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Home My WebLink About2687 PALA MESA CT - Building Permits� ` ,,#q� e�„ J �� 1 CITY OF COSTA MESA CALIFORNIA 92628-1200 . P.O. BO% 1200 DEVELOPMENT SERVICES DEPARTMENT September 17, 1990 To: Building Safety Division Code Enforce;�ent Communications Copley-Colony of Costa Mesa County Administration Office County Clerk/Bd. of Supervisors County Registrar of Voters County Tax Assessor Engineering Division (2) Fire Administration Fire Prevention Manager, MIS Mesa Consolidated Water Dist. Newport-Mesa Un. School Dst. (2) PdC1f1C Bf'.11 Police Dept. - Ping. & Research Santa Ana Heights Water Company Sanitary District Engineer Southern California Edison Co. Southern California Gas Co. State Board of Equalization Street Division U.S. Post Office - AIS U.S. Post Office, Adams Avenue File (2) The City of Costa Mesa wishes to advise you that the following addresses have been changed or added: �161 161 161 �161 161 OLD ADDRESS "A" Mesa Drive "B" Mesa Drive "C" Mesa Drive "D" Mesa Drive "Ei° Mesa Drive NEW ADDRESS A.P. N0. 2689 Pala Mesa Court, 439-221-64 2687 Pala Mesa Court 2685 Pala Mesa Court 2683 Pala Mesa Court 2o^oi Pala Masa Court �M 165 Mesa Drive �2682�Pala Mesa Court 439-221-23 FS-Mesa Drive �2684�Pala Mesa Court, 165 Mesa Drive �2686;Pala Mesa Court � 165 Mesa Drive 2688_ Pala Mesa Court � 165 Mesa Drive 1=2690iPala Mesa Court � � �(,�QO� For your convenience we are listing the agencies above that we have notified of the change. In addition to those listed, you are advised to notify your correspondents of the change in order to avoid any possible interruption of mail service. 77 FAIR DRIVE Buildinq Division (714) 750.5626 • CoCe EnforcemenUBusiness License (774) 754�523d • Planning Division (7t4) 754-5245 _.. � PALA MESA COURT /�� . � 2sss MESA DRIVE __ _ � � ' �� I � . 1 4 I U Q ( � � W � Q J • Q a. L6717 2ses � i ssas I A 0 September 17, 1990 Page 2 Your cooperation in this matter is appreciated. Sincerely, � � RICHARD WELMERS Planning Intern " RW:jl(ADDCHNGE.80A) cc: wSS Development Company Jim Westhoff 2 Corporate Park #702 Irvine, CA 92'I14 ' Todd Schooler and Associates 50o North Newport Boulevard #206 Newport Beach, CA 92663 . a AOO��ant to fil� in al� soaces exce0t those within heavy EorCer lines anC sign ali aDVroO��ate Oeciarations. Ci7Y qP COSTA MESA CONSTRUCTIqON PERMITn PE mn1 No. rRacr No LOT NO — u T o ProjectP�dress �� CSA 02 /S�Oc-�� ")�'C� - Applicant'z Mailing Address � C" p_� �"aK �q/� 4,'jv L 6;vner'sName wss �eVc�ofl^�'"� Phone SS.S�oyO Address Arch/Eng. License No. Adtlress Contracror's Name—�VA�S �/'-�3 U Phone � �% Adtlress (mailingl � Z� wN rr�rE� ST CI� Ciry License No. �3 � !-> � LICENSED CONTRACTOR DECLA0.ATION I hereby aHi�m thdt � am licensetl untler provision5 ot Charter 9(cpmmenting wit� section ]000) a/ Divislon 3 of the Business antl Professions Cotle, antl my Iicense is in tull lorce antl effect. License Class � License No. Date%-�4-y� Signature �1 — q WORKERS' COMPENSATION DECLARATION � 1 nereby atfirm that I �ave a certificate of <on5ent [o self-insure or a certit7cate ` WorkerY Compensation Insurance, or a certified coOY �hereo! (Sectlon �o. uo. c.� orcy No. t�, P 9 iYng 3om,Company �Q2 •`� o...T B Certifietl coDY is �ereby lurnishea. Dateen� ie i� py i} rj�etl with the city Bwl oJ'�'�isio�{� �� a Applicant .��-�"(� J EXEMPTION FROM WORKERS' COMVENSATION OECLARATION (This section neetl not be completetl if the permit is for one �unEretl (E100) or less). I certify inat in tne performance of lhe work (or w�lc� ibis perm�t is issuetl, I sball not emoioy any oerson in any manner so as to become suDject to the Workers' ComDensali0� laws oT Calitornia. Date Signature NOTICE: It, after mak��9 this tleclaration, you shoultl become suDject to the Workers' Compensation provisions of Ihe Labor Cotle, you must torlhwith comply with such provisions or this vermil snall be tleemeC' revoketl. CONSTRUCTION LENDING AGENCV - I nereby affirm t�at there is a construction IenGing agency for the performance of the work for which this permit is issuetl (Section 3097 Civ. C.) l.entler's Name �entler's Aaarezs OWNER BUIIDER DECLARATION I hereby affirm Ihat I am exempt from t�e Contractor's License Law for the fotlowing reason (Sec�ion �031.5 eusiness anC Grofessional Cotle: Any city or county whic0 iequires a permit to Const�uc[, altEr, improVe, Eemolish