititit�ri�itit�it*ftir***+rit�rrtitir�r���r*ar****+tir
LEGALIZATION:N F E E S U M�f A R Y STRUCTURAI. SEGMENT:N
DLDG PMT PLUMHING ELFCTRIC.�MECHANIC FIRE SMIP/REi GRI,DING
PERMIT ' ].02.75:
SOt SMIP/NON-NES
C�I.I�N .
ISSUE FEE 15.00�
13UILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PA'!D DUE
TO'CAL�----> ]0"L.75 15.00 ; 0.00 ]1'7.'75 11'7.75 .00
RGVHNUE DIVISION TOTALS--% COLLECQ'GDf 117.75 OVEH/SHORT: 00
HI,DG FMT PI.UMBING ELEC9'RIC MECH'ANTC FIRE SM.IF/TOT 'GRADING PLAN-CHECK
177:75 '
*�*� k��� *�**�ft���itr.**itu����*xx�r*��e****at��klr��e��r�e�r**xitir*�riex �r�r�*�+�*�itit�+r+t�+tk+r�rrtatir*x
I N D I V.i D U A I� F G E D R F. A K D O W N
TYI'G QT1 D G S C R I P T I O N UNIT COST TO'TAL COST
EI.� 20 FIXTUE2EFi� LIGIIT.TNG � 1 ST 20 EA. .75 15.00
ELF 5 L•'.T.XTURES, LIGHTING ; ADDTTIONAI. � F'A. .45 25
ELE 20 RECEPT/OUTLET 1 ST 20 F..A. .7. �, . 0
GLE 76 RFCEPT/OUTLET • AllllITIONAI. EA. "•.•� 1. 0
ELc zo xrcerriswzz•cx '• i sr 2o r:n. t. . o
L'LE 4 RECEPT/SWITCH ADDITIONAL EA. -� 3'�90 , 0
EI,E ] SERVICES BELOW 600�V S 2D0-- 1000 AMP 37 FEB 1 3" 0
END O�' FEES
' CITY -OF~GOSfV+M�SA
CONSTRUCTION AND PLANNINv � � �01 ;PA
APPROVALS Permit # Date � I'nspector, '• �APPROVALS Permit # Date Inspector
i
� i. Temporary Electrical ��r Pole � .52. Pool &�Equipment Location � ,
' 2. Soil Pipe�Undrgrnd. - 53. Steel Reinforcement .!
3. Electrical Conduit�Uti�iry-Undrgr�d. ��� ;�� . ' 54�.�'Forms- �� � � � . '
4. Electrical Conduit�Undrgrnd.• . 55. Electrical Bonding ' . ��
�
5. Steel Reinforcement , . 56. Rough Plumbing & Pressure Test �
6. Electrlca� UF£R Gmd. ' � . 57. APPROVAL TO COVE�R�GUNIT�E
,7: Footings . 58. Electrical Conduit-Undrgrnd. �
�8. Foundation , 59. Gas Pipe, O Undrgrnd., Test - `"1
9. Water Pipe�Undrgrnd. . 60. Backwash Lines, P-Trap, O Undrgrnd. �
10. Structural Floor System 61. APPROVAL TO DECK �
1 t. Property Sewer Line'& House Connection � 62. Backwash & Receptor-Final y ,
�
12. Sewer CaP � . i � � �
63. Heater & Vent�Final
r j r
13. Roof Drains . �� 64. Plumbing System - Final � � �
14. fiough Plumbing '- - � 65. Electrical-Final � .� �
15. flough Elecirical-Conduit � 66. Solar SYstem-Final F� � . �
t
- 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 �
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20.� Rough Factory Fireplace _ � - APPROVALS Permit # �
21'. Ducts, in Structure 70. fJnderground HYdro
22. Ducts. Ventilating 77. Produc2 Piping OGas OOiI
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StoraggTank OGas ❑Oil
� 25. Roof Sheathing � 74, Overhead Hydro
26. T-Bar Ceiling (StrucWral) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe _
' 28. Lathing & Siding ' � 77. FIXED SYSTEM FINAL . .
29. Insulation ' 78. FIRE PfiEV. FINAL �
30. Drywall Nailing _ �• ti�, HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat �f �� 79. FINAL INSPECTION � �
32. Electrical Power Meter�Final ��,(j�� 80. FOOD CERTIFICATE ISSUED
33� Final Electric , �� - Notes: a a7 !T 0. O J
34. Final HeSting & Air Conditioning . rrnl ,
f
35: Final Gas P�Pe-Test - .%- �• s4me
�36. Hood or CanopY • , , '� � �
37. Final FactocY Fireplace ' '
�.38. Final Plumbing ' 1
39. Water Service-Final, � . _.
40. Gas Service-Final ' � '
� 41. Solar pomesticFinal � � . ' - �
42. Backflow Preventer -
�43. Backflow Irrigation .