or r¢Oair any struclure, p�io� to its issuanCe, dlso r¢puires tM1e appli[ant for suGh permi[ to file a signed stater�ent that he/she is licensed pursuant to Me provisions of the Con[ractor's LicePm Lav+ (Chapter 9(commenung with Section 7000) of DiviSion 3 of the BJSine55 dntl Vrofes5ion5 Cotle) or thdt he/Sh! I5 exampt 'nerefrom antl the bd5i5 for the allegetl exemption. Any violatiOn Of Section �31.5 by any appPcan[ lor a Oermit subjects the applicant to a civil �nalty o/ not more than five buntl�ed tlollars (E500). L� I, as owner o( tPe property or my employees with wages as their sole compenzation, will tl0 the work, anG the ztructure is not inten0etl or of(eretl for sale (Seciion �044, Business ana �rafessional Cotle: The Contractor's License Law tloes not apo�Y �o an owner of a o�operty who builtls or improves Nereon, antl who tlees such work himself/herselr or Mrouqh nis or her own employees, provitletl Ihat such imOrovements are not intentletl or olferea tor sale. I/, however, Ihe builtling or im0�ovement is soltl witnin one year of com- pletioq tne owner w�� nave the burtlen ot Oroving ne/she tlitl not builtl or im- prove for the puroose of zale). ❑ 1, az owner of the P�operty, am ezclusively contracting with licensetl con- Vactorst0 tOnS[ru[t the projeGt ($ection ]044, Business a�tl P/ofe55ion5 Cotle: The ContractoYs License Law tloes not apPty to an owner of property who builds or improves tnereon. and who conVacts �or zucn oroiects with a r.on- tractor(s) license purSuant ro[ne Contractor•s �icense Law�. 1 am aware that proot of their Workdr'S ComOe�sation insurance Shou10 be O�oWded to me. ❑ 1 am exempt untlef Section B. & P. C. �or this reason Oate _ Owner I hereby certify tnat I have reatl this ap0lication antl state Mat the above information is correcL � agree to comply with all city and counry ortlinances antl state laws relatin9 to builtling construction, and hereby duthorize �ep�e- Senta[ives ot thiz ci t� u on the dbove-m¢ntiOnGC Orop¢rty fo� InSpGttion purpo ,� �_� y� J D Signature Date O 0 Drivers' License or 55 # �� 3S � S A.P. � � :�� S Main Building: T EOFCONSTRUCTION NEW ADO ALTERATION REPAIR E ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T Front DESCRIPTION OF WORK/USE OF BLDG. A Rear C Right TVPE Of PERMIT GRADING�q �FOUNOATION STRUCTURAL K ❑ TENANT ❑ ELECTRICAL yeYYLUMBING ❑ MECHANICAL S' Le1t ❑ OTHER Ping. Ref. # PROJECT DESCRIPTION 5Q. F7. OCCUaANcv Planning Notes: C O N ST RUCT I ON TYPE V ALUATI ON $ ZONE GRAOINGCU.�'D5. ACRES Remarks: �%.0 � it Bar Sink Backflow Preventer Backflow Irrigation Drinking Fountain5 Floor Dreins Floor Sinks Gas Servic.e Outlets Interceptor5 Kitchen Sink Lavatories l l � " T P-Trap Roof Drains Reinspec[ion Fee � $15 Boiler Duct-UnderGround Duct - Sttucwral Duct- Ventilating Enhaust System ❑ MWtiple ❑ Firepl/Fact. Blt. ICBO � Heating System & Ducting ❑P700,000 BTU �100,000BT Reinspec[ion Fee � S15 0865-46, rev. 5/BB White - Builtling; Canary - Appiicant: Pink - Accounting; Goltlevotl - Assessor Showers Service Sink SewerCap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Cloret 'A Water Heater Warer Service Auto-Wash �'^ Laundry Trays laue Fee Hootl or Typel ❑ Canopy Type 11 ❑ Fefrigeretion SVstem ❑0-100,000 BTU ❑ 100,000 6T System Repair(Alteration Fire Dampers Regiscers Iswe Fee Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher •. Dryers ❑Gas �Electric Fan - F.A.U. Fixtures - Device Boxes Outlets $WIlCh25 Garbage Dispoul Generetor �65 KW C Fee zo�a Accessory Building: Parking Req./Provided ELECTRICAL Transtormer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over100amps Sub Panel Motors �61 HP � 1 h- 6 Inc.Solar �9-75 HP �16-75+ Microwave Pole Light Range Standing Sections 5 KW Trash Compacwr S15 Issue Fee $ 3 DEVELOPMENTSERVICESFE�UIREMENTS: 2oning APProved By FEES Building Approved By � Application Issued By $ 3 FEES $ 3 SUMMARV OF FEES BUIL�ING PERMIT S SMIP $ PLAN CHECK S _,�_ PERMIT PLUMBING S _��_ ISSUANCE $ PLAN CHECK 25% 5 ENEPGV P.C. $ EIECTRICAL S GRADING $ PLAN CHECK 50% S MICROFILM $__�T MECHANICAL 5 TOTAL FEE g.�^ PLAN CHECK 25% $ �.1 ADO�kant to fill in all spaces except ihose witifin �eavy OorOer linei antl sign all appropriate tleUarations. CITYOF COSTA E�SA CONSTRUCTION PERMIT 3�;n,�� '•�Trl, �,� TRACT NO. LOT NO. UNIT NO. A P# r PrnMc[ AdCress r/ �!'�'G �%'�- A%� G Applicant's PAailing Address �<< � C�7 ��f �T{� E� "'�'�' �.0 Ouv/ier's Name Phone Adtlress ArchlEng. License No. Address Contractor'S NamF�'�'p�� T�2lL Phon� —�3��G' Address (mailing) �SH7 �, �T -6F�P_ i ,.� ��I�� Ciry license No. 2 �/'Z�O � LICENSED CONTRACTOR DECIARATION . hereDy affirm that I am IitGnsetl untler provi5ion5 of C�arter 9(comm¢ncinq wit� section 7000) of Division 3 of the Business antl P�ofesslons Cotle, antl my license is in full forcIea, _ntl etlect. �( Q LicenS¢ Class `^ �V Li fyP(� 7 �` 7� Date • � � Si9nature �`"'Q � �� WORKERS' COMPENSATION DECLARATION i hereoy afiirm inat I have a certi(icate of consent to self-insure or a certificate Workers' Compensation Insurance, or a certified copy Ihereof (Section J0, Lab. C.) Policy No. COmpany eCertifietl copY �s hereby (urnishetl. Certifietl Copy is filetl wiN the tity Builtling DiviSion. EXEMPTION iROM WORKERS' COMPENSATION DECLARATION (This section neetl nol be completetl if the permit iz tor one hunCrea (E300) or iesz). I certify that in [he per(ormance of the work (Or whICM1 tbjype�m�t is IsSU�p, I shall not employ any parson In any manne DDD Co e sub' t to thg Worker¢+�Cpq�qen5aiipn Laws ot Calif �T // �_ / Date Y G:3 SJ�" Si9natu' � ` /!%./�� - NOTICE: 1f, atter makin9 this tleclaration, you 5houltl become subjecl lo the Workers' Compensation provisionz ot the Labor Cotle, you must lorthwith tomply with such provi5ion5 or thi5 permit Shdll be tleemeC revokeC. CONSTRVCTION LENDING AGENCV I he�eDy atfitm tha[ th¢re is a tons[ructio0 IGnAing agency fo� the pe�tormdrlte ot th! work fOr whiU this permit i5 i55ue❑ (Section 3097 Civ. C.) lRntler'S Name LendeYs Atltlress OWNER BIIILDER DECLARATION 1 hereby at�i�m Lhat I am exempt from the Contractor'S License Law for t�e following reason (Section 7031.5 Business antl ProfeSsional Cotle: Any city or munty whiCh r¢quires a permil t0 cOnstru<[, alte�, improve, tl¢moliSn o� repai� any structure, priOr to its is5uanc¢, also requires the aOP��anl fOr SUG� Dermit t0 /ile a signetl Stdt¢Tent t�at he/She is IiCenseU Pu�suant to Ih! Provision5 ot the Contracto�'s Li<ense Law (Chapter 9(commencing with Section 7000) of fJivision 3 of tne Business antl Protessions Cotle) or that he/she is ezempt •refrom antl the basis for the alle9etl exemption. Any violation of Section 31.5 by any applicant to� a p<rmi[ 5ubject5 the aOPliCant to a Civil c-,nalty ot nat more than tive nuntlretl tlollars (E500). LI I, as owner o1 the Oroperty or my employees witn wages az Meir sole compensalion, will tlo Ihe wo�k, dnd the Strutture is noS intentl<C or offe�etl for sale (Section 7044, Business and Profezsional Cotle: The ConUactor'S License'Law tloes not apply to an owner of a property w�o builtls or improves thereon, antl who tloes such work nimseH/herself or through his or Oer own employees, o�ovitletl that such improvements are not intentletl or ofterea for sale. I1, M1owever, the builtling or improvement is soltl within one year of com- pleSion, the owner will have the buraen oi provin9 he/she tlitl not Duiltl or im- prova for the ourpose of sale). ❑ I, as owner of tbe property, am exUusively tontracting wi[h licensetl con- tractors to mnstruct tne Oroject (Section 7044, Business antl Protessions Cotle: The Contractor's License Law aoes not apply co an owner oi property who builtls or imoroves tltereon. antl wno cOn[racts fo� Such oroiects with a mn- tractor(sl Iimnse oursuan� to cne ConVactors �icense Law). I am aware thac proo/ o( Ihei� Worker'S ComOensation insurance shoultl be prOvitleO to me. ❑ 1 am exempt unaer Section B. 3 P. C. tor tbis reason Date Owner I nereby certify that 1 nave reatl this aoPlicalion antl state that lhe above intormation is correct. I agree to comply with all city antl county orGinances antl itate laws relating to �uil0ing constr ion, antl hereby au[�orize reore- S¢ntative5 of thi5 �,�tY !n{gvyp O dbOve-mintionetl proDe![y for Ins ection puryq�/ /J/ -,+ � /,j � y"�`lyF �� oate•• ' � � Signature DrivCrs' Li �� TYPE OF CONSTRISCTION � NEW I.J AD� LJ ALTERATION LI REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OT ER DE CRIPTION OF WOR /USE OF BLDG. �LFLTJ�/C C i � � DF-n. D�G TVPE OF PERMI� GRADING FOUNDATION STRUCTV RAL ❑ TENANT ELECTRICAL ❑ VLUMBING ❑ MECHANICAL ❑ OTHER PRQIECT DESCRIPTION SQ.FT. OCCUPANCV CONSTRUCTION TVGE VALUATION $ _ ZONE GRADING CU. VOS. ACRES_. Remarks: $ Z S Z '� _/ Sink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Servic.e Outlecs Interceptors Kitchen $ink Lavatories P—Trep Roof Drains Reinspection Fee � $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact Blt. iCBO dk Heating System & Ducting ❑0.100,000 BTU � 100,000 Rainspaction Fee I §15 Showers Service Sink Sewer Cap Sewer COnnection $olar ColleCtors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service A uto-W ash Laundry Trays Issue Fee Hoodor Typel ❑ Canopy Type II ❑ Refrigeration System ❑aioo,000aTu ❑ioo,000sT System Repair/Alteration Fire Dampers Registers laue ee S Main Buildi E T Front 6 Rear A C Right K Left S Ping. Ref. # Ptanning Notes: Automatic Washer Consvuction Pole Sub. Cooking Unit D ishwasher Dryers ❑Gas Elec Fan F.A.U. Fixtures Device Bozes 0 utlets � zona Accessory Building: Z C � i N G R Parking Req.IProvided E ELECTRICAL Transformer � 15-50 KW ❑ 50+KW 3 Meter ❑up to 100 amps Meter ❑over100amps j Sub Panel Motors �41 HP O1 h- 8 Inc. Soiar �9�75 HP �16-15+ Microwave Pole Light �vrtcnes Sign Garbage Disposal Standing Sections Generator OP5 KW �5-15 KW Trash Compactor Reinspection Fee J$15 � I Iszue Fee $ 3 DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By FEES Building AVProved By � Appliption laued By FEES $ 3 SUMMARV OF FEES BUILDINGPEftM1T S SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE g PIAN CHECK 25% $ ENERGV P.C. g ELECTRICAL $ �� GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE $ _� PLAN CHECK 25% $ s3 44��Co.o3 _ : _.. .. .._. ' _.. _. � fl�S�-�-ci.-� � 1� >a- COIVSTRUCTION PERMjI, , � ADplicant t0/ill in all spacei exce0� ��oze witnin �lavy Gortler lines anC si9n all approoriate tleclarations. 1 P(� 13 � T� r4�j 44T4 � UNIT NO. A.P. � � — -' S Main Builtling: .sMailingAddl¢S5� iC� TYPEOFCONSTRUCTION NEW ADD ALTERATION RE AIR E � ❑ CONVERSION ❑ DEMOLISH ❑ OTHER '� � 7 FrOni „�i's Nas � Phone,'�'�L -+�O DESCRIPTION OF WORK/USE OF BL�G. T�i�-%-X � A Rear Addre55 / � O r �+ �� Apfh/Eng. icenze No.L � Address � Coniroc[or's Nam Phone Address Smailingl � City L�cense No. LICENSED CONTRACTOR DECLAqATION I hereby aftirm thdt 1 am lic�iisatl unUer OroviSioni ot Chart¢r 9(Commencing with se<tion 7000) of Divition 3 0/ the Buziness antl Protessions Cotla, antl my license is in tull force antl effect. ' License Class Li<ense No. � Dale S�9nature W00.KER5' COMPENSATION DECLARATION p,�0ef¢Dy af}irm lhat I 11dve a Ultl(IcdtB o/ ConSent t0 S¢�f-inSure oI a CBItItICdt¢ �Wofk¢ri' COmpenSdtiOn InSUldnce, Or d ceftifietl Copy th¢rloT (SBCtlon 00, LaO. C.) - . � � ' Policy No. ' CompSnY eCertifietl copy is hereby /urNs�e4 � Certitietl copy is filetl with t�e Uly Builtling Division: . Oate ApOticanb� � EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Tnis section neCtl not be �ompletetl if the permit is for one huntlretl (5300) or less). I certity tha� in the pe�tormdnce of;h! w0/k t0� wnich Ihis pE� � is Isiue I s 11 not'employ any person in aoy menoer so as �o be<ame ubject e rkej� en Udn 4aws ot Cali/or la. Datq/ � �y 1� Si9nature NOfICE: I,afte making thi9 tleclar tfon, you s�ou�tl Gecome subject to t�e Workers' Compensation O�ov�slons of the Labor Cotle, you must forthwith"�- co�npry with such prodsiolK or tMs permN ShaN be Ceemetl wvokeQ. CONSTRUCTION LENOING AGENCV I �ereby afllrm [�at there I5 a con5truction IenEing agency �or tne pertOrmance of lhe work tor which tMz Dermit fs issuetl �Section 3097 Cfv. CJ Lentler's Name Lentler's AtlGress OWNER BUILDER DEGLARATION 1 �erebY aHirm lhat 1 am exempt irom the Contracror's License Law for the followin9 reason (Seclion �031.5 Business anE Professional Cotle: AnY Uty or county wfiith reV Wres a peRl�R to construct, alteq imprave, aemolish or repalr any siruUure, Orior to Its issuance, alSo requires Ihe applicant tor such Oermlt m tile a siqnetl statement mat ne/sne IS licensed pp�suant to the prov�SiOns of t�e Conlracror'S IJcense Law (Cnapter 9(commencin9 wiln Section 7000) of rDivisio� 3 of t�e Buslneis antl Profesiions Cotle) or that he/she (5 examD� �herefrom aoA the basis �Oi t�e allegetl exem0��on. Any violation of Section 031.5 oy any apP��cant Rd a perml� SUDjects the aOP�icant t0 a Civil �enalty of not more than tive �untlretl Oollars (E500). LJ I, as ownar of the P�oplrty or my employees with wa9es as tbe(r SOIe compensatfon, wul tlo tna vrork, antl t�e structure is m[ intentled o��oltam0 ior Sale ($CCtiOn 7044, Builne53 anC Prof¢ssional COQe: The CorttfdctOf'S lJCen52 Ldw tloei nOt app�Y to dn Owner o� a prop¢fty who bviltls Of iTpfovCs thereon, antl who tloes sucn work himsell/herseli or tnrough his or her own empioyees, pro+itletl that suth ImprovemeNs are mt intentletl or otferetl 1or sale. H, �owaver, l�e Eu�IGing or ImO�ovement is soitl within one year of com- pletion, lne owner will nave tns burtlen ol proving he(she tliC not bui10 or Im- {� ve for lhe pu�0ou oT sale). �L'l.l, as own!