44. Landscape Irrigation System , . _ � �
" 45. Sound Attenuation , . , � � .
� 46. Handicap Regulations ' • �
47: FINAL STRUCTURE & BUILDING ,'� . .
46. FINAL PLANNING �� ',
49. Electric fleleate to Edison �. .� '
50. Gas Release to Southem California Gas Co - -, �� �
51. CERTIFICATE OF OCCUPANCY '
No. Date
�
�
�
AOP�icant to fill in all spaces except lhose with(n heavY �ortler lines antl sign all appropriate Eecla�atians.
CITY.rJF COSTA A CO�� SyTRUCT�I!ON PERMIT PERMIT O„ ... /!Y TFjFaCS NO. LOT ryQ.� UNIT NO.
Project Address ��� �-/ ✓ uC�N�
ApplicanYs Mailing A�rJ�/ ess � Z�-S I� CI�1A __
Owner's Name �j ' t
(� �'�� Phone
Address ('�� �U�'Q�Q�-
ArchlEng. � .License No.
Address �-
Convactor'sNam � � P�e-^
Address (mailing) �" �
City License No. 2
LICEIVSED CONTRACTOR D CLARATION
I nereby atfirm [M1al I am licensetl untle� O�ovisions of Cha�te� 9(commencing
with section ]000) of Division 3 of tM1e Business antl Professions Cotle, antl
my Iicense is in II or antl etfecL q/�G
Licen CI s Lic No �� �
Date � Si9nature
WORKERS' COMPENSATION DECLARATION
' hereby afiirm tnat I have a certificate ot consent to self-insure or a cerHiicate
Wo�ke�s' Compensation InSurance, ot a certifietl copy thereof (Section
.800, Lab. C.)
PoliGy No. Company V
8 Certifietl copy is hereby furnishetl.
Certifietl copy i5 tiletl with the city Builtlinq Dlvlsion.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION �
(Thissection neetl not be completetl if the permit is fo/ one huntl�etl ($100) or
less).
I tertlty that in the perfo�mance of the�,�p(o�k for which this permit is issuetl, I
shall not pioy an person in any @f3�e^so as be,�orPe subject to the
Worker ' S ws ot Calif6mi7 //)Q.,,✓
Date - � Signature �� Q �YJC./1
NOTIC . It, tter makin9 tnis tleclaration, you snoultl become subject to tna
Worker Compensation provisions of the Labor Cotle, you must torthwith
comply with such provisions o� thi5 permit shall be tleemetl rewketl.
CONSTRUCTION LENDING AGENCV
I hereCy affirm that there is a construction lentling agency tor the performance
of the work for which this permit is isiuetl (Section 3097 Civ. Q)
Lentle�'s Name
Lentler's Atltlress
OWNER BUILDER �ECLARATION
I he�eby affirm that I am exempt from the Cont�acto�4 LicenSe Law for the
j followinq reason (Section �031.5 Business antl�Professional Cotle:�Any city or
� county which requires a petmlt lo construct, alter, imp/ove, tlemolish o� �epair
'I any stru<ture, p�ior [o its issuance, also �equirgs the aOP�icant foYsuch permit
to tile a signetl statemenl that he/51te is litensetl pu�suant to the Orovisions of
the Contractor's License Law (Chapter 9(commencing with Section "]000) of
'livision 3 of Me Business antl Professions Cotle) or [hat he/she is exempt
erefrom antl the basis for the allegetl exemption. Any violation of Section
13L5 by any applicant fo� a permit subjects the applicant to a civil
penalty of not more than five huntlretl tlollars ($500�.
LJ I, as'owner ot the property or my employees with wa9es as their sole
mmpensation, will tlo the work, antl the structu�e is no[ intentle0 or offere0
for sale (Sec[ion ]044, Business antl Professionai Cotle: The Contractor'S
License Law tloes not appty to an owner of a property who builtls or improves
thereon, antl who tloes SucM1 work bimselt/herself or through hiz or her own
employees, pwvitletl thal such improvements are not intentletl or offe�etl for
sale. If, bowever, the builtling or improvement is soltl within one year of com-
pletion, tne owner will have Ihe burtlen Of proving he/sne tlitl no[ builtl or im-
p�ove for the purpo5e of sale).
❑ I, as owner of the property, am exclusively contracting wlth Ilcensetl con-
tractors to construct the project (Section ]044, Business antl Professions COCe:
The Cont�actor's Litense Law tloes not apply to an owne� of p�operty who
builtls or improves thereon, antl who contracts for such project5 witM1 a con-
t�actor(5 bcense pursuant to the ConVactor's Litense Law). I am aware that
proof o� their Worker's Compensation insurance ihoultl be provitled to me.