/ o( th! prope�ty, !m exUusively con�ra[ting wit� IittnSGtl m�- �racto6 to coniV uGt the O�o�ecl (Section ]06a, Businesz antl Professions Cotle: T�e Contractor's Ucansa law does not aOPly to an owner of property who , Oui�tiz or imo�oves tnereon. ana wno contracts tor such oroiecta with a con- , tra<tor(s1 license Vursuan� to tne Conuacrors �icense Law). i am aware f0at � proot of Inei� Worker'S Compensatbn insuran�e Should be Provitl<d [o me. '❑ I am axempt un0er Se<tlon B. & P. C. (or tbis reason Date ana sta�e IdWS leuung � sentaliVes of thi5 Uly inipectlon purp05ss. Signature Driwrs' Litense or 55 rt nnFS-66. rev. 5/88 owne. ��1�nc � ..i e___ � v� raaE Mis e0��ication antl state tha[ t�e abow, �irdt�to comply witn all �i�y antl county ord��antes Oulltlin9 �onsiructlon, antl hereby authorize reprc mtar upon the ;Dove��Aen��nn n.noartv for TYPE OF PERMIT LJ GRADING ❑ TENANT ❑ ELECTFIC L ❑ OTHER PRQIECT DE IPTION Sa. F..� FOUNDATION LJ STRUCTURAL LUMBWG � MECHANICAL CONSTRUCTIONTVP��AI VALUAT 20NE GRADINGCU.VDS.— Remarks: Preventer Irrigation Floor Drains FloorSinks' � - GazService Outlets Interceptorz Kitchen Sink LevetOrieS P-Trep Roof Drains fl�impaRion F�e S15 BOiIlf Duct - Under Ground Duct - Structural Duct � Ventileting Exhaust Syztem O Multiple ❑ Firepl/Fect. BH. �C80 � Heatinp System & Ducting ❑4100,000 BTU � 100,000 BT '�'L Dare�(�� p�infp�ction FM S75 W�Ite - Bulltlin9: Canary . qoei��,�.. u�.,� _ naountln9: GOltlsnroE • Atsauor 0 Showers Servite Sink � Sewer Cap Sewer Connection �' Solar Collector5 Solacpipin9 ' Solar Tank Swimming Pool w/Spa ' Urinal Water Closet Water Heater _� Water Service Auto-Wash Isue Fee Hood or Typel ❑ Canopy Typell ❑ Retrigeration System ❑aioo,000eru ❑ioo,000eru System Repair�Alteretion Fire Dampers Registers laue Fee C Right � K g Left Ping. Ret. # t Planning Noces: FEES Automatic Washer Construttion Pole Sub. Cooking Unit Dishwasher Drye�s OGas ❑Electric Fan F.A.U. FixtUres Device Boxes Outlets Switches Garbage Dispoul Genetator �65 KW �5-15 KW 2ane (� Accessory Bui�ding: Z O N � N G R Parking Req./Frovided � 1,3 E � — bI ,, 6 c.,n.� M T i::'��Gti� S. ELECTRICAL Transformer LJ 15 50 KW ❑ 50+KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors �0.1 HP �l h- 6 Inc.Soiar L79-15 HP �16-15+ Microwave Pole Light qange Sign $tanding $ections� Trash Compactor Reinspection Fee ' $15 Issue Fee s 3 DEVELOPMENTSERVICESR QUIREMENTS: Zoning APGroved BY FEES Buildi�g Approved By S 53 SUMMARV OF FEES BUILDING PERMIT 5 � 2��•7J SMIP PLAN CHECK $ PERMIT PLUMBING $ �SSUANCE PLAN CHECK 25% S ENERG�' ELECTRICAL $ �� ( PLAN CHECK 50°b $ '��/ \ \ \ MECHANICAL $ _ PLAN CHECK 25% ^ � GEES $ 3 e� �,a b'-19-38- -,3-3d $ l9.sz P ' �� '/J/y�� 2�� 1�JApplicant fo fill in all sDatts excepl ihose within heavy borEer lioes an0 sign all aoDropriate eeciarations. i v � CITY O�F COSTA MESA CONSTRUCTION PERMI PER IT NO. TRACT NO. LO7 NO. UNIT O. r,a�e�cnd'a��s \�e\ C'��esa'Dc (3\a�\ ApPlicant's Mailing Addreu _LoV�a B� L�viGc�n d C'Ci � Owrier's Name ' +^ �n Phone Addreu �� \ \ - '�.r �f v , Arch/Eng. ��On��nr d�Pfa�,cc License No. C\`�3.�3 Addrezs � 3^ 3,. �' �% `� Con[ractor's Namn V�CL�cX��ro�l.� C Phone �"' Oa� Addresslmailingl IobbB L.!»coJn Orar�c��iCq ��1.�.,�' City License No. ��"�� LICENSED CONTRACTOR DECLARATION 1 �ereby affirm t�a[ 1 am licensetl untler provisions of Charter 9(commencing witn section 7000) ot Divizion 3 of the 9usines5 antl Grofeisions Code, antl my license is in u1l force antl etfect. Licenze lass � L eqse No.y 5� A(.3 Date�j�_ Signature "•'ORKERS' COMPENSATION OECLARATION "•eby affirm t0at I have a certi(icate of consent to self-insure or a certifirate orkers' ComOensation Insurdnce, or a certitietl copy thereoi (5eclion �. �b. ��15�„379S5oc..8&� Cflr� � 1 ZnS Policy No. [ompany \N<nc er[ifietl copy is �ereby furnis�etl. Certi ie�copY ii filetl with the t y i�tli i`S S(, Date � qpplican�- �^� EXEMMION FROM WORKERS' COMPENSATION DECLHRATION (T�is sec[ion neetl not be completetl if the permit is tor one hundretl (y100) or less). I certity that in the perf0/mance ot lhe wOrk tor which this pe�rtdt is BSuetl� I shall not employ any person fn any manner so as [o become subject to the Workers' Compensation �aws o( California, Date S�9nature NOTICE: If, after makin9 this tleclaration, you snoultl become subject to tne Work¢r5' Comp¢nsation provizions ot the Labor Cotle, you mu5t tOrthwitn mmply wi[h suc� provi5ions or tnis permit shall be tleemed revokeC. CONSTRUCTION LENDING AGENCV I hereDy aHirm thal there is a construction lentling agency for the performance oi Ih¢ work fOt whi�h t�is OerTit ib iSSuetl (Section 3097 Civ. CJ Lentler's Name Lentler's Atltlress OWNER BUILDER DECLARATION I nereby aftirm ihat I am ezemp[ irom l�e ConVacror'S Litense Law for Ihe rollowing reason (Section �031,5 Business antl ProleSsional Cotle: Any city or county which requires a permit to construct, al[er, improve, tlemolisn or repair any stru<tule, pliol to Its i55uant¢, a150 fEquires th¢ applicant tOf SUCh permit to file a signetl Statemept that h!/Sfle i5 lic¢n5¢tl pUrSuant t0 th¢ D�ovi5ion5 of the Contractor's License Law (Chapter 9Jtommen<ing with gection 7000) of ^'•�ision 3 of the Business antl Professions Cotle) or that he/she is enempt 'efrom antl tne basi2 for the allegetl exemptlon. Any violation o( Section ' ,1.5 by any applicant for a permit subjects tne applicant to a civil �enalty of not more tban five huntlretl tlollars (5500�. 1, as Owner of Ihe proDerty or my ¢mP�oYeeS with wd9e5 d5 thei� sol¢ compensation, will tlo the work, antl tbe stmcturo is not intentletl or offeretl ror sale (Section 7044, Business antl Profezsional Cotle: The ConVactoYs LicenSp Law tloes not apply [o an owner Of a property who bui1E5 O� imOrOveS tnereon, antl who does such work nimselt/herseH or through his or her own employees, provitletl thdt sucM1 iR�provements are not intentletl O� oHeretl lo� sdl¢. H, boweveq the builtlin9 or iTp�ovement is SOItl within One y¢ar of cOm- pletion, the owner will have the burtlen of proving he/she tlitl not builtl or im- provlfor the pUrpose of sale). ❑ I, as owner o/ th¢ property, am excWsively contractfng with IicGn5e4 com tractorsto consbuct tne project (Section �044, 8usiness antl Professions Cotle: The Contractor's Llcense Law tices not apP�Y �o an owner o� P�operty who bulltls or imDroveS thereon. antl who wnVaCts for such oroiect5 M'ith a r.on- tractor(sl Imense ourzuan[ to [ne ContractorY License Law). 1 am aware that proof of their Worker'S ComOensation insurance shoul0 be provitletl to me. ❑ I am exempt un0er Sec[ion B. & P. C. for t�is reason Date Inspection u z. \ Signature Owner have reaa this a0P!ication antl state that [he above agree to comply with all city antl counb orainances o iltlinq`construction, antl hereby authorize re0�e� er upon [he above-mentionetl D�o,�pe�ty for \_ � D t �Y6`a 3 b A.P. #` S Main Buildin9: TYPE OFCONSTRUCTION NEW ADD ALTERATION IiEPAIR E ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' T Front DESCRIPTION OF WORK/USE OF BLDG. �� A Rear C Right TVPEOFPERMIT GRADING FOUN�ATI STRUCTURAL �K ❑ TENANT ❑ ELECTRICAI ❑ PLUMBING MECHANICAL S Left ❑ 97HER Ping. Ref. # PROJECT DESCRIPTION 5q. FT. OCCUPAnCV Planning Notes: CON STRUCTION TVPE VA�UATION $ 20NE GRADINGCU.VDS. ACRES Remarks: Backflow Prevente� 8ackflow Irrigation 7rinking Fountains Floor Drains Floor Sinks GasService �U[I2L5 Interceptors Kitchen Sink Lavatories P-Trap Roof Orains Reinspaction Fee � $15 Bol ler Duct - Under Ground DUct - $tfuCtural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Pact. Blt. iCBO dk Heating System & Ducting � � �OO,OOOBTUO100,0008T ae � �,—� ' I I Reinspection Fee .. _ '____ ' _ .. . ..._�. �.....�..r�,.�. r ine...,.r _ u.�e�.,.. $15 Showers Servite Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pppl w/Spa Urinal Wacer Closet Water Heater Water Service Auto-Wash Laundry Tra'ys Issue Fee Hood or Type I ❑ Canopy Type II ❑ Retngeration System ❑oioo,000eTu ❑ioo,000 System Repair/Alteration Fire Dampers Issue Fee F zo�e Builtling: Req./Provided ELECTRICAL Automatic Washer Trensformer ❑ 15-50 KW Construction Pole Sub. � 50 + KW Cooking Unit Dishwa5her Dryers ❑Gas ❑Electric Fan F.A,U. Fixtures � Device Boxes OuLIetS $witCh25 Garbage Disposal Generator �0.5 KW 05-15 KW Merer Uup to 100 amps Meter �overi00amps Sub Panel M�t6rs O67 HP O7 X- 8 Inc. Solar 09�15 HP 016-15+ Microwave Pole Light Range Standing Sections Trash Compactor Reinspection Fee $15 laue Fee $ 3 DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By FEES Building Approved By �r' Appliwtion Issued BY BUILDINGPERMIT 5 � PLAN CHECK 5 PLUM8ING � P�,4N CHECK 25% S ELECTRICAL 5 PLAN CHECK 50% 5 ��.� �� MECHANICAL S _�_,rt�-_ PLAN CHECK 25% $ � �Z O 1 N G R E � M T S. FEES $ 3 SMIP $ PERMI7 ISSUANCE $ ENERG� P.C. 3 GRADING $ MICROFILM § TOTAL FEE $ � Applicant to till,in all spaees exceo� those witnin heavy borOer Ilnes ana sign all aOProorlate tleclarations. CITYOF:COSTAMESA� CONS� R�UCTI NPERMIT Projact Addiess �� 5�" �� •. Applicant's Mailing Address t-- � Owner'sName U�SS �`�� PhonC's3'� 6 Address � ��` ArchlEng. License No. — Address � Contractor's Nam � �%�F`F Phon , — Addresslmailingl��8 � d�'r-�—< City License No. �-r3 / � LICENSEO CONTRACTOR OECLARATION 1 here�y affi�m that I am litensetl untler provi5lons of Cha�t¢t 9�(Comm¢ncing with 5ection ]000) of Di ' on 3 of [he Business antl Profe55ions Cotle, antl my license is in full torce eftect. �3 S License lass r 'te 1— Si9nature _ ��RKERS' COMPE SATION D R ION ereby affirm that I nave a cer t' ate of consent o /-Insure or a cerN(icate ot Workers' Cam � ztic}n�l ance, or a ce itietl coo thereot (Sectio 3800, Lab. C.) y(o 88 � PW icy No. �L Compan yp��'�,,ertifietl copy is hereby furnishetl. �� LJ Certifietl c py i f" tl with the city iltlin s Date � Applicant EXE PTION��RKERS' COM AT ON EC A (Thissection neetl not be completEtl i( e ermit i5 tor one hun ($S00) or less�. I carti/y that in the perto�mance ot wo�k to� which this rmit is i55uetl, I shall not employ any person in an manner so as to beco e subject to tne Workers' Compensation LawS of Cdlifornia. Date Signature NOTICE: If, after making thi5 tleClaration, you shoultl become subject to the Worker5' Comp¢nsation provisions of th¢ LabOr Cotle, you must torthwith comply with such p�ovisions o� this permit shall be tleemetl �evoketl. CONSTRUCTION LENDING AGENCV I hereby affi�m that there is a const�uction lentling agency fo� the pe�to�mance of the work for which this permit is issued (Section 3097 Civ. C.) Lentler's Name Lentler's Atltlress , OWNER BVILDER OECLARATION I hereby affirm ihat I am exempt from tne ContractoYs License �aw for the following reason (Section-7031.5 Business antl Professional Cotle: Any ciry or counry wnich requires a permit to construct, alter, improve, tlemolish or repalr �ny sVuclure, prior to it5 i55uance, also requires the ap0�icant for Such pe�mit file a signetl statement that he/she Is licensetl pursuant to the provisions of : Cantractor's License Law (Chapter 9(commencinq with Section 7000) oi .vision 3 ot Ihe Bu5ine55 antl Pro(e55ions Cotle) o� that h¢/Sbe is exempt .nere(ram antl the basis for the allegetl exemption. Any violatlon of Section 7031.5 ,by any applicant tor a permit subjec[s the applicanY to a civil , enalty of not more than five huntlretl tlollars ($500). ' � I, as owner o( the p�operty o� my ernployees with wage5 a5 thei� sole bompen5ation, will tlo the wo�k, antl [he st�ucture is not intentletl o��o(te�etl for saie (Section 7044, Business antl Professional Cotle: The Contractor4 License'Law tloes not apply to an owner of a property who builtls or improves thereon, antl who tloes such wo/k himself/herself ot through his or her own employees, providetl tbat sucM1 ImOrovements are not intentletl'or o(fe�etl for sale. If, however, the builtling or'imProvement is soltl within one year of com- pletion, the owner will have the burtlen of provin9 he/she tlia not buila or im- p�ove tortne pu�0ose of sale). � ❑ I, as owner of the property, am e8clusivery contracting with licensetl con-� tracmrs co construct tne oroject (Section 7044, Business antl Professlons Cotle: The Contractor's .License Law tloes not appty to an owner of oroperty who � builtls or improves thereon. antl who contracts tor such oroiects witn a con- tractor(51 hcense pursuan[ ro me COMractor's License Law). I am aware that proof of Iheir Worker'S Compensation insu�ance shoultl be provitletl to me. ❑ I am exempt untler Sectlon B. & P. C. for this reason Date J� Owner ��1 b� 5 /J/�/L��i i I hereby'certity that 1 have'reatl this application antl state that the above information is wrrect. I agree ta como�Y with all cit antl county ortlinances antl. state laws rp�etJs� uiltling const ' n, a �ereby authorize repre- sentatives of t]s t nfer up n the o en[ionetl property. for inspection pur s �+ Signature Da[e �' � —D Drivers'�Li ns or 55 � 0865-46, re . 