❑ I am exempt untler Section B. & P. C. for this �eason
Date Owner _
I hereby certify that I have reatl thi5
Information is correci. I a9ree to comp
antl state laws � ' 9 to builtling con
sentatives of t ct to en r oi
'mipection purp es.
Signature
Drivers' LicenSe or 55 �
CMF 08fi5-46, rev. 30/B4 Wnite - Builtling; Canary - Appllcanp
a0ove
TYPE OF CONSTRUCTION � LJ rvEw LJ ADD L'J ALTERATION LJ REPAIR
❑ COIVVERSION ❑ DEMOLISH ❑ OTHE
DESC�TIONOOF�WORISJ�U `F�B�I_�tC� �?/ ! ti) A'
.��
TVPE OF PERMIT GRADING FOUNDATI� STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL
❑ OTHER 1
PROJECT DESCRIPTION 5Q. F7. ' � oCCUPANcv
CONSTRUCTIONTVPE 'VALUATION$
ZONE GRADINGCU.VDS. AC(3E5
Remarks:
Bar Sink
Backflow
�rinking Fountains
Floor Drains
Floor Sinks
Gas Service Outtets
Interceptors
Kiichen Sink
lavatories
P—Trap
Roof Drains
Reinspection Fee
ShOw¢IS
Service Sink
Sewer Cap
Se'wer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry:Trays
$15 ' Issue Fee
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Faci. BIL ICBO #
Heating SYstem & Ducting
❑0.100,000 BTU �100,000BT'�
� I I Re�nspec[ion Fee I $15
Accoun[ing; Goltlenrotl - Assessor
Hood ar Typel ❑
Canopy Type I I ❑
Refriqeration System
❑0-100,OOOBTU ❑100,000
System Repair/Alteration
FireDampers �
Registers
Issue Fee
FEES
A.P. #
S Main Building:
E
T Front
A Rear
C Right
K
g Left
Ping. Ref. #
Planning Notes:
9641 II/16/B7
�
2one
Accessory Building:
Parking fleq./Provided
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas �Electric
Fan
F.A,U.
Fixtures
Device Boxes
Outlets
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Garbage Disposal
Generator �0-5 KW �5-15 KW
Meter ❑up to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors 00-1 HP O1 Y� - 8
Inc.Solar �9-15 HP �i6-15+
Microwave �
Pole Light
Range
Sign
Standing $ections
Trash Compactor
5 3
Reinspection Fee $15 Issue Fee
FEES
�DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved By
Building Approved By _�
Aoolication Iwued Bv
$ 3
IIo00' Tl
2
O
N
I
N
G
R
E
Q
M
T
S
FEES
$ 3
. SUMMARV OF FEES F% �--
BUILDINGPERMIT $ SMIP $
PLAN CHECK $ PERMIT �
PLUMBING g � ISSUANCE 3
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $�
PLANCHECK 5096 $ MICROFILM $
MECHANICAL $ TOTALFEE , $ �
PLAN CHECK 25% $
,CONSTRUCTION�AND'PLANNING POOL & SPA . � �
�APPROVALS Permit # � Date Inspector AppROVALS Permit # Date Inspector
t-
1.�Temporary Electrical Service or Pole , 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. , 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE �
7. Footings �� 58. Electrical Conduit-Undrgrnd.
}
8. Foundation (� 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. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains . 64. Plumbing System - Final .
14. Rough Plumbing . 65. Electrical-Final '
75. Rough Electrical-Conduit 66. Solar System-Final -
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED'FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace APPROVALS Permit # -
21. Ducts, in Structure 70. Underground Hydro
22. Ducts,Ventilating 71. ProductPipingOGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush � �
24. Roof Framing . 73. Undergrnd. Storage Tank � Gas ❑ Oil =
25, Roof Sheathing � -- -" �- •- ' 74, Overhead Hy�dro ,
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 '
r";..
33. Final Electric Notes: � � M� J'. �
34. Final Heating & Air Conditioning � _
35. Final Gas Pipe-Test "'"
36. Hood or Canopy
37. Final Factory Fireplace �
38. Final Plumbing 2��� (�� �
39. Water Service-Final � � ' -
40. Gas Service-Final
41. Solar pomesticFinal - - � -
'�
� 42. Backflow Preventer �` -�.}js/ (�� - . ' i
43. Backflow Irrigation -' � i
� 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 , �'
s���y r�
� OWNER PHILLIPS� BUD - DATE SEP 1 1 196t
SUBCONTfLACTOR
-� 2293£i
CfJSTA MESA BUILDING-SAFEfY DEPARTMENT
P. O. BOX 917 C09TA ME6A. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
��oirv6 �//J �/ � �O, �t J
DRESS �77 /J9�lPiS/71,i�'Zn�
COSTA MESA. CALIFORNIA
(1 MAIL
J
■ BETBACK L�NE FROM
TEL.
EFT v [� O I RIGF{T
DESCRIPTION OF WORK
� EXTERIOR WALL
NO. OP
ROOM9
I ROOF
�
I� HEHEBY ACKNOWLEO68 TNAT I XAVH RHAO TH�9 APPLIGT�ON
M1N� BTRTB THAT THE ABOVH IH <ONRECT ANO AOqEE TO COM.
PLY WITM �1LL CITY OHOINANCHB ANC 8TAT8 L�WB qeOULATINO
euaoirvoconaraucr�oH. /1 / i
I AUTHORIZED A6ENT � n � U u L_ 1�' ( 1ri/
�EE RECEIV�U
SEP 11 1964 �`
FINrA�NCE UEPl. 6't/U
ltPPL1CJ��lOtY �PC7R "PeRTAIT
BUIIDING
For Offica Use Only
p[C[I'T NO. PFRMIT NO.
2zy3 ,
e�x o�reM� owrr �esuac
iI I NO.OI
PLAN9
YARDSAPPROVEO
MAIN BUILDING
VAR. �j
UB80PN6W
BUILOINO
SHALL BE LE89 THAN
YARDSAPPROVEO
ACGESSORY BUILDING
BET. MAIN 8
ACCESS. BLL
DATE
n
SQ. FT. ^
TH8 AMOUNT 9HOWN UNOER VALIIATION 19 FOp TH8
PUPPOBE OP eBTABLIBHINO A PeRMIT F88 ONLY. F
O
VALUATION � 0 O m
PERMIT F8E S �
�
m
$ �
a
66�:— �a� e
TOTALREE $
ORANGE COUNTY BUILDING DEPARTMENT
� , 636 North Broadwar �
, .. SANTA ANA, CALIFORNIA •
fOR APPLICANT TO FILL IN
NEAREST National Ave•
CROSS ST.
OWNER Chevenne 130�Pi8 InCi•
MA'L 9363 Wilahire Blvd.
AODRE55
��,� Beverly Hille No`. CR
ARCHITECTC�`�n—Dic
ENGINEER
AODRESS ZZZO E.
ITRACTOR BA1bC
ADDRE55 6 w�
LEGAL LOT 'f
JESCRIPTION NO. ^I
L
/ NO.OF BLDGS.
SIZE OF LOT p7 ][ lO7 NOW ON LOT
USE OF NO.OF NO.
E%ISTING BLDG. Fnmiues ROC
CENB ER OP STREETM� JO P U� SEDE YARD 1�
DESCRIPTION OF WORK
NEW I � AITERATION I I ADDITIOI
REPAIR I I MOVING I I OEMOLIS
BlIII,DI q 1, NO. OF
SIZE V3Y' BO.Yt�ROOMS ORIES
EXTERIOR WALL p1. L ROOF
COVERIN6 vyUCiCipCOVERING I
OF NEW
�owc RaalAonno_ntt (!n»rn�
APPLICATION FOR PERMIT
� � � � � � � �
FOR OFFICE USE ONLY
RECEIPT NO. PFRI
7s� � 5 s
PY DATE REG'D. OATE ISSUEO
MAY 8 �gg� MAY 6.,o�q
BUIL�ADDRESS
SCHOOL DIST.
OR TOWN
61 NEAREST .
APPROVED.
I-LL\�F'J
CORRECTIONS
APPROVALS
DATE.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS FORMS, MATERIA
APPLICATION AND STATE THAT THE ABOVE IS CORRECT UNOER-PINNING
AND AGREE TO COMPLY WITH ALL COUNTY OROINANCES FAAME: FIRE STOPS.
BRAGING, BOLTS
ANO STATE LAWS REGULATING BUILDING CONSTRUCTION.
LATH.INT. ``
SIGNATURE OF Ba1bOE. VSB yB. CO • LATH. E%T.
PERMIiTEF -
L^1 ��.({�/_ PLASTER, INT.
AUTHORIZE� AGT /^ � �- • ��+� � �"�—�
/�'/u� �\ PLASTER, EXT. �
I
PSAtn�i Fee S� MASONRY REINFORCE
VALUATION s �a3o�00
PLAN CXECK S BON� BEAM
TOTAL
Feg S � FINAL
O (
A
�
Z
f