5/88 White - Build g; Canary - Applicant Pink - Ac<ounting; Goltlenrotl - Assessor TYPE OF CONSTRUCTION LI NEW U ADD LI ALTERATION LI REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL ❑ OTHER PROJECT�DESCRIPTION 5Q. FT. � oCCUPqNCv_ CONSTRUCTION TVPE VALUATION $ ZONE GRADING CU. VDS. ACRES_ Remarks: (% � � 7 �y }( Bar Sink Backflow Preventer .� Backfiow Irrigation /� Bathtubs � Clarifiers �,�' Dishwasher Drinking Fountains'% Floor Drains � Floor Sinks • GasService � Outlets Kitchen Sink Lavatories � P—TraP '- Roof Dreins Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal lN3[Qf C1052L Water Heater Water Service Auto-Wash A.P. # S Main Building: E T Front B Rear A C Fight K Left S Pin9. Ref. # Planning Notes: FEES Automatic Washer Construction Pole Sub. Cooking Unit D ishwashe;: Dryers ❑Gas ❑Eleci Fan ,�j F.A.U. Fixtures i /j Device Bozes Outlet5 � Reinspection Fee � $15 I I Issue Fee I $ 3 Boiler ' Duct- UnderGround Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ FirepVFact. Blt. �CBO �� J' Heating System & Ducting ❑ 0�100,000 BTU � 100,000 BT Reinspec[ion Fee , � $15 Hood or Type I. ❑ Canopy Type I I ❑ RefrigeraGon System ❑0.100,OOOBTU ❑100,000 System Repair/Alteration F ire Dampers Registers Issue Fee Garbage Disposal Generator OO-5 KW �5-15 Zone Accessory Building: Parking EIECTRICAL Transtormer ❑ 15-50 KW ❑ SO+KW Meter ❑up to 100 amps Meter ❑over100amps Sub Panel Motors OO-1 HP O 1 K- B Inc.Solar 09-15 HP �16� Microwave Pole Light Range Sign Standing Sections � Trash Compactor Reinspection Fee �$15 � � Issue Fea DEVELOPMENT SER VICES REQUIREMENTS: 2oning Approved By Building Approved By �— FEES $ 3 I N G R E Q M T S. SUMMARV OF FEES ' BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GAADING $ PLAN CHECK 50°/ $ MICROFILM $ MECHANICAL . $ .� TOTAL FEE $ ��. SO PLAN CHECK 25% $ O1 Q�024�59-QQ424359 T��iT ?a,jp DATE. 01; ibl84 TitlE: It:=? ..-� __._ . . . . 1 ,; _. . . .. , w . , . � .CONSTRUCTION AND PLANNIN6 ��-� � " � � - & SPA APPFOVALS Permit# •G � Date � Inspector AppROVALS Permit# - Date Inspector '�:7. Temporary Electrical Service or Pole . 52. Pool & Equipment Location . �. 2. SOiI Pipe-Undrgrnd. , ' . � .53. Steel Reinforcement - � „ •� � 3. Electrical Conduit�Utility-Undrgrrid,• ' !. 54. Forms '' 4..•Electrical Conduit-Undrgrnd. ," ' 55. Electrical Bonding , • • 5.' Steel �Reinforcement� "- � 56. Rough Plumbing & Pressure Test •� :6. ElecfricalUFER�Grnd. � � _ 57. APPROVALTOCOVER-GUNITE � '�Jr Footings �� y�:.� : I; " 58. Electrical Conduit-Undrgrnd. ' ' 8: Foundation �� "�� •• �. 59. Gas Pipe, � Undrgrnd., Test � . ,9. Water Pipe-Undrgmd. � i�, � ' �: -�' 60. Backwash Lines, P-Trap, O Undrgmd. �� ' t� •10 ��Structural Floor System . '� 61. APPROVAL TO DECK . � 77. Property Sewer Line�& House Connection ' �� - 62. Beckwash & Receptor-Final i� /, �. 12. Sewer Cap�. � 1 % �' � - 63. Heater & Vent-Final �� :' 13. Roof Drain3 + � �,�� 64. Plumbing System - Final . 14. Rough Plumbing ;, � 65. Electrical-Final - 15. Rough Electrical-Conduit 66. Solar System-Final � .- - j 6. Rough Electric Wiring � 67. Fencing & Access Approval � 17.: Rough Wiring Sign � 68. APPROVED FOR PLASTERING r 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 J� 22. Ducts, Ventilating _r. 71. Product Piping OGas ❑Oil t� `�.r 23. Gas Pipe-Rough & Test ;�f• 72. Underground Flush 24. Roof Framing . � 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical ' 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29 � Insulation 78. FIRE PREV. FINAL - 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION � 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED ij; i 33. Final Electric Notes. /• �,, ` 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-Test 36. Hood or Canopy . .. 37. Final Factory Fireplace �f f� 38. Final Plumbing 39. Water Service-Final � • - � . - 40. Gas Service-Final � � 41. Solar pomestic-Final � 42. Backflow Preventer " ',1 43. Backflow �rrigation ' } 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 Ca�ifornia Gas Co ' � .' 51. CERTIFICATE OF OCCUPANCY t � . ; i '.. No. Date � � � z_